Journal of investigative medicine high impact case reports最新文献

{"title":"Successful Implementation of Peripheral Venoarterial ECMO in a Patient With Eisenmenger Syndrome as a Bridge to Lung Transplant: A Case Report.","authors":"Ashie Kapoor, Nicole Shalit, June Tong, Marisa Hernandez-Morgan","doi":"10.1177/23247096261494797","DOIUrl":"https://doi.org/10.1177/23247096261494797","url":null,"abstract":"<p><p>Eisenmenger syndrome (ES) is a form of cyanotic congenital heart disease resulting in pulmonary hypertension and right-to-left shunting. End-stage ES often requires lung transplantation and patients may require extracorporeal membrane oxygenation (ECMO) as a bridge, though the optimal cannulation strategy is not standardized. A 49-year-old woman with ES due to unrepaired ostium secundum atrial septal defect presented with acute on chronic pulmonary embolism and refractory hypoxemia, ultimately requiring VA ECMO cannulation, which was complicated by venous cannula migration across the ASD and into the left atrium, requiring bedside repositioning under echocardiographic guidance. Differential hypoxemia was managed throughout her ECMO course and she was ultimately bridged to bilateral lung transplantation after three days. ECMO use in ES is complex and requires appreciation of the inherent limitations of each cannulation strategy. Peripheral VA ECMO can serve as a short-term strategy when emergent circulatory support is needed.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"14 ","pages":"23247096261494797"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pericardial Decompression Syndrome after Drainage of Malignant Pericardial Effusion: A Case Report.","authors":"Mohamed Elhussain, Muhammad Bilal, Mazen Ahmed, Mustafa Marzoug, Ali Mohamedshata, Esra Abdalla, Shaun Cardozo, Luis Afonso","doi":"10.1177/23247096261491198","DOIUrl":"https://doi.org/10.1177/23247096261491198","url":null,"abstract":"<p><p>Pericardial decompression syndrome (PDS) is an uncommon but potentially fatal complication that can follow technically successful drainage of a hemodynamically significant pericardial effusion. A 61-year-old woman with stage IVB lung adenocarcinoma presented with progressive dyspnea and edema. Computed tomography and transthoracic echocardiography demonstrated a large pericardial effusion with right ventricular diastolic collapse and preserved left ventricular ejection fraction (LVEF) of 65% to 70%. Emergent echo-guided pericardiocentesis removed 360 to 380 mL of serosanguineous fluid, followed by catheter drainage totaling approximately 1.51 L. The next morning, echocardiography showed new severe biventricular systolic dysfunction with basal sparing and only trivial residual effusion. High-sensitivity troponin remained 10 ng/L or less without a meaningful rise. The clinical course was managed supportively with close hemodynamic and echocardiographic surveillance, cautious diuresis, and low-dose guideline-directed therapy as tolerated. LVEF improved from a nadir of 15% to 20% to 50% to 55% at follow-up, with resolution of the wall-motion abnormality and no recurrent effusion. The temporal association with large-volume drainage, absence of recurrent pericardial constraint, low troponin, and reversible dysfunction supported PDS. New heart failure after malignant pericardial effusion drainage should prompt urgent evaluation for PDS.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"14 ","pages":"23247096261491198"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Hepatitis C Infection in a MSM Living With HIV in Trinidad.","authors":"Robert Jeffrey Edwards, Jonathan Edwards","doi":"10.1177/23247096261497020","DOIUrl":"https://doi.org/10.1177/23247096261497020","url":null,"abstract":"<p><p>Hepatitis C virus (HCV) infection is widespread globally, however the data on HCV is sparse in the anglophone Caribbean particularly among persons living with HIV. Acute HCV infection is frequently asymptomatic and in resource limited countries, there are numerous challenges with diagnosis and treatment. We present the case of a 45 year old man who has sex with men (MSM) living with HIV in Trinidad with sexually acquired HCV infection in whom there were elevated liver transaminases and low HCV RNA levels that signified a strong immune mediated response in an attempt to clear the virus, but this was ultimately unsuccessful resulting in chronic infection. This case highlights the importance of maintaining a high index of suspicion for hepatitis C among MSM living with HIV without a history of injection drug use and the many obstacles that were encountered in the medical management of this patient.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"14 ","pages":"23247096261497020"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ulcers and Eosinophils: A Rare Presentation of PDGFRA-Rearranged Myeloid Neoplasm Responding to Imatinib.","authors":"Aura Calderon, Shubhank Goyal, Jose Loayza Pintado, Brandon Cantazaro, Everardo Cobos","doi":"10.1177/23247096251414051","DOIUrl":"10.1177/23247096251414051","url":null,"abstract":"<p><p>Myeloid/lymphoid neoplasms with eosinophilia and tyrosine kinase fusions (M/LN-eo-TK) are uncommon but highly treatable disorders. Among them, FIP1L1::PDGFRA-driven disease is distinguished by marked eosinophilia and multisystem involvement that can rapidly reverse with targeted therapy. We describe a 50-year-old man with uncontrolled diabetes who presented with progressive dyspnea, abdominal discomfort, and painful necrotic scrotal ulcers. Laboratory testing revealed leukocytosis with a striking absolute eosinophil count of 22.1 × 10³/µL, while imaging showed pulmonary infiltrates, small-bowel inflammation, and splenomegaly. Bone marrow examination demonstrated hypercellularity with prominent eosinophilic proliferation. Fluorescence in situ hybridization confirmed a PDGFRA rearrangement with CHIC2 deletion, establishing the diagnosis of FIP1L1::PDGFRA-positive M/LN-eo-TK. Imatinib was initiated at 400 mg daily, later reduced to 200 mg, leading to a rapid normalization of eosinophil counts and resolution of systemic and dermatologic manifestations within 2 weeks. The case highlights how delayed recognition of clonal eosinophilia can permit extensive organ injury, whereas early molecular testing and prompt initiation of imatinib yield dramatic clinical and hematologic remission. Persistent hypereosinophilia, particularly with cutaneous or gastrointestinal involvement, should prompt evaluation for PDGFRA-rearranged disease to enable early intervention and prevent irreversible tissue damage.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"14 ","pages":"23247096251414051"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12804641/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145966393","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":"Management Challenges of Acute Promyelocytic Leukemia in Pregnancy: A Case Report.","authors":"Joseph Hemry, Pranati Shah, Iris Lee, Aren Dermarderosian, Mojtaba Akhtari","doi":"10.1177/23247096251411669","DOIUrl":"10.1177/23247096251411669","url":null,"abstract":"<p><p>Acute promyelocytic leukemia (APML) is a rare hematologic emergency with a high mortality rate due to bleeding diathesis, which is due to a disseminated intravascular coagulation-like coagulopathy; APML is complicated enough to treat on its own and becomes particularly challenging when it occurs during pregnancy due to the complexities in managing both maternal and fetal health. APML is associated with a challenging therapeutic dilemma for pregnant women, and there is a risk of fetal malformations and developmental abnormalities caused by exposure to chemotherapy. A 31-year-old woman at 29 weeks of gestation presented with a 3-week history of fatigue. Complete blood count revealed pancytopenia, and further evaluation confirmed a diagnosis of APML. Due to her severe thrombocytopenia and associated pregnancy risks, ATRA therapy was initiated, and a primary Cesarean section was performed at 31 weeks 3 days of gestation to mitigate maternal and fetal complications. After delivery, arsenic trioxide was added to the treatment regimen, resulting in a favorable response. In this case report, we discuss clinical decisions and therapeutic interventions and compare our patient's case with those found in the literature. This case highlights the importance of prenatal care and early intervention in improving outcomes for both mother and child.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"14 ","pages":"23247096251411669"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12924916/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146258317","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 Acute Fibrinous Organizing Pneumonia in a Patient With Post-obstructive Pneumonia and Malignancy.","authors":"Ruba Habib, Katrina Villegas, Arielle Aiken, Rayan Sabouh, Rouba Isshak, Mourad Ismail","doi":"10.1177/23247096261455123","DOIUrl":"10.1177/23247096261455123","url":null,"abstract":"<p><p>Acute fibrinous organizing pneumonia (AFOP) is a rare form of interstitial lung disease characterized histopathologically by intra-alveolar fibrin \"balls\" and organizing pneumonia. AFOP is associated with infections, malignancies, and immune dysregulation, posing diagnostic and therapeutic challenges. We present the case of a 66-year-old female with rectal adenocarcinoma, chronic obstructive pulmonary disease (COPD), and a posterior mediastinal mass who was admitted with sepsis and post-obstructive pneumonia. Imaging revealed consolidations in the right middle and lower