Case Reports in Medicine最新文献

Shoulder injuries related to COVID-19 vaccines presented in the literature include many forms that occurred either early in the first days after injection or late, after weeks or months, but not all have convincingly demonstrated a cause-and-effect relationship. We present and illustrate a unique case to our knowledge of late-onset bilateral myositis ossificans of the deltoid muscles and spontaneous stabilization of evolution, without functional impairment of the shoulders, after the correct administration of the Pfizer-BioNTech COVID-19 mRNA vaccine. This case highlights the possibility of diagnosing some late muscle changes after this type of vaccination, which should not be considered tumor masses, and watchful waiting is recommended as a useful approach. The possibility of late side effects after vaccination has received little consideration in the past. This case report is intended to be an argument in favor of further studies to evaluate the risks, contraindications, and better management of late side effects of the new mRNA vaccines.

Purtscher-like retinopathy is a rare microvascular retinal disorder characterized by sudden visual loss and distinctive fundoscopic findings, often associated with systemic vascular insults. We report a 31-year-old male presenting with bilateral sudden blurred vision, hypertensive crisis, and renal failure following excessive intake of anabolic steroids, amino acids, and creatine supplements. Fundoscopy revealed Purtscher flecken, cotton-wool spots, and intraretinal hemorrhages, consistent with Purtscher-like retinopathy. Spectral-domain OCT demonstrated inner retinal hyperreflectivity and fluid accumulation. The patient's systemic condition was managed with antihypertensive therapy and hemodialysis; however, he left prematurely, limiting follow-up. This case underscores the importance of recognizing ocular findings as early indicators of systemic vascular compromise in young patients with anabolic steroid and supplement abuse, highlighting the systemic risks of such overuse and the critical role of early diagnosis and interdisciplinary management.

Pure red cell aplasia (PRCA), a rare cause of anemia limited to the erythroid lineage, is characterized by normocytic normochromic anemia, severe reticulocytopenia, and markedly reduced or absent erythroid precursors in the bone marrow. We report a 44-year-old male with end-stage renal disease (ESRD) secondary to autosomal dominant polycystic kidney disease (ADPKD) who developed refractory PRCA following a live-donor renal transplant. One month posttransplant, the patient presented with severe, persistent anemia accompanied by fatigue and dyspnea. Initial management included blood transfusions, vitamin B12 supplementation, and adjustments to immunosuppressive therapy due to suspected drug-induced cytopenia. Bone marrow biopsy confirmed PRCA, and polymerase chain reaction (PCR) revealed a persistently elevated parvovirus B19 infection, a commonly recognized etiology of PRCA in immunocompromised patients. Treatment included intravenous immunoglobulin (IVIG) and frequent blood transfusions. Despite therapy, the patient experienced recurrent anemia, pancytopenia, and febrile neutropenia. Over successive hospitalizations, hematologic improvement was achieved with hemoglobin stabilization and significant viral load reduction. This case underscores the diagnostic and therapeutic complexity of managing parvovirus B19-induced PRCA in posttransplant patients, emphasizing the need for individualized strategies incorporating IVIG, supportive care, and tailored immunosuppressive regimens.

Waldenström's macroglobulinemia is a rare lymphoproliferative disorder that can be treated with Bruton's Tyrosine Kinase inhibitors (BTKi), including zanubrutinib. Although zanubrutinib is associated with fewer off-target effects than first-generation BTKi, dermatologic toxicities may still occur. We report the case of an 81 year-old man with Waldenström's macroglobulinemia who developed a Grade I acneiform rash shortly after initiating zanubrutinib. The eruption, characterised by folliculocentric papules and pustules on the face and trunk, resolved with topical azelaic acid and salicylic acid, as well as oral azithromycin. Histology showed a perivascular and periadnexal CD3⁺ T-cell infiltrate without epidermotropism. A Naranjo score of 8 supported a probable drug reaction. This report highlights the need for awareness of cutaneous side effects associated with newer BTKi to ensure prompt diagnosis and optimal patient management.

Anticoagulated patients are at increased risk of complications from drug interactions, including with antibiotics. Piperacillin-tazobactam (PTZ) has been associated with coagulation disruptions, potentially leading to severe bleeding when combined with anticoagulants like rivaroxaban. This report describes the first known case of massive gastrointestinal (GI) bleeding potentially associated with PTZ in a rivaroxaban-treated patient, successfully managed by discontinuing both drugs. We present a 52-year-old male with deep vein thrombosis on rivaroxaban, admitted for severe left leg cellulitis. Shortly after starting PTZ, he experienced massive GI bleeding with hematochezia, hematemesis, and syncope, requiring urgent intervention, cessation of both medications, and esophagogastroduodenoscopy (EGD), which revealed minor erosions. The temporal relationship suggests a possible PTZ-induced hemostasis disruption or interaction with rivaroxaban. This case highlights the need for research into PTZ-anticoagulant interactions and emphasizes vigilant monitoring and timely management to reduce life-threatening bleeding risks in anticoagulated patients.

Pituitary macroadenomas are prevalent benign tumors that can present with insidious symptoms, leading to delayed diagnoses. We report the case of a 29-year-old South Asian male who presented with acute neurological symptoms including severe headache, confusion, and vomiting, initially diagnosed as meningitis with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Despite initial improvement, the patient developed central diabetes insipidus (CDI) and was found to have physical features consistent with acromegaly. Magnetic resonance imaging (MRI) revealed a large sellar/suprasellar lesion, and hormonal profile confirmed elevated insulin-like growth factor 1 (IGF-1) with low levels of prolactin, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone, consistent with pituitary apoplexy. The patient underwent successful transnasal transsphenoidal resection of a hemorrhagic macroadenoma. This case highlights the importance of considering pituitary apoplexy in the differential diagnosis of acute neurological symptoms and its potential for atypical complications such as SIADH followed by CDI. Timely diagnosis and appropriate management are crucial to mitigate risks and improve outcomes.

Introduction: Placental lakes are smooth and blood-filled cavities of varying sizes observed during routine ultrasound examination of pregnant women.

Presentation of case: This report describes a case of a 35-year-old Syrian woman who complained of vaginal bleeding at 39 weeks of gestation. The patient had a history of seven cesarean sections. Echography revealed anterior accreta placenta previa and 4 large placental lakes measuring 10, 8, 4, and 4 cm. Complete hysterectomy was performed, and the patient was discharged without complications.

Discussion: The importance of this case lies in the presence of four placental lakes, with the largest reaching a size of 10 cm, accompanied by an accreta placenta previa, which is rare.

Conclusion: Maternal and fetal complications remain controversial, as some studies have suggested direct effects on the health of the mother and fetus, whereas others have refuted any correlation.

Sinonasal intraosseous cavernous hemangioma is an uncommon vascular bone tumor with clinical, radiological, and histologic characteristics that differ from soft tissue hemangioma. This case comprises an exceptionally rare intraosseous cavernous hemangioma that develops from the nasal bone. A 66-year-old male patient appeared with a protruding left nasal bone region and epiphora. A complete surgical excision was accomplished through a rhinotomy incision. Histological investigation revealed an intraosseous cavernous hemangioma. The patient was pleased with the cosmetic outcome, and no recurrences were detected during the 18-month follow-up.

Rothia kristinae is usually found in the environment, on normal skin and mucosal surfaces of humans, and there is a limited medical literature available on this organism and its pathogenicity. Our case describes a woman in her early 70's with left hip osteoarthritis presented with generalized weakness, fever, and altered mentation associated with left hip and back pain. Laboratory workup was significant for leukocytosis and elevated inflammatory markers. Blood culture demonstrated Gram-positive cocci, later identified as Rothia kristinae. She was subsequently diagnosed with native aortic valve endocarditis, multilevel discitis, and left hip septic arthritis. She completed 2 weeks of intravenous vancomycin. Treatment was complicated by a drug reaction to vancomycin and switched to linezolid. She developed a left hip abscess and underwent left hip arthroplasty. Follow-up transthoracic echocardiogram showed resolution of infective endocarditis. This case describes the extent of disseminated infection the organism can cause and its pathogenic potential warranting a low threshold for clinicians to initiate treatment.

A 47-year-old woman presented with significant respiratory symptoms and was diagnosed with a bronchial tumor. Histological analysis confirmed the tumor, initially treated with endobronchial treatment (EBT), was a typical carcinoid. Given the patient's improved pulmonary function and in accordance with current clinical guidelines, she underwent video-assisted thoracoscopic right upper lobe sleeve resection for the residual tumor. The combination of surgical resection and EBT may offer an effective treatment strategy for other bronchial tumors.