Case Reports in Medicine最新文献

A 55-year-old male patient with diffuse cutaneous systemic sclerosis (dcSSC) since 2018 presented with a history of arrhythmia. He had been stable for 5 years with pantoprazole, diltiazem, and mycophenolate mofetil (MMF); vitamin E; and vitamin D until he developed arrhythmia. Different evaluations revealed left bundle branch block, wall motion abnormality, mildly reduced systolic function, diffused interstitial fibrosis, and lesions in the left circumflex artery (LCX) and left anterior descending artery (LAD) and stenosis in LCX, without significant improvement following percutaneous coronary intervention for LCX stenosis. Holter monitoring demonstrated persistent ventricular premature beats and couplets. Arrhythmia was not responsive to bisoprolol therapy, and it was not feasible to perform cardiac ablation. Suspecting MMF-induced arrhythmia, MMF was discontinued, which led to a reduction in arrhythmia and symptom improvement after 9 months. This case report emphasized a possible heart-related complication of MMF, which healthcare providers should consider when prescribing medication to patients.

Helicobacter pylori (H. pylori) is a urease-producing bacterium that has a tendency to colonize the gastric mucosa. H. pylori can cause atrophic gastritis and gastric intestinal metaplasia (GIM). H. pylori has also been associated with MALT lymphoma, which is an extranodal marginal zone lymphoma. The gold standard for the diagnosis of H. pylori is histopathological analysis from biopsied gastric mucosa. MALT lymhoma can have a wide range of clinical manifestations, such as epigastric pain, iron-deficiency anemia, and overt upper gastrointestinal (GI) bleeding. MALT lymphoma has been rarely associated with headaches. We describe a case of H. pylori-positive MALToma manifesting as epigastric pain occurring concomitantly with throbbing headaches; hence, headache can be a heralding symptom for the diagnosis of MALToma.

Iliopsoas abscess (IPA) is a rare but potentially life-threatening complication that may occur in patients with Crohn's disease. We present the case of a 28-year-old male with Crohn's disease who developed a complicated IPA. Diagnosis was confirmed via CT imaging and colonoscopy, revealing a fistulous connection to the terminal ileum. The treatment involved percutaneous drainage (PCD), antibiotics, and infliximab. Timely diagnosis, appropriate imaging, and multidisciplinary care are critical to prevent morbidity and recurrence in patients with Crohn's disease complicated by IPA. This case highlights the importance of personalized treatment strategies and close follow-up in managing Crohn's-related IPA.

Relapsing epiglottitis has rarely been reported, and its etiology is not well established. A 44-year-old previously healthy Japanese man presented with a quickly progressing choking sensation. He had been experiencing refractory and relapsing laryngeal edema and probably acute epiglottitis (three episodes within 2 weeks), with rash and elevated pancreatic amylase. The patient required immediate intubation. After the initial extubation, he required reintubation and a subsequent tracheostomy. Antibiotics, glucocorticoid, and antihistamines were administered, and he finally recovered with the tracheostomy's closure. Potential causes of this patient's relapsing epiglottitis are as follows: persistent right swollen tonsil; a positive result on a Mycoplasma pneumoniae antigen test and a particle agglutination (PA) test, implicating chronic tonsillitis; and/or Mycoplasma infection. This is the first case report of refractory and relapsing epiglottitis requiring reintubation possibly concurrent with chronic tonsillitis and Mycoplasma infection.

Congenital arhinia and hyporhinia are rare facial anomalies whose knowledge usually comes from case reports. The severity of each case described in literature is variable; it also depends on associated malformations too. Since the newborns are obligate nasal breathers, babies with arhinia or hyporhinia usually have respiratory distress and need airway stabilization. In addition, most of these children present difficulties in feeding and this impairment must be managed early. We describe an unusual case of partial congenital arhinia, the baby did not have other anomalies or any specific complication such as respiratory and feeding issues, so the major problem was the aesthetic and psychological issues for the family. Even if the neonatal course was uncomplicated, a coordinated approach of the pediatrician with the pediatric otolaryngologist, the geneticists and the neurosurgeons was necessary because the management of these malformations is always very complex; due to the lack of reports described in literature, an univocal management and also the best timing and technique for reconstructive surgery are still not defined.

The case involves a 63-year-old hypertensive man, taking antihypertensive medication (olmesartan) for the previous two years, who sought medical attention due to voluminous diarrhea, with several episodes per day and weight loss of 10 kg. He was submitted to a series of diagnostic procedures without elucidation and empirical treatment with unsuccessful outcome. After hospitalization for clinical stabilization and for presenting with duodenal atrophy, obtained by duodenal biopsy associated with negative markers for celiac disease, the patient was diagnosed with suspected olmesartan-induced enteropathy, showing rapid improvement of diarrhea after the drug was withdrawn, with weight regain in 6 months and normalization of the duodenal histological picture after 10 months.

Objective: This case report describes a rare presentation of a cartilaginous choristoma of the oral cavity within the tonsillar fossa, emphasizing the importance of recognizing and differentiating this uncommon entity from more frequently encountered oral lesions. Methods: A comprehensive clinical and histopathological examination was conducted on a 30-year-old male patient who presented with a painless mass in the nasopharynx. An excisional biopsy was carried out, and a histopathological analysis was conducted to establish a definitive diagnosis. Results: Histopathological examination demonstrated a cartilaginous choristoma, characterized by the presence of mature hyaline cartilage surrounded by the connective tissue. The patient underwent surgical excision of the lesion, and follow-up assessments indicated a favorable postoperative outcome without recurrence. Conclusion: Cartilaginous choristomas in the oral cavity are exceedingly rare. Awareness of this entity is crucial for accurate diagnosis and appropriate management, as it can mimic other more common oral lesions. This case report contributes to the limited literature on oral cartilaginous choristomas and underscores the significance of considering this entity in the differential diagnosis of oral mucosal masses.

Introduction: Spontaneous hepatic rupture is a rare complication that occurs in pregnant mothers with HELLP syndrome, or preeclampsia with severe features, or eclampsia. The most common symptom of hepatic rupture/hematoma is right upper quadrant pain or epigastric pain, which is similar to the presentation of preeclampsia with severe features. Therefore, the absence of specific signs and symptoms leads to a diagnostic dilemma and a delay in management. The objective of this index study is to report available evidence on incidence, clinical presentation, pathophysiology, diagnosis, maternal and perinatal outcome, challenges, and best experiences in the management of hepatic rupture. Case History: A 38-year-old G3P1A1 kaffa mother whose gestational age was 30 weeks plus 4 days from reliable last normal menstrual period had three ANCs. She presented with right upper quadrant pain of 3 days duration and severe global headache and blurring of vision of 5 days duration. Abdominal ultrasound showed a well-defined hyperechoic mass measuring 6 cm by 8 cm on the subcapsular area of the left lobe of the liver, as well as free intra-abdominal fluid. A diagnosis of ruptured hepatic subcapsular hematoma associated with preeclampsia with severe features was made, and an emergency laparotomy was done. Intraoperatively, 2500 mL of hemoperitoneum, a large hematoma (9 × 10 cm) on the left lobe of the liver, and active bleeding from the right lobe of the liver were found. Surgicell was applied to the actively bleeding site, and the right hepatic artery was ligated, along with perihepatic packing and a subhepatic drainage tube. Cesarean delivery was made to effect a delivery of a freshly dead male fetus weighing 1.4 kg. Despite this management, after 6 h of admission to the ICU, she passed away with a possible cause of death of multiorgan failure (liver, kidney, respiratory, and heart) secondary to underlying illness. Conclusion: A high index of suspicion, multidisciplinary approach, and urgent laparotomy to secure hemostasis could prevent maternal death and perinatal loss due to hepatic rupture in preeclamptic mothers. The absence of specific signs and symptoms and a high case fatality rate mandate standardized protocols of management for hepatic rupture during pregnancy.

Background: The risk of cytokine release syndrome (CRS) in patients with infections prior to chimeric antigen receptor T-cell (CAR T-cell) therapy represents an important and underreported event. Patients with active infections needing prompt CAR T-cell therapy to treat aggressive hematologic malignancies remain a clinical challenge. Case Report: This case describes the clinical course of a 35-year-old male patient with relapsed/refractory T-cell/histiocyte-rich large B-cell lymphoma who received axicabtagene ciloleucel. The patient developed ASTCT Grade II CRS on day +5, necessitating hospital admission and intravenous antibiotics, dexamethasone and tocilizumab. The patient was found to have a Pneumocystis jirovecii pneumonia (PJP) infection 3 days prior to CAR T-cell infusion and cytomegalovirus (CMV) viremia 3 days after CAR T-cell infusion. He received TMP-SMX for 21 days to treat PJP and valganciclovir to treat CMV viremia. PET/CT on day +26 demonstrated near resolution of pulmonary nodules and significant partial response of disease according to Deauville criteria. Conclusion: This case highlights the risk of CRS in immunocompromised patients with infections, and presents a unique case of CRS associated with PJP and CMV infections. Although the patient's clinical course was fraught with complications, he achieved a significant partial response to CAR T-cell therapy with the help of a multidisciplinary medical team.

Spread of Mycobacterium tuberculosis (MTB) to the larynx is exceedingly rare and can be obscured by more common conditions such as laryngeal cancer or oropharyngeal candidiasis, complicating an accurate diagnosis. Risk factors for chronic laryngeal disease, such as smoking and toxin exposure, place TB infection comparatively lower for consideration on a physician's differential. However, identifying these lesions is crucial from a medical and public health perspective to prevent community spread. We report the case of a 60-year-old male who presented with dysphonia, pharyngitis, aphasia, and significant unintentional weight loss. X-rays demonstrated focal opacities in the upper lung lobes. Laryngoscope biopsy revealed caseating granulomas and a positive culture for MTB. Laryngeal TB presents as a suspicious throat mass with nonspecific symptoms and should be thoroughly investigated by clinicians.