Oxford Medical Case Reports最新文献

Lassa fever is a viral haemorrhagic illness endemic in West Africa, with Nigeria accounting for a significant proportion of global cases. While most patients recover, sensorineural hearing loss (SNHL) is a serious and often overlooked post-infectious complication. We present the case of a 13-year-old girl who developed sudden profound right-sided SNHL shortly after recovering from Lassa fever, despite a high cycle threshold (Ct) value on PCR, indicating low viral load. She was treated with intravenous mannitol and hydrocortisone, along with oral betahistine and neurovite, and demonstrated notable improvement in hearing over a one-month period. Follow-up revealed subclinical involvement of the contralateral ear, emphasizing the risk of bilateral progression. This case underscores that significant auditory sequelae can occur even at low viral loads and highlights the potential benefits of early pharmacologic intervention. It also reinforces the urgent need for routine hearing assessment and auditory rehabilitation in Lassa fever survivors.

Progressive supranuclear palsy-Richardson syndrome (PSP-RS) is a sporadic atypical parkinsonian disorder typically resistant to levodopa. While most cases are neurodegenerative, various conditions (genetic, vascular, infectious, or paraneoplastic) can mimic this phenotype, termed PSP-like or PSP mimics. Although paraneoplastic PSP is extremely rare, it is important to recognize because of its potential reversibility. The diagnosis can be particularly challenging, especially when classical tumor markers or imaging fail to identify a clear neoplastic origin. Here, we describe a 39-year-old man with an Anti-Ri-mediated PSP-like syndrome in whom an extensive evaluation, including surgical removal of two suspicious sites (thymus and testis), failed to identify an underlying tumor. The patient presented with rapidly progressive symptoms characteristic of PSP-RS, raising clinical suspicion for a paraneoplastic cause. We also review the literature on paraneoplastic PSP.

Primary percutaneous coronary intervention (PCI) remains pivotal in managing ST-segment elevation myocardial infarction (STEMI), enabling prompt revascularization. While radial and femoral accesses are conventionally preferred, the brachial (humeral) artery can represent a valuable alternative, particularly when punctured proximally in the upper arm (high brachial/humeral access). We present a 70-year-old hypertensive patient with recent ischemic stroke and end-stage renal disease on dialysis, who developed an inferobasal STEMI complicated by slow atrial fibrillation and cardiogenic shock. Radial and femoral accesses were not feasible due to diffuse arterial disease, including iliac occlusion, radial thrombosis, and a thrombosed arteriovenous fistula. Surgical exposure of the right high brachial (humeral) artery enabled successful PCI with drug-eluting stent implantation, without immediate complications. This report highlights humeral/brachial access as an effective rescue option, and to our knowledge, represents one of the rare descriptions of surgical humeral access for primary PCI in STEMI with cardiogenic shock.

McKittrick-Wheelock syndrome (MWS) is a rare condition characterized by chronic diarrhea caused by colorectal villous adenoma, which can lead to severe hyponatremia, hypokalemia, and kidney injury. We present a case of MWS resulting from a 9.6 cm rectal tubulovillous adenoma, which caused significant electrolyte abnormalities and kidney injury. While MWS has been documented in association with villous adenomas, there is limited literature on its occurrence with tubulovillous adenomas, as seen in our case.

Systemic mastocytosis co-occurring with chronic myelomonocytic leukemia (SM-AHN) presents therapeutic challenges, especially in cases of cytopenia. We present a case of a 76-year-old woman with advanced SM-AHN and thrombocytopenia, who responded to reduced-dose avapritinib combined with dexamethasone. Initial treatment with midostaurin and azacitidine was discontinued due to hematological toxicity. Avapritinib (100 mg/day) initiated but reduced to 50 mg/day due to thrombocytopenia risk, with dexamethasone (20 mg) added for platelet support. Clinical improvement was observed within two weeks, with lymphadenopathy resolution, spleen and liver size reduction, platelet count normalization, and serum tryptase decrease. Avapritinib combined with dexamethasone offers a promising therapeutic strategy for SM-AHN, particularly in thrombocytopenic cases.

Background: Hydatid cyst (HC) represents a remarkable zoonotic parasitic disease, mostly affecting the liver and lungs. In this report, we present a patient from northern Iran who exhibited HC involvement in the pelvic region, a rare occurrence that is often asymptomatic.

Case presentation: A 41-year-old female presented with hypogastric pain, and imaging survey showed the potential presence of cystadenoma, endometriosis, and various typical ovarian lesions. She underwent laparotomy, during which pelvic HC was identified. Serological testing confirmed this finding. Also, albendazole was prescribed, and she was discharged in relatively good condition.

Conclusion: In regions where this infection is prevalent, HC must be considered in the differential diagnosis of ambiguous cystic tumors. This case highlights the importance of including HC in the differential diagnosis of pelvic cysts, especially in endemic areas. Furthermore, we recommend the using of molecular techniques during surgical interventions as potentially beneficial.

Background: Ewing sarcoma rarely arises in the gastrointestinal (GI) tract, and rectosigmoid presentations are exceptionally uncommon.

Case presentation: 36-year-old man with rectosigmoid mass showing small round blue cells with pseudorosettes, CD99 and FLI1 positive, diagnosed as Ewing sarcoma; managed with surgical resection followed by chemotherapy.

Conclusion: Primary EES of rectosigmoid is extremely rare; diagnosis requires morphology, IHC and molecular testing wherever possible; early biopsy allows neoadjuvant chemo before surgery.

We report a case of a 65-year-old man with diffuse hepatic artery dilation. Laboratory tests and imaging studies indicated signs of chronic liver disease. Specific measurements of dilated vessels are provided, and relevant diagnostic and therapeutic considerations are discussed. The patient was treated with common hepatoprotective agents and the progression of cirrhosis was prevented. Importantly, this case emphasizes the need to distinguish hepatic artery dilation from other vascular anomalies, particularly in the absence of portal hypertension, through high-resolution imaging and clinical correlation.

Laryngeal webs are rare structural anomalies, typically anterior in location when congenital. Posterior laryngeal webs are exceedingly uncommon and are most often acquired, with common associations including prior intubation and gastroesophageal reflux disease (GERD). GERD-induced laryngeal inflammation is a proposed mechanism for web formation due to chronic mucosal irritation and fibrosis. We present the case of a 24-year-old male with recurrent globus pharyngeus and chest discomfort, found to have a posterior laryngeal web in the absence of prior intubation or trauma. The patient was diagnosed with GERD and demonstrated marked symptomatic improvement following anti-reflux therapy. This case highlights the potential link between GERD and posterior laryngeal web formation, emphasizing the role of conservative management in select cases. Further research is warranted to explore the pathophysiological relationship between GERD and laryngeal structural changes, as well as to refine treatment strategies.