Case Reports in Medicine最新文献

Survivors of renal cell carcinoma (RCC), especially following nephrectomy, require long follow-up for recurrence or systemic complications. While those with a history of RCC develop pulmonary nodules often with concern for metastasis, we must consider infectious diseases, especially in patients with environmental exposures and immune alterations related to metabolic changes secondary to nephrectomy. We report a 49-year-old male with a history of RCC status postnephrectomy, history of long-term smoking, and history of significant coal dust exposure, who developed progressive pulmonary nodules. Although initially suspected to be metastatic RCC (mRCC), serial imaging demonstrated nodule enlargement without metabolic activity on PET scan, requiring further evaluation. Given the persistent respiratory symptoms, he underwent bronchoscopy with microbiologic analysis which identified Aspergillus fumigates and was ultimately diagnosed with chronic pulmonary aspergillosis. Our patient was successfully treated with voriconazole and over time demonstrated significant clinical improvement. In this case, we have made the observation of the diagnostic dilemma presented by the pulmonary nodules in RCC survivors and the importance of a broad differential to avoid misdiagnosis. Immune changes following nephrectomy, possible accompanying chronic kidney disease (CKD), or prolonged oncologic surveillance could place patients at risk for opportunistic infections. In order to ensure timely detection and treatment of infections that may mimic tumor progression, clinicians treating RCC survivors should integrate microbiologic diagnostics into routine pulmonary evaluations.

Introduction: Cytomegalovirus (CMV) retinitis typically occurs in patients with acquired immunodeficiency syndrome. It may also manifest in patients with hematological diseases, mostly after allogeneic hematopoietic cell transplantation. However, its incidence in multiple myeloma remains exceedingly rare, with only 15 reported cases in the literature. Case Report: A 71-year-old man diagnosed with multiple myeloma achieved complete response following treatment with daratumumab, lenalidomide, and dexamethasone. After 2 years of therapy, he developed CMV retinitis. Systemic antiviral treatment led to improved visual acuity, and antimyeloma treatment was successfully resumed with reduced intensity of chemotherapy. Conclusion: CMV reactivation is increasingly being reported with the development of new treatment strategies for multiple myeloma and is considered a significant drug-related clinical complication. We reviewed previous reports and discussed the incidence and optimal management of CMV reactivation in this patient population.

Duplex kidneys, though relatively uncommon (occurring in 1%-4% of the cases), can pose significant clinical challenges when associated with urinary tract symptoms. Complications requiring intervention include stone formation, urinary obstruction, and reflux disease. We present the case of a 22-year-old male with complete duplex right kidney with upper moiety hydronephrosis due to a distal ureteral stone, diagnosed by ultrasonography and confirmed with intraoperative retrograde pyelography (RPG). Definitive management was achieved via ureteroscopy (URS) lithotripsy.

Oral and maxillofacial space infection (OMSI) progresses rapidly, and when combined with diabetic ketoacidosis (DKA), it can become a serious and life-threatening condition. Cases of OMSI with concurrent DKA are relatively rare. This case report describes a young man who developed OMSI caused by methicillin-resistant Staphylococcus aureus in the setting of DKA. A 21-year-old man presented with swelling and pain in the right lower lip that had persisted for four days; the symptoms were both atypical and severe. Based on the patient's clinical course, hyperglycemia may play an important role in the onset and progression of OMSI in young individuals. It is essential to identify the underlying cause of OMSI and to closely monitor clinical signs for timely intervention.

Exogenous lipoid pneumonia (ELP) is a rare disease with both acute and chronic forms. This paper primarily summarizes the diagnosis and treatment process of bronchoalveolar lavage combined with glucocorticoids treatment of acute ELP caused by aspiration of liquid hydrocarbons (e.g., kerosene and diesel fuel) at our hospital. Furthermore, the present study analyzes the advantages of bronchoalveolar lavage combined with glucocorticoids treatment of acute ELP.

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.