Journal of Medical Case Reports最新文献

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Add-on hemoperfusion in SARS-CoV-2-infected pregnant patients: a case series. 对感染 SARS-CoV-2 的孕妇进行附加血液灌流:一个病例系列。
IF 0.9
Journal of Medical Case Reports Pub Date : 2024-09-03 DOI: 10.1186/s13256-024-04726-6
Supattra Chiewroongroj, Thummaporn Naorungroj, Ranistha Ratanarat
{"title":"Add-on hemoperfusion in SARS-CoV-2-infected pregnant patients: a case series.","authors":"Supattra Chiewroongroj, Thummaporn Naorungroj, Ranistha Ratanarat","doi":"10.1186/s13256-024-04726-6","DOIUrl":"10.1186/s13256-024-04726-6","url":null,"abstract":"<p><strong>Background: </strong>Pregnant women are more likely to have a higher severity of illness after being infected with coronavirus disease 2019 compared with the general population, particularly in the hyperinflammatory phase. However, immunomodulatory drugs are contraindicated and have been associated with an increased risk of fetal abnormalities. Therefore, we are reporting our experience with the use of HA330 hemoperfusion in combination with standard therapy in severe to critical coronavirus disease 2019 cases among pregnant patients.</p><p><strong>Case presentation: </strong>From January 2020 to December 2021, four pregnant Thai women were treated with hemoperfusion using a cytokine adsorptive technique. The patients' ages ranged from 21 to 36 years old, and their gestational ages at the time of admission ranged from 18 to 38 weeks. Two patients required intubation. Extracorporeal blood purification with an adsorptive cartridge (HA330<sup>®</sup>, Jafron, China) was applied as an adjunctive strategy to standard therapy approximately one week after the onset of symptoms, and most patients received three sessions of hemoperfusion. The baseline C-reactive protein level was greater than 80 mg/dL. The results showed that hemoperfusion could decrease the C-reactive protein level by approximately 80% and improve oxygenation. The newborns were delivered by Cesarean section without complications. Neither mortality nor serious adverse events related to hemoperfusion occurred.</p><p><strong>Conclusion: </strong>This report may help ensure the use of the hemoperfusion strategy in pregnant patients during a cytokine storm. However, a larger cohort is needed to confirm its safety and efficacy.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11370091/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142119996","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}
引用次数: 0
Unilateral amelanotic conjunctival malignant melanoma: a case report. 单侧巩膜结膜恶性黑色素瘤:病例报告。
IF 0.9
Journal of Medical Case Reports Pub Date : 2024-09-03 DOI: 10.1186/s13256-024-04729-3
Marcelo Ayala, Kalliopi Erripi, Iva Johansson
{"title":"Unilateral amelanotic conjunctival malignant melanoma: a case report.","authors":"Marcelo Ayala, Kalliopi Erripi, Iva Johansson","doi":"10.1186/s13256-024-04729-3","DOIUrl":"10.1186/s13256-024-04729-3","url":null,"abstract":"<p><strong>Introduction: </strong>Cutaneous malignant melanomas rarely occur in the eye, usually in the eyelids or the conjunctiva. Conjunctival malignant melanomas are even rarer. Most melanomas are dark in color as they are pigmented. However, amelanotic conjunctival malignant melanomas, a scarce variant of the cancer, can be challenging to diagnose accurately.</p><p><strong>Case presentation: </strong>We present two cases of white Caucasian Swedish-born women who were diagnosed with unilateral amelanotic malignant melanoma in the conjunctiva of the eye. In the first case, the patient was an 81-year-old woman who was suffering from redness and foreign body sensation in the left eye. The initial diagnosis was blepharitis. Three biopsies were taken, which showed malignant melanoma in the eyelid and the conjunctiva. Unfortunately, the eye and the rest of the orbit could not be saved, and the patient had to undergo an orbital exenteration. In the second case, the patient was a 50-year-old woman, and the tumor was localized in the temporal conjunctiva of the left eye. The initial diagnosis was pinguecula, but at the time of surgery, the physician suspected conjunctival intraepithelial neoplasia. The tumor was not completely removed, so adjuvant brachytherapy and local chemotherapy were used. The eye was preserved. No neck and/or lung metastasis was detected in either case at the time of diagnosis.