American Journal of Case Reports最新文献

BACKGROUND Amyloidosis is a group of diseases characterized by the pathological deposition of misfolded proteins in various organs, including the heart, leading to structural and functional alterations. The primary types of cardiac amyloidosis are light chain amyloidosis and transthyretin amyloidosis. Early diagnosis is critical for effective management. This report describes the case of a 68-year-old Colombian man presenting with heart failure and a diagnosis of cardiac amyloidosis. CASE REPORT A 68-year-old man presented with heart failure symptoms, biceps tendon rupture, neuropathic pain in the extremities, and an electrocardiogram showing low QRS voltage and a pseudo-infarct pattern. Transthoracic echocardiogram revealed a left ventricular ejection fraction of 30%, severely thickened walls with a speckled appearance, a global longitudinal strain of -6.2% in a bull's eye pattern, and a left ventricular posterior wall thickness of 21.3 mm. Cardiac magnetic resonance imaging showed severe symmetric hypertrophy, moderate global dysfunction, and an elevated native T1 value of 1225 milliseconds. Post-gadolinium T1 mapping revealed a significantly increased extracellular volume of 72%. Perugini grade 3 pyrophosphate scintigraphy, negative hematological tests, and endomyocardial biopsy confirmed the diagnosis of amyloidosis, without monoclonal spikes. Genetic testing identified a heterozygous c.424G>A (p.Val142Ile) variant in the transthyretin gene, consistent with variant transthyretin amyloidosis. CONCLUSIONS Amyloidosis may affect up to 13% of patients with heart failure and preserved ejection fraction. Early recognition of red flags and implementation of a diagnostic algorithm are crucial for timely intervention in this population.

BACKGROUND Optic disc melanocytoma (magnocellular nevus of the optic disc) is a benign congenital pigmented tumor, usually unilateral, asymptomatic, and mostly discovered in routine examinations in adult patients; however, it is associated with choroidal neovascularization. It can be difficult to differentiate it from juxta-papillary choroidal melanoma. Aflibercept is a monoclonal antibody targeting vascular endothelial growth factor A (anti-VEGF-A). This report describes a 54-year-old man with a diagnosis of optic disc melanocytoma complicated by choroidal neovascularization who was treated with intravitreal injection of anti-VEGF-A with intermittent follow-up. CASE REPORT A 54-year-old man received a diagnosis of asymptomatic right optic disc melanocytoma in a routine examination in 2015. We decided to follow up every 6 months, and 1 year later, due to growth of the lesion, we performed magnetic resonance imaging to exclude malignant transformation. The patient was lost to follow-up from 2019 to 2021. He came back 6 years after diagnosis, and fundus examination revealed multiple perilesional and macular exudates. We diagnosed a neovascular membrane by multimodal imaging. According to recommendation from our expert colleagues at the Curie Institute, he was treated with intravitreal injection of anti-VEGF-A with intermittent follow-up, and the evolution was favorable. CONCLUSIONS Optic disc melanocytoma is a rare benign tumor, but neovascularization can occur in <1% of cases. Because it is a very pigmented lesion, we need multimodal imaging to diagnose choroidal neovascularization. Choroidal neovascularization associated with magnocellular nevus of the optic disc can be successfully treated by intravitreal VEGF-A in a "treat and extend" protocol.

BACKGROUND Due to the complexity of the golf swing, poor form affects performance and lead to injuries in the spine and extremities. The Titleist Performance Institute (TPI) has created a movement screen to identify a golfer's physical limitations. The TPI includes 16 movement patterns within a golfer's swing that could lead to poor performance, dysfunction, and pain. TPI recommends specific exercises to address any dysfunctions. CASE REPORT This case report examined the benefit of a TDI-specific exercise program for a 78-year-old man with a history of low back pain and decreasing golf performance. Treatments included 3 sessions over 10 weeks, including lumbar stabilization exercises, balance training, and manual therapy. The dependent variables were the TDI movement screen, Trackman Driver analysis, and 3D Kvest Swing analysis. The patient's main goal was to increase driving distance and be able to play a round of golf without pain. The patient's specific functional scale showed that trunk rotation, right shoulder mobility, and hamstring length improved. His TPI Fitness handicap decreased, and his Trackman Driver averages improved. CONCLUSIONS This case report demonstrates that the TDI movement screen and TDI-recommended exercises in combination with manual therapy improved a golfer's TPI composite score, overall performance, and kinematic sequencing. Although, based on a case report, cause and effect cannot be established, it does appear that interventions, in this case, contributed to a decrease in low back pain and self-reported disability, improved golf swing and performance, and met the patient's objectives.

