Journal of investigative medicine high impact case reports最新文献

{"title":"Unusual Thromboembolic Sequelae of MRSA Bacteremia in A Pediatric Patient: A Case Report.","authors":"Shahd Khatib, Omer Innab, Nardeen Hammad, Adel Rajab, Shahd Al-Aloul, Miar Haj-Abdalrahman, Aysha Masri","doi":"10.1177/23247096261440355","DOIUrl":"10.1177/23247096261440355","url":null,"abstract":"<p><p>Methicillin-resistant <i>Staphylococcus aureus</i> infection can cause serious illness in children. It can progress to life-threatening bloodstream issues or bone infections, including: deep vein thrombosis, septic pulmonary embolism, toxic shock syndrome, and osteomyelitis. Treatment depends on control of infection with adequate antibiotics and early anticoagulation. We present a case of a 11-year old male child who presented with left arm and right leg pain and swelling that was associated with fever. However, there was no history of trauma. Blood culture was taken and showed Methicillin-resistant <i>Staphylococcus aureus</i> growth. Initial ultrasound of the affected limbs was unremarkable except for subcutaneous edema. On the following day, ultrasound of the affected limbs was consistent with deep vein thrombosis. Additionally, the patient developed pleuritic chest pain and a computed tomography scan with pulmonary angiography demonstrated a filling defect in the left upper segmental artery suggesting septic pulmonary embolism. Magnetic resonance imaging of the lower limbs was recommended and it suggested the diagnosis of osteomyelitis. Ultrasound guided drainage was done and the patient was treated with appropriate antibiotics and enoxaprine. Multifocal thromboembolic events with osteomyelitis in an immunocompetent child are rare and clinically important. This case highlights the complex nature of methicillin-resistant <i>Staphylococcus aureus</i> infection in pediatrics and emphasizes the value of early imaging and multidisciplinary collaboration to establish an accurate diagnosis and a good clinical outcome. Awareness of such presentations can facilitate earlier diagnosis and intervention, to reduce the risk of complications in pediatric patients.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"14 ","pages":"23247096261440355"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147623351","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 Pediatric Paratesticular Spindle Cell Rhabdomyosarcoma and Systematic Literature Review.","authors":"Gevara Arja, Omar Hammam Salloum, Jamal Jaber, Tala Jubah, Sumaya Alrjoub, Taghreed Imran, Asma Alrjoub, Ammar W M Hassouneh, Motaz Natsheh","doi":"10.1177/23247096251415447","DOIUrl":"10.1177/23247096251415447","url":null,"abstract":"<p><p>Paratesticular rhabdomyosarcoma (RMS) is a rare malignancy, representing ~3% of all pediatric soft tissue tumors. The spindle cell subtype, a variant of embryonal RMS, is particularly uncommon but is typically associated with a favorable prognosis. We report the case of a 12-year-old boy who presented with a painless, progressively enlarging right inguinoscrotal mass. Imaging studies revealed a heterogeneous lesion without distant metastasis, and tumor markers were within normal limits. The patient underwent radical orchiectomy, and histopathology confirmed spindle cell RMS, with immunohistochemical positivity for myogenin and desmin. After completing treatment with the Children's Oncology Group (COG)-ARST0531 Vincristine, Actinomycin D, and Cyclophosphamide protocol, a retroperitoneal lymph node recurrence was detected 1 year later. Management consisted of surgical resection and escalated chemotherapy per the COG-ARST0431 protocol, with subsequent imaging showing no evidence of disease. This case demonstrates that despite a favorable histology, paratesticular spindle cell RMS carries a risk of late, regional recurrence, underscoring the necessity of vigilant long-term surveillance. We also performed a systematic literature review to contextualize our findings, focusing on clinical presentation, therapeutic strategies, and outcomes.