Archive of clinical cases最新文献

Drug-induced parkinsonism has been commonly studied and discussed regarding antipsychotic agents, but lithium-induced parkinsonism should also be considered when patients present with parkinsonian symptoms and chronic lithium use. There are several reports of parkinsonism arising during lithium administration and regressing following its reduction or discontinuation. Our case is, to date, the first case in the literature in which vocal cord paralysis occurred as the first symptom of lithium-induced parkinsonism, contributing to confuse doctors and patients and to delay diagnosis and treatment. In our clinical case prompt withdrawal of lithium and its reintroduction at lower doses led to complete resolution of this disabling clinical presentation. This report emphasizes the importance of careful monitoring of lithium levels, especially in elderly subjects, and the need to consider lithium-induced parkinsonism even when unusual motor symptoms appear in chronic lithium users.

Besides respiratory and gastrointestinal symptoms, SARS-CoV-2 also has potential neurotropic effects. Acute hemorrhagic necrotizing encephalopathy is a rare complication of Covid-19. This article presents a case of an 81-year-old female, fully vaccinated, who underwent laparoscopic transhiatal esophagectomy due to gastroesophageal junction cancer. In the early postoperative period, the patient developed persistent fever accompanied by acute quadriplegia, impaired consciousness, and no signs of respiratory distress. Imaging with Computed Tomography and Magnetic Resonance revealed multiple bilateral lesions both in gray and white matter, as well as pulmonary embolism. Covid-19 infection was added to the differential diagnosis three weeks later, after other possible causes were excluded. The molecular test obtained at that time for coronavirus was negative. However, the high clinical suspicion index led to Covid-19 antibody testing (IgG and IgA), which confirmed the diagnosis. The patient was treated with corticosteroids with noticeable clinical improvement. She was discharged to a rehabilitation center. Six months later, the patient was in good general condition, although a neurological deficit was still present. This case indicates the significance of a high clinical suspicion index, based on a combination of clinical manifestations and neuroimaging, and the confirmation of the diagnosis with molecular and antibody testing. Constant awareness of a possible Covid-19 infection among hospitalized patients is mandatory.

Fluoropyrimidines remain some of the most used chemotherapeutics, despite the appearance in the therapeutic arsenal of targeted therapy and immunotherapy. Fluropyrimidines related cardiotoxicity is an undesirable adverse event and affects almost 20% of patients. The mechanisms of fluoropyrimidine toxicity are closely related to deficient allelic variants of DPYD, but considering the low penetrance and interindividual variability, not all adverse reactions are explained by their presence. In this case, we report a patient with recurrent fluoropyrimidine toxicity without a deficient allelic variant and how this case was managed by the oncologist and cardiologist, considering the need to use fluoropyrimidine in the treatment.

A central venous catheter is a flexible catheter that is inserted into a vein and ends close to the superior vena cava. It may be inserted through a vein in the neck, chest, or arm. It's also called a central venous line or central line. Peripherally inserted central venous catheters (PICCs) are usually implanted in arm veins such as the basilic vein, the brachial veins or in some cases in the cephalic vein. PICCs can remain in place for up to six months or more. If properly managed, they last even more than a year. PICCs offer the advantage of greater safety for infusion of vesicants/irritants and hyperosmolar solutions and enable the administration of antibiotics, prolonged parenteral nutrition, and chemotherapy agents. They are however, associated with some adverse events such as spontaneous late migration. The reasons for these complications are not yet fully understood. There are now established causes and in some cases hypotheses to explain these phenomena. We describe two clinical cases in which apparently correctly positioned PICCs migrated spontaneously from their original position. The identification of the migration of the vascular catheter was accidental in the two patients, and they did not developed complications. One of the two patients had a pacemaker. The remote migration of a PICC is an event that can occur, and the causes are not definitively clarified in all cases.

IgA vasculitis (IgAV) is a small-vessel vasculitis common in children but rare in adults. It is usually an auto-limited disease in children but has a more severe course and worse prognosis in adults. The classical manifestations are non-thrombocytopenic purpura, arthralgias, gastrointestinal involvement and renal involvement. Herein we report a case of a 39-year-old man with a rash of the lower limbs associated with testicular and lower abdominal pain. The initial study revealed increased inflammatory biomarkers and enlarged left testis with bilateral ischemic areas on doppler ultrasound. A cutaneous biopsy later revealed leukocytoclastic vasculitis, confirming the diagnosis of IgAV with scrotal involvement. The patient started prednisolone, with improvement in the first week and sustained remission after two years of follow-up. This case report describes an adult with IgAV and scrotal involvement, which is rarely reported in adults and appears to be different from the one in children. The prevalence of scrotal involvement is presumably underestimated. In all men with IgAV, a scrotal examination should be performed and ultrasonography accordingly since it affects the treatment and follow-up. Recommendations for IgAV diagnosis and treatment in adults are still lacking and more research is needed.

