Journal of Medical Case Reports最新文献

{"title":"Successful management of paraquat poisoning: a case report.","authors":"Amarja Ashok Havaldar","doi":"10.1186/s13256-025-05546-y","DOIUrl":"https://doi.org/10.1186/s13256-025-05546-y","url":null,"abstract":"<p><strong>Background: </strong>Paraquat is a herbicide used for weed control and is one of the lethal poisons associated with high mortality. Exposure to this compound could be accidental or as a deliberate self-harm. Clinical manifestations can range from mild symptoms initially to multiorgan failure. Owing to high case fatality (50-90%) and no specific antidote is available; different treatment regimens are proposed with variable success rates. Here, we present two patients with paraquat poisoning, their initial presentation, clinical progress, and successful management.</p><p><strong>Case presentation: </strong>Two young adults, one 29-year-old male and one 32-year-old female patient from South India, presented with gastrointestinal symptoms and worsening renal and Liver failure. Patients had already received gastric lavage at the local hospital and later transferred to our hospital. We initiated immunosuppressive therapy with cyclophosphamide at 15 mg/kg/day for 3 days and steroids. Both patients received renal replacement therapy and N-acetyl cysteine infusion. We observed improvement in clinical and biochemical parameters over a week. There were no respiratory symptoms throughout the hospitalization. At the time of discharge, both patients were off renal replacement therapy. On long-term follow-up after 2.5 years, both patients had recovered well without any renal dysfunction.</p><p><strong>Conclusion: </strong>This case report highlights the successful management of paraquat poisoning with high-dose cyclophosphamide with steroids. The timely initiation of immunosuppression prevented disease progression and facilitated prompt recovery.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":"19 1","pages":"479"},"PeriodicalIF":0.8,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225542","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":"Management of pseudoaneurysm and cervical hematoma following carotid sheath placement in a patient with middle cerebral artery thrombosis: a case report.","authors":"Meghdad Ghasemi Gorji, Rojan Abdollahzadeh Mirali, Yasamin Bigdeli","doi":"10.1186/s13256-025-05531-5","DOIUrl":"10.1186/s13256-025-05531-5","url":null,"abstract":"<p><strong>Background: </strong>Middle cerebral artery occlusions are present in up to one third of patients with acute ischemic strokes who are undergoing endovascular mechanical thrombectomy, which, especially with intravenous thrombolysis, effectively treats proximal middle cerebral artery stroke when performed promptly. However, carotid sheath placement carries risks such as pseudoaneurysm and hematoma.</p><p><strong>Case presentation: </strong>This report describes a 73-year-old male of Iranian ethnicity with right middle cerebral artery occlusion who developed a pseudoaneurysm and cervical hematoma after carotid sheath placement during mechanical thrombectomy. Despite these complications, the patient underwent successful surgical repair and recovered fully.</p><p><strong>Conclusion: </strong>This case emphasizes the importance of timely middle cerebral artery thrombectomy and highlights the potential complications of carotid sheath placement. It underscores the need for timely management to minimize risks and achieve optimal outcomes.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":"19 1","pages":"477"},"PeriodicalIF":0.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12487206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206673","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 challenges of dermatomyositis in a resource-limited setting: a case report.","authors":"Getachew Sahile Alemu, Mekdes Tarekegn Ambaye","doi":"10.1186/s13256-025-05446-1","DOIUrl":"10.1186/s13256-025-05446-1","url":null,"abstract":"<p><strong>Background: </strong>Dermatomyositis is a rare idiopathic inflammatory myopathy characterized by distinct cutaneous manifestations and progressive proximal muscle weakness. However, in areas with limited diagnostic tools without a high index of suspicion, early identification is often challenging, increasing the risk of complications.</p><p><strong>Case presentation: </strong>We report the case of a 50-year-old Ethiopian woman who presented with progressive difficulty swallowing, proximal muscle weakness, and characteristic dermatologic manifestations. Despite multiple emergency visits and extensive workups, such as chest computed tomography and barium swallow, the diagnosis was delayed. Key findings included elevated muscle enzymes and low serum albumin, and a muscle biopsy revealed muscle fiber atrophy. The diagnosis of dermatomyositis was confirmed by the American College of Rheumatology-European League Against Rheumatism classification criteria.</p><p><strong>Management: </strong>We treated the patient with high-dose prednisolone and methotrexate as a steroid-sparing agent, along with nutritional support. Her muscle strength and dysphagia significantly improved within weeks of therapy initiation.