Oxford Medical Case Reports最新文献

Erythema multiforme (EM) is an immune-mediated condition that manifests as targetoid skin lesions and can be triggered by various factors, including infections and vaccinations. This case report describes a 41-day-old full-term male infant who developed widespread annular, bullseye-shaped erythematous skin lesions one week after receiving the Bacillus Calmette-Guérin (BCG) vaccination. The infant, exclusively breastfed and without a significant past medical history, presented with these lesions but no associated systemic symptoms. Physical examination revealed characteristic targetoid lesions, sparing the face, palms, soles, and mucous membranes. Laboratory tests, including a complete blood count and infection markers, were within normal ranges except for a mildly elevated C-reactive protein. The differential diagnosis ruled out other conditions and EM diagnosis is confirmed. The infant was managed conservatively with supportive care, and the lesions resolved without the need for antibiotics or any additional therapy. The patient remained stable and was discharged with instructions for monitoring and follow-up. So this case highlights the importance of distinguishing EM from other similar conditions such as Stevens-Johnson syndrome, toxic epidermal necrolysis, and urticaria.

Transcatheter arterial embolization is the therapy of choice for recurrent peptic ulcer bleeding refractory to standard endoscopic hemostatic techniques. It offers a minimally invasive approach with high efficacy, lower mortality, and complication rates compared to surgery. However, rare adverse events attributed to coil migration including pulmonary embolism, stroke, myocardial infarction, and bowel obstruction have been reported. We report the case of a 72-year-old female with a massive duodenal ulcer bleed refractory to endoscopic hemostatic techniques of epinephrine injection and bipolar cautery. She had a successful transcatheter arterial embolization of the culprit vessels. Repeat esophagogastroduodenoscopy for increasing vasopressor requirements and transfusion unresponsive anemia revealed the visualization of the metallic coil in the duodenal ulcer base with no active bleeding which was successfully managed conservatively through multidisciplinary consultation.

Aim: To report a patient with choroidal bulging, sub-retinal fluid, and optic nerve head (ONH) swelling who was finally diagnosed with focal nodular posterior scleritis. Case report: A 51-year-old male patient presented to us with acute painful visual loss of his left eye (LE) from 3 days ago. The best-corrected distance visual acuity (BCDVA) was 20/20 and hand motion (HM) for the right eye (RE) and LE, respectively. Fundus examination of the LE showed ONH swelling, choroidal bulging, multiple patches of subretinal fluid accumulation, and retinal pigment epithelial (RPE) corrugations. Orbital and brain MRI showed a retrobulbar nodular mass with gadolinium enhancement at the optic nerve and sclera junction. Oncology and rheumatology work-ups were unremarkable. With the clinical diagnosis of nodular posterior scleritis oral prednisolone 50 mg/Kg was started. Conclusion: Posterior scleritis is an uncommon inflammatory condition that could be misdiagnosed with choroidal tumors, posterior uveitis, and orbital inflammation.

We present the case of a 73-year-old woman with coronary artery-left ventricular multiple microfistulae, who was admitted with symptoms and ECG suggestive of coronary artery disease. Coronary angiography revealed tortuous coronary arteries with multiple microfistulae between the left coronary artery and the left ventricle, as well as between the right coronary artery and the left ventricle. Transthoracic echocardiography (TTE) was also able to clearly demonstrate the presence of the microfistulae with their direction of blood flow towards the left ventricle. Despite traditional reliance on coronary angiography, this case advocates for the diagnostic role of TTE due to its non-invasive nature and ability to provide crucial preliminary information, even in cases with such small structures as these microfistulae. We emphasize the importance of precise, modern terminology over historical eponyms such as Thebesian veins or vessels of Wearn, aligning medical communication with contemporary diagnostic capabilities.

Backgrounds: Primary hepatic epithelioid hemangioendothelioma (HEHE) is a rare neoplasm of vascular origin with varying biologic behavior, making it challenging to diagnose.

