Journal of medical cases最新文献

{"title":"Gastric Schwannoma: A Rare Cause of Gastric Bleeding.","authors":"Daniela Pato Pais, Sara Andrade, Ines Bertao Colaco, Margarida Luis, Nuno Azenha, Ana Couceiro, Jose Valente Cecilio","doi":"10.14740/jmc4312","DOIUrl":"10.14740/jmc4312","url":null,"abstract":"<p><p>Gastric schwannomas and gastrointestinal stromal tumors (GISTs) are two types of mesenchymal tumors, which represent a group of rare tumors of the gastrointestinal tract. The differential diagnosis between these two tumors is difficult given their very similar appearance and clinical features. The authors present a case of a 63-year-old man with melena and epigastric pain. An upper digestive endoscopy was performed, revealing an ulcerated gastric subepithelial lesion suspected to be a GIST. Further imaging with a computed tomography (CT) scan revealed a well-defined hypodense solid nodular mass, with homogeneous enhancement, measuring 22 × 18 mm, on the anterior wall of the transition between the body and gastric antrum, situated within the submucosal layer. The patient subsequently underwent a laparoscopic atypical gastrectomy, which proceeded without complications. The pathological examination of the excised lesion confirmed it to be a gastric schwannoma, with complete excision. This case report illustrates a rare cause of gastrointestinal bleeding, that requires immediate action, and <i>en bloc</i> resection is usually curative. Given the excellent prognosis after complete resection, a correct diagnosis is essential.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"15 12","pages":"371-375"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11602179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752671","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":"New Onset of Type 1 Diabetes Mellitus Post-COVID-19 Vaccine.","authors":"Khaled H Aburisheh, Hamza M K Enabi, Nora A Alodah, Bassam H Alotary, Linah A Algheryafi, Ayman M Almairi, Amani A Aldhewaila","doi":"10.14740/jmc4307","DOIUrl":"10.14740/jmc4307","url":null,"abstract":"<p><p>Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with an increased morbidity and mortality worldwide. Coronavirus disease 2019 (COVID-19) vaccines have shown high efficacy in preventing the infection but with many possible side effects such as hyperglycemia. New-onset diabetes mellitus (DM) and severe metabolic complications have been reported post-vaccination. Here we report a 45-year-old woman who came to the hospital complaining of polyurea, polydipsia, and weight loss 3 weeks after the first activation dose of COVID-19 vaccine. Her hemoglobin A1c (HbA1c) upon presentation was 9% without any prior history of DM. She was diagnosed with type 1 diabetes mellitus (T1DM), as the anti-glutamic acid decarboxylase (GAD) antibody was positive and complicated during follow-up with diabetic ketoacidosis (DKA). This is the first case in Saudi Arabia suggesting that the COVID-19 RNA-based vaccines might cause new onset of T1DM, complicated by late DKA.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"15 12","pages":"367-370"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11602176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752731","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":"Gastrointestinal Bleeding/Angiodysplasia in Patients With Glanzmann Thrombasthenia.","authors":"Raghad A Tarawah, Ahmad M Tarawah","doi":"10.14740/jmc4340","DOIUrl":"10.14740/jmc4340","url":null,"abstract":"<p><p>Glanzmann thrombasthenia (GT) is a common type of bleeding disorder, with a prevalence of 1/10,000 in Al Madinah, Saudi Arabia. GT causes bleeding owing to the lack of platelet aggregation associated with glycoprotein IIb/IIIa deficiency, which is characterized by mucocutaneous bleeding symptoms, such as epistaxis, gingival bleeding, and menorrhagia. Gastrointestinal angiodysplasia (GIAD) is a rare presentation of GT, where eight cases have been reported. GIAD is a vascular malformation of the digestive system caused by abnormal angiogenesis. Treatment of GIAD include surgical resection, electrocoagulation, embolization, and medical therapy with octreotide, thalidomide, and bevacizumab. GIAD has a high tendency to recur. We report the cases of eight patients of different ages who were diagnosed with GT and presented with gastrointestinal bleeding.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"15 12","pages":"401-405"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11602174/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752712","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":"Mirtazapine-Induced Premature Ventricular and Atrial Contractions.","authors":"Sabrina Nguyen, Denzil Robinson, Alexander T Phan, Haroon Azhand, Dan Vo","doi":"10.14740/jmc4265","DOIUrl":"10.14740/jmc4265","url":null,"abstract":"<p><p>Mirtazapine, an alpha-2 adrenergic receptor, 5-hydroxytryptamine (5-HT)2, and 5-HT3 antagonist, is commonly used in patients for depression and anorexia. Its mechanism disinhibits serotonin and norepinephrine. Though typically a well-tolerated medication, a rare adverse effect is arrhythmia, including ventricular bigeminy. To date, no case report has cited normal dosing of mirtazapine as a cause of premature ventricular or premature atrial contractions. Only cases of mirtazapine overdose have been associated with arrhythmias, including QT prolongation and bradycardia. We report on a unique case of a 64-year-old female who developed sinus tachycardia with premature ventricular and atrial contractions after starting mirtazapine.