AME Case Reports最新文献

{"title":"Fulminant hepatitis A in a robust adult: a case report of acute liver failure requiring urgent living donor liver transplantation.","authors":"Hussein Zaghloul Kandeel, Mohamad Abdelmonem Omar, Hesham Fawzy Kewan, Mahmod Elshahat Makhlof, Anand Bhaskarrao Kotgire, Mohamed Aly Elbouhy, Rami Khaled Abou El Foul, Syed Urooj Ahmed","doi":"10.21037/acr-2026-0019","DOIUrl":"10.21037/acr-2026-0019","url":null,"abstract":"<p><strong>Background: </strong>Hepatitis A virus (HAV) infection is generally a self‑limited disease; however, in adults it can rarely progress to acute liver failure (ALF), a rapidly evolving and potentially fatal condition. Although HAV‑related ALF occurs in <1% of the general adult population, the incidence may rise to about 10% in hospitalized or severe cases, with reported outcomes of 55% recovered, 31% transplanted, and 14% died. Early recognition, rapid prognostic assessment, and timely referral to a transplant center are essential because deterioration can occur abruptly and unpredictably.</p><p><strong>Case description: </strong>A previously healthy 34‑year‑old man presented with fever, severe abdominal pain, vomiting, diarrhea, and dizziness shortly after returning from travel. He reported frequent consumption of street‑vended food, a potential risk factor for HAV exposure. On examination, he was jaundiced and acutely ill, and laboratory evaluation revealed profound hepatocellular injury [aspartate aminotransferase (AST) 4,520 U/L; alanine aminotransferase (ALT) 3,880 U/L], marked hyperbilirubinemia, lactic acidosis, acute kidney injury, thrombocytopenia, and elevated ammonia. Serology confirmed acute HAV infection. Despite aggressive intensive care unit (ICU) management, he deteriorated rapidly, developing septic shock and multiple organ dysfunction, including worsening encephalopathy and coagulopathy. Based on poor prognostic indicators, he was urgently transferred to a transplant center and underwent successful living donor liver transplantation (LDLT) within 96 hours of presentation. His postoperative recovery was remarkable, with rapid normalization of graft function and discharge just 7 days after surgery.</p><p><strong>Conclusions: </strong>This case highlights that HAV infection in adults, though uncommon, can progress swiftly to fulminant liver failure requiring urgent transplantation. Prompt diagnosis, early transfer to a specialized transplant center, and timely LDLT can lead to excellent outcomes, as demonstrated by this patient's rapid recovery.</p>","PeriodicalId":29752,"journal":{"name":"AME Case Reports","volume":"10 ","pages":"110"},"PeriodicalIF":0.6,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13264776/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148259844","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":"Eruptive zoophilic dermatophytosis and the expanding role of molecular diagnostics.","authors":"Ankan Gupta, Anju George","doi":"10.21037/acr-2026-0065","DOIUrl":"10.21037/acr-2026-0065","url":null,"abstract":"","PeriodicalId":29752,"journal":{"name":"AME Case Reports","volume":"10 ","pages":"81"},"PeriodicalIF":0.6,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13264760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148259826","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":"Multiloculated Klebsiella liver abscess successfully treated with early laparoscopic drainage after failed percutaneous drainage: a case report.","authors":"Shun Nakahara, Yusuke Hirao, William Kawahara, Adivitch Sripusanapan, Kuo-Chiang Lian","doi":"10.21037/acr-2026-0077","DOIUrl":"10.21037/acr-2026-0077","url":null,"abstract":"<p><strong>Background: </strong>Klebsiella pneumoniae liver abscess is characterized by an aggressive clinical course with a high risk of metastatic complications. Early initiation of appropriate antibiotics and timely drainage are essential for successful management. However, large multiloculated Klebsiella pneumoniae liver abscesses are associated with a high risk of percutaneous drainage failure.</p><p><strong>Case description: </strong>A 70-year-old man with a history of prediabetes and chronic kidney disease presented with a 2-week history of progressively worsening right upper quadrant abdominal pain. On presentation, he was tachycardic at 107 beats per minute. Physical examination revealed marked right upper quadrant tenderness and hepatic percussion tenderness. Laboratory testing demonstrated neutrophil-predominant leukocytosis and elevated alkaline phosphatase and gamma-glutamyl transferase levels. Contrast-enhanced abdominal computed tomography (CT) revealed an 11-cm multiloculated mass in the right hepatic lobe consistent with a liver abscess. Intravenous ceftriaxone and metronidazole were initiated, and percutaneous drainage was performed. Culture of the aspirated fluid grew Klebsiella pneumoniae. Despite percutaneous drainage, the patient continued to experience severe pain and persistent leukocytosis, and follow-up CT demonstrated a persistent hepatic abscess. He subsequently underwent laparoscopic partial liver resection with fenestration of the abscess cavity. Postoperative imaging showed marked improvement, with resolution of symptoms and leukocytosis.