Oxford Medical Case Reports最新文献

SANT is a rare, non-lymphoid, benign entity, originating from the red pulp of the spleen. It is characterized by the presence of vascular nodules surrounded by a stroma of collagen fibers. It was introduced as a distinct disease entity by Martel et al in 2004, after the histopathological examination of 25 cases. Symptoms are unspecific, and in most cases, it is incidentally diagnosed, mostly in patients who undergo imaging for other underlying conditions. Moreover, radiological findings are usually inconclusive, and a definite diagnosis is established through histopathological examination. We herein report the case of a 76-year-old female diagnosed with stage I rectal cancer who was subsequently diagnosed with a splenic lesion after a Computed Tomography (CT) scan that was performed for follow-up purposes. Different imaging modalities were employed for further assessment; however, findings were inconclusive and the possibility of metastatic disease could not be excluded. The patient was referred for splenectomy and the diagnosis of SANT was established through histopathological examination.

Hepatectomy is the curative treatment for hepatocellular carcinoma (HCC), with targeted therapy used when resection is difficult. In this rare case, the tumor shrank with targeted therapy, enabling radical treatment through conversion surgery. The patient, a man in his 70s, developed an 11.5-cm HCC (T3N0M0 Stage III) in the posterior hepatic zone after being virologically negative for hepatitis C. The tumor was near the right portal vein branch, making the liver lobe unresectable due to poor liver function. Upon tumor enlargement, he was treated with atezolizumab and bevacizumab. After 5 courses, the tumor significantly shrank, allowing for complete resection with posterior segment removal. The surgery revealed mostly necrotic tumors with no active cancer cells remaining.

The leucine-rich glioma-inactivated protein 1 (LGI1) antibody-related autoimmune encephalitis can occur alone or in the setting of a malignancy and manifest with faciobrachial dystonic seizures (FBDS), cognitive decline, hyponatremia, and neuropsychiatric disorders. The importance of differentiating this entity from acute delirium cannot be overemphasized. This review provides a detailed account of a 71-year-old man with previous diagnosis of lung cancer who presented with subacute onset behavioural changes, urinary retention, and FBDS. Investigation revealed hyponatremia, bilateral mesial temporal lobe high signal abnormality worse on the right on MRI and CSF positive anti-LGI1 antibodies (1:30). The patient was treated with immunosuppressive therapy with consequent symptom improvement. This case emphasizes the need to have a high index of suspicion for this disease entity in patients presenting with new onset behavioural changes and the importance of identifying the typical FBDS, as early initiation of treatment confers a positive outcome for diseased patients.

We present a case detailing the diagnostic challenges of a 23-year-old male presenting with a sudden severe headache, nausea, vomiting, and chest heaviness. Initial evaluation showed elevated blood pressure and respiratory rate. An emergency electrocardiogram (ECG) indicated ST-segment elevation myocardial infarction (STEMI), leading to immediate referral for percutaneous coronary intervention, which revealed normal coronary arteries. Further investigations identified a cisternal subarachnoid haemorrhage (SAH) on CT brain imaging. Despite multidisciplinary management, the patient's condition rapidly deteriorated, resulting in cardiac arrest and mortality. Our case highlights the importance of thorough evaluation and multidisciplinary collaboration in managing complex presentations, emphasizing vigilance in recognizing and managing concurrent pathologies in young patients with acute symptoms.

A 67-year-old lady was admitted with, right sided weakness and right arm shaking. She had recently completed a course of Linezolid for a diabetic foot infection and osteomyelitis. Prior to this she had prodromal symptoms including lethargy and loss of appetite. Clinical features prompting presentation included global weakness, verbal dysfluency and visual disturbance. MRI brain showed bilateral alteration of signal in the deep white matter of the posterior frontal and parietal lobes, sparing the superficial cortical areas. These areas showed diffusion restriction, suggestive of, but not limited to, ischaemic stroke. During admission she had a decline in consciousness and was hypertensive. An acute drop in haemoglobin and platelets occurred prompting consideration of Thrombotic Microangiopathy and other drug related/malignant/infective aetiologies. A diagnosis of Linezolid induced Acute Toxic Leukoencephalopathy and thrombocytopenia was made based on clinico-radiographic features and exclusion of other causes.

Strongyloides stercoralis is an intestinal nematode. It is widely distributed in the tropics and sub-tropics of the world. It can cause a wide array of illnesses ranging from asymptomatic autoinfection to a severe form of hyperinfection and disseminated strongyloidiasis. Here we report a case of a 73-year-old patient presenting with obstructive shock with bipedal edema without any evidence of adrenal insufficiency. An upper gastrointestinal endoscopy revealed Strongyloides larva in the lumen of duodenal crypts. Stool examination and broncho-alveolar lavage revealed the presence of S. stercoralis larva. Computed tomography of pulmonary angiography revealed pulmonary thromboembolism. A long segment thrombus was also noted in the right external iliac vein on color Doppler with negative screening for malignancy on computed tomography scan. This case suggests that pulmonary thromboembolism with anemia and hypoalbuminemia could be a rare presentation of a systemic illness like Strongyloides hyperinfection in an immunocompetent patient from the tropics.

Basal cell carcinoma is a malignant skin cancer, originating from basal cells. However, it is regarded more benign than other skin cancers, in the majority of the cases. If left untreated, it can lead to various complications, degradation of quality of life and even mortality to the patient. A basal cell carcinoma with one dimension more than 20 cm, is defined as super-giant. In this report, we present a case of a super-giant basal cell carcinoma occupying most of the scalp in an elderly patient, causing him severe anemia and general malaise.

This study reports a unique case of a 19-year-old male with Takayasu arteritis initially misdiagnosed as brucellosis due to persistently positive brucella serology. Despite multiple anti-brucellosis treatments, symptoms persisted until the correct diagnosis of Takayasu arteritis was made, Subsequent immunosuppressive therapy for Takayasu arteritis led to symptom improvement and normalization of serological markers. This highlights the challenge of distinguishing between these conditions and the potential for immunosuppression to impact brucella serology in such cases.

Dengue may begin as a straightforward fever episode with or without rash also it may affect some organs and cause serious symptoms. Although it is uncommon, severe abdominal discomfort has been a concerning indicator of acute pancreatitis. We report on a male patient, age 26, who first presented with fever, vomiting, and stomach pain. Later, he developed severe pancreatitis. When an acute viral infection causes pancreatitis, ketoacidosis can occur without hyperglycemia. We emphasize that in dengue patients reporting stomach pain, it is important to rule out acute pancreatitis (AP), an uncommon but serious impediment in the course of treatment.