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Coexistence of Cecal duplication cyst and Meckel's diverticulum presenting as intestinal obstruction: a rare case report: Retraction. 以肠梗阻为表现的盲肠重复囊肿和梅克尔憩室并存:一例罕见病例报告:撤回。
IF 1.7 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-04 eCollection Date: 2024-10-01 DOI: 10.1097/MS9.0000000000002572

[This retracts the article DOI: 10.1097/MS9.0000000000002431.].

[本文撤回了文章 DOI:10.1097/MS9.0000000000002431]。
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引用次数: 0
Bladder transitional cell carcinoma anatomic primary site as a predictor of survival and mortality: a population-based retrospective cohort study. 膀胱过渡细胞癌解剖学原发部位作为生存率和死亡率的预测因素:一项基于人群的回顾性队列研究。
IF 1.7 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-09-18 eCollection Date: 2024-10-01 DOI: 10.1097/MS9.0000000000002581
Ali Hemade, Souheil Hallit

Background: Bladder cancer is a heterogeneous disease with varying prognostic outcomes based on the primary tumor site within the bladder. This study aims to evaluate the impact of tumor location on overall survival and cancer-specific survival in bladder cancer patients.

Methods: The authors conducted a retrospective cohort study using data from the Surveillance, Epidemiology, and End Results database. Patients with primary transitional cell carcinoma of the bladder were categorized based on their tumor locations. Survival outcomes were assessed using Kaplan-Meier analysis and Cox proportional hazards regression models, adjusted for age, sex, race, cancer stage, and treatment modalities. Additionally, binary logistic regression models were employed to predict overall mortality (OM) and cancer-specific mortality (CSM) at 1, 5, and 10 years.

Results: The study included 107 909 patients diagnosed with primary bladder cancer between 2000 and 2021. Significant differences in survival outcomes were observed across different tumor sites. Bladder cancer originating in the urachus had the worst OS before 100 months and the worst CSS overall. Tumors in the anterior wall showed the worst OS after 100 months. In the Cox multivariable analysis, anterior wall tumors were associated with a 1.513-fold increased risk of death compared to lateral wall tumors. The binary logistic regression models showed that anterior wall tumors predicted the highest OM and CSM at 1-year, while urachal tumors had the worst outcomes at 5 and 10 years.

Conclusions: The primary site of bladder cancer is a significant predictor of survival outcomes, with tumors in the urachus and anterior wall associated with a poorer prognosis. These findings underscore the importance of considering tumor location in the prognosis and management of bladder cancer. Future studies should aim to validate these findings in more diverse populations and explore the underlying biological mechanisms that drive these differences.

背景:膀胱癌是一种异质性疾病,根据膀胱内原发肿瘤部位的不同,预后结果也不同。本研究旨在评估肿瘤位置对膀胱癌患者总生存期和癌症特异性生存期的影响:作者利用监测、流行病学和最终结果数据库中的数据进行了一项回顾性队列研究。根据肿瘤位置对原发性膀胱过渡细胞癌患者进行分类。采用卡普兰-梅耶分析和考克斯比例危险回归模型评估生存结果,并根据年龄、性别、种族、癌症分期和治疗方式进行调整。此外,还采用二元逻辑回归模型来预测1年、5年和10年的总死亡率(OM)和癌症特异性死亡率(CSM):研究纳入了 2000 年至 2021 年期间确诊的 107 909 例原发性膀胱癌患者。不同肿瘤部位的生存结果存在显著差异。原发于尿道的膀胱癌在100个月前的生存率最差,总体CSS最差。前壁肿瘤在 100 个月后的生存率最差。在Cox多变量分析中,与侧壁肿瘤相比,前壁肿瘤的死亡风险增加了1.513倍。二元逻辑回归模型显示,前壁肿瘤预测1年后的OM和CSM最高,而泌尿道肿瘤预测5年和10年后的结果最差:结论:膀胱癌的原发部位是预测生存结果的重要因素,尿道和前壁肿瘤的预后较差。这些发现强调了在膀胱癌的预后和治疗中考虑肿瘤位置的重要性。未来的研究应着眼于在更多样化的人群中验证这些发现,并探索导致这些差异的潜在生物机制。
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引用次数: 0
Male breast cancer: a 32-year retrospective analysis in radiation therapy referral center in northern Iran. 男性乳腺癌:伊朗北部放射治疗转诊中心 32 年的回顾性分析。
IF 1.7 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-09-12 eCollection Date: 2024-10-01 DOI: 10.1097/MS9.0000000000002571
Mahboobeh Asgharian, Dariush Moslemi, Hossein-Ali Nikbakht, Mohammad-Ali Jahani, Ali Bijani, Hakimeh Mehdizadeh

Background: Breast cancer commonly occurs in women, and male breast cancer makes up less than 1% of all cases of breast cancer. The limited prevalence of male breast cancer has led to decreased attention being paid to this condition, resulting in its diagnosis occurring at later ages and at more severe disease stages.

