Medicine最新文献

{"title":"Iatrogenic propagation of left main coronary artery dissection during diagnostic coronary angiography: A case report.","authors":"Nghia Thuong Nguyen, Nga Anh Thi Nguyen, Hai Phuong Nguyen Tran, Sang Quang Ly","doi":"10.1097/MD.0000000000042040","DOIUrl":"10.1097/MD.0000000000042040","url":null,"abstract":"<p><strong>Rationale: </strong>Iatrogenic dissection of the left main coronary artery (LMCA) extending to the left anterior descending (LAD) and left circumflex arteries is a very rare but catastrophic complication during coronary intervention. Prompt diagnosis and appropriate management are essential for improving patient outcomes.</p><p><strong>Patient concerns: </strong>We report the case of a 78-year-old male with a past medical history of hypertension and previous myocardial infarction who presented to the emergency department with progressively worsening angina over 2 weeks.</p><p><strong>Diagnoses: </strong>During coronary angiography, LMCA dissection occurred due to catheter manipulation. The dissection extended to both the LAD and left circumflex arteries, causing hemodynamic instability.</p><p><strong>Interventions: </strong>Using a provisional stenting strategy, the dissection was successfully treated with percutaneous transluminal coronary angioplasty and stent placement from the LMCA to the proximal and mid-LAD. Intravascular ultrasound-guided optimization confirmed appropriate stent expansion and apposition after the proximal optimization technique.</p><p><strong>Outcomes: </strong>The patient's chest pain resolved postprocedure, and he remained hemodynamically stable during a 6-month follow-up with patent stents confirmed on check angiogram.</p><p><strong>Lessons: </strong>This case highlights the importance of preventing, recognizing, and promptly managing iatrogenic LMCA dissection to prevent fatal outcomes. Intravascular ultrasound-guided optimization plays a crucial role in ensuring optimal stent placement in these high-risk emergency interventions.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"104 14","pages":"e42040"},"PeriodicalIF":1.3,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mendelian-based urolithiasis risk concerning fish consumption and fish oil supplement.","authors":"Jiali Zhu, Jianqiang Nie","doi":"10.1097/MD.0000000000041760","DOIUrl":"10.1097/MD.0000000000041760","url":null,"abstract":"<p><p>The link between fish consumption and urolithiasis risk has been observed in previous observational studies, yet a definitive causal relationship remains uncertain. We acquired data regarding fish consumption, fish oil supplementation, and urolithiasis from publicly available large-scale genome-wide association studies (GWAS). Urolithiasis data were sourced from the FinnGen consortium, comprising 5347 cases and 213,445 controls. Information on fish consumption and fish oil supplementation was extracted from the UK Biobank, encompassing 460,443 samples for oily fish consumption, 460,880 samples for non-oily fish consumption, and 461,384 samples for fish oil intake. We conducted 2-sample Mendelian randomization (MR) analyses employing random effects inverse variance weighting, weighted median, and MR-Egger methods, respectively. Additionally, a sensitivity analysis was executed. Our study revealed a heightened risk of urolithiasis associated with non-oily fish consumption (odds ratio [OR] = 1.78, 95% confidence interval [CI]: 1.04-3.03; P = .03), whereas no causal link was found between oily fish consumption and urolithiasis (OR = 0.92, 95% CI: 0.60-1.40; P = .69). Conversely, fish oil supplementation was linked to a diminished urolithiasis risk (OR: 0.02, 95% CI: 0-0.30; P = .005). Furthermore, our sensitivity analysis yielded no evidence of heterogeneity or pleiotropy in our MR analysis. In summary, our study, utilizing genetic data, suggests that non-oily fish consumption may increase the risk of urolithiasis formation, while fish oil supplementation may mitigate this risk.