Archive of clinical cases最新文献

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.

As marijuana, the most widely-used illicit drug in adolescents and adults, has some unknown side effects, marijuana abuse has become a public health concern. Also, marijuana affects different organs such as heart in its rate, rhythm and coronary flow; it eventually leads to events such as myocardial infarction and rarely myocarditis. A 24-year-old man without any medical history or cardiovascular risk factors presented with chest pain after marijuana consumption. Based on electrocardiogram, myocardial cytolysis and transthoracic echocardiography acute myocarditis diagnosis was established. A few days later, transthoracic echocardiography showed a small clot in apex with reduced left ventricle ejection fraction, in the absence of local akinesia. The patient was discharged with oral anticoagulant stable and without any symptoms. The myocarditis after marijuana abuse is rare. The physicians should include acute myocarditis in differential diagnosis of a patient with chest pain after using marijuana.

Ixekizumab is one of the three biologic agents including Secukinumab and Brodalumab that targets the Interleukin-17 (IL-17) pathway to reduce inflammation in psoriasis and ankylosing spondylitis. In this report we present the case of 42-year-old woman, who was diagnosed with psoriasis and psoriatic arthritis. One week after first administration of Ixekizumab, she developed diffuse abdominal pain, bloody diarrhea (7-8 stools/day) and fever. Following imaging (colonoscopy, computed tomography) and laboratory investigations, she was diagnosed with acute severe ulcerative colitis complicated with toxic megacolon. The medical treatment (first corticotherapy, then infliximab) has failed and the patient needed emergency colectomy. Based on the immunological mechanisms and the observation from other studies, Ixekizumab should be considered an etiology for new-onset inflammatory bowel disease.

The global COVID-19 vaccination had an undeniable influence on the pandemic management, despite of having reported rare but life-threatening side-effects of vaccines. Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare autoimmune complication determined by thrombocytopenia and thrombosis propensity in the circulatory system. The activation of antibodies against platelet factor-4 (PF-4) which mimics the heparin-induced thrombocytopenia (HIT) characteristic is the main known pathogenicity of the disease. Herein, we reported a case of VITT in a middle-aged woman with no previous history of thrombophilia or other medical conditions who presented with thrombosis of the left superficial femoral artery 3-days after receiving the second dose of inactivated BBIBP-CorV (Sinopharm) vaccine. The patient underwent bypass vascular surgery and received none-heparin anticoagulation consistent with high-dose intravenous immunoglobin. Eight days after the discharge, she was subsequently referred to our center with the presentation of sub-massive pulmonary thromboembolism in spite of receiving the prophylactic anticoagulants during follow-up period. Details on side-effects of COVID-19 vaccines, specifically the inactivated ones are yet to be fully ascertained. Clinicians should consider the history of COVID-19 vaccines in thromboembolism patients who do not have well-acknowledged risk factors. Further studies about the necessity of prophylactic anticoagulants and clinical judgment for receiving other vaccines in such patients are required.

Thromboembolic event is an important and widely regarded risk factor, influencing the outcome and overall survival in post-operative cases with second highest association with gynaecological surgeries. Here we report a 52 years old female who underwent total laparoscopic hysterectomy with bilateral salpingo-oophorectomy (TLH+BSO) presented to our emergency in unconscious and intubated state on her post-operative day-1 with cardiorespiratory failure. Based on the immediate investigations after successful resuscitation, an initial diagnosis of massive pulmonary thromboembolism was made following supportive and conservative management. Interestingly on subsequent days she started to display episodic non-rhythmic symmetric myoclonic jerks persisting for seconds to minutes; resembling 'post-hypoxic' or 'post-anoxic' status myoclonus due to hypoxic ischemic brain injury. Further neuro-electrophysiological examination revealed rhythmic well-formed delta activity on both sides symmetrically with a transformation into theta activity with forward displacement on subsequent days, bilaterally over the same areas. Later on, magnetic resonance imaging with magnetic resonance-spectroscopic findings also corroborated to hypoxic ischemic brain injury related changes over bilateral basal ganglia mostly in caudate nucleus. Post operative venous thromboembolism is a major clinical challenge and a subject of constant intensive care yet the neurological sequalae of such event is given less priority despite of its major contribution on overall prognostic and survival index.