Objectives: This study evaluates the demographic and clinicopathological characteristics of male patients diagnosed with breast cancer who visited the northern region of Iran from 1992 to 2023.

Methods: This descriptive study reviewed data from 58 cases of male breast cancer between 1992 and 2023. The study aimed to examine and describe the information connected to these patients. The data were analyzed with SPSS.22 set at P value less than 0.05.

Results: The mean age of the patients examined was 62.10±13.40 years, while their mean BMI was 27.08±4.95. The study found no statistically significant correlation between BMI with stage and kinds of recurrence, including metastasis and local recurrence (P>0.05). The right and left breast involvement rates were equal (48.28%) in 28 cases, and 2 cases (3.40%) had bilateral involvement. The bone was the predominant site of metastasis, accounting for 69.23% of cases. The analysis revealed no significant correlation between stage and metastasis (P=1.000) or local recurrence (P=0.543). Most metastasis and all the local recurrence were observed in stages 3 and 4.

Conclusion: Male breast cancer mainly occurs in older age and is diagnosed in the advanced stages of the disease. Therefore, it is recommended to inform men and develop suitable screening programs, especially in high-risk families.

背景:乳腺癌通常发生在女性身上,男性乳腺癌在所有乳腺癌病例中所占比例不到 1%。男性乳腺癌的发病率有限,导致人们对这一疾病的关注度下降,导致其诊断年龄较晚,病情阶段较严重:本研究评估了 1992 年至 2023 年期间在伊朗北部地区就诊的男性乳腺癌患者的人口统计学和临床病理学特征:这项描述性研究回顾了 1992 年至 2023 年间 58 例男性乳腺癌患者的数据。研究旨在检查和描述这些患者的相关信息。数据用 SPSS.22 进行分析,P 值小于 0.05:受检患者的平均年龄为(62.10±13.40)岁,平均体重指数为(27.08±4.95)。研究发现,BMI 与分期和复发类型(包括转移和局部复发)之间无统计学意义(P>0.05)。28例患者的左右乳房受累率相同(48.28%),2例(3.40%)为双侧受累。骨是主要的转移部位,占 69.23%。分析显示,分期与转移(P=1.000)或局部复发(P=0.543)之间无明显相关性。大多数转移和所有局部复发发生在 3 期和 4 期:结论:男性乳腺癌主要发生在老年期,且确诊时已是晚期。因此,建议告知男性并制定合适的筛查计划,尤其是在高危家庭中。
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引用次数: 0
Bilateral visual loss as the initial presentation of chronic myeloid leukemia: a case report. 慢性髓性白血病初期表现为双侧视力丧失:病例报告。
IF 1.7 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-09-12 eCollection Date: 2024-10-01 DOI: 10.1097/MS9.0000000000002570
Salah Marwan Saadeldine, Yara Mohammad Alammouri

Introduction: Chronic myeloid leukemia (CML) is the most common leukemia in adults. It can present with a wide variable range of symptoms and signs related to the phase of the disease. Ophthalmic manifestations as the first presentation of CML are unique, although they can occur during any stage of the disease. Ocular lesions in CML patients may be asymptomatic, so all patients should undergo an eye evaluation at the initial diagnosis.

Case presentation: The authors report a case of a 17-year-old Syrian male who initially presented with progressive loss of vision, fatigue, and abdominal pain. Clinical examination showed bilateral retinal aneurysm hemorrhage, jaundice, and splenomegaly. Bone marrow biopsy results were consistent with the diagnosis of CML returning to AML. The patient was treated with intensive chemotherapy and then prepared for hematopoietic transplantation.

