Clinical Medicine Insights. Case Reports最新文献

{"title":"Atraumatic Bilateral Anterior Shoulder Dislocation With Bilateral Greater Tuberosity Fractures Accompanied by the Diagnosis of Epilepsy: A Case Report.","authors":"Mehmet Kemal Gürsoy, Burak Demirekin, Mustafa Ürgüden","doi":"10.1177/11795476261456792","DOIUrl":"10.1177/11795476261456792","url":null,"abstract":"<p><strong>Case: </strong>A 23-year-old female patient with no previously known medical conditions presented to the orthopedic clinic with bilateral shoulder pain persisting since the previous day after an episode of loss of consciousness and convulsions. She had no history of trauma during the event and had been evaluated in the emergency department with a preliminary diagnosis of an epileptic seizure before discharge following acute medical treatment. Bilateral anterior shoulder dislocation with accompanying bilateral greater tuberosity fractures was identified. Both shoulders were reduced under sedation, followed by surgical fixation due to >10 mm fragment displacement and instability risk. A cannulated screw and washer were used on the right side, and plate osteosynthesis on the left, resulting in favorable functional outcomes after rehabilitation.</p><p><strong>Conclusion: </strong>Bilateral greater tuberosity fractures associated with atraumatic bilateral anterior shoulder dislocation due to an epileptic seizure are exceedingly rare and may represent the first manifestation of epilepsy. This case demonstrates that seizure-induced muscle contractions can cause severe extremity injuries without external trauma; therefore, every post-seizure patient requires systematic extremity examination and early orthopaedic review. Appropriate surgical management with a multidisciplinary approach can yield favorable functional outcomes.</p>","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261456792"},"PeriodicalIF":0.6,"publicationDate":"2026-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13219883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148136807","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":"Genotype Versus Phenotype in Pandrug-Resistant <i>Pseudomonas aeruginosa</i>: Key Considerations for Interpretation.","authors":"Tarun Kumar Suvvari, Venkataramana Kandi, Sridhar Vns Kocharlakota","doi":"10.1177/11795476261457672","DOIUrl":"10.1177/11795476261457672","url":null,"abstract":"","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261457672"},"PeriodicalIF":0.6,"publicationDate":"2026-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13219933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148136781","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":"Air Everywhere: A Rare Post-ERCP Syndrome of Acute Pancreatitis, Pneumothorax, and Multicompartment Air Leak without Perforation.","authors":"Antonio Al Hazzouri, Maria Ziade, Katherine Atallah, Mandy El Khoury, Julie Bechara, Philippe Attieh, Pierre Mourad","doi":"10.1177/11795476261454434","DOIUrl":"10.1177/11795476261454434","url":null,"abstract":"<p><p>Endoscopic retrograde cholangiopancreatography (ERCP) is a widely used therapeutic procedure for pancreatobiliary disorders but is associated with a range of complications, most commonly post-ERCP pancreatitis (PEP). Post-ERCP air leak syndromes-including pneumothorax, pneumomediastinum, pneumoperitoneum, and subcutaneous emphysema-are exceptionally rare, particularly in the absence of an identifiable gastrointestinal perforation. We report the case of a 72-year-old woman who developed severe abdominal pain, acute respiratory distress, and hypoxemia 6 hours after ERCP performed for common bile duct stenting and biopsy of a suspected biliary tumor. Laboratory investigations revealed markedly elevated serum amylase and lipase, consistent with acute pancreatitis. Imaging demonstrated a moderate right-sided pneumothorax, diffuse pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum, extensive subcutaneous emphysema, and radiological features of acute pancreatitis, without evidence of duodenal or esophageal perforation. The patient was managed conservatively in the intensive care unit with bowel rest, intravenous fluids, antibiotics, supplemental oxygen, and close monitoring. Clinical and biochemical parameters improved progressively, with repeat imaging showing regression of air collections. This case highlights a rare constellation of post-ERCP complications occurring simultaneously without demonstrable perforation and underscores the importance of prompt recognition, multidisciplinary assessment, and individualized conservative management in selected stable patients.</p>","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261454434"},"PeriodicalIF":0.6,"publicationDate":"2026-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13219879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148136778","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":"Evaluating the Role of Subcoronal Botulinum Toxin Injection in the Management of Premature Ejaculation.","authors":"Seyed Reza Hosseini, Mahdi Najarzadegan, Mohammad Mahdi Mehrabi, Hossein Chivaee, Abdolreza Mohammadi, Sara Ashtari, Fateme Guitynavard, Parsa Nikoufar, Seyed Mohammad Kazem Aghamir","doi":"10.1177/11795476261452323","DOIUrl":"10.1177/11795476261452323","url":null,"abstract":"<p><strong>Background: </strong>Premature ejaculation (PE) is the most common male sexual dysfunction, which often causes significant psychological problems. Although botulinum toxin A (Botox) has shown promise for delaying ejaculation through chemodenervation, the optimal anatomical target remains uncertain. This study evaluated the efficacy and safety of Botox injection into the penile prepuce and subcoronal region as a novel approach for lifelong PE.</p><p><strong>Methods: </strong>A prospective case series was conducted in 7 adult men (mean age 54.7 ± 6.5 years) diagnosed with lifelong PE (intravaginal ejaculatory latency time <1 minute, PEDT ⩾11). Participants received a single 100-unit Botox injection, administered subcutaneously into the prepuce and subcoronal region. The Premature Ejaculation Diagnostic Tool (PEDT) and Male Sexual Health Questionnaire (MSHQ) were completed before, 4 weeks, and 6 months after treatment to assess the efficacy.</p><p><strong>Results: </strong>Seven patients were included in the analysis. No significant changes were observed in PEDT scores at 4 weeks (18.00 ± 0.9; <i>P</i> = .7358) or at 6 months (17.71 ± 0.4; <i>P</i> = .762) compared with baseline. Similarly, MSHQ erection scores (5.00 ± 2.0 at 4 weeks; 4.85 ± 2.2 at 6 months), ejaculation scores (23.43 ± 3.8 at 4 weeks; 23.42 ± 3.1 at 6 months), and satisfaction scores (10.71 ± 4.07 at 4 weeks; 10.14 ± 3.5 at 6 months) did not differ significantly from baseline values (<i>P</i> > .05 for all comparisons). No adverse events or treatment-related side effects were reported throughout the study period.</p><p><strong>Conclusions: </strong>Subcoronal Botox injection was safe and well-tolerated, but it did not show significant improvements in ejaculatory control or sexual function scores. The findings suggest that sensory-targeted Botox administration alone is insufficient to enhance the ejaculatory reflex.</p>","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261452323"},"PeriodicalIF":0.6,"publicationDate":"2026-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13213118/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148053053","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":"Ruptured Subserosal Pyomyoma Presenting as Peritonitis in the Early Postpartum Period: A Case Report.","authors":"Rediet G Kebede, Biruk T Mengistie, Chernet T Mengistie, Selam D Temesgen, Eden H Hagos, Zeynu M Seid","doi":"10.1177/11795476261456807","DOIUrl":"10.1177/11795476261456807","url":null,"abstract":"<p><strong>Introduction: </strong>Uterine leiomyomas (fibroids) are common benign tumors in women of reproductive age. Pyomyoma (suppurative leiomyoma) is a rare life-threatening complication arising from infarction and secondary infection of a fibroid, most often occurring during pregnancy or the postpartum period. Diagnosis is challenging due to nonspecific presentations.</p><p><strong>Case presentation: </strong>We report a 24-year-old primiparous woman (G1P1) who presented on postpartum day 9 with acute abdominal pain, fever, and leukocytosis. Imaging (CT) revealed a large subserosal fibroid with intraperitoneal free fluid and pockets of gas.</p><p><strong>Management and outcome: </strong>The patient underwent emergent exploratory laparotomy. A 10×15 cm perforated, purulent pedunculated subserosal leiomyoma with surrounding adhesions was identified, and postpartum abdominal hysterectomy was performed for source control. Postoperative broad-spectrum antibiotics were administered. The patient improved rapidly, with normalization of white blood cell count and resolution of symptoms, and was discharged home in good condition.</p><p><strong>Conclusion: </strong>This case highlights the need for high suspicion for pyomyoma in postpartum patients with fibroids who develop severe abdominal pain and sepsis. Prompt imaging and surgical intervention are critical to avoid morbidity and mortality from this rare complication.</p>","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261456807"},"PeriodicalIF":0.6,"publicationDate":"2026-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13213113/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148053054","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":"Hyperinflammatory Syndrome of Unknown Origin Complicated by Shock, DIC, Intracranial Hemorrhage and Spontaneous Splenic Rupture: A Case Report.","authors":"Zofia Serafinowicz, Jarosław Gadomski, Paweł Andruszkiewicz, Mateusz Zawadka","doi":"10.1177/11795476261455925","DOIUrl":"10.1177/11795476261455925","url":null,"abstract":"<p><p>Hyperinflammation syndrome is a life-threatening condition of heterogeneous etiology. Common manifestations include fever, organomegaly, leukopenia or leukocytosis and malaise. We would like to present a rare case of hyperinflammatory syndrome of unknown origin complicated by shock, severe coagulopathy, spontaneous splenic rupture, and intracranial hemorrhage. A 24-year-old man with no past medical history was admitted to intensive care unit presenting with hemodynamic instability, severe acidosis, splenomegaly, bi-cytopenia, with significantly elevated inflammatory markers. Broad spectrum microbiology, hematology and genetic tests were performed to identify a trigger. Due to presence of both sepsis and hemophagocytic lymphohistiocytosis features (HLH), sepsis-HLH overlap syndrome was suspected. Aggressive treatment (broad-spectrum antibiotics, immunomodulation therapy, therapeutic plasma exchange and renal replacement therapy) was instantly initiated. Despite that, shock and profound disseminated intravascular coagulopathy exacerbated. Unexpected splenic rupture and intracranial hemorrhage required urgent surgical intervention, along with amputation of distal foot phalanges due to severe ischemia. Treatment in the intensive care unit lasted 40 days. One year after a discharge from ICU, patient still required neurological rehabilitation and orthopedic treatment. We do hope that this case will make clinicians more aware of HLH and sepsis-HLH overlap syndrome. Further research is required to improve treatment of severe hyperinflammation.</p>","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261455925"},"PeriodicalIF":0.6,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13201946/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148041368","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 Tail Leiomyosarcoma With Hepatic Metastases: Diagnostic and Therapeutic Challenges: A Case Report.","authors":"Somaya Al Kiswani, Nid'a Mubarak, Renad Abu Ruman, Muna Shahwan, Rahaf Zorba, Shaimaa Abu Laban, Omar Sawafta, Abdullah Nofal","doi":"10.1177/11795476261452331","DOIUrl":"10.1177/11795476261452331","url":null,"abstract":"<p><p>Primary pancreatic leiomyosarcoma (PLMS) is a rare malignant tumor accounting for less than 0.1% of all pancreatic neoplasms and often presents at an advanced stage with distant metastases or local invasion. Clinical symptoms are nonspecific, including gastrointestinal discomfort, abdominal pain, or distension, which frequently leads to delayed diagnosis. We report a 53-year-old woman with persistent abdominal distension, bloating, and central discomfort, in whom imaging revealed a 7.5 cm mass in the pancreatic tail with multiple liver metastases, encasement of the splenic arteries, and no direct invasion of the spleen or adjacent adrenal gland; her family history was notable for hematological, breast, and pancreatic cancers. Due to its rarity, aggressive metastatic behavior, and lack of standardized therapy, PLMS presents significant diagnostic and treatment challenges. This case highlights the importance of recognizing pancreatic leiomyosarcoma as a distinct clinical entity and contributes to the limited literature guiding its management.</p>","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261452331"},"PeriodicalIF":0.6,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13195217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148013585","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":"Acute Pancreatitis as an Initial Presentation of Hereditary Chronic Calcific Pancreatitis with Pancreatic Duct Stones: A Case Report.","authors":"Tya Youssef, Tracy Zouein, Karim Zodeh, Hilda E Ghadieh, Mahmoud Othman","doi":"10.1177/11795476261445483","DOIUrl":"10.1177/11795476261445483","url":null,"abstract":"<p><strong>Background: </strong>Hereditary pancreatitis is a rare type of chronic pancreatitis that is due to an inherited germline mutation, involving pancreatic trypsin activity. This condition causes either increased trypsinogen activation or impaired trypsin inhibition/degradation, resulting in recurrent pancreatic injury and progression to chronic pancreatitis.</p><p><strong>Case presentation: </strong>We present the case of a young male who presented with acute pancreatitis in the setting of a positive family history of chronic pancreatitis. He had no prior similar episodes. Imaging revealed features consistent with chronic calcific pancreatitis, including diffuse dilation of the main pancreatic duct with intraductal stones. The patient underwent ERCP with pancreatic sphincterotomy and successful removal of multiple pancreatic stones resulting in symptomatic relief. Genetic testing confirmed the diagnosis of hereditary pancreatitis with identification of a pathogenic PRSS1 mutation.</p><p><strong>Management: </strong>Therapeutic interventions typically involve management of acute pancreatitis flares and its complications, chronic pain management, exocrine and endocrine insufficiency, and endoscopic and surgical interventions, and genetic counseling and surveillance.</p><p><strong>Conclusion: </strong>Our case report emphasizes the significance of taking hereditary pancreatitis into account in acute-on-chronic presentations. This helps in establishing a genetic diagnosis for directing treatment, long-term surveillance, and family screening.</p>","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261445483"},"PeriodicalIF":0.6,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13172716/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147962397","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":"Antipsychotics-Associated Allergic Reaction: A Case Report and Review of Literature.","authors":"Fatemeh Sadeghi, Mahnaz Momenzadeh, Mahsa Panahishokouh","doi":"10.1177/11795476261432486","DOIUrl":"10.1177/11795476261432486","url":null,"abstract":"<p><p>Hypersensitivity reactions to second-generation antipsychotics and mood stabilizers are uncommon and can lead to serious complications. These medicines are generally well tolerated, but there have been reports of unusual allergic reactions, such as hives or itching, associated with these drugs. The patient is a 45-year-old woman who presented with a recurrence of a manic episode of bipolar I disorder and developed skin complications and itching after receiving valproate and levetiracetam. She subsequently experienced severe skin allergic reactions, including hives and itching, after taking various second-generation antipsychotics, including risperidone, aripiprazole, and quetiapine. These allergic reactions occurred shortly after starting the medication and resolved after discontinuing the drug. The purpose of this case report is to highlight the importance of being aware of the possibility of concomitant hypersensitivity with various antipsychotic and anticonvulsant medications, which can affect the diagnosis and treatment of the disease.</p>","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261432486"},"PeriodicalIF":0.6,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13168710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147940393","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 Case Report of Pancreatic Acinar Metaplasia of the Distal Esophagus Mimicking Barrett's Esophagus: A Diagnostic Pitfall.","authors":"Souhaila Akir, Karam Karam, Kim Charro, Aurélien Morini, Emilien Brousset, Christophe Locher","doi":"10.1177/11795476261449609","DOIUrl":"10.1177/11795476261449609","url":null,"abstract":"<p><strong>Background: </strong>Pancreatic acinar metaplasia (PAM) is defined as the presence of islands of exocrine pancreatic glands in areas outside of the pancreas. It is most commonly detected incidentally within the upper gastrointestinal tract. Histologically, PAM typically contains lobular or nested aggregates of epithelial cells with basal nuclei and abundant cytoplasm, which is acidophilic and finely granular in the apical and middle portion and basophilic in the basal compartment, closely resembling pancreatic acinar cells.</p><p><strong>Case presentation: </strong>We report a rare case of PAM located at the gastroesophageal junction (GEJ). Endoscopic examination revealed a lesion mimicking Barrett's esophagus. Histopathological analysis demonstrated a focus of pancreatic acinar metaplasia comprised of acinar-like cells, located at the squamocolumnar junction of esophagus, consistent with PAM.</p><p><strong>Conclusion: </strong>PAM of the esophagus is an exceptionally rare entity that may mimic other esophageal conditions on endoscopic evaluation. Accurate diagnosis relies on histopathological assessment, which is essential for differentiating this uncommon lesion from more prevalent esophageal pathologies.</p>","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261449609"},"PeriodicalIF":0.6,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13168708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147940375","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}