Oxford Medical Case Reports最新文献

Background: Crescentic glomerulonephritis, which is mostly recognized due to lupus nephritis, anti-neutrophil cytoplasmic antibody-associated vasculitis, anti-glomerular basement membrane antibody disease, and immune complex-mediated injury, complicates acute kidney disease (AKD).

Case description: A 37 year-old male patient with oligo-anuric AKD who developed indications for renal replacement therapy secondary to crescentic complement 3 (C3) glomerulopathy was presented. Endocapillary necrotizing crescentic glomerulonephritis with isolated C3 deposition in the kidney biopsy of our patient was confirmed as complement 3 glomerulopathy (C3G). The patient was successfully treated with oral methylprednisolone and 6 doses of monthly parenteral cyclophosphamide.

Conclusion: We emphasize the importance of proteinuria evaluation in patients with oligo-anuric AKD even when polyuria phase begins which means that the recovery period of AKD is initiated. Therefore, crescentic C3G should be considered in such patients. Monoclonal gammopathy and genetic factor H defects should be investigated to determine the underlying etiology in C3G patients. Monthly cycles of cyclophosphamide infusion (a total of 6 cycles) are beneficial for these patients.

Background: Male breast cancer (MBC), accounting for < 1% of all breast malignancies, remains underrepresented in clinical trials evaluating human epidermal growth factor receptor 2 (HER2)-targeted therapies. Most MBCs are hormone receptor-positive (HR+), with a high rate of HER2-low expression. However, men were excluded from clinical trials evaluating HER2-directed agents, which is an absolute evidence gap.

Case report: We present the case of a 76-year-old man with heavily pretreated, HR+/HER2-low (immunohistochemistry [IHC] 1+) metastatic breast cancer (mBC) who achieved a complete metabolic response (CMR) following four cycles of trastuzumab deruxtecan (T-DXd) without any grade ≥ 2 (G ≥ 2) toxicity.

Conclusion: This case highlights the potential efficacy and tolerability of T-DXd in men and challenges the systematic exclusion of male patients from clinical trials involving HER2-low mBC. We advocate routine HER2-low testing and gender-inclusive trial design.

Miliary tuberculosis (TB) in pregnancy presents unique diagnostic and therapeutic challenges due to overlapping physiological changes, imaging limitations, and fetal considerations. We describe a 42-year-old third-trimester healthcare worker who presented with prolonged fever and rapidly progressive hypoxaemia. Initial investigations were inconclusive, and imaging showed subtle reticulonodular opacities. Her condition worsened into severe ARDS, requiring emergency caesarean delivery and mechanical ventilation. Placental histopathology revealed necrotizing granulomatous inflammation, and fundoscopy identified choroidal tubercles. Mycobacterium tuberculosis was later confirmed on bronchoalveolar lavage. Anti-tubercular therapy and corticosteroids led to gradual clinical recovery and successful extubation. The neonate remained well on follow-up. This case underscores the diagnostic complexity of miliary TB in pregnancy and the value of placental pathology and fundoscopy when conventional tools fall short. With timely intervention and multidisciplinary care, even fulminant presentations can result in favourable maternal and neonatal outcomes.

Low-grade fibromyxoid sarcoma (LGFMS) is a rare soft-tissue tumor that mainly affects young adults. We present a rare case of LGFMS with scrotal involvement in a 66-years-old man. Our patient presented with a large, painless scrotal mass exhibiting pelvic extension, which was deemed inoperable. He underwent combined chemoradiotherapy. In the light of this case and a literature review, we discuss diagnostic and therapeutic approaches to establish optimal management strategies for LGFMS tumors.

Background: Pacemakers attempt to accurately mirror normal physiology; however, even normal pacemaker functionality can have undesirable effects.

Case summary: A 59-year-old male with a background including heart failure, presented with symptoms of 'hitting a brick wall' during exertion, years following the implantation of a biventricular pacemaker for third-degree atrioventricular block. He was extensively evaluated, with cardiopulmonary exercise testing and simultaneous device interrogation. After reaching a heart rate of 140 beats/minute, continued exercise resulted in Wenckebach phenomenon and progression to sustained 2:1 atrioventricular block with immediate reductions in oxygen consumption. Ultimately, the aetiology was attributed to upper rate behaviour, rather than the progression of heart failure, and resolved with simple device reprogramming.

Discussion: Cardiopulmonary exercise testing is an invaluable tool when evaluating patients who present with cardiovascular symptoms. Device reprogramming is often required, including the use of rate-response algorithms where appropriate. Personalisation is key, with programming tailored to the individual's physiology.

