Journal of Medical Case Reports最新文献

{"title":"Clinically presumed primary malignant melanoma of the parotid gland with extensive cervical lymph node metastasis: a case report.","authors":"Xinran Lin, Yafang Zhou, Minge Li, Yujie Ma, Xuewen Yang","doi":"10.1186/s13256-026-06399-9","DOIUrl":"10.1186/s13256-026-06399-9","url":null,"abstract":"<p><strong>Background: </strong>Primary malignant melanoma of the parotid gland (PMMPG) is an exceedingly rare neoplasm, accounting for < 0.7% of all parotid malignancies. Differentiating it from metastatic melanoma to the parotid is clinically critical but diagnostically challenging.</p><p><strong>Case presentation: </strong>A 62-year-old Chinese man presented with a 6-month history of a painless, enlarging left parotid mass. Extensive physical examination and imaging (CT and MRI) of the head, neck, and chest revealed no extraparotid primary lesion. Core needle biopsy and immunohistochemistry (S100+, HMB45+, MelanA+, Ki-67 ~ 50%) confirmed malignant melanoma. He underwent total parotidectomy with comprehensive neck dissection (levels I-V). The marginal mandibular branch was sacrificed because it was encased by tumor; other branches were preserved. Pathology confirmed a 32 × 25 × 23 mm melanoma with invasion into adjacent salivary tissue and metastasis in 14 of 48 cervical nodes; intraparotid nodes were negative. Postoperatively, the patient developed incomplete eyelid closure and lower lip weakness (planned nerve sacrifice plus traction neuropraxia). Adjuvant radiotherapy was advised, but the patient was lost to follow-up.</p><p><strong>Conclusions: </strong>Clinically presumed primary parotid melanoma should be considered in a parotid mass without an identifiable primary site. Complete surgical resection with appropriate neck dissection remains the mainstay. A high Ki-67 index and extensive nodal metastasis predict poor prognosis, underscoring the need for adjuvant therapy and close surveillance.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13670479/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of severe tardive dyskinesia induced by arpiprazole in a schizophrenic patient: a case report.","authors":"Farzad Fayedeh, Mahya Mojahedi, Danial Gharaie Amirabadi","doi":"10.1186/s13256-026-06384-2","DOIUrl":"https://doi.org/10.1186/s13256-026-06384-2","url":null,"abstract":"<p><strong>Introduction: </strong>Tardive dyskinesia (TD) is a disabling movement disorder induced by prolonged administration of dopamine receptor-blocking agents, primarily high-potency first-generation antipsychotics.</p><p><strong>Case presentation: </strong>We report the case of a 32-year-old Iranian male patient with schizophrenia who developed TD following treatment with the second-generation antipsychotic aripiprazole. The patient experienced involuntary facial and jaw movements that started about four weeks after he abruptly discontinued the drug on his own. While there was a generally reduced risk of extrapyramidal symptoms with second-generation antipsychotics, the patient's symptoms were clinically significant and impacted his quality of life. Initial management efforts were not beneficial; however, after adjustment of the previous antipsychotic therapy and introduction of tetrabenazine, a VMAT2 inhibitor approved for TD, the patient showed marked symptomatic improvement.</p><p><strong>Conclusion: </strong>This case emphasizes clinical awareness of the possibility of risk for tardive dyskinesia despite atypical antipsychotics such as aripiprazole and the therapeutic value of tetrabenazine as an important treatment option for this intractable condition.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148536022","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":"Concurrent psoriatic arthritis and autoimmune hepatitis in a patient with psoriasis: a case report.","authors":"Yazan AlHabil, Nael Arr, Mustafa A Shahrori, Gabriel S Breuer","doi":"10.1186/s13256-026-06388-y","DOIUrl":"10.1186/s13256-026-06388-y","url":null,"abstract":"<p><strong>Background: </strong>Psoriasis is a chronic, autoimmune skin disorder that can be associated with systemic comorbidities, including psoriatic arthritis (PsA). The coexistence of psoriasis, PsA, and autoimmune hepatitis (AIH) is uncommon and may present diagnostic and therapeutic challenges. This case report highlights a patient with psoriasis who developed both PsA and AIH without prior immunosuppressive therapy.