Clinical Medicine Insights. Case Reports最新文献

{"title":"Hybrid Laparoscopic-Open-Laparoscopic Repair for a Large Recurrent Inguinoscrotal Hernia: A Case Report.","authors":"Hadi Farhat, Georges Khalifeh","doi":"10.1177/11795476261465451","DOIUrl":"10.1177/11795476261465451","url":null,"abstract":"<p><p>Recurrent inguinoscrotal hernias with visceral involvement present significant technical challenges, particularly when dense adhesions and large hernia sacs limit safe laparoscopic dissection. We report the case of a 55-year-old man with a large recurrent right inguinoscrotal hernia containing predominantly small bowel loops following previous open bilateral inguinal hernia repair. Preoperative computed tomography demonstrated bowel herniation with features suggestive of early incarceration. Surgery was initiated laparoscopically, allowing safe reduction of the herniated bowel and assessment of bowel viability. Due to dense adhesions and difficulty dissecting the large hernia sac laparoscopically, a limited open inguinal approach was performed for controlled sac dissection, followed by laparoscopic posterior mesh placement. This laparoscopic-open-laparoscopic hybrid approach provided a safe and effective solution, combining the benefits of minimally invasive assessment with secure open sac management, and should be considered in complex recurrent inguinoscrotal hernias when laparoscopic sac dissection is unsafe.</p>","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261465451"},"PeriodicalIF":0.6,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13309633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148344024","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":"Intra-Familial Phenotypic Variability in Lipoid Proteinosis: A Case Series of Three Siblings.","authors":"Muhammad Murtaza, Insharah Zafar, Bareea Mubashar, Abedin Samadi, Ahmed Asad Raza","doi":"10.1177/11795476261465037","DOIUrl":"10.1177/11795476261465037","url":null,"abstract":"<p><p>Lipoid proteinosis (LP), or Urbach-Wiethe disease, is an ultra-rare autosomal-recessive disorder caused by loss-of-function variants in the ECM1 gene. It is characterized by the progressive deposition of hyaline-like material in the skin, mucosae, and central nervous system. This series describes three siblings (aged 16, 24, and 25) from Gujranwala, Pakistan, born to non-consanguineous parents. All patients presented with infant-onset hoarseness of voice and recurrent vesiculobullous eruptions that evolved into waxy papules and hyperkeratotic plaques. Physical examination revealed the pathognomonic \"beaded\" eyelid papules (moniliform blepharosis), pock-like facial scarring, and a thickened lingual frenulum restricting tongue protrusion. Despite shared genetics, intrafamilial variability was observed, with the male sibling exhibiting a more severe \"leonine-like\" facies. Neuropsychiatric symptoms, including aggression and insomnia, were noted across the series. Due to resource constraints, the diagnosis was established clinically. Management focused on symptomatic control using oral acitretin (0.5 mg/kg/day), antihistamines, and intensive topical emollients. At 12-week follow-up, patients showed significant reduction in pruritus and stabilization of skin lesions, though hoarseness and established scarring remained unchanged. This series underscores the importance of recognizing cardinal clinical triads-moniliform blepharosis, mucosal tethering, and early hoarseness-to diagnose LP in resource-limited settings where genetic or histological confirmation is unavailable.</p>","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261465037"},"PeriodicalIF":0.6,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13305404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148344022","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":"Critical Airway Obstruction From a Near-Carinal Intratracheal Tumor Managed with Intratracheal Cryotherapy: A Case Report.","authors":"Antonio Al Hazzouri, Maya Hneidi, Philippe Attieh, Katherine Atallah, Kaity Saliba, Pierre Mourad","doi":"10.1177/11795476261462790","DOIUrl":"10.1177/11795476261462790","url":null,"abstract":"<p><strong>Background: </strong>Intratracheal tumors are rare neoplasms that may pose significant diagnostic and therapeutic challenges because of their critical location within the central airway. Pleomorphic adenoma arising in the trachea is exceedingly rare, with only a limited number of cases reported in the literature.</p><p><strong>Case presentation: </strong>We report a case of a 45-year-old patient presenting with stridor, dyspnea, and hemoptysis who was found to have a distal intratracheal mass located one to two tracheal rings above the carina. Bronchoscopic biopsy with planned cryotherapy was performed; however, airway management was particularly challenging due to the tumor's location, which made tracheostomy unfeasible and distal endotracheal intubation technically difficult. During cryotherapy, manipulation of the lesion triggered bleeding, bronchospasm, and acute airway collapse, resulting in severe ventilatory compromise that required urgent airway stabilization and selective intubation distal to the tumor. Histopathological examination confirmed pleomorphic adenoma.