Clinical Medicine Insights. Case Reports最新文献

{"title":"Primary Testicular Tuberculosis Presenting as a Testicular Tumor: A Case Report.","authors":"Saeid Sadeghzadeh, Mohammad Eslami, Zohreh Panahi, Shabnam Danaei Mehrabad","doi":"10.1177/11795476261436590","DOIUrl":"https://doi.org/10.1177/11795476261436590","url":null,"abstract":"<p><p>Testicular tuberculosis (TB) is a rare form of extrapulmonary TB that can closely mimic testicular malignancy, making diagnosis challenging in immunocompetent patients without systemic symptoms. We report the case of a 50-year-old immunocompetent man who presented with a gradually enlarging, painless right testicular mass of several weeks' duration, without constitutional symptoms such as fever, night sweats, or weight loss. Ultrasonography revealed a well-defined, heterogeneous hypoechoic and relatively hypervascular solid-cystic lesion, while serum tumor markers were within normal limits. Given the high clinical suspicion for malignancy, radical inguinal orchiectomy was performed without complications. Histopathological examination demonstrated necrotizing granulomatous inflammation with Langhans-type giant cells, and Ziehl-Neelsen staining was positive for acid-fast bacilli. Comprehensive systemic evaluation revealed no evidence of pulmonary or extrapulmonary TB, although both PPD and IGRA tests were positive. The patient was treated with standard anti-tubercular therapy and remained asymptomatic at 9-month follow-up. This case underscores the importance of considering primary isolated testicular TB in the differential diagnosis of atypical testicular masses, highlighting that early recognition and appropriate medical therapy may prevent unnecessary.</p>","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261436590"},"PeriodicalIF":0.6,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13087372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147721701","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":"Gallbladder Volvulus, A Surgical Challenge in Inflammatory Pathology of the Gallbladder: A Case Report.","authors":"Juan Sebastián Rodriguez Uribe, Vanessa Cabrera Guarín, Alexandra Bastidas, Jorge Andrés Gutierrez","doi":"10.1177/11795476261437635","DOIUrl":"https://doi.org/10.1177/11795476261437635","url":null,"abstract":"<p><strong>Introduction: </strong>Gallbladder volvulus (GV) is a rare surgical entity marked by torsion of the gallbladder on its axis secondary to mesenteric anomalies. Due to its clinical similarity to acute cholecystitis and preoperative diagnosis is difficult.</p><p><strong>Clinical case: </strong>A 79-year-old female with cardiovascular comorbidities presented with sudden abdominal pain and emesis. Initial laboratory examination tests showed leukocytosis and hyperbilirubinemia, while ultrasound suggested acute cholecystitis. Due to persistent symptoms and the development of a palpable mass, the patient underwent laparoscopic cholecystectomy. Intraoperatively, a gangrenous gallbladder secondary to complete volvulus was identified.</p><p><strong>Results: </strong>The gallbladder was detorsed and resected without complications. The postoperative course was uneventful, and the patient was discharge on the third day.</p><p><strong>Conclusion: </strong>GV should be suspected in elderly patients presenting with atypical biliary symptoms and a \"floating gallbladder\" on imaging. Early surgical intervention via laparoscopic cholecystectomy is essential to prevent life-threatening complications such as perforation and peritonitis.</p>","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261437635"},"PeriodicalIF":0.6,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13069168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147670925","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":"Case Report: Complexities in the Management of Glossopharyngeal Neuralgia: Lessons from a Refractory Case.","authors":"Robert Maksymowicz, Jeremi Jan Matysek, Dominika Maja Lech, Cyprian Norbert Strączek, Krzysztof Nosek","doi":"10.1177/11795476261426065","DOIUrl":"https://doi.org/10.1177/11795476261426065","url":null,"abstract":"<p><strong>Background: </strong>Glossopharyngeal neuralgia is a rare cranial neuropathy characterized by paroxysmal, severe pain localized to the sensory distribution of the glossopharyngeal nerve. Diagnostic overlap with trigeminal neuralgia can lead to misclassification and delays in effective management.</p><p><strong>Case report: </strong>We report a 76-year-old female with an 18-year history of right-sided tongue and facial pain initially misdiagnosed as trigeminal neuralgia. Despite undergoing radiotherapy, thermolesion, and microvascular decompression, she experienced recurrent episodes of severe pain. At presentation, she was receiving pregabalin, carbamazepine, and fentanyl transdermal patch with limited efficacy and notable adverse effects. Transition to oxycodone, in combination with optimized pregabalin, carbamazepine, and venlafaxine, led to substantial pain relief and improved functionality. Hyponatremia secondary to high-dose carbamazepine was identified and corrected by dose adjustment.</p><p><strong>Conclusion: </strong>This case underscores the diagnostic challenges of glossopharyngeal neuralgia and highlights the importance of individualized, multimodal treatment strategies. While surgical interventions may offer partial benefit, adjunctive pharmacotherapy, including opioid therapy in refractory cases, can be essential for achieving adequate pain control.</p>","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261426065"},"PeriodicalIF":0.6,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147637937","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":"Dextrocardia with Situs Inversus Totalis in an Ethiopian Woman: A Case Report.","authors":"Tsegaab Mesele, Kebron W Aweke, Gelila S Kassa, Mikiyas G Teferi, Muluken Bekele Wondimagegnehu, Leul M Manyazewal, Samuel Dereje Bedada","doi":"10.1177/11795476261439206","DOIUrl":"https://doi.org/10.1177/11795476261439206","url":null,"abstract":"<p><p>Dextrocardia with situs inversus totalis (SIT) is a rare congenital anomaly involving complete mirror-image reversal of thoracic and abdominal organs, which may complicate diagnostic evaluation and management despite often being benign. We report a 45-year-old Ethiopian woman with type 2 diabetes mellitus and hypertension who presented with dry cough, right-sided pleuritic chest pain, dyspnea, and low-grade fever. Examination revealed respiratory distress and a right-sided cardiac apex, while laboratory workup demonstrated anemia, impaired renal function, and proteinuria. Imaging confirmed SIT with right lower lung consolidation and incidental cholelithiasis, and electrocardiogram (ECG) showed extreme right-axis deviation with absent R-wave progression; echocardiography revealed normal intracardiac anatomy and preserved function. Although SIT is commonly discovered incidentally, reversed anatomy can create diagnostic challenges and requires careful clinical correlation, particularly in settings with limited imaging availability. This case highlights the importance of recognizing SIT to prevent misinterpretation, guide safe management, and contribute to the limited regional epidemiological data.</p>","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261439206"},"PeriodicalIF":0.6,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147637928","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":"Complete Neurological Recovery Following Suicidal Near-Hanging: A Case Report From Ethiopia.","authors":"Ayenew A Wolie, Chernet T Mengistie, Biruk T Mengistie, Gedefaw T Minwagaw, Demmelash G Nigatu, Nardos K Melaku, Awetahegn E Kenno, Akililu Azazh","doi":"10.1177/11795476261438875","DOIUrl":"https://doi.org/10.1177/11795476261438875","url":null,"abstract":"<p><strong>Introduction: </strong>Near-hanging is a common method of attempted suicide that can cause severe hypoxic brain injury, and survivors often require intensive care. We report a near-hanging case in a resource-limited setting with full neurological recovery despite an initially severe presentation.</p><p><strong>Case presentation: </strong>A previously healthy 22-year-old man presented in mid-2025 unconscious after being rescued from a hanging incident. He had no known psychiatric history or prior suicide attempt. On arrival, he was comatose (Glasgow Coma Scale 6) with stable vital signs. Head CT was unremarkable for acute injury. Airway was secured by rapid sequence intubation without complication; cervical spine immobilization was applied, and imaging revealed no cervical or laryngeal trauma. A bedside ultrasound measurement of the optic nerve sheath diameter (ONSD) was performed (resource-limited setting, MRI unavailable).</p><p><strong>Management and outcome: </strong>The patient received standard intensive care support, including mechanical ventilation, sedation, and monitoring of oxygenation and perfusion. His blood glucose and metabolic status were managed carefully. The initially elevated ONSD prompted continued neuroprotective care. Over 72 hours, he gradually regained consciousness and was extubated on day 4. He exhibited no focal deficits or cognitive impairment. By discharge on day 7, he had returned to baseline neurologic function and was oriented with normal examination.