Case Reports in Medicine最新文献

Ectopic spleen (ES) is a rare complication of autologous transplant following spleen injury. Autopsy studies suggest that the true incidence rate could be as high as 67%, though only 5%-10% of patients require clinical intervention. This case report describes a highly cautionary case of ES, with an extremely long latent period. The patient presented with dull lower abdominal pain 24 years after undergoing a splenectomy. An ultrasound examination revealed a round-shaped, solid mass measuring 1.6 × 2.5 cm adjacent to the right ovary. Following laparoscopic surgery, a 2.5 × 1.5 cm mass on the surface of the sigmoid colon and a 1.0 cm dark red nodule on the pelvic floor were completely removed. Pathological and immunohistochemical examinations confirmed that both lesions were splenic tissue. This case highlights the fact that the latent period of ES can last for decades. For patients with a history of splenectomy, any new pelvic or abdominal masses should be included in the differential diagnosis of ES. We urge the implementation of standardized long-term follow-up mechanisms combined with multimodal imaging techniques for a comprehensive assessment in order to effectively avoid misdiagnosis and overtreatment.

COVID-19 pandemic led to a fast vaccine design due to the threat of rapid spreading worldwide. Safety profile of the approved vaccines has been achieved mostly through clinical trials. However, some unsolicited adverse events in a longer duration of time have been recorded in addition to the late disorders known as long-COVID, stemming from classical infection. Therefore, case studies and long-term follow-up are required to enrich the current data on SARS-COV-2 infection/vaccination. In this study, two cases of autoimmune diseases induced by COVID-19 and/or vaccination were followed in three years. The profile of each is presented, and the probable cause has been discussed. The laboratory findings approved systematic lupus erythematosus and Hashimoto's thyroiditis in the studied cases. The key finding of this study is that the importance of probable autoimmune diseases flares up in individuals with a history of autoimmunity in their families which could manifest as a long-COVID symptom or late vaccination side effect.

Introduction: Interstitial cystitis (IC) is a chronic pelvic pain syndrome characterized by urinary urgency, frequency, and pain. Although the exact cause of IC is unclear, severe cases may lead to chronic kidney disease (CKD), requiring complex surgical interventions. Case Presentation: This case report presents a 46-year-old male with IC complicated by CKD secondary to total urethral stricture. Following recurrent surgeries for urinary tract infections and strictures, the patient underwent a staged surgical approach involving bilateral nephrectomy, supratrigonal cystectomy, and renal transplantation with Bricker ileal conduit diversion. Postoperatively, renal function was fully restored, and IC-related symptoms resolved. Conclusion: This case underscores the efficacy of major surgical interventions for refractory IC, highlighting the need for individualized, multidisciplinary management in complex cases.

Potassium is vital for cellular function, particularly in excitable tissues like nerves and muscles, which rely on potassium gradients to function normally. Hypokalemia can lead to severe issues such as muscle weakness and irregular heart rhythms. This case series presents four instances of hypokalemic paralysis, a neuromuscular condition that can be either periodic or isolated. The cases vary in presentation and treatment approach, highlighting the need to differentiate between primary and secondary causes of hypokalemia for optimal management. Fast and accurate diagnosis through laboratory tests and history taking is critical, and while acute management is standard, preventive strategies depend on the underlying cause. Further research is needed to establish definitive guidelines for the prevention of hypokalemic paralysis.

A 65-year-old woman presented with pneumococcal sepsis and meningitis. Despite appropriate antimicrobial therapy and intravenous (IV) dexamethasone, her mental status did not improve. Findings of brain imaging were suggestive of cerebral vasculitis. Her condition improved rapidly with the initiation of high-dose IV methylprednisolone therapy. One week after completion of a 3-week oral prednisone taper, the patient's neurocognitive deficits recurred. A more extensive diagnostic evaluation, including conventional angiography, was again consistent with a presumptive diagnosis of cerebral vasculitis. High-dose IV methylprednisolone and a more prolonged taper of oral prednisone led to remission of her disease, with marked improvement in mental status and left-sided hemiparesis. Cerebral vasculitis is a rare but potentially lethal complication of pneumococcal meningitis that may be difficult to recognize and treat. The role of brain biopsy in diagnosis is unclear, and due to its rarity, management of this condition lacks conclusive evidence-based data.

