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Poorly differentiated non-small cell lung carcinoma presenting as a fever of unknown origin. 低分化非小细胞肺癌表现为不明原因的发热。
IF 0.6 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-01-29 DOI: 10.1136/bcr-2025-270547
Brandon Boyarsky, Caroline Cox, Sarah Boutwell

To achieve a definitive diagnosis of a fever of unknown origin (FUO), clinicians must consider infectious, autoimmune, neoplastic and other pathologies. While thorough history taking is crucial, it may not reveal the underlying aetiology behind the FUO. Several weeks of laboratory testing, imaging studies and advanced testing may be involved. We present the case of a woman in her 70s who came to her primary care provider with a primary complaint of FUO and describe the diagnostic steps, which identified a poorly differentiated, advanced non-small cell lung carcinoma. This case also highlights several missed diagnostic opportunities, including delayed imaging and diagnostic inertia, which contributed to the late identification of her underlying malignancy.

为了获得不明原因发热(FUO)的明确诊断,临床医生必须考虑感染性、自身免疫性、肿瘤和其他病理。虽然彻底的历史研究是至关重要的,但它可能无法揭示FUO背后的潜在病因。可能需要数周的实验室检查、影像学检查和高级检查。我们报告了一名70多岁的妇女,她以FUO的主要主诉来到她的初级保健提供者那里,并描述了诊断步骤,确定了一种低分化的晚期非小细胞肺癌。这个病例也强调了几个错过的诊断机会,包括延迟的成像和诊断惯性,这导致了她的潜在恶性肿瘤的晚期发现。
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引用次数: 0
Use of intravenous immunoglobulin in combination with corticosteroids for immune checkpoint inhibitor pneumonitis. 静脉注射免疫球蛋白联合皮质类固醇治疗免疫检查点抑制剂肺炎。
IF 0.6 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-01-28 DOI: 10.1136/bcr-2025-270094
Neha Puttagunta, Saman Suleman, Divija Sharma, Syed E Ahmad

Immune checkpoint inhibitor (ICI) pneumonitis is a potentially life-threatening immune-related adverse event associated with ICI therapy across various malignancies. ICIs enhance antitumour immunity by targeting inhibitory cell surface receptors, but this can lead to immune-mediated tissue damage. Prompt recognition is critical, as symptoms are often nonspecific and overlap with infectious or malignant processes.Standard treatment involves discontinuation of ICIs and initiation of corticosteroids. However, optimal management of steroid-refractory cases remains unclear, with intravenous immunoglobulin (IVIG) considered a second-line option.We present a case of a patient with hepatocellular carcinoma on durvalumab and tremelimumab who developed severe ICI pneumonitis and acute hypoxic respiratory failure. Notably, the patient was treated with upfront pulse-dose corticosteroids and IVIG-a combination not currently described in the literature. The patient's rapid clinical improvement without the need for intubation suggests this approach may be effective and warrants further investigation.

免疫检查点抑制剂(ICI)肺炎是一种潜在的危及生命的免疫相关不良事件,与各种恶性肿瘤的ICI治疗相关。ICIs通过靶向抑制性细胞表面受体增强抗肿瘤免疫,但这可能导致免疫介导的组织损伤。及时识别是至关重要的,因为症状通常是非特异性的,并与感染性或恶性过程重叠。标准治疗包括停止使用ICIs和开始使用皮质类固醇。然而,类固醇难治性病例的最佳管理仍不清楚,静脉注射免疫球蛋白(IVIG)被认为是二线选择。我们报告了一例接受durvalumab和tremelimumab治疗的肝细胞癌患者,他发展为严重的ICI肺炎和急性缺氧呼吸衰竭。值得注意的是,患者接受了脉冲剂量皮质类固醇和ivig的治疗,这是目前文献中没有描述的组合。患者的快速临床改善而无需插管,这表明这种方法可能是有效的,值得进一步研究。
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引用次数: 0
Fatal cerebral air embolism following chest drain removal for empyema: a rare but serious complication. 致死性脑气栓塞后胸腔引流术为脓胸:罕见但严重的并发症。
IF 0.6 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-01-28 DOI: 10.1136/bcr-2025-270454
Ria Prajapati, Rafael Sabio Fernandez, Alexander Jackson, Paul Albert

Air embolism is a rare but potentially fatal complication of pleural drainage. We present a case of a late elderly man who developed a cerebral air embolism shortly after the removal of a chest drain inserted for empyema, in a setting without positive pressure ventilation. This resulted in a catastrophic neurological deterioration and death. The case highlights the importance of recognising air embolism as a differential in post-drain removal collapse, understanding its proposed mechanisms, and considering preventative measures. This report contributes to the limited literature on air embolism following chest drain removal and underscores the need for vigilance during all stages of pleural drainage management.