</p><p><strong>Conclusion: </strong>Our goal is to emphasize the importance of early recognition of dermatomyositis, especially in resource-limited settings, to avoid unnecessary, financially debilitating workups and prevent complications such as malnutrition, which are completely avoidable with early detection.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":"19 1","pages":"478"},"PeriodicalIF":0.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12487581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206719","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":"Navigating the clinical complexity of acute heart failure in an untreated adult with dextrotransposition of the great arteries (D-TGA) and multiple cardiac anomalies: a case report and review of literature.","authors":"Mihret Hailu Mecha, Lensa Million, Elsah Tegene Asefa","doi":"10.1186/s13256-025-05239-6","DOIUrl":"10.1186/s13256-025-05239-6","url":null,"abstract":"<p><strong>Background: </strong>Transposition of the great arteries is a critical congenital heart defect characterized by the reversal of the aorta and pulmonary arteries, resulting in two parallel circulatory pathways. This condition is typically incompatible with life unless a shunt, such as an atrial or ventricular septal defect, facilitates the adequate mixing of oxygenated and deoxygenated blood in the heart. Survival into adulthood without surgical correction is exceptionally rare. While a limited number of cases have been reported globally, none, to the best of our extensive search, have been associated with a patent ductus arteriosus and pulmonary artery aneurysm.</p><p><strong>Case presentation: </strong>We present a unique case of a 25-year-old Ethiopian male with complex dextrotransposition of the great arteries, who survived into adulthood and presented with acute decompensated heart failure. Remarkably, this patient had a constellation of associated anomalies, including an atrial septal defect, ventricular septal defect, patent ductus arteriosus, and severe pulmonary hypertension. Owing to resource limitations, insufficient medical knowledge, and financial constraints, the patient was managed conservatively. Despite these challenges, the patient showed symptomatic improvement with the conservative management provided.</p><p><strong>Conclusion: </strong>This case offers novel insights into the natural history of untreated dextrotransposition of the great arteries with multiple associated anomalies in adults. It also underscores the challenges of managing complex congenital heart defects in resource-limited settings and highlights the urgent need for accessible advanced diagnostic and therapeutic interventions to improve outcomes for similar patients.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":"19 1","pages":"476"},"PeriodicalIF":0.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12486961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206787","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":"Marked regression of a chronic elbow keloid after a single intralesional corticosteroid injection: a case report.","authors":"Peyman Khaledi","doi":"10.1186/s13256-025-05442-5","DOIUrl":"10.1186/s13256-025-05442-5","url":null,"abstract":"<p><strong>Background: </strong>Keloid scars can be challenging to manage, especially in resource-limited settings. This case demonstrates successful regression of a chronic keloid with a single intralesional corticosteroid injection.</p><p><strong>Case presentation: </strong>A 29-year-old Iranian male with a 3-year history of a posttraumatic keloid on the posterior elbow presented after failing to respond to topical therapies. A single dose of triamcinolone-lidocaine (1:1 ratio) was injected intralesionally. A total of 4 weeks postinjection, significant flattening and softening of the keloid was observed, and the patient returned 3 months later with sustained improvement.</p><p><strong>Conclusion: </strong>This case highlights the potential efficacy of a single intralesional corticosteroid injection for chronic keloid management in primary care.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":"19 1","pages":"475"},"PeriodicalIF":0.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12487239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206721","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":"Methotrexate-induced acute neurotoxicity in patients with osteosarcoma: a case report.","authors":"Olivia L Makos, Nicole A Shonka, Kealy M Marth, Shawna L Stricker, Mark Keiper, Makayla E Schissel","doi":"10.1186/s13256-025-05500-y","DOIUrl":"10.1186/s13256-025-05500-y","url":null,"abstract":"<p><strong>Background: </strong>Methotrexate is commonly used to treat osteosarcoma and acute lymphoblastic leukemia. Methotrexate can rarely cause neurotoxicity with a wide range of presentations including seizure, hemiparesis, dysarthria, dysphagia, and more. Acute neurotoxicity typically occurs within 2-14 days after methotrexate administration. The incidence of methotrexate-induced neurotoxicity, risk factors, treatments, and recurrence of neurotoxicity on methotrexate rechallenge all largely come from literature involving patients with acute lymphoblastic leukemia.</p><p><strong>Case presentation: </strong>We present a case of methotrexate-induced neurotoxicity and leukoencephalopathy in a 20-year-old Hispanic male with osteosarcoma who improved after treatment with dextromethorphan and aminophylline. To better understand methotrexate-induced neurotoxicity in patients with osteosarcoma specifically, we conducted a literature review of 16 cases, including ours.