Journal of medical cases最新文献

{"title":"An Unusual Entity in Urology: Urinary Bladder Paraganglioma.","authors":"Ignacio Calleja Duran, Jose Emilio Hernandez Sanchez, Oana Beatrice Popescu","doi":"10.14740/jmc5145","DOIUrl":"10.14740/jmc5145","url":null,"abstract":"<p><p>Bladder paraganglioma accounts for < 0.05% of all bladder tumors, and very few cases have been reported to date. Because clinical and radiological findings are often nonspecific, many lesions are misdiagnosed until surgery, exposing patients to preventable perioperative catecholamine crises. We report an unusual case of a 77-year-old woman, in whom a 17-mm bladder paraganglioma was discovered incidentally during imaging for suspected Crohn's disease. The patient was entirely asymptomatic and had normal catecholamine levels. Transurethral resection of the bladder (TURB) achieved complete excision, and no recurrence was detected at 6-month follow-up. This case illustrates that bladder paraganglioma can occur outside the typical age range and without adrenergic symptoms, emphasizing the need to consider this entity in the differential diagnosis of any well-circumscribed, hypervascular bladder mass. Early recognition enables appropriate perioperative planning and long-term multidisciplinary surveillance. We discuss the tumor's characteristics, management, and the importance of long-term surveillance.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"16 8","pages":"287-292"},"PeriodicalIF":0.9,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144994879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Successful Treatment of Hemifacial Spasm After Flow Diverter Stent Placement for Ipsilateral Internal Carotid Artery Saccular Aneurysm.","authors":"Ferda Selcuk Muhtaroglu, Belin Kamiloglu, Musa Muhtaroglu","doi":"10.14740/jmc5165","DOIUrl":"10.14740/jmc5165","url":null,"abstract":"<p><p>Hemifacial spasm (HFS) is a neurological disorder characterized by involuntary, paroxysmal contractions of the muscles innervated by the facial nerve on one side of the face. While primary HFS is most often caused by vascular compression at the root exit zone (REZ) of the facial nerve, secondary causes such as tumors, arteriovenous malformations, and intracranial aneurysms are rare. The management of HFS due to aneurysmal compression remains challenging, and the literature on endovascular treatment, particularly with flow diverter stents, is limited. We report the case of a 56-year-old woman with a history of diabetes mellitus type 2, hypertension, and hypercholesterolemia, who presented with progressive right-sided HFS. Imaging revealed a saccular aneurysm of the right internal carotid artery (ICA) at the cavernous-ophthalmic segment. The patient underwent successful endovascular treatment with a Derivo embolization device (DED) flow diverter stent. Her HFS resolved completely post-procedure, with no neurological deficits or recurrence at 6-month follow-up. This case highlights the efficacy of flow diverter stent placement for HFS caused by ICA saccular aneurysm and represents the first such report from Northern Cyprus. The case underscores the importance of considering secondary etiologies in atypical HFS and demonstrates the therapeutic potential of endovascular flow diversion in this context.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"16 8","pages":"323-329"},"PeriodicalIF":0.9,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404114/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144994932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcatheter Arterialization of the Deep Veins for Chronic Limb-Threatening Ischemia: A Case Series of the Direct Cost Associated With Limb Salvage.","authors":"Aldin Malkoc, Xinfei Miao, Lana Mamoun, Catherine Lai, Raja GnanaDev, Michelle Lee, Samuel Lee, Samuel Schwartz","doi":"10.14740/jmc5155","DOIUrl":"10.14740/jmc5155","url":null,"abstract":"<p><p>Our study aims to estimate the long-term cost of procedurally successful transcatheter arterialization of the deep veins (TADV) coupled with adjunct therapy. Patients with no conventional endovascular/open options were considered for TADV. TADV index procedure cost, cost of subsequent procedures and wound care/adjuncts were collected. Cost data were obtained from Medicare claims and other published sources. All patients in the study had limb salvage 180 days after TADV. Success was defined as lime salvage with no more than a transmetatarsal amputation of the affected limb. The average cost of the procedure was $320,850. The average hospital cost (hospitalization and wound care adjuncts) was $895,546. The overall average total cost was $1,216,396. TADV and associated multidisciplinary wound care approach for \"no option\" chronic limb-threatening ischemia does not appear to be a cost-effective strategy, with an average total cost of over 1 million dollars per patient.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"16 8","pages":"318-322"},"PeriodicalIF":0.9,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144994887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extended-Hours Hemodialysis Without Dietary Restrictions Reduces Risk of Vascular Calcification.","authors":"Hiroshi Kaneda, Toshiro Nishiyama, Kazunori Owada, Koichi Katayose, Yutaka Takagi, Katsuhiko Suzuki, Fumika Kaneda","doi":"10.14740/jmc5146","DOIUrl":"10.14740/jmc5146","url":null,"abstract":"<p><p>Vascular calcification is common in dialysis patients and is severely associated with cardiovascular morbidity and mortality. They have mineral metabolism disorders, which are considered to promote vascular calcification. In addition, hypertension and malnutrition, both prevalent in dialysis patients, are also considered risk factors contributing to vascular calcification. Our clinic has implemented extended-hours hemodialysis without dietary restrictions to solve the problems of hypertension and malnutrition in dialysis patients. We report a case where aortic calcification was slight despite 34 years of long-term dialysis. He underwent his first computed tomography (CT) scan of the chest and abdomen 29 years after initiating hemodialysis to evaluate his kidney transplant. The abdominal aortic calcification index 29 years after initiating dialysis was low at 5.8%, and even after 5 years, it was only 6.7%. The coronary artery calcification score was moderate at 214.0, but the degree of vascular calcification appeared milder than in conventional dialysis patients. His dialysis modality is unique. He began extended-hours hemodialysis without dietary restrictions 1.5 years after his transfer to our clinic, extending his dialysis time to 6 h. He gradually increased it to 10 h, and the dietary restriction was significantly relaxed. Moreover, he has been undergoing this treatment for about 26 years. His muscle mass increased, and his nutritional status remained adequate. The mean serum phosphorus and calcium levels were within the normal range (5.4 ± 0.5 mg/dL and 8.8 ± 0.3 mg/dL), and the calcium-based phosphate binder was successfully reduced and eventually discontinued. Furthermore, the blood pressure normalized without the use of antihypertensive medications. These may have removed some of the risk factors for vascular calcification. Recent studies suggest that extended-hours hemodialysis without dietary restrictions significantly lowers calciprotein particle levels, a risk factor for vascular calcification, compared to conventional dialysis. In conclusion, extended-hours hemodialysis without dietary restrictions may reduce the risk of vascular calcification by improving control of malnutrition, hypertension, and mineral metabolism.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"16 8","pages":"300-308"},"PeriodicalIF":0.9,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144994884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When the Tumor Leaves but the Damage Lingers: A Case of Delayed Cardiomyopathy Recovery Post-Paraganglioma Resection.","authors":"Josephine Ria Pitasari, Sajjad Gul, Jerry Kenmoe, Ahmad Munir","doi":"10.14740/jmc5166","DOIUrl":"10.14740/jmc5166","url":null,"abstract":"<p><p>Catecholamine-induced cardiomyopathy secondary to paraganglioma is a rare and potentially reversible condition. However, the course of recovery post-resection remains variable and may be delayed despite biochemical cure. We present the case of a 47-year-old male with biopsy-confirmed extra-adrenal paraganglioma who developed acute decompensated heart failure due to catecholamine-induced cardiomyopathy (left ventricular ejection fraction (LVEF) 30-35%) and multiorgan dysfunction. Despite successful surgical resection, his LVEF remained reduced postoperatively, and he was discharged on heart failure therapy and a wearable cardioverter defibrillator. A follow-up echocardiogram showed improvement in LVEF to 45% 2 weeks later, but his blood pressure remained poorly controlled despite adherence to a multi-drug regimen and lifestyle measures. He was readmitted with a transient ischemic attack (TIA) shortly after surgery. This case illustrates the variable recovery trajectory in paraganglioma-induced cardiomyopathy and highlights persistent cardiovascular risks, including resistant hypertension and cerebrovascular events despite biochemical cure. It emphasizes the importance of ongoing cardiac surveillance and multidisciplinary management, particularly in patients facing socioeconomic barriers to follow-up care.