</p><p><strong>Conclusion: </strong>This case highlights the unique airway management challenges posed by intratracheal tumors located near the carina and underscores the importance of meticulous pre-procedural planning, anticipation of complications, and readiness for emergency airway interventions during bronchoscopic treatment. Even minimally invasive procedures such as cryotherapy may lead to life-threatening airway compromise when tumors are located in critical central airway regions.</p>","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261462790"},"PeriodicalIF":0.6,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13305496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148344028","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":"Miller-Fisher Syndrome Presenting With Severe Headache and Transient Loss of Consciousness: A Case Report From Yemen.","authors":"Sadek Beshr, Najeeba Al-Shaibani, Anas Al-Kubati","doi":"10.1177/11795476261463669","DOIUrl":"10.1177/11795476261463669","url":null,"abstract":"<p><strong>Background: </strong>Miller-Fisher syndrome (MFS) is a rare variant of Guillain-Barré syndrome (GBS), characterized by the classic triad of ataxia, areflexia, and ophthalmoplegia. Atypical presentations involving severe headache and transient loss of consciousness (LOC) are extremely rare, posing a significant diagnostic challenge.</p><p><strong>Case presentation: </strong>We present a 38-year-old Yemeni female with hypertension, type II diabetes mellitus, and recurrent deep vein thrombosis, with no history of recent infection. She presented with an acute, severe headache lasting three days, followed by transient LOC. By the fourth day, the classic MFS triad emerged. In a resource-limited setting, diagnosis was based on the clinical triad and evidence of demyelinating polyneuropathy on nerve conduction studies (NCS), in the absence of anti-GQ1b antibody testing and normal brain neuroimaging. After receiving intravenous immunoglobulin (IVIG), the headache resolved significantly by the third dose. The patient showed improvement in ophthalmoplegia and ptosis, achieving complete neurological recovery within two months.</p><p><strong>Conclusion: </strong>Acute severe headache and transient LOC can be an early, atypical manifestation of MFS. The clinical triad and electrophysiology findings remain the cornerstones of diagnosis when antibody testing is unavailable. Early intervention with IVIG led to a successful outcome.</p>","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261463669"},"PeriodicalIF":0.6,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13305643/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148344053","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":"Reversible Metronidazole-Induced Encephalopathy With Typical MRI Features Following a Low Cumulative Dose: Case Report.","authors":"Mohammad Adi, Shaza Mostafa, Javdat Latipov, Otabek Kuziev, Ahmed Ashraf","doi":"10.1177/11795476261463624","DOIUrl":"10.1177/11795476261463624","url":null,"abstract":"<p><strong>Introduction: </strong>Metronidazole-induced encephalopathy (MIE) is an under-recognised but potentially reversible neurotoxic complication of metronidazole therapy, typically associated with high cumulative doses or underlying comorbidities such as hepatic dysfunction. Classic MRI findings include symmetric T2/FLAIR hyperintensities in the cerebellar dentate nuclei, brainstem, and splenium of the corpus callosum.</p><p><strong>Case presentation: </strong>We report a 64-year-old woman with well-controlled hypertension and type 2 diabetes who developed acute dysarthria, gait instability, and a generalized seizure after a 7-day course of metronidazole totaling 10.5 g. Laboratory evaluation was unremarkable.Stool cultures and pathogen-specific PCR were negative. The MRI shows bilateral symmetric T2/FLAIR hyperintensities in the dentate nuclei, brainstem, and splenium, consistent with MIE. No alternative etiology was identified. This case occurred in an adult without hepatic dysfunction. Metronidazole was discontinued immediately, leading to rapid clinical improvement and complete neurological recovery.</p><p><strong>Conclusion: </strong>This case highlights that MIE can occur even after short treatment durations and low cumulative doses, particularly in patients without traditional risk factors. Early recognition of the clinical and radiologic features is essential, as prompt drug cessation leads to full reversibility in most cases.