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"14 ","pages":"23247096251415447"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12861383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146093200","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":"Encephalopathy Post CAR-T Cell Therapy in Relapsed/Refractory Multiple Myeloma: Beyond ICANS.","authors":"Rita Ahmad, Mackenzie Wild, Tyler Friesen, Michael Hall, Sammantha Kouba, Seth Maliske","doi":"10.1177/23247096261478903","DOIUrl":"10.1177/23247096261478903","url":null,"abstract":"<p><p>Human herpesvirus 6 (HHV-6) reactivation is a rare but serious complication of chimeric antigen receptor T-cell (CAR-T) therapy that can overlap with immune effector cell-associated neurotoxicity syndrome (ICANS) or cytokine release syndrome (CRS), making diagnosis and management challenging. We describe a 68-year-old man with relapsed/refractory IgA kappa multiple myeloma who received multiple prior therapies, including CyBorD, mVRD-lite, Dara-CyBorD, VD-ACE, and KPd, before undergoing lymphodepleting chemotherapy and CAR-T infusion. Early after infusion he developed grade 2 CRS and ICANS that improved with tocilizumab and corticosteroids, followed by recurrent encephalopathy with progressive neurologic decline. Initial infectious evaluation was negative, but repeat cerebrospinal fluid (CSF) and plasma polymerase chain reaction testing revealed HHV-6 reactivation. Antiviral therapy with foscarnet, later switched to ganciclovir, was initiated with corticosteroids and intravenous immunoglobulin. Although repeat CSF testing showed transient viral clearance, neurologic function continued to decline, and brain MRI demonstrated findings consistent with ICANS, including scattered white matter signal abnormalities and dural enhancement. Despite aggressive management, the patient developed multiorgan failure and died. This case illustrates the diagnostic complexity of HHV-6 reactivation during CAR-T therapy, where overlapping clinical and radiologic features with ICANS can obscure recognition; profound immunosuppression from prior treatment and CAR-T-induced immune dysregulation likely predisposed to viral reactivation. HHV-6 reactivation is a critical, underrecognized cause of neurotoxicity after CAR-T therapy, and clinicians should maintain a high index of suspicion in patients with delayed or atypical neurotoxicity, since early virologic testing and prompt antiviral therapy may improve outcomes in this vulnerable population.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"14 ","pages":"23247096261478903"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148706791","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":"Diagnostic Uncertainty in Pancreatic Masses: The Critical Role of excluding Malignancy in Suspected Autoimmune Pancreatitis.","authors":"Swati Mahapatra, Shivangini Duggal, Brian J Lee, M Ammar Kalas, Jesus Guzman, Vital Rangashamanna, Ioannis Konstantinidis, Fsso, M Nawar Hakim, Sherif E Elhanafi","doi":"10.1177/23247096261462291","DOIUrl":"10.1177/23247096261462291","url":null,"abstract":"<p><p>Autoimmune pancreatitis (AIP) is an uncommon inflammatory condition of the pancreas characterized by glandular enlargement and ductal narrowing arising from dysregulated immune activity. Its clinical and imaging overlap with pancreatic malignancy makes accurate distinction essential. We describe a case series of four patients who initially presented with a pancreatic mass suspicious for malignancy, but received a confirmed diagnosis of AIP following thorough diagnostic evaluation. The cohort comprised three male patients (aged 32, 55, and 68 years) and one female patient (aged 73 years). The predominant presenting features included abdominal pain (n=2), scleral icterus (n=3), and pruritus (n=1). Laboratory workup demonstrated elevated total and direct bilirubin in all patients, and serum IgG4 levels were above the normal range in every case. Cross-sectional abdominal imaging with contrast-enhanced CT or MRI identified a pancreatic mass in each patient. All four patients underwent endoscopic ultrasound (EUS)-guided fine needle biopsy (FNB) with rapid on-site evaluation (ROSE), none of which revealed evidence of malignancy. Histopathologic examination showed intact pancreatic acinar architecture in all cases; chronic inflammation and fibrosis were noted in three patients. IgG4 and CD138 immunohistochemical staining was non-reactive in three patients. All patients underwent endoscopic retrograde cholangiopancreatography (ERCP) with biliary stent placement to address biliary obstruction. Interval ERCP confirmed resolution of the obstruction, enabling stent removal without subsequent recurrence. Following establishment of an AIP diagnosis, all patients were treated with a corticosteroid taper, resulting in symptomatic resolution and complete radiologic clearance of the pancreatic mass, with removal of biliary stents thereafter. Patients remained asymptomatic with no evidence of relapse at 3-, 6-, and 12-month follow-up intervals.