Oxford Medical Case Reports最新文献

Non-small cell lung cancer, specifically adenocarcinoma, is amenable to targeted therapy for genetic alterations. The role of BRCA mutations in pathogenesis and the efficacy of PARP inhibitors in these cases are still unclear. This case involves a 61-year-old male patient with a past history of Hodgkin's Lymphoma and a heavy smoking history who developed lung adenocarcinoma and was found to have a BRCA2 mutation. Following disease progression on first-line chemotherapy and a detailed case discussion in the multidisciplinary team meeting, second-line Olaparib was started, but the patient's condition worsened rapidly, and he died from the illness. This case highlights the fact that BRCA mutations, though less common, are a potential target that should be explored further. Further large-scale studies are crucial to understanding and improving treatment outcomes for patients with BRCA-mutated NSCLC.

Papilliferous syringocystadenoma is a rare cutaneous adnexal tumor, described in the literature as benign and of hamartomatous origin, although the underlying mechanisms are not fully understood. This tumor is usually seen on the lower eyelids and cheeks. Vulvar syringoma, on the other hand, is an extremely rare condition, with only a few cases reported in the literature. We report here the case of a 63-year-old woman who consulted us for a single nodular lesion located on the large right lip of the vulva. Microscopic examination of the biopsy revealed tumor proliferation with tubular and papillary architecture, associated with epidermis. Although the diagnosis of vulvar syringoma is rare, it is important to consider it when establishing the differential diagnosis in the presence of vulvar pruritus.

Bowen's disease (BD) is the second most common skin cancer worldwide, often linked to sun exposure, arsenic, and immunosuppression. Though rare in pediatrics, it is the third most common pediatric skin cancer, associated with conditions like albinism and immunosuppression. Recent years have seen an increase in Squamous Cell Carcinoma (SCC) cases among children, potentially related to immunosuppression and human papillomavirus (HPV) infection, particularly subtype 16. We present the case of an 11-year-old girl from Mexico City with a five-year history of a slowly growing, asymptomatic, dark-brown plaque on the periungual region of her right hand. Histopathological examination revealed Pigmented Squamous Cell Carcinoma in situ. The lesion was treated with excision, nail apparatus removal, and adjuvant 5% imiquimod cream, followed by skin grafting. This case underscores the importance of considering malignancy in pediatric patients, particularly with atypical presentations in acral sites, and highlights the diagnostic challenges of pigmented SCC.

Brucellosis, a zoonotic infection typically presenting with nonspecific symptoms, rarely leads to cardiac complications, particularly conduction abnormalities. We report a unique case of an 84-year-old female who presented with dizziness, bradycardia, and hypotension, ultimately diagnosed with complete heart block. On admission, blood cultures and further diagnostic workup identified Brucella bacteremia as the underlying cause, with further history revealing that she had recently traveled from a farm in Colombia, a brucellosis-endemic area. The patient underwent dual-chamber pacemaker implantation to stabilize her heart rhythm and was initiated on a three-month antibiotic regimen of doxycycline and rifampin. This case highlights the importance of considering brucellosis as a differential diagnosis for heart block in patients with recent travel from endemic regions. Early recognition and intervention, including antibiotic therapy and pacemaker placement when necessary, are essential for achieving favorable outcomes in brucellosis-related cardiac complications.

A 40-year-old patient with no cardiovascular risk factors was admitted to our center for palpitations with dyspnea involving for 4 months. Clinical exam showed signs of global heart failure. The electrocardiogram showed atrial fibrillation and the chest X-ray revealed right atrial enlargement with left paraventricular calcifications. The diagnosis of constrictive pericarditis (CP) was diagnostic based on echocardiography and cardiac catheterization. Computed tomography (CT) scan chest showed extensive calcifications suggestive of calcific CP. Subsequently, he underwent pericardiectomy, through median sternotomy approach and is currently on follow-up with asymptomatic cardiac status.

Amyloidosis is a rare disease in which abnormally folded proteins form accumulations called amyloid fibrils that accumulate in different tissues and organs, sometimes leading to organ dysfunction, organ failure and death. Rarely, pulmonary involvement can take one of three forms: nodular, diffuse alveolar-septal, or tracheobronchial. We report the case of a 60-year-old woman previously treated for confirmed pleural tuberculosis. She was admitted with progressive dyspnea for three months and a chest CT scan revealed a pulmonary nodule in the middle lobe. She underwent CT-guided biopsy and diagnosis of pulmonary amyloidosis was retained by histology. Follow up has been unremarkable.

Interventional treatment using catheters, particularly coil embolization, is a common therapy for cerebral aneurysms. While generally safe, complications such as allergic vasculitis due to metal allergies can occur. We report the case of a 57-year-old Japanese woman who developed vasculitis after undergoing coil embolization for a cerebral aneurysm. Two days post-procedure, she presented with left-sided facial paralysis, paresis, and hearing loss. MRI revealed multiple small lesions, and vasculitis due to metal allergy was suspected. Treatment with steroids led to improvement, and steroid therapy was tapered off within a year. Allergy tests performed post-treatment identified a positive reaction to the GDC coil and potassium dichromate but not to nickel or platinum. Unfortunately, recurrent vasculitis lesions were detected following the patch test. This case highlights the importance of considering metal allergies before coil embolization and the potential risks of allergy testing after the procedure.

We describe a case of oral contraceptive pill (OCP)-induced esophagitis in a 43-year-old Rwandan woman. She presented with epigastric and retrosternal pain and reported daily use of a combined OCP containing ethinyl estradiol and levonorgestrel. Upper endoscopy revealed a solitary, clean-based esophageal ulcer. Histopathologic evaluation excluded infectious causes, and she improved with proton pump inhibitor therapy and modification of pill consumption habits. This is the first reported case of OCP-induced esophagitis on the African continent and the fifth case overall, and it highlights the importance of awareness of this rare gastrointestinal adverse effect of a commonly used class of drugs, particularly in an area of the world that is promoting the increased uptake of female contraception as a tool for family planning.