BACKGROUND Cardiac tumors are divided into 2 categories: primary, originating from the heart, and metastatic, which spread to the heart from a different location, with metastatic tumors representing the vast majority. Cardiac tumors, depending on the size and location, can predispose patients to arrhythmic or hemodynamic complications. We present a patient with a history of B-cell lymphoma (DLBCL) in remission for 3 years who developed acute onset congestive heart failure and complete heart block secondary to DLBCL invasion of the myocardium. CASE REPORT A 67-year-old female patient with a history of stage IV double-hit DLBCL in remission for 3 years presented with acute-onset heart failure. Nuclear medicine PET/CT revealed a massive poorly defined right lower anterior mediastinal mass extending into the entire cardiac base and right ventricular myocardium, with cardiophrenic and retroperitoneal adenopathy. Vital signs and laboratory test results were significant for a heart rate of 56 beats per min (bpm) and elevated brain natriuretic peptide. Electrocardiogram was significant for a complete heart block, maintained by a junctional escape rhythm. Biopsies of the mass revealed recurrence of DLBCL. The patient was treated with diuretics and later started on RICE chemotherapy. CONCLUSIONS Mediastinal DLBCL infiltrating the myocardium is aggressive and presents a treatment dilemma, as retreat of the mass from emergency chemotherapy can result in catastrophic complications. Our patient's condition, rarely described in literature, was severe blood flow obstruction and significant arrhythmia, both of which improved after only 1 cycle of chemotherapy and without need for permanent pacemaker.

BACKGROUND The thumb is crucial for the aesthetic and functional aspects of the upper extremity. A crushed thumb injury can be particularly challenging, especially for individuals with high demands. Currently, there is no consensus on the best approach for treating a crushed thumb. The scapular flap, vascularized by the subscapular artery system, shows great potential as a free flap option. This report aims to highlight the use of a triple flap procedure to preserve the function of the crushed thumb. CASE REPORT A 47-year-old man had a severe injury to his left hand, resulting in significant soft tissue damage in the thenar region, an amputated thumb, and multiple fractures in the phalanx and metacarpal bones. The case was managed using a combination of scapular, parascapular, and osteo-cutaneous parascapular flaps. The first surgery focused on debridement and preserving viable structures, while the second surgery, performed 3 days later, involved the creation of a triple flap, utilizing the circumflex scapular artery and thoracodorsal artery as skin paddles. The flap remained viable, and 6 months postoperatively, the patient regained significant strength and functionality in his left hand. CONCLUSIONS This case demonstrates that severe hand injuries with thumb amputation require a strategic approach based on wound condition and reconstruction feasibility. Triple flaps can be an effective option for such injuries. This report highlights the challenges of treating severe hand crush injuries and emphasizes the importance of personalized surgical approaches for optimal outcomes.

BACKGROUND Necrobiotic pulmonary nodules represent an exceptionally rare extraintestinal manifestation of inflammatory bowel disease (IBD), comprising conditions such as Crohn's disease and ulcerative colitis. These nodules pose significant diagnostic challenges, often mimicking autoimmune pathologies like sarcoidosis, rheumatoid arthritis, and other granulomatous diseases, thereby complicating the clinical management of affected patients. The rarity and nonspecific clinical presentation of necrobiotic pulmonary nodules necessitate a reliance on a combination of radiological and histological findings for accurate diagnosis. Herein, we discuss a 36-year-old woman with necrobiotic pulmonary nodules, underscoring this rarity and application of a surgical diagnostic approach. CASE REPORT This case study describes a 36-year-old woman with ulcerative colitis who developed necrobiotic pulmonary nodules, a rare extraintestinal manifestation of IBD with initial presentation of persistent cough. Further investigations revealed multiple bilateral lung nodules through computed tomography (CT) and positron emission tomography (PET) scans. CT-guided biopsy was not conclusive; therefore, uniportal video-assisted thoracoscopic surgery (VATS) was done for histological confirmation, which indicated necrosis without evidence of malignancy or infection. CONCLUSIONS The diagnosis of necrobiotic pulmonary nodules represents a formidable challenge in clinical practice, largely attributable to their rarity and the limited number of documented cases in the medical literature, with only 7 instances reported thus far. Compounding this difficulty is their clinical and radiological similarity to various autoimmune and infectious conditions, which often leads to diagnostic ambiguity. This case study underscores the utility of VATS as a diagnostic tool that is minimally invasive in the management of necrobiotic pulmonary nodules.

BACKGROUND Occipital neuralgia is a headache caused by irritation or damage to the occipital nerves situated at the rear of the head and neck. It is characterized by sharp, stinging, or electric shock-like pain in the distribution area of the occipital nerve, which often causes patients acute pain and discomfort. To report on the feasibility of non-drug therapy in addressing this condition, we present a case report showcasing the remarkable improvement in occipital neuralgia symptoms achieved with a single acupuncture session, followed by a brief period of care. CASE REPORT The patient was a 76-year-old man who had persistent head pain for over a decade. This pain significantly disrupted his daily activities and diminished his quality of life. Seeking to avoid pharmacological treatments, with their associated adverse effects, and invasive surgical procedures, the patient opted for acupuncture treatments. Over a period of 12 days, the patient underwent 6 acupuncture sessions, each carefully planned and performed by a skilled acupuncturist, ensuring utmost safety and precision. Astonishingly, following the very first session, the patient reported significant alleviation from his head pain. CONCLUSIONS Although the initial approach to managing occipital neuralgia often primarily revolves around conservative drug treatment, acupuncture has emerged as a highly effective modality in alleviating pain symptoms associated with this condition. The favorable outcome of this case report provides convincing evidence that acupuncture can serve as a highly advantageous treatment approach for occipital neuralgia. This case report acts as an encouraging starting point, facilitating the investigation of non-invasive and non-pharmacological pain management strategies.

