Journal of investigative medicine high impact case reports最新文献

{"title":"Cerebral Septic Emboli: A Unique Complication of <i>Clostridium septicum-</i>Induced Myonecrosis.","authors":"Lily Xu, Iyawnna Hazzard, Faith Sumandea, Yui Seo, Ardavan Afrasiabi","doi":"10.1177/23247096251342027","DOIUrl":"10.1177/23247096251342027","url":null,"abstract":"<p><p>Nontraumatic clostridial myonecrosis infections are predominantly caused by <i>Clostridium septicum</i>. Most patients have an underlying gastrointestinal malignancy. This case presents a rare association of spontaneous clostridial myonecrosis preceding cerebral septic emboli with underlying invasive colorectal adenocarcinoma. A 60-year-old male with a history of hypertension, diabetes, and a family history of colon cancer presented to the emergency room with worsening left-sided chest pain radiating to his left shoulder. Extensive workup revealed elevated D-dimer, troponin, C-reactive protein, white blood cell count, and creatinine phosphokinase. Due to his clinical signs, symptoms, elevated white count, and further decompensation, he was started on antibiotics for sepsis. Physical exam revealed left upper extremity (LUE) crepitus consistent with imaging of innumerable soft tissue gas collections along the LUE. Incision, drainage, and myomectomy were performed due to concerns of myositis and necrotizing infection. Muscle biopsy revealed myonecrosis, and subsequent samples were positive for <i>C. septicum</i>. Postoperative pressor support and several sessions of surgical debridement were required. He continued to deteriorate and developed left-sided paralysis. Computed tomography head revealed several white matter infarcts indicative of septic emboli. The patient slowly recovered neurologically after switching to central nervous system-penetrating antibiotics. Months later, a colonoscopy revealed cecal adenocarcinoma. This case features a unique course of spontaneous <i>C. septicum</i> infection. There are high mortality rates, and previous studies report an association with colorectal malignancies. Therefore, preventative and diagnostic evaluations are imperative with a confirmed <i>C. septicum</i> infection. To our knowledge, this is the first case reported of cerebral septic emboli secondary to spontaneous myonecrosis with <i>C. septicum</i>, highlighting a unique burden of emboli-induced neurological deficits.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"13 ","pages":"23247096251342027"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12126657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191901","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":"An Unusual Presentation of Bullous Skin Lesions During Pregnancy.","authors":"Stanley C Jordan, Bonnie Balzer, Susane Morrison, Allison Truong, Ananth Karumanchi","doi":"10.1177/23247096251347403","DOIUrl":"10.1177/23247096251347403","url":null,"abstract":"<p><p>Here, we present a 33-years-old pregnant female who at 27-weeks gestation developed an unusual rash on her left knee after a spider bite. The rash rapidly became systemic requiring admission and treatment with high-dose steroids. Patient rapidly developed complications of steroid therapy and saw no benefits in reducing the activity of the rash of symptoms of itching. A repeat biopsy showed linear fluorescence along the dermal epidermal junction with C3 (strong) and IgG (weak) suggestive of pemphigus gestationis (PG). After balancing concerns for the health of the mother and risk for disease transmission to the child, we decided to treat the patient with high-dose intravenous immunoglobulin (IVIg). This resulted in rapid remission of disease and delivery of a healthy child without evidence of PG at 36-weeks gestation. A discussion of the mechanism(s) of action of IVIg that were salutary in this case is presented. Importantly, we discuss the likely benefits of IVIg in saturation of the Fc-receptor neonatal IgG recycling and preservation system in accelerating the degradation of pathogenic IgGs and the inhibitory of effects of IVIg on C3 activation which was the predominant immunoreactant in skin biopsy. The patient recovered completely after the fourth monthly IVIg infusion and continues to do well.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"13 ","pages":"23247096251347403"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12163261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275127","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":"Infection and Drug Associated Tubulointerstitial Nephritis and Acute Tubular Necrosis in a Presentation Similar to That of Post-Streptococcal Glomerulonephritis: A Case Report.","authors":"George Karaghossian, Anthony Lim, Tommy Zaharakis","doi":"10.1177/23247096251374512","DOIUrl":"10.1177/23247096251374512","url":null,"abstract":"<p><p>Tubulointerstitial nephritis (TIN) is an inflammatory infiltrate of interstitial kidney most commonly caused by infections, drugs, allergies, and a number of autoimmune conditions. In this case, we have a 40-year-old male who was thought to have post-streptococcal glomerulonephritis given his symptoms of sore throat and pharyngitis before having renal involvement; however, after further evaluation was found to have biopsy proven interstitial nephritis without glomerular involvement. We note that TIN has multiple etiologies, and in our patient, we believe the combination of sore throat and pharyngitis attributed to <i>Streptococcus pyogenes</i> and the concomitant nonsteroidal anti-inflammatory drug use and eventual bacterial translocation into the bloodstream, led to all the atypical manifestations described in this study. Although TIN is diagnosed definitively through biopsy, it is not able to reveal the specific causes especially when there are multiple causes suspected simultaneously. Such situations may be challenging to pinpoint a cause therefore it is of utmost importance to keep a broad differential for unexplained acute kidney injury.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"13 ","pages":"23247096251374512"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12409010/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Rare Case of <i>Brevibacterium luteolum</i> Bacteremia in a Patient With Acute Promyelocytic Leukemia.","authors":"Lefika Bathobakae, Mansi Patel, Mohita Jariwala, Shaimaa Elshaarawy, Simi Philip, Basil Taha, Jin S Suh","doi":"10.1177/23247096251347409","DOIUrl":"10.1177/23247096251347409","url":null,"abstract":"<p><p>The <i>Brevibacterium</i> genus is a group of nonmotile, catalase-positive, and aerobic bacteria that form part of the skin flora. <i>Brevibacterium</i> species are an emerging opportunistic bacteria with an unknown pathogenic potential; hence, further research is needed. Most <i>Brevibacterium</i> bacteremia cases have been treated successfully with vancomycin, but there is still no consensus on the duration of treatment or the removal of the infected hardware. We describe a unique case of <i>Brevibacterium luteolum</i> bacteremia in a geriatric male patient undergoing chemotherapy for acute promyelocytic leukemia.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"13 ","pages":"23247096251347409"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12163253/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275126","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":"Immunotherapy With Pembrolizumab for Resectable dMMR/MSI-H Stage III Colon Cancer: A Case of Personalized, Precision Surgery-Sparing Immunotherapy.","authors":"Stanley Kim, Joseph I Clark","doi":"10.1177/23247096251368093","DOIUrl":"https://doi.org/10.1177/23247096251368093","url":null,"abstract":"<p><p>Colorectal cancer (CRC) with deficient mismatch repair (dMMR) and microsatellite instability-high (MSI-H) status represents a highly immunogenic subset that responds well to immune checkpoint inhibitors (ICIs). However, the role of ICIs in resectable, early-stage CRC remains under investigation. We report the case of an 81-year-old woman diagnosed with stage III adenocarcinoma of the right colon, who declined surgery. Immunohistochemistry revealed loss of MLH1 and PMS2, consistent with dMMR. Tumor genomic profiling demonstrated MSI-H, high tumor mutational burden, BRAF V600E, and BRCA2 mutation. Germline testing was negative for BRCA and Lynch syndrome-associated mutations. The patient was treated with neoadjuvant pembrolizumab. After 4 months, mesenteric lymphadenopathy resolved, but focal colonic thickening persisted. The patient again declined surgery. At 10 months of pembrolizumab therapy, PET/computed tomography and colonoscopy showed no residual disease. She developed immune-related adrenal insufficiency, managed with corticosteroids. This case demonstrates complete clinical remission of resectable colon cancer with pembrolizumab alone in a patient with somatic dMMR/MSI-H, BRAF V600E, and BRCA2 mutations. It supports the hypothesis that early use of ICIs-prior to metastatic progression and immune escape-may enhance efficacy. This report highlights the potential for personalized, surgery-sparing treatment strategies in genomically selected CRC patients.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"13 ","pages":"23247096251368093"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12374102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957265","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":"New Sarcoidosis Diagnosis Following Unresponsive Event During Hemodialysis.","authors":"Alisha Patel, Jacob Boccucci, Cameron Liss, Laura Mulloy","doi":"10.1177/23247096251365753","DOIUrl":"https://doi.org/10.1177/23247096251365753","url":null,"abstract":"<p><p>Sarcoidosis is a systemic disease where extrapulmonary presentation of the disease often goes unrecognized as it overlaps with many disease manifestations. End-stage renal disease (ESRD) can be complicated by hypercalcemia and encephalopathy, both potential signs of sarcoidosis. These numerous extrapulmonary presentations may delay timely diagnosis and treatment. In this case report, a 53-year-old male with ESRD was admitted following an unresponsive episode during routine hemodialysis, later found to have sarcoidosis. Initial presentation notable for hypothermia, tachycardia, leukocytosis, and metabolic derangements. Bronchoalveolar lavage cultures subsequently grew methicillin-sensitive staphylococcus aureus, successfully treated with cefazolin. However, the patient remained encephalopathic and hypercalcemic. Further workup showed nonparathyroid hormone-mediated hypercalcemia with a normal 25-OH vitamin D and elevated 1,25-OH vitamin D, concerning for sarcoidosis, malignancy, or tuberculosis. Additional computed tomography imaging and endobronchial ultrasound-guided biopsy illustrated enlarged lymph nodes with splenomegaly and nonnecrotizing granulomas, respectively, confirming the diagnosis of sarcoidosis. He was started on methylprednisolone, pantoprazole, and trimethoprim/sulfamethoxazole for pneumocystis jirovecii pneumonia prophylaxis; serum calcium levels started to drop, and his mentation improved. While his encephalopathy was initially presumed secondary to his ESRD and infection, further workup revealed sarcoidosis. Untreated sarcoidosis has significant health complications including lung fibrosis, pulmonary hypertension, heart arrhythmias, and neurological deficits. This case highlights the importance of maintaining a broad differential in the setting of critically ill patients as clinical presentations can be multifactorial. Furthermore, patients with a complex medical history such as ESRD on hemodialysis can make concluding sarcoidosis as a diagnosis more difficult.