</p><p><strong>Conclusions: </strong>This case underscores the importance of carefully evaluating morphology and causative organism of abscess when selecting a drainage strategy for pyogenic liver abscess. In patients with multiloculated Klebsiella pneumoniae liver abscess, clinicians should maintain a low threshold for considering early surgical drainage.</p>","PeriodicalId":29752,"journal":{"name":"AME Case Reports","volume":"10 ","pages":"118"},"PeriodicalIF":0.6,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13264780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148259810","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":"Erratum: Spontaneous pneumothorax in a patient with tuberculosis-induced destroyed lung successfully treated with autologous blood and minocycline pleurodesis: a case report.","authors":"","doi":"10.21037/acr-20262-01","DOIUrl":"10.21037/acr-20262-01","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.21037/acr-2025-151.].</p>","PeriodicalId":29752,"journal":{"name":"AME Case Reports","volume":"10 ","pages":"123"},"PeriodicalIF":0.6,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13264770/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148259814","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":"Adult-onset nephroblastoma in a male patient: a case report.","authors":"Ashorne K Mahenthiran, Zain A Abedali, Kevin R Rice","doi":"10.21037/acr-2025-349","DOIUrl":"10.21037/acr-2025-349","url":null,"abstract":"<p><strong>Background: </strong>Nephroblastoma, also known as Wilms tumor, is one of the most common malignancies diagnosed in children. Contrarily, the incidence in adults is only 0.2 cases per million people annually. As such, there are no standardized guidelines for clinical management in adults.</p><p><strong>Case description: </strong>This case describes an adult male in his twenties who presented to the emergency department with 1 week of intermittent hematuria and right flank pain. Imaging unexpectedly revealed a large, radiographically abnormal-appearing mass in the upper pole of the right kidney. The decision was made to biopsy the mass to assist with decisions regarding intervention in case neoadjuvant chemotherapy was indicated. This was later pathologically found to be consistent with nephroblastoma (Wilms tumor). The patient underwent adrenal-sparing right radical nephrectomy with regional lymph node dissection followed by adjuvant chemotherapy with vincristine and dactinomycin. Prior to this, he underwent testicular sperm extraction (TESE) due to azoospermia and fertility concerns. He tolerated this well and has had no evidence of disease on surveillance imaging 9 months postoperatively.</p><p><strong>Conclusions: </strong>This case report provides unique insight into specific diagnostic and intraoperative surgical considerations for abnormal adult presentation of nephroblastoma. Specifically, we discuss the role of preoperative biopsy for consideration of neoadjuvant therapy and the role of adrenal-sparing and lymph node sampling. We highlight this in the context of the current literature available regarding the management of adult nephroblastoma.</p>","PeriodicalId":29752,"journal":{"name":"AME Case Reports","volume":"10 ","pages":"97"},"PeriodicalIF":0.6,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13264755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148259275","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":"Multi-agent pleurodesis: a new horizon in management.","authors":"Nitin Nadella, Shamus R Carr","doi":"10.21037/acr-2026-0072","DOIUrl":"10.21037/acr-2026-0072","url":null,"abstract":"","PeriodicalId":29752,"journal":{"name":"AME Case Reports","volume":"10 ","pages":"82"},"PeriodicalIF":0.6,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13264713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148259803","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":"Clinical outcomes following Impella escalation in cardiogenic shock: a single-centre case series highlighting the gap between haemodynamic improvement and survival.","authors":"Atsutaka Aratame, Daisuke Kaku, Toshio Baba","doi":"10.21037/acr-2026-0107","DOIUrl":"10.21037/acr-2026-0107","url":null,"abstract":"<p><strong>Background: </strong>The use of temporary mechanical circulatory support has increased in patients with cardiogenic shock, particularly those with acute myocardial infarction (AMI). Impella provides effective left ventricular unloading and haemodynamic stabilisation. Escalation of such systems to higher-flow devices (e.g., Impella 5.0/5.5) has been proposed for patients with inadequate responses to Impella CP; however, the clinical impact and optimal timing of this approach remain unclear.