</p>","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261463624"},"PeriodicalIF":0.6,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13305506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148344016","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":"Liraglutide-Induced Acute Hepatocellular Injury With Positive Rechallenge: A Case Report and Literature Review.","authors":"Mohammad Adi, Ahmed Ashraf, Shohsanam Eshimova, Saidbek Husanov","doi":"10.1177/11795476261461221","DOIUrl":"10.1177/11795476261461221","url":null,"abstract":"<p><p>Glucagon-like peptide-1 receptor agonist liraglutide is widely used in type 2 diabetes mellitus and obesity and is generally considered non-hepatotoxic, with only rare reports of idiosyncratic liver injury. We report the case of a 58-year-old obese woman with type 2 diabetes who developed marked hepatocellular injury 12 weeks after initiating liraglutide therapy, with alanine aminotransferase (ALT) 876 U/L and aspartate aminotransferase (AST) 702 U/L after exclusion of alternative causes. Liver enzyme levels improved rapidly following drug discontinuation. A supervised rechallenge resulted in recurrence of severe transaminitis (ALT 1245 U/L, AST 980 U/L) within 10 days, with RUCAM score of 11 supporting a highly probable drug-induced liver injury. This case highlights a rare but definite idiosyncratic hepatocellular injury associated with liraglutide. Prompt recognition, discontinuation, and avoidance of rechallenge are essential. Further pharmacovigilance is warranted to better characterize incidence and mechanisms and guide safe clinical use of GLP-1 therapies in practice settings.</p>","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261461221"},"PeriodicalIF":0.6,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13269733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148270347","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":"The Treatment Process and Clinical Analysis of 2 Cases of Enterococcus Faecalis Infection Following Cataract Surgery.","authors":"Weili Bao, Jiao Liu, Yanfeng Yang, Genzhu Sun","doi":"10.1177/11795476261454441","DOIUrl":"10.1177/11795476261454441","url":null,"abstract":"<p><strong>Purpose: </strong>To report the clinical diagnosis and treatment of 2 cases of endophthalmitis caused by Enterococcus faecalis following cataract surgery.</p><p><strong>Methods: </strong>Two elderly patients (aged 69 and 87 years) who developed postoperative endophthalmitis after cataract extraction underwent emergency vitrectomy, anterior chamber irrigation, and intravitreal vancomycin injection. Aqueous humor and vitreous fluid samples were collected for bacterial culture and antimicrobial susceptibility testing.</p><p><strong>Results: </strong>Both patients required repeat irrigation due to persistent vitreous opacity. Bacterial culture of vitreous fluid confirmed Enterococcus faecalis (Group D) infection, which was sensitive to vancomycin, penicillin G, levofloxacin, and tigecycline. Post-treatment visual acuity improved to 0.5 (Case 1 at 3 months) and 0.1 (Case 2 at 1 month), respectively.</p><p><strong>Conclusion: </strong>These 2 cases suggest that early vitrectomy combined with intravitreal vancomycin may be an effective treatment for postoperative Enterococcus faecalis endophthalmitis. However, due to the small sample size, these findings should be interpreted with caution. Vitreous fluid culture appears more reliable than aqueous humor culture for pathogen identification.</p>","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261454441"},"PeriodicalIF":0.6,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13263506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148249320","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":"Extrahepatic Biliary Atresia With Situs Inversus and Ventricular Septal Defect: A Case Report.","authors":"Marium Khan, Kanza Farhan, Maliha Rahim, Aisha Farooq, Ahmed Asad Raza, Abedin Samadi, Fehmina Arif","doi":"10.1177/11795476261459498","DOIUrl":"10.1177/11795476261459498","url":null,"abstract":"<p><strong>Background: </strong>Biliary atresia is a rare, progressive cholangiopathy of infancy and a leading cause of pediatric liver failure. Syndromic forms associated with laterality defects and congenital heart disease are uncommon and pose diagnostic challenges.</p><p><strong>Case presentation: </strong>A 3-month-old female infant, born at term via home delivery to a consanguineous couple, presented with persistent jaundice since birth. Examination revealed icterus, anemia, hepatomegaly, and a pansystolic murmur. Laboratory tests showed conjugated hyperbilirubinemia, elevated liver enzymes, and coagulopathy, while infectious, metabolic, and endocrine causes were excluded. Imaging revealed a small gallbladder with a triangular cord sign, biliary obstruction on HIDA scan, and situs inversus. Echocardiography identified a small perimembranous ventricular septal defect. Percutaneous liver biopsy confirmed bile duct proliferation, fibrosis, and cholestasis, consistent with extrahepatic biliary atresia.</p><p><strong>Diagnostic assessment: </strong>Syndromic biliary atresia was diagnosed based on clinical, radiological, and histopathological findings, with associated situs inversus and a congenital heart defect.</p><p><strong>Therapeutic intervention and outcome: </strong>The patient received supportive care including vitamin K and nutritional supplementation. Pediatric surgical consultation was obtained; however, in view of advanced fibrosis, the syndromic constellation, and the family's decision to decline operative intervention after counseling, Kasai portoenterostomy was not performed. Liver transplantation was discussed but declined by the family. The infant's condition deteriorated and she died approximately one month after diagnosis from complications of advanced liver disease.</p><p><strong>Conclusion: </strong>Early recognition of biliary atresia and its syndromic associations is crucial. Delayed presentation and limited access to specialized care can adversely affect outcomes, underscoring the need for timely diagnosis, multidisciplinary evaluation, and family counseling.</p>","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261459498"},"PeriodicalIF":0.6,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13241611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148197610","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":"Primary Intrarenal Neuroblastoma in an Infant Mimicking Wilms Tumor: A Rare Case Report and Diagnostic Dilemma.","authors":"Samuel Negash, Mesfin Wubishet Gurmu, Aneso Mohammed, Diriba Fufa Hordofa, Hailu Alemu, Melese Abere, Hawi Babu, Esubalew Mezgebu","doi":"10.1177/11795476261459500","DOIUrl":"10.1177/11795476261459500","url":null,"abstract":"<p><strong>Background: </strong>Primary intrarenal neuroblastoma (IRNB) is an exceptionally rare pediatric malignancy that can closely resemble Wilms tumor on clinical and radiologic evaluation, posing significant diagnostic and therapeutic challenges. Accurate differentiation between these two entities is critical, as their management strategies and prognostic profiles differ considerably.</p><p><strong>Case presentation: </strong>We report the case of an 8-month-old male infant who presented with a progressively enlarging right-sided abdominal mass. Contrast-enhanced computed tomography revealed a large heterogeneously enhancing right renal mass with vascular encasement and intratumoral calcifications, findings that initially favored a diagnosis of Wilms tumor. The patient received preoperative chemotherapy in accordance with the SIOP protocol, followed by radical nephrectomy. Histopathologic examination of the resected specimen demonstrated a poorly differentiated neuroblastoma characterized by Homer-Wright rosettes, neuropil formation, and salt-and-pepper nuclear chromatin. Immunohistochemical analysis showed diffuse synaptophysin positivity and absence of WT1 expression, confirming the diagnosis of primary intrarenal neuroblastoma. The patient subsequently received neuroblastoma-directed chemotherapy and achieved complete remission.</p><p><strong>Conclusion: </strong>Primary intrarenal neuroblastoma is a rare but important differential diagnosis of renal masses in infancy, particularly when imaging reveals atypical features, such as vascular encasement and intratumoral calcifications, or when there is a suboptimal response to Wilms tumor-directed chemotherapy. Because of its significant clinical and radiologic overlap with Wilms tumor, preoperative diagnosis remains challenging. In patients with atypical findings, tissue diagnosis by core needle or open surgical biopsy, followed by histopathologic and immunohistochemical evaluation, should be considered before initiating empiric chemotherapy. Early multidisciplinary assessment is essential for accurate diagnosis and appropriate management.</p>","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261459500"},"PeriodicalIF":0.6,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13241612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148197662","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":"Pancreatic Calculi: Two Case Reports and Literature Review.","authors":"Ribal Aby Hadeer, Souad Ghattas, Ayman Tabche, Johnny Salem, Hani Maalouf, Noha Al Hachem, Raja Wakim","doi":"10.1177/11795476261458471","DOIUrl":"10.1177/11795476261458471","url":null,"abstract":"<p><p>Pancreatic calculi are the sequelae of Chronic Pancreatitis and can occur in about 50% of patients. These calculi produce the typical pancreatic pain experienced by patients, and pain relief is the most important goal of therapy. Herein, we present two cases of 66- and 39-year-old male patients who had severe abdominal pain associated with calculi obstructing chronic pancreatitis. The two patients were successfully managed with distal pancreatectomy. The decision regarding the management of pancreatic duct stones should be made in a multidisciplinary fashion; it depends on multiple factors. The results of these cases showed that distal pancreatectomy with pancreatico-jejunostomy could be offered as curative treatment for selected patients with obstructive chronic pancreatitis.</p>","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261458471"},"PeriodicalIF":0.6,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13234371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148197594","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}