</p><p><strong>Conclusion: </strong>This case highlights that even severe near-hanging can have excellent neurologic recovery. It also underscores that a normal head CT in the acute period does not exclude significant hypoxic brain injury. In settings without advanced imaging, bedside ONSD ultrasonography may provide useful information about intracranial dynamics. Clinicians should be aware of these diagnostic and prognostic nuances and maintain aggressive supportive care in such cases.</p>","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261438875"},"PeriodicalIF":0.6,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13051100/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147632634","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":"Klippel-Trenaunay Syndrome in a Pediatric Patient: A Case Report.","authors":"Anant Khandelwal, Raihan Shakeel, Manjiri Rhishikesh Babar, Channagiri Srinivas Bhargavram, Amogh Verma","doi":"10.1177/11795476261436592","DOIUrl":"https://doi.org/10.1177/11795476261436592","url":null,"abstract":"<p><strong>Introduction: </strong>Klippel-Trenaunay syndrome (KTS) is a rare congenital vascular disorder defined by the triad of capillary malformation, venous or lymphatic anomalies, and soft tissue or bony hypertrophy. Pediatric presentations pose distinct challenges because clinical manifestations evolve with growth, and early phenotypes may not reliably predict long-term morbidity. In early childhood, accurate flow phenotyping and anticipatory surveillance are therefore central to management.</p><p><strong>Case presentation: </strong>A 4-year-old girl presented with an extensive port-wine stain involving nearly half of the right buttock, progressive hypertrophy of the right lower limb, and superficial varicosities. Limb circumference differed by 3.5 cm at the thigh and 2.8 cm at the calf compared with the contralateral side. Doppler ultrasonography demonstrated superficial venous ectasia with preserved deep venous flow and no evidence of arteriovenous shunting. Magnetic resonance venography confirmed superficial venous malformations confined to the right lower limb without pelvic or visceral involvement. Radiographs revealed cortical thickening and bony overgrowth of the right foot, and scanogram analysis demonstrated a 1.2 cm limb-length discrepancy. Conservative management with compression therapy, orthopedic surveillance, and regular dermatologic follow-up was initiated. At 6 months, the child remained asymptomatic, functionally active, and without progression of hypertrophy.</p><p><strong>Discussion: </strong>This case illustrates the diagnostic and management considerations of KTS in early childhood, emphasizing differentiation from high-flow vascular syndromes, justification of imaging strategies, and the importance of growth-adapted surveillance and family counseling. Emerging targeted therapies may offer future options for progressive disease.</p><p><strong>Conclusion: </strong>Early recognition, structured monitoring, and multidisciplinary care are essential in pediatric KTS. Conservative management is effective when paired with defined surveillance strategies and caregiver-centered education.</p>","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261436592"},"PeriodicalIF":0.6,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13039645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147608353","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":"Descending Necrotizing Mediastinitis, When Mediastinal Drainage By Thoracoscopy Is Not Sufficient: Case Report and Review of the Literature.","authors":"Carlos Daniel Solano, Natalia Restrepo-Abisambra, Sebastian Rodriguez, Fernando Alvarado, Mauricio Peláez","doi":"10.1177/11795476261436589","DOIUrl":"https://doi.org/10.1177/11795476261436589","url":null,"abstract":"<p><strong>Introduction: </strong>Descending necrotizing mediastinitis (DNM) is an acute infection of the mediastinum secondary to odontogenic, pharyngeal, or cervical infections that extend into the deep cervical spaces and progress into the mediastinum. This case report and literature review aim to contribute to the understanding of DNM and emphasize the importance of the surgical approach in its treatment.