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"14 ","pages":"23247096261462291"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13287421/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148271822","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":"Antiphospholipid Syndrome-Associated Lemierre's Syndrome With Extensive Cervicothoracic Venous Thrombosis Mimicking Thoracic Outlet Syndrome.","authors":"Neha Arsha, John Zadran, Abhimannu Majumder, Samuel Y Huang, Seema Rai, Mark Lodespoto, Aliza Khanam","doi":"10.1177/23247096261452328","DOIUrl":"10.1177/23247096261452328","url":null,"abstract":"<p><p>Lemierre's syndrome is a rare postanginal septic thrombophlebitis involving the internal jugular vein in younger adults. Extension into the thoracic inlet and upper extremity venous system is uncommon, and the role of underlying autoimmune disease in amplifying thromboinflammatory responses remains poorly characterized. A 29-year-old man with systemic lupus erythematosus (SLE), intermittently compliant with hydroxychloroquine, presented with two weeks of progressive right-sided neck pain and swelling, meeting sepsis criteria on arrival with marked systemic inflammation, acute kidney injury, and proteinuria. Initial contrast-enhanced computed tomography demonstrated diffuse cervicothoracic cellulitis without abscess. Within 24 hours, he developed worsening neck pain, dysphagia, and right upper extremity swelling with C5-C8 distribution numbness, and hand weakness. Repeat imaging revealed extensive septic thrombophlebitis involving the right internal jugular, subclavian, brachiocephalic, axillary veins, and superior vena cava, producing thoracic outlet-like neurovascular compression. Blood cultures remained persistently negative. Autoimmune evaluation demonstrated high-titer antinuclear antibody, elevated anti-double-stranded DNA antibodies, positive anti-Smith and anti-SSA antibodies, and preserved complement levels. Coagulation studies confirmed lupus anticoagulant positivity and concurrent antiphospholipid syndrome. The patient was treated with broad-spectrum antibiotics, therapeutic anticoagulation, and corticosteroids, resulting in clinical improvement with C-reactive protein decline and resolution of upper extremity swelling. No surgical intervention was required. While anticoagulation remains debated in Lemierre's syndrome, therapeutic anticoagulation was strongly indicated given the multifactorial nature of presentation. The culture-negative presentation, absence of pharyngitis, potential environmental exposure, age, and suboptimally controlled SLE with active lupus nephritis distinguish this from classic Lemierre's syndrome and highlight diagnostic challenges in atypical presentations.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"14 ","pages":"23247096261452328"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13172717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147874268","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":"Case Report: Spontaneous Tumor Lysis Syndrome in a Patient With Cholangiocarcinoma.","authors":"Maria A Lasprilla-Pallares, Jorge C Nakazaki, Jairo A Rivera-Castro","doi":"10.1177/23247096251407832","DOIUrl":"10.1177/23247096251407832","url":null,"abstract":"<p><p>Tumor lysis syndrome (TLS) consists of a rapid tumor cell breakdown that ends in multiple metabolic derangements and can occur spontaneously or be triggered by oncological therapies. It is a serious oncological emergency, primarily seen in hematological malignancies like non-Hodgkin lymphomas and particularly Burkitt's lymphoma, as well as in certain bulky solid tumors like neuroblastoma. This report discusses a case of spontaneous TLS in a patient with metastatic cholangiocarcinoma. We present a case of a 72-year-old