BACKGROUND Kidney transplantation is the optimal treatment for end-stage kidney disease. Over the last decades, the long-term survival of renal allografts has significantly increased. Nevertheless, several causes, including the recurrence of native kidney disease, can impair the allograft function over time. C3 glomerulopathy (C3GN) is a rare disease, characterized by an abnormal activation of the alternative complement pathway that leads to the accumulation of C3 complement component in the glomeruli. C3GN frequently recurs after kidney transplantation during the first years, leading to graft failure. Recently, during the Covid-19 pandemic, the outcome of kidney transplant patients generally worsened, and several studies showed the effects of SARS-CoV-2 infection on renal function. CASE REPORT Here, we present the clinical case of a female kidney transplant recipient whose renal function worsened after 28 years of transplantation concurrently with two SARS-CoV-2 infections (in October 2020 and March 2022). In 1994, the patient received a diagnosis of acute post-infectious glomerulonephritis, leading to end-stage kidney disease and a living-donor kidney. The most recent allograft biopsy and laboratory test results showed chronic rejection and features of C3GN. Thus, given the possibility of a recurrent glomerulopathy, we reanalyzed the previous patient's renal biopsies performed in 1982 and 1988 and found that both suggested C3GN. CONCLUSIONS Based on these data and the current evidence, we could conclude that in this case, C3GN occurred as a late recurrence disease caused by complement activation after SARS-CoV-2 infection.

BACKGROUND Pericardiocentesis is a commonly used procedure to remove or sample pericardial effusion, and complications of this procedure are rare. This report describes a 75-year-old man with lymphoma and right ventricular perforation during pericardiocentesis for pericardial effusion. CASE REPORT A 75-year-old male patient with diffuse large B cell lymphoma was admitted with concerns of refractory chest tightness and breath shortness after physical exercise. Images from echocardiography showed massive pericardial effusion. After a comprehensive clinical assessment, pericardiocentesis was selected as the corresponding strategy, with the aim to improve the symptom of pericardial compression. However, during the procedure, it was found that the catheter was not placed into the expected location, and the right ventricle was damaged by inappropriate puncture, which led to hemopericardium. Computed tomography showed a high-density 2-mm suspected foreign body penetrating from the pericardial cavity, right ventricle to pulmonary main artery. At the same time, echocardiography showed that cardiac compression was more severe from the progressive effusion and continuous clot formation, which could lead to tamponade or even sudden cardiac arrest. Therefore, this patient immediately underwent emergent exploratory thoracotomy to drain the hemopericardium and remove the misplaced catheter, as well as to repair the damaged right ventricle. CONCLUSIONS Pericardiocentesis has risks due to the invasiveness of the procedure; hence, it is important to conduct complete and comprehensive assessments and preparations before the procedure. Once related complications are found, earlier and effective intervention, including emergent surgery, should be necessary.

BACKGROUND Herpes simplex virus (HSV) is a rare cause of hepatitis. HSV hepatitis can be life-threatening due to its rapid progression to liver failure if not treated on time. It affects primarily immunocompromised individuals but can also present in immunocompetent hosts. HSV hepatitis in solid organ transplant recipients usually occurs in the early post-transplant period as fulminant hepatitis. We present a rare case of febrile anicteric HSV2 hepatitis occurring late in the post-transplant period, with only mild elevation in transaminase levels. CASE REPORT A 60-year-old man presented to the Emergency Department with generalized weakness, chills, and fever for 1 day. His medical history included Crohn's disease, primary sclerosing cholangitis, liver transplantation, and cholangiocarcinoma. Initial laboratory findings revealed leukocytosis. Extensive workup did not reveal a clear etiology of persistent fever. Liver enzymes peaked to aspartate transaminase 198 U/L and alanine transaminase 135 U/L, suggesting possible hepatitis. Liver biopsy showed focal areas of necrosis with vague histiocyte collections. Liver biopsy tissue was positive for HSV2 by polymerase chain reaction; therefore, HSV2 hepatitis diagnosis was made. Intravenous acyclovir was initiated for treatment of HSV2 hepatitis, which resulted with fever resolution within 48 h of initiation and return of liver enzymes to normal levels. CONCLUSIONS This case highlights the importance of having a high suspicion of HSV hepatitis as a rare cause of persistent fevers in immunosuppressed, post-transplant patients even in the late post-transplant period and in the absence of mucocutaneous lesions. Prompt recognition of this disease is crucial to start prompt treatment and decrease mortality.