Clinical Medicine Insights. Case Reports最新文献_第7页

An Atypical Case of Metastatic Esophageal Adenocarcinoma Causing Biliary Obstruction and Duodenal Infiltration Requiring EUS-Guided Choledochoduodenostomy. 转移性食管腺癌致胆道梗阻及十二指肠浸润需行eus引导胆总管十二指肠吻合术1例。

IF 0.6

Clinical Medicine Insights. Case Reports Pub Date : 2026-05-11 eCollection Date: 2026-01-01 DOI: 10.1177/11795476261449607

Philippe Attieh, Antonio Al Hazzouri, Karam Karam, Abdellah Chabni

{"title":"An Atypical Case of Metastatic Esophageal Adenocarcinoma Causing Biliary Obstruction and Duodenal Infiltration Requiring EUS-Guided Choledochoduodenostomy.","authors":"Philippe Attieh, Antonio Al Hazzouri, Karam Karam, Abdellah Chabni","doi":"10.1177/11795476261449607","DOIUrl":"10.1177/11795476261449607","url":null,"abstract":"Esophageal adenocarcinoma (EAC) is an aggressive malignancy with a poor prognosis, especially in advanced stages. Common metastatic sites include the liver, lungs, adrenal glands, lymph nodes, and bones; however, metastasis to the biliary tree is exceedingly rare. We report the case of a 50-year-old male with a history of testicular cancer in remission and metastatic EAC involving the liver, lungs, adrenal glands, peritoneum, bones, and lymph nodes. The patient presented with acute onset jaundice but no abdominal pain, fever, or gastrointestinal symptoms. Laboratory findings revealed significant cholestasis, and imaging demonstrated biliary tree dilation with obstruction at the distal common bile duct. ERCP was unsuccessful due to duodenal invasion by the tumor, which precluded access to the biliary system. Endoscopic ultrasound-guided biliary drainage was performed, and a stent was successfully placed. The patient subsequently developed post-ERCP pancreatitis, which was managed conservatively with intravenous fluids. This case illustrates a highly uncommon metastatic pattern of EAC, with involvement of both the biliary tree and the duodenum, leading to obstructive jaundice and necessitating advanced endoscopic intervention. The combination of widespread metastasis, duodenal obstruction, and biliary involvement makes this presentation exceptionally rare. It also underscores the importance of recognizing atypical manifestations of metastatic EAC and highlights the critical role of endoscopic ultrasound in managing complex biliary obstructions when standard approaches fail. To our knowledge, very few cases of EAC metastasizing to the biliary tree have been reported, making this case a valuable addition to the medical literature and clinical understanding of EAC.","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261449607"},"PeriodicalIF":0.6,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13168714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147940380","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}

引用次数: 0

Esophagitis Dissecans Superficialis Due to Possible Fishbone Ingestion: A Case Report. 食入鱼骨致浅表性食管炎1例。

IF 0.6

Clinical Medicine Insights. Case Reports Pub Date : 2026-05-05 eCollection Date: 2026-01-01 DOI: 10.1177/11795476261448713

Mohamed Sidahmed Elmahadi, Mohammed Alfatih, Ahmed Mohamed Badi, Anwar Ibrahim Joudeh

{"title":"Esophagitis Dissecans Superficialis Due to Possible Fishbone Ingestion: A Case Report.","authors":"Mohamed Sidahmed Elmahadi, Mohammed Alfatih, Ahmed Mohamed Badi, Anwar Ibrahim Joudeh","doi":"10.1177/11795476261448713","DOIUrl":"10.1177/11795476261448713","url":null,"abstract":"Introduction: Esophagitis Dissecans Superficialis (EDS) is a rare, underrecognized mucosal disorder of the esophagus. It is often associated with certain medications, systemic diseases, or direct esophageal trauma. Diagnosis is challenging due to its overlap with other esophageal conditions and the lack of standardized criteria.Case presentation: We report the case of a 38-year-old woman presenting with acute chest pain, dysphagia, and hematemesis following suspected fishbone ingestion. Initial endoscopic findings revealed sloughed esophageal mucosa with friability predominantly in the upper and mid-esophagus. Supportive management with high-dose proton pump inhibitor therapy and dietary modification resulted in rapid clinical improvement. Follow-up endoscopy at day 56 demonstrated complete resolution of mucosal abnormalities, and esophageal biopsies showed normal squamous epithelium. Based on the characteristic endoscopic findings, exclusion of alternative diagnoses, and benign, self-limited course, the presentation was most consistent with EDS, with fishbone ingestion considered a probable precipitating factor.Conclusion: This case highlights mechanical esophageal trauma due to possible fishbone ingestion as a rare but plausible trigger for EDS and underscores the importance of recognizing this entity in patients presenting with acute chest pain and upper gastrointestinal bleeding. Increased awareness of EDS may facilitate accurate diagnosis and prevent unnecessary interventions.","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261448713"},"PeriodicalIF":0.6,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13158487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147927120","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}

引用次数: 0

Polycythemia Vera with Incidental Large Aortic Aneurysm and Giant Cell Arteritis: Case Report. 真性红细胞增多症并发大动脉瘤和巨细胞动脉炎1例。

IF 0.6

Clinical Medicine Insights. Case Reports Pub Date : 2026-05-04 eCollection Date: 2026-01-01 DOI: 10.1177/11795476261445478

Koutaibah Obaid, Khaled Sadek, Fatima Al Jaber, Mohammad Altermanini, Abdulrahman F Al-Mashdali, Mohammed Yassin, Abdulaziz M Alkhulaifi, Cornelia S Carr, Shehab F Mohamed

{"title":"Polycythemia Vera with Incidental Large Aortic Aneurysm and Giant Cell Arteritis: Case Report.","authors":"Koutaibah Obaid, Khaled Sadek, Fatima Al Jaber, Mohammad Altermanini, Abdulrahman F Al-Mashdali, Mohammed Yassin, Abdulaziz M Alkhulaifi, Cornelia S Carr, Shehab F Mohamed","doi":"10.1177/11795476261445478","DOIUrl":"10.1177/11795476261445478","url":null,"abstract":"Polycythemia vera (PV) is a JAK2-mutated myeloproliferative neoplasm associated with thrombotic and vascular complications. Giant cell arteritis (GCA) is a granulomatous large-vessel vasculitis that may involve the aorta and can present as aortitis or aneurysm formation. Coexistence of PV and GCA is uncommon and may complicate diagnosis and management. We report a 41-year-old man with low-risk PV (JAK2 V617F-positive) who presented 4 months later with an ischemic stroke and was incidentally found to have a 5.0 cm ascending aortic aneurysm. Despite cytoreduction and surveillance, the aneurysm enlarged to 5.6 cm and was repaired electively. Histopathology of the resected aortic wall showed granulomatous inflammation with multinucleated giant cells and elastic lamina fragmentation, consistent with GCA. The patient had no cranial or systemic features suggestive of active GCA at diagnosis; therefore, systemic corticosteroids were deferred and close rheumatology follow-up was arranged. This case underscores the need to consider inflammatory aortitis/large-vessel vasculitis when atypical vascular findings occur in PV and highlights the value of multidisciplinary evaluation.","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261445478"},"PeriodicalIF":0.6,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13157574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147873763","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}

引用次数: 0

Haematohidrosis in a Young Boy Temporally Associated With Psychological Stress: A Case Report. 小男孩血汗病暂时与心理压力相关：1例报告。

IF 0.6

Clinical Medicine Insights. Case Reports Pub Date : 2026-04-30 eCollection Date: 2026-01-01 DOI: 10.1177/11795476261446756

Venkata Sarma Jayant Tetta, Jaya Krishna Sahitya Mattaparthi, Yamini Subha Lakshmi Rajeswari Siripurapu, Sai Priya Kandukoori, Dilli Siva Chandana Doddapaneni, Tejinder Singh

{"title":"Haematohidrosis in a Young Boy Temporally Associated With Psychological Stress: A Case Report.","authors":"Venkata Sarma Jayant Tetta, Jaya Krishna Sahitya Mattaparthi, Yamini Subha Lakshmi Rajeswari Siripurapu, Sai Priya Kandukoori, Dilli Siva Chandana Doddapaneni, Tejinder Singh","doi":"10.1177/11795476261446756","DOIUrl":"10.1177/11795476261446756","url":null,"abstract":"Haematohidrosis is an exceptionally rare and poorly understood clinical phenomenon characterized by the spontaneous excretion of blood through intact skin or natural orifices, with episodes often reported in association with extreme emotional or psychological stress. Owing to its rarity, the condition often poses significant diagnostic challenges and may be misinterpreted as a bleeding disorder, self-inflicted injury, or factitious illness. We report the case of an 11-year-old boy who presented with a 1-month history of recurrent, painless, self-limiting episodes of bleeding from the eyes, nose, and ears. These episodes were temporally associated with periods of academic and parental stress. Comprehensive hematological, biochemical, and radiological investigations, including coagulation studies and von Willebrand factor assays, were within normal limits, effectively excluding systemic or inherited bleeding disorders. Cytological examination and a positive benzidine test confirmed the presence of blood in the secretions. A temporal association between psychosocial stressors and symptom onset was observed. The patient was managed with propranolol to attenuate sympathetic hyperactivity and cognitive behavioral therapy aimed at stress management and coping strategies. This case highlights the importance of recognizing haematohidrosis as a rare clinical condition in which psychosocial factors may play a contributory role, and emphasizes the role of multidisciplinary management to achieve favorable outcomes.","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261446756"},"PeriodicalIF":0.6,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13153475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147867084","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}

引用次数: 0

Silent Gastroesophageal Reflux Disease Presenting With Acute Cough and Poor Response to Antitussives: A Case Report. 以急性咳嗽和抗咳药反应差为表现的无症状胃食管反流病1例报告。

IF 0.6

Clinical Medicine Insights. Case Reports Pub Date : 2026-04-27 eCollection Date: 2026-01-01 DOI: 10.1177/11795476261446356

Hussein Mussa Muafa

{"title":"Silent Gastroesophageal Reflux Disease Presenting With Acute Cough and Poor Response to Antitussives: A Case Report.","authors":"Hussein Mussa Muafa","doi":"10.1177/11795476261446356","DOIUrl":"10.1177/11795476261446356","url":null,"abstract":"Silent gastroesophageal reflux disease (GERD) is an atypical form of reflux disease in which patients present predominantly with extra-esophageal manifestations rather than classic symptoms such as heartburn or acid regurgitation. In this form, gastric refluxate may reach the upper aerodigestive tract, leading to laryngeal or respiratory symptoms that are frequently misattributed to infectious or allergic conditions. The absence of typical gastrointestinal complaints often results in delayed diagnosis and repeated ineffective treatments. We report the case of a 27-year-old male who presented with acute dry cough and progressive hoarseness without gastrointestinal symptoms. After excluding infectious and allergic etiologies, and noting a poor response to antitussive and bronchodilator therapies, a presumptive clinical diagnosis was established. Recognition of dietary triggers and rapid symptom resolution following a 4-week empirical trial of proton pump inhibitor therapy-along with symptom recurrence upon temporary discontinuation-supported the diagnosis of silent GERD. This case highlights the importance of considering reflux-related etiologies in patients with unexplained cough and laryngeal symptoms to avoid diagnostic delays and unnecessary empirical treatments.","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261446356"},"PeriodicalIF":0.6,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13133487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811941","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}

引用次数: 0

When Hiccups Speak Louder Than Cough: A Case Report of An Unusual Presentation of Lung Abscess. 当打嗝比咳嗽更响亮：一个不寻常的肺脓肿的病例报告。

IF 0.6

Clinical Medicine Insights. Case Reports Pub Date : 2026-04-27 eCollection Date: 2026-01-01 DOI: 10.1177/11795476261443093

Antonio Al Hazzouri, Philippe Attieh, Karam Karam, Ihab I El Hajj, Said G Farhat, Elias Fiani

{"title":"When Hiccups Speak Louder Than Cough: A Case Report of An Unusual Presentation of Lung Abscess.","authors":"Antonio Al Hazzouri, Philippe Attieh, Karam Karam, Ihab I El Hajj, Said G Farhat, Elias Fiani","doi":"10.1177/11795476261443093","DOIUrl":"10.1177/11795476261443093","url":null,"abstract":"Hiccups are commonly benign, self-limiting events often triggered by transient gastrointestinal or central nervous system irritants. However, when persistent, they may indicate underlying pathology involving the thoracic, gastrointestinal, or neurological systems. We report the case of a 65-year-old male smoker who presented with a 4-day history of persistent hiccups. He denied fever, chest pain, hemoptysis, or other systemic symptoms. Physical examination was largely unremarkable except for decreased air entry in the right middle and lower lung zones. Initial investigations, including gastroscopy and tumor markers, ruled out gastrointestinal causes. CT scan of the chest revealed a right lower lobe consolidation and cavitation with air fluid level and adjacent ground-glass opacities, along with enlarged subcarinal lymph nodes. Differential diagnoses included lung abscess, pneumonia, and tuberculosis cavitation. The patient was admitted for suspected lung abscess and received antibiotics. Bronchoscopy with bronchoalveolar lavage revealed no endobronchial lesions, and PCR testing and culture of the fluid was negative for tuberculosis but positive for klebsiella pneumonia. Despite radiologic regression of pneumonia, the cavitary lesion and lymphadenopathy persisted initially, but later started to regress. This case highlights an unusual presentation of lung abscess manifesting solely as persistent hiccups, without classic respiratory or systemic signs. We aim to emphasize the need to consider thoracic causes in patients with otherwise unexplained persistent hiccups, and undergo further evaluation in such cases.","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261443093"},"PeriodicalIF":0.6,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13133434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812003","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}

引用次数: 0

Dual Antithyroid Drug-Induced Agranulocytosis in Graves' Disease With Decompensated Heart Failure: A Multidisciplinary Approach. 双重抗甲状腺药物诱导的粒细胞缺乏症在Graves病伴失代偿性心力衰竭：一个多学科的方法。

IF 0.6

Clinical Medicine Insights. Case Reports Pub Date : 2026-04-27 eCollection Date: 2026-01-01 DOI: 10.1177/11795476261446355

Amarildo Voci, Liri Seraj, Mario Shehu, Asfloral Haxhiu

{"title":"Dual Antithyroid Drug-Induced Agranulocytosis in Graves' Disease With Decompensated Heart Failure: A Multidisciplinary Approach.","authors":"Amarildo Voci, Liri Seraj, Mario Shehu, Asfloral Haxhiu","doi":"10.1177/11795476261446355","DOIUrl":"10.1177/11795476261446355","url":null,"abstract":"Antithyroid drug-induced agranulocytosis is a rare but potentially life-threatening complication, particularly in patients with limited therapeutic options. This case illustrates the complexity of managing uncontrolled thyrotoxicosis in the context of a patient with decompensated heart failure, chronic obstructive pulmonary disease (COPD), and adverse reactions to both methimazole and propylthiouracil. A 54-year-old male patient with a 2-year history of Graves' disease presented with worsening dyspnea and tachycardia in the setting of thyrotoxicosis with a TSH of 0.0007 mIU/L. He had previously developed agranulocytosis (ANC 180 cells/µL) subsequent to treatment with methimazole, and subsequently developed febrile agranulocytosis (ANC 190 cells/µL) upon initiation of propylthiouracil, thereby exhausting all antithyroid drug options. A bridging therapy of Lugol's iodine and granulocyte colony-stimulating factor (G-CSF) was utilized, which enabled successful total thyroidectomy. Right heart catheterization confirmed the patient's suitability for surgery despite a left ventricular ejection fraction of 35%. This case highlights the importance of interdisciplinary collaboration in managing complex endocrine-cardiac-hematology presentations.","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261446355"},"PeriodicalIF":0.6,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13133480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811957","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}

引用次数: 0

Endoscopic Ultrasound-Guided Transoesophageal Biopsy in a Mediastinal Tumour: A Case Report. 超声内镜引导下经食管纵隔肿瘤活检1例。

IF 0.6

Clinical Medicine Insights. Case Reports Pub Date : 2026-04-25 eCollection Date: 2026-01-01 DOI: 10.1177/11795476261440723

Roberto Antonio Alvarado-Hernández, Yoeli Marisa Escandón-Espinoza, Katia Daniela López-García

{"title":"Endoscopic Ultrasound-Guided Transoesophageal Biopsy in a Mediastinal Tumour: A Case Report.","authors":"Roberto Antonio Alvarado-Hernández, Yoeli Marisa Escandón-Espinoza, Katia Daniela López-García","doi":"10.1177/11795476261440723","DOIUrl":"10.1177/11795476261440723","url":null,"abstract":"Endoscopic ultrasound-guided transoesophageal biopsy (EUS-FNA/FNB) is a minimally invasive and highly accurate diagnostic technique for evaluating mediastinal lesions, particularly in centres where surgical approaches or endobronchial ultrasound are unavailable. We report the case of a 79-year-old woman with multiple comorbidities who presented with non-specific abdominal pain and a 5 kg weight loss over 1 month. Imaging revealed a 50% left pleural effusion and mediastinal and retroperitoneal lymphadenopathy. Endoscopic ultrasound demonstrated hilar, retroperitoneal and interaortocaval lymph nodes, prompting a transoesophageal fine-needle biopsy using a 22G needle and fanning technique, which was performed without complications. Initial histopathology suggested a lymphoproliferative process, and a subsequent excisional lymph node biopsy confirmed classical mixed-cellularity Hodgkin lymphoma associated with Epstein-Barr virus. This case highlights the diagnostic value of EUS-FNA/FNB in mediastinal lesions that are difficult to access using traditional techniques. Although its diagnostic yield is high, lymphomas-particularly Hodgkin lymphoma-may require additional tissue sampling to preserve architectural detail. Procedure success depends on sample adequacy, needle selection and operator expertise. Integrating EUS-guided biopsy into a multidisciplinary diagnostic pathway enables safe, effective and timely evaluation of mediastinal pathology, especially in resource-limited settings or in patients with significant comorbidities.","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261440723"},"PeriodicalIF":0.6,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13129358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811937","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}

引用次数: 0

Sydenham's Chorea as the Sole Presenting Symptom of Acute Rheumatic Fever in a 14-Year-Old Boy: A Case Report. 西德纳姆舞蹈病是14岁男孩急性风湿热的唯一表现症状：1例报告。

IF 0.6

Clinical Medicine Insights. Case Reports Pub Date : 2026-04-21 eCollection Date: 2026-01-01 DOI: 10.1177/11795476261437634