</p><p><strong>Presentation of the case: </strong>A 28 year old male with no relevant history, consulted a fourth level institution after presenting upper respiratory symptoms. CT scans revealed compatible findings with type II DNM plus bilateral pleural empyema. Pleural and mediastinal drainage, pleurectomy, and pulmonary decortication were performed using bilateral thoracoscopy. Cervical drainage via cervicotomy was subsequently required. Antibiotic treatment was continued for 6 weeks. For the literature review, a search was conducted in PubMed, Elsevier, and Scielo, yielding 35 articles published between 1938 and 2024, of which 22 were selected by the authors.</p><p><strong>Discussion: </strong>Treatment of DNM requires broad-spectrum antibiotics and timely surgical drainage. The approach must depend on the anatomical extent of the disease. Endo's classification, revised by Sugio, allows appropriate staging and surgical guidance. Mediastinal drainage can be performed via thoracotomy or video-assisted thoracoscopy, and it often needs to be complemented with cervicotomy for adequate infection control.</p><p><strong>Conclusion: </strong>This case exemplifies the pivotal role of anatomical classifications as a tool to guide the surgical approach. Nonetheless, more evidence is still needed to standardize management. Detailed knowledge of the pathophysiology and the pathways of dissemination allows for the Implementation of effective surgical strategies tailored to each patient.</p>","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261436589"},"PeriodicalIF":0.6,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13039556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147608378","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":"Hoarseness Beyond Cancer: Laryngeal Presentation of Tuberculosis.","authors":"Leul Adane Chemeda, Yewibdar Mulu Mekonnen, Helina K Teklehaimanot","doi":"10.1177/11795476261430039","DOIUrl":"10.1177/11795476261430039","url":null,"abstract":"<p><strong>Introduction: </strong>Tuberculosis (TB) remains a leading infectious disease worldwide, with Ethiopia among the highest-burden countries. Laryngeal tuberculosis is rare, accounting for less than 1%-2% of TB cases and typically affects the posterior glottis and true vocal cords. However, atypical involvement of the subglottic region is uncommon and can closely resemble laryngeal carcinoma both clinically and radiologically, posing a significant diagnostic challenge.</p><p><strong>Case presentation: </strong>We report a 64-year-old man with a 1-year history of progressive hoarseness. Neck CT demonstrated asymmetric mucosal thickening and enhancement of the glottis with anterior subglottic extension, along with a rim-enhancing necrotic prelaryngeal node which are findings highly suggestive of malignancy. Chest CT revealed right upper lobe cavitation, nodularity and tree-in-bud opacities consistent with active pulmonary tuberculosis. GeneXpert MTB/RIF confirmed Mycobacterium tuberculosis, and laryngeal biopsy revealed caseating granulomatous inflammation with acid-fast bacilli. A diagnosis of concomitant pulmonary and laryngeal tuberculosis was established, and the patient was started on standard first-line anti-tubercular therapy.</p><p><strong>Discussion: </strong>Laryngeal tuberculosis typically involves the posterior glottis, but in this case, anterior subglottic disease with necrotic nodal involvement created strong radiologic overlap with carcinoma. Recognition of such atypical patterns is crucial, especially in endemic regions, as misdiagnosis may lead to unnecessary surgical interventions.</p><p><strong>Conclusion: </strong>Persistent hoarseness with mass-like laryngeal lesions should prompt consideration of tuberculosis in endemic settings. Radiologists play a key role in identifying suggestive features and integrating them with pulmonary imaging and microbiologic results to ensure accurate diagnosis and timely treatment.</p>","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261430039"},"PeriodicalIF":0.6,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13009847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147510054","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 <i>Staphylococcus aureus</i> Associated Lemierre's Disease Complicated by Pneumothorax.","authors":"S Deepan Raj, Tarun Kumar Suvvari, Vaishnavi Vallurupalli, Keerthi Sai Koneru, Rahul Pottabathini, Dayana Sai Swetha Nimmalapudi, Tejinder Singh, Vimal Thomas","doi":"10.1177/11795476261433735","DOIUrl":"10.1177/11795476261433735","url":null,"abstract":"<p><strong>Background: </strong>Lemierre's syndrome is a rare but life-threatening condition characterized by septic thrombophlebitis, most often due to <i>Fusobacterium necrophorum</i>. Although uncommon, <i>Staphylococcus aureus</i> can also cause atypical and severe presentations.