</p><p><strong>Conclusions: </strong>Conjunctival amelanotic malignant melanomas should be suspected when tumors are present in the eye and/or the eyelids. By suspecting amelanotic malignant melanoma, the delay in treatment can be shortened. Treating them as soon as possible is essential to minimize the risk of metastasis.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11370060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142119997","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}
引用次数: 0
Bilateral breast metastases from anaplastic lymphoma kinase-positive lung cancer in a male: a case report. 一名男性无细胞淋巴瘤激酶阳性肺癌的双侧乳房转移:病例报告。
IF 0.9
Journal of Medical Case Reports Pub Date : 2024-09-02 DOI: 10.1186/s13256-024-04707-9
Sumire Koh, Yumiko Koi, Wakako Tajiri, Junji Kawasaki, Sayuri Akiyoshi, Yoshiaki Nakamura, Chinami Koga, Tatsuro Okamoto, Kenichi Taguchi, Eriko Tokunaga
{"title":"Bilateral breast metastases from anaplastic lymphoma kinase-positive lung cancer in a male: a case report.","authors":"Sumire Koh, Yumiko Koi, Wakako Tajiri, Junji Kawasaki, Sayuri Akiyoshi, Yoshiaki Nakamura, Chinami Koga, Tatsuro Okamoto, Kenichi Taguchi, Eriko Tokunaga","doi":"10.1186/s13256-024-04707-9","DOIUrl":"10.1186/s13256-024-04707-9","url":null,"abstract":"<p><strong>Background: </strong>Distant metastases from lung cancer are commonly found in the brain, bone, and liver. Metastases to the breast from non-mammary malignancies are extremely rare, and their clinical presentations remain unclear.</p><p><strong>Case presentation: </strong>We herein report a case of bilateral breast metastases from anaplastic lymphoma kinase-positive advanced lung cancer in a 51-year-old Japanese male patient. During the course of systemic treatment for advanced lung cancer, computed tomography revealed bilateral breast enlargement without contrast enhancement, a finding consistent with gynecomastia. While other metastatic lesions responded to chemotherapy, both breast masses grew vertically like nodules. The breast masses were immunohistochemically diagnosed as metastases from lung cancer and were removed surgically. Simultaneous bilateral breast metastases from malignancies of other organs, like ones in this case, have rarely been described.</p><p><strong>Conclusions: </strong>It is important to keep in mind that breast metastases from nonmammary malignancies are a possible explanation for unusual breast findings in a patient with a history of malignancies.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11367847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142108215","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}
引用次数: 0
Noninvasive ventilation and laser-assisted unilateral posterior cordotomy as novel multidisciplinary approaches for Charcot-Marie-Tooth disease 4B vocal cord paralysis: a case report. 无创通气和激光辅助单侧后脊髓切开术是治疗夏科-玛丽-牙病 4B 声带麻痹的新型多学科方法:病例报告。
IF 0.9
Journal of Medical Case Reports Pub Date : 2024-09-01 DOI: 10.1186/s13256-024-04742-6
Seyed Ahmad Tabatabaii, Joben Kianparsa, Mohammad Hossein Golkhani Zavareh, Abolfazl Khosravi, Amir Reza Bahadori, Nazanin Farahbakhsh