Discussion: CML can present with variable symptoms and signs, but the ophthalmic manifestations are uncommon. Ophthalmic problems occur either from infiltration of neoplastic cells or from secondary causes, like thrombocytopenia, leukocytosis, hyperviscosity syndrome, or leukoembolization. In the literature, only some case reports presented eye involvement in CML as the first manifestation.

Conclusion: Although this is a rare presentation of CML, we believe that it should be taken into consideration when managing these situations to obtain the right diagnosis and better treatment results. Collaboration between hematologists and ophthalmologists is necessary in deciding the treatment. Acute myeloid leukemia needs immediate medical attention and different treatment from CML.

简介慢性髓性白血病(CML)是成人中最常见的白血病。它可表现出与疾病阶段相关的多种症状和体征。眼部表现是 CML 的首发症状,虽然在疾病的任何阶段都有可能出现,但眼部表现是独一无二的。CML 患者的眼部病变可能没有症状,因此所有患者在最初确诊时都应进行眼部评估:作者报告了一例 17 岁叙利亚男性患者的病例,该患者最初表现为进行性视力下降、疲劳和腹痛。临床检查显示双侧视网膜动脉瘤出血、黄疸和脾脏肿大。骨髓活检结果与 CML 重返 AML 的诊断一致。患者接受了强化化疗,然后准备进行造血移植:讨论:慢性骨髓性白血病可出现多种症状和体征,但眼部表现并不常见。眼部问题的出现可能是由于肿瘤细胞的浸润,也可能是继发性原因,如血小板减少、白细胞增多、高粘滞综合征或白血病栓塞。在文献中,只有一些病例报告称眼睛受累是 CML 的首发表现:尽管这是一种罕见的 CML 表现,但我们认为在处理这些情况时应将其考虑在内,以获得正确的诊断和更好的治疗效果。在决定治疗方法时,血液科医生和眼科医生之间的合作是必要的。急性髓性白血病需要立即就医,其治疗方法与 CML 不同。
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引用次数: 0
Unveiling post-COVID-19 Rasmussen's encephalitis: a case report of rare neurological complication. 揭开 COVID-19 后拉斯穆森脑炎的神秘面纱:罕见神经系统并发症的病例报告。
IF 1.7 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-09-12 eCollection Date: 2024-10-01 DOI: 10.1097/MS9.0000000000002569
Zaira Naisr, Abdullah Munir Ahmed, Hajira Arooj, Lava Abdullah, Zunaira Naeem, Muhammad Usman Hashmi

Introduction and importance: Rasmussen encephalitis (RE) is a rare autoimmune disorder that causes unilateral inflammation of the cerebral cortex and can lead to drug-resistant epilepsy and progressive neurological decline. Although the emergence of RE following COVID-19 has not been well documented, it emphasizes the need to understand the impact of COVID-19 on neurological health. This case emphasizes the importance of early recognition and intervention to prevent adverse outcomes related to post-COVID-19 neurological complications.

Case presentation: A 30-year-old woman, recently diagnosed with COVID-19, experienced recurrent seizures that primarily affected the left side of her body. Despite medical management, signs of progressive weakness and altered consciousness were observed. Neurological examination, imaging, and electroencephalography confirmed a diagnosis of post-COVID-19 RE. Despite conservative management, the patient's condition continued to deteriorate, ultimately resulting in fatal outcomes.

Clinical discussion: The relationship between COVID-19 and autoimmune responses, which can lead to neurological complications, such as RE, is a matter of concern. Accurate diagnosis of RE depends on imaging and EEG studies; however, a definitive diagnosis often requires histopathological examination. The management of RE involves the use of anti-seizure medications and surgical interventions to control symptoms and improve outcomes. However, the unusual presentation of this case, along with challenges in diagnosis and treatment, underscores the need for increased awareness and extensive research on the neurological consequences of COVID-19.

Conclusion: This case underscores the severe neurological consequences that can emerge after COVID-19, emphasizing the need for prompt identification and intervention. Additional research is essential to improve the comprehension and management of the neurological aftermath of COVID-19 with the ultimate goal of enhancing patient outcomes.

导言和重要性:拉斯穆森脑炎(Rasmussen encephalitis,RE)是一种罕见的自身免疫性疾病,可引起单侧大脑皮层炎症,并可导致耐药性癫痫和进行性神经功能衰退。虽然 COVID-19 后出现 RE 的记录并不多,但它强调了了解 COVID-19 对神经系统健康影响的必要性。本病例强调了早期识别和干预对预防 COVID-19 后神经系统并发症相关不良后果的重要性:一名 30 岁的女性最近被诊断为 COVID-19 患者,她的癫痫反复发作,主要影响身体左侧。尽管接受了药物治疗,但仍出现了进行性乏力和意识改变的症状。神经系统检查、影像学检查和脑电图检查证实了 COVID-19 后 RE 的诊断。尽管进行了保守治疗,但患者的病情持续恶化,最终导致死亡:临床讨论:COVID-19与自身免疫反应之间的关系令人担忧,而自身免疫反应可导致神经系统并发症,如RE。RE的准确诊断有赖于影像学和脑电图检查;然而,明确诊断往往需要组织病理学检查。RE的治疗包括使用抗癫痫药物和手术干预来控制症状和改善预后。然而,本病例的不寻常表现以及诊断和治疗方面的挑战突出表明,有必要加强对 COVID-19 神经系统后果的认识和广泛研究:本病例凸显了 COVID-19 可能导致的严重神经系统后果,强调了及时识别和干预的必要性。为了提高对 COVID-19 神经系统后遗症的理解和管理,必须开展更多的研究,以实现改善患者预后的最终目标。
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引用次数: 0
Multiple primary malignancies: sequential development of Ewing sarcoma and carcinoid tumor in a single patient. 多种原发性恶性肿瘤:一名患者相继罹患尤文肉瘤和类癌。
IF 1.7 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-09-11 eCollection Date: 2024-10-01 DOI: 10.1097/MS9.0000000000002561
Huzafa Ali, Dipendra Adhikari, Azka Noor, Husnain Abbas, Huzaifa Saqib, Ayesha Siddiqa, Amna Khan, Nayab Naeem

Introduction and importance: Multiple primary malignancies (MPMs) involve two or more distinct primary cancers in one individual, either simultaneously or at different times. The incidence of MPMs is rising due to advancements in cancer detection, improved survival rates, and long-term treatment effects. This case report, likely the first of its kind, highlights a rare instance of a 30-year-old female developing a carcinoid tumor 5 years after Ewing sarcoma, emphasizing the need for vigilant monitoring of cancer survivors.

Case presentation: A 30-year-old female with a history of Ewing Sarcoma diagnosed 5 years prior, initially presenting with a vascular, hard mass on her right shoulder, underwent neoadjuvant chemotherapy and surgical excision. She recently presented with high-grade fever, cough, weight loss, and severe chest pain. Imaging and biopsy confirmed a high-grade carcinoid tumor. Histopathology showed positive markers for Synaptophysin, CD56, and Chromogranin, with a Ki-67 index of 30-40%. The patient passed away after one cycle of chemotherapy.

Clinical discussion: Diagnosing and managing MPMs is challenging due to the complexity of distinguishing primary tumors from metastases. This case fits the Warren and Gates' criteria for MPMs. This case confirmed Ewing sarcoma and atypical carcinoid tumor as distinct primary malignancies. Delayed diagnosis worsens outcomes, especially for aggressive atypical carcinoids. This case underscores the importance of thorough diagnostics, long-term follow-up, and improved healthcare infrastructure.

Conclusion: This case report emphasizes the importance of a multidisciplinary approach, regular follow-ups, and timely detection for effective management of MPMs.

