首页 > 最新文献

Archive of clinical cases最新文献

英文 中文
Ocrelizumab-induced organizing pneumonia in multiple sclerosis: case report and literature review. 奥克立珠单抗诱发的多发性硬化症组织性肺炎:病例报告和文献综述。
IF 0.8 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-07-16 eCollection Date: 2024-01-01 DOI: 10.22551/2024.43.1102.10291
Shaheryar Usman, Muhammad Cheema, Zoha Ghuman, Saleem Mustafa, Asma Iftikhar

Patients with relapsing-remitting multiple sclerosis should be offered disease-modifying therapies as part of their management. Recommended options include integrin antagonist therapy including natalizumab as well as anti-CD20 monoclonal antibodies like, ocrelizumab, rituximab, ofatumumab, and ublituximab. These therapies reduce relapse rates and slow brain lesion accumulation. Disease-modifying therapies selection may depend on patient preferences, potential fetal harm, and specific drug risks, requiring continuous monitoring via tracking clinical relapses and new MRI brain lesions. Natalizumab carries a risk of progressive multifocal leukoencephalopathy, particularly in anti-JCV antibody-positive patients, necessitating regular monitoring. Ocrelizumab, rituximab, and ublituximab are associated with an increased risk of infections (especially respiratory and skin infections), infusion reactions, and hypogammaglobulinemia. Ocrelizumab additionally poses a heightened risk of immune-mediated colitis and breast cancer, and it is contraindicated for patients with active hepatitis B due to the risk of viral reactivation. Ublituximab has been noted to be linked to potential fetal harm. We report the case of a 42-year-old male with relapsing-remitting multiple sclerosis on ocrelizumab who developed persistent fever and shortness of breath, two weeks after his last ocrelizumab dose. Despite antibiotic treatment for suspected pneumonia, his symptoms persisted. A chest CT scan revealed multifocal ground-glass opacities suggestive of organizing pneumonia, likely secondary to ocrelizumab. The patient's condition improved with high-dose corticosteroids, underscoring the importance of vigilance for extremely rare ocrelizumab-associated pulmonary side effects and the need for prompt, appropriate intervention.

复发缓解型多发性硬化症患者在治疗过程中应接受改变病情疗法。推荐的治疗方案包括整合素拮抗剂疗法(包括纳他珠单抗)以及抗CD20单克隆抗体(如奥克利珠单抗、利妥昔单抗、ofatumumab和乌利昔单抗)。这些疗法可降低复发率,减缓脑部病灶的积累。疾病改变疗法的选择可能取决于患者的偏好、对胎儿的潜在伤害和特定药物的风险,需要通过跟踪临床复发和新的磁共振成像脑病变进行持续监测。纳妥珠单抗有发生进行性多灶性白质脑病的风险,尤其是抗 JCV 抗体阳性患者,因此需要定期监测。奥克利珠单抗、利妥昔单抗和乌利昔单抗会增加感染(尤其是呼吸道感染和皮肤感染)、输液反应和低丙种球蛋白血症的风险。此外,奥克利珠单抗还会增加患免疫介导的结肠炎和乳腺癌的风险,而且由于病毒再激活的风险,活动性乙型肝炎患者禁用。据悉,乌布鲁昔单抗与潜在的胎儿伤害有关。我们报告了这样一例病例:一名 42 岁的男性复发性多发性硬化症患者在服用奥克立珠单抗两周后出现持续发热和气短。尽管他接受了疑似肺炎的抗生素治疗,但症状依然存在。胸部 CT 扫描发现多灶性磨玻璃不透明,提示可能继发于奥克立珠单抗的组织化肺炎。大剂量皮质类固醇治疗后,患者的病情有所好转,这凸显了警惕极为罕见的奥克立珠单抗相关肺部副作用的重要性,以及及时采取适当干预措施的必要性。
{"title":"Ocrelizumab-induced organizing pneumonia in multiple sclerosis: case report and literature review.","authors":"Shaheryar Usman, Muhammad Cheema, Zoha Ghuman, Saleem Mustafa, Asma Iftikhar","doi":"10.22551/2024.43.1102.10291","DOIUrl":"10.22551/2024.43.1102.10291","url":null,"abstract":"<p><p>Patients with relapsing-remitting multiple sclerosis should be offered disease-modifying therapies as part of their management. Recommended options include integrin antagonist therapy including natalizumab as well as anti-CD20 monoclonal antibodies like, ocrelizumab, rituximab, ofatumumab, and ublituximab. These therapies reduce relapse rates and slow brain lesion accumulation. Disease-modifying therapies selection may depend on patient preferences, potential fetal harm, and specific drug risks, requiring continuous monitoring via tracking clinical relapses and new MRI brain lesions. Natalizumab carries a risk of progressive multifocal leukoencephalopathy, particularly in anti-JCV antibody-positive patients, necessitating regular monitoring. Ocrelizumab, rituximab, and ublituximab are associated with an increased risk of infections (especially respiratory and skin infections), infusion reactions, and hypogammaglobulinemia. Ocrelizumab additionally poses a heightened risk of immune-mediated colitis and breast cancer, and it is contraindicated for patients with active hepatitis B due to the risk of viral reactivation. Ublituximab has been noted to be linked to potential fetal harm. We report the case of a 42-year-old male with relapsing-remitting multiple sclerosis on ocrelizumab who developed persistent fever and shortness of breath, two weeks after his last ocrelizumab dose. Despite antibiotic treatment for suspected pneumonia, his symptoms persisted. A chest CT scan revealed multifocal ground-glass opacities suggestive of organizing pneumonia, likely secondary to ocrelizumab. The patient's condition improved with high-dose corticosteroids, underscoring the importance of vigilance for extremely rare ocrelizumab-associated pulmonary side effects and the need for prompt, appropriate intervention.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"11 2","pages":"69-73"},"PeriodicalIF":0.8,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11250650/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141629368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
An unusual variant of type I common bile duct duplication associated with ampullary carcinoma. 与胰腺癌相关的 I 型总胆管重复的不寻常变异。
IF 0.8 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-07-16 eCollection Date: 2024-01-01 DOI: 10.22551/2024.43.1102.10289
Andrei Bancu, Thomas Poundall, Claudia Santos, Yutaro Higashi, Abed M Zaitoun, Dileep N Lobo

Common bile duct duplications represent exceptionally rare congenital anomalies of the biliary tract. In this case report we document an unusual variant of common bile duct duplication in a 79-year-old man who underwent a pancreaticoduodenectomy for ampullary cancer. The duplication consisted of two unseparated, completely-layered, common bile ducts which originated above the cystic duct junction and terminated prior to the point of insertion into the pancreas, where the two lumens converged into a single duct. Duplication of the bile duct is rare and often goes undetected. In the present case, the anomaly was found incidentally in a patient who had a pancreaticoduodenectomy for an ampullary carcinoma. However, duplication may be associated with choledocholithiasis, cholangitis, pancreatitis, and pancreaticobiliary malignancies and it is important to be aware of the condition.

胆总管重复是胆道异常罕见的先天性畸形。在本病例报告中,我们记录了一名因胰腺癌接受胰十二指肠切除术的 79 岁男性的胆总管重复畸形。重复的胆总管由两根未分离、完全分层的胆总管组成,这两根胆总管起源于胆囊管交界处上方,终止于插入胰腺点之前,在该处两管腔汇合成一根胆总管。胆总管重复的情况非常罕见,通常不会被发现。在本病例中,异常是在一名因胰十二指肠癌而进行胰十二指肠切除术的患者身上偶然发现的。然而,胆管重复可能与胆总管结石、胆管炎、胰腺炎和胰胆管恶性肿瘤有关,因此必须警惕这种情况。
{"title":"An unusual variant of type I common bile duct duplication associated with ampullary carcinoma.","authors":"Andrei Bancu, Thomas Poundall, Claudia Santos, Yutaro Higashi, Abed M Zaitoun, Dileep N Lobo","doi":"10.22551/2024.43.1102.10289","DOIUrl":"10.22551/2024.43.1102.10289","url":null,"abstract":"<p><p>Common bile duct duplications represent exceptionally rare congenital anomalies of the biliary tract. In this case report we document an unusual variant of common bile duct duplication in a 79-year-old man who underwent a pancreaticoduodenectomy for ampullary cancer. The duplication consisted of two unseparated, completely-layered, common bile ducts which originated above the cystic duct junction and terminated prior to the point of insertion into the pancreas, where the two lumens converged into a single duct. Duplication of the bile duct is rare and often goes undetected. In the present case, the anomaly was found incidentally in a patient who had a pancreaticoduodenectomy for an ampullary carcinoma. However, duplication may be associated with choledocholithiasis, cholangitis, pancreatitis, and pancreaticobiliary malignancies and it is important to be aware of the condition.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"11 2","pages":"56-60"},"PeriodicalIF":0.8,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11250649/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141629367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Type II pleuropulmonary blastoma in a fetus: case report of a rare mesenchymal mediastinal tumor and literature review. 胎儿胸膜肺泡瘤 II 型:罕见间质纵隔肿瘤病例报告和文献综述。
IF 0.8 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-06-24 eCollection Date: 2024-01-01 DOI: 10.22551/2024.43.1102.10286
Valentin Tiberiu Moldovan, Maria Sajin, Sergiu D Habago, Leila Ali

Mediastinal tumors are exceedingly rare during fetal development, presenting significant diagnostic challenges and potentially leading to severe outcomes such as stillbirth or metastatic disease if not promptly identified and managed. Pleuropulmonary blastomas are primitive mesenchymal tumors often linked to mutations in the DICER1 gene, indicating a hereditary pattern associated with other common adult neoplasms with dominant inheritance. This report describes a case involving a 20-year-old Caucasian woman whose pregnancy was complicated by a stillbirth in the second trimester. Initial suspicions of a mediastinal tumor arose from blood tests and ultrasound examinations during pregnancy surveillance. However, the definitive diagnosis of a type II pleuropulmonary blastoma was established through a pathological examination at autopsy. This case underscores the complexities of diagnosing fetal mediastinal tumors and contributes to the sparse literature on neonatal pleuropulmonary blastomas. Our comprehensive review of the differential diagnoses and literature emphasizes the unique characteristics of pleuropulmonary blastoma and its similarities to other soft tissue sarcomas, enhancing understanding of their clinical and genetic profiles.

纵隔肿瘤在胎儿发育过程中极为罕见,给诊断带来了巨大挑战,如果不能及时发现和处理,有可能导致死产或转移性疾病等严重后果。胸膜肺泡瘤是一种原始间质肿瘤,通常与 DICER1 基因突变有关,表明其遗传模式与其他常见成人肿瘤的显性遗传有关。本报告描述了一例 20 岁高加索女性的病例,她在怀孕的第二个三个月因死胎而并发妊娠。在妊娠监测期间,通过血液化验和超声波检查,最初怀疑是纵隔肿瘤。然而,通过尸检病理检查,最终确诊为 II 型胸膜肺泡瘤。该病例凸显了胎儿纵隔肿瘤诊断的复杂性,也为新生儿胸膜肺泡瘤的稀少文献做出了贡献。我们对鉴别诊断和文献的全面回顾强调了胸膜肺泡瘤的独特性及其与其他软组织肉瘤的相似性,从而加深了对其临床和遗传特征的了解。
{"title":"Type II pleuropulmonary blastoma in a fetus: case report of a rare mesenchymal mediastinal tumor and literature review.","authors":"Valentin Tiberiu Moldovan, Maria Sajin, Sergiu D Habago, Leila Ali","doi":"10.22551/2024.43.1102.10286","DOIUrl":"10.22551/2024.43.1102.10286","url":null,"abstract":"<p><p>Mediastinal tumors are exceedingly rare during fetal development, presenting significant diagnostic challenges and potentially leading to severe outcomes such as stillbirth or metastatic disease if not promptly identified and managed. Pleuropulmonary blastomas are primitive mesenchymal tumors often linked to mutations in the DICER1 gene, indicating a hereditary pattern associated with other common adult neoplasms with dominant inheritance. This report describes a case involving a 20-year-old Caucasian woman whose pregnancy was complicated by a stillbirth in the second trimester. Initial suspicions of a mediastinal tumor arose from blood tests and ultrasound examinations during pregnancy surveillance. However, the definitive diagnosis of a type II pleuropulmonary blastoma was established through a pathological examination at autopsy. This case underscores the complexities of diagnosing fetal mediastinal tumors and contributes to the sparse literature on neonatal pleuropulmonary blastomas. Our comprehensive review of the differential diagnoses and literature emphasizes the unique characteristics of pleuropulmonary blastoma and its similarities to other soft tissue sarcomas, enhancing understanding of their clinical and genetic profiles.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"11 2","pages":"41-46"},"PeriodicalIF":0.8,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11195025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141452309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pacemaker lead thrombosis - a rare cause of breathlessness. 起搏器导线血栓--导致呼吸困难的罕见原因。
IF 0.8 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-06-24 eCollection Date: 2024-01-01 DOI: 10.22551/2024.43.1102.10288
Megan Ashleigh Kelly, Alexander Davidson, Kirsty Griffiths, Renzo Pessotto, Stephen James Leslie

As the number of pacemaker insertions increases to manage numerous cardiac arrhythmias, the number of complications is also increasing as a result. More common complications such as infection and lead displacement are routinely discussed with patients before they undergo the procedure. However rare complications such as superior vena cava syndrome are not discussed during the consenting period. But they do occur, as seen in this case of a 69-year-old male. This fit and active man had a right-sided dual-chamber pacemaker inserted due to sinus node disease and presented 5 years later with symptoms suggestive of superior vena cava obstruction (SVCO). Despite anticoagulation and before surgical intervention could be performed, the patient developed a right-sided chylothorax which was drained. An autologous pericardial patch repair of the SVC and a thrombectomy of SVC clots was subsequently performed. This was only partially successful and the SVCO recurred. A low fatty chain diet was initiated to manage the chylothorax, which remains stable. This rare complication has left the patient with a small pleural effusion and chronic pleural thickening. They can still exercise with mild breathlessness. The management of such a complication, which requires the input of many specialists, is challenging and often does not completely resolve all symptoms. For this reason, superior vena cava obstruction should be considered as a risk during the consenting procedure for a pacemaker insertion.

随着为控制各种心律失常而植入起搏器的数量增加,并发症的数量也随之增加。感染和导联移位等较常见的并发症在患者接受手术前都会进行常规讨论。然而,上腔静脉综合征等罕见并发症并没有在同意手术期间进行讨论。但这种并发症确实存在,本例中一名 69 岁的男性就是如此。这名体格健壮、活泼好动的男子因窦房结病而安装了右侧双腔起搏器,5 年后出现了提示上腔静脉阻塞 (SVCO) 的症状。尽管进行了抗凝治疗,但在进行手术治疗之前,患者出现了右侧乳糜胸,并进行了引流。随后对上腔静脉进行了自体心包补片修复,并对上腔静脉血栓进行了切除。但这只取得了部分成功,SVCO 再次复发。为了控制乳糜胸,患者开始进食低脂肪链饮食,目前病情仍然稳定。这种罕见的并发症导致患者有少量胸腔积液和慢性胸膜增厚。他们仍然可以进行运动,但有轻微的呼吸困难。这种并发症的处理需要许多专家的参与,具有挑战性,而且往往不能完全消除所有症状。因此,在起搏器植入同意程序中,应将上腔静脉阻塞视为一种风险。
{"title":"Pacemaker lead thrombosis - a rare cause of breathlessness.","authors":"Megan Ashleigh Kelly, Alexander Davidson, Kirsty Griffiths, Renzo Pessotto, Stephen James Leslie","doi":"10.22551/2024.43.1102.10288","DOIUrl":"10.22551/2024.43.1102.10288","url":null,"abstract":"<p><p>As the number of pacemaker insertions increases to manage numerous cardiac arrhythmias, the number of complications is also increasing as a result. More common complications such as infection and lead displacement are routinely discussed with patients before they undergo the procedure. However rare complications such as superior vena cava syndrome are not discussed during the consenting period. But they do occur, as seen in this case of a 69-year-old male. This fit and active man had a right-sided dual-chamber pacemaker inserted due to sinus node disease and presented 5 years later with symptoms suggestive of superior vena cava obstruction (SVCO). Despite anticoagulation and before surgical intervention could be performed, the patient developed a right-sided chylothorax which was drained. An autologous pericardial patch repair of the SVC and a thrombectomy of SVC clots was subsequently performed. This was only partially successful and the SVCO recurred. A low fatty chain diet was initiated to manage the chylothorax, which remains stable. This rare complication has left the patient with a small pleural effusion and chronic pleural thickening. They can still exercise with mild breathlessness. The management of such a complication, which requires the input of many specialists, is challenging and often does not completely resolve all symptoms. For this reason, superior vena cava obstruction should be considered as a risk during the consenting procedure for a pacemaker insertion.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"11 2","pages":"51-55"},"PeriodicalIF":0.8,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11195026/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141452307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Is it a thrombus or a tumor? An imaging dilemma for clinicians. 是血栓还是肿瘤?临床医生的影像难题。
IF 0.8 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-06-24 eCollection Date: 2024-01-01 DOI: 10.22551/2024.43.1102.10285
James Choi, Toby Speirs, Ranvir Bhatia, Sanjay Sivalokanathan, Colin Craft

Atrial fibrillation, the most common cardiac arrhythmia in the Western world, confers a 5-fold increase in stroke, mainly due to thrombus formation in the left atrial appendage. Early rhythm control is often beneficial in reducing adverse cardiovascular events in higher-risk populations. Here, we present a patient who was found to have a 1 cm stalk-like lesion in the left atrial appendage on transesophageal echocardiogram prior to electrical cardioversion. Using multiple cardiac imaging modalities, including cardiac magnetic resonance imaging and computed tomography, the mass was eventually determined to be a chronic resolving thrombus.

心房颤动是西方世界最常见的心律失常,主要由于左心房附壁血栓形成,导致中风的发生率增加 5 倍。在高危人群中,早期控制心律往往有利于减少不良心血管事件的发生。在此,我们介绍了一名在电复律前通过经食道超声心动图发现左心房阑尾有 1 厘米长的茎样病变的患者。通过心脏磁共振成像和计算机断层扫描等多种心脏成像方式,最终确定该肿块为慢性溶解性血栓。
{"title":"Is it a thrombus or a tumor? An imaging dilemma for clinicians.","authors":"James Choi, Toby Speirs, Ranvir Bhatia, Sanjay Sivalokanathan, Colin Craft","doi":"10.22551/2024.43.1102.10285","DOIUrl":"10.22551/2024.43.1102.10285","url":null,"abstract":"<p><p>Atrial fibrillation, the most common cardiac arrhythmia in the Western world, confers a 5-fold increase in stroke, mainly due to thrombus formation in the left atrial appendage. Early rhythm control is often beneficial in reducing adverse cardiovascular events in higher-risk populations. Here, we present a patient who was found to have a 1 cm stalk-like lesion in the left atrial appendage on transesophageal echocardiogram prior to electrical cardioversion. Using multiple cardiac imaging modalities, including cardiac magnetic resonance imaging and computed tomography, the mass was eventually determined to be a chronic resolving thrombus.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"11 2","pages":"37-40"},"PeriodicalIF":0.8,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11195027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141452306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Transcatheter prosthetic valve endocarditis of an aortic valve-in-valve bioprosthesis in an elderly male. 一名老年男性的主动脉瓣瓣中瓣生物假体经导管人工瓣膜心内膜炎。
IF 0.8 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-06-24 eCollection Date: 2024-01-01 DOI: 10.22551/2024.43.1102.10287
Shreyas Bellur, Michele Gallo, Brian Ganzel, Praveen Seshabhattar, Siddharth Pahwa

Transcatheter aortic valve replacement (TAVR) is the percutaneous alternative to traditional surgery. Infective endocarditis is a fatal complication of TAVR, especially in the elderly. A 65-year-old male with a history of valve-in-valve TAVR presented to our emergency room with altered mentation. On examination, he was febrile. Laboratory investigations and echocardiography suggested infective endocarditis. Explantation and surgical aortic valve replacement were planned. The biopsy of the prostheses showed acute inflammation. Transcatheter prosthetic valve endocarditis warrants early diagnosis, particularly in the elderly. Our case emphasizes the importance of the prompt inclusion of endocarditis in the differential and surgical referral.

经导管主动脉瓣置换术(TAVR)是传统手术的经皮替代手术。感染性心内膜炎是经导管主动脉瓣置换术的致命并发症,尤其是在老年人中。一名65岁的男性患者曾接受过瓣中瓣TAVR手术,因精神异常到我院急诊就诊。经检查,他发热。实验室检查和超声心动图提示他患有感染性心内膜炎。我们计划为他进行剥离术和主动脉瓣置换术。人工瓣膜活检显示存在急性炎症。经导管人工瓣膜心内膜炎需要早期诊断,尤其是老年人。我们的病例强调了及时将心内膜炎纳入鉴别诊断和手术转诊的重要性。
{"title":"Transcatheter prosthetic valve endocarditis of an aortic valve-in-valve bioprosthesis in an elderly male.","authors":"Shreyas Bellur, Michele Gallo, Brian Ganzel, Praveen Seshabhattar, Siddharth Pahwa","doi":"10.22551/2024.43.1102.10287","DOIUrl":"10.22551/2024.43.1102.10287","url":null,"abstract":"<p><p>Transcatheter aortic valve replacement (TAVR) is the percutaneous alternative to traditional surgery. Infective endocarditis is a fatal complication of TAVR, especially in the elderly. A 65-year-old male with a history of valve-in-valve TAVR presented to our emergency room with altered mentation. On examination, he was febrile. Laboratory investigations and echocardiography suggested infective endocarditis. Explantation and surgical aortic valve replacement were planned. The biopsy of the prostheses showed acute inflammation. Transcatheter prosthetic valve endocarditis warrants early diagnosis, particularly in the elderly. Our case emphasizes the importance of the prompt inclusion of endocarditis in the differential and surgical referral.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"11 2","pages":"47-50"},"PeriodicalIF":0.8,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11195028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141452308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Triple whammy in a patient with portal vein thrombosis. 门静脉血栓患者的三重打击。
Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-05-14 eCollection Date: 2024-01-01 DOI: 10.22551/2024.42.1101.10280
Elamein Yousif, Elamin Dahawi, Sarah Premraj, Wissem Melki

Infection with SARS-CoV-2 has been shown to predispose to thromboembolic events. The risk of such thromboses further increases in those with underlying inherited or acquired prothrombotic states. The authors present a 30-year-old lady who developed acute abdominal pain, three days after recovery from a mild COVID-19 infection. She was also using oral contraceptive pills. Laboratory investigations revealed elevated inflammatory markers, and a contrast-enhanced abdominal CT scan demonstrated portal vein thrombosis (PVT). Due to the unusual site of thrombosis, a thrombophilia screen was performed, which detected a heterozygous Factor V Leiden mutation (FVL). Thus, her PVT was attributed three simultaneous risk factors, namely COVID-19 infection, OCP use and FVL mutation. She was initiated on anti-coagulation, with which she improved significantly. In patients presenting with thromboses at uncommon sites, investigation for evidence of recent Covid-19 infection and screening for inherited and acquired thrombophilia should be considered, while discontinuing any offending medications.

感染 SARS-CoV-2 已被证明容易导致血栓栓塞事件。如果患者存在遗传性或获得性血栓前状态,发生血栓栓塞的风险会进一步增加。作者介绍了一位 30 岁的女士,她在轻度 COVID-19 感染痊愈三天后出现急性腹痛。她还在服用口服避孕药。实验室检查显示炎症指标升高,对比增强腹部 CT 扫描显示门静脉血栓形成(PVT)。由于血栓形成的部位不寻常,医生对她进行了血栓性疾病筛查,发现了杂合子因子 V Leiden 突变(FVL)。因此,她的 PVT 可归因于三个同时存在的危险因素,即 COVID-19 感染、使用 OCP 和 FVL 基因突变。她开始接受抗凝治疗,病情明显好转。对于出现非常见部位血栓的患者,在停用任何违规药物的同时,应考虑调查近期是否有感染Covid-19的证据,并筛查遗传性和获得性血栓性疾病。
{"title":"Triple whammy in a patient with portal vein thrombosis.","authors":"Elamein Yousif, Elamin Dahawi, Sarah Premraj, Wissem Melki","doi":"10.22551/2024.42.1101.10280","DOIUrl":"10.22551/2024.42.1101.10280","url":null,"abstract":"<p><p>Infection with SARS-CoV-2 has been shown to predispose to thromboembolic events. The risk of such thromboses further increases in those with underlying inherited or acquired prothrombotic states. The authors present a 30-year-old lady who developed acute abdominal pain, three days after recovery from a mild COVID-19 infection. She was also using oral contraceptive pills. Laboratory investigations revealed elevated inflammatory markers, and a contrast-enhanced abdominal CT scan demonstrated portal vein thrombosis (PVT). Due to the unusual site of thrombosis, a thrombophilia screen was performed, which detected a heterozygous Factor V Leiden mutation (FVL). Thus, her PVT was attributed three simultaneous risk factors, namely COVID-19 infection, OCP use and FVL mutation. She was initiated on anti-coagulation, with which she improved significantly. In patients presenting with thromboses at uncommon sites, investigation for evidence of recent Covid-19 infection and screening for inherited and acquired thrombophilia should be considered, while discontinuing any offending medications.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"11 1","pages":"16-18"},"PeriodicalIF":0.0,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11091492/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140923728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Internal hernia as cause of acute abdomen in a preterm neonate: when necrotizing enterocolitis is not the culprit. 早产新生儿急腹症的原因是内疝:当坏死性小肠结肠炎不是罪魁祸首时。
Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-05-14 eCollection Date: 2024-01-01 DOI: 10.22551/2024.42.1101.10284
Zoi Lamprinou, Elisavet Kanna, Ioannis Skondras, Rodanthi Sfakiotaki, Jonida Mene, Orthodoxos Achilleos

Internal hernias in preterm neonates, although rare, can arise due to various anatomical and physiological factors associated with prematurity. We report a case of a preterm infant with symptoms of suspected necrotizing enterocolitis (NEC) that turned out to be an internal hernia during surgical exploration. Given the overlapping symptoms, it is crucial to maintain a high index of suspicion and utilize the appropriate imaging techniques, such as ultrasound or radiographic studies, to aid in the differentiation between NEC and internal hernia, especially when responding to cases that do not improve with standard NEC management or exhibit atypical features. Early recognition and accurate differentiation are crucial for appropriate management and prevention of complications in affected neonates.

早产新生儿内疝虽然罕见,但可因与早产有关的各种解剖和生理因素而发生。我们报告了一例早产儿,其症状疑似坏死性小肠结肠炎(NEC),但在手术探查时却发现是内疝。鉴于症状的重叠,保持高度的怀疑指数并利用适当的成像技术(如超声波或射线检查)来帮助区分坏死性小肠结肠炎和内疝气至关重要,尤其是在应对经标准坏死性小肠结肠炎治疗后仍无改善或表现出非典型特征的病例时。早期识别和准确鉴别对适当治疗和预防受影响新生儿的并发症至关重要。
{"title":"Internal hernia as cause of acute abdomen in a preterm neonate: when necrotizing enterocolitis is not the culprit.","authors":"Zoi Lamprinou, Elisavet Kanna, Ioannis Skondras, Rodanthi Sfakiotaki, Jonida Mene, Orthodoxos Achilleos","doi":"10.22551/2024.42.1101.10284","DOIUrl":"10.22551/2024.42.1101.10284","url":null,"abstract":"<p><p>Internal hernias in preterm neonates, although rare, can arise due to various anatomical and physiological factors associated with prematurity. We report a case of a preterm infant with symptoms of suspected necrotizing enterocolitis (NEC) that turned out to be an internal hernia during surgical exploration. Given the overlapping symptoms, it is crucial to maintain a high index of suspicion and utilize the appropriate imaging techniques, such as ultrasound or radiographic studies, to aid in the differentiation between NEC and internal hernia, especially when responding to cases that do not improve with standard NEC management or exhibit atypical features. Early recognition and accurate differentiation are crucial for appropriate management and prevention of complications in affected neonates.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"11 1","pages":"34-36"},"PeriodicalIF":0.0,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11091493/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140923508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A reevaluation of mixed depressive states from the DSM-5- TR perspective: a series of prototypical cases. 从 DSM-5- TR 角度重新评估混合抑郁状态:一系列原型病例。
Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-04-30 eCollection Date: 2024-01-01 DOI: 10.22551/2024.42.1101.10282
Stefano Pini, Accursio Raia, Giulia Amatori, Benedetta Nardi, Barbara Carpita, Antonio Tundo, Liliana Dell'Osso

Mixed depressive states are defined by the co-presence of depressive and manic symptoms. They represent extremely variable conditions from the point of view of clinical expressiveness and are difficult to recognize, ranging from clear schizophrenic-like psychoses and pseudodemented pictures to subsyndromal psychopathology. At the basis of the extreme variability of depressive pictures with mixed features are the different combinations that depressive and manic symptoms can assume. Furthermore, the intensity of depressive symptoms and manic symptoms, combined, can be variable, a factor that contributes to making the picture even more variable. Each form of mixed depressive state therefore presents its own specific symptomatic characteristics and specific difficulties in differential diagnosis and each form requires a different therapeutic strategy. In this work we have distinguished four possible specific subtypes of mixed depressive states, describing their specific clinical presentation and the therapeutic options most supported by the literature with the aim of contributing to a better recognition of mixed depressive states, to avoid incorrect diagnoses at patient and treatments that are useless if not worsening.

混合抑郁状态的定义是抑郁症状和躁狂症状同时存在。从临床表现的角度来看,混合抑郁状态的情况极为多变,而且难以辨认,既有明显的精神分裂症样精神病和假性痴呆,也有亚综合征精神病态。具有混合特征的抑郁症状之所以极其多变,是因为抑郁症状和躁狂症状可以有不同的组合。此外,抑郁症状和躁狂症状的组合强度也可以是多变的,这也是导致抑郁症状更加多变的一个因素。因此,每种形式的混合抑郁状态都有其特定的症状特征,在鉴别诊断方面也存在特定的困难,而且每种形式都需要不同的治疗策略。在这项工作中,我们区分了混合抑郁状态的四种可能的特定亚型,描述了它们的具体临床表现和文献中最支持的治疗方案,目的是帮助更好地识别混合抑郁状态,避免对患者的错误诊断和无用甚至恶化的治疗。
{"title":"A reevaluation of mixed depressive states from the DSM-5- TR perspective: a series of prototypical cases.","authors":"Stefano Pini, Accursio Raia, Giulia Amatori, Benedetta Nardi, Barbara Carpita, Antonio Tundo, Liliana Dell'Osso","doi":"10.22551/2024.42.1101.10282","DOIUrl":"https://doi.org/10.22551/2024.42.1101.10282","url":null,"abstract":"<p><p>Mixed depressive states are defined by the co-presence of depressive and manic symptoms. They represent extremely variable conditions from the point of view of clinical expressiveness and are difficult to recognize, ranging from clear schizophrenic-like psychoses and pseudodemented pictures to subsyndromal psychopathology. At the basis of the extreme variability of depressive pictures with mixed features are the different combinations that depressive and manic symptoms can assume. Furthermore, the intensity of depressive symptoms and manic symptoms, combined, can be variable, a factor that contributes to making the picture even more variable. Each form of mixed depressive state therefore presents its own specific symptomatic characteristics and specific difficulties in differential diagnosis and each form requires a different therapeutic strategy. In this work we have distinguished four possible specific subtypes of mixed depressive states, describing their specific clinical presentation and the therapeutic options most supported by the literature with the aim of contributing to a better recognition of mixed depressive states, to avoid incorrect diagnoses at patient and treatments that are useless if not worsening.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"11 1","pages":"22-28"},"PeriodicalIF":0.0,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11060145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140867744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Exploring the severity and early onset of familial type 1 diabetes in Romania: genetic and microbiota insights. 探索罗马尼亚家族性 1 型糖尿病的严重性和早期发病情况:遗传和微生物群的启示。
Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-04-30 eCollection Date: 2024-01-01 DOI: 10.22551/2024.42.1101.10283
Amalia Ioana Arhire, Dorian Sorin Ioacara, Teodora Papuc, Gratiela Gradisteanu Parcalibioru, Simona Fica

