Oxford Medical Case Reports最新文献

Background: The 'spiked helmet' sign is a rare electrocardiographic (ECG) phenomenon characterized by transient ST-segment elevations mimicking an acute coronary syndrome, typically seen in critically ill patients. While often associated with severe physiological stress, its presence in sepsis is particularly uncommon.

Case presentation: A 68-year-old male with a history of hypertension and diabetes mellitus presented to the emergency department with fever, altered mental status, and hypotension. Initial workup revealed severe sepsis secondary to pneumonia. His ECG showed pronounced ST-segment elevations in leads II, III, and aVF, with a distinctive 'spiked helmet' pattern. Troponin levels were mildly elevated, raising concerns for concurrent myocardial ischemia. However, the patient denied chest pain, and further cardiac evaluation, including echocardiography, showed no evidence of ischemia or infarction. Intensive care management included broad-spectrum antibiotics, intravenous fluids, and vasopressors. Despite the severity of his illness, the patient's condition gradually improved, and repeat ECGs showed resolution of the ST-segment elevations. The 'spiked helmet' sign was attributed to severe sepsis-induced autonomic dysfunction rather than primary cardiac pathology.

Conclusion: This case highlights the importance of recognizing the 'spiked helmet' sign as a marker of severe stress in critically ill patients, which may mimic myocardial ischemia on ECG. Prompt differentiation between this sign and true ischemia is crucial to avoid unnecessary interventions and focus on managing the underlying critical illness.

We present the case of a 65-year-old woman who came to our clinic with a pruriginous annular skin eruption suggestive of erythema migrans. She reported a previous mild respiratory syndrome. Given the suspicion, the patient was empirically given doxycycline 100 mg q12h for two weeks, which led to a resolution of the dermatosis. Initially, laboratory tests revealed positive IgM for Lyme disease, however these IgM persisted for several months of longitudinal follow-up and IgG was never positive. Seroconversion occurred, however, for Mycoplasma pneumoniae over the course of three weeks. M. pneumoniae is known to cause mucositis, but to our knowledge this is the first reported case of Mycoplasma-induced figurate erythema. She maintained longitudinal follow-up at our clinic and showed no signs of recurrence during this period.

Gestational trophoblastic disease (GTD) encompasses a spectrum of premalignant and malignant conditions arising from trophoblastic tissue. This case highlights an unusual and severe progression of a partial hydatidiform mole complicated by preeclampsia, hyperthyroidism, torsion of a theca-lutein cyst, and ultimately metastatic choriocarcinoma. The patient's course illustrates the importance of early recognition, close monitoring, and multidisciplinary management. This rare and instructive presentation underscores the malignant potential of partial moles. Case: A 36-year-old patient who presented with abdominal pain and vaginal bleeding, associated with hypertension and a beta-human chorionic gonadotropin (β-hCG) of 1561722.6 mIU/mL. Ultrasound revealed a pattern suggestive of a partial mole. Manual vacuum aspiration (MVA) was performed, finding 750 mL of vesicular tissue. Histopathological examination confirmed a partial mole. Days later, the patient developed torsion of a theca lutein cyst, which required exploratory laparotomy. During follow-up, β-hCG levels progressively increased, indicating persistent trophoblastic disease. The patient was referred to an oncology center, where she was diagnosed with choriocarcinoma with pulmonary metastases. She is currently undergoing her first cycle of chemotherapy. The chosen regimen was etoposide and cisplatin, administered over four cycles. This decision was guided by a FIGO risk score assessment, which placed the patient in the low to intermediate-risk category. The initial response was favorable, with no observed complications during the first two cycles.

Lithopedion (from the Greek words 'lithos' meaning stone and 'paidion' meaning child) refers to a rare medical complication in which a fetus dies during an abdominal pregnancy and, unable to be absorbed by the body, calcifies and is gradually turned into stone. This process of calcification serves as the body's way of protecting itself from the dead tissue, preserving the fetus inside the mother's abdomen for many years, often without any symptoms. Lithopedion cases are extremely rare, with about 330 to 340 documented cases reported throughout 400 years of medical literature. We report a rare clinical case of retained abdominal pregnancy for decades in a 70-year-old postmenopausal female, who presented with chronic back pain. Multiple fetal bones calcified in the abdomen were observed on computed tomography.

This case series details two paediatric cases of Mycobacterium avium complex (MAC) mastoiditis that presented to the same hospital within three years of each other and were successfully managed. One female and one male patient, both pre-school aged, presented with otorrhoea and postauricular oedema unresponsive to intravenous antibiotics. Imaging demonstrated opacification of the mastoid air cells and middle ear with cortical breaks, and surgical exploration revealed granulation tissue in the mastoid cavity and antrum on gross and histopathological examination, as well as bony dehiscence. Mycobacterial culture revealed acid fast bacilli and polymerase chain reaction confirmed MAC infection. Both children received antimycobacterial agents and mastoidectomies. This series highlights the importance of considering atypical organisms when managing resistant mastoiditis, especially given the outcomes of sub-optimal management (such as conductive hearing loss, facial nerve palsy and meningitis). We suggest effective management based on our cases and the literature.