空气栓塞是胸腔引流术中一种罕见但可能致命的并发症。我们提出了一个案例,一个老年男子谁发展脑空气栓塞后不久,在没有正压通气设置胸引流管插入腹腔积血。这导致了灾难性的神经退化和死亡。该病例强调了将空气栓塞视为引流管移除后塌陷的差异、了解其可能的机制并考虑预防措施的重要性。本报告补充了关于胸腔引流术后空气栓塞的有限文献,并强调了在胸腔引流术的所有阶段保持警惕的必要性。
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引用次数: 0
Pregnancy complicated by Takayasu arteritis and recurrent pregnancy loss. 妊娠合并高须动脉炎及复发性妊娠丢失。
IF 0.6 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-01-28 DOI: 10.1136/bcr-2025-267412
Bhavika Katyal, G Prasanna, Devansh Goyal, Haider Abbas

A young woman (G4P2L0A1) diagnosed with a case of Takayasu arteritis (Type IV) and a history of recurrent pregnancy loss presented at 7 weeks of gestation with chronic hypertension. She was on immunosuppressive and antihypertensive therapy preconceptionally. At 29 weeks, she developed a hypertensive emergency with stage 2 fetal growth restriction. Despite aggressive management, blood pressure (BP) remained elevated (up to 200/110 mm Hg). A preterm caesarean section was performed at 31 weeks under steroid cover, resulting in the delivery of a 1.45 kg male neonate. Both mother and baby had uneventful recoveries, and the patient achieved the target BP by discharge.

一名年轻女性(G4P2L0A1)被诊断为高须动脉炎(IV型)病例,并在妊娠7周时出现慢性高血压复发性妊娠丢失史。她在孕前接受免疫抑制和抗高血压治疗。29周时,她出现高血压急症,伴有2期胎儿生长受限。尽管积极治疗,血压(BP)仍然升高(高达200/110毫米汞柱)。31周时,在类固醇覆盖下进行了早产剖腹产,导致分娩了一个1.45公斤的男婴。母亲和婴儿均顺利恢复,出院时患者血压达到目标。
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引用次数: 0
From dog bite to dialysis: complement-mediated haemolytic uraemic syndrome . 从狗咬伤到透析:补体介导的溶血性尿毒综合征。
IF 0.6 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-01-28 DOI: 10.1136/bcr-2025-270618
Tobias Evason Fredriksen, Burhan-Ud-Din Mian, Szilveszter Dolgos

A previously healthy woman in her late 40s presented with rapidly progressive sepsis 4 days after a dog bite. She developed disseminated intravascular coagulation, pancytopenia and acute kidney injury, ultimately progressing to complete anuria and dialysis dependence. Blood cultures confirmed Capnocytophaga canimorsus bacteraemia. Despite an initial clinical improvement with antibiotics and supportive care, she developed sudden isolated haemolysis and persistent thrombocytopaenia. Laboratory and renal biopsy findings confirmed the presence of a thrombotic microangiopathy (TMA), and complement-mediated haemolytic uraemic syndrome (CM-HUS) was diagnosed. Following plasma exchange and initiation of eculizumab therapy, haematological remission was achieved, and her kidney function partially recovered.This case highlights C. canimorsus infection as a rare trigger of CM-HUS in immunocompetent adults and outlines the patient's diagnostic workup, the challenges of differential diagnosis and the complexity of both the clinical course and therapeutic approach in case of TMA following sepsis. .

一位40多岁的健康女性在被狗咬伤4天后出现了迅速进展的败血症。她出现弥漫性血管内凝血、全血细胞减少和急性肾损伤,最终发展为完全无尿和透析依赖。血培养证实为嗜鲸细胞噬菌血症。尽管最初的临床改善抗生素和支持性护理,她出现突然孤立性溶血和持续性血小板减少症。实验室和肾脏活检结果证实存在血栓性微血管病(TMA),并诊断为补体介导的溶血性尿毒综合征(CM-HUS)。血浆置换和eculizumab治疗后,患者血液学缓解,肾功能部分恢复。本病例强调了犬棘球蚴感染是免疫功能正常的成人中罕见的CM-HUS的触发因素,并概述了患者的诊断检查,鉴别诊断的挑战以及败血症后TMA的临床病程和治疗方法的复杂性。
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引用次数: 0
Dual renal pathologies in tuberous sclerosis complex: bilateral renal angiomyolipomas and concurrent left renal cell carcinoma. 结节性硬化症的双肾病理:双侧肾血管平滑肌脂肪瘤和并发左肾细胞癌。
IF 0.6 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-01-28 DOI: 10.1136/bcr-2025-267429
Jaideep Singh Soni, Shiv Charan Navriya, Gautam Ram Choudhary, Panugothu Leela Madhav, Meenakshi Rao

