AME Case Reports最新文献

{"title":"Tracheal carina reconstruction, fistula repair and esophageal reconstruction assisted by extra-corporeal membrane oxygenation for complex huge tracheoesophageal fistula: a case report.","authors":"Jie Tang, Mengtian Wang, Qinghua Zhou, Xiaofei Li, Xinghe Tong, Yu Fang, Juan Hu, Wen Yu, Yunping Zhao, Xiaobo Chen","doi":"10.21037/acr-24-14","DOIUrl":"https://doi.org/10.21037/acr-24-14","url":null,"abstract":"<p><strong>Background: </strong>Tracheoesophageal fistula is a pathological communication between the trachea and the adjacent esophagus due to various factors. It is a complicated disease in thoracic surgery, which can seriously affect patients' quality of life and even lead to death. The effect of traditional medical or surgical treatment is not satisfactory, so it is necessary to find a suitable surgical method to improve the prognosis and quality of life of patients.</p><p><strong>Case description: </strong>A case of benign complex tracheoesophageal fistula is reported. The patient had a history of malignant tumor, which recurred after surgical and medical antitumor therapy. Then esophageal stenosis was caused by radiation esophagitis, and tracheoesophageal fistula was caused after implantation of esophageal stents. After long-term medical and surgical treatments, the patient's condition was still out of well control, complicated with multiple complications, and the quality of life was poor. We completed esophageal stent removal, tracheoesophageal fistula repairing by \"double-flaps of esophagus\" method, tracheal carina reconstruction, partial esophageal resection, and gastro-esophageal replacement operations in concurrent assisted by extra-corporeal membrane oxygenation (ECMO). Good therapeutic effect was obtained after the surgery.</p><p><strong>Conclusions: </strong>The \"double-flaps of esophagus\" method assisted by ECMO can be used as an effective surgical treatment for patients with complex tracheoesophageal fistula, and can significantly improve the prognosis of patients.</p>","PeriodicalId":29752,"journal":{"name":"AME Case Reports","volume":"9 ","pages":"45"},"PeriodicalIF":0.7,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053436/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056514","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":"CO₂ laser frenuloplasty for cryotherapy-induced frenulum perforation: a case report.","authors":"Giuseppe Lodi, Fabrizio Rocco Mancuso, Tiziano Zingoni, Irene Fusco, Giovanni Cannarozzo, Mario Sannino","doi":"10.21037/acr-24-165","DOIUrl":"https://doi.org/10.21037/acr-24-165","url":null,"abstract":"<p><strong>Background: </strong>The penile frenulum is a sensitive tissue fold connecting the glans to the penile shaft, preventing excessive foreskin retraction during an erection. Susceptible to injuries from trauma or medical treatments, effective repair is crucial for restoring functionality and alleviating discomfort. Traditional frenulum repair typically involves scalpel surgery, but CO₂ laser frenuloplasty has emerged as an innovative alternative, offering enhanced precision and faster recovery. This study examines a case of frenulum perforation post-cryotherapy for condylomas, highlighting the use of CO₂ laser frenuloplasty and its outcomes.</p><p><strong>Case description: </strong>A 25-year-old male experienced a frenulum perforation after aggressive cryotherapy for recurrent genital condylomas. This damage required effective treatment to restore functionality and relieve discomfort. The patient underwent CO₂ laser frenuloplasty, known for its precision in delicate tissues. The procedure, conducted in a single session with the laser set to 0.3-1 W and 10 Hz, involved local anesthesia with 0.5 mL of lidocaine. An incision in the median frenulum was made, dividing it into two parts, followed by vaporization of the proximal and distal ends using the laser. This minimized thermal damage and intraoperative bleeding, promoting quicker healing. Post-procedure, the patient exhibited localized inflammation and mild swelling but no significant bleeding. A topical healing gel with cicatrizing agents and topical antibiotics was prescribed. At the 1-month follow-up, the patient reported significant symptom improvement. Photographs showed well-healed tissue with minimal scarring, and the patient experienced no significant pain or functional limitations. The topical gel positively contributed to the healing process, preventing infection and supporting tissue regeneration.</p><p><strong>Conclusions: </strong>CO₂ laser frenuloplasty offers several advantages over traditional scalpel surgery, including enhanced accuracy, reduced tissue trauma, minimal bleeding, and faster recovery. The laser's ability to coagulate blood vessels ensures a clearer surgical field and better hemostasis, while its sterilizing effect reduces post-operative infection risk. This case demonstrates the effectiveness of CO₂ laser frenuloplasty in treating frenulum damage, resulting in successful healing with minimal complications. Further studies with larger cohorts are recommended to confirm these findings and refine treatment protocols, highlighting the importance of precise surgical techniques and targeted post-operative care.