International Medical Case Reports Journal最新文献

{"title":"A Rare Battle: Multidisciplinary Care for a Child with Rhino-Orbital Cerebral Mucormycosis in Somali Region of Ethiopia.","authors":"Abdirashid Abdirahman Hussein, Mahamed Mahamoud Mahamed, Habtamu Dildil, Ismail Abdulahi, Abdulaziz Ibrahim Osmael, Sebsbie Admas, Mohamoud Hashi Abdi, Abdirahman Omer Ali","doi":"10.2147/IMCRJ.S524811","DOIUrl":"10.2147/IMCRJ.S524811","url":null,"abstract":"<p><strong>Background: </strong>Rhino-orbital-cerebral mucormycosis (ROCM) is a rare, aggressive fungal infection with high mortality, primarily affecting immunocompromised individuals, especially those with uncontrolled diabetes mellitus, though it can occur in immunocompetent hosts. Cerebral involvement carries a near 100% fatality rate if untreated, and overall mortality remains high (>30%) even with therapy. We present a pediatric ROCM case from the resource-limited Somali region of Ethiopia.</p><p><strong>Case presentation: </strong>A 12-year-old female with type 1 diabetes mellitus presented with a 10-day history rapidly progressing from headache and fever to right-sided periorbital swelling, proptosis, vision loss, and a necrotic eschar. She had uncontrolled hyperglycemia and diabetic ketoacidosis (DKA) upon arrival. Imaging via CT and MRI revealed findings highly suggestive of ROCM, demonstrating right orbital involvement, cavernous sinus thrombosis, and further intracranial extension including cerebral abscesses/cerebritis and meningeal enhancement. Microbiological confirmation was unavailable due to resource limitations. Treatment included intravenous liposomal amphotericin B (requiring dose adjustment for transient nephrotoxicity), extensive endoscopic nasal debridement, right eye exenteration, and intensive glycemic control.</p><p><strong>Discussion and conclusion: </strong>This case highlights the diagnostic and management challenges of ROCM in resource-limited settings. Despite the high mortality associated with ROCM, particularly in children, the patient improved significantly and was discharged in good health, albeit with persistent visual impairment. Successful management involved prompt recognition, aggressive multimodal therapy (medical and surgical), and close multidisciplinary collaboration (Pediatrics, Ophthalmology, ENT). This outcome demonstrates the feasibility of successful treatment even in resource-constrained environments and underscores the critical importance of managing underlying conditions like diabetes to prevent opportunistic infections.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"18 ","pages":"769-776"},"PeriodicalIF":0.7,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12206433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527847","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":"Treatment and Survival Outcomes in Rhino-Orbital Mucormycosis with and without Orbital Exenteration: A Retrospective Case Series and Literature Review.","authors":"Shadi Boqaaiya, Yuval Cohen, Karine Beiruti Wiegler, Otzem Chassid","doi":"10.2147/IMCRJ.S530233","DOIUrl":"10.2147/IMCRJ.S530233","url":null,"abstract":"<p><p>Rhino-orbital mucormycosis (ROM) is a life-threatening, fungal infection, primarily affecting immunocompromised patients. The role of orbital exenteration in treatment remains debated, especially regarding its impact on survival outcomes. This case series presents two patients from our Ophthalmology department and compares them with eight cases from the literature, focusing on treatment outcomes and survival rates. We specifically explore the impact of orbital exenteration and other management strategies. The analysis reveals that survival outcomes are closely linked to the timely initiation of antifungal therapy, the patient's underlying conditions, and the extent of orbital involvement at the time of diagnosis. Our findings, in line with the literature, show that early-stage ROM can be treated successfully with less invasive methods, while advanced cases may require orbital exenteration. The need for exenteration should be evaluated on a case-by-case basis, with early detection and appropriate antifungal treatment being critical factors for survival. This study highlights the importance of early diagnosis and individualized treatment plans, emphasizing that while orbital exenteration may improve survival in severe cases, less invasive interventions should be considered for less advanced ROM. Further research and standardized guidelines are needed to refine treatment strategies.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"18 ","pages":"747-762"},"PeriodicalIF":0.7,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12205758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527850","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":"Full-Thickness Macular Hole Formation After Intravitreal Faricimab Injection for Polypoidal Choroidal Vasculopathy.","authors":"Fahsiri Tavonvunchai, Karntida Chanwimol","doi":"10.2147/IMCRJ.S527975","DOIUrl":"10.2147/IMCRJ.S527975","url":null,"abstract":"<p><strong>Purpose: </strong>To report a case of an Asian man with idiopathic polypoidal choroidal vasculopathy (PCV) who developed a full-thickness macular hole (FTMH) following treatment with intravitreal faricimab, which resolved after vitreoretinal surgery.