</p><p><strong>Case presentation: </strong>A 57-year-old Palestinian woman with longstanding plaque psoriasis presented with worsening skin lesions, progressive arthralgia involving both knees and ankles, chronic inflammatory low back pain, and persistently abnormal liver biochemistry. She had been diagnosed with psoriasis at age 49, which had been resistant to various treatments, including topical corticosteroids and phototherapy. One year before presentation, the patient developed progressive arthralgia, particularly in the knees, ankles, and lower back. Physical examination revealed swollen joints and limited range of motion. Laboratory tests indicated elevated liver enzymes, and autoimmune panel results were positive for antinuclear antibodies (ANA) and anti-smooth muscle antibodies (ASMA), raising suspicion for autoimmune hepatitis. A liver biopsy confirmed type 1 AIH, characterized by lymphocytic infiltration and plasma cell predominance. Cyclosporine 100 mg daily was initiated, atorvastatin was discontinued, and the patient was monitored clinically and biochemically. After 6 weeks, psoriasis severity improved markedly, joint symptoms decreased, and liver enzyme levels normalized. No treatment-related adverse effects were documented during the reported follow-up period.</p><p><strong>Conclusions: </strong>This case highlights the importance of considering autoimmune hepatitis in patients with psoriatic disease who develop persistent liver enzyme abnormalities, even in the absence of prior systemic immunosuppressive therapy. A multidisciplinary approach is important in such complex presentations, and cyclosporine may be a useful therapeutic option in selected patients requiring concomitant control of dermatologic, rheumatologic, and hepatic disease.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13670740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535957","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":"Recurrent paratesticular aggressive angiomyxoma in an elderly patient: a rare case report.","authors":"Ahmed Chaabouni, Wafa Elleuch, Mahmoud Ghozzia, Idriss Mhamdi Aloui, Nouri Rebai, Mourad Hadj Slimen","doi":"10.1186/s13256-026-06383-3","DOIUrl":"10.1186/s13256-026-06383-3","url":null,"abstract":"<p><p>Aggressive angiomyxoma is a rare benign mesenchymal tumor with local infiltrative potential and a high risk of local recurrence. Its occurrence in the paratesticular region is exceptional. We report the case of an 86-year-old male patient, with no significant past medical history, managed in our Urology Department for a recurrent paratesticular aggressive angiomyxoma. The patient underwent surgery three times for successive local recurrences, which were histologically confirmed. The current evolution is marked by a small, asymptomatic local recurrence under surveillance. This case illustrates the diagnostic difficulty, the complex surgical management, and the importance of prolonged follow-up for this rare entity.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13670507/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148536081","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":"Cabozantinib-related pneumothorax in responsive patients with renal cell carcinoma: a case report.","authors":"Keiko Kodaka, Toru Inakawa, Hidekazu Kuramochi","doi":"10.1186/s13256-026-06030-x","DOIUrl":"10.1186/s13256-026-06030-x","url":null,"abstract":"<p><strong>Background: </strong>Cabozantinib is a multi-kinase inhibitor that has been shown to be effective in the treatment of unresectable or metastatic renal cell carcinoma and unresectable hepatocellular carcinoma that worsened after anticancer drug therapy. Tyrosine kinase inhibitors (TKIs) are known to suppress tumor angiogenesis by inhibiting vascular endothelial growth factor (VEGF). Furthermore, cabozantinib possesses inhibitory effects against AXL and mesenchymal-epithelial transition (MET) not seen with other TKIs. Consequently, cabozantinib may exhibit stronger anti-angiogenic activity than other vascular endothelial growth factor receptors (VEGFR) inhibitors. We report our experience with two cases of pneumothorax presumed to be related to cabozantinib in patients with renal cell carcinoma presenting with lung metastases.</p><p><strong>Case presentation: </strong>A 59-year-old-asian-woman with renal cell carcinoma developed pneumothorax 4 months after starting cabozantinib. After drainage and subsequent bronchial embolization, cabozantinib was resumed, but the patient developed a contralateral pneumothorax. There was inadequate improvement despite multiple adhesive therapies; therefore, repeat bronchial embolization was performed. A 42-year-old-Asian-man with renal cell carcinoma developed a refractory pneumothorax 10 months after starting cabozantinib, which required drainage for 3 weeks.</p><p><strong>Conclusion: </strong>Although drug treatment of kidney cancer with cabozantinib has made great progress in recent years, more careful symptomatic monitoring is needed for adverse events associated with this drug. Our results suggest the need to pay attention to the occurrence of pneumothorax, although it is rare.