</p>","PeriodicalId":29752,"journal":{"name":"AME Case Reports","volume":"9 ","pages":"44"},"PeriodicalIF":0.7,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144018244","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":"Severe hyponatremia due to trimethoprim-sulfamethoxazole: a case report.","authors":"Mansour Ibrahim Alrasheed, Reem Khalid Almanea, Bashayr Mohammed Hijaz, Muhammad Riazuddin","doi":"10.21037/acr-24-175","DOIUrl":"https://doi.org/10.21037/acr-24-175","url":null,"abstract":"<p><strong>Background: </strong>Hyponatremia, a prevalent electrolyte imbalance with varying degrees of severity, can lead to mild to severe complications. Trimethoprim-sulfamethoxazole (TMP-SMX) and spironolactone are two frequently administered medications; regrettably, most healthcare professionals are not aware that these medications might cause hyponatremia. Concurrently, the two drugs have a high chance of medication interactions that raise the risk of hyponatremia, hyperkalemia, and death overall. TMP-SMX is implicated in causing hyponatremia through diverse mechanisms, such as inhibiting the renal tubular epithelial enzyme carbonic anhydrase. Structurally akin to the potassium-sparing diuretic amiloride, TMP-SMX is linked to hyperkalemia and hyponatremia by obstructing epithelial sodium channels in the distal nephron. Moreover, TMP-SMX may enhance antidiuretic hormone (ADH) release, exacerbating the imbalance.</p><p><strong>Case description: </strong>This is a case of a 76-year-old man with a medical history including hypertension, type II diabetes, coronary artery disease, and dyslipidemia. This case highlights an elderly patient treated with TMP-SMX for a soft tissue wound infection, which resulted in severe hyponatremia.</p><p><strong>Conclusions: </strong>Timely identification and careful monitoring of TMP-SMX-induced hyponatremia enabled the correction of sodium levels without severe complications. Thus, this report underscores the importance of vigilant monitoring and prompt identification of hyponatremia in patients undergoing TMP-SMX treatment. Further research is warranted due to limited data on the precise mechanisms of TMP-SMX-induced hyponatremia.</p>","PeriodicalId":29752,"journal":{"name":"AME Case Reports","volume":"9 ","pages":"43"},"PeriodicalIF":0.7,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053988/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031150","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":"Right atrial metastasis after renal cell carcinoma operation: a case report.","authors":"Mei-Juan Zhu, Yu Tang, Ya-Wei Shen, Shawn Dason, Ashorne Krithiesh Mahenthiran, Xian-Wen Zhang","doi":"10.21037/acr-24-258","DOIUrl":"10.21037/acr-24-258","url":null,"abstract":"<p><strong>Background: </strong>Treatment options for patients with high-risk metastatic clear cell renal cell carcinoma (mccRCC) include immune checkpoint inhibitors and tyrosine kinase inhibitors (TKIs), but clinical manifestations and treatment of these patients are rarely reported because patients with cardiac metastases and abrupt circulatory disorders are very rare and there are no precise guidelines to follow. In this study, we analyzed and discussed the clinical characteristics, related characteristics, pathogenesis and treatment strategies of patients with cardiac metastases of kidney cancer, so as to provide reference for the diagnosis and treatment of cardiac metastatic tumors.</p><p><strong>Case description: </strong>The patient was diagnosed with renal cell carcinoma and underwent surgical radical resection, no special treatment was performed after surgery. Metastases of the right thigh muscles and both lungs were found after 4 years, and the patient was treated with 1 cycle of sunitinib + sintilimab. The patient had sudden symptoms of circulatory obstruction, computed tomography angiography (CTA) showed that the right atrial mass was occupied, and cardiac surgery was performed, and the postoperative pathology confirmed that it was kidney cancer heart metastasis, the operation was successful. The patient had aggravated lung infection after 2 weeks of follow-up, and the symptoms improved after treatment with antibiotics, anticoagulation, and nutritional support. This operation relieved the patient's circulatory embolism, saved the patient's life, and prolonged the patient's survival.</p><p><strong>Conclusions: </strong>This case study highlights the rare clinical manifestations of cardiac metastasis from ccRCC. For patients who have the opportunity for surgery, surgical treatment is recommended as the preferred option. Early detection and treatment are the key to prolonging the survival of patients with cardiac metastasis from tumors.</p>","PeriodicalId":29752,"journal":{"name":"AME Case Reports","volume":"9 ","pages":"35"},"PeriodicalIF":0.7,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047330","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-modal approach with dye laser and CO₂ laser for the resolution of vascularized acne scars: a case series.","authors":"Giovanni Cannarozzo, Beatrice Marina Pennati, Irene Fusco, Piero Campolmi, Tiziano Zingoni","doi":"10.21037/acr-24-130","DOIUrl":"https://doi.org/10.21037/acr-24-130","url":null,"abstract":"<p><strong>Background: </strong>As a prevalent condition of the pilosebaceous unit, acne vulgaris affects approximately 85% of people between the ages of 12 and 25 years. Among the patients, 47% report having acne scars. Considering the characteristics of the dye laser, we believe that this device can be a feasible solution for treating these facial skin imperfections. Specifically, in this study, we suggest the combