BMJ Case Reports最新文献

Caesarean scar defects (CSDs) are a known complication of caesarean section (C-section) that can influence various reproductive outcomes. These defects are characterised by an indentation at the site of the previous caesarean scar, potentially leading to clinical issues such as abnormal bleeding, pelvic pain and infertility. Here, we report and discuss a case of a woman in her late 30s who presented with a series of complications and subsequently subfertility as a result of her CSD and how she was sequentially managed. Following open repair of her CSD with a novel modified myometrial repair technique, she managed to conceive through in vitro fertilisation techniques and delivered uneventfully via elective repeat C-section at term.

Adrenal myelolipomas are rare benign tumours, usually asymptomatic and discovered incidentally. Haemorrhage is an uncommon complication, typically associated with larger lesions. We present the case of a man in his 50s, with no history of trauma or antithrombotic therapy, who presented to the emergency department with acute low back pain. Contrast-enhanced CT revealed a right adrenal haematoma measuring 5 cm with active intralesional bleeding, associated with retroperitoneal and subcapsular hepatic haematoma. He underwent successful transarterial embolisation. Follow-up MRI showed a 3.8 cm lesion with internal fat content, consistent with an adrenal myelolipoma, and progressive reabsorption of the haematomas. This case highlights the potential for significant spontaneous haemorrhage in small adrenal myelolipomas and illustrates the use of transarterial embolisation as a minimally invasive management option.

Aluminium phosphide is a highly lethal pesticide that liberates phosphine gas, leading to mitochondrial dysfunction, distributive shock and cardiotoxicity, but guidance on late pulmonary complications is limited. We report a previously healthy adolescent who ingested ~1.5 g of aluminium phosphide in a suicide attempt and initially presented haemodynamically stable with metabolic acidosis and elevated lactate. By 72-96 hours, she developed progressive hypoxemic respiratory failure with bilateral infiltrates fulfilling Berlin criteria for moderate acute respiratory distress syndrome (ARDS) (PaO₂/FiO₂ nadir ≈115 on FiO₂ 1.0), preceded by fever and culture-proven lower respiratory and urinary tract infections, resulting in sepsis and disseminated intravascular coagulation (DIC). She required escalation from non-invasive to invasive mechanical ventilation, with lung-protective strategies, targeted antibiotics, component therapy for DIC and early magnesium and calcium supplementation. Despite markedly elevated N-terminal pro-B-type natriuretic peptide with preserved biventricular function on echocardiography and transient acute kidney injury, she made a full clinical recovery and was discharged with normal oxygenation and functional status. This case underscores that delayed moderate ARDS with superimposed sepsis and DIC can complicate initially stable aluminium phosphide poisoning and highlights that meticulous, protocol-based supportive care can still result in survival in this rarely reported scenario.

Syngnathia is a congenital condition characterised by fibrous and/or bony fusion between maxilla and mandible. We report the case of a neonate who underwent surgical release of syngnathia under general anaesthesia. Management required multidisciplinary planning involving surgeons, anaesthesiologists and paediatricians, spanning pre-operative assessment through postoperative care. Prior to surgery, availability of neonatal intensive care unit (NICU) bed and appropriate airway equipment-including a fibreoptic bronchoscope sized for neonate was ensured. This case highlights the importance of tertiary-level healthcare facilities with coordinated multidisciplinary team, advanced airway management capabilities and a well-equipped NICU staffed by trained personnel for management of rare and difficult cases.

This report describes a female patient in her 60s with an immune-mediated necrotising myopathy (IMNM) occurring after semaglutide use. She was found to have progressive dysphagia, dysphonia, proximal muscle weakness and creatine kinase elevation over a 4-month course. Her symptoms were preceded by a single dose of semaglutide. Her work-up revealed features consistent with necrotising myopathy with inflammatory infiltrate on biopsy, and she responded to immunosuppression with corticosteroids and intravenous immunoglobulin (IVIG). She gradually improved and successfully returned to her baseline functional status while off immunosuppression for several months and with continued avoidance of glucagon-like peptide-1 (GLP-1) receptor agonists. Here, we describe the first reported case of IMNM probably associated with GLP-1 receptor agonist use, with apparent response to a short course of immunosuppression and IVIG.

