Case Reports in Medicine最新文献

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).

Clinical signs and symptoms of posterior reversible encephalopathy syndrome (PRES) include headache, altered mental state, vision loss, and seizures. Neuroradiological results exhibiting white matter abnormalities, primarily in the parieto-occipital areas of the brain, are linked to PRES. Hypertensive encephalopathy, eclampsia, renal failure, and immunosuppressive or anticancer treatment are the most common conditions associated with PRES. In the context of increasing renovascular hypertension resulting from bilateral atherosclerotic renal artery stenosis, we present a case with PRES coupled with severe hypertension. The patient's MRI brain showed extensive white matter changes consistent with the syndrome. The pathophysiology of PRES is examined, and the significance of an early diagnosis and course of therapy is underlined.

The misuse of inhaled forms of corticosteroids may expose one to oesophageal candidiasis. In our case, the patient used to rinse his mouth with water and to swallow it after each inhalation of FP. Considering their lipophilic characteristic, the laboratories should manufacture a new efficacious hydrophilic inhaled corticosteroid.

Dimethylsulfoxide (DMSO) is often used for freezing hematopoietic stem cells. DMSO is associated with mild side effects and rarely serious side effects such as anaphylaxis. We present a patient with acute anaphylaxis after DMSO and patient management.

This report underscores the urgent necessity of early and accurate diagnosis in cases of aortic dissection (AD) with atypical presentations. A 76-year-old male presented to Al-Zahra Hospital in Isfahan, Iran, with a 7-day history of left flank pain radiating to the left testicle and groin, accompanied by fever, hematuria, and dysuria. Initial assessments, including a kidney and urinary tract ultrasound, revealed severe left kidney hydronephrosis and free fluid, leading to a preliminary diagnosis of pyelonephritis with a possible abscess. Broad-spectrum antibiotics were promptly administered. However, a subsequent CT scan revealed a retroperitoneal hematoma, prompting a CT angiography (CTA), which confirmed an abdominal AD. Despite rapid surgical intervention, the patient succumbed to cardiac arrest. This case highlights the critical importance of vigilance and thorough investigation in patients with atypical symptoms to prevent potentially fatal misdiagnoses.

Dermatomyositis is an autoimmune disease. Common treatment with glucocorticoids, immunoglobulins, methotrexate, and rituximab is recommended. Telitacicept is an immunosuppressant that has been approved for the treatment of systemic lupus erythematosus in recent years. Considering the mechanism of action of telitacicept and the pathogenesis of dermatomyositis, it is rational to suppose that telitacicept may be useful in treating dermatomyositis. Here, we describe a case of a 65-year-old male patient with erythema on the face and neck, limb weakness, and edema in both upper and lower limbs. After conventional treatment therapy plus telitacicept, the patient showed significant clinical remission during the maintenance treatment. Methylprednisolone was successfully reduced after injections of telitacicept. After 1 year of follow-up, the patient's clinical symptoms were improved dramatically. This is the first report indicating that telitacicept is effective for dermatomyositis and it deserves attention.