Case presentation: We present a case of synchronous hepatocellular carcinoma (HCC) and HEHE in a 43-year-old Chinese male patient. Multiple hypoechoic liver lesions were depicted, but no specific imaging findings were detected on enhanced computed tomography (CT) or contrast-enhanced magnetic resonance imaging (MRI). The patient then underwent [¹⁸F]-FDG PET/CT, [¹¹C]-acetate PET/CT, and [⁶⁸Ga]Ga-FAPI-04 PET/CT. The HEHE lesions demonstrated no uptake on both ¹⁸F-FDG and ¹¹C-acetate PET/CT imaging, but presented a clear visualization in [⁶⁸Ga]Ga-FAPI-04 PET/CT. The largest lesion located in segment VII was finally diagnosed as HCC, while the other smaller ones were diagnosed as HEHE, which was confirmed by immunohistochemical staining for CD31. To the best of our knowledge, only 2 cases have been reported in the worldwide literature, and the first case undertook both ¹¹C-acetate and [⁶⁸Ga]Ga-FAPI-04 PET/CT instead of ¹⁸F-FDG PET/CT.

Conclusion: In this report, we show that HCC and HEHE may occur synchronously, and HEHE should be considered when liver lesions are detected. [⁶⁸Ga]Ga-FAPI-04 PET/CT has great potential in the detection, staging and therapy selection of HEHE.

This case involved an 89-year-old woman with a history of left nephrectomy for left renal cell carcinoma at the age of 87 years. She had been gradually accumulating pericardial effusion for the past 4 years. She presented with signs of tachycardia and hypotension suggestive of cardiac tamponade due to pericardial effusion, and pericardiocentesis was performed below the xiphoid process in the cardiology department. Serous fluid was aspirated, and malignancy was ruled out by various tests. The patient subsequently developed recurrent pericardial effusion and was admitted to the hospital. Cardiovascular surgery was performed for pericardial drainage. A left intercostal incision was made for pericardiotomy and drainage of the pericardial effusion, allowing it to accumulate in the left pleural cavity in case of future accumulation. Pathological examination of the pericardium revealed no specific findings, and no cancer cells were present in the pericardial fluid. Prednisolone therapy was initiated for idiopathic pericarditis.

Hydatid disease is an infection caused by the larval form of Echinococcus. It is a zoonosis primarily affecting the lungs and liver. While pulmonary involvement is most common, the cysts can develop in various extrapulmonary sites within the thorax, such as the pleural cavity, fissures, mediastinum, heart, vascular structures, chest wall, and diaphragm. However, intracardiac localization of hydatid cyst is very rare and it is found in less than 2% of cases. Cardiac involvement can be caused by systemic or pulmonary circulation, or by direct spread from adjacent structures. Imaging techniques, particularly MRI, play a crucial role not only in diagnosing hydatid cysts, but also in assessing their extension and identifying complications. We report a case of a 13-year-old girl, with a left ventricular myocardial hydatid cyst.

Background: Pulmonary endarteritis secondary to Patent ductus arteriosus (PDA) can present even in silent PDAs. Pulmonary endarteritis is treated with prolonged duration of antibiotics followed by PDA closure. It can also cause septic pulmonary emboli requiring critical care if multi-organ dysfunction ensues.

Case presentation: A 9-year-old boy had high grade fever for one week and few nonspecific complaints. Echocardiogram showed PDA with infective endarteritis. Child was admitted with IV antibiotics. CECT chest done for resurgence of fever and need for increased oxygen demand showed multiple septic pulmonary emboli with pulmonary infarction. Surgical closure of PDA prevented further clinical deterioration.

Conclusion: This case highlights the poor medical scenario of rural communities of Nepal. Such life- threatening complication can be prevented by timely recognition of the condition which is only possible by implementation of standard, accessible and affordable health care system across the country.

Rupioid psoriasis is a rare subtype of psoriasis characterized by distinctive lesions resembling oyster shells, known as rupioid lesions. This subtype is particularly uncommon in the pediatric population and is often associated with poor treatment compliance. Ustekinumab, an IgG monoclonal antibody, targets IL-12 and IL-23, reducing the release of proinflammatory cytokines TNFα, IL-2, and IL-17α, which play vital roles in psoriasis pathophysiology. Approved for pediatric patients aged six years and older, ustekinumab provides a therapeutic option for moderate to severe psoriasis. We present the case of a 10-year-old girl diagnosed with psoriasis vulgaris at age two. She presented with rupioid lesions following a urinary tract infection that had been treated with oral cefixime (200 mg). After conducting appropriate tests, ustekinumab (45 mg subcutaneously) was administered, leading to significant improvements in the thickness of the lesions and overall appearance. This case demonstrates ustekinumab's efficacy in treating this challenging form of psoriasis.