Case Reports in Medicine最新文献

Hodgkin lymphoma (HL) is a type of lymphoma, characterized by the presence of abnormal Reed-Sternberg cells. It typically affects lymph nodes, generally in the upper body (such as neck, chest, and armpits). It can also involve the spleen, liver, and bone marrow. In the literature, there are sporadic cases of atypical localization of HL. The aim of this article is to report a peculiar case of HL in a 55-year-old male presenting with primary epitrochlear lymphadenopathy as the only localization of disease, also performing a literature review on this atypical presentation. We also summarized the possible underlying malignant pathologies that arise from the soft tissues of the upper limb adjacent to the elbow.

Background: Inguinal hernia is one of the most common causes of surgeries around the world; however, the herniation of the urinary bladder as a recurrence in this region is rare. It can have urinary symptoms with pain and protrusion in the inguinoscrotal region. Case Presentation: We report the case of a 65-year-old Iranian male patient who presented with obstructive urinary symptoms and a reducible protrusion in the right inguinoscrotal region. The patient underwent a successful repairment operation in a laparoscopic manner without any intra- or postoperative complications. Also, here, we review the risk factors, symptoms, and paraclinics that should be noted regarding the inguinal hernia with visceral organ protrusion. Conclusion: Clinicians must be aware of different symptoms of herniated organs in the inguinal region to avoid unwanted complications.

Female fertility decline with age presents a challenge to successful IVF outcomes. The rising trend of delayed family planning due to societal changes has led to increased demand for reproductive assistance among older women. Despite clinical and scientific advances in Assisted Reproductive Technology, age remains a barrier to successful outcomes mainly due to declining oocyte quality and quantity, leading to decreased fecundity rates and increased miscarriage risks. This report highlights an exceptional case of a women aged 46 achieving live birth through IVF using her own oocytes. Notably, awareness among women about the profound effect of age on fertility remains insufficient. Educating women about these age-related reproductive challenges is crucial. Oocyte cryopreservation emerges as a potential strategy, while egg donation stands as a pragmatic alternative. However, the probability of live birth among women at the extremes of reproductive age using their own oocytes is low, at 0.3%. It is important to approach this case report with caution to avoid unrealistic expectations among women aged 45 or older seeking IVF services.

Background: Malaria poses a significant public health challenge, especially in pregnant women, due to potential complications for both mother and fetus. The occurrence of pancytopenia as an initial manifestation of acute Plasmodium vivax malaria is extremely rare, with most cases reported in Plasmodium falciparum (P. falciparum) malaria infections. To the best of our knowledge, there are no documented cases of pancytopenia due to hemophagocytic syndrome (HPS) associated to P. vivax malaria in pregnant women. Case Presentation: A 22-year-old gravida one woman from Debre Berhan, Ethiopia, who was nine weeks pregnant, presented with a high-grade fever, headache, nausea, vomiting, joint pain, and fatigue lasting for 1 week. She had recently traveled to a malaria-endemic region. Upon examination and investigation, she was found to be hypotensive and febrile, with pale conjunctiva, hepatosplenomegaly, and pancytopenia, along with elevated levels of triglycerides and serum ferritin. Blood smear analysis showed the trophozoite and gametocyte stages of P. vivax. She was diagnosed with HPS based on clinical criteria. The patient achieved full recovery following antimalarial and supportive treatment. Conclusion: This case highlights a rare but serious presentation of P. vivax malaria in a pregnant woman, characterized by HPS and resultant pancytopenia. Timely diagnosis and effective treatment are crucial for achieving good outcomes for both the mother and the fetus, highlighting the importance of increased awareness in clinical practice.