</p><p><strong>Patients and methods: </strong>A 63-year-old man with idiopathic PCV was treated with intravitreal faricimab. Although pigment epithelial detachment (PED) decreased, he developed cystoid macular edema with vitreomacular traction (VMT), which progressed to a FTMH.</p><p><strong>Results: </strong>Pars plana vitrectomy and internal limiting membrane peeling successfully treated the FTMH. One year after the procedure, the macular hole remains closed, and the PCV was inactive.</p><p><strong>Conclusion: </strong>Various mechanisms may have contributed to the exacerbation of the preexisting VMT and PED, which finally resulted in the development of a FTMH. Careful attention should be paid to changes in the vitreomacular interface and posterior vitreous detachment before performing intravitreal anti-vascular endothelial growth factor treatment. Nevertheless, FTMHs can be successfully treated with prompt vitreoretinal surgery.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"18 ","pages":"741-746"},"PeriodicalIF":0.7,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12205330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527848","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":"In situ Serial Trident Chop for Low-IOP Phacoemulsification without Nuclear Rotation: A Case Report.","authors":"Hung-Chou Lin, Yung-Han Lin","doi":"10.2147/IMCRJ.S520654","DOIUrl":"10.2147/IMCRJ.S520654","url":null,"abstract":"<p><strong>Background: </strong>Phacoemulsification had been made efficient by hydrodissection, nucleus rotation, chopping, and using high vacuum to aspirate lens fragments under high hydrostatic pressure. Yet hydrodissection might be incomplete with the lens nucleus resisting rotation. Further vigorous hydrodissection might rupture the posterior capsule and forceful nuclear rotation might cause zonular dialysis. Encountered with such conditions, we present a case using an in situ serial trident chop technique and hydrodelineation independent of complete hydrodissection and nucleus rotation to avoid related complications.</p><p><strong>Case presentation: </strong>A 61-year-old male patient with grade II nuclear opalescence received phacoemulsification from the author. Incomplete hydrodissection, inadvertent hydrodelineation and difficult nuclear rotation were noted during operation. The author turned to in situ serial trident chop without nuclear rotation under low intraocular pressure (IOP), which was done by dividing the nucleus into four fragments through three serial in situ horizontal chops in the 12 o'clock, 3 o'clock, and 10 o'clock directions, then the fragments were picked to the phaco tip by nucleus manipulator instead of high vacuum produced by phaco tip to reduce the hydrostatic pressure needed for keeping the safe depth of the anterior chamber. The resultant four small nuclear fragments were readily emulsified under a stable anterior chamber with an IOP of 20-28 mmHg and cumulative dissipated energy of 3.28. The eye's central corneal thickness increased from 522 μm before the operation to 540 μm on the following day.</p><p><strong>Conclusion: </strong>Phacoemulsification could be accomplished by in situ serial trident chop under low IOP and hydrodelineation without complete hydrodissection or nuclear rotation for grade II nuclear opalescence, although further investigation is needed to confirm its safety and efficacy.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"18 ","pages":"763-768"},"PeriodicalIF":0.7,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12204098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527849","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":"Large Anterior Cervical Spine Schwannoma Causing Dysphagia: Case Report.","authors":"Aleksander Joniec, Jedrzej Mikolajczyk, Bartosz Godlewski","doi":"10.2147/IMCRJ.S522776","DOIUrl":"10.2147/IMCRJ.S522776","url":null,"abstract":"<p><strong>Introduction: </strong>Schwannomas are rare benign tumours of Schwann cell origin that rarely undergo malignant transformation and are most often (25-45%) found in the head and neck region. We present a case of a large schwannoma arising directly from the anterior aspect of the cervical spine (C6-C7-Th1) that caused considerable oesophageal displacement and compression, manifesting as dysphagia.</p><p><strong>Case report: </strong>A 52-year-old male patient sought medical advice on account of intermittent dysphagia and a sense of pressure in the neck, in the absence of pain or neurological deficits. A magnetic resonance (MRI) scan and a subsequent open/surgical biopsy revealed a large schwannoma on the anterior aspect of the spine at C6-C7-Th1 causing compression of the oesophagus. Following a neurosurgical consultation, a radical gross resection of the tumour was carried out from an anterior approach, with no neurological complications. A histological examination of the tumour confirmed the initial diagnosis and a follow-up MRI scan demonstrated complete resection.