{"title":"Noninvasive ventilation and laser-assisted unilateral posterior cordotomy as novel multidisciplinary approaches for Charcot-Marie-Tooth disease 4B vocal cord paralysis: a case report.","authors":"Seyed Ahmad Tabatabaii, Joben Kianparsa, Mohammad Hossein Golkhani Zavareh, Abolfazl Khosravi, Amir Reza Bahadori, Nazanin Farahbakhsh","doi":"10.1186/s13256-024-04742-6","DOIUrl":"10.1186/s13256-024-04742-6","url":null,"abstract":"<p><strong>Background: </strong>Charcot-Marie-Tooth disease (CMT) is one of the most common inherited neuropathies. The disease is generally characterized by sensory loss most prominent in distal extremities, muscle weakness, and muscle wasting. There is still no effective therapy for Charcot-Marie-Tooth disease.</p><p><strong>Case presentation: </strong>The patient is a 6-year-old Iranian girl, of Fars ethnicity, who was admitted with a chief complaint of hoarseness and an impression of Charcot-Marie-Tooth disease type 4B. She was initially treated with noninvasive ventilation and, after a year, electively underwent cordotomy as a novel therapeutic approach.</p><p><strong>Conclusions: </strong>Charcot-Marie-Tooth disease type 4B is a less common but important cause of stridor. Noninvasive ventilation treatment and unilateral posterior cordotomy can be utilized for hereditary neuropathies.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11366128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142108222","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}
引用次数: 0
Multiple dermatofibromas in a patient with Ehlers-Danlos syndrome: a case report. 埃勒斯-丹洛斯综合征患者的多发性皮纤维瘤:病例报告。
IF 0.9
Journal of Medical Case Reports Pub Date : 2024-08-31 DOI: 10.1186/s13256-024-04628-7
Fatemeh Mohaghegh, Mahsa Bahraminejad, Zahra Talebzadeh, Elham Tavousi Tabatabaei
{"title":"Multiple dermatofibromas in a patient with Ehlers-Danlos syndrome: a case report.","authors":"Fatemeh Mohaghegh, Mahsa Bahraminejad, Zahra Talebzadeh, Elham Tavousi Tabatabaei","doi":"10.1186/s13256-024-04628-7","DOIUrl":"https://doi.org/10.1186/s13256-024-04628-7","url":null,"abstract":"<p><strong>Background: </strong>Dermatofibromas, also known as benign fibrous histiocytomas, are among the most common cutaneous soft-tissue lesions. Association of multiple dermatofibromas with some diseases was described and it has not been reported with Ehlers-Danlos syndrome before. We present a case with Ehlers-Danlos syndrome and multiple dermatofibromas.</p><p><strong>Case presentation: </strong>An 18-year-old Iranian woman presented with multiple purple nodules ranging from 0.5 to 1.5 cm in diameter, which were mobile and located on the proximal part of the lower limb. The dimple sign of these lesions was positive. During the physical examination, several features suggestive of Ehlers-Danlos syndrome were observed, including hyperextensibility and fragility of the skin, wide atrophic scars on the upper limb, hypermobility of joints and fingers, swan neck deformities of the digits, nodules on the knee, and striae alba on the leg. The patient was previously unaware of having Ehlers-Danlos syndrome. She had a history of asthma and atopic dermatitis. Family history was negative. A biopsy of the nodular lesions was performed, and the findings confirmed the diagnosis of dermatofibromas.</p><p><strong>Conclusion: </strong>We describe a patient with Ehlers-Danlos Syndrome who presented with multiple dermatofibromas. To our knowledge, this combination of findings is a previously unreported occurrence.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11365123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142108221","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}
引用次数: 0
Ewing sarcoma presenting in the lung: a case report. 出现在肺部的尤文肉瘤:病例报告。
IF 0.9
Journal of Medical Case Reports Pub Date : 2024-08-31 DOI: 10.1186/s13256-024-04749-z
Mohammad Berro, Abdulrahman Al Balkhi, Yahia Ranjous, Khalil Kashour, Mohamad Shbat, Hussain Chaban
{"title":"Ewing sarcoma presenting in the lung: a case report.","authors":"Mohammad Berro, Abdulrahman Al Balkhi, Yahia Ranjous, Khalil Kashour, Mohamad Shbat, Hussain Chaban","doi":"10.1186/s13256-024-04749-z","DOIUrl":"https://doi.org/10.1186/s13256-024-04749-z","url":null,"abstract":"<p><strong>Background: </strong>Ewing sarcoma is a malignant round-cell tumor that primarily affects bones in children. It can also arise in extraosseous tissues, such as the lung, kidneys, and liver. The presentation symptoms of Ewing sarcoma may include cough, dyspnea, and chest pain.