Pitchaporn Yingchoncharoen, Nattanicha Chaisrimaneepan, Miriam Paz, Alexandra Hoffman, Kuldeep Lohano, Safaa Labib, John Pixley
{"title":"Case Report: Two Cases of Kikuchi Disease in West Texas With Non-Self-Limited Disease.","authors":"Pitchaporn Yingchoncharoen, Nattanicha Chaisrimaneepan, Miriam Paz, Alexandra Hoffman, Kuldeep Lohano, Safaa Labib, John Pixley","doi":"10.1177/23247096251350580","DOIUrl":"10.1177/23247096251350580","url":null,"abstract":"<p><p>Kikuchi-Fujimoto disease, also known as histiocytic necrotizing lymphadenitis, is characterized by high fever, lymph node swelling, and leukopenia. It is usually a benign self-limited disease. However, there are reports that it can be associated with other conditions, including infectious and noninfectious processes, autoimmune diseases such as systemic lupus erythematosus (SLE), or even life-threatening conditions like macrophage activation syndrome (MAS). Here, we report 2 cases of Kikuchi disease with non-self-limited disease in West Texas. The first case involves a 13-year-old Hispanic female who presented with prolonged fever for 8 weeks, cervical lymphadenopathy, and malaise. A year later, she was diagnosed with SLE. The second case is a 36-year-old Hispanic female who presented with prolonged fever and cervical, supraclavicular, axillary lymphadenopathy, and pancytopenia. She then developed MAS or hemophagocytic lymphohistiocytosis.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"13 ","pages":"23247096251350580"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12198531/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484756","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":"Exceptional Long-term Response to Immunotherapy in an African American Man With <i>STK11/TP53/RB1</i>-Mutated Metastatic Lung Adenocarcinoma.","authors":"Yaolin Zhou, Maneesh Gaddam, Sunil Badami","doi":"10.1177/23247096251346830","DOIUrl":"10.1177/23247096251346830","url":null,"abstract":"<p><p>Immunotherapy has become the standard of care for advanced and resectable lung cancer, and specific mutations may predict immunotherapy response. For example, <i>STK11</i> mutations, which are more common in African American patients, are associated with immunotherapy resistance. A 68-year-old African American man with stage IIIB lung adenocarcinoma with mediastinal lymph node involvement progressed on first-line concurrent carboplatin-based chemoradiotherapy. Molecular testing of the patient's subcarinal lymph node tissue revealed <i>STK11</i> S216F, <i>TP53</i> R273L, and <i>RB1</i> splice site mutations; high tumor mutation burden (19.0 mutations/Mb); and high PD-L1 22c3 expression (TPS 70%, 2+ intensity). Treatment with carboplatin-based chemotherapy with radiation therapy failed to control the disease, but the patient has tolerated and responded well to intravenous pembrolizumab. Although <i>STK11</i> mutations are associated with immunotherapy resistance, our patient demonstrated an exceptional and sustained response to immunotherapy for over two years. The patient's <i>STK11/TP53</i> co-mutation, along with high TMB and PD-L1 22c3 TPS scores, may help explain his continued responsiveness to immunotherapy and longer survival. Importantly, incorporating genetic ancestry differences in mutation prevalence and the impact of specific mutations and co-mutations, may help ensure the equitable and optimal treatment of all patients with lung cancers.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"13 ","pages":"23247096251346830"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12126655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191902","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}
Candice A Sternberg, Andres Martinez, Ayoola Olayiwola, Maria Morel Almonte, Christine A Vu, Tanya Quiroz, Nadine Montreuil, Folusakin Ayoade
{"title":"A Case of Tuberculous Meningitis With Concomitant Spinal Co-infection With Tuberculosis and <i>Aspergillosis</i>.","authors":"Candice A Sternberg, Andres Martinez, Ayoola Olayiwola, Maria Morel Almonte, Christine A Vu, Tanya Quiroz, Nadine Montreuil, Folusakin Ayoade","doi":"10.1177/23247096251329684","DOIUrl":"10.1177/23247096251329684","url":null,"abstract":"<p><p>Co-infection with <i>Mycobacterium tuberculosis</i> and <i>Aspergillus</i> in an immunocompetent host is rare but can occur. In this case, we present a patient with central nervous system tuberculosis (TB) and biopsy-proven spinal co-infections with TB and Aspergillosis. We highlight the complexities of treating a TB-Aspergillosis co-infection given drug-drug interactions between standard therapy for both conditions. Using susceptibilities for the <i>Aspergillus</i> and carefully monitoring drug levels of the antifungal agents, we were able to optimally treat the co-infection. This patient was ultimately discharged on isoniazid 1200 mg (15 mg/kg) daily, levofloxacin 750 mg daily, rifabutin 450 mg daily, and posaconazole 300 mg twice daily with a tentative plan to treat for at least 1 year with close outpatient follow-up. This case can serve as a guide for other providers who need to treat cases of TB and Aspergillosis co-infection by learning from our experience and paying attention to potential pitfalls.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"13 ","pages":"23247096251329684"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730385","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":"Thanks to Reviewers.","authors":"","doi":"10.1177/23247096251316453","DOIUrl":"https://doi.org/10.1177/23247096251316453","url":null,"abstract":"","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"13 ","pages":"23247096251316453"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188773","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":"Abdominal Actinomycosis Abscess Mimicking Malignancy: A Case Report and Review of the Literature.","authors":"Yosra Loukil, Saadia Makni, Youssef Mejdoub, Haitham Rejab, Nozha Toumi, Slim Charfi, Tahya Sallemi Boudawara, Marwa Bouhamed","doi":"10.1177/23247096251316374","DOIUrl":"10.1177/23247096251316374","url":null,"abstract":"<p><p>Actinomycosis is a rare chronic granulomatous infection caused by <i>Actinomyces</i> species. We report the case of a 47-year-old man with no previous medical history, who presented with a slowly growing abdominal mass extending to the abdominal wall, initially mimicking a malignant tumor. A diagnosis of an <i>Actinomyces</i> abscess was confirmed through surgical resection and histopathological examination. This case is presented to highlight the morphological characteristics and emphasize the diagnostic difficulties of this disease.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"13 ","pages":"23247096251316374"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11851742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483343","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}
Nagihan Orhun, Islam Rajab, Utku Ekin, George Horani, Mourad Ismail
{"title":"Unveiling Rare Pulmonary Complications in Infective Endocarditis: Pneumatoceles and Pneumothorax in a Case Series With Contextual Literature Review.","authors":"Nagihan Orhun, Islam Rajab, Utku Ekin, George Horani, Mourad Ismail","doi":"10.1177/23247096251334228","DOIUrl":"https://doi.org/10.1177/23247096251334228","url":null,"abstract":"<p><p>Patients with a history of drug abuse and right-sided endocarditis are particularly susceptible to developing septic pulmonary emboli. Rarely, septic pulmonary emboli can cause severe lung injury resulting in parenchymal loss despite appropriate antibiotic therapy. We present 2 cases of severe lung injury associated with septic pulmonary emboli stemming from right-sided infective endocarditis, emphasizing 2 rare complications: bilateral spontaneous pneumothorax and pneumatocele formation.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"13 ","pages":"23247096251334228"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12033459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971717","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}
Jayalekshmi Jayakumar, Manasa Ginjupalli, Giovannie Isaac Coss, Fiqe Khan, Daniel Stein, Davin Turku, Khalimullah Quadri
{"title":"Unveiling the Link Between Breast Cancer and Liver Abscess: A Case Report and Review of Literature.","authors":"Jayalekshmi Jayakumar, Manasa Ginjupalli, Giovannie Isaac Coss, Fiqe Khan, Daniel Stein, Davin Turku, Khalimullah Quadri","doi":"10.1177/23247096251334232","DOIUrl":"https://doi.org/10.1177/23247096251334232","url":null,"abstract":"<p><p>The introduction of screening mammograms has revolutionized the early detection of breast cancer. However, it remains the most common cancer in women in the United States, excluding skin cancer. As the incidence rates continue to rise, unusual presentations have become more frequent. Additionally, healthcare barriers can lead to delayed detection of breast cancer, resulting in unexpected complications. The occurrence of pyogenic liver abscess (PLA) in diabetic cancer patients, due to the synergistic effect of insulin-like growth factor-1 in tumorigenesis and abscess formation, is well documented. PLA is also prevalent in hepatocellular, colorectal, and pancreato-biliary tumors. However, the occurrence of PLA as an initial presentation of isolated advanced breast cancer without these comorbidities is understudied. This may be due to direct spread of infection from affected skin or spread via lymphatics or vasculature in the setting of immunosuppression from cancer. We present an exceedingly rare case of PLA, complicated by pulmonary embolism, in an elderly female with newly diagnosed stage IIIB breast carcinoma.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"13 ","pages":"23247096251334232"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12033507/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024462","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}
Victoria Watson, Saif Ghishan, Tata Avalishvili, Sinen Zeleke, Saron Tigabe, Anderson White, Fuad Zeid, Zakaria Alagha
