Cureus最新文献

We report the case of a 15-day-old neonate presenting with multifocal osteoarticular infection, initially manifesting as septic arthritis of the right wrist, which rapidly progressed to involve multiple sites, including the right deltoid and left hip. The etiological agent was identified as methicillin-sensitive Staphylococcus aureus (MSSA). This case is notable for its multifocality, the severity of the clinical course in the neonatal period, and the association with a prior history of neonatal admission for severe hypernatremic dehydration.

Pulmonary nodules with increased metabolic activity on positron emission tomography (PET) are frequently presumed malignant; however, inflammatory and rare benign neoplastic processes may produce false-positive findings. A 61-year-old African American male with a history of calcified and non-calcified pulmonary nodules and severe emphysema was referred to our pulmonary nodule clinic from the emergency department after a newly discovered lung nodule was identified on computed tomography (CT) of the chest. Subsequent evaluation demonstrated metabolic activity on PET, raising concern for malignancy; however, tissue diagnosis revealed organizing pneumonia. This case highlights diagnostic pitfalls associated with commonly used imaging and biomarker modalities in the evaluation of pulmonary nodules and emphasizes the importance of clinical awareness of a rare tumor, granular cell tumor (GCT), among physicians who may be unfamiliar with or have never encountered this condition.

The most influential timing of continuous renal replacement therapy (CRRT) in gravely ill patients with acutely severe, uncompensated renal dysfunction continues to be a subject of ongoing debate. Although earlier initiation has been hypothesized to limit metabolic disturbances and prevent downstream organ dysfunction, clinical trials have yielded inconsistent findings, in part because of variability in how "early" initiation is defined across studies. This meta-analysis, in conjunction with a systematic review, sought to examine the correlation between early versus delayed CRRT initiation and mortality, with analyses stratified according to initiation strategy, including clinical staging-based benchmark by Kidney Disease: Improving Global Outcomes (KDIGO) and biomarker-driven approaches using neutrophil gelatinase-associated lipocalin (NGAL). A literature search was conducted in PubMed, EMBASE, and the Cochrane Library to identify studies published between January 2015 and June 2025. Eligible studies included randomized controlled trials and observational investigations that compared early and delayed CRRT initiation among critically ill adults with acute kidney injury (AKI). The primary outcome of interest was all-cause mortality measured between 28 and 90 days or at the time of intensive care unit (ICU) discharge. Pooled relative risks (RR) and odds ratios (OR) were estimated using random-effects meta-analytic models, with subgroup analyses performed according to initiation criteria. Nine studies encompassing 2,349 patients were included (six randomized trials and three observational studies). Overall, early CRRT initiation was not associated with a statistically significant decrease in mortality compared with delayed initiation (risk ratio (RR) = 0.87; 95% confidence interval (CI), 0.69-1.10; p = 0.25; I² = 90.4%). Subgroup analysis demonstrated no significant mortality benefit with biomarker-guided (NGAL-based) early initiation (RR = 0.90; 95% CI, 0.41-2.01), whereas KDIGO-based initiation showed a borderline association favoring early therapy (RR = 0.75; 95% CI, 0.57-0.99), though heterogeneity remained substantial. No meaningful interaction was observed between initiation strategy and mortality.

Rheumatoid vasculitis (RV) is an uncommon but potentially fatal extra-articular manifestation of rheumatoid arthritis (RA), characterized by severe systemic inflammation and high mortality despite advances in disease-modifying therapies. We describe a 52-year-old woman with long-standing seropositive RA and irregular use of methotrexate who presented with progressive digital ischemia and extensive necrotic cutaneous ulcers, in the absence of active synovitis. Histopathology revealed small-vessel vasculitis, accompanied by markedly elevated rheumatoid factor and anti-cyclic citrullinated peptide titers, hypocomplementemia, and negative antineutrophil cytoplasmic antibodies. Despite high-dose corticosteroids, vasodilator therapy, and broad-spectrum antibiotics, the disease rapidly evolved to multiorgan involvement, including respiratory failure requiring mechanical ventilation, rapidly progressive renal failure requiring hemodialysis, and ischemic central nervous system lesions, culminating in refractory multiorgan failure and death. This case illustrates a fulminant presentation of RV with aggressive cutaneous and visceral involvement, emphasizing that severe vasculitis may occur independently of articular disease activity and is associated with poor prognosis. RV should be suspected in patients with long-standing RA who develop unexplained ischemic or ulcerative lesions, even in the absence of active arthritis. Early recognition and timely, sustained immunosuppression are critical to prevent irreversible organ damage and fatal outcomes.

