American Journal of Case Reports最新文献

BACKGROUND Allergic bronchopulmonary aspergillosis (ABPA) is a pulmonary disorder that occurs in patients allergic to Aspergillus species. It is typically characterized by reversible airway obstruction, transient pulmonary infiltrates, eosinophilia, and fever. Chest radiographs and high-resolution computed tomography (CT) are essential for diagnosis and differential diagnosis. Carcinoembryonic antigen (CEA), a tumor-specific marker, is often elevated in various malignant tumors but can also be increased in nonmalignant conditions. This overlap can result in misdiagnosis and unnecessary anxiety, leading to inappropriate clinical management. We report a case of ABPA presenting with pulmonary shadows that mimicked lung cancer, as well as elevated serum CEA levels. This report aims to enhance clinicians' understanding of ABPA, improve diagnostic accuracy, and reduce the likelihood of misdiagnosis or missed diagnosis. CASE REPORT A 39-year-old woman with a history of bronchial asthma presented with a productive cough. Chest CT revealed solid lesions in the left upper pulmonary lobe with mediastinal lymphadenopathy. Her serum CEA level was elevated, raising suspicion of malignancy. A positron emission tomography-CT scan demonstrated increased fluorodeoxyglucose uptake in the lungs. However, a CT-guided percutaneous lung biopsy, combined with other relevant diagnostic tests, confirmed ABPA according to the International Society for Human and Animal Mycology (ISHAM) criteria. After corticosteroid therapy, both the radiographic findings and serum CEA levels improved. CONCLUSIONS To avoid unnecessary invasive procedures and misdiagnosis of malignancy, ABPA should be considered in the differential diagnosis of patients with asthma who present with pulmonary solid lesions and elevated serum CEA levels.

BACKGROUND Ethambutol is a first-line treatment for tuberculosis and a cornerstone of treatment for atypical mycobacteria. It is considered to have a low incidence of adverse drug reactions, compared with that of other anti-tuberculosis drugs. Apart from causing optic neuropathies, ethambutol is rarely implicated in the adverse effects of tuberculosis treatment. CASE REPORT We report the case of a 41-year-old man treated for cervical lymph node tuberculosis who developed ethambutol-induced thrombocytopenia. We reviewed the patient's medical history to reconstruct the chronology of his treatment and to assess the causal relationship between ethambutol and the adverse event. Isolated thrombocytopenia was noticed 10 days after the start of antituberculous treatment, motivating the discontinuation of ethambutol, as the Mycobacterium tuberculosis strain had no resistance to other first-line antituberculosis drugs. The platelet count nadir of 72×10⁹/L was observed 48 hours after ethambutol discontinuation, after 3 weeks of treatment. Discontinuation of ethambutol alone led to a rapid recovery of the platelet count within 5 days. Despite the absence of drug reintroduction, the Naranjo causality score was +6, indicating that ethambutol was probably responsible for the adverse event. We discussed this case in relation to previously reported cases, and our findings were consistent with the only 2 cases documented in the literature. CONCLUSIONS Ethambutol can cause thrombocytopenia, which occurs within 2 weeks of its introduction and disappears within days of its discontinuation.

BACKGROUND Pheochromocytoma is a rare neuroendocrine tumor. Some patients are asymptomatic, and misdiagnosis is common, especially when it lacks typical imaging features. In asymptomatic patients misdiagnosed with pheochromocytoma, hemodynamic instability often occurs during surgical procedures, posing significant challenges to surgeons and anesthesiologists. This case report presents a patient who was misdiagnosed as having a pancreatic cystadenoma prior to surgery, aiming to explore the intraoperative decision-making and considerations for such cases. CASE REPORT A 48-year-old woman with abdominal pain was preoperatively diagnosed with pancreatic cystadenoma by imaging. Laparoscopic surgery was performed following standard procedures, including patient positioning, stomach suspension, tumor search, and tissue dissection. The surgery lasted 156 min, with minimal blood loss (50 mL). Intraoperative hemodynamic instability occurred, and the final histopathological report confirmed the tumor as a pheochromocytoma. The patient was monitored in the intensive care unit (ICU) after surgery and was discharged on the 8th postoperative day, without complications. CONCLUSIONS Clinicians should be aware of the limitations of imaging. When dealing with abdominal tumors lacking typical features, especially those located in the adrenal gland or para-adrenal region, a high suspicion for asymptomatic pheochromocytoma is necessary. In the event of intraoperative hemodynamic instability, a high degree of suspicion for pheochromocytoma is needed. Moreover, it is crucial to strengthen multidisciplinary collaboration and emphasize the optimization of preoperative laboratory tests and examinations to compensate for the limitations of imaging studies. Surgeons need to be prepared for unexpected findings during surgery and adjust the surgical plan according to local anatomy to improve surgical safety and success rates.

BACKGROUND Sarcoidosis is a multisystem inflammatory disorder characterized by non-caseating granulomas. Although the disease most commonly affects the respiratory and lymphatic systems, extrapulmonary manifestations involving the brain and heart also occur. Neurosarcoidosis may cause dysfunction of the cranial nerves, meninges, peripheral nerves, or the pituitary system. Cardiac sarcoidosis may lead to arrhythmias, cardiomyopathy, or heart failure. These specific diagnoses can be challenging because they may masquerade as isolated pathologies. In this clinical vignette, we present a rare case of systemic sarcoidosis with concomitant neurological and cardiac involvement. CASE REPORT A woman in her late 50s with a history of bilateral anterior uveitis presented with stroke-like symptoms. Initial workup was negative for stroke, but imaging identified a prevascular mediastinal lymph node and moderate mitral regurgitation. Lumbar puncture results were consistent with neurosarcoidosis, and steroids initiation led to symptom improvement. The patient subsequently exhibited non-sustained ventricular tachycardia, and further investigation revealed findings consistent with cardiac sarcoidosis. An implantable cardioverter-defibrillator was placed. The patient continued steroids and immunosuppressive therapy with favorable results. CONCLUSIONS Diagnosis of systemic sarcoidosis can be difficult because of its variable presentation. This challenge is enhanced when uncommon organs such as the brain and heart are affected. Thorough evaluation is therefore essential when evaluating systemic diseases.

BACKGROUND Lymphoma can involve any orbital soft tissue (excluding bone) and may mimic other orbital diseases, often leading to misdiagnosis. Early diagnosis improves both disease management and patient survival. This rare case provides insights into the early diagnosis and treatment of orbital lymphoma. CASE REPORT An 87-year-old Asian man presented with sudden swelling of the left eyelid, vision loss, and severe pain. His intraocular pressure increased, and vision eventually deteriorated to no light perception. Biopsy of the orbital mass revealed small cell malignancy. Immunohistochemistry showed CD20(+++), Bcl-6(+++), and other markers consistent with diffuse large B-cell lymphoma. The patient received combined chemotherapy and radiotherapy, which relieved swelling and pain but did not restore vision. CONCLUSIONS Orbital lymphoma may present with or without systemic symptoms. Its clinical and imaging features often overlap with other orbital diseases, contributing to misdiagnosis. Pathogenesis plays a critical role in prognosis, emphasizing the importance of early diagnosis to improve outcomes. This case is among the few reported in which initial presentation included elevated intraocular pressure.

BACKGROUND Carbamazepine (CBZ) is a common therapy for seizures, neuropathic pain, and painful tonic spasms following spinal cord disease; however, it is associated with rare autoimmune complications, including drug-induced lupus erythematosus (DILE). Diagnosis of DILE can be challenging, especially when onset occurs after a prolonged latency period. Neuromyelitis optica spectrum disorder (NMOSD), an autoimmune disease characterized by recurrent inflammation of the central nervous system, frequently coexists with other autoimmune disorders. This report describes a case of DILE in a 61-year-old woman with NMOSD involving the cervical and thoracic spinal cord after 14 years of CBZ therapy. CASE REPORT A 61-year-old woman with aquaporin-4-IgG-positive NMOSD involving the cervical and thoracic spinal cords had received CBZ for 14 years to control painful tonic spasms. She presented with fatigue, weight loss, intermittent fever, and pleural effusion. Laboratory testing showed a high antinuclear antibody titer (1: 640) and elevated anti-single-stranded DNA, anti-DNA, and anti-histone antibodies. Chest imaging demonstrated pleural effusion and pleural thickening; malignancy and infection were excluded. Discontinuation of CBZ led to resolution of symptoms, normalization of inflammatory markers, and a decline in lupus-related autoantibodies, confirming the diagnosis of DILE. No recurrence was observed during a 30-month follow-up period. CONCLUSIONS This report describes a rare delayed-onset autoimmune adverse effect of CBZ that developed 14 years after treatment initiation. It highlights the importance of clinical awareness of potential autoimmune associations, particularly when CBZ is used in patients with preexisting autoimmune disorders such as NMOSD.

BACKGROUND Infantile corneal foreign bodies (CFBs) are rare and frequently result in delayed diagnoses and treatment challenges. This report describes a case of a very young infant with a small plastic CFB that was successfully removed. CASE REPORT A 2-month-old boy was observed to have a "small dot" foreign body on his left cornea by his parents. No crying response to the CFB or other symptoms had ever been identified. Slit lamp examination revealed the presence of a small, oval, plastic foreign body in the corneal epithelial layer. This CFB was determined to be an ornament affixed to the dress that the babysitter was wearing at the time. For CFB removal, medical sedation was rejected by the infant's guardian. The initial attempt to flush the CFB out with saline or extract the CFB using a cotton-tipped applicator alone proved unsuccessful. Subsequent release of the CFB from the cornea was facilitated by the addition of proparacaine hydrochloride drops to the conjunctival sac and the use of a 1-mL needle, which was then adhered to the cotton-tipped applicator, thereby enabling its removal. CONCLUSIONS CFBs in young infants may not manifest any symptoms and thus can be easily ignored. The removal of plastic CFBs in those young infants who exhibit limited communication and cooperation abilities remains a challenging procedure. This report proposes a viable and low-risk, office-based approach to address the issue of CFB removal in infants.

BACKGROUND Splenic tumors are rare and challenging to diagnose, and laparoscopic splenectomy (LS) is useful for treatment. Splenic hamartoma is a rare benign condition that consists of disorganized normal splenic tissue, including red pulp elements, that can be asymptomatic and found incidentally. CASE REPORT A 42-year-old woman underwent ultrasonography, and a 70×55 mm splenic mass was detected. The tumor was composed of a solid component and a cystic lesion, and splenomegaly was observed (size: 143 mm). Contrast-enhanced computed tomography (CT) of the solid component clearly showed homogeneous and strong enhancement in the early phase. The estimated splenic volume was 650.7 mL. Magnetic resonance imaging did not indicate malignancy. A preoperative diagnosis of splenic hamartoma was made, and LS was performed. To control intraoperative bleeding and to shrink the spleen, the splenic artery was ligated first. The spleen was caught in the containment bag, and a 50 mm transverse skin incision was made cranially at the pubic bone. The stump of the splenic vein was cut within the bag, and 30 mL of blood was removed to further shrink the spleen. Next, the extremely shrunken spleen (201 g) was removed through the small abdominal incision. Histopathologically, disorganized normal splenic tissue, including red pulp elements, were observed. The patient was discharged on postoperative day 4, and rehabilitation was accomplished by postoperative day 7. No postoperative complications were observed. CONCLUSIONS This report highlights the rare condition of splenic hamartoma, and described the key techniques for advantageous LS.

BACKGROUND Rhabdomyolysis and autoimmune myopathies often present with similar clinical features, including myalgias, muscle weakness, and elevated serum creatine kinase (CK) levels. This overlap can make early diagnosis challenging and delay appropriate management. The recent rise in SARS-CoV-2 infections has led to an increasing number of reports of autoimmune myositis associated with the virus. CASE REPORT Here, we present a unique case of a young African American male who developed myalgias and bilateral upper and lower extremity weakness without any skin changes following a recent SARS-CoV-2 infection. His CK level exceeded 300 000 U/L; however, he had normal inflammatory markers and a basic autoimmune panel, and a chest computed tomography scan did not demonstrate interstitial lung disease. Initial treatment with intravenous fluids for presumed viral-induced rhabdomyolysis showed minimal clinical improvement. Surprisingly, empiric steroid therapy led to a rapid recovery in both CK levels and symptoms. A subsequent muscle biopsy revealed necrotizing myositis, and an autoimmune myositis panel showed elevated melanoma differentiation-associated gene 5 (MDA5) antibodies. CONCLUSIONS To the best of our knowledge, this is the first reported case of MDA5-associated necrotizing myositis following SARS-CoV-2 infection. Most patients with MDA5-related disease develop skin changes and underlying interstitial lung disease; however, our patient lacked these findings. At an 8-month outpatient follow-up, the patient had residual proximal muscle weakness and remained on immunosuppressive therapy. Further research is needed to better understand the pathophysiology of COVID-19-mediated autoimmune myopathies and to develop targeted therapies for these patients.

BACKGROUND Subdural empyema (SDE) is a rare, life-threatening intracranial infection characterized by pus accumulation between the dura and arachnoid mater. It is most commonly associated with sinusitis, typically affecting young males. The presence of pneumocephalus without trauma or surgery is exceedingly rare and should raise concern for intracranial infection. Early diagnosis through neuroimaging and prompt multidisciplinary intervention are crucial for preventing morbidity and mortality. CASE REPORT We present a case of SDE and atraumatic pneumocephalus in a 76-year-old woman who was found unresponsive at home. Laboratory tests revealed leukocytosis, elevated inflammatory markers, and fever. Non-contrast computed tomography (CT) showed a 2-3 mm subdural collection with intracranial air foci, along with evidence of otitis media, mastoiditis, and pansinusitis. Lumbar puncture revealed xanthochromic cerebrospinal fluid (CSF) with elevated protein and white blood cells (WBC). Streptococcus pneumoniae was confirmed by CSF culture and urine antigen. She underwent emergency craniotomy, draining 75 cc of purulent material, followed by the ear, nose, and throat (ENT) intervention with maxillary antrostomy, ethmoidectomy, and tympanostomy. She experienced a full neurological recovery. CONCLUSIONS This case underscores the importance of high clinical suspicion and early imaging in elderly patients with altered mental status and sinus pathology. Atraumatic pneumocephalus in non-surgical patients may signal severe intracranial infection. Timely, multidisciplinary management led to rapid recovery, and this case adds to the limited literature on pneumococcal SDE with pneumocephalus in elderly women with chronic sinusitis.