Hispanic male with a history of hypertension, tobacco use disorder, and alcoholism who was admitted for 20 days of worsening abdominal distention, edema, dyspnea, cough, and hyporexia. Physical examination revealed jaundice and signs of ascites. Laboratory studies showed mildly elevated liver enzymes and a resolved hepatitis B infection. A multiphase computerized tomography (CT) scan of the abdomen revealed a large heterogeneous hepatic mass, ascites, lymphadenopathy, and portal vein thrombosis. Chest CT showed nodules with perilymphatic distribution. A paracentesis yielded 3000 cc of ascitic fluid, showing a serum-ascites albumin gradient of 1.81 g/dL and neutrophil predominance. Tumor markers indicated elevated CA 19-9 levels. Subsequent liver biopsy confirmed moderately differentiated adenocarcinoma, and the immunohistochemistry supported a diagnosis of cholangiocarcinoma. On day 5 of hospitalization, the patient's renal function worsened, leading to spontaneous TLS. Overall, TLS is a life-threatening emergency in cancer patients, necessitating regular lab tests for early diagnosis, especially in those on chemotherapy or with known solid tumors. There is no consensus on diagnosing spontaneous TLS.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"14 ","pages":"23247096251407832"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13009863/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147498878","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":"Expanding the Phenotypic Spectrum of <i>SLC1A4</i>-Related Spastic Tetraplegia: A Case With Novel Multisystem Features.","authors":"Ramzi H Mujahed, Leyana Alawawdeh, Baraa Nassar, Ranya Abu Khalaf, Adam Hafiz Qabaha, Taha Z Makhlouf","doi":"10.1177/23247096261440338","DOIUrl":"10.1177/23247096261440338","url":null,"abstract":"<p><p>Spastic tetraplegia, thin corpus callosum, and progressive microcephaly (SPATCCM) is a rare autosomal recessive neurodevelopmental disorder caused by pathogenic variants in the <i>SLC1A4</i> gene. 24 cases have been reported worldwide. We describe a 30-month-old boy born to consanguineous parents, presenting with global developmental delay, seizures, progressive microcephaly, spastic tetraplegia, feeding difficulties, and recurrent infections. Genetic testing confirmed a homozygous pathogenic variant in <i>SLC1A4</i> (p.Arg457Trp). Notably, our patient exhibited novel systemic phenotypic features, including grade 2 finger clubbing, recurrent infections, bilateral hernias, meatal stenosis, and dysmorphic features (high-arched palate, low-set ears, pectus carinatum). Brain MRI demonstrated a diffusely thin corpus callosum, a typical finding consistent with the classic SPATCCM phenotype. These previously unreported systemic features broaden the recognized phenotypic spectrum and underscore the need for genetic testing in suspected cases.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"14 ","pages":"23247096261440338"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13051137/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147615831","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 Paratesticular Leiomyosarcoma Presenting as a Painless Scrotal Mass in an Elderly Patient: A Case Report.","authors":"Marvin A Simpkins, Garrett Douglas, Dominic M Collins, Aishniya Kandula, Darshan Sangani, Roger Robertson","doi":"10.1177/23247096261420891","DOIUrl":"10.1177/23247096261420891","url":null,"abstract":"<p><p>Leiomyosarcomas (LMS) are malignant tumors originating from smooth muscle and rarely found in the scrotum. LMS has an insidious presentation that is often misdiagnosed as a benign lesion. This report outlines an innocuous case of paratesticular leiomyosarcoma while focusing on the diagnosis and treatment paratesticular LMS. We report the case of an 84-year-old male who presented with a painless left scrotal swelling of 5 days' duration. Imaging and tumor markers suggested a paratesticular mass suspicious for malignancy. Surgical excision revealed a Fédération Nationale des Centres de Lutte Contre le Cancer Grade 2 leiomyosarcoma arising from the scrotal soft tissue, confirmed by positive smooth muscle markers on immunohistochemistry. Postoperative imaging demonstrated no recurrence at 8 months. This case highlights the diagnostic challenge of paratesticular leiomyosarcoma and the importance of surgical resection and careful follow-up for optimal patient outcomes.