Type 1 diabetes mellitus (T1DM) is a chronic condition characterized by pancreatic autoimmunity and destruction of the insulin producing beta-cells. The risk of familial type 1 diabetes (FT1DM) is greater in families with paternal T1DM. The children with paternal FT1DM have a more severe form of the disease with diabetic ketoacidosis. Three families with FT1DM, out of which two with paternal diabetes and daughters diagnosed with this disease, and one family with sibling FT1DM were evaluated between 2019-2021 in the Pediatric Diabetes and the Diabetes, Nutrition and Metabolic Departments of a tertiary hospital. Clinical, biological, and genetic evaluations were performed, together with an assessment of the gastrointestinal microbiota. The Romanian children with FT1DM had a more severe onset, a median of age at onset of 9 years old and a genetic predisposition with positive HLA DR3/R4, DQB1*02:01. The protecting allele, DPB1*04:01, was found only in the siblings with FT1DM. A gastrointestinal dysbiosis, characterized by pro-inflammatory bacteria, with high levels of Enterobacteriaceae and Candida, was observed in the gut microbiota. This is the first case series of FT1DM in Romanian patients that shows the presence of genetic determinants but also a pathological microbiota which may determine a more severe and an early-age onset of disease.

1 型糖尿病(T1DM)是一种慢性疾病,其特点是胰腺自身免疫和产生胰岛素的 beta 细胞遭到破坏。在父系患有 T1DM 的家族中,患家族性 1 型糖尿病(FT1DM)的风险更大。父系 FT1DM 患儿的病情更为严重,会出现糖尿病酮症酸中毒。一家三甲医院的儿童糖尿病科和糖尿病、营养与代谢科在2019-2021年间对三个FT1DM家庭进行了评估,其中两个家庭的父亲患有糖尿病,女儿也被诊断患有此病,还有一个家庭的兄弟姐妹都患有FT1DM。他们进行了临床、生物学和遗传学评估,并对胃肠道微生物群进行了评估。患有 FT1DM 的罗马尼亚儿童发病较严重,发病年龄中位数为 9 岁,遗传倾向为 HLA DR3/R4、DQB1*02:01 阳性。保护性等位基因 DPB1*04:01 仅在患有 FT1DM 的兄弟姐妹中发现。在肠道微生物群中观察到胃肠道菌群失调,其特征是肠道微生物群中含有大量肠杆菌科和白色念珠菌的促炎细菌。这是罗马尼亚 FT1DM 患者的首例系列病例,显示了遗传决定因素和病理微生物群的存在,而病理微生物群可能决定疾病的严重程度和发病年龄。
{"title":"Exploring the severity and early onset of familial type 1 diabetes in Romania: genetic and microbiota insights.","authors":"Amalia Ioana Arhire, Dorian Sorin Ioacara, Teodora Papuc, Gratiela Gradisteanu Parcalibioru, Simona Fica","doi":"10.22551/2024.42.1101.10283","DOIUrl":"https://doi.org/10.22551/2024.42.1101.10283","url":null,"abstract":"<p><p>Type 1 diabetes mellitus (T1DM) is a chronic condition characterized by pancreatic autoimmunity and destruction of the insulin producing beta-cells. The risk of familial type 1 diabetes (FT1DM) is greater in families with paternal T1DM. The children with paternal FT1DM have a more severe form of the disease with diabetic ketoacidosis. Three families with FT1DM, out of which two with paternal diabetes and daughters diagnosed with this disease, and one family with sibling FT1DM were evaluated between 2019-2021 in the Pediatric Diabetes and the Diabetes, Nutrition and Metabolic Departments of a tertiary hospital. Clinical, biological, and genetic evaluations were performed, together with an assessment of the gastrointestinal microbiota. The Romanian children with FT1DM had a more severe onset, a median of age at onset of 9 years old and a genetic predisposition with positive HLA DR3/R4, DQB1*02:01. The protecting allele, DPB1*04:01, was found only in the siblings with FT1DM. A gastrointestinal dysbiosis, characterized by pro-inflammatory bacteria, with high levels of <i>Enterobacteriaceae</i> and <i>Candida</i>, was observed in the gut microbiota. This is the first case series of FT1DM in Romanian patients that shows the presence of genetic determinants but also a pathological microbiota which may determine a more severe and an early-age onset of disease.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"11 1","pages":"29-33"},"PeriodicalIF":0.0,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11060146/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140873822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Archive of clinical cases
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1