Archive of clinical cases最新文献

Post-polypectomy syndrome or post-polypectomy coagulation syndrome (PPCS) is a rare adverse event of thermal injury caused during hot snare aided, endoscopic mucosal resection of colon polyps. Its diagnosis is tricky as it is commonly misdiagnosed as perforation leading to unnecessary exploratory abdominal surgeries. The authors aim to present an early diagnosed and successfully treated, case of PPCS, and to highlight the difference in the safety profile of two techniques; hot snare versus cold snare polypectomy.

Introduction: The COVID-19 pandemic is related to a higher incidence of myocarditis; we present a case series of seven patients, admitted with COVID-19 related acute myocarditis, evaluated with cardiac magnetic resonance imaging, showing an altered profile of the free wall of the right ventricle, no longer present after six months follow-up.

Materials and methods: Seven patients have been evaluated for COVID-19 related acute myocarditis, all patients have been evaluated with cardiac magnetic resonance imaging both in the acute setting and after six months follow-up.

Results: In the acute phase, myocarditis was confirmed in keeping with the current diagnostic criteria. In five out of seven cases, the presence of a crinkling profile of the free wall of the right ventricle was observed; at six months follow up, remission in four out of the five cases and a significant reduction in the remaining case, of the previously described findings, was observed.

Conclusions: Crinkling appearance in the profile of the free wall of the right ventricle, detectable with cardiac magnetic resonance imaging, might represent a morphological feature present in the acute setting of COVID-19 related myocarditis; several underlying physiopathological mechanisms are conceivable. Further studies are needed to confirm this correlation, define the underlying mechanisms and the prognostic implication related to it. This is the first report in the literature that has considered such findings to the best of our knowledge.

Drug induced erythema multiforme (EM) is a rare clinical entity which majorly involves the oral cavity. It commonly occurs due to intake of drugs such as NSAID'S, certain antibiotics, and anticonvulsants. It is characterized by rapidly rupturing vesicles leading to ill-defined erosions in the oral cavity and encrusted lip lesions. These lesions are usually difficult to differentiate from other vesiculo bullous and ulcerative lesions which would have a similar presentation and the absence of skin lesions can sometimes lead to misdiagnosis. Drug induced EM has an acute onset and is a self-limiting inflammatory hypersensitivity reaction that causes blistering and ulcerations of the skin and mucous membrane. The lesions heal following the discontinuation of the causative medications. This case report describes a case of drug induced erythema multiforme of the oral cavity that occurred consequent to the intake of Tab.Diclofenac Sodium and Tab.Cephelexin. The patient developed painful, bleeding, burning ulcerations with severe crustations on the upper, and lower lip, lateral and ventral surface of tongue, hard palate and retro molar regions. The case was managed with corticosteroids.

Juvenile Xanthogranuloma (XG) is a rare disorder that belongs to the heterogeneous group of histiocytic neoplasms, characterized by a clonal expansion of non-Langerhans cell histiocytes that share a dermal macrophage phenotype. Although the head and neck region is the most common reported site of involvement by the Juvenile Xanthogranuloma family, laryngeal localization is extremely rare. We report a unique case of Adult Onset Xanthogranuloma with subglottic localization, presenting as a solitary laryngeal mass without other systemic or cutaneous lesions. A review of the previously described cases of laryngeal Xanthogranuloma has been performed, highlighting 7 cases of Juvenile Xanthogranuloma and only 3 cases of Adult Onset Xanthogranuloma. Despite the extreme rarity of laryngeal localization of XG, this histiocytic neoplasm should be considered as a differential diagnosis for laryngeal masses causing airway obstruction, even in the absence of other concomitant manifestations.

Gastrointestinal (GI) involvement in the pathogenesis of Parkinson's Disease (PD) has been widely recognized and supported in recent literature. Prospective and retrospective studies found non-motor symptoms within the GI, specifically constipation, precede cardinal signs and cognitive decline by almost 20 years. In 2002, Braak et al. were the first to propose that PD is a six-stage propagating neuropathological process originating from the GI tract (GIT). Aggregated α-synuclein (α-syn) protein from the GIT is pathognomonic for the development of PD. This article reviews the current literature from the past 10 years as well as original research found in PubMed on the combined effects of enteric glial cells and lectins on the development of Parkinson's Disease. Studies have found that these aggregated and phosphorylated proteins gain access to the brain via retrograde transport through fast and slow fibers of intestinal neurons. Plant lectins, commonly found within plant-based diets, have been found to induce Leaky Gut Syndrome and can activate enteric glial cells, causing the release of pro-inflammatory cytokines. Oxidative stress on the enteric neurons, caused by a chronic neuro-inflammatory state, can cause a-syn aggregation and lead to Lewy Body formation, a hallmark finding in PD. Although the current literature provides a connection between the consumption of plant lectins and the pathophysiology of PD, further research is required to evaluate confounding variables such as food antigen mimicry and other harmful substances found in our diets.

Peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS) is the most common subgroup of peripheral T-cell lymphomas (PTCL), and constitutes a diagnosis of exclusion. At presentation, most patients exhibit B symptoms and generalized lymphadenopathy, with or without concomitant extra-nodal involvement. We present a case of a man admitted to the hospital with B symptoms, generalized lymphadenopathy and a pruritic exanthema. Laboratory workup reveled persistent eosinophilia and malignant hypercalcemia. The excisional lymph node biopsy diagnosed PTCL-NOS, and the skin biopsy demonstrated a lichenoid dermatitis, compatible with the presumptive clinical diagnosis of a drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. The patient was treated with topical betamethasone with good overall response, and initiated the first cycle of chemotherapy before discharge. This case report describes a PTCL-NOS with a concomitant non-lymphoproliferative disease, the challenging diagnostic workup of the two diseases and reinforces the most important features of the lymphoproliferative neoplasm.

Even with Dupuytren's proximal interphalangeal joint (PIPJ) contractures successfully released, volar flexor muscle memory can contribute to persistent contracture. We report using botulinum toxin (BoNTA) to the flexor digitorum superficialis muscle (FDS) to reduce flexor tone during recovery. Case Description. Two Collagenase clostridium histolyticum (CCH) injections were given to a patient with a -90° (PIPJ) contracture and a -35° degree distal interphalangeal joint (DIPJ) contracture. At the first CCH injection, 20 μ total of the Botulinum toxin was placed into the FDS muscle. Manipulation occurred at one week. A second injection of CCH followed by manipulation one week later occurred at two months, but no additional BoNTA was given. The final follow-up measurements at 53 months showed a PIPJ of -30° and a DIPJ of 0°. Total active motion improved from 140° to 240°. Outcomes of any treatment for severe Dupuytren's PIPJ contractures of the little finger are unpredictable and are often considered for staged external expansion or even salvage procedures. BoNTA injections weaken flexor tone in tendon repairs and for treating hypertonic muscles after strokes. Conclusion. We hypothesized that BoNTA injection could enhance the outcomes of DC treatment by inhibiting volar flexion forces during the recovery phase. The following case illustrates that using a BoNTA injection may have helped treat a severe PIPJ contracture. BoNTA injections need further research and controlled clinical trials to discover their proper role in Dupuytren's contractures treated via CCH injections, fasciotomies, and fasciectomies.

Unilateral recurrent laryngeal nerve palsy is a potential complication of the anterior approach for cervical surgery. It is a rare complication of radiotherapy to the neck. Only one case has been reported following radiotherapy apical lung cancer. It can result in unilateral vocal cord paralysis. We report a patient who demonstrated bilateral vocal cord paralysis immediately following right-sided anterior cervical surgery, with significant consequences, including aphonia, respiratory distress and subsequent takotsubo cardiomyopathy. She was diagnosed with acute, (temporary) post-operative right recurrent laryngeal nerve palsy, on the background of undetected and previously asymptomatic left recurrent laryngeal nerve palsy following radiotherapy for left apical lung cancer. The possibility of recurrent laryngeal nerve palsy should be considered in patients with previous apical lung cancer and/ or radiotherapy. Patents undergoing subsequent anterior cervical surgery should be considered for the appropriate precautions in the form of same-side surgery or pre-operative investigation for vocal cord paralysis.

Acute pulmonary thromboembolism is a critical and sometimes fatal event that is difficult for clinicians to diagnose because of its various initial manifestations. Here, we report a previously healthy 50-year-old man without any history of seizures who presented to the emergency ward with the new-onset seizure. Neurology consult was performed, but found no focal neurological deficits. The diagnosis of massive pulmonary embolism was confirmed by echocardiography and pulmonary CT angiography. Alteplase and heparin with therapeutic dosage were started for the patient. After initiating treatment, patient's dyspnea, arterial O2 saturation, and general condition were significantly improved. Echocardiography was repeated and showed a smaller right ventricle size and lower pulmonary artery pressure than the first echocardiography.

Epithelioid hemangioendothelioma is a rare vascular malignancy that originates from vascular endothelial or pre-endothelial cells and is composed of epithelioid or histiocytoid cells. This malignancy has an incidence of approximately one per one million individuals and can occur in various regions of the body including the lungs, liver, bones, and soft tissues. The behavior of this cancer can range from indolent to aggressive and diagnosis and treatment are often delayed due to variable presentations and lack of established treatment guidelines. Here we present the case of a 27-year-old Hispanic male that presented with right groin pain, abdominal pain, and a fifty-pound weight loss over one year. The patient had a complex hospital course during which he was found to have an angiomyomatous hamartoma of his right groin area, postsurgical right inguinal wound infection with Actinomyces meyeri, and epithelioid hemangioendothelioma distal to the right iliac bifurcation. The patient is currently pending further imaging studies to evaluate candidacy for surgical resection and following with oncology for chemotherapeutic options.