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"104 14","pages":"e41760"},"PeriodicalIF":1.3,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative management of cesarean section in pregnant women complicated by central core disease: A case report and literature review.","authors":"Sipei Cheng, Rou Yu","doi":"10.1097/MD.0000000000042089","DOIUrl":"10.1097/MD.0000000000042089","url":null,"abstract":"<p><strong>Rationale: </strong>The central core disease (CCD) is a relatively uncommon yet frequently encountered condition characterized by slow or nonprogressive weakness primarily affecting the proximal limbs, predominantly observed during infancy or childhood. Pregnancy combined with CCD is an exceedingly rare occurrence, which needs a multidisciplinary approach for perinatal management. However, there remains considerable debate regarding the optimal timing and methodology for pregnancy termination as well as the utilization of anesthesia or sedatives.</p><p><strong>Patient concerns: </strong>We present a case of a patient complicated by CCD, in which we also identified a family carrying a missense mutation of RYR1 (NM_000540) c.13910 C>T (exon 95), p.T4637I (heterozygous). The patient uneventfully delivered a female neonate via cesarean section under continuous epidural anesthesia.</p><p><strong>Diagnoses: </strong>The patient, a 27-year-old pregnant woman with complications of CCD and a missense mutation of RYR1, expressed the desire to terminate her pregnancy.</p><p><strong>Intervention: </strong>Multiple protocols of anesthesia management were developed based on the patient's specific condition and surgical requirements, which included scheduled surgery under neuraxial anesthesia, as well as preparation of general anesthetic drugs, dantrolene sodium, airway devices, and specialized anesthesia machines for emergencies such as cord prolapse or fetal bradycardia.</p><p><strong>Outcomes: </strong>The cesarean section went smoothly with continuous epidural anesthesia at the L3-4 and T12-L1 intervertebral space with the catheter inserted upwards at T12-L1, and downwards at L3-4. The patient and her baby were discharged after 4 days without any complications related to anesthesia.</p><p><strong>Lessons: </strong>The identification of a CCD family in our case not only contributes to a deeper understanding of anesthesia methods in CCD pregnant women but also enriches the variation database of the RYR1 gene, which is essential for conducting long-term follow-up studies.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"104 14","pages":"e42089"},"PeriodicalIF":1.3,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acid-etched monolithic translucent zirconia laminate veneer for restoring a discolored anterior tooth: A case report.","authors":"Nguyen Viet Anh, Nguyen Thi Trang, Nguyen Thi Loan","doi":"10.1097/MD.0000000000042093","DOIUrl":"10.1097/MD.0000000000042093","url":null,"abstract":"<p><strong>Rationale: </strong>Laminate veneers have become the treatment of choice for restoring tooth esthetics and function conservatively. However, due to their thin nature, the esthetic rehabilitation of discolored teeth following pulp necrosis can be challenging. Translucent zirconia offers a favorable balance between masking ability and optical translucency while maintaining high durability. To enhance the bonding strength between zirconia and adhesive agents, the treatment of the zirconia surface with strong acids has been extensively investigated in laboratory settings. However, the clinical application of this technique has not yet been published.</p><p><strong>Patient concerns: </strong>A discolored anterior incisor that had undergone endodontic treatment.</p><p><strong>Diagnosis: </strong>Discolored anterior incisor following pulp necrosis.</p><p><strong>Interventions: </strong>Restoration of the discolored anterior incisor with an acid-etched translucent zirconia veneer.</p><p><strong>Outcomes: </strong>The monolithic translucent zirconia veneer successfully restored the discolored anterior tooth. A 2-year follow-up demonstrated that the acid-etched surface ensured the long-term survival of the restoration.</p><p><strong>Lessons: </strong>Enhancing bond strength through micromechanical retention created by strong acid etching has proven effective in ensuring a secure bond between the veneer and adhesive cement, contributing to the long-term success of translucent zirconia veneers.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"104 14","pages":"e42093"},"PeriodicalIF":1.3,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Takayasu arteritis: Diagnosis of a rare clinical entity: A case report.","authors":"Selemon Hileeyesus, Abilo Tadesse, Addissie Fekrie, Berhanu Shetie, Nebiyu Bekele, Guadie Beyazn, Temesgen Tadesse, Weynishet Kebede","doi":"10.1097/MD.0000000000042096","DOIUrl":"10.1097/MD.0000000000042096","url":null,"abstract":"<p><strong>Rationale: </strong>Takayasu arteritis is a rare, autoimmune, granulomatous inflammatory vascular disease of the aorta and its main branches. Delayed diagnosis was attributed to vague early clinical features, lack of specific diagnostic marker, rarity of disease, and lack of awareness by physicians of the disease condition.</p><p><strong>Patient concerns: </strong>A 28-year-old woman presented with sudden onset right sided body weakness associated with transient loss of consciousness, left-sided facial deviation, and slurring of speech. She had history of limb claudication. She was told to have rheumatic regurgitant aortic valve disease 5 years back. Physical examination revealed elevated blood pressure, reduced left radial artery pulse, faintly palpable right dorsalis pedis and posterior tibial arteries pulse, blood pressure asymmetry in arms, early diastolic murmur at erb's area, and right-sided hemiparesis with ipsilateral supra-nuclear facial palsy. Laboratory markers revealed high erythrocyte sedimentation rate. Two dimensional-transthoracic echocardiography and neck Doppler ultrasound revealed aortic regurgitation, and stenosed and thrombosed left common carotid artery, respectively. Post-contrast computed tomography showed thickened, occluded and thrombosed left common carotid artery, stenosed right common carotid artery, and thickened, stenosed and calcified descending thoracic aorta and abdominal aorta. Brain magnetic resonance imaging showed left basal ganglia infarction. Diagnosis of thromboembolic stroke secondary to Takayasu arteritis was made.</p><p><strong>Diagnoses: </strong>Diagnosis of Takayasu arteritis was settled using modified Ishikawa Diagnostic Criteria and American College of Rheumatology Classification Criteria.</p><p><strong>Interventions: </strong>She was started on glucocorticoids 50 mg po daily for 3 months and tapered by 5 mg po weekly over 3 months, azathioprine 100 mg po daily, aspirin 81 mg po daily, atorvastatin 40 mg po daily, amlodipine 10 mg po daily, and cotrimoxazole 960 mg po trice weekly. Physical therapy was continued.</p><p><strong>Outcomes: </strong>The patient showed marked symptomatic improvement after 3 months of treatment. She was referred to higher health institution for evaluation of vascular intervention.</p><p><strong>Lessons: </strong>High index of clinical suspicion is required for early diagnosis of rare diseases to prevent adverse outcomes.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"104 14","pages":"e42096"},"PeriodicalIF":1.3,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A rare case of Castleman disease presented with diffuse ground glass nodules in both lungs: Case report.","authors":"Xiaotong Guo, Caixia Zhu, Fen Zhang, Juan Chen, Kedong Zhang","doi":"10.1097/MD.0000000000040681","DOIUrl":"10.1097/MD.0000000000040681","url":null,"abstract":"<p><strong>Rationale: </strong>Castleman disease (CD) is a rare chronic lymphoproliferative disorder with unclear etiology and pathogenesis. It is divided into unicentric CD, which involved a single enlarged lymph node or region of lymph nodes, and multicentric CD, which involved multiple lymph node stations. Chest computed tomography (CT) scan is of great value in the diagnosis and differential diagnosis of the disease. CT scan mainly present large soft tissue mass in lungs and multiple mediastinal lymph node enlargement. Multiple ground glass nodules in both lungs are rare in CD patient.</p><p><strong>Patient concerns: </strong>A 48-year-old woman presented with chest tightness, shortness of breath, cough, and sputum. The chest CT scan showed multiple ground glass nodules in both lungs.</p><p><strong>Diagnoses: </strong>Multicentric Castleman disease was diagnosed through biopsies of the mediastinal 4R group, 7th group lymph nodes and the right inguinal lymph nodes.</p><p><strong>Interventions: </strong>Initial treatment with prednisone was administered, but due to the absence of significant radiological improvement on chest CT after 1 month, a systemic chemotherapy was initiated.</p><p><strong>Outcomes: </strong>After 6 cycles of systemic chemotherapy with cyclophosphamide, vincristine, and prednisone, the patient chest CT and clinical symptoms improved. Currently, the patient is still receiving low-dose prednisone and cyclophosphamide orally for long-term maintenance treatment.</p><p><strong>Lessons: </strong>CD that presents multiple ground glass nodules in both lungs is rare. It is easily confused with other diseases, identified diagnosis is depend on pathological examination. The accuracy of clinical subtype and histopathogenic type are important for treatment and outcome.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"104 14","pages":"e40681"},"PeriodicalIF":1.3,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"X-linked dominant chondrodysplasia punctata due to novel mutation in EBP gene: A case report.","authors":"Xiaoping Shi, Yanxing Lv, Yongjiang Jiang, Pianpian Pan, Yueju Cai","doi":"10.1097/MD.0000000000042086","DOIUrl":"10.1097/MD.0000000000042086","url":null,"abstract":"<p><strong>Rationale: </strong>Chondrodysplasia punctata is a rare hereditary disorder that affects bone development. The disease is primarily caused by mutations in the emopamil binding protein (EBP) gene, leading to X-linked dominant metabolic enzyme abnormalities. This study aims to report a novel EBP mutation in X-linked dominant chondrodysplasia punctata type 2 (CDPX2), expanding the genetic spectrum of the disease and highlighting the critical role of combined clinical and genetic diagnosis in guiding prenatal counseling and postnatal management.</p><p><strong>Patient concerns: </strong>Multiple prenatal ultrasounds revealed misalignment of the spinal column and short femur. Postnatally, the infant exhibited craniofacial defects, short limbs, congenital ichthyosis, and alopecia.</p><p><strong>Diagnoses: </strong>Radiographic examination revealed multiple punctate calcifications bilaterally in the pyramids, ischium, pubis, and calcaneus. Whole-exome sequencing of the family revealed a heterozygous mutation, c.204G>A (p.Trp68Ter), in the EBP gene in the affected infant, which is a new pathogenic mutation.</p><p><strong>Interventions: </strong>The infant received continuous positive airway pressure support for respiratory distress, which was discontinued after 7 days due to clinical improvement.</p><p><strong>Outcomes: </strong>At discharge, respiratory status was stable. Follow-up at 3 months showed significant growth delay: weight 4.6 kg (<3rd percentile) and length 54.5 cm (9th percentile).</p><p><strong>Lessons: </strong>This case underscores that meticulous physical examination combined with genetic analysis is critical for diagnosing CDPX2. Early identification of EBP mutations enables accurate prenatal counseling and risk assessment for future pregnancies.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"104 14","pages":"e42086"},"PeriodicalIF":1.3,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Misdiagnosis of spinocerebellar ataxia type 3 as persistent postural-perceptual dizziness: A case report.","authors":"Yisi Zhang, Xiaoguang Chen, Songbin Pan","doi":"10.1097/MD.0000000000041850","DOIUrl":"10.1097/MD.0000000000041850","url":null,"abstract":"<p><strong>Rationale: </strong>Spinocerebellar ataxia type 3 (SCA3) is the most common autosomal dominant inherited spinocerebellar disorder. The disease can easily be misdiagnosed because the symptoms of SCA3 are diverse and not obvious in the early stages.</p><p><strong>Patient concerns: </strong>A 55-year-old woman had experienced dizziness and an unstable gait since 2017. She was misdiagnosed with persistent postural-perceptual dizziness at another hospital because of normal brain magnetic resonance imaging and emotional abnormalities. In our hospital, there were no abnormalities in routine laboratory tests and brain magnetic resonance imaging, but various examinations showed peripheral and central vestibular dysfunction. She had a typical family history of dizziness and an unstable gait.</p><p><strong>Diagnoses: </strong>The patient was diagnosed with SCA3 by genetic testing.</p><p><strong>Interventions: </strong>The patient underwent a regimen of betahistine therapy combined with vestibular rehabilitation training.</p><p><strong>Outcomes: </strong>The patient exhibited clinical improvement and was discharged after 2 weeks.</p><p><strong>Lessons: </strong>Detailed neuro-otological and neuro-ophthalmological evaluations are helpful for the diagnosis of patients with suspected cerebellar ataxia.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"104 14","pages":"e41850"},"PeriodicalIF":1.3,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Portal vein thrombosis after laparoscopic appendectomy for acute appendicitis: A case report.","authors":"İsmail Tirnova, Maya Gasimova, Behlül Igus, Alpay Yeşilaltay, Derya Kaşkari, Saime Ramadan, Ahmet Serdar Karaca","doi":"10.1097/MD.0000000000042068","DOIUrl":"10.1097/MD.0000000000042068","url":null,"abstract":"<p><strong>Rationale: </strong>Portal vein thrombosis (PVT) has a complex pathophysiologic pathway and may cause life-threatening clinical complications. Malignancies, hepatic cirrhosis, auto-immune disorders, previous splenectomy, and other causes of thrombocytosis (over 1,000,000/mL) are the most common causes of PVT. On the other hand, hematologic disorders and infectious processes in the abdominal cavity may cause PVT uncommonly. We present a case of PVT following acute appendicitis and laparoscopic appendectomy in this report.</p><p><strong>Patient concerns: </strong>A 32-year-old male was admitted to our emergency room due to lower quadrant pain and vomiting. Acute appendicitis was diagnosed and after a routine laparoscopic appendectomy, the patient was discharged. The patient was admitted to the emergency room with nonspecific epigastric pain on postoperative day 30.</p><p><strong>Diagnoses: </strong>Portal vein thrombosis was diagnosed by computed tomography. Hematologic investigations revealed a homozygous mutation of the methylene tetrahydrofolate 1298 gene.</p><p><strong>Interventions: </strong>Immediate low-molecular-weight heparin administration was initiated. The gastrointestinal system council and interventional radiology team opted for a medical approach and converted the low-molecular-weight heparin to apixaban.</p><p><strong>Outcomes: </strong>The computed tomography revealed the complete resolution of the thrombus on postoperative day 100.</p><p><strong>Lessons: </strong>Laparoscopic appendectomy can be complicated by portomesenteric axis thrombosis. When unusual findings are encountered during the postoperative follow-up period, rapid and detailed examinations should be performed.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"104 14","pages":"e42068"},"PeriodicalIF":1.3,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remitting seronegative symmetrical synovitis with pitting edema syndrome with two different underlying malignancies: A case report.","authors":"Samar Alharbi","doi":"10.1097/MD.0000000000042091","DOIUrl":"10.1097/MD.0000000000042091","url":null,"abstract":"<p><strong>Rationale: </strong>Remitting seronegative symmetric synovitis with pitting edema is a rare, benign disorder symmetrically affecting the peripheral joints. It begins with acute-onset pitting edema on the dorsum of the hands and feet, and primarily affects elderly men and has a favorable response to low-dose steroids. It may also be a paraneoplastic symptom of an underlying hidden cancer; hence, thorough clinical evaluation is required.</p><p><strong>Patient concerns: </strong>A 58-year-old woman who presented with acute-onset polyarthritis and pitting edema affecting both hands and feet. Based on clinical and laboratory findings, remitting seronegative symmetric synovitis with pitting edema was diagnosed. A thorough clinical investigation led to a diagnosis of papillary thyroid carcinoma and adenocarcinoma of unknown origin.</p><p><strong>Diagnoses: </strong>Based on clinical and laboratory findings, remitting seronegative symmetric synovitis with pitting edema was diagnosed. A thorough clinical investigation led to a diagnosis of papillary thyroid carcinoma and adenocarcinoma of unknown origin.</p><p><strong>Interventions: </strong>The patient initially received prednisolone; when she faced difficulty in maintaining remission at a dose of <12.5 mg, hydroxychloroquine was added. Subsequently, the corticosteroid dose was tapered successfully without further arthritis flares. She also received palliative chemotherapy for an unknown primary.</p><p><strong>Outcomes: </strong>Five rounds of chemotherapy successfully reduced the size of bilateral inguinal lymphadenopathy and garnered resolution of the small bilateral external iliac lymph nodes. Both corticosteroid and hydroxychloroquine discontinued. The patient remained stable and cancer-free at the 9-month follow-up.</p><p><strong>Lessons: </strong>Physicians should be knowledgeable about the distinct signs and symptoms of remitting seronegative symmetric synovitis with pitting edema and investigate patients suspected of having the syndrome for hidden cancers.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"104 14","pages":"e42091"},"PeriodicalIF":1.3,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}