A female patient in the 70s presented with bilateral flank pain and haematuria. Evaluation confirmed tuberous sclerosis complex (TSC) with cutaneous findings, a giant renal angiomyolipoma (AML) in the patient's left kidney with a bleeding pseudoaneurysm, and a large mass in the right kidney containing distinct AML and high-grade renal cell carcinoma tumours. Situs inversus totalis was noted. Transarterial embolisation controlled the haemorrhage from the left kidney, followed by open partial nephrectomy on the right kidney to address the malignancy while preserving renal function. Everolimus was initiated post discharge to manage residual AMLs and lymphangioleiomyomatosis. Histopathology confirmed dual pathology in the right kidney. The patient recovered well, with stable renal function and resolved haematuria at 6 months. This case underscores the need for comprehensive imaging, histopathological confirmation and nephron-sparing strategies in managing complex renal pathologies in TSC, particularly with anatomical anomalies such as situs inversus.

一位70多岁的女性患者表现为双侧腹部疼痛和血尿。评估证实结节性硬化症(TSC)伴皮肤表现,患者左肾巨大肾血管平滑肌脂肪瘤(AML)伴出血假性动脉瘤,右肾大肿块伴明显AML和高级别肾细胞癌肿瘤。注意到位置相对于整体。经动脉栓塞术控制左肾出血,随后行右肾部分切除术,在保留肾功能的同时解决恶性肿瘤。出院后开始使用依维莫司来治疗残留的AMLs和淋巴管平滑肌瘤病。组织病理学证实右肾双重病理。患者恢复良好,6个月时肾功能稳定,血尿消失。该病例强调了在处理TSC中复杂的肾脏病理时需要全面的成像、组织病理学确认和保留肾脏的策略,特别是在解剖异常(如倒位)时。
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引用次数: 0
Duodenal ulcer with endoscopically visible coil post pseudoaneurysm embolisation. 假性动脉瘤栓塞后十二指肠溃疡内窥镜可见线圈。
IF 0.6 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-01-27 DOI: 10.1136/bcr-2025-269931
Jessica Satya Graha, Joshua Haron Abasszade, Benhur Reynauld
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引用次数: 0
Colonic polyp as a rare aetiology of paediatric colocolic intussusception. 结肠息肉是一种罕见的儿科结肠肠套叠病因。
IF 0.6 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-01-27 DOI: 10.1136/bcr-2025-269693
Nzuekoh Nchinda, Katelynn Ho, Ghassan Wahbeh, Matthew Dellinger

Intussusception is a common cause of abdominal pain and bowel obstruction in infants and children. Colocolic intussusception is a rare form, for which diagnostic imaging should be critically reviewed for identification of a lead point. This is the case of a young child who presented with abdominal pain and was found to have colocolic intussusception. Complete reduction was achieved with a pneumatic enema followed by a contrast enema. A pathological lead point was suspected based on radiological findings during reduction. A colonoscopy revealed a solitary, large juvenile polyp in the descending colon and a complete polypectomy was performed endoscopically. Both endoscopic and surgical management are viable treatment options for colocolic intussusception when a lead point is identified.

肠套叠是婴儿和儿童腹痛和肠梗阻的常见原因。结肠肠套叠是一种罕见的形式,诊断成像应严格审查,以确定一个主要点。这是一个小孩的情况下,谁提出腹痛,并发现有结肠肠套叠。通过气动灌肠和对比灌肠实现完全复位。根据复位时的放射学表现,怀疑有病理铅点。结肠镜检查发现在降结肠有一个孤立的,大的幼年息肉,并在内镜下进行了完整的息肉切除术。内窥镜和手术管理是可行的治疗选择结肠肠套叠当一个引线点被确定。
{"title":"Colonic polyp as a rare aetiology of paediatric colocolic intussusception.","authors":"Nzuekoh Nchinda, Katelynn Ho, Ghassan Wahbeh, Matthew Dellinger","doi":"10.1136/bcr-2025-269693","DOIUrl":"10.1136/bcr-2025-269693","url":null,"abstract":"<p><p>Intussusception is a common cause of abdominal pain and bowel obstruction in infants and children. Colocolic intussusception is a rare form, for which diagnostic imaging should be critically reviewed for identification of a lead point. This is the case of a young child who presented with abdominal pain and was found to have colocolic intussusception. Complete reduction was achieved with a pneumatic enema followed by a contrast enema. A pathological lead point was suspected based on radiological findings during reduction. A colonoscopy revealed a solitary, large juvenile polyp in the descending colon and a complete polypectomy was performed endoscopically. Both endoscopic and surgical management are viable treatment options for colocolic intussusception when a lead point is identified.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"19 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146059682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Recurrent sigmoid volvulus in pregnancy. 妊娠期乙状结肠扭转复发。
IF 0.6 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-01-27 DOI: 10.1136/bcr-2025-270837
Catarina Costa Neves, Daniela Albuquerque, Cláudia Andrade, Filipa Marques

