Oxford Medical Case Reports最新文献

Squamous cell carcinoma (SCC), also known as epidermoid carcinoma, represents the most common malignant tumor affecting the nails. A 60-year-old tailor with no significant medical history presented with a three-year history of macerated skin between the toes, previously treated with a topical antifungal. Dermatological examination revealed a verrucous, infected ulceration with infiltrated and hyperkeratotic edges, characterized by a whitish, fissured base. This lesion in the fourth interdigital space and extended onto the dorsal surface of the foot without any other associated symptoms. The clinical diagnosis identified it as a neoplastic ulceration. An initial biopsy found keratoacanthoma but showed no malignant features. However, follow-up biopsy at our department revealed moderately differentiated SCC. Surgical resection was successful in treating our patient. Diagnostic errors due to insufficient understanding of the pathology and inadequate biopsy methods contribute to the progression of SCC. Surgery is the main treatment for such malignant tumors.

Insulin autoimmune syndrome (IAS) is a rare cause of spontaneous hypoglycaemia. We discuss a 91-year-old Caucasian lady who presented with syncope and episodic adrenergic and neuroglycopenic symptoms. Despite significantly elevated insulin, C-peptide, and proinsulin levels with the presence of anti-insulin antibodies, a pancreatic mass was not identified. Serum immunoelectrophoresis demonstrated monoclonal gammopathy of undetermined significance (MGUS). Treatment involved high-dose steroids, diazoxide, corn starch and acarbose, however the patient passed away four months later due to worsening co-morbidities. The management of IAS in the setting of MGUS is challenging.

It is estimated that 8 million arterial lines are placed in the United States yearly, with a low incidence of complications reported as less than 1% Gardner RM. (Direct arterial pressure monitoring. Curr Anaesth Crit Care 1990;1:239-46.), Scheer B, Perel A, Pfeiffer UJ. (Clinical review: complications and risk factors of peripheral arterial catheters used for haemodynamic monitoring in anaesthesia and intensive care medicine. Crit Care 2002;6:199-204.) Fracture of a radial arterial catheter is a very rare complication of radial arterial line placement or removal, with surgical removal of a retained catheter fragment being reported infrequently in the literature. We report the first occurrence of this complication at our institution, with proximal migration of the retained catheter fragment, requiring surgical removal. This case serves to reinforce the care and attention to detail required in the placement, securing of and removal of radial arterial lines.

Anti-MDA-5 dermatomyositis (DM) is a subtype of idiopathic inflammatory myopathy, commonly presenting as clinically amyopathic dermatomyositis. It is associated with rapidly progressive interstitial lung disease and a poor prognosis. Here, we present two cases of anti-MDA-5 DM and discuss the challenges associated with timely diagnosis, and the importance of early and aggressive treatment.

Pyomyositis is a purulent infection of skeletal muscle that is mostly observed in tropical countries. Aseptic pyomyositis is a rare, potentially life-threatening disorder characterized by the formation of sterile pus in muscle. We present a case of 53-years old female, diagnosed case of seropositive rheumatoid arthritis, presented with pain and swelling of the right calf muscle for 2 weeks. There was no history of fever, cough, skin erythema, no history of prolonged standing or immobility, or fetal loss. The diagnosis was made as rheumatoid arthritis with autoimmune pyomyositis, and the patient was treated with oral prednisolone 1mg/kg body weight in tapering dose, cs DMARDS, (methotrexate 25 mg once a week, and leflunomide 20mg daily hydroxychloroquine 200 mg daily orally) and another supportive treatment along with surgical drainage of pus was done. There was complete resolution of the initial lesion and remission of the primary disease in 3 months.

Ceftriaxone is a third-generation cephalosporin. Due to its wide range of activity and acceptable safety profile, it is frequently prescribed to paediatric patients. However, there are several documented cases of reports of uncommon adverse events, such as cholecystitis, linked to the use of ceftriaxone. This study discusses the case of an 8-year-old female patient who developed cholecystitis, an inflammation of the gallbladder, after being treated with ceftriaxone. The patient presented with right upper quadrant pain, associated with nausea. Imaging studies showed the presence of stones and shadowing sludge, leading to acute inflammation of the gallbladder. Prompt cessation of ceftriaxone and supportive treatment led to the resolution of cholecystitis and the complete disappearance of the sludge and stones. The study highlights that early identification and withdrawal of the antibiotic can lead to successful therapy and the avoidance of unnecessary surgical procedures.

Immune checkpoint inhibitor (ICI) mediated encephalitides are increasingly being recognized in the literature, but atypical cases may be missed or misdiagnosed. Recent efforts are directed to identify biomarkers to help elucidate early diagnosis and treatment. Herein, we describe two cases of antibody negative ICI-mediated encephalitis with elevated serum Neurofilament light chain (sNfL) levels. Practical Implication: Baseline and longitudinal measurements of serum neurofilament light chains can help determine treatment strategies and prognosis in patients with suspected immune checkpoint inhibitor encephalitis.