Schistosomiasis is one of the neglected tropical diseases caused by parasitic worm infections of the genus Schistosoma. Involvement of the brain in schistosomiasis represents a particularly severe manifestation of the infection. Accurate diagnosis and appropriate treatment of cerebral schistosomiasis are essential, especially in our healthcare facility located in a remote area of Indonesia, where available resources are highly limited. We reported a 31-year-old female patient complaining of tonic-clonic convulsions. Before experiencing seizures, the patient reported experiencing headaches for 6 months. The patient's anamnesis regarding her social life revealed that she has been employed on a plantation for 15 years; the plantation serves as a natural habitat for snails, intermediate hosts for Schistosoma sp. Serological examinations were not performed due to the constraints of diagnostic instruments in the region. Cerebral schistosomiasis diagnosis was verified based on biopsy, stool examination, and CT scan results. She was admitted with a combination of steroids and praziquantel at a dosage of 60 mg/kg single dose. She was released after 14 days in satisfactory overall health. The follow-up CT scan revealed improvement, corroborated by the patient's clinical recovery. This report emphasizes the diagnostic obstacles associated with cerebral schistosomiasis, particularly in remote regions and resource-limited settings in Indonesia. Despite the absence of serological testing, a definitive diagnosis was successfully established through radiological imaging, stool microscopic examination, and brain tissue biopsy (histopathological analysis) which revealed Schistosoma eggs surrounded by granulomatous inflammation. The patient presented with space-occupying brain lesions and neurological symptoms, but without hepatic involvement, making the diagnosis less straightforward. This case illustrates the significance of recognizing cerebral schistosomiasis as a differential diagnosis in patients presenting cerebral lesions in endemic locations. Diagnosis of cerebral schistosomiasis based on a detailed social occupational history correlated with radiological imaging, stool microscopic examination, and brain tissue biopsy (histopathological analysis) is essential when other diagnostic tools (serological testing) are unavailable.

Chronic kidney disease (CKD) is a global health concern characterized by the gradual loss of renal function as seen by the decline of the estimated glomerular filtration rate (eGFR). While hypertension is a well-documented risk factor for CKD progression, the influence of hypotension on this condition remains less explored. Hypotension is an independent predictor of CKD progression. Patients experiencing hypotension show a significantly faster and steadier decline in the eGFR when compared to the normotensive CKD patients. Notably, the use of antihypertensive medication and diuretics is associated with a higher likelihood of hypotension. We have seen several cases where tapering down or completely stopping antihypertensive medications, as well as treating orthostatic hypotension, has resulted in improved CKD and renal function. These findings highlight the importance of monitoring blood pressure levels in CKD patients, as hypotension may contribute to an accelerated decline in renal function and increased morbidity. These case studies aim to investigate the sustained improvement of the eGFR from avoiding chronic episodic hypotension by adjusting blood pressure medications for a duration of 2-5 years.

Background: Lithium, commonly used in the treatment of bipolar disorders, is primarily known for causing neurological and renal side effects. However, cardiac side effects are rarely reported. Case Summary: We present a case of chronic lithium toxicity in an 80-year-old woman. The patient was admitted to the emergency room due to loss of consciousness. Initial evaluation revealed severe sinus bradycardia as a presentation of sinus node dysfunction on the electrocardiogram, prompting the insertion of a pacemaker. During her admission to the critical care unit, it was discovered that the patient had been undergoing long-term lithium treatment without medical supervision. The serum lithium level confirmed lithium intoxication. Following the discontinuation of lithium, both neurological and cardiac manifestations of lithium toxicity resolved. After the pacemaker was removed, the patient was discharged in stable condition. Discussion: Lithium has a narrow therapeutic range, which can lead to toxicity in the absence of routine monitoring. Lithium toxicity can cause serious cardiac effects and rhythm disturbances that are often overlooked because these manifestations are rare. Cardiac manifestations include arrhythmias, bradycardia, collapse, hypotension, myocardial infarction, and even death. Additionally, lithium toxicity can present with various electrocardiographic abnormalities such as T-wave inversion, sinoatrial block, PR interval prolongation, QT prolongation/dispersion, and ventricular tachyarrhythmias. Clinicians should be aware of the potential cardiac effects of lithium toxicity and consider it in patients undergoing lithium treatment. A thorough understanding of these manifestations is essential, as the wide range of symptoms can be misleading without adequate knowledge.