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"15 12","pages":"376-381"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11602173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752729","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":"Diffuse Type Pancreatic Ductal Adenocarcinoma: The Linitis Plastica Type of the Pancreas.","authors":"Mohammad Radwan, Basel Darawsha, Subhi Mansour, Safi Khuri","doi":"10.14740/jmc5062","DOIUrl":"10.14740/jmc5062","url":null,"abstract":"<p><p>Pancreatic malignant tumors are diverse and characterized by aggressive nature with high mortality rates. Pancreatic ductal adenocarcinoma (PDAC) is the most common type of pancreatic malignant tumors and accounts for approximately 90% of pancreatic malignancies. A subtype of PDAC, diffuse type PDAC (DTP), is a very rare and underreported tumor, known for its aggressive traits. Although little data are available about this tumor subtype characteristics, it usually presents with distinct features that are different from the known ones in PDAC. Herein, we present a case of a 61-year-old male patient, who presented with abdominal discomfort, weight loss and newly diagnosed diabetes mellitus. An abdominal computed tomography (CT) scan showed an ill-defined mass at the uncinate process with diffuse dilatation of the main pancreatic duct. Endoscopic ultrasound (EUS)-guided fine-needle biopsy showed cellular atypia suspicious for malignancy. The patient underwent total pancreatectomy with Roux-en-Y reconstruction. His postoperative course was uneventful. The final histopathological report showed well-differentiated diffuse ductal adenocarcinoma involving the pancreatic head, neck and body.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"15 12","pages":"406-410"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11602175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752690","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":"Rapid Resolution of Delayed Facial Palsy in Miller Fisher Syndrome With Steroid Therapy.","authors":"Nithisha Thatikonda, Alexandru Lerint, Vijaya Valaparla, Chilvana Patel","doi":"10.14740/jmc4305","DOIUrl":"10.14740/jmc4305","url":null,"abstract":"<p><p>Miller Fisher syndrome (MFS), a variant of Guillain-Barre syndrome (GBS), is characterized by the classic triad of ataxia, areflexia, and ophthalmoplegia. Approximately 20% of MFS patients experience facial weakness, with a subset developing delayed facial palsy (DFP) after other neurological symptoms have peaked or begun to improve. Initially, DFP was considered a natural progression of MFS, leading to recommendations against additional treatment. However, DFP persisted for more than 50 days without additional treatment in some patients, prompting additional steroid therapy, resulting in quicker resolution of DFP. We describe an MFS patient who presented with the classic triad of MFS and subsequently developed DFP. The patient was treated with methylprednisolone pulse therapy (1,000 mg/day for 3 days) followed by oral prednisolone (60 mg/day) with a gradual taper, resulting in rapid and complete resolution of DFP, suggesting an alternative mechanism behind DFP, opening avenues for further research and insights into this matter. MFS-DFP is rarely reported in the literature. In addition to this case, we aim to provide a comprehensive literature review on MFS-DFP, to further expand the existing knowledge on the current concepts of DFP-MFS.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"15 11","pages":"341-346"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11483148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142485137","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":"Pulmonary Kaposi Sarcoma in the Era of Antiretroviral Therapy: A Case Series.","authors":"Michael Alexander Pelidis, Lefika Bathobakae, Arielle Aiken, Katrina Villegas, Malina Mohtadi, Abraam Rezkalla, Nargis Mateen, Hussein Mhanna, Medhat Ismail, Patrick Michael","doi":"10.14740/jmc4251","DOIUrl":"10.14740/jmc4251","url":null,"abstract":"<p><p>Kaposi sarcoma (KS) is an angioproliferative neoplasm that affects the skin and lymph nodes. Human herpesvirus-8 (HHV-8) triggers KS by infecting the endothelium and inducing angiogenesis through the production of vascular endothelial growth factors and cytokines. KS is characterized by purplish or hyperpigmented plaques involving the skin and mucous membranes, and visceral involvement is very rare. Pulmonary KS (PKS) is an exceedingly rare visceral manifestation of KS and has a poor prognosis. PKS often presents with cough, hemoptysis, pleuritic chest pain, fever, and weight loss. In this case series, we share our experience in diagnosing and treating two patients with PKS. We also provide a concise review of the epidemiology, signs and symptoms, diagnosis, and management of this rare condition.