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"16 8","pages":"282-286"},"PeriodicalIF":0.9,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144994969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dengue Virus Transmission via Deceased Renal Allograft: A Case Report Highlighting the Need for Donor Screening in Endemic Areas.","authors":"Muhammad Abdul Mabood Khalil, Nihal Mohammed Sadagah, Alfatih Abdalla Altom, Ahmed Abdelahad Basha, Hinda Hassan Khideer Mahmood, Hisham Ismael Mohamed Sakran, Ibrahim Mohammed Nasser Assiri, Ghaleb Anas Aboalsamh, Salem H Al-Qurashi","doi":"10.14740/jmc5140","DOIUrl":"10.14740/jmc5140","url":null,"abstract":"<p><p>Dengue virus infection (DVI) has multiple routes of transmission. Modes of transmission include mosquito bites, perinatal transmission, blood transfusions, organ transplantation, needle stick injuries, or laboratory accidents. DVI in kidney transplant recipients is common in an endemic area. In an endemic area, it is usually caused by a mosquito bite. Solid organ transplantation, including the kidney, has been implicated in the transmission of DVI in the immediate post-transplant period. We describe a case of end-stage renal disease in which the patient got DVI immediately after getting a kidney from a deceased kidney donor. Our patient presented with fatigue and pain around the graft, anemia, thrombocytopenia, coagulopathy, hepatitis, and was found to have a hematoma around the graft. The recipient of the second kidney from the same donor also presented with fever and was found to have dengue. We describe our experience with managing our case, along with a detailed literature review of similar cases transmitted through renal allograft.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"16 8","pages":"293-299"},"PeriodicalIF":0.9,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404104/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144994882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Clinical Case of Methotrexate Toxicity.","authors":"Ana Cristina Peixoto, Rodrigo de Almeida Mota, Ana Luisa Maceda Rodrigues, Margarida Miguel Paraiso, Leila Amaro Cardoso, Jorge Almeida","doi":"10.14740/jmc5159","DOIUrl":"10.14740/jmc5159","url":null,"abstract":"<p><p>Methotrexate is a commonly prescribed immunosuppressant and chemotherapy agent, carefully monitored by healthcare providers due to its potential adverse effects. As a result, methotrexate toxicity is relatively rare. We present the case of a 79-year-old man followed in rheumatology for symmetrical polyarthralgia, who inadvertently took methotrexate 10 mg daily, instead of weekly, leading to methotrexate toxicity. The patient presented with erosive mucositis affecting the lateral tongue, buccal mucosa, and hard palate, as well as pustular lesions on the scalp (occipital and cervical regions) extending to the trunk. Laboratory findings revealed pancytopenia and transaminitis, and upper gastrointestinal endoscopy showed erythema and superficial ulcerations in the oropharyngeal region. Methotrexate was discontinued immediately, and the patient was treated with intravenous fluids, filgrastim, and supportive care. This case highlights the importance of early recognition of methotrexate toxicity, as well as the critical role of patient education. It underscores how easily a medication with numerous therapeutic benefits can cause serious adverse outcomes if not taken as prescribed. Effective communication between healthcare providers and patients is essential to ensure medication safety.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"16 8","pages":"314-317"},"PeriodicalIF":0.9,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404118/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144994929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Benralizumab in a Patient With Refractory Eosinophilic Endocarditis.","authors":"Hanna M Schultz, Daniel Valdes, Ronald R Butendieck, Candido E Rivera","doi":"10.14740/jmc5168","DOIUrl":"10.14740/jmc5168","url":null,"abstract":"<p><p>Hypereosinophilic syndrome (HES) is a hematologic disorder characterized by an increased absolute eosinophil count (AEC) that can lead to tissue infiltration and damage. Idiopathic HES (iHES) comprises a subset of patients with HES, in which a reactive cause such as infections or an inflammatory process cannot be identified, and clonality is not demonstrable. iHES remains a challenge to treat since there is no specific mutation to target. Interleukin-5 (IL-5) is a cytokine responsible for the proliferation and maturation of eosinophils. Anti-IL-5 and anti-IL-5 receptor therapies represent recent advancements in the management of these disorders. A 25-year-old female developed transient and recurrent visual deficits lasting several minutes at a time. Marked peripheral blood eosinophilia was noted. Over a year, she developed Loeffler's endocarditis (LE), leading to microvascular ischemic strokes and heart failure due to mitral valve infiltration. The patient needed an urgent mitral valve replacement. Multiple lines of standard eosinophil-lowering agents were tried and appeared ineffective or could not be maximally dosed due to hematologic dose-limiting toxicity. Benralizumab (Fasenra^®) is an IL-5 receptor antagonist indicated for eosinophilic asthma and eosinophilic granulomatosis with polyangiitis (EGPA) but not Food and Drug Administration (FDA)-approved for other HESs. Off-label benralizumab was tried, and her eosinophil count normalized within a week, allowing hemodynamic stability for a mitral valve replacement. After a year of continued bimonthly treatment with off-label benralizumab, her eosinophil count remains within normal limits, resulting in stabilization of her cardiac parameters. Off-label benralizumab treatment was effective in controlling our patient's eosinophilic counts and preventing further cardiac injury. Benralizumab should be considered earlier in the treatment of LE, particularly when rapid control of the eosinophil count is needed.