</p><p><strong>Case presentation: </strong>This report details the history of a 15-year-old Syrian boy with a previous diagnosis of Hodgkin lymphoma who presented with chronic shoulder pain. Imaging studies revealed an 80 mm mass in the apex of the left lung, which was confirmed through histopathological examination to be Ewing sarcoma following a computed-tomography-guided biopsy. The patient received multiple cycles of chemotherapy and subsequently underwent surgical resection of the remaining mass.</p><p><strong>Conclusions: </strong>This case highlights the rare occurrence of Ewing sarcoma in the lung and the unusual clinical presentation of shoulder pain without other accompanying symptoms.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11365186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142108219","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}
引用次数: 0
Does gait influence biomechanics in a distal femoral osteotomy? An early post operative fracture after DFO above a Tomofix® plate in a multiple sclerosis and low-density bone affected patient: choose a longer plate-a case report. 步态会影响股骨远端截骨术的生物力学吗?多发性硬化症和低密度骨病患者在使用Tomofix®钢板进行DFO术后早期骨折:选择更长的钢板--病例报告。
IF 0.9
Journal of Medical Case Reports Pub Date : 2024-08-31 DOI: 10.1186/s13256-024-04739-1
Antongiulio Favero, Domenico Alesi, Vito Gaetano Rinaldi, Tosca Cerasoli, Stefano Zaffagnini, Giulio Maria Marcheggiani Muccioli
{"title":"Does gait influence biomechanics in a distal femoral osteotomy? An early post operative fracture after DFO above a Tomofix<sup>®</sup> plate in a multiple sclerosis and low-density bone affected patient: choose a longer plate-a case report.","authors":"Antongiulio Favero, Domenico Alesi, Vito Gaetano Rinaldi, Tosca Cerasoli, Stefano Zaffagnini, Giulio Maria Marcheggiani Muccioli","doi":"10.1186/s13256-024-04739-1","DOIUrl":"https://doi.org/10.1186/s13256-024-04739-1","url":null,"abstract":"<p><strong>Background: </strong>Distal femur osteotomies are a well known and valuable treatment option to manage valgus malalignment with unicompartmental arthritis. Early postoperative complications are well known, and risk factors, such as pulmonary diseases, smoke, high dependent functional status, and body mass index, have been studied, but no study is available about osteotomies when gait is abnormal because of neurodegenerative conditions or when mineral density is below the normal rate.</p><p><strong>Case presentation: </strong>We report the case of a 44 year-old female Mediterranean patient who underwent a biplanar distal femur opening wedge osteotomy surgery following a lateral meniscus total removal, which led to the subsequent development of lateral compartment osteoarthritis and pain, despite general comorbidities, such as multiple sclerosis. Additionally, 2 months later a supracondylar femur fracture above the previously applied Tomofix<sup>®</sup> plate was reported. Fracture was treated by applying a LCP condylar 16 hole (336 mm) plate, a structural fibular graft, and strut fibular graft on the opposite side.</p><p><strong>Conclusion: </strong>The overall aim of this case report is to provide a lesson to surgeons who want to perform a realignment surgery of the lower limb in patients with abnormal gait. Not only mechanical axes are to be considered, but also bone density, patient's gait, and load force distribution along the bone stock. Emerging literature on three-dimensional cutting guides fails to account for these factors, thus promoting a standardized approach to surgery across all patients. The present case highlights a patient with low bone density and abnormal force distribution resulting from a pathologic neurodegenerative gait. In such cases, treatment decisions must carefully consider the biomechanical vulnerabilities of the native bone and the distribution of vector forces. These conditions must lead the choice toward a longer plate if an osteotomy is indicated, because surgery is more likely to fail.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11365175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142108217","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}
引用次数: 0
Extrahepatic intraabdominal hydatid cyst: a case report. 肝外腹腔内包虫囊肿:病例报告。
IF 0.9
Journal of Medical Case Reports Pub Date : 2024-08-30 DOI: 10.1186/s13256-024-04733-7
Nagham Bazzi, Hussein Baalbaki, Alain Njeim, Ali Hmede, Mohammad Chaaban, Mohammad Ali Almokdad, Ali Alhousseini, Gaby Abou Sleiman
{"title":"Extrahepatic intraabdominal hydatid cyst: a case report.","authors":"Nagham Bazzi, Hussein Baalbaki, Alain Njeim, Ali Hmede, Mohammad Chaaban, Mohammad Ali Almokdad, Ali Alhousseini, Gaby Abou Sleiman","doi":"10.1186/s13256-024-04733-7","DOIUrl":"10.1186/s13256-024-04733-7","url":null,"abstract":"<p><strong>Background: </strong>Hydatid disease, also known as echinococcosis, is a zoonotic parasitic infection caused by the larvae of the Echinococcus tapeworm. It is endemic in various regions worldwide, particularly in rural areas of countries in southern South America, Central Asia, China, parts of Africa, the Mediterranean, and parts of the Middle East. The disease primarily affects the liver (60-70% of cases) and the lungs (10-25% of cases), but it can involve any organ, including the brain, bones, and rarely the pelvic region, as seen in our case report. Hydatid disease typically follows an asymptomatic course in the early stages of the primary infection and may remain so potentially for years or even permanently. If symptoms occur, they depend on various factors, such as the number, size, and location among other factors. Typically, hydatid disease presents with nonspecific symptoms. Common symptoms include abdominal pain, hepatomegaly, as well as anaphylaxis in case of cyst rupture. Extrahepatic intra-abdominal isolated hydatic cyst is a rare finding (6-11%).</p><p><strong>Case presentation: </strong>In our case, a 70 year-old Asian white male presented with right thigh pain radiating to the lower leg, which is an atypical presentation for an extrahepatic intraabdominal hydatid cyst. Primary intraabdominal hydatid cysts involving the pelvic region are relatively rare, and such cases pose diagnostic and management challenges.</p><p><strong>Conclusion: </strong>This case report underscores the challenges in diagnosing and managing extrahepatic intraabdominal hydatid cysts, particularly in atypical presentations. A combination of clinical evaluation, serological studies, and imaging techniques facilitates accurate diagnosis.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11363457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142108220","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}
引用次数: 0
Epstein-Barr virus-positive mucocutaneous ulcer resulting in severe methotrexate intoxication: a case report. 严重甲氨蝶呤中毒导致的 Epstein-Barr 病毒阳性粘膜溃疡:一份病例报告。
IF 0.9
Journal of Medical Case Reports Pub Date : 2024-08-30 DOI: 10.1186/s13256-024-04730-w
Kazutoshi Ebisawa, Toshihide Iwashita, Kohdai Uchiyama, Yasuhiko Kitayama, Takahiro Takeuchi
{"title":"Epstein-Barr virus-positive mucocutaneous ulcer resulting in severe methotrexate intoxication: a case report.","authors":"Kazutoshi Ebisawa, Toshihide Iwashita, Kohdai Uchiyama, Yasuhiko Kitayama, Takahiro Takeuchi","doi":"10.1186/s13256-024-04730-w","DOIUrl":"10.1186/s13256-024-04730-w","url":null,"abstract":"<p><strong>Background: </strong>Epstein-Barr virus-positive mucocutaneous ulcer is one of the mature B-cell lymphoproliferative diseases occurring in patients with immune dysfunction including those with immunosuppressive treatment such as methotrexate.</p><p><strong>Case presentation: </strong>A Japanese elderly man in his 80s with rheumatoid arthritis on methotrexate was admitted to our hospital complaining persistent pharyngeal pain. Laboratory tests revealed severe pancytopenia, elevated C-reactive protein, and increased creatinine levels. An otolaryngological examination showed ulceration of the right tonsil, from which diagnostic biopsy was performed. The diagnosis of Epstein-Barr virus-positive mucocutaneous ulcer was made and bone marrow aspiration revealed hypocellularity and megaloblastic changes. Pancytopenia was improved after discontinuing methotrexate, and repeated bone marrow aspiration test revealed recovery of normal cellularity and disappearance of dysplasia, confirming the diagnosis of methotrexate intoxication. Tonsil ulcer was improved only with discontinuation of methotrexate, which strongly supported the diagnosis of EBV-MCU.