</p><p><strong>Conclusion: </strong>This case of successful treatment of a large schwannoma at the C6-C7-Th1 level highlights the importance of both MR imaging and biopsy in pre-operative planning. An anterior approach, routinely employed in cervical spine surgery, made it possible to perform a radical resection without neurological complications or the need to stabilise the cervical spine, which expedited the patient's return to full fitness.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"18 ","pages":"735-739"},"PeriodicalIF":0.7,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12191174/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144496639","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":"Right Internal Jugular Vein Access for Micra Leadless Pacemaker Implantation in a High-Risk Patient with Severe Iliac Vein Stenosis: A Case Report.","authors":"Haixiang Xu, Jianfeng Qian, Wen Pan, Jianhua Fan","doi":"10.2147/IMCRJ.S529596","DOIUrl":"10.2147/IMCRJ.S529596","url":null,"abstract":"<p><strong>Background: </strong>Leadless pacemakers offer a promising alternative to traditional transvenous pacemakers, especially in patients with complex vascular anatomy or a high risk of infection. Conventional access routes may be compromised in patients with significant venous stenosis or prior vascular interventions, requiring alternative strategies for device implantation.</p><p><strong>Case presentation: </strong>We report the case of a 74-year-old female with sick sinus syndrome, chronic kidney disease, type 2 diabetes, and severe bilateral iliac vein stenosis, who was deemed high-risk for conventional pacemaker implantation. After failed attempts through both femoral veins, the right internal jugular vein (RIJV) was successfully used as an alternative access route for Micra leadless pacemaker implantation. The procedure was performed under ultrasound and fluoroscopic guidance without complications. Post-procedure, the pacing threshold was 0.75 V, sensing was 8.5 mV, and impedance was 760 Ω, all within normal limits.</p><p><strong>Conclusion: </strong>This case highlights the feasibility and safety of using the right internal jugular vein as an alternative access route for leadless pacemaker implantation in high-risk patients when femoral access is not possible. This approach provides a valuable option for patients with complex venous anatomy, contributing to the broader application of leadless pacing technology.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"18 ","pages":"727-733"},"PeriodicalIF":0.7,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12184698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144475170","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":"Autoimmune Polyglandular Syndrome Type 2 Presentation with Alopecia Universalis, Hashimoto's Disease, and Addison's Disease.","authors":"Karla Denisse Sales-Morales, Nazhira Torres-Neme, Vladimir Barrera-Villanueva, Alejandro Martínez-Carreón","doi":"10.2147/IMCRJ.S515059","DOIUrl":"10.2147/IMCRJ.S515059","url":null,"abstract":"<p><p>Autoimmune polyglandular syndrome type 2 (APS2) is characterized by the coexistence of primary adrenal insufficiency with autoimmune thyroid disease and/or type 1 diabetes. APS2 frequently includes conditions affecting non-endocrine organs, such as alopecia, vitiligo, celiac disease, and autoimmune gastritis associated with vitamin B12 deficiency. We report the case of a 30-year-old male with a history of Hashimoto's disease and alopecia universalis, who presented with diarrhea, anorexia, hypoglycemia, and abdominal pain. Physical examination revealed orthostatic hypotension, a non-tender abdomen, and generalized hair loss. Initial laboratory workup showed hyponatremia and hyperkalemia. Further testing, including serum cortisol, ACTH, aldosterone, and 21-hydroxylase antibodies, confirmed the diagnosis of Addison's disease. The patient was treated with prednisone and fludrocortisone. Only two previous cases of APS2 associated with alopecia universalis have been reported: one with concurrent Crohn's disease and another with hypoparathyroidism. This case highlights the importance of recognizing non-endocrine manifestations in patients with autoimmune endocrinopathies to facilitate earlier diagnosis and management.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"18 ","pages":"719-725"},"PeriodicalIF":0.7,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12182093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144475169","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":"Recurrent Cerebrospinal Fluid Rhinorrhea Secondary to a Seizure-Induced Skull-Base Defect: An Unusual Complication of Epilepsy.","authors":"Feras Alsulaiman","doi":"10.2147/IMCRJ.S528739","DOIUrl":"10.2147/IMCRJ.S528739","url":null,"abstract":"<p><p>Cerebrospinal fluid (CSF) rhinorrhea is a rare but serious condition that most commonly follows skull-base trauma or surgery, and its manifestation as a complication of epilepsy is exceptionally rare. Epilepsy management focuses on seizure control and prevention of immediate complications, such as status epilepticus or fall-related injuries. We describe a 36-year-old male with focal-onset epilepsy who developed recurrent CSF rhinorrhea