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"13 ","pages":"23247096251365753"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12391705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957274","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":"From Dust to Casts: Plastic Bronchitis in a Drywall Worker Treated With Thoracic Duct Embolization.","authors":"Karen Clarke, Sathyabama Naidu, Albahi Malik, David Berkowitz, Stephanie Hampton, Mary Ann Kirkconnell Hall, Viranuj Sueblinvong","doi":"10.1177/23247096251381142","DOIUrl":"10.1177/23247096251381142","url":null,"abstract":"<p><p>Plastic bronchitis is a rare pulmonary condition, most frequently observed in children, that can lead to respiratory failure due to airway obstruction. We present the case of a 50-year-old man with occupational exposure to drywall who experienced recurrent episodes of hypoxic respiratory failure, necessitating multiple intubations. He was initially diagnosed with interstitial lung disease and treated with corticosteroids, but showed minimal clinical improvement. Subsequent flexible bronchoscopy revealed a bronchial cast obstructing the left mainstem bronchus. As plastic bronchitis is typically associated with disorders that cause abnormal lymphatic drainage, thoracic duct embolization was performed. The patient also underwent cryoprobe-assisted bronchoscopy for cast removal. Performance of these 2 procedures led to improved oxygenation and resolution of hypoxic respiratory failure, with no further need for mechanical ventilation.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"13 ","pages":"23247096251381142"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12461031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130970","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":"Altered Mental Status Due to Hyperammonemia Syndrome and PRES in a 31-Year-old Bone Marrow Transplant Recipient.","authors":"Mary Bridget Lee, Daniel Gorman","doi":"10.1177/23247096251344702","DOIUrl":"10.1177/23247096251344702","url":null,"abstract":"<p><p>Hyperammonemia syndrome and posterior reversible encephalopathy syndrome (PRES) are potentially devastating diagnoses in transplant patients. Their underlying etiologies and pathophysiologies remain incompletely understood, and while they are separately well-documented complications in posttransplant patients, they have not been described concurrently. Here we present a case of both hyperammonemia syndrome and PRES causing rapid mental status decline in a 31-year-old bone marrow transplant recipient. The patient had extensive testing to rule out other diagnoses and made a full recovery after correction of her hyperammonemia. Further research is needed to elucidate the underlying mechanisms of these disease processes; however, clinicians should keep both diagnoses in mind when treating transplant patients with acute neurologic changes.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"13 ","pages":"23247096251344702"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12099132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110899","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":"Beyond the Generalized Weakness: A Rare Case of Statin-Induced Immune-Mediated Necrotizing Myopathy.","authors":"Leo Sakai, Hana Kazbour, James Huang","doi":"10.1177/23247096251344727","DOIUrl":"10.1177/23247096251344727","url":null,"abstract":"<p><p>Statin-induced immune-mediated necrotizing myopathy (IMNM) is a rare subtype of idiopathic inflammatory myopathy associated with statin exposure and characterized by positive anti-hydroxymethylglutaryl coenzyme A reductase antibodies. Here, we describe a case of a 66-year-old male who was admitted with the presumed diagnosis of rhabdomyolysis in the setting of chronic statin use but was later confirmed to have statin-induced IMNM after his symptoms were refractory to treatment. This case highlights the importance of having a high clinical suspicion for statin-induced IMNM when statin-associated muscle symptoms fail to resolve after the discontinuation of statins.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"13 ","pages":"23247096251344727"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142717","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":"Relatively Safer and Efficient Pleurodesis With 50% DW for Very Elderly Patients With Secondary Spontaneous Pneumothorax: Report of 2 Cases.","authors":"Min Kyun Kang","doi":"10.1177/23247096251374511","DOIUrl":"10.1177/23247096251374511","url":null,"abstract":"<p><p>I report 2 cases of pleurodesis with 50% dextrose water (DW) in very elderly patients with secondary spontaneous pneumothorax. In both cases, a chest computed tomography scan showed a large pneumothorax with emphysema and multiple bullae. Patients were expected not to tolerate surgical treatment, considering their old age and underlying pulmonary disease. Previously, pleurodesis is performed using other chemical agents. However, chemical pleurodesis can be associated with chest pain, fever, and rarely, respiratory failure. Pleurodesis with 50% DW was performed in 2 patients with resolution of pneumothorax without complications. I recommend that even in elderly patients who could not tolerate surgery or chemical pleurodesis, pleurodesis using 50% DW could be considered because it is relatively safer and effective.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"13 ","pages":"23247096251374511"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12409020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957353","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}