</p><p><strong>Conclusion: </strong>Our case suggested that even this best prognosis form of lymphoproliferative disease could lead to fatal complications if not appropriately managed.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11363652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142108218","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}
引用次数: 0
Anesthesia for an infant with congenital mediastinal mass: a case report. 先天性纵隔肿块婴儿的麻醉:病例报告。
IF 0.9
Journal of Medical Case Reports Pub Date : 2024-08-30 DOI: 10.1186/s13256-024-04677-y
Samar Adam, Abdullah Baseet, Ali Alshaiby, Faris Alghamdi, Mohamed Alaseeri, Yahya Alsahabi, Ahmed Faqih, Hatim Azzam, Maha Alzayr, Faisal Alqasmi
{"title":"Anesthesia for an infant with congenital mediastinal mass: a case report.","authors":"Samar Adam, Abdullah Baseet, Ali Alshaiby, Faris Alghamdi, Mohamed Alaseeri, Yahya Alsahabi, Ahmed Faqih, Hatim Azzam, Maha Alzayr, Faisal Alqasmi","doi":"10.1186/s13256-024-04677-y","DOIUrl":"10.1186/s13256-024-04677-y","url":null,"abstract":"<p><strong>Background: </strong>Giant anterior mediastinal masses in infants are one of the most challenging cases faced in pediatric anesthesia practice. They can pose unique challenges for resection such as cardiovascular collapse on induction of anesthesia and injury to surrounding structures that maybe compressed or displaced. Principles that must be followed and kept in mind during removal of giant mediastinal mass include appropriate diagnostic imaging to define mass extent, airway control during induction, a multidisciplinary team approach including cardiothoracic for sternotomy, cannulation to institute cardiopulmonary bypass, otolaryngology for rigid bronchoscopy, preservation of neurovascular structure, and complete resection whenever possible. Our patient had a mass that weighed twice his whole body weight.</p><p><strong>Case presentation: </strong>Here we present a 3-month-old Middle Eastern infant weighing 3.2 kg with a large congenital teratoma who presented to the emergency room with cyanosis and respiratory distress. During his hospital course, he underwent three procedures, two of them under light-to-moderate sedation: a diagnostic computer tomography scan followed by mass content drainage by interventional radiology (Figs. 1, 2). On the third day, he had a thoracotomy with complete tumor resection under general anesthesia with the help of an epidural for pain control (Fig. 3). The resected tumor weighed 2.5 kg, which was equal to twice the patient's total body weight (Fig. 4). After the surgery, he was extubated in the operating room and discharged home 3 days later. Fig. 1 Anterior-posterior chest x-ray showing the anterior mediastinal mass (AMM) Fig. 2 Cross-section computed tomography (CT) showing large anterior mediastinal mass (AMM) Fig. 3 Gross anatomy of the tumor before resection Fig. 4 Gross anatomy of the removed tumor CONCLUSION: Anterior mediastinal mass patients can be challenging for the anesthesiologist. They need meticulous thorough perioperative assessment to determine the extent of compression on major intramediastinal structures and to predict the complications. Planning by multidisciplinary team and discussion with the family is important. These types of cases should be preferably operated on by an experienced team in a well-equipped operation room in tertiary care institutes.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11363491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142108214","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}
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