Case Reports in Medicine最新文献

Background: Oxaliplatin is widely used in the treatment of gastrointestinal tumors but is associated with rare adverse effects, including immune thrombocytopenia. The incidence of oxaliplatin-associated immune thrombocytopenia (OIIT) may be frequently overlooked due to its rarity, and in some cases, it can be difficult to treat. We present our successful experience with the use of combination therapy consisting of cyclosporine and eltrombopag in one patient, who was not suitable for steroid medication due to schizophrenia and had failed to respond when treated with eltrombopag alone.

Case presentation: A 57-year-old Chinese woman with colon cancer suffered from schizophrenia, whereas thrombocytopenia had never been demonstrated. She experienced persistent thrombocytopenia and recurrent bleeding at mucocutaneous sites after oxaliplatin-containing chemotherapy. Then, oxaliplatin-induced immune thrombocytopenia was diagnosed after almost all necessary examinations. The medical history limits the use of long-term hormone therapy. Her condition remained uncontrolled following a range of treatments regimen that involved eltrombopag alone. However, after initiating a combination of agents such as cyclosporine and eltrombopag, her platelet count normalized within 6 months, and she experienced no relapses during a 2-year follow-up period.

Conclusion: Our results suggest that combination therapy with cyclosporine and eltrombopag exhibits better response rates in settings of the existence of contraindications to other therapies and less efficacy of eltrombopag alone. This knowledge will be helpful for other clinicians to choose an appropriate treatment in such difficult circumstances.

The saphenous vein (SV) remains one of the most widely used grafts in coronary artery bypass grafting (CABG), and the integrity of the endothelium-a complex structure susceptible to deleterious effects from proinflammatory comorbidities-is a critical factor for graft patency. A 75-year-old patient with hypertension, dyslipidemia, insulin-dependent Type 2 diabetes mellitus, gout, peripheral arterial occlusive disease, and active smoking presented with unstable angina and cardiogenic shock, exhibiting severe coronary artery disease refractory to medical treatment. Emergency CABG was indicated due to the patient's clinical deterioration. During the procedure, the SV was harvested using skin-bridged incisions in an atraumatic manner with minimal handling. Immediately after excision, the SV was maintained at room temperature (∼20°C), and a venous cannula was attached to the distal portion of a 3-cm segment, which was perfused with a fixation solution containing 2.5% glutaraldehyde, 4% paraformaldehyde, and 0.1 M sodium cacodylate buffer (pH 7.4). It was then stored in an isothermal container and transported for scanning electron microscopy (SEM) analysis. SEM revealed significant endothelial damage, with extensive areas of endothelial cell detachment and loss, exposure of the basement membrane and collagen fibers, and-particularly in areas of endothelial denudation-the presence of fibrin aggregates and microthrombi. This case suggests that, in critically ill patients with multiple comorbidities, the SV may exhibit substantial endothelial damage, including microthrombi formation, immediately after surgical excision. These findings are associative and speculative; further studies are needed to explore whether such changes contribute to an increased risk of early venous graft failure. Upon identifying patients at high risk, intensive therapeutic measures should be promptly implemented to address comorbidities and minimize their deleterious effects on the endothelium.

Methotrexate (MTX) can cause MTX-associated lymphoproliferative disorders (MTX-LPDs) characterized by a T-cell phenotype. Herein, we report an extremely rare case of MTX-LPD with peripheral T-cell lymphoma (PTCL) phenotype and lung and skeletal muscle involvement. A 66-year-old man who had received MTX for 8 years for rheumatoid arthritis was admitted for right groin pain. A computed tomography scan revealed masses in the right middle lobe and right psoas muscle and multiple nodules in both lung fields. Pathological and immunohistochemical examinations of a lung nodule and psoas muscle tumor revealed PTCL. Remission was achieved soon after discontinuing MTX.

Appendiceal mucoceles (AMs) are rare pathological entities characterized by the accumulation of mucin within the appendiceal lumen. They may arise from either non-neoplastic or neoplastic processes, including low-grade appendiceal mucinous neoplasms (LAMNs). Due to their variable clinical presentation and often incidental discovery, diagnosis can be challenging. We report the case of a 29-year-old female who presented with a 3-month history of constipation and intermittent abdominal pain. Physical examination revealed mild right lower quadrant tenderness without signs of peritonitis. Laboratory findings were unremarkable. Abdominal CT demonstrated a cystic, fluid-filled structure at the base of the appendix. Colonoscopy revealed a glossy, dome-shaped protrusion at the appendiceal orifice, consistent with a mucocele. The patient underwent an elective laparoscopic appendectomy. Histopathologic examination confirmed the diagnosis of LAMN. Her postoperative course was uneventful, and she remained asymptomatic on follow-up. This case illustrates the diagnostic complexity of appendiceal mucoceles, particularly in young adults, where the condition is uncommon. The combination of cross-sectional imaging and endoscopic evaluation was pivotal in establishing the diagnosis. Early surgical management was crucial to prevent rupture and the potential development of pseudomyxoma peritonei. Clinicians should maintain a high index of suspicion for AMs in patients with unexplained gastrointestinal symptoms and characteristic imaging findings. Prompt diagnosis and appropriate surgical intervention ensure favorable outcomes and prevent serious complications.

Introduction: Swyer syndrome is a genetic abnormality characterized by a 46,XY karyotype in a phenotypically female individual. Affected individuals typically have average or tall stature, unambiguous genitalia at birth, the presence of Müllerian structures, and bilateral streak gonads. Familial Swyer syndrome is extremely rare, and we identified only two case reports describing families with two and three sisters affected by this syndrome. Individuals with Swyer syndrome have an increased risk of developing gonadal malignancies.

Case: A 19-year-old patient with primary amenorrhea, who had been followed up with a diagnosis of Swyer syndrome, was referred to our hospital due to a complaint of progressive abdominal distension and a 5-month history of lower abdominal pain. Karyotype analysis had been performed at another hospital when her older sibling was diagnosed with Swyer syndrome. However, she did not undergo bilateral gonadectomy after the diagnosis was confirmed, as her family postponed the procedure due to the COVID-19 pandemic. Surgical debulking of ovarian cancer was performed, and histopathology revealed a dysgerminoma, FIGO Stage IIIC.

Conclusion: Early diagnosis of Swyer syndrome is essential, considering the significant risk of malignant gonadal tumors that may arise at an early age. Prepubertal female siblings of patients diagnosed with Swyer syndrome should be screened. Early diagnosis and prompt prophylactic gonadectomy can allow for a conservative treatment plan that may preserve fertility and improve patient survival.

White cord syndrome (WCS) is a rare but serious postoperative complication characterized by new neurological deficits and hyperintense signal changes on T2-weighted magnetic resonance imaging (MRI) following spinal decompression surgery. Since it was first described by Chin et al. in 2013, WCS has been attributed to reperfusion injury resulting from sudden restoration of blood flow to chronically ischemic spinal cord tissue. Oxidative stress, microvascular thrombosis, and impaired autoregulation have been proposed as contributing factors. We report the case of a 61-year-old Iranian man with a history of cervical canal stenosis who developed quadriparesis and paresthesia following posterior decompression surgery. Postoperative MRI revealed hyperintense signals consistent with WCS. High-dose methylprednisolone was administered immediately, leading to partial neurological recovery during hospitalization. This case highlights the importance of early recognition and aggressive management of WCS to improve functional outcomes. Raising awareness of this syndrome among spine surgeons is essential for timely diagnosis and management.

Introduction: Lumbar disc herniation (LDH) is a frequent cause of low back pain and radiculopathy, often resulting in diminished functional capacity and a lower quality of life. Nonsurgical interventions are frequently sought to manage symptoms and enhance spinal stability. This case report explores a novel application of the prone knee extension (PKE) exercise as part of a comprehensive physiotherapy regimen aimed at addressing pain, mobility limitations, and functional impairments in a patient with LDH.

Case presentation: A 34-year-old male with a history of LDH and radiating lower limb symptoms presented with an acute exacerbation following heavy physical activity. MRI confirmed a disc protrusion at the L4-L5 level. The patient reported severe pain, restricted lumbar extension, and functional limitations. A 5-week treatment plan was implemented, consisting of 10 physiotherapy sessions combining the PKE exercise, infrared heat therapy, dry needling, diaphragmatic breathing, and core stability exercises, alongside a home exercise program. Significant improvements were observed, including pain reduction, resolution of radiating symptoms, increased lumbar range of motion, and improved sleep quality. Functional assessments using the Oswestry Disability Index (ODI) and Global Rating of Change (GRC) Scale demonstrated reduced disability and enhanced overall function.

Conclusion: This case highlights the potential effectiveness of integrating the PKE exercise into the management of LDH. The approach facilitated pain relief, improved health status, and enhanced functional capacity, suggesting that it could serve as a valuable nonsurgical intervention in clinical practice. However, as the findings are preliminary, further research is needed to validate these results.

Development of new atrial fibrillation (AF) is uncommon in pregnancy with an incidence of 0.03%. The occurrence of drug-refractory AF during pregnancy in individuals with structurally normal hearts is even rarer, and there are no reports of ablation-refractory AF during pregnancy in the literature. Early recognition and treatment of AF are crucial, as it causes hemodynamic changes that can adversely impact both the mother and fetus, potentially resulting in poor outcomes. We report a case of a 35-year-old woman at 19 weeks of gestation who presented with recurrent paroxysmal AF. Two years earlier, during her previous pregnancy, she was hospitalized for AF, where she experienced labetalol-related hypotension and failed therapy with verapamil and digoxin. She was then managed with flecainide pill-in-pocket therapy until delivery. Eighteen months before this pregnancy, she underwent catheter ablation and remained stable until this current pregnancy, when she experienced 2 episodes of AF. These episodes were unresponsive to her scheduled regimen, prompting an increase in her beta-blocker dose. However, the patient developed syncope and persistent palpitations prompting her presentation to the emergency department (ED).

Babesiosis is a vector-borne protozoal disease primarily transmitted by the Ixodes scapularis tick, though it can also be transmitted through blood transfusions from infected donors. The illness can be asymptomatic or present with mild flu-like symptoms. Still, in severe cases, it can lead to disseminated intravascular coagulation and severe hemolytic anemia, sometimes necessitating management in the intensive care unit. Traditionally, severe babesiosis has been linked to individuals over 50 years old, asplenia, and those who are immunocompromised. Notably, parasitemia levels greater than 10% are also associated with severe disease. However, we report a case of a young, immunocompetent male with severe babesiosis exhibiting severe hemolytic anemia and a rare complication of splenic infarction despite a low level of parasitemia. This case emphasizes that significant clinical complications, like spontaneous splenic infarction, can arise from low parasitemia levels, underscoring the need for heightened awareness of this potential outcome.

Acute transverse myelitis is a rare neurological complication of systemic lupus erythematosus (SLE), particularly in sub-Saharan African origin patients. We report a case of acute transverse myelitis in a sub-Saharan African origin patient with SLE. This case involved a 37-year-old female patient with SLE and secondary Sjögren's syndrome, presenting with progressively worsening paraplegia. Examination revealed paraplegia of the lower limbs and paraparesis of the upper limbs. Lumbar puncture yielded clear cerebrospinal fluid with hyperproteinorachia. Spinal magnetic resonance imaging showed transverse myelitis in lumbar level; the 24-hour proteinuria was 4.2 g. The diagnosis of acute transverse myelitis and renal flare of SLE was made. Clinical improvement was achieved with methylprednisolone, cyclophosphamide, and physiotherapy. Acute transverse myelitis remains a rare and poorly understood complication of lupus, characterized by its severity and very poor prognosis.