lobes with adjacent abscess formation. Lung biopsy confirmed AFOP, demonstrating intra-alveolar fibrin balls and organizing pneumonia. Cultures identified <i>Streptococcus anginosus</i> and <i>Prevotella melaninogenica</i>, indicating a polymicrobial infection. The patient was treated with antibiotics; corticosteroids were withheld due to active infection and immunosuppression from malignancy. Surgical intervention addressed the mediastinal mass and abscess. The patient recovered without AFOP recurrence. This case highlights the diagnostic complexity of AFOP, especially in patients with multiple risk factors such as malignancy, infection, and immunosuppression. The decision to withhold corticosteroids underscores the importance of individualized therapy. Clinicians should consider AFOP in the differential diagnosis of acute lung infiltrates, particularly in patients with malignancies or infections. Prompt recognition and tailored management can improve outcomes in this rare condition.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"14 ","pages":"23247096261455123"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13195238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147981907","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":"Severe Tertiary Hyperparathyroidism with Brown Tumor and Multisystem Complications Mimicking Plasma Cell Dyscrasia in a Middle-Aged Man with Childhood-Onset FSGS.","authors":"Timothy Han Chuong, Jakia Islam, Seth Politano, Justin Sagami","doi":"10.1177/23247096261470725","DOIUrl":"10.1177/23247096261470725","url":null,"abstract":"<p><p>Chronic kidney disease-mineral and bone disorder (CKD-MBD) is a well-recognized complication of end-stage kidney disease (ESKD), encompassing abnormalities in calcium, phosphorus, parathyroid hormone (PTH), vitamin D metabolism, and bone turnover. In advanced cases, secondary or tertiary hyperparathyroidism may lead to severe skeletal disease, including osteitis fibrosa cystica and brown tumors, which can mimic hematologic malignancies. We present the case of a 47-year-old man with childhood-onset focal segmental glomerulosclerosis (FSGS), two prior kidney transplants, and long-standing dialysis dependence who presented with bone pain, pancytopenia, neurologic symptoms, and imaging abnormalities initially concerning for multiple myeloma. Comprehensive evaluation revealed a single unifying diagnosis: severe tertiary hyperparathyroidism (parathyroid hormone 1,467 pg/mL) with advanced renal osteodystrophy and brown tumor-like skeletal changes, without evidence of plasma cell dyscrasia or marrow infiltration. This case highlights the diagnostic pitfalls posed by extreme manifestations of CKD-MBD and underscores the importance of prioritizing cohesive pathophysiologic reasoning in complex ESKD patients.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"14 ","pages":"23247096261470725"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13373391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148447434","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":"Leukapheresis in Pediatric T-ALL with Extreme Hyperleukocytosis: A Case Highlighting the Importance of Early Recognition.","authors":"Allison Guild, Jeffrey Salomon, Jayesh Thakker, Shelly M Williams, James Ford","doi":"10.1177/23247096261429199","DOIUrl":"10.1177/23247096261429199","url":null,"abstract":"<p><p>Hyperleukocytosis (HL) in acute leukemia is associated with increased morbidity and mortality, mainly secondary to the effects of leukostasis. Many strategies for cytoreduction exist, however prompt initiation of chemotherapy is paramount. Leukapheresis is an additional strategy, though there is conflicting data for its use in HL in acute leukemia. Below we detail a case of HL and leukostasis in newly diagnosed pediatric T-cell acute lymphoblastic leukemia and the use of leukapheresis. We highlight that leukapheresis can rapidly and safely reduce the white blood cell count, as an adjunct to symptom management, and potentially prevent life-threatening complications while not delaying chemotherapy initiation. However, this case underscores that early recognition of HL prior to the development of severe neurological complications is critical, as once cerebral leukostasis with intracranial hemorrhage is established, neither leukapheresis nor chemotherapy may alter the fatal outcome. The patient's initial presentation with epistaxis and hematemesis two days prior-without laboratory evaluation-represents a missed opportunity that may have allowed earlier recognition and intervention.