temporally associated with nocturnal convulsions and a seizure-related cribriform-plate defect confirmed by magnetic resonance imaging and β-2 transferrin testing. We hypothesize that repeated minor cranial trauma and transient intracranial pressure surges during these seizures precipitated the skull-base defect. All alternative etiologies were systematically excluded; although a definitive causal link cannot be proven, the strong temporal association supports this hypothesis. The CSF leak was successfully addressed through endoscopic surgical repair, and preventive measures, including alterations to sleeping arrangements, were implemented. This case underscores the importance of considering CSF leakage in individuals with epilepsy presenting with unexplained nasal discharge, highlighting the need for enhanced seizure management, prompt recognition, and multidisciplinary care to prevent complications.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"18 ","pages":"713-718"},"PeriodicalIF":0.7,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12178260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333117","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":"Asymptomatic Bradycardia in a Neonate: A Rare Manifestation of Respiratory Syncytial Virus Infection with Literature Review.","authors":"Dina W Abdulghani, Dina Tariq Alafandi","doi":"10.2147/IMCRJ.S524907","DOIUrl":"10.2147/IMCRJ.S524907","url":null,"abstract":"<p><p>Respiratory syncytial virus (RSV) is a leading cause of pulmonary infections and is associated with significant morbidity and mortality in infants and children under the age of 2 years. Although RSV infection most commonly affects the respiratory system, it has increasingly been linked to cardiovascular manifestations such as conduction abnormalities. Such complications are exceedingly rare in neonates, especially in the absence of clinical signs of infection. Herein, we present the case of a 3-day-old full-term neonate who presented to the emergency department owing to maternal concern of yellowish discoloration of the skin. During assessment, he exhibited multiple episodes of isolated bradycardia necessitating admission to the intensive care unit for further investigation and monitoring. After an extensive work up for bradycardia, he was found to be RSV positive via nasopharyngeal polymerase chain reaction (PCR). He remained hemodynamically stable with resolution of bradycardia episodes after 4 days. This case highlights the importance of recognizing RSV as a potential cause of arrhythmia in newborns, even in the absence of respiratory symptoms and underscores the need for further studies on the cardiovascular effects of RSV.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"18 ","pages":"705-711"},"PeriodicalIF":0.7,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325629","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":"Successful Management of Incidentally-Detected Subclavian Stenosis During Anesthetic Preparation for Spinal Surgery: A Case Report.","authors":"Ala A Alhowary, Saif Gharaibeh, Abdelwahab Aleshawi","doi":"10.2147/IMCRJ.S515664","DOIUrl":"10.2147/IMCRJ.S515664","url":null,"abstract":"<p><strong>Background: </strong>Subclavian artery stenosis is mainly caused by atherosclerotic changes, which may result in ischemic events in the upper limbs and the central nervous system. Other etiological causes include radiation exposure, vasculitis, neurofibromatosis, external compression syndrome, and fibromuscular dysplasia. The conventional anesthetic challenge for these patients is to maintain cerebral perfusion.</p><p><strong>Case presentation: </strong>We present a case of incidentally discovered left subclavian stenosis in a 65-year-old male who was admitted for spinal surgery. The patient had a history of peripheral arterial disease, diabetes mellitus, and heavy smoking. During the preoperative assessment, the blood pressure readings in the department were within the normal range. In the operating theater, blood pressure readings of the two arms revealed readings of 136/85 mmHg and 235/114 mmHg in the right and left arms, respectively. Accordingly, the operation was postponed for further evaluation of the increased interarm systolic blood pressure difference. Computed tomography angiography revealed focal stenosis at the origin of the left subclavian artery, causing approximately 90% narrowing. The patient underwent a successful subclavian artery angioplasty.</p><p><strong>Conclusion: </strong>It is important to report BP readings of blood pressure in both arms of patients with a history of peripheral arterial disease, heavy smoking, or severe metabolic syndrome. Patients with subclavian stenosis are prone to increased inter-arm systolic blood pressure difference. Accordingly, the bilateral measurement of BP is a simple test with valuable impact on the preanesthetic assessment in an emergency setting.</p>","PeriodicalId":14337,"journal":{"name":"International Medical Case Reports Journal","volume":"18 ","pages":"699-704"},"PeriodicalIF":0.7,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144316891","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}