Varicella-zoster virus, colloquially known as chickenpox in the United States, complicating pregnancy has become a rare diagnosis following the introduction of the varicella-zoster vaccine. Despite a lower incidence of chickenpox than in the past, those providing prenatal care should keep a high index of suspicion for varicella-zoster among patients presenting with a vesicular rash and no history of having received the varicella-zoster vaccine. This report reviews the case of a 28-year-old gravida three at 35 weeks gestation who presented with concern for a full-body vesicular rash and pruritus. The evaluation, diagnosis, and medical management of varicella-zoster infection in pregnancy are discussed.

Acute aortic syndromes (AAS) encompass life-threatening conditions that require rapid diagnosis and specialized intervention. Among these, large-vessel vasculitides, such as Takayasu arteritis (TA), pose unique surgical and anesthetic challenges due to active vascular inflammation, tissue fragility, and possible multiorgan involvement. We report the perioperative management of a 34-year-old female, who was 20 weeks pregnant, with TA who presented with rapidly progressive aneurysmal dilation and dissection of the thoracic aorta, complicated by multiorgan failure. She underwent emergent hybrid repair of the aortic arch using a frozen elephant trunk (FET) prosthesis, followed by second-stage thoracic endovascular aortic repair (TEVAR) for a descending aortic aneurysm six months later. The initial perioperative period was complicated by hemodynamic instability, cardiac arrest, ventilatory challenges, renal failure, and fetal loss. Intraoperative management included transesophageal echocardiographic assessment, hemostatic optimization, and prioritization of cerebral and end-organ protection using moderate hypothermia and antegrade cerebral perfusion. The postoperative period was further complicated by severe myopathy, bilateral vocal cord paralysis, and limb ischemia secondary to vasopressor use. Despite the complexity of the surgical case and the subsequent complications, the patient achieved a favorable functional recovery and remains under follow-up with stable aortic imaging findings. This report highlights the multidisciplinary challenges of managing extensive aortic disease, particularly when surgery is required during an active inflammatory phase. Careful preoperative assessment, individualized surgical and anesthetic strategies, advanced intraoperative monitoring, and prolonged postoperative support are essential to maximize outcomes in this high-risk population.

Background and objective Breast lesions represent a wide clinicopathological spectrum, with breast cancer being the most common malignancy in Bangladeshi women. It often presents at a younger age and at an advanced stage, placing strain on the country's limited oncology services. This study aimed to observe the histopathological pattern of breast lesions in women attending a tertiary care center in Dhaka and to identify clinical predictors of pathologically confirmed malignant breast cancer. Methods A retrospective, hospital-based study was conducted in the Department of Pathology, Medical College for Women and Hospital, Dhaka, from June to November 2025, including 160 women with histologically confirmed breast lesions. Clinical data and histopathology reports were analyzed using descriptive statistics, chi-square/Fisher's exact tests, and multivariable logistic regression. Results The mean age was 31.79 ± 11.88 years, with most patients aged 30-39 years. The predominant diagnoses were fibroadenoma (52; 32.5%), granulomatous mastitis (24; 15.0%), invasive breast carcinoma (24; 15.0%), and fibrocystic change (13; 8.1%). Overall, 47.5% of lesions were benign, 35.6% inflammatory, and 16.9% malignant. Age ≥40 years (OR 2.582; 95% CI 1.754-3.802), bilateral involvement (OR 2.088; 95% CI 1.391-3.134), and a clinical impression of malignancy (OR 2.290; 95% CI 1.536-3.414) independently predicted malignancy. Histopathology-based classification demonstrated a sensitivity of 98.68%, a specificity of 74.07%, and an overall accuracy of 89.82% in differentiating benign from malignant lesions. Conclusions Benign and inflammatory lesions, particularly fibroadenoma and granulomatous mastitis, predominate among Bangladeshi women; however, a substantial malignant burden is evident, especially in older and bilaterally affected patients. Because the histopathology-based classification showed moderate specificity, further robust studies incorporating immunohistochemistry and molecular subtype analysis are warranted. Strengthening clinicopathological correlation and maintaining high-quality histopathology services are essential to support earlier diagnosis and targeted management in this setting.

Perioperative management of immune thrombocytopenic purpura (ITP) in cardiac surgery represents a rare yet formidable clinical challenge driven by immune-mediated platelet dysfunction, obligatory systemic anticoagulation, and the profound hemostatic derangements induced by cardiopulmonary bypass. We systematically synthesized the available evidence on perioperative strategies and outcomes in adults with ITP undergoing cardiac surgery in elective and urgent or emergent settings by reviewing PubMed/MEDLINE, Embase, Scopus, Web of Science, Cochrane CENTRAL, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform from inception through August 26, 2025. Nineteen studies comprising approximately 74 patients, predominantly with severe thrombocytopenia, were identified, including three observational cohorts and sixteen case reports or series. Reported management approaches centered on rapid immunomodulation with intravenous immunoglobulin and/or corticosteroids, selective adjunctive platelet transfusion, antifibrinolytic therapy, thrombopoietin receptor agonists in selected cases, and carefully monitored cardiopulmonary bypass anticoagulation, most commonly using unfractionated heparin with activated clotting time guidance; bivalirudin was described in isolated reports. Across studies, perioperative bleeding occurred in approximately 32% of patients, platelet transfusion in 45%, reoperation for bleeding in 8%, thrombotic complications in 6%, and perioperative mortality in 7%, with consistently inferior outcomes observed in urgent and emergent procedures. Although the evidence base remains largely case-derived and heterogeneous, these data support a coherent multimodal perioperative strategy integrating rapid platelet-directed immunotherapy, patient blood management-guided hemostasis, antifibrinolytic use, and vigilant anticoagulation, while underscoring the urgent need for prospective, multicenter registries with harmonized outcome definitions to inform standardized, evidence-based perioperative pathways for this high-risk population.

Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common cause of paroxysmal supraventricular tachycardia in adults and frequently presents with sudden-onset palpitations and regular narrow-complex tachycardia. Although generally considered benign, recurrent symptomatic episodes often lead to repeated emergency department visits and reduced quality of life, warranting definitive therapy. We report the case of a 42-year-old woman who presented with several hours of palpitations and was found to have a regular narrow-complex tachycardia at approximately 200 beats per minute without visible P waves. Subtle pseudo r' deflections in lead V1 and pseudo S waves in the inferior leads were noted, consistent with typical slow-fast AVNRT. Vagal maneuvers were ineffective, and intravenous adenosine at a dose of 12 mg resulted in transient atrioventricular block followed by the prompt restoration of sinus rhythm. Post-conversion electrocardiography demonstrated normal atrioventricular conduction without evidence of ventricular preexcitation, and transthoracic echocardiography confirmed the absence of structural heart disease. The patient reported multiple similar episodes over the preceding months, frequently occurring around the onset of menstruation, suggesting a potential influence of hormonal fluctuations on arrhythmia susceptibility. Given the recurrent and symptomatic nature of the episodes, she was referred for electrophysiological study and catheter ablation, which is recommended as first-line definitive therapy for AVNRT. This case highlights the classic electrocardiographic features and adenosine sensitivity of AVNRT, supports early referral for curative ablation in recurrent cases, and draws attention to possible hormonal modulation as a trigger for supraventricular tachycardia in susceptible patients.

Nasolabial cysts are rare, nonodontogenic cysts of the anterior nasal floor and nasolabial fold. Bilateral presentation is uncommon and may mimic inferior turbinate hypertrophy, leading to misdiagnosis. A 41-year-old Qatari man presented with a five-year history of persistent nasal obstruction, headache, and nasal discharge. He had chronic sinonasal polyposis and a prolonged history of topical nasal decongestant use, with poor response to intranasal steroids. Two CT scans performed three years apart were initially reported as showing sinonasal polyposis; however, retrospective review revealed subtle, bilateral, well-circumscribed anterior cystic lesions inferior to the inferior turbinates that had been overlooked. During functional endoscopic sinus surgery, symmetric bilateral nasolabial cysts measuring 1.5-2.5 cm were identified and excised endoscopically. Histopathology confirmed respiratory epithelium-lined cysts. Postoperative recovery was favorable, with no recurrence at 4.5 months. Bilateral nasolabial cysts are rare and can clinically and radiologically mimic inferior turbinate hypertrophy, especially in patients with rhinitis or sinonasal polyposis. Careful review of the anterior nasal cavity on imaging can prevent misdiagnosis. Endoscopic excision is both diagnostic and curative.