Intestinal volvulus during pregnancy is a rare and potentially severe cause of bowel obstruction, associated with high maternal and fetal morbidity and mortality. Diagnosis is challenging due to nonspecific symptoms, requiring a high index of suspicion. We report a primigravida in her late 30s diagnosed with sigmoid volvulus at 25 weeks of gestation, initially treated successfully with endoscopic decompression. Recurrence occurred at 36 weeks, leading to an urgent caesarean section with sigmoidopexy, achieving excellent maternal and fetal outcomes. This case emphasises the diagnostic challenge of these acute conditions in pregnancy and underscores the need for early recognition and a coordinated multidisciplinary approach to optimise maternal-fetal outcomes.

妊娠期肠扭转是一种罕见且可能严重的肠梗阻原因,与母婴高发病率和死亡率相关。由于非特异性症状,诊断具有挑战性,需要高度怀疑。我们报告了一位30多岁的初产妇,在怀孕25周时被诊断为乙状结肠扭转,最初通过内窥镜减压成功治疗。复发发生在36周,导致紧急剖宫产乙状结肠固定术,获得良好的母婴结局。本病例强调了这些急性妊娠条件的诊断挑战,并强调了早期识别和协调多学科方法以优化母胎结局的必要性。
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引用次数: 0
Klippel-Feil syndrome presenting as posterior circulation stroke in a paediatric patient. klipppel - feil综合征表现为儿科患者后循环卒中。
IF 0.6 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-01-27 DOI: 10.1136/bcr-2025-270875
Xing-Chuan Li, Song Wang, Xiao-Yan Liu, Yan Xu

Klippel-Feil syndrome (KFS) is a rare congenital disorder characterised by the fusion of the cervical vertebrae. We report the case of an early adolescent patient who presented with acute dizziness, vomiting, slurred speech and left-sided hemiparesis following neck movements. Imaging revealed craniocervical anomalies (including atlanto-occipital assimilation and C2-C3 fusion) and severe vertebrobasilar artery stenosis/occlusion, which led to acute ischaemic infarcts in the cerebellum and pons. Notably, the patient lacked the classical short-neck phenotype. The patient was diagnosed with KFS and a posterior circulation stroke. The patient showed significant improvement with antiplatelet therapy, anticoagulation and rehabilitation. This case underscores the fact that KFS can present with life-threatening stroke even in the absence of typical clinical features, highlighting the importance of early imaging and a multidisciplinary approach.

klipppel - feil综合征(KFS)是一种罕见的先天性疾病,以颈椎融合为特征。我们报告的情况下,早期的青少年患者谁提出了急性头晕,呕吐,言语不清和左侧偏瘫后颈部运动。影像学显示颅颈异常(包括寰枕同化和C2-C3融合)和严重的椎基底动脉狭窄/闭塞,导致小脑和脑桥急性缺血性梗死。值得注意的是,该患者缺乏典型的短颈表型。患者被诊断为KFS和后循环卒中。经抗血小板治疗、抗凝治疗及康复治疗,患者病情有明显改善。这个病例强调了这样一个事实,即即使没有典型的临床特征,KFS也可能出现危及生命的中风,突出了早期成像和多学科方法的重要性。
{"title":"Klippel-Feil syndrome presenting as posterior circulation stroke in a paediatric patient.","authors":"Xing-Chuan Li, Song Wang, Xiao-Yan Liu, Yan Xu","doi":"10.1136/bcr-2025-270875","DOIUrl":"10.1136/bcr-2025-270875","url":null,"abstract":"<p><p>Klippel-Feil syndrome (KFS) is a rare congenital disorder characterised by the fusion of the cervical vertebrae. We report the case of an early adolescent patient who presented with acute dizziness, vomiting, slurred speech and left-sided hemiparesis following neck movements. Imaging revealed craniocervical anomalies (including atlanto-occipital assimilation and C2-C3 fusion) and severe vertebrobasilar artery stenosis/occlusion, which led to acute ischaemic infarcts in the cerebellum and pons. Notably, the patient lacked the classical short-neck phenotype. The patient was diagnosed with KFS and a posterior circulation stroke. The patient showed significant improvement with antiplatelet therapy, anticoagulation and rehabilitation. This case underscores the fact that KFS can present with life-threatening stroke even in the absence of typical clinical features, highlighting the importance of early imaging and a multidisciplinary approach.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"19 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146059757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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BMJ Case Reports
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