{"title":"Exploring Extubation Readiness in Guillain-Barré Syndrome: A Case Report and Literature Review.","authors":"Victoria Watson, Saif Ghishan, Tata Avalishvili, Sinen Zeleke, Saron Tigabe, Anderson White, Fuad Zeid, Zakaria Alagha","doi":"10.1177/23247096251331859","DOIUrl":"https://doi.org/10.1177/23247096251331859","url":null,"abstract":"<p><p>Guillain-Barré Syndrome (GBS) is an acute immune-mediated polyneuropathy causing rapidly progressive muscle weakness and often respiratory failure, requiring mechanical ventilation in 30% of cases. Successful weaning and extubation are crucial, focusing on readiness for spontaneous breathing trials, optimal timing, and minimizing complications such as ventilator-associated pneumonia and extubation failure. This case report describes an 83-year-old male with multiple comorbidities who was intubated after his negative inspiratory force dropped below -30 cm H₂O and treated with plasmapheresis, leading to partial improvement. Despite not meeting standard extubation criteria, he was successfully extubated, maintained stable respiratory function, and was safely discharged. This case highlights the challenges of extubation in GBS patients, where advanced age, decreased physiological reserve, and comorbidities increase the risks of prolonged intubation and complications. This case also highlights the need for individualized extubation strategies in GBS, particularly in elderly patients who may not meet standard criteria. Tailored approaches can still lead to successful outcomes. Based on our institutional experience, we propose factors that predict the success or failure of extubation in these patients. Further research is needed to refine predictive markers and improve extubation success in this population, ultimately enhancing outcomes and reducing ICU and hospital stays.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"13 ","pages":"23247096251331859"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12062643/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144008516","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}
Pedro Pallangyo, Zabella Mkojera, Loveness Mfanga, Makrina Komba, Peter R Kisenge
{"title":"Peripartum Cardiomyopathy as the Initial Manifestation of Undiagnosed Sickle Cell Disease: A Case Report.","authors":"Pedro Pallangyo, Zabella Mkojera, Loveness Mfanga, Makrina Komba, Peter R Kisenge","doi":"10.1177/23247096251346829","DOIUrl":"10.1177/23247096251346829","url":null,"abstract":"<p><p>Peripartum cardiomyopathy (PPCM) occurring in the context of sickle cell disease (SCD) is exceedingly rare, particularly as the initial presentation of undiagnosed SCD. We report the case of a 39-year-old African primigravida at 36 weeks of gestation who presented with a 1-week history of heart failure symptoms. Her antenatal course was largely uneventful apart from severe anemia, for which she was transfused 2 units of whole blood followed by prescription of hematinics. Laboratory investigations revealed hemolytic anemia, a positive sickling test, and confirmatory hemoglobin electrophoresis demonstrating 93% sickle hemoglobin and 4.1% hemoglobin fetal, establishing a new diagnosis of homozygous SCD. Transthoracic echocardiography revealed a severely reduced left ventricular ejection fraction (LVEF 26%) and dilated left heart chambers, consistent with a diagnosis of PPCM. She was admitted to the maternity intensive care unit and managed by a multidisciplinary team, with stabilization on supportive therapy. At 38 weeks, she underwent a successful elective cesarean section, followed by an uneventful postpartum recovery. She was discharged 9 days postpartum in a stable condition (New York Heart Association Class II) on guideline-directed medical therapy and enrolled in outpatient follow-up. At 6 months, follow-up echocardiography showed partial recovery of cardiac function with an LVEF of 38%. She continues to be monitored by cardiology and hematology teams. This case highlights the critical importance of considering underlying hemoglobinopathies in pregnant patients presenting with unexplained heart failure, especially in regions where SCD is endemic.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"13 ","pages":"23247096251346829"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12126653/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191904","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":"Transient Supine-Induced Advanced Heart Block in an Octogenarian.","authors":"Lakshmipathi Peram, Priya Ramcharan, Matthew Maharaj, Arun Katwaroo, Stephanie Battersby, Valmiki Seecheran, Rajeev Seecheran, Naveen Seecheran","doi":"10.1177/23247096251345375","DOIUrl":"10.1177/23247096251345375","url":null,"abstract":"<p><p>Atrioventricular block (AVB) is a conduction disorder that can lead to significant bradyarrhythmias with resultant hemodynamic compromise and cardiogenic shock. While most cases of positional AVB that occur during erect posture are attributed to neurocardiogenic mechanisms, complete AVB occurring exclusively in the supine position is an exceedingly rare phenomenon. We present a case of an 87-year-old Caribbean Black male who presented with symptomatic supine-induced advanced heart block, which transiently resolved during standing with unremarkable comprehensive investigations and subsequently underwent successful dual-chamber permanent pacemaker implantation. The clinician should be cognizant of assessing positional vital signs with telemetric monitoring in patients presenting with idiopathic bradyarrhythmias and presyncope.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"13 ","pages":"23247096251345375"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12126686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191906","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}