Oxford Medical Case Reports最新文献

Oligosecretory multiple myeloma (OSMM) is a rare subtype of plasma cell dyscrasia that poses significant diagnostic challenges due to the absence of a clear monoclonal (M) spike on serum protein electrophoresis. We report the case of a 64-year-old woman with a history of ovarian tumor who presented with progressive fatigue, weight loss, bone pain, anaemia, hypercalcemia, and renal dysfunction. Despite the absence of a definitive M-spike, further immunochemical testing revealed discrete IgG-kappa bands on immunofixation, skeletal x-rays showed extensive osteolytic lesions. A bone marrow biopsy confirmed a diagnosis of OSMM. This case highlights the importance of considering oligosecretory variants in patients with clinical and radiological features suggestive of myeloma, even when routine tests appear normal, and illustrates how comprehensive evaluation with immunofixation and bone marrow examination can prevent diagnostic delays and allow timely initiation of treatment in these diagnostically challenging cases.

Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory systemic disease characterised by ossification of ligaments and entheses. Although it is usually asymptomatic, in its cervical localisation it can cause dysphagia secondary to oesophageal compression or functional limitation due to ankylosis. We present the case of a 58-year-old male with progressive dysphagia of three years' evolution, with an EAT-10 score of 34/40. Surgical resection of the impressive osteophyte formation was performed by an anterior cervical spine approach and precision drilling. Within a few weeks, there was a reported progressive improvement and complete resolution of the symptoms. The pathophysiological mechanisms involved and current recommendations on surgical indications, prognosis and follow-up are discussed. Awareness of this therapeutic option is paramount in non-surgical specialties, and interdisciplinary discussion is recommended.

Catatonia is a rare neuropsychiatric syndrome that has been exceptionally described as the initial manifestation of systemic lupus erythematosus (SLE). We report the case of a 32-year-old woman who presented with severe catatonia, autoimmune hemolytic anemia, and lupus hepatitis as the first expression of SLE. Positive ANA, anti-SM, and anti-ribosomal P antibodies, elevated anti-dsDNA with low complement, and a SLEDAI-2 K score of 8 supported the diagnosis. Antiphospholipid antibodies were negative. The patient received high-dose corticosteroids, cyclophosphamide, hydroxychloroquine, and lorazepam, with marked improvement after three days and complete recovery within two weeks, remaining relapse-free during follow-up. This case emphasizes the importance of considering catatonia as an initial manifestation of neuropsychiatric SLE and highlights the diagnostic relevance of anti-ribosomal P antibodies in such presentations.

Thyroid hormone is essential in human metabolism. Hypothyroidism causes bradycardia, sinus pause, sinus arrest, and the most severe form, myxedema coma, and cardiopulmonary arrest. Most cardiovascular manifestations secondary to hypothyroidism are reversible with timely thyroid hormone replacement. Herein, we report a case of a 53-year-old woman with hypothyroidism who experienced episodes of prolonged sinus arrest, which resolved following temporary pacing and initiation of levothyroxine therapy. Factors such as seasonal variation, medication noncompliance, recent viral illness, and concurrent escitalopram use likely contributed to her presentation. This case highlights the importance of prompt recognition and management of hypothyroid-related cardiac arrhythmias.

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.