Background: Oroantral communications (OACs) are pathological openings between the oral cavity and the maxillary sinus, often resulting from dental extractions. If not treated promptly, they may lead to sinus infections and persistent oroantral fistulas (OAFs). Objective: This report aims to present a minimally invasive technique for the closure of OACs using flowable composite resin stabilized within a network of crossing sutures and to assess its clinical efficacy. Case Descriptions: Two male patients, aged 27 and 31, presented with OACs measuring 8 mm and 6 mm in diameter following maxillary molar extractions. Both cases were managed within 24-48 h postextraction. Intervention: Under local anesthesia, the extraction sockets were sutured using absorbable threads, creating a cross-matrix over the alveolus. Flowable composite resin was then applied into and over this suture network to form a sealing layer. The material was light-cured, and a secondary application was performed following socket curettage to promote stable blood clot formation. In this technique, the flowable composite is mechanically stabilized within the network of crossing sutures, which enhances the retention of the material, ensures effective sealing of the OAC, and supports a more predictable and secured healing process. Outcomes: In both cases, healing was uneventful, with complete closure of the OAC and no signs of sinusitis or fistula formation. Follow-up at 8 and 9 months confirmed successful mucosal healing and radiographic bone regeneration. Conclusion: The fixation of flowable composite within a suture matrix offers a novel, cost-effective, and reproducible technique for the immediate closure of small-to-moderate OACs. This approach enhances mechanical stability, improves sealing, and facilitates predictable healing while avoiding more invasive surgical interventions.

Background and Aims/Introduction: Mad honey disease is caused by consuming honey containing grayanotoxanes-neurotoxins found in certain species of Rhododendron plants. Mad honey, derived from the nectar of these plants, can cause significant cardiovascular and neurological symptoms. While most cases are reported in regions where it is produced, extensive travel among diverse expatriate communities in various global regions is one of the factors that may contribute to cases occurring in nonendemic areas. Other factors leading to its increased demand include the global demand for its recreational and medicinal use, as well as its reputation as an aphrodisiac. Our case report on mad honey disease aims to raise awareness of this condition, highlight its clinical presentation and management, and emphasize the possibility of its occurrence outside endemic regions. Case Presentation: A 40-year-old Nepalese male living in Qatar presented with dizziness, hypotension, and severe bradycardia a few hours after consuming approximately 50 g of imported mad honey from Nepal. His admission ECG revealed sinus bradycardia without evidence of heart block. Initial stabilization was achieved with 0.5 mg of atropine and a norepinephrine infusion. The patient's symptoms resolved with supportive care while he was closely observed in the intensive care unit. He was discharged symptom free after 24 h. Conclusion: This case, to the best of our knowledge, represents the first reported incidence of mad honey disease in Qatar, emphasizing the importance of recognizing this rare condition in nonendemic areas. Proper history-taking, particularly with a focus on food and ingestion history, along with a high index of clinical suspicion, is crucial for timely diagnosis and management. While unintentional and accidental overdose and poisoning, as occurred in our case, may happen sporadically, the widespread use and import/export of mad honey necessitates stringent measures and precautions, similar to those adopted by various countries.

Scurvy, caused by vitamin C deficiency, is increasingly recognized in contemporary clinical practice, particularly among vulnerable populations. Despite its historical association with maritime exploration, scurvy persists in patients with malnutrition, alcoholism, psychiatric disorders, and limited access to fresh produce. This report presents two cases of scurvy diagnosed in a low socioeconomic urban setting, emphasizing the diverse and atypical manifestations of this condition. The first case involves a 76-year-old female presenting with altered mental status and pulmonary hypertension, ultimately attributed to severe vitamin C deficiency. Echocardiography revealed a pulmonary artery pressure of 36 mmHg and severe tricuspid regurgitation. A thorough evaluation, combined with evidence of malnourishment and neuropsychiatric symptoms, led to the diagnosis of scurvy, confirmed by undetectable serum vitamin C levels. High-dose intravenous vitamin C supplementation resulted in marked clinical improvement and resolution of cardiopulmonary abnormalities. The second case describes a 68-year-old male with alcohol use disorder presenting with syncope, anemia, and systemic inflammation. Laboratory tests revealed leukocytosis, acute kidney injury, elevated ferritin, and undetectable iron-binding capacity. A nutritional workup identified severe vitamin C deficiency (0.2 mg/dL). Oral vitamin C supplementation improved inflammatory markers, anemia, and general well-being. These cases highlight the importance of considering scurvy in patients with unexplained systemic symptoms and malnutrition. Early diagnosis and prompt treatment with vitamin C supplementation can lead to full recovery and prevent severe complications. Clinicians should maintain a high index of suspicion for scurvy, especially in at-risk populations with atypical clinical presentations.