</p><p><strong>Conclusion: </strong>To the knowledge of these authors, this is the largest compilation of cases of methotrexate-induced neurotoxicity involving patients with osteosarcoma. There is no standard treatment for methotrexate-induced neurotoxicity. In our review we discuss dextromethorphan, aminophylline, and ketamine use in the treatment of methotrexate-induced neurotoxicity. Methotrexate is a crucial, first-line treatment for osteosarcoma and if safe, would be beneficial to continue even after acute neurotoxicity. Unfortunately, methotrexate is often discontinued after the first episode of neurotoxicity, owing to fear of recurrence on rechallenge. In our review, 5 of 16 patients were known to be rechallenged with methotrexate. None had recurrence of neurotoxicity with subsequent methotrexate treatment. While our study is limited by the number of cases, our findings suggest that methotrexate rechallenge in patients with osteosarcoma could be considered. Our review adds to the limited existing literature on patients with osteosarcoma with methotrexate-induced neurotoxicity and can aid in the understanding of the complicated pathophysiology, available treatments, and decision of whether to proceed with methotrexate rechallenge.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":"19 1","pages":"473"},"PeriodicalIF":0.8,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12487186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199617","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":"Ross syndrome following COVID-19 infection in an 18-year-old Syrian male patient: a case report.","authors":"Ahed Assaf, Suleiman Khaddour, William Borghol, Saja Karaja, Faisal Alfaksh, Khayry Al-Shami","doi":"10.1186/s13256-025-05483-w","DOIUrl":"10.1186/s13256-025-05483-w","url":null,"abstract":"<p><strong>Background: </strong>Ross syndrome is an exceptionally rare disorder characterized by tonic pupils, areflexia, and anhidrosis, with a prevalence that appears to be higher in women than in men, typically presenting in individuals during their 30s. While Adie Syndrome closely mimics Ross syndrome, Adie syndrome lacks anhidrosis, making Ross syndrome clinically differentiable. This condition can manifest with a variety of symptoms, including cardiovascular anomalies attributable to autonomic nervous system dysfunction. We present the first case in the literature of COVID-19 being a potential trigger for Ross syndrome.</p><p><strong>Case presentation: </strong>An 18-year-old Syrian male was evaluated at the ophthalmology clinic owing to progressive bilateral pupillary dilation following a symptomatic COVID-19 infection. Subsequent investigations and a thorough neurological examination revealed tonic pupils and areflexia, leading to an initial diagnosis of Adie syndrome. However, the patient's clinical picture expanded to include diffuse anhidrosis, prompting a revised diagnosis of Ross syndrome (refer to graphical abstract).</p><p><strong>Conclusion: </strong>Clinicians should remain vigilant regarding the possibility of undefined neurological or ophthalmic sequelae, including Adie syndrome and Ross syndrome, following COVID-19 infection, regardless of the severity of initial symptoms. Further research is warranted to elucidate the underlying mechanisms and to develop appropriate management strategies.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":"19 1","pages":"474"},"PeriodicalIF":0.8,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12486791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199593","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":"Challenges on diagnosis and treatment of refractory adult-onset still disease in Sub-Saharan Africa: a case report.","authors":"Sylvain Raoul Simeni Njonnou, Fernando Kemta Lekpa, Aimé Raymond Essoka Essoka, Marie-Josiane Ntsama Essomba, Jean Roger Moulion Tapouh, Christelle Nguemo, Félicité Soh Maleu, Michel Noubom","doi":"10.1186/s13256-025-05477-8","DOIUrl":"10.1186/s13256-025-05477-8","url":null,"abstract":"<p><strong>Background: </strong>Adult-onset-Still's disease is a rare, multi-systemic condition with difficult and delayed diagnosis, characterized by a diversity of signs and symptoms related to hyperactivation of macrophages and neutrophils. Although diagnosis in the classical form is easily realized, there are atypical presentations that can be challenging, particularly in the absence of diagnostic means.</p><p><strong>Case presentation: </strong>We report the case of a 28-year-old single African woman who had been experiencing prolonged fever and diffuse inflammatory joint pain for months, and who had manifested odynophagia and a fleeting, salmon-pink skin rash in her upper limbs, in whom, after thorough evaluation, the diagnosis of adult-onset-Still's disease was made. This was based on the various symptoms presented by the patient, a positive acute phase reactant with elevation of C-reactive protein, erythrocyte sedimentation rate, and high serum ferritin with a low percentage of glycosylated ferritin (< 20%), an absence autoimmunity markers and comorbidities, and confirmed by both Fautrel and Yamaguchi diagnostic criteria, within the month following admission after excluding all differential diagnoses.