Omar Nashwan, Ziad W Elmezayen, Bassel Alrabadi, Natalie Bandak, Mohammad Adi

{"title":"Sydenham's Chorea as the Sole Presenting Symptom of Acute Rheumatic Fever in a 14-Year-Old Boy: A Case Report.","authors":"Omar Nashwan, Ziad W Elmezayen, Bassel Alrabadi, Natalie Bandak, Mohammad Adi","doi":"10.1177/11795476261437634","DOIUrl":"10.1177/11795476261437634","url":null,"abstract":"Background: Rheumatic chorea is an uncommon but time-honored neurological manifestation of acute rheumatic fever that usually presents weeks to months after an untreated streptococcal pharyngitis. When it presents alone, that is, without other manifestations of the disease, it could easily be overlooked or delayed in its diagnosis. In such a scenario, it is uniquely presented as an isolated primary presentation of rheumatic fever, which underscores the challenge of diagnosis and the importance of early recognition.Case presentation: A 14-year-old boy presented with automatic, aimless, and arrhythmic movements of his limbs and face. There was no fever, rash, or joint pain in the preceding weeks. Neurological examination demonstrated choreiform movements typical of Sydenham's chorea, and serology suggested a recent Group A streptococcal infection. Transthoracic echocardiography revealed mild mitral valve leaflet thickening with mild mitral regurgitation consistent with subclinical rheumatic carditis. The patient was treated with benzathine penicillin for eradication and long-term prophylaxis, and valproic acid for symptomatic control. Symptoms improved over weeks and follow-up assessments showed near resolution of valvular changes without development of clinically significant rheumatic heart disease.Conclusion: This case highlights that rheumatic chorea may occur as an isolated type of acute rheumatic fever. Recognition of such a presentation is important in making early diagnosis and treatment, which are essential to prevent long-term effects such as rheumatic heart disease.","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261437634"},"PeriodicalIF":0.6,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13111883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147763986","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}

引用次数: 0

Systemic Epinephrine Toxicity Following Topical Anesthetic Gel on Mucosal Surfaces: A Case Report and Literature Review. 局部麻醉凝胶在粘膜表面的全身肾上腺素毒性：1例报告和文献复习。

IF 0.6

Clinical Medicine Insights. Case Reports Pub Date : 2026-04-21 eCollection Date: 2026-01-01 DOI: 10.1177/11795476261437585

Ziad W Elmezayen, Zeina Zakarya Marzouk, Mohammad Adi

{"title":"Systemic Epinephrine Toxicity Following Topical Anesthetic Gel on Mucosal Surfaces: A Case Report and Literature Review.","authors":"Ziad W Elmezayen, Zeina Zakarya Marzouk, Mohammad Adi","doi":"10.1177/11795476261437585","DOIUrl":"10.1177/11795476261437585","url":null,"abstract":"Introduction: Systemic toxicity from topical epinephrine is rare because dermal and mucosal absorption is typically limited. However, application to highly vascular mucosa, particularly under occlusion, may result in clinically significant systemic absorption.Case presentation: A 42-year-old woman developed severe headache, palpitations, tremor, and marked hypertension shortly after a compounded 2.5% lidocaine with epinephrine (1:2000; 0.5 mg/mL) gel was applied to the labial mucosa under occlusion during a cosmetic procedure. An estimated 0.5 to 1.5 mg of epinephrine was applied. Symptoms began within 10 minutes and persisted until gel removal approximately 25 minutes later. On EMS arrival, heart rate was 145 bpm and blood pressure 210/110 mmHg. In the emergency department, ECG showed sinus tachycardia without ischemic changes; laboratory studies were unremarkable except for mild respiratory alkalosis, and serial high-sensitivity troponin I was negative. Management included prompt removal of the topical agent, supportive care, and cardiac monitoring. Symptoms resolved spontaneously without pharmacologic intervention, and the patient was discharged after 4 hours of observation.Conclusion: Topical epinephrine applied to highly vascular mucosal surfaces-especially under occlusion-can rarely cause systemic sympathomimetic toxicity characterized by hypertension, tachycardia, tremor, and anxiety. Although it may resemble local anesthetic systemic toxicity, it is clinically distinct. Careful dosing, avoidance of occlusive dressings, close monitoring, and immediate removal of the agent at the first sign of systemic effects are essential to prevent complications.","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261437585"},"PeriodicalIF":0.6,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13111853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764002","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}

引用次数: 0