</p><p><strong>Case presentation: </strong>This case describes an unusual presentation of Lemierre's syndrome in an 18-year-old male, associated with <i>Staphylococcus aureus</i> and complications including left-sided secondary spontaneous pneumothorax, septic pulmonary emboli, and pleural effusion. The patient initially presented with fever, headache, periorbital swelling with double vision, neck pain, and acute onset left-sided chest pain with shortness of breath. Initial evaluations revealed thrombosis in the superior ophthalmic veins, cavernous sinuses, and bilateral internal jugular veins, along with left-sided pneumothorax and diffuse cavitating nodules in both lung fields. Blood cultures confirmed Staphylococcus aureus resistant to macrolides. Treatment includes high-flow oxygen, intravenous vancomycin followed by oxacillin, and anticoagulation therapy. At 3-month follow-up, the patient had fully recovered with resolution of pneumothorax and inflammatory markers.</p><p><strong>Conclusion: </strong>This case highlights the importance of recognizing atypical presentations of Lemierre's syndrome and the need for prompt multidisciplinary intervention to prevent fatal outcomes.</p>","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261433735"},"PeriodicalIF":0.6,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13009821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147510005","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":"Unusual Ampullary Presentation of Pediatric Burkitt Lymphoma: Case Report and Literature Review.","authors":"Khadija Malik, Muddassir Syed Saleem, Hammad Amjad, Nidal Bin Kamran, Syed Muhammad Faiq Hussain, Umme Roman Akhtar, Abdul Haseeb, Ahmed Asad Raza, Muhammad Areeb Jawed, Abedin Samadi, Adil Ahmed","doi":"10.1177/11795476261429279","DOIUrl":"10.1177/11795476261429279","url":null,"abstract":"<p><strong>Introduction: </strong>Burkitt lymphoma (BL) is a highly aggressive B-cell non-Hodgkin lymphoma that typically presents with abdominal masses; ampullary involvement with obstructive jaundice and gastrointestinal bleeding is exceptionally rare in children. Early biliary decompression can be crucial to permit timely chemotherapy.</p><p><strong>Case presentation: </strong>A 14-year-old boy presented with 1 week of worsening abdominal pain, non-bilious vomiting, constipation, jaundice, and melena. Examination showed pallor, icterus, firm hepatomegaly, and a palpable epigastric mass. Laboratory testing revealed cholestatic liver function abnormalities and elevated pancreatic enzymes. Ultrasound and contrast computed tomography demonstrated a large retroperitoneal mass compressing the biliary tree. Upper gastrointestinal endoscopy identified a friable, ulcerated ampullary mass with active bleeding. Biopsy confirmed BL by morphology (starry-sky) and immunohistochemistry/fluorescence in situ hybridization (CD20+, CD10+, c-MYC+, Ki-67 ~95%). Main diagnosis made was pediatric BL presenting with ampullary involvement causing obstructive jaundice and upper gastrointestinal bleeding. Given persistent cholestasis and bleeding risk, the patient underwent Roux-en-Y choledochojejunostomy for biliary decompression, followed by initiation of rituximab-cyclophosphamide-vincristine-doxorubicin-high-dose methotrexate/rituximab-ifosfamide-etoposide-high-dose cytarabine (R-CODOX-M/R-IVAC) with central nervous system prophylaxis. Post-operative bilirubin improved, and early chemotherapy cycles were tolerated. During the 2-week hospitalization, the patient had symptomatic improvement; however, objective radiologic response could not be documented because care was transferred and post-transfer positron emission tomography-computed tomography was unavailable.</p><p><strong>Conclusion: </strong>Ampullary BL should be considered in pediatric patients with obstructive jaundice and upper gastrointestinal bleeding. Surgical biliary decompression can stabilize cholestasis and facilitate timely multi-agent chemotherapy.</p>","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261429279"},"PeriodicalIF":0.6,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13009807/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147510092","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}