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"14 ","pages":"23247096261429199"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13033054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147521012","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":"Morganella Morganii Respiratory Infection as an Initial Presentation of Acute Myeloid Leukemia With Monocytic Differentiation: A Rare Opportunistic Pathogen in a Newly Diagnosed Immunocompromised Host.","authors":"Varun Muppidi, Ragul Manoharan, Rouba Isshak, Aqsa Sorathia Zoey, Ivan Mercado, Patrick Michael","doi":"10.1177/23247096261442154","DOIUrl":"10.1177/23247096261442154","url":null,"abstract":"<p><p>Infective manifestations of hematological malignancies can be traced to a variety of pathogens, necessitating broad spectrum empiric antibiotic coverage, and prompt identification of pathogenic microbes to improve clinical outcomes. We present a case of Morganella morganii leading to pneumonia as the presenting illness in a previously undiagnosed, functionally neutropenic adult presenting with acute myeloid leukemia with monocytic differentiation. Our patient was a 64 year old man with no prior medical care who presented with complaints of progressive abdominal pain, productive cough and fevers. Chest radiography revealed no organized consolidations, and computed tomographic imaging of the chest showed bibasilar atelectasis and trace pleural effusions. Laboratory analysis revealed marked leukocytosis with predominant monocytosis, and circulating blasts, suggestive of acute myeloid leukemia with monocytic differentiation, later confirmed with bone marrow biopsy. The patient was initially started on guideline directed empiric therapy for respiratory infection, with sputum cultures later found to be growing Morganella morganii, necessitating a change in antimicrobial therapy, following which the patient showed clinical improvement. To our knowledge, this is the first reported case of Morganella morganii pneumonia presenting at the initial diagnostic encounter of de novo acute myelomonocytic leukemia. This report underscores the need for prompt microbiologic evaluation, broad empiric coverage with early de-escalation, and inclusion of M. morganii in the differential diagnosis of pneumonia in functionally neutropenic patients when standard pathogens are not identified. This case highlights the need to recognize atypical Gram-negative organisms as potential pathogens in these populations, even in the absence of characteristic radiographic findings.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"14 ","pages":"23247096261442154"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13110331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147729215","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":"Effusion Unveiled: Impending Cardiac Tamponade as the Initial Manifestation of Rheumatoid Arthritis.","authors":"David Ramzy, Rouba Isshak, Michael El Masry, Noma Shri, Rayan Sabouh, Disha Patel, Abdel Rahman Dajani, Fayez E Shamoon","doi":"10.1177/23247096261497014","DOIUrl":"https://doi.org/10.1177/23247096261497014","url":null,"abstract":"<p><p>Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized primarily by inflammatory polyarthritis, although extra-articular manifestations, including pericardial disease, are well recognized. While pericardial effusions are relatively common, large symptomatic effusions causing cardiac tamponade as the initial manifestation of RA are exceedingly rare. We report a 75-year-old woman with hypertension and dyslipidemia who presented with progressive dyspnea and fatigue one month after an episode of right-hand monoarthritis with an initially unrevealing rheumatologic evaluation. Electrocardiography demonstrated low-voltage QRS complexes, and bedside echocardiography revealed a large pericardial effusion with tamponade physiology. She underwent urgent surgical pericardial window, and pericardial fluid analysis excluded infectious and malignant etiologies. Notably, the erythrocyte sedimentation rate and C-reactive protein were both normal, and the fluid met an exudative threshold on protein content alone.Autoimmune testing demonstrated markedly elevated rheumatoid factor (246 IU/mL), positive antinuclear antibody (1:1280), and strongly positive anti-cyclic citrullinated peptide antibodies, supporting a diagnosis of seropositive RA. Treatment with high-dose intravenous methylprednisolone followed by an oral prednisone taper resulted in significant clinical improvement. This case highlights that cardiac tamponade may precede the classic manifestations of RA, delaying diagnosis. It underscores the importance of early bedside echocardiography and consideration of autoimmune etiologies in patients with unexplained pericardial effusions after common causes have been excluded, as prompt recognition and immunosuppressive therapy can be lifesaving.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"14 ","pages":"23247096261497014"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}