Apert syndrome is a rare congenital disorder characterised by craniosynostosis, syndactyly and distinct facial dysmorphisms. We found a child with Apert syndrome from an economically disadvantaged family residing in an urban slum during a routine home visit by the All India Institute of Medical Sciences Bhubaneswar Extended Health Clinic. The child presented with global developmental delay, unvaccinated status and severe malnutrition, manifesting as underweight and stunted growth. Despite being eligible for free healthcare services under the Rashtriya Bal Swasthya Karyakram, the child remained unlinked to it. Contributing factors to this delayed intervention included the family's low socio-economic status, profound lack of awareness of the condition, poor healthcare-seeking behaviour and insufficient engagement from healthcare workers. Moreover, complex psychosocial issues, such as maternal depression, parental substance abuse, limited social support and insufficient family involvement, further intensified the obstacles to the optimal growth and development of the child, highlighting the multifaceted factors that shape health outcomes in vulnerable populations.

Anterior cutaneous nerve entrapment syndrome (ACNES) is an under-recognised cause of chronic abdominal or chest wall pain in the era of increased reliance on diagnostic imaging and laboratory studies. We present the case of a man in his mid-60s who was hospitalised eight times over a 2-year period for unexplained abdominal pain despite extensive non-diagnostic workups. Careful re-examination, focusing on physical examination, demonstrated a positive Carnett's sign, leading to the diagnosis of ACNES. Ultrasound-guided trigger point injection with corticosteroid and local anaesthetic led to immediate symptom relief, confirming the diagnosis. This case highlights the diagnostic value of the physical exam and the need to consider ACNES in patients with persistent abdominal pain and normal imaging and laboratory studies, as early diagnosis can reduce symptom burden, prevent unnecessary testing and improve patient outcomes.

Staphylococcus lugdunensis is a highly virulent coagulase-negative staphylococcus, capable of causing rapidly destructive infective endocarditis (IE). We report an elderly male who developed P wave asystole as the initial manifestation of S. lugdunensis IE, occurring in the absence of fever or classical IE symptoms. Transoesophageal echocardiography (TOE) revealed severe aortic regurgitation from cusp destruction, a perivalvular abscess and an acquired Gerbode defect-a rare left ventricular-to-right atrial communication. An urgent aortic valve replacement was performed, and intraoperatively, the Gerbode defect was found to have spontaneously closed. Due to permanent pacing requirements and infection risk, a leadless pacemaker was implanted. This case underscores the importance of suspecting IE in unexplained conduction abnormalities, recognising the virulence of S. lugdunensis and using early TOE to detect life-threatening structural complications.

An ectopic pregnancy in a retroperitoneal location is an extremely rare and life-threatening situation. Here, we present a case report of a nulliparous woman in her 30s who presented with rising β-human chorionic gonadotropin (hCG) titre after embryo transfer but with no pregnancy detected on transvaginal scan. She was referred to us after two negative laparoscopies done outside and finally an MRI revealing a retroperitoneal pregnancy embedded close to the aorta near the origin of the left renal artery. As parenteral methotrexate had no effect, an ultrasound-guided intrasac methotrexate instillation was done. Though the hCG levels fell to near normal levels, the sac did not regress and seemed to increase in size. Laparoscopic removal was attempted, but the intraoperative bleeding necessitated an open procedure. This case highlights the diagnostic difficulty, limitations of systemic methotrexate in retroperitoneal ectopic pregnancies and the need for individualised multidisciplinary management.

Although mild leukocytosis is common in pregnancy, markedly elevated counts warrant prompt evaluation to exclude pathological causes such as infections and leukaemia. Chronic myeloid leukaemia (CML) is a chronic myeloproliferative condition increasingly being seen in younger age groups.Here we report a woman in her early 30s with asymptomatic marked leukocytosis at term, subsequently diagnosed with CML. As she was near term, she was managed conservatively through delivery before initiation of definitive therapy postpartum. This case underscores the importance of baseline and serial leucocyte monitoring in pregnancy and highlights the unique therapeutic challenges of managing CML during pregnancy.