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"14 ","pages":"23247096261420891"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12936359/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147306685","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":"Suspected Kearns-Sayre-associated Tachy-Brady Syndrome.","authors":"Arun Katwaroo, Matthew Maharaj, Priya Ramcharan, Valmiki Seecheran, Rajeev Seecheran, Robin Seemongal-Dass, Anil Ramlackhansingh, Sherry Sandy, Naveen Seecheran","doi":"10.1177/23247096261501858","DOIUrl":"https://doi.org/10.1177/23247096261501858","url":null,"abstract":"<p><p>Kearns-Sayre syndrome (KSS) is a rare mitochondrial disorder characterized by a triad of onset before the age of 20 years, chronic progressive external ophthalmoplegia (CPEO), and pigmentary retinopathy, together with systemic features such as cardiac conduction disease. Deletions or mutations in mitochondrial deoxyribonucleic acid (mtDNA) can disrupt cellular function, affecting the myocardial intercalated discs, resulting in arrhythmias. We hereby present the case of a 65-year-old Caucasian male of German origin with a pre-existing diagnosis of KSS, who presented with tachy-brady syndrome (TBS) with paroxysmal atrial fibrillation (PAF) and sinus bradycardia (SB) with a first-degree atrioventricular block (AVB). He was treated with guideline-directed medical therapy (GDMT) for heart failure with preserved ejection fraction (HFpEF) and direct oral anticoagulation (DOAC) for PAF. He deferred device therapy despite extensive counseling for sudden cardiac death (SCD) associated with KSS. Given the relative paucity of conventional risk factors, suspected Kearns-Sayre-associated tachy-brady syndrome (TBS) was deemed the likely diagnosis.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"14 ","pages":"23247096261501858"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149269007","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":"Central Variant Posterior Reversible Encephalopathy Syndrome, the Brainstem, and Chronic Kidney Disease: Call for Rapid Diagnosis With Brain Magnetic Resonance Imaging.","authors":"Liliana Guevara-Bermudez, Mary Ann Kirkconnell Hall, Toby Terwilliger","doi":"10.1177/23247096261502314","DOIUrl":"10.1177/23247096261502314","url":null,"abstract":"<p><p>Posterior reversible encephalopathy syndrome (PRES) is characterized by reversible vasogenic edema that most commonly involves the parieto-occipital regions. Isolated brainstem involvement, as is seen in the case of central variant PRES (cvPRES), is rare. PRES can be the first presentation of chronic kidney disease and hypertension; we report a combination of both, with brainstem involvement and atypical presentation (acute loss of consciousness versus typical confusion and seizures). Our patient, a man in his 30s with hypertension and stage IV chronic kidney disease, was found unresponsive with blood pressure 266/166 mmHg. Head computed tomography and angiography showed no evidence of hemorrhage or occlusion. He was admitted with acute-on-chronic kidney disease requiring emergent dialysis. Brain magnetic resonance imaging (MRI) with and without contrast showed pontine enlargement with diffuse T2 hyperintensity with no evidence of restricted diffusion. He was diagnosed with cvPRES. His blood pressure was aggressively controlled with continuous nicardipine infusion. Repeat MRI 8 days later showed partial resolution of T2 hyperintensities. MRI, particularly diffusion-weighted imaging, is the preferred diagnostic tool for PRES because it allows differentiation of vasogenic edema from cytotoxic edema, enabling timely diagnosis and treatment that can lead to complete remission. In patients with the appropriate clinical context, repeat MRI to assess interval improvement may help confirm cvPRES and avoid unnecessary invasive evaluation of brainstem abnormalities.</p>","PeriodicalId":16198,"journal":{"name":"Journal of investigative medicine high impact case reports","volume":"14 ","pages":"23247096261502314"},"PeriodicalIF":0.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149268962","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}