</p><p><strong>Case description: </strong>We conducted a single-centre retrospective case series of patients who underwent Impella escalation between September 2020 and March 2026. Their clinical characteristics, haemodynamic responses, and outcomes were analysed. Among 130 patients treated with Impella CP, eight underwent upgrades. The underlying aetiology was AMI in six patients and myocarditis in two. Six patients required ECPELLA support. Following the upgrades, four patients were successfully weaned off extracorporeal membrane oxygenation (ECMO). Despite haemodynamic improvements, the overall outcomes were poor. Thirty-day survival was achieved in four patients; however, three experienced severe frailty (Clinical Frailty Scale scores of 7-8). Only one patient survived until hospital discharge. Infection-related complications, particularly sepsis, represented the leading causes of death. Device-related complications (e.g., access site infections) were observed in five patients, who required continuous negative-pressure wound therapy.</p><p><strong>Conclusions: </strong>Impella escalation may facilitate haemodynamic stabilisation and ECMO-weaning in selected patients; however, this may not necessarily translate into improved survival outcomes. Non-haemodynamic factors (e.g., infection and frailty) likely play critical roles in determining patient outcomes. These findings should not be interpreted as evidence against Impella escalation itself, but rather highlight the importance of careful patient selection, comprehensive clinical assessment beyond haemodynamic parameters, and further investigation into the optimal timing of escalation.</p>","PeriodicalId":29752,"journal":{"name":"AME Case Reports","volume":"10 ","pages":"127"},"PeriodicalIF":0.6,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13466742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148724132","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":"Idiopathic granulomatous mastitis a mimicking disease: a case report.","authors":"Erika A La Torre Castillo, Eduardo Gonzalez, Jessiane Salazar, Zuleika Diaz Negron","doi":"10.21037/acr-2026-0035","DOIUrl":"10.21037/acr-2026-0035","url":null,"abstract":"<p><strong>Background: </strong>Idiopathic granulomatous mastitis (IGM) is a rare, benign, chronic inflammatory breast disease that frequently mimics infection or malignancy, resulting in diagnostic and therapeutic challenges. Although erythema nodosum is a recognized extramammary manifestation, it occurs in approximately 10% of cases and may further obscure timely diagnosis. Our objective is to present a rare case of granulomatous mastitis and highlight the challenges associated with its diagnosis and management.</p><p><strong>Case description: </strong>We report the case of a 25-year-old Hispanic female who presented with persistent right breast inflammation unresponsive to multiple courses of antibiotic therapy. Diagnostic evaluation with core needle biopsy confirmed IGM. The patient developed concurrent erythema nodosum, representing a rare clinical presentation. Initial management with high-dose systemic corticosteroids resulted in significant adverse effects and progressive disease. Given refractory symptoms and intolerance to medical therapy, the patient underwent a right total mastectomy. Final surgical pathology confirmed the diagnosis of IGM.</p><p><strong>Conclusions: </strong>This case underscores a rare association between IGM and erythema nodosum and highlights the importance of early tissue diagnosis to guide management. While systemic corticosteroids and immunosuppressive therapy remain the cornerstone of treatment, surgical intervention should be considered in patients with severe, refractory disease or those experiencing significant complications from medical therapy. An individualized, severity-based approach and multidisciplinary management are essential for optimizing outcomes in this uncommon condition.</p>","PeriodicalId":29752,"journal":{"name":"AME Case Reports","volume":"10 ","pages":"133"},"PeriodicalIF":0.6,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13466860/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148726578","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":"Smooth muscle actin (SMA)-negative uninodular plexiform fibromyxoma: case report of a challenging atypical presentation of a rare gastric mesenchymal tumor in a 25-year-old female.","authors":"Armin Jarosch, Tomasz Dziodzio, Brigitta Globke, Robert Öllinger, Frederik Maximilian Schäfer, Kathrin Hauptmann, Sabina Niyazova, Anne Flörcken, David Horst, Abbas Agaimy, Simon Schallenberg","doi":"10.21037/acr-2025-295","DOIUrl":"10.21037/acr-2025-295","url":null,"abstract":"<p><strong>Background: </strong>Plexiform fibromyxoma (PFM) is an uncommon, benign mesenchymal tumor typically arising in the gastric antrum and usually characterized by a multinodular, plexiform growth pattern of smooth muscle actin (SMA)-expressing myofibroblastic-like cells. Rare variants with uninodular architecture and absence of SMA expression pose significant diagnostic challenges, as they may mimic gastrointestinal stromal tumors (GISTs) and require comprehensive histopathologic, immunohistochemical, and molecular evaluation to avoid misdiagnosis and inappropriate therapy.