Infective endocarditis is a devastating disease with high morbidity and mortality. Infective endocarditis affecting all four valves is rarely encountered. Even rarer is the involvement of all four valves by nutritionally variant streptococci, Granulicatella. The case describes a female in her 40s, known case of small perimembranous ventricular septal defect, who presented with symptoms of fever and congestive cardiac failure, with severe anemia, glomerulonephritis, and pain abdomen, who was found to have vegetations on pulmonary, tricuspid, mitral, and aortic valves, with pulmonary regurgitation, tricuspid regurgitation, mitral, and aortic regurgitations. Blood culture grew Granulicatella adiacens species. She improved clinically after intravenous antibiotics, decongestive measures, and blood transfusion. Causation of quadrivalvular infective endocarditis is rare and previously has not been documented in Granulicatella infection, a fastidious species. Interestingly, the patient remained quite stable despite involvement of all four heart valves, likely due to the predominant involvement of the pulmonary valve. This case report discusses the factors predisposing to infective endocarditis in a known case of congenital heart disease and the importance of timely diagnosis and treatment.

The fourth heart sound (S4) is an auscultatory marker of left ventricular diastolic dysfunction (LVDD). Additionally, S4 correlates with atrial function, which is typically impaired in patients with Type 2 diabetes (T2D) but can improve with sodium-glucose co-transporter-2 inhibitor (SGLT2i) therapy. This case report highlights the dynamic changes in S4 associated with modification of SGLT2i therapy. An 83-year-old male with T2D and LVDD, confirmed via echocardiography, was treated with SGLT2i therapy for 4 years for glycemic control. The therapy was discontinued in December 2023 because of increased nocturnal urination. Two months after discontinuation, the patient developed pronounced S4, accompanied by mild chest discomfort and worsening of evening leg edema. Resumption of SGLT2i therapy led to a marked reduction in S4 along with a remarkable improvement in chest discomfort and edema within 1 month. These findings were confirmed by visual phonocardiography. This case underscores the potential utility of dynamic S4 changes as a noninvasive indicator of SGLT2i therapy adjustment. These findings highlight the novel clinical application of S4 monitoring in mitigating heart failure progression in patients with T2D.

Granuloma annulare (GA) is an inflammatory and granulomatous dermatosis characterized by annular erythematous papules/plaques frequently localized in acral regions. Proinflammatory cytokines such as tumor necrosis factor-alpha (TNF-α) and interferon-gamma (IFN-γ), which are released by T helper 1 (Th1) lymphocytes inducing macrophages, are thought to play a role in its pathogenesis. Lichen planus (LP) is an inflammatory dermatosis characterized by pruritic scaly purple papules, often on the wrists and ankles, and can also affect mucosa, hair, and nails. T-cell-mediated proinflammatory cytokines such as IFN-γ and TNF-α, which are released by macrophages upon Th1 stimulation, have been implicated in the pathogenesis of LP, as in GA. A new treatment option is needed in the treatment of these diseases due to suboptimal results and adverse side-effect profiles with conventional treatments. Apremilast is a phosphodiesterase-4 (PDE4) inhibitor and inhibits the production of various inflammatory mediators such as IFN-γ, TNF-α, IL-2, IL-5, IL-8, IL-12, and leukotriene B4. This molecule has three Food and Drug Administration (FDA) approved indications: moderate to severe plaque psoriasis, psoriatic arthritis, and oral ulcers associated with Behcet's disease. Apremilast exhibits a favorable side-effect profile compared to conventional treatments and is a good treatment option with its ability to reduce cytokines implicated in the pathogenesis of GA and LP. Here, we report the case of a 55-year-old woman in whom apremilast treatment led to an almost complete resolution of her GA and LP.

Background: Pleomorphic adenoma is the most prevalent benign tumor of the salivary glands. While it primarily affects the parotid gland, it can also arise from minor salivary glands in the soft palate. Presentation: A case of a 28-year-old female who presented with a painless, slowly enlarging mass on the soft palate was reported. CT revealed a well-circumscribed lesion measuring 2.5 × 2.0 cm. Complete surgical excision was performed, and histopathological analysis confirmed the diagnosis of pleomorphic adenoma. Conclusion: Pleomorphic adenoma of the palate is an important entity to consider in the differential diagnosis of salivary gland neoplasms. Early recognition and complete surgical removal are key to preventing recurrence and malignant transformation.

A 56-year-old female patient, with no significant comorbidities, presented with abnormal breast exam findings. Imaging revealed a 5.4-cm irregular nodule in the left breast, diagnosed as invasive breast carcinoma (NST, Grade 2). Neoadjuvant chemotherapy was initiated, leading to a reduction in lesion size. Surgical intervention included quadrantectomy, sentinel lymph node biopsy, and axillary lymphadenectomy, which revealed residual carcinoma and positive lymph nodes. Postoperatively, chylous drainage through a Portovac drain was observed, prompting reoperation, during which the injured lymphatic duct was identified. Conservative management with medium-chain triglycerides resulted in a progressive reduction of drainage. The patient was discharged on the 13th postoperative day, subsequently underwent adjuvant radiotherapy, and is currently receiving regular outpatient follow-up.