导言和重要性:多原发恶性肿瘤(MPM)是指一个人同时或在不同时间患上两种或两种以上不同的原发癌症。由于癌症检测技术的进步、生存率的提高以及长期治疗效果的改善,多原发性恶性肿瘤的发病率正在上升。本病例报告很可能是首例此类病例报告,重点介绍了一名 30 岁女性在患尤文肉瘤 5 年后又患类癌的罕见病例,强调了对癌症幸存者进行警惕性监测的必要性:一名 30 岁女性,5 年前确诊为尤文肉瘤,最初表现为右肩血管性硬肿块,接受了新辅助化疗和手术切除。她最近出现高烧、咳嗽、体重减轻和剧烈胸痛。影像学检查和活组织检查证实她患有高级别类癌。组织病理学显示,突触素、CD56和色粒素标记阳性,Ki-67指数为30-40%。患者在一个化疗周期后去世:临床讨论:由于区分原发肿瘤和转移瘤的复杂性,诊断和治疗 MPM 具有挑战性。本病例符合沃伦和盖茨的 MPM 标准。该病例证实尤文肉瘤和非典型类癌是不同的原发性恶性肿瘤。延迟诊断会恶化预后,尤其是侵袭性非典型类癌。本病例强调了彻底诊断、长期随访和改善医疗基础设施的重要性:本病例报告强调了多学科方法、定期随访和及时发现对于有效管理类癌的重要性。
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引用次数: 0
FDA endorses NALIRIFOX for metastatic pancreatic adenocarcinoma: an editorial. FDA 批准 NALIRIFOX 用于治疗转移性胰腺腺癌:社论。
IF 1.7 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-09-10 eCollection Date: 2024-10-01 DOI: 10.1097/MS9.0000000000002564
Wajiha Urooj, Bisma Ahmed, Yumna Shahzad, Amal Siddiqui, Zaib Un Nisa Mughal, Khabab Abbasher Hussien Mohamed Ahmed
{"title":"FDA endorses NALIRIFOX for metastatic pancreatic adenocarcinoma: an editorial.","authors":"Wajiha Urooj, Bisma Ahmed, Yumna Shahzad, Amal Siddiqui, Zaib Un Nisa Mughal, Khabab Abbasher Hussien Mohamed Ahmed","doi":"10.1097/MS9.0000000000002564","DOIUrl":"10.1097/MS9.0000000000002564","url":null,"abstract":"","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11444624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364053","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
Diagnostic accuracy of percutaneous transthoracic needle biopsy among peripheral pulmonary lesions: a multicenter observational study. 经皮穿刺活检对周围肺部病变的诊断准确性:一项多中心观察研究。
IF 1.7 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-09-10 eCollection Date: 2024-10-01 DOI: 10.1097/MS9.0000000000002539
Reza Basiri, Farzad Sharifnezhad, Amir H Jafarian, Sara Samadi, Amirreza Zarghi

Introduction: The diagnosis of peripheral pulmonary lesions (PPL) poses a significant challenge, prompting the widespread utilization of various modalities to ensure the precision in diagnosis. This study aims to assess the diagnostic accuracy of computed tomography-guided percutaneous transthoracic needle biopsy (CT-PTNB) in the context of pulmonary malignancy.

Methods and materials: This multicenter retrospective observational study, included 1317 cases of CT-PTNB performed on adult patients with PPLs from January 2018 to December 2022 in Mashhad, Iran. The pathology results of CT-PTNB from 94 cases were compared to the definitive pathology results obtained through methods such as surgery to assess the sensitivity, specificity, and overall accuracy of CT-PTNB in diagnosing of pulmonary malignancy.

Results: CT-PTNB exhibits an accuracy of 82.98%, with sensitivity and specificity rates of 75.41 and 91.43%, respectively. This study underscores the issue of false-negative results in CT-PTNB and underscores the importance of integrating clinical, radiological, and additional diagnostic modality to guide diagnostic decisions.

Conclusion: In this large-scale multicenter study, the accuracy of CT-PTNB for diagnosis of pulmonary malignancy is acceptable but fairly low compared to previous studies.

简介:肺外周病变(PPL)的诊断是一项重大挑战,促使人们广泛采用各种方法来确保诊断的准确性。本研究旨在评估计算机断层扫描引导下经皮经胸穿刺活检(CT-PTNB)对肺部恶性肿瘤的诊断准确性:这项多中心回顾性观察研究纳入了2018年1月至2022年12月期间在伊朗马什哈德为1317例PPLs成人患者实施的CT-PTNB。将94例CT-PTNB的病理结果与通过手术等方法获得的明确病理结果进行比较,以评估CT-PTNB诊断肺部恶性肿瘤的敏感性、特异性和总体准确性:CT-PTNB的准确率为82.98%,敏感性和特异性分别为75.41%和91.43%。这项研究强调了CT-PTNB假阴性结果的问题,并强调了综合临床、放射学和其他诊断方式来指导诊断决策的重要性:在这项大规模多中心研究中,CT-PTNB 诊断肺部恶性肿瘤的准确性是可以接受的,但与之前的研究相比,准确性相当低。
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引用次数: 0
Reevaluating the association between cholecystectomy and gastroesophageal reflux disease: recommendations for enhanced Mendelian randomization analysis. 重新评估胆囊切除术与胃食管反流病之间的关联:加强孟德尔随机分析的建议。
IF 1.7 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-09-10 eCollection Date: 2024-10-01 DOI: 10.1097/MS9.0000000000002541
Xingcheng Zhu, Shi Fu, Junhao Chen
{"title":"Reevaluating the association between cholecystectomy and gastroesophageal reflux disease: recommendations for enhanced Mendelian randomization analysis.","authors":"Xingcheng Zhu, Shi Fu, Junhao Chen","doi":"10.1097/MS9.0000000000002541","DOIUrl":"10.1097/MS9.0000000000002541","url":null,"abstract":"","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11444601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364139","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
Purulent pericarditis and cardiac tamponade in HIV: a case report on a dreaded complication of Streptococcus pneumoniae. 艾滋病毒感染者的化脓性心包炎和心脏填塞:肺炎链球菌可怕并发症的病例报告。
IF 1.7 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-09-10 eCollection Date: 2024-10-01 DOI: 10.1097/MS9.0000000000002552
Laxman Wagle, Parmartha Basnyat, Anuj Timshina, Rashmita Regmi, Lakpa Diku Sherpa, Sishir Poudel

