Oxford Medical Case Reports最新文献

Acrodysostosis (ADO) is a rare form of peripheral dysostosis characterized by skeletal malformations, growth delays, short stature, and distinctive facial features caused by in part by underdeveloped (hypoplasia) of facial bones. Skeletal dysplasia is specific and includes disproportional short stature with short extremities and brachydactyly, multiple cone-shaped epiphyses, scoliosis or kyphosis with spinal stenosis, and advanced bone maturation. Herein, we are highlighting a case that presented with clinical features such as brachydactyly, delayed milestone, growth delay, muscle weakness and nasal hypoplasia. Patient genetic testing was in line with the diagnosis of acrodysostosis. The clinic-radiological correlation was also suggestive of the rare diagnosis of ADO.

There is an increased risk of cardiac complications in COVID-19 among patients with pre-existing comorbidities due to their existing pro-inflammatory status. The manifestation of complete heart block has been evidenced as transient and in no need of intervention. This case presents a previously healthy woman who was diagnosed with SARS-CoV-2 infection and complete heart block; she underwent permanent dual-chamber pacemaker implantation after successful treatment and a negative COVID-19 test. She was then discharged from the hospital with an uneventful follow-up. Persistence of complete heart block symptoms post-COVID-19 resolution and the need for permanent pacing indicate a potential association between COVID-19 and complete heart block. Healthcare workers should consider electrographic examination in the initial assessment of suspected COVID-19 cases, even among those with no pre-existing conditions. This report highlights the need for further research to explore the relationship between COVID-19 and complete heart block.

Background: Several studies have investigated the potential beneficial and side effects of levetiracetam on Parkinson's disease (PD). We hereby report a case of PD exacerbation following Levetiracetam administration for seizure prophylaxis.

Case description: A 77-year-old female, known to have PD, presented with a head injury following a fall. Brain CT showed diffuse subarachnoid hemorrhage. The patient was started on Levetiracetam for seizure prophylaxis. Four days after, the patient dropped GCS from 15 to 9. She was having progressive exacerbation of Parkinson's disease symptoms. After ruling out all possible causes of PD exacerbation, Levetiracetam was gradually weaned until it was discontinued. Consequently, the patient had rapid significant clinical improvement after discontinuation of Levetiracetam.

Conclusion: The use of Levetiracetam for seizure prophylaxis in patients with PD can rarely lead to acute exacerbation of symptoms and worst outcome. Close monitoring of patients with PD is recommended when prescribing anti-epileptics.

Autoimmune gastritis (AIG) is a chronic condition in which the body's immune system mistakenly attacks the stomach lining, specifically targeting parietal cells that produce stomach acid and intrinsic factors. After the H. pylori infection was eradicated, AIG developed in an elderly woman with symptoms of the disease. 1.5 years after eradication, esophagogastroduodenoscopy revealed remnants of the oxyntic mucosa sticky adherent dense mucus and scattered minute whitish protrusions at the greater curvature of the gastric corpus. Biopsy specimens from the greater curvature site of the gastric corpus before H. pylori eradication revealed neutrophilic cells in the superficial mucosa of the stomach that were mildly inflammatory and infiltrating. With the removal of H. pylori, the number of infiltrating inflammatory neutrophilic cells in the superficial mucosa decreased, whereas that of infiltrating lymphocytes increased in the sub-superficial mucosa. This case suggests that further studies regarding the detailed time course of AIG are required.

Crush trauma of extremities, resulting from a crushing force, can be life-threatening even without involving vital organs. Crush syndrome, or traumatic rhabdomyolysis, occurs when muscle cell breakdown releases contents into the bloodstream, leading to systemic complications like acute renal failure. A 35-year-old woman trapped under rubble during11 hours during a seismic event, presenting with compartment syndrome in her left arm and thigh and crush syndrome. Emergent fasciotomy and aggressive fluid resuscitation were performed, preventing renal failure and metabolic derangement. Post-fasciotomy, pulses returned to her affected limbs. She was extubated and moved to the ICU under close surgical supervision. Early, aggressive resuscitation is critical, ideally before extrication, to minimize complications. Awareness of hyperkalemia and acute renal failure risk post-extrication is essential. Continuous fluid resuscitation is the cornerstone of treatment, and prompt fasciotomies are crucial for compartment syndrome management.

Historically, adolescents and young adults diagnosed with acute lymphoblastic leukemia (ALL) have faced lower survival rates compared to children with the same illness. Bullous pemphigoid (BP), a rare autoimmune skin disorder, poses unique challenges when occurring alongside hematologic malignancies. A 23-year-old male with ALL-L1 diagnosis who developed bullous pemphigoid in this report. The patient exhibited typical ALL-L1 symptoms, including constitutional manifestations and signs of bone marrow compromise. Dermatological assessment revealed extensive edematous urticaria-like plaques, erosions, excoriations, crusts, and a hemorrhagic bulla. Severe thrombocytopenia was evident in laboratory tests, with histopathological examination confirming bullous pemphigoid. Despite aggressive treatment, including platelet transfusions, the patient's condition worsened. This case emphasizes the critical need for timely diagnosis and intervention in patients with concurrent hematologic and dermatologic conditions, as mortality rates may surpass those in BP patients without comorbidities.

Craniocervical edema appears soon after chimeric antigen receptor T-cell (CAR-T) therapy in some cases. This phenomenon is often observed right after systemic cytokine release syndrome (CRS), and it is called local CRS (L-CRS). In severe cases, L-CRS causes airway obstruction and asphyxia, but it is not yet well known among hematologists. In this report, we present mild and severe cases of L-CRS. Tocilizumab might have limited efficacy against L-CRS, and early administration of corticosteroids can be important. We hope that this case report raises awareness of L-CRS as an acute-onset adverse event after CAR-T therapy.

Intermittent or transient right bundle branch block (RBBB) can occur in various clinical situations but is rarely described in acute pulmonary embolism. We present a unique case involving a 57-year-old male who experienced a syncopal episode during transit. He displayed signs of a transient right bundle branch block (RBBB) and S1Q3T3 on the initial EMS ECG, which reverted to normal ECG later. This case highlights the significance of recognizing transient RBBB and S1Q3T3 patterns as potential markers of acute PE. Anticoagulation therapy is the mainstay of PE treatment, but other modalities like thrombolysis and surgical embolectomy can be used in selected cases.

Background: Saprochaete capitata may cause fatal infections in immunocompromised patients. This is the first case report of invasive Saprochaete capitate infection at an academic-tertiary care center in Palestine.

Case presentation: We report a 36-year-old woman who presented with fever and severe neutropenia and was found to have AML/Non M3. While receiving her initial chemotherapy treatment, she encountered a rare fungal infection (Saprochaete capitata) that spread throughout her lungs, stomach, spleen, liver, and kidneys, presenting difficulties in both diagnosing and treatment. In addition to being treated with both voriconazole and amphotericin B, the patient underwent surgery to remove the infection source, resulting in a cure.

Conclusion: In immunocompromised patients, Saprochaete capitata infection is frequently overlooked. It is essential to give antifungal combinations and to control the source of infection to enhance the outcome for patients.