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"16 8","pages":"271-276"},"PeriodicalIF":0.9,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144994913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thinking Outside the Box: Case Report of a Rare Quadricuspid Aortic Valve as an Underrecognized Cause of Heart Failure and Atrial Fibrillation.","authors":"Klevis Mihali, Birgit Markus, Bernhard Schieffer, Marcus Bauer, Julian Kreutz","doi":"10.14740/jmc5153","DOIUrl":"10.14740/jmc5153","url":null,"abstract":"<p><p>Quadricuspid aortic valve (QAV) is a rare congenital anomaly with an estimated incidence of 0.008% to 0.043% based on autopsy and echocardiographic studies. Although often asymptomatic, it can lead to progressive aortic regurgitation (AR), left ventricular (LV) dysfunction, and arrhythmias such as atrial fibrillation (AF). Due to its rarity, QAV is often misdiagnosed or discovered incidentally, highlighting the need for advanced cardiac imaging in young patients presenting with unexplained heart failure symptoms and arrhythmias. We present the case of a 41-year-old female patient who was admitted with new-onset dyspnea classified as New York Heart Association (NYHA) class III and palpitations due to persistent AF with a European Heart Rhythm Association (EHRA) symptom class 2b. There was no family history of congenital or structural heart disease, with arterial hypertension being the only identified predisposing condition. Initial transthoracic echocardiography revealed moderate AR, but more detailed transesophageal echocardiography performed before pulmonary vein isolation incidentally revealed a QAV. Further cardiac magnetic resonance imaging confirmed normal aortic root dimensions with early LV remodeling. The patient was managed conservatively with rate control, anticoagulation, and regular follow-up to monitor disease progression. This case highlights the importance of advanced imaging techniques in the diagnosis of rare structural heart abnormalities in young patients presenting with unexplained heart failure symptoms and arrhythmias. Early identification of QAV allows for timely medical intervention, optimal patient monitoring, and prevention of long-term complications. Regular follow-up is essential to monitor disease progression and determine the need for surgical intervention.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"16 8","pages":"277-281"},"PeriodicalIF":0.9,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404117/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144994950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Secondary Central Nervous System Lymphoma Involving Meninges: A Rare Case Report and a Comprehensive Review of Peripheral T-Cell Lymphoma, Not Otherwise Specified.","authors":"Mrudula Thiriveedi, Muralidhar Idamakanti, Siddharth Patel, Rafik ElBeblawy, Sujatha Baddam, Bala Nimmana, Virginia Dailey, Rishi Patel","doi":"10.14740/jmc5149","DOIUrl":"10.14740/jmc5149","url":null,"abstract":"<p><p>Peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS), is a rare and aggressive subtype of non-Hodgkin lymphoma (NHL) that arises from mature T or natural killer (NK) cells, accounting for about 5% of all NHL cases. While PTCL-NOS typically involves lymph nodes, extranodal sites such as the skin, gastrointestinal tract, liver, and lungs can also be affected. Central nervous system (CNS) involvement is extremely rare, especially at the time of initial presentation. When it does occur, the brain is most commonly affected, followed by the spinal cord and meninges. We present a rare case of PTCL-NOS with secondary CNS lymphoma involving the meninges at initial diagnosis. Our patient is a 75-year-old male with multiple comorbidities who presented with several weeks of intermittent headaches. Imaging showed multiple extra-axial brain lesions with infiltration into extracranial soft tissues, epidural space, meninges, and brain parenchyma. A subsequent lymph node biopsy confirmed PTCL-NOS. He was started on rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP), with plans for high-dose methotrexate. Thereafter, the patient was readmitted several times due to various complications and expired approximately 2.5 months after diagnosis. We conclude that secondary CNS involvement in PTCL-NOS is very rare and has a poor prognosis, with a median survival after CNS diagnosis of about 1.1 months. Early diagnosis and tailored treatment strategies, including CNS-penetrating agents, are essential. Continued research is needed to better understand and improve outcomes for this aggressive disease.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"16 7","pages":"259-266"},"PeriodicalIF":0.9,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12292011/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}