Introduction and importance: Purulent pericarditis is an uncommon complication of Streptococcus pneumoniae, which commonly occurs in an immunocompromised state such as HIV and can lead to life-threatening complications such as cardiac tamponade and potentially death if untreated. Early identification, pericardiocentesis, and general measures such as antibiotics and anti-inflammatory medications can be life-saving.

Case presentation: The authors present a case of a 64-year-old male with HIV who presented with clinical symptoms suggestive of pericarditis. Chest imaging revealed multifocal airspace diseases and moderate pericardial effusion. He had worsening lactic acidosis, and bedside point-of-care ultrasound showed pericardial effusion with features suggestive of cardiac tamponade. His lactic acidosis improved with emergency pericardiocentesis. Blood and pericardial fluid cultures revealed Streptococcus pneumoniae. He was further treated with intravenous antibiotics, colchicine, and ibuprofen.

Clinical discussion: Although Streptococcus pneumoniae is a common etiology of community-acquired pneumonia (CAP), it has not been cited as the leading cause of pericarditis or pericardial effusion. In immunocompromised patients, it is necessary to consider a broad differential diagnosis as an etiology of acute chest pain, as it may be challenging to differentiate pleuritic and pericarditic chest pain from clinical presentation only. Moreover, infectious etiology of acute pericarditis and pericardial effusion should be considered in this patient population, especially those with HIV. At the same time, it is crucial to promptly identify and treat cardiac tamponade to prevent further deterioration.

Conclusion: This case provides insight into the diagnosis and management of CAP and its potential complication of purulent pericarditis and cardiac tamponade in immunocompromised patients.

导言和重要性:化脓性心包炎是肺炎链球菌的一种不常见的并发症,通常发生在免疫力低下的人群(如艾滋病患者)中,如不及时治疗,可导致心脏填塞等危及生命的并发症,甚至可能导致死亡。早期发现、心包穿刺以及抗生素和消炎药等一般措施可以挽救生命:作者介绍了一例 64 岁男性艾滋病感染者的病例,他的临床症状提示患有心包炎。胸部影像学检查发现多灶性气腔病变和中度心包积液。他的乳酸酸中毒症状不断加重,床旁护理点超声检查显示心包积液,并提示有心脏填塞的特征。紧急心包穿刺术后,他的乳酸酸中毒症状有所好转。血液和心包积液培养发现了肺炎链球菌。他接受了静脉抗生素、秋水仙碱和布洛芬的进一步治疗:尽管肺炎链球菌是社区获得性肺炎(CAP)的常见病因,但它并不是心包炎或心包积液的主要病因。对于免疫力低下的患者,有必要将广泛的鉴别诊断作为急性胸痛的病因,因为仅从临床表现来区分胸膜炎性胸痛和心包炎性胸痛可能具有挑战性。此外,对于这类患者,尤其是艾滋病毒感染者,应考虑急性心包炎和心包积液的感染性病因。同时,及时发现和治疗心脏填塞也至关重要,以防止病情进一步恶化:本病例为免疫功能低下患者诊断和治疗 CAP 及其潜在并发症化脓性心包炎和心脏压塞提供了启示。
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引用次数: 0
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