Aspergillus is a ubiquitous fungus that can cause a variety of clinical syndromes. It can lead to a spectrum of clinical presentations depending upon the severity of the disease, degree of immune compromisation, nature and intensity of inflammatory host response. Ovarian aspergilloma is extremely unusual, only a few case reports have been described in the literature. Here, we report a case of ovarian aspergilloma which was masquerading as ovarian neoplasm on clinical examination and radiology. To the best of our knowledge, this is the first case report of isolated ovarian aspergillosis in an immunocompetent patient.

The markedly increased survival of transfusion-dependent beta thalassemia patients has led to the recognition of new complications, such as renal disorders. Kidney transplantation is nowadays the preferred treatment option for end-stage kidney disease (ESKD). We describe a case of a 49-year-old woman with β-Transfusion Dependent Thalassemia, who developed ESKD as a result of focal segmental glomerulosclerosis and received a deceased-donor kidney transplant following hemodialysis for over a decade. The particular challenges of this case are discussed, including the long-term survival in hemodialysis. Our patient had to overcome multiple obstacles, including hypercoagulability issues presented in the form of thromboembolism, infections, such as hepatitis C and gastroenteritis, and the acute T-cell-mediated rejection, which had to be managed postoperatively. A review of the current literature revealed only one previous report of a thalassemia patient who successfully underwent renal transplantation. More than a year after the transplantation our patient presents with a normal glomerular filtration rate (GFR=62ml/min/1.73m²) and creatinine level (Cr=0.96mg/dL) and is transfused every 3 weeks. In conclusion, renal transplantation is possible in patients with TDT and should not be discouraged. Regular transfusions and optimal follow-up for the elimination of post-transplant complications are required.

Peri-implant fractures have gained increasing importance in orthopedics as the number of surgical procedures involving orthopedic implants rises globally. These fractures pose a significant challenge in terms of diagnosis, treatment, and postoperative management. They manifest as stress fractures distal to the implant site. Developing an effective treatment strategy involves evaluating multiple influencing factors. This article presents a rare case of a peri-implant distal radius fracture in a 63-year-old man, with no comorbidities, resulting from a car accident, classified as C1U in the Michele D'Arienzo system. The surgical intervention included plate fixation for the radius and wire fixation for the ulna. The wire was used for ulna instead of a plate, due to skin injuries, with good results. As life expectancy rises and individuals remain active in their elder years, the incidence of peri-implant fractures is expected to increase. Factors such as the implant type, surgeon's approach, and patient-specific elements may influence peri-implant fracture occurrence. The widespread use of plate fixation for distal radius fractures may also contribute to a parallel increase in such fractures. Providing detailed context and specific case presentation allows better understanding and implications for clinical practice.

Uveal melanoma (UM) is a rare malignant tumor that differs from cutaneous melanoma in terms of pathogenesis, clinical behavior, and treatment response. Despite treatment for the primary tumor, 50% of UM patients develop metastatic disease, with the liver being the most affected organ. Furthermore, UM responds poorly to chemotherapy and immune checkpoint inhibitors. We present a clinical case of a 58-year-old female patient who was diagnosed with right eye choroidal melanoma cT2aN0M0. For the treatment of the initial tumor, the patient received stereotactic radiotherapy. However, 11 months after the initial diagnosis, the disease had progressed to the liver. The patient underwent radiofrequency ablation of liver metastases, then as the UM progressed - anti-PD-1 immunotherapy with nivolumab and ipilimumab were prescribed for the first-line palliative systemic treatment, later chemotherapy with dacarbazine (5 cycles) as the second-line systemic treatment. Based on the Foundation-One®CDx findings and an overview of clinical trials data, the MEK inhibitor trametinib was prescribed as a third-line palliative treatment. The patient died due to cancerous intoxication, with overall survival (OS) of 28 months (∼2.33 years) and a progression-free survival (PFS) of 11 months (∼0.92 years) since the initial diagnosis. Treatment-related adverse events could have an impact on the general health condition of the patient.

Coralliform kidney stones represent a severe form of nephrolithiasis, posing significant challenges due to their size and associated complications, such as recurrent infections and renal impairment. We present the case of a 34-year-old female with chronic venous disease, anemia, and recurrent Escherichia coli urinary tract infections, who was diagnosed with a right-sided coralliform renal calculus and a ureteral pelvic stone. The management included semi-rigid ureteroscopy with laser lithotripsy for the ureteral stone, percutaneous nephrolithotomy (PCNL) for the coralliform stone, and placement of a ureteral stent. Despite anatomical challenges during PCNL, residual stones were addressed via staged extracorporeal shock wave lithotripsy. This case highlights the complexity of surgical management in advanced nephrolithiasis and the necessity for a multidisciplinary approach.