Autoimmune hepatitis (AIH) is a chronic inflammatory disease that results from autoantibody mediated hepatocyte injury. Given its immune-mediated mechanism, it is more likely to present with other autoimmune conditions, particularly involving thyroid gland. In patients presenting with both Graves' disease and hepatitis, the diagnostic challenge is to determine the cause of elevated liver enzymes. We present an 11-year-old girl with acute liver cell failure and cholestasis in a setting of untreated hyperthyroidism. She was diagnosed to have Graves' disease with AIH and primary sclerosing cholangitis. She underwent radioactive iodine ablation of thyroid gland and is currently responding well on steroid, azathioprine, and thyroid replacement therapy.

Aim: We describe a case report of a 71-year-old with a long history of Paranoid Schizophrenia presenting with psychogenic polydipsia.

Background: Psychogenic polydipsia is a rare and challenging complication of Paranoid Schizophrenia. Research is limited with regards to how to treat this effectively, however the management normally involves fluid restriction and behavioural therapy.

Method: We looked through his history and liaised with multiple specialities to compile this report.

Result: This patient has long history of psychogenic polydipsia. More recently he presented with his chronic hyponatremia. To aid reduction of his hyponatraemia, his duloxetine was stopped, and his olanzapine dose reduced.

Conclusions: There is evidence in the role of naltrexone in reducing compulsive drinking. We trialled this at 25 mg and the patient's drinking behaviour has reduced in the community.

Biliary ascariasis is a clinical condition, in which the roundworm Ascaris lumbricoides migrates from the small intestine into the biliary tract. We report a case of a 21-year-old female patient from Skardu, Pakistan. The patient shows an unusual presentation that makes the diagnosis quite tricky. The symptoms include dull, persistent right hypochondrial pain, nausea, and vomiting without any signs of jaundice or fever. Moreover, the blood tests revealed only a mild increase in eosinophil count, just above the borderline, and completely normal liver function, a distinguishing feature of parasitic infections. Ultrasound showed a dilated bile duct containing a roundworm, indicating a parasite infection. Initially, the patient was given deworming medication. Furthermore, Magnetic resonance cholangiopancreatography (MRCP) findings were consistent with biliary ascariasis characterized by the presence of Ascaris within the hepatic biliary channels causing its significant dilatation. This case report highlights that lab reports can sometimes be misleading when making a diagnosis of biliary ascariasis. Additionally, there is a need for improvement in the healthcare system and sanitation.

Syphilis, caused by Treponema pallidum, is a re-emerging infectious disease with diverse clinical manifestations. While primary syphilis often goes unnoticed, secondary syphilis is characterized by systemic symptoms and variable skin lesions, earning it the epithet 'the great imitator'. Histologically, secondary syphilis typically shows a plasma cell-rich dermal infiltrate, whereas granulomatous inflammation is rare. This report describes a case of nodular secondary syphilis with granulomatous inflammation in a 22-year-old woman who presented with persistent erythematous nodules on the face. Initial mismanagement with corticosteroids delayed the diagnosis, which was later confirmed by histopathology and positive serologic tests. Treatment with benzathine penicillin G led to complete resolution of the lesions. The case highlights the importance of recognizing atypical presentations of syphilis, especially granulomatous forms, in the differential diagnosis. Serologic testing remains essential for confirmation, and benzathine penicillin is the treatment of choice for all stages of syphilis.

Background: Methemoglobinemia is an uncommon but potentially life-threatening disorder where hemoglobin iron is oxidized to the ferric state, impairing oxygen transport. Topical anesthetics such as lidocaine can induce methemoglobinemia. Methylene blue (MB) is the first-line antidote, but high doses can oxidize hemoglobin and may precipitate hemolysis even in individuals with normal glucose-6-phosphate dehydrogenase (G6PD) activity.

Case presentation: A 31-year-old woman with recurrent genital herpes self-applied excessive 5% lidocaine cream (≈3 tubes/day) for two weeks. She presented with progressive fatigue, cyanosis and hypoxemia. Arterial blood gas showed methemoglobin 13.6%. She received intravenous MB at another hospital and subsequently developed severe anemia (hemoglobin 6.6 g/dL) with laboratory evidence of intravascular hemolysis. G6PD activity was normal. Supportive management included high-flow oxygen, oral ascorbic acid, intravenous antivirals and antibiotics, and transfusion of two units of packed red blood cells. Methemoglobin levels and hemoglobin gradually normalized, and she was discharged in stable condition.

Conclusion: This case illustrates the paradoxical risk of MB-induced hemolysis in a G6PD-sufficient patient. Clinicians should consider alternative treatments such as ascorbic acid when managing methemoglobinemia and educate the public on safe use of topical anesthetics.