Background: Superior mesenteric artery (SMA) dissection is an uncommon yet potentially fatal vascular condition that often manifests as acute abdominal pain complicates the diagnostic process. Contrast-enhanced CT is essential for diagnosis, revealing the extent of dissection and associated complications such as thrombosis or aneurysm.

Case presentation: We report a case of a 58-year-old male presenting with right hypochondriac and epigastric pain, accompanied by vomiting. Laboratory tests showed leukocytosis, elevated amylase and lipase, and a falling hemoglobin level, leading to a preliminary diagnosis of acute pancreatitis and initiation of supportive management. Persistent pain and progressive decline in hemoglobin prompted a contrast-enhanced CT, which revealed an isolated superior mesenteric artery dissection with a partially thrombosed false lumen, small pseudoaneurysmal dilation, and a significant intraperitoneal hematoma. Bowel wall thickening in the distal jejunum and proximal ileum suggested ischemia or early necrosis, with associated mild ascites and edematous bowel loops, but no pneumoperitoneum.

Conclusion: Isolated SMA dissection with thrombosis, aneurysm, and hematoma can closely mimic acute pancreatitis, highlighting the importance of considering vascular causes in acute abdominal pain. Early use of contrast-enhanced CT guided by clinical red flags is crucial to prevent complications such as bowel necrosis. Our case demonstrates that, in hemodynamically stable patients, conservative management with supportive care, antihypertensives, and anticoagulation can result in favorable clinical and radiologic outcomes. This case demonstrates the integration of systematic CT imaging with clinical red-flag assessment to differentiate SMA dissections requiring urgent intervention from those amenable to conservative management, potentially reducing diagnostic delays and improving outcomes.

Background: Focal dystonia is an uncommon movement disorder that may emerge secondary to structural brain lesions. This report presents a rare case of delayed-onset, levodopa-responsive hemidystonia following a brainstem hemorrhage with suspected disruption of the nigrostriatal pathway.

Case report: A 58-year-old man developed sustained dystonic posturing of the left upper and lower limbs one year after suffering a right-sided pontine-midbrain hemorrhage. MRI demonstrated hypointensities in the right substantia nigra and red nucleus, consistent with hemosiderin deposition. Levodopa was initiated at 300 mg/day and titrated to 600 mg/day over 4 weeks, resulting in marked symptomatic improvement. No craniofacial dystonia or parkinsonism was observed.

Discussion: Delayed-onset dystonia can arise from secondary degeneration or iron deposition within the nigrostriatal system. This case highlights the importance of advanced imaging and therapeutic trial of dopaminergic agents in post-lesional dystonia. Literature review indicates similar pathophysiological mechanisms in post-stroke dystonia, although levodopa-responsiveness is rarely reported.

A woman in her 60s presented with a three-week history of progressive subacute back pain without neurological deficits. MRI of the lumbar spine demonstrated necrosis at the L3-L4 disc and adjacent vertebral bodies, raising suspicion for malignancy or infection. Two image-guided bone biopsies were nondiagnostic. A peripheral infectious disease workup was similarly unremarkable. Owing to the persistent concern for infection, 16S ribosomal RNA sequencing was performed on biopsy samples, which identified Capnocytophaga canimorsus. Only after receiving this result did the patient recall a minor dog bite sustained six weeks prior to symptom onset. She was managed with an extended course of oral antibiotics with complete clinical recovery. This case illustrates the capacity of C. canimorsus to cause insidious vertebral osteomyelitis in immunocompetent individuals, underscores the diagnostic utility of 16S rRNA sequencing in culture-negative infections, and highlights the critical importance of a detailed exposure history in atypical clinical presentations.

Radioulnar synostosis is a rare but severe complication of pediatric forearm trauma that results in the loss of forearm rotation and functional impairment. We report the case of a 7-year-old boy who developed post-traumatic distal radioulnar synostosis following a high-energy road traffic accident. Initial management involved open reduction and internal fixation of both forearm bones. One year later, due to loss of pronation-supination, the child underwent revision surgery with bony bridge resection and interposition. Sixteen months after the second surgery, the outcome was excellent with full restoration of forearm rotation and no recurrence. This case highlights the diagnostic and therapeutic challenges in pediatric synostosis and supports the role of early surgical resection with interposition for optimal results.

Background: Primary hyperparathyroidism due to overproduction of parathyroid hormone may present with fatigue, renal stone, abdominal pain, constipation; However, it is rare to observe a pathological fracture as the initial manifestation. We present a case of a young woman with multiple fractures, highlighting the diagnostic challenge. Case presentation: A 35-year-old woman was presented with pain, swelling, and restricted movement in her right upper limb and unable to stand after a minor fall. Initially, she received treatment in the orthopedics department for fractured right humerus and both shaft of femur, then transferred to the medicine department for further evaluation. Serum parathyroid and calcium levels were elevated. A 99m TC MIBI parathyroid SPECT-CT scan revealed persistence of the intense focal radiotracer concentration at right lobe thereby confirming a lower right parathyroid adenoma. Conclusions: This case underscores the potential for primary hyperparathyroidism to manifest with atypical symptoms, leading to delayed diagnosis and management.