</p><p><strong>Case description: </strong>Here, we present a case of PFM with a rare uninodular architecture, complete absence of SMA expression and no detectable MALAT1-GLI1 translocation in a 25-year-old female with unremarkable laboratory work-up (hemoglobin 13.9 g/dL, normal blood count and biochemistry) presented with diffuse upper abdominal discomfort and a palpable epigastric mass noted on self-examination. Physical examination revealed a firm, non-tender mid-abdominal mass without peritonism. The tumor measured 13 cm and was discovered as a palpable mass on self-examination during diagnostic work-up for upper abdominal discomfort. Histologically, the lesion was composed of bland spindle cells embedded in a loose myxoid stroma, lacking the classic multinodular configuration. Immunohistochemistry was negative for SMA, DOG1, S100, CD34, desmin, and anaplastic lymphoma kinase (ALK). Molecular analysis revealed no pathogenic mutations in KIT or platelet-derived growth factor receptor alpha (PDGFRA) and no detectable gene fusions. The final diagnosis was most consistent with uninodular PFM as diagnosed by exclusion.</p><p><strong>Conclusions: </strong>This case highlights the importance of an early multimodal diagnostic work-up (including histology, immunohistochemistry, and next-generation sequencing) in atypical gastric mesenchymal tumors, e.g., PFMs, to avoid misdiagnosis as a GIST and inappropriate tyrosine kinase inhibitor therapy. Complete surgical resection with negative margins using stomach-preserving techniques is curative and associated with an excellent prognosis.</p>","PeriodicalId":29752,"journal":{"name":"AME Case Reports","volume":"10 ","pages":"128"},"PeriodicalIF":0.6,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13467000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148722344","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":"One-lung ventilation with intentional closure of the nonventilated lumen in a patient with giant pulmonary bullae undergoing laparoscopic anterior resection: a case report.","authors":"Sou-Hyun Lee, Sung-Hye Byun","doi":"10.21037/acr-2026-0078","DOIUrl":"10.21037/acr-2026-0078","url":null,"abstract":"<p><strong>Background: </strong>Anesthetic management of patients with giant pulmonary bullae undergoing nonthoracic laparoscopic surgery is challenging because positive pressure ventilation (PPV) may further distend or rupture the bullous lung, whereas carbon dioxide (CO₂) pneumoperitoneum and Trendelenburg positioning increase ventilatory demand. In conventional one-lung ventilation (OLV) with double-lumen tube (DLT), non-ventilated lumen is usually left open to ambient air. However, this may theoretically promote further bullous distension in closed-chest state. Reports of intentionally keeping the nonventilated lumen closed in this setting are limited.</p><p><strong>Case description: </strong>An 86-year-old man with a giant pulmonary bulla in the right lung underwent laparoscopic anterior resection for sigmoid colon cancer. Preoperative computed tomography showed a 17.5-cm bulla occupying the right middle-to-lower lung fields, and pulmonary function testing showed moderate obstructive ventilatory impairment. After induction of general anesthesia, a left-sided DLT was placed. OLV was initiated with ventilation of the left lung only, and the lumen connected to the nonventilated right lung was intentionally clamped and kept closed to ambient air as an initial risk-reduction strategy to reduce both direct positive pressure transmission and possible ambient air entrainment. Low tidal-volume ventilation and low-pressure pneumoperitoneum were used. Oxygenation remained acceptable, but progressive hypercapnia and acidosis developed during prolonged CO₂ pneumoperitoneum, requiring conversion to two-lung ventilation (TLV). The patient was extubated uneventfully without pneumothorax or evidence of bulla rupture.</p><p><strong>Conclusions: </strong>OLV using a DLT with intentional closure of the nonventilated lumen may be considered a reasonable initial risk-reduction strategy when further inflation of a bullous lung is a major concern. However, prolonged laparoscopic surgery may exceed the ventilatory limits of OLV even when this approach is used. Close monitoring of gas exchange and readiness to convert to TLV are essential.</p>","PeriodicalId":29752,"journal":{"name":"AME Case Reports","volume":"10 ","pages":"130"},"PeriodicalIF":0.6,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13466961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148724493","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}