Case Reports in Medicine最新文献

A previously healthy 28-year-old woman who developed pharyngeal, pulmonary, and ocular manifestations due to Lemierre's syndrome is reported. High-grade fever, severe sore throat, neck pain, and diarrhea were the initial symptoms. Worsening of these symptoms following oral azithromycin therapy prompted the patient to present to our hospital's emergency department. Physical examination, chest X-ray, blood tests, and contrast-enhanced CT scans of the neck and chest revealed enlargement of the left palatine tonsil, thrombosis of the left internal jugular vein, multiple enlarged left cervical lymph nodes, and bilateral pulmonary consolidations, confirming the diagnosis. Admission to the intensive care unit (ICU) was required due to multiorgan failure. A combination of antibiotic therapy, anticoagulation, and surgical drainage of a left palatine tonsillar abscess was essential for a favorable outcome. After a left-sided pleural empyema was identified, a chest drainage tube was inserted for treatment. Conservative management was chosen for the ocular involvement. This case highlights the importance of maintaining a high index of clinical suspicion in primary care and emergency settings, as well as the early initiation of an appropriate antibiotic regimen, which can improve the prognosis and reduce morbidity and mortality. Its relevance is increasing, as recent guidelines for oropharyngeal infections may not adequately address this condition because of its low incidence.

Urinary tract complications can occasionally occur due to iatrogenic causes, particularly following surgical interventions for gynecological diseases. However, non-iatrogenic ureteral injuries can also occur, for example, by the cancer invasion. This study reports the case of an 83-year-old woman who was referred to our hospital for right ureteral tumor. The patient's chief complaint was macroscopic hematuria, and earlier, she had been referred to an urologist by a general physician. Right hydronephrosis and a lower ureteral tumor were observed on computed tomography and cystoscopy. Transurethral resection of the right ureteral orifice tumor had been carried out previously by an urologist. The condition was classified as urothelial cancer, Grade 2, pT1. A retroperitoneoscopic right nephroureterectomy was performed at our hospital. Extensive adhesion of the lower ureter to the surrounding tissue was detected. Consequently, the ureter, bladder cuff, and small intestine were resected en bloc. The pathological diagnosis was endometrial cancer recurrence. This is the first reported case of ureteral recurrence of the endometrial cancer. The recurrence or metastasis of endometrial cancer to the urinary tract is rare. Ureteral injuries are generally subtle; therefore, clinicians must maintain a high level of suspicion. Unrecognized or mishandled ureteral injuries might result in substantial complications. Herein, we present this rare case with some previously reported similar cases in the literature.

Interleukin-10 (IL-10) signaling is critical for intestinal immune homeostasis, and defects in this pathway underlie infantile-onset inflammatory bowel disease (IOIBD). While numerous IL-10-related mutations have been reported, their pathogenic mechanisms and genotype-phenotype correlations remain incompletely understood. Here, we describe four patients from two Chinese families with IOIBD harboring novel IL-10RA mutations. We detailed the clinical presentations and performed bioinformatics analyses to assess mutation conservation, pathogenicity, and structural impact via 3D modeling. Our findings broaden the IL-10RA mutation spectrum and provide preliminary genetic insights that may support clinical diagnosis and prenatal screening for IOIBD in Chinese populations, while also highlighting the need for further functional validation.

Introduction: Large cystic lesions of the jaws in children present unique challenges due to potential damage to developing teeth and facial structures. Traditional aggressive treatments may compromise these structures. Decompression offers a minimally invasive alternative.

Case presentation: This report describes two pediatric female patients (ages 6 and 9) in the mixed dentition phase presenting with large, asymptomatic mandibular swellings. Diagnostic assessments including clinical examination, panoramic radiography, and histopathology revealed a large cystic lesion initially suspected as odontogenic in origin and later confirmed histopathologically as an ameloblastoma involving the impacted canine and premolar in Case 2. Both lesions caused significant bone destruction and tooth displacement.

Interventions and outcomes: Both patients underwent surgical decompression under general anesthesia. Case 1 involved decompression via extraction site, while Case 2 involved decompression followed by secondary surgery for definitive treatment after initial biopsy results. Follow-up over 15-42 months showed significant radiographic bone fill, shrinkage of the cystic cavities, and successful eruption in Case 1 and preservation of the involved teeth in Case 2 of the involved permanent teeth. No nerve damage or recurrence was noted during the follow-up period.

Conclusion: Within the limitations of this report, decompression appeared to be an effective and conservative management strategy for these large mandibular cystic lesions in the mixed dentition phase, allowing for bone regeneration and preservation of developing permanent teeth.

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.