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":"20 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13386895/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148536045","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":"Oncocytic lipoadenoma of the parotid presenting as an unusual neck mass: a case report.","authors":"Somayeh Sheidaei, Mahdi Naeimaei Aali, Saman Rezaei","doi":"10.1186/s13256-026-06377-1","DOIUrl":"10.1186/s13256-026-06377-1","url":null,"abstract":"<p><strong>Background: </strong>Oncocytic lipoadenoma is an extremely rare benign tumor of the salivary glands, with fewer than 50 cases reported in the literature. Most cases occur in the parotid gland, with atypical locations presenting diagnostic challenges.</p><p><strong>Case presentation: </strong>We report a case of a 53-year-old Iranian man presenting with a large parapharyngeal mass originating from the deep lobe of the parotid gland. The patient had a 7-year history of a slowly enlarging, painless swelling, with recent onset of dysphagia, dyspnea, and choking sensation. MRI revealed a giant 10 × 7.4 × 3.5 cm mass in the left deep parotid extending to the parapharyngeal space, causing severe airway compression.</p><p><strong>Conclusion: </strong>Our case highlights the importance of considering oncocytic lipoadenoma in the differential diagnosis of parapharyngeal masses and emphasizes the need for thorough histological examination. It contributes to the limited literature on this rare tumor and illustrates the potential for atypical presentations and growth patterns.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520465","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 presentation of spinal epidural abscess in a seven-year-old VACTERL patient: a case report.","authors":"Sarah Kebbeh, Sana Masoud, Mary Alakkash, Manar Abdullah","doi":"10.1186/s13256-026-06356-6","DOIUrl":"10.1186/s13256-026-06356-6","url":null,"abstract":"<p><strong>Background: </strong>Spinal epidural abscess is a rare but potentially life-threatening infection of the central nervous system. VACTERL association is a rare congenital condition characterized by vertebral, anal, cardiac, tracheoesophageal, renal, and limb anomalies.</p><p><strong>Case presentation: </strong>We report a 7-year-old Arab male with VACTERL association presenting with back pain, fever, and gait difficulty. Laboratory studies showed leukocytosis (27 × 10⁹/L) and anemia (Hb 9 g/dL). MRI revealed multiloculated cystic lesions with thick walls and mixed fluid-gas content extending from T4 to L5, forming an extensive epidural abscess with paraspinal extension and vertebral erosions. The patient was treated with intravenous vancomycin, metronidazole, and imipenem, followed by surgical drainage and local vancomycin irrigation. Clinical condition improved markedly, and he was discharged after two months in good health.</p><p><strong>Conclusion: </strong>This case highlights the diagnostic challenges of SEA in children with complex congenital anomalies and emphasizes the importance of early recognition and multidisciplinary management.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520446","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":"Multiple ventral hernias in a 30-year-old female with Down syndrome: a case report and review of the literature.","authors":"Seyed Abbas Fatemiyoun, Saina Sadeghipour, Farzad Rafiei, Shahab Sheikhalishahi","doi":"10.1186/s13256-026-06397-x","DOIUrl":"10.1186/s13256-026-06397-x","url":null,"abstract":"<p><strong>Background: </strong>Ventral hernias are common abdominal wall defects, usually occurring as isolated entities related to prior surgery, trauma, or increased intra-abdominal pressure. The occurrence of multiple synchronous ventral hernias in a single patient is rare, and reports in individuals with Down syndrome are particularly scarce. Down syndrome is associated with connective tissue abnormalities, hypotonia, and ligamentous laxity, which may predispose patients to hernia formation. However, multiple simultaneous ventral hernias in this population have not been widely described. This case adds to the limited literature by presenting an unusual constellation of three synchronous ventral hernias in an adult female with Down syndrome, highlighting the diagnostic and therapeutic challenges in such patients.</p><p><strong>Case presentation: </strong>A 30-year-old Baluch female with Down syndrome presented with a 2-month history of abdominal pain, progressive swelling, postprandial vomiting, anorexia, constipation, and weight loss. She had no history of prior abdominal surgery. Clinical examination revealed epigastric tenderness and protrusions along the linea alba. Abdominal ultrasonography confirmed two distinct fascial defects containing omentum, consistent with ventral hernias. Preoperative evaluation was significant for hypothyroidism and long QT syndrome but otherwise unremarkable. Following optimization, she underwent open surgical repair via a midline incision. Intraoperative exploration revealed three discrete fascial defects, ranging from 0.5 to 2 cm in diameter, each with hernia sacs. The sacs were excised, the defects connected, and closure was performed with non-absorbable sutures reinforced by an onlay polypropylene mesh. The postoperative course was uneventful. She resumed oral intake on the first postoperative day, was discharged on the second day, and showed no evidence of recurrence or complications at 30-day follow-up. At 1 month, she had returned to normal daily activities with satisfactory wound healing.</p><p><strong>Conclusions: </strong>This case adds to the limited literature on multiple ventral/epigastric hernias in individuals with Down syndrome. It highlights the need to consider multiple fascial defects when evaluating abdominal wall symptoms in patients with communication limitations, the complementary value of physical examination, ultrasonography, and intraoperative assessment, and the importance of tailoring the surgical approach to patient-specific factors and local resource availability.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663290/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520459","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":"Lazarus phenomenon in a brain-dead patient: a case report.","authors":"Dina Sadeghi, Seyedeh Rojina Mortazavi, Tara Khoeini","doi":"10.1186/s13256-026-06331-1","DOIUrl":"10.1186/s13256-026-06331-1","url":null,"abstract":"<p><strong>Background: </strong>Brain death is defined as the irreversible cessation of all cerebral and brainstem functions, confirmed through clinical examination and, when necessary, ancillary testing. While the diagnostic criteria are well established, certain spinal reflexes, such as the Lazarus phenomenon, can complicate clinical examinations and lead to diagnostic uncertainty. Most reported cases describe predominant upper-limb movements; however, atypical variants involving truncal or lower-limb responses have rarely been reported.</p><p><strong>Case presentation: </strong>We report the case of a 33-year-old Iranian man with cerebellar hemangioblastoma who developed transtentorial herniation and fulfilled all clinical criteria for brain death. Brain death determination was performed independently by two neurologists 6 h apart after exclusion of sedative exposure, metabolic disturbances, neuromuscular blockade, and hypothermia. Apnea testing demonstrated an increase in PaCO₂ from 39 to 64 mmHg without spontaneous respiratory effort. During examination, reproducible reflex movements were triggered by passive neck flexion and painful stimulation, consisting predominantly of bilateral hip and knee flexion with lower-limb adduction, accompanied by limited upper-extremity flexion. These findings were interpreted as spinal reflex activity consistent with an atypical lower-limb-predominant Lazarus phenomenon.</p><p><strong>Conclusion: </strong>This variation reinforces the importance of recognizing spinal reflexes in brain-dead individuals and underscores the need for awareness of such findings to avoid misinterpretation. Clinicians must distinguish these movements from indicators of residual brain function to ensure accurate and timely determination of brain death.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520474","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":"Toripalimab-induced isolated ACTH deficiency associated with gastroparesis: a case report.","authors":"Chicheng Lu, Weijie Li, Qiyong Li","doi":"10.1186/s13256-026-06375-3","DOIUrl":"10.1186/s13256-026-06375-3","url":null,"abstract":"<p><p>Immune checkpoint inhibitors can cause isolated ACTH deficiency, a rare condition often misdiagnosed due to nonspecific symptoms. We report a cholangiocarcinoma patient on toripalimab and lenvatinib who experienced recurrent gastrointestinal symptom and precordial discomfort for 2 years, mistakenly attributed to drug toxicity or functional disorders. Following surgery, the patient developed refractory delayed gastric emptying, during which IAD was identified through negative imaging examinations, low ACTH and cortisol levels. Glucocorticoid replacement rapidly resolved symptoms. This case highlights that persistent unexplained somatic complaints in ICI-treated patients warrant endocrine evaluation to avoid diagnostic anchoring and recognize atypical presentations of adrenal insufficiency.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663009/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497662","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}