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"15 11","pages":"311-318"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11483144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142486113","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 Closure of a Patent Foramen Ovale With a Small Adjacent Atrial Septal Defect and a Double Interatrial Septum Post Cryptogenic Stroke.","authors":"Michaela Kyriakou, Christos Rotos, Thrasos Constantinides, Demetris Taliotis, Christos Eftychiou","doi":"10.14740/jmc4296","DOIUrl":"10.14740/jmc4296","url":null,"abstract":"<p><p>The phenomenon of double interatrial septum (DIAS) represents a particularly rare subtype of atrial septal malformation, characterized by the presence of dual membranes separating the atria, resulting in a distinctive interatrial space. This unique anatomical structure has been linked to a paradoxical right-to-left shunt, potentially contributing to embolic ischemic strokes. Within this context, we report a rare case of a 34-year-old female who presented with a transient ischemic attack (TIA) and was diagnosed with patent foramen ovale (PFO) and a small adjacent atrial septal defect (ASD), along with the presence of a DIAS. The diagnosis was confirmed wit transoesophageal echocardiography and cardiac magnetic resonance imaging (MRI), and the condition was successfully treated with a transcatheter occluder device.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"15 11","pages":"330-334"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11483143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142485139","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 Rare Case of Systemic Epstein-Barr Virus-Positive Diffuse Large B-Cell Lymphoma With Hemophagocytic Lymphohistiocytosis in an Immunocompetent Young Man: Potential Diagnostic Pitfall and Therapeutic Challenge.","authors":"Shu Yao Liu, Sha Zhao, Yu Wu, Guang Cui He","doi":"10.14740/jmc4314","DOIUrl":"10.14740/jmc4314","url":null,"abstract":"<p><p>Epstein-Barr virus-positive diffuse large B-cell lymphoma (EBV⁺ DLBCL) is an uncommon subtype of aggressive B-cell lymphoma, with both nodal and extranodal involvement being exceedingly rare. We present a unique case of a 32-year-old immunocompetent male with a nasopharynx lesion accompanied by fever and bilateral cervical lymphadenopathy. The initial biopsy from the nasopharynx proposed infectious mononucleosis (IM) as a potential diagnostic pitfall. The further discovery of lymph node and intestinal mucosa biopsies confirmed the diagnosis of systemic EBV⁺ DLBCL. After receiving four cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) treatment, the patient got complete remission. However, hemophagocytic lymphohistiocytosis (HLH) developed following the fifth cycle of CHOP. The patient accepted allogeneic hematopoietic stem cell transplantation (allo-HCT) subsequently. Unfortunately, the survival time was only 14 months. Appeals for a multi-dimension approach to understanding more fully and improving the outcomes of such cases are underscored.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"15 11","pages":"347-353"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11483140/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142485133","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":"Epididymo-Orchitis Mimicking Malignancy Resulting From Intravesical Bacillus Calmette-Guerin Immunotherapy for Bladder Cancer: An Attempt to Understand Pathophysiology, Diagnostic Challenges, Patients' Implications and Future Directions.","authors":"Sharadchandra K Prasad, Fahmi Sabr Raza, Sourabh Karna, Nahin M Hoq, Robert McCormick, Abu Sadiq, Imoh Ibiok, Achamma John, Mohammed Mansoor Raza, Mohamed H Ahmed, Mohammed Alsheikh","doi":"10.14740/jmc4323","DOIUrl":"10.14740/jmc4323","url":null,"abstract":"<p><p>This case report describes an 85-year-old patient who presented with painless, unilateral right testicular swelling of 2 months' duration. This raised the possibility of testicular cancer, especially given his recent treatment for bladder cancer, which included adjuvant intravesical bacillus Calmette-Guerin (BCG) therapy. This poses a diagnostic dilemma regarding tuberculosis (TB) of the testis, BCG complications or a true testicular malignancy. Biochemical markers and a computed tomography (CT) scan showed no evidence of malignancy or disseminated TB. A TB-ELISpot test was negative. An ultrasound of the testis revealed a hypoechoic soft tissue lesion measuring approximately 24 × 19 mm, with internal vascularity and calcifications, causing a bulge in the testicular capsule with probable extracapsular extension. Based on the clinical suspicion of a testicular tumor, a right inguinal orchidectomy was performed. Histopathologic examination revealed isolated tuberculous orchitis with focal epididymal involvement; the spermatic cord was not involved. Polymerase chain reaction (PCR) testing on the histological sample confirmed the presence of <i>Mycobacterium bovis</i> DNA. As a radical right orchidectomy had been performed, no abnormal tissue remained. Additionally, the CT scan showed no evidence of TB dissemination, and the patient was asymptomatic, so he was being closely monitored in the infectious disease clinic. Importantly, a urine culture became positive for TB, and he was started on antituberculosis medication. BCG-induced granulomatous epididymo-orchitis may rarely occur as a late complication following intravesical BCG therapy for superficial bladder cancer. In this case report, we attempted to understand the pathophysiology, diagnostic challenges, patient implications, and potential future research directions.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"15 11","pages":"354-358"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11483141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142485134","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}