</p><p><strong>Conclusion: </strong>Adult-onset-Still's disease is a rare pathology considered as a diagnosis of exclusion, which should be considered in the face of any fever of unknown origin. It is present in young adults over 16 years old, with an average peak at diagnosis of 38-39 years old and a sex ratio of 2:1 (female:male), with a female predominance of the disease. Rapid diagnosis and appropriate management with steroids, biologics and immunosuppressants are the keys to a favorable prognosis for this condition.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":"19 1","pages":"472"},"PeriodicalIF":0.8,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12487006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199570","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":"Extraneural and extracranial metastatic astrocytoma with primitive neuroectodermal component: a case report.","authors":"Frayne Gomez, Stephen Evans, Forough Foroughi, Narayan Karanth","doi":"10.1186/s13256-025-05474-x","DOIUrl":"10.1186/s13256-025-05474-x","url":null,"abstract":"<p><strong>Background: </strong>Astrocytoma is a highly malignant tumor of the central nervous system with limited survival, despite standard multimodal therapies. While typically remains confined to the central nervous system, rare instances of extraneural and extracranial metastasis have been documented. The underlying pathophysiology remains poorly understood, with very few reported cases-particularly in tumors harboring isocitrate dehydrogenase mutations.</p><p><strong>Case presentation: </strong>We describe the case of a 21-year-old female New Zealander of European descent with O⁶-methylguanine-DNA methyltransferase promoter-methylated, IDH1-R132H-mutant astrocytoma (World Health Organization 2021 central nervous system grade 4) containing a primitive neuroectodermal tumor-like component, which exhibited diffuse skeletal and leptomeningeal metastases.</p><p><strong>Conclusion: </strong>This case represents an unusual presentation of extraneural and extracranial metastatic spread in a young female New Zealander of European descent with an isocitrate dehydrogenase-mutant astrocytoma. Compared with recent literature, it is notable for early systemic dissemination and the coexistence of bone and leptomeningeal disease. A multidisciplinary discussion concluded that additional biopsy of metastatic sites was unwarranted owing to clear pathological correlation, clinical decline, and poor prognosis. Molecular characteristics such as cyclin-dependent kinase inhibitor 2A/2B deletion may further refine classification. A review of current literature underscores the importance of the 2021 World Health Organization classification updates and highlights potential roles for epithelial-mesenchymal transition and glymphatic dissemination in metastasis. Targeted therapies-particularly isocitrate dehydrogenase inhibitors-are under active investigation. This case reinforces the need for ongoing research into predictive biomarkers and individualized treatment strategies.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":"19 1","pages":"471"},"PeriodicalIF":0.8,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12486764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199635","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":"Hypoglycemic noncardiogenic pulmonary edema: a case report.","authors":"Filmon Tesfay, Goitom Hagos, Lidya Musie","doi":"10.1186/s13256-025-05413-w","DOIUrl":"10.1186/s13256-025-05413-w","url":null,"abstract":"<p><strong>Background: </strong>Hypoglycemic pulmonary edema was well addressed in the mid-1900s, and experimental data in addition to clinical reports have confirmed the association. The pathophysiology is similar to a neurogenic type of noncardiogenic pulmonary edema. Despite this, medical textbooks have not included hypoglycemia as a possible cause of this type of pulmonary edema, and only a few case reports are published, meaning that this association is often forgotten. To the best of our knowledge, our case is the first case report in over 15 years.</p><p><strong>Case presentation: </strong>A 55-year-old Eritrean male patient with known diabetes presented to our emergency room after he became unconscious at home. He was accompanied by his family. On examination, his random blood sugar was measured at 58 mg/dL, and he had a Glasgow Coma Scale score of 9/15. He was severely hypoxic, with bilateral crackles. Upon management of hypoglycemia with dextrose infusion, he improved steadily with supportive oxygen until his Glasgow Coma Scale score reached 15/15, when his pulmonary edema showed marked improvement. He was discharged, with his condition improved, on third day of admission.</p><p><strong>Conclusion: </strong>The unique presentation of pulmonary edema in a 55-year-old patient with diabetes underscores the possibility of hypoglycemia causing noncardiogenic pulmonary edema. This case contributes to the understanding of atypical complications of hypoglycemic neurologic insult.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":"19 1","pages":"464"},"PeriodicalIF":0.8,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191794","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}