Case Reports in Medicine最新文献

Hepatitis A virus (HAV) is a viral infection that can present with a wide range of clinical manifestations, including rare complications such as acute acalculous cholecystitis (AAC). We present the case of a 31-year-old woman who arrived at the emergency department with severe epigastric pain, fever, early satiety, nausea, and vomiting. Physical examination revealed a positive Murphy's sign, hepatomegaly, and epigastric tenderness, suggesting obstructive acute cholecystitis. Imaging studies showed reactive changes in the gallbladder and mild dilation of the intrahepatic bile ducts. Laboratory tests indicated elevated bilirubin levels and a cholestatic pattern with markedly increased transaminases. Magnetic resonance cholangiopancreatography confirmed AAC and ruled out biliary obstruction. Positive serology for Hepatitis A led to the definitive diagnosis of AAC secondary to Hepatitis A. Treatment focused on supportive care with intravenous hydration and symptomatic management, avoiding antibiotics due to the self-limiting nature of the viral infection. The patient showed a favorable clinical course, with a progressive decrease in gallbladder diameter and normalization of liver parameters. This case highlights the importance of considering rare viral infections as a cause of AAC and demonstrates that a conservative approach can be effective in managing this condition. This case underscores the importance of considering viral etiologies, particularly HAV, in the differential diagnosis of AAC in adults. It further demonstrates that, in carefully selected patients, conservative management can be both safe and effective, thereby avoiding unnecessary antibiotic use or surgical intervention in the context of a self-limiting viral infection.

Background: Persistent left superior vena cava (PLSVC) is a rare congenital vascular anomaly that can complicate central venous catheterization. While axillary vein cannulation is an increasingly recognized alternative to the subclavian or femoral route, inadvertent passage of a catheter into a PLSVC through the axillary vein has not been described in the literature.

Case presentation: A 46-year-old male with refractory status epilepticus required multiple intravenous infusions. Jugular and femoral access was contraindicated due to behavioral risks and local contamination, respectively, prompting ultrasound-guided catheter placement in the left axillary vein. Initial investigations confirmed venous placement, yet a chest X-ray suggested an aberrant catheter trajectory near the left hilum. Review of past imaging revealed a PLSVC draining into the coronary sinus, explaining the unusual line path. The malpositioned catheter was removed without incident, and access was successfully re-established via the internal jugular vein.

Conclusion: This case stresses the importance of recognizing and evaluating unexpected catheter pathways, as variant venous anatomy can complicate central venous access. While routine imaging prior to every cannulation is impractical, prompt investigation of an atypical catheter track is essential to minimize complications. Clinicians should be aware of PLSVC in patients with unusual radiographic findings, including when using the axillary vein for central access.

We discuss the case of a patient with diabetes on long-term glipizide and stable glucose management who presented with delayed-onset hypoglycemia 6 weeks after initiating levofloxacin for osteomyelitis. The patient presented with neuroglycopenic symptoms, including dysarthria, slurred speech, and syncopal episodes. Serum glucose level was 35 mg/dL, and C-peptide was markedly elevated at 12.42 ng/mL. Hypoglycemia resolved immediately after D50 administration. Discontinuation of glipizide while on levofloxacin did not result in any new hypoglycemic episodes. In previously documented cases, hypoglycemia occurred within days or less than a week after initiating levofloxacin. This report represents an interesting case of delayed-onset hypoglycemia after initiating levofloxacin in a stably managed diabetic patient on long-term glipizide secretagogue.

Follicular dendritic cell sarcoma (FDCS) is a rare neoplasm of mesenchymal origin arising from B-cell follicles, typically presenting as a painless, slow-growing mass. According to the available literature, this is only the second reported case of FDCS during pregnancy and the first associated with fetal growth restriction and preeclampsia. A 30-year-old pregnant woman at 28 weeks of gestation was diagnosed with preeclampsia and fetal growth restriction, during which an incidental abdominal mass was identified on ultrasound. Excisional surgery was performed 27 days after an emergency cesarean delivery, and histopathological analysis confirmed FDCS arising in association with hyaline-vascular type Castleman disease. This case highlights the importance of multidisciplinary evaluation and awareness of rare abdominal neoplasms during pregnancy.

Angiolymphoid hyperplasia with eosinophilia (ALHE) and Kimura disease were previously considered the same entities and are now considered a distinct disorder clinically and histologically. ALHE is a benign vasoproliferative disorder with unclear etiology. The clinical presentation of ALHE includes the involvement of skin and vascular structures sparing lymph nodes. It predominantly involves the head and neck region, extremities, and rarely orbit, oral mucosa, bones, and colon. On the other hand, Kimura disease is a rare benign chronic inflammatory disorder of unknown etiology that predominantly involves subcutaneous lymphoid masses and regional lymph nodes of the head and neck region. Both disorders are classified under hypereosinophilia (HE); however, Kimura disease is more associated with peripheral eosinophilia. It is tough to differentiate both the disorders clinically from each other and also from other HE syndromes including eosinophilic granulomatosis with polyangiitis and systemic HE syndromes. However, tissue diagnosis is the key to differentiation. Here, we describe a female at her 50s without any prior comorbidities, presented to our OPD with atypical multiple symmetrical soft tissue swellings which were of diagnostic dilemmas. She showed features of both ALHE and Kimura disease in investigations. As there is no specific recommendation for treatment, she was started with oral glucocorticoid and weekly methotrexate showing a good response in follow-up visit.

Background: Fuchs syndrome, also known as atypical Stevens-Johnson syndrome (SJS), is a rare variant of SJS that primarily affects the mucosae of the mouth, eyes, and genitalia with minimal to no skin involvement. This case is notable due to the absence of skin manifestations and the critical need for accurate diagnosis and appropriate management, especially following drug administration.

Case presentation: We report a case of a 22-year-old male patient who presented with severe oral ulcers, causing difficulty in talking and swallowing. The patient was recently treated for an upper respiratory tract infection with levofloxacin. Shortly thereafter, he developed oral and genital ulcers, as well as conjunctivitis. Upon admission, various differential diagnoses including autoimmune and infectious were considered but subsequently ruled out. As symptoms worsened, a biopsy of the affected mucosa was performed and confirmed the diagnosis of SJS. The patient was subsequently treated with corticosteroids resulting in rapid improvement of his symptoms.

Conclusions: This case highlights the importance of considering Fuchs syndrome as a potential cause of mucositis following drug administration, particularly in the absence of cutaneous lesions. Accurate diagnosis and prompt treatment are crucial for patient recovery.

Hafnia alvei is a rare opportunistic pathogen of the Enterobacteriaceae family, typically regarded as a gastrointestinal commensal. However, it has been implicated in serious infections, particularly in immunocompromised patients, posing diagnostic and therapeutic challenges. We present the case of a 70-year-old woman with a history of cryptogenic cirrhosis postliver transplant, complicated by sepsis and advanced pancreatic adenocarcinoma under palliative care. She developed a urinary tract infection caused by Hafnia alvei and Klebsiella oxytoca, confirmed by cultures. Despite targeted antibiotic therapy with vancomycin and ciprofloxacin, her condition deteriorated, leading to death due to oncologic disease progression. This case underscores the pathogenic potential of Hafnia alvei, its role in polymicrobial infections, and the importance of antimicrobial susceptibility testing. Raising awareness of this under-recognized pathogen is crucial to improving outcomes in vulnerable populations.

Background: Bone marrow tuberculosis (TB) is a rare but severe form of extrapulmonary TB, often presenting with nonspecific symptoms such as fatigue, weakness, and cytopenia, making diagnosis challenging.

Case presentation: We report the case of a 71-year-old male with a history of pituitary surgery and chronic corticosteroid use, who presented with pancytopenia, hyponatremia, and a chronic productive cough. Initial investigations, including chest CT, abdominal and pelvic ultrasound, liver elastography, dynamic liver MRI, blood cultures (from peripheral blood), and sputum cultures (from expectorated sputum), were inconclusive. A bone marrow biopsy revealed caseating granulomas, and acid-fast staining confirmed Mycobacterium tuberculosis.

Management and outcome: The patient was initiated on a 12-month antitubercular therapy regimen, extended due to the disseminated nature of bone marrow TB and the patient's immunocompromised state from chronic corticosteroid use, leading to clinical improvement and resolution of cytopenia.

Discussion: This case highlights the diagnostic complexities of bone marrow TB, particularly in immunocompromised individuals, and underscores the importance of considering TB in patients with unexplained hematological abnormalities. Limited literature on this condition emphasizes the need for further research to enhance diagnostic accuracy and optimize treatment strategies.

Conclusion: Early recognition and appropriate management are crucial for improving outcomes in this rare but serious manifestation of TB.

This article reports a case of successful treatment of thoracic disc herniation using unilateral biportal endoscopy (UBE) technology. The patient was a young male presenting with thoracic and right rib pain for 9 months, worsening over the past 3 months. Preoperative examinations revealed protrusion of the T10/11 and T12/L1 intervertebral discs to the right, with localized calcification compressing the right nerve root. By enlarging the intervertebral foramen and utilizing UBE technology, we successfully removed the protruding calcified nucleus pulposus, significantly alleviating the patient's pain symptoms. The patient recovered well postoperatively. This case suggests that UBE technology can be a viable treatment option for patients with thoracic disc herniation.

Dilated cardiomyopathy presenting acutely as cardiogenic shock in a young adult is an infrequent and life-threatening condition. We present a case of a 25-year-old South Asian male without any significant past medical history, presenting with complaints of nonspecific abdominal bloating and subacute cough. Upon presentation, he was in sinus tachycardia and found to have moderate right pleural effusion, which was urgently drained. His echocardiogram revealed an ejection fraction of 15%-20%. He quickly progressed into cardiogenic shock with prerenal acute kidney injury, acute congestive hepatopathy, pancreatitis, and hypoxic respiratory failure. He required pressors and noninvasive positive pressure ventilation. He was transferred to a tertiary center, where he was placed on a left ventricle assist device and eventually had a heart transplant. The search for the cause of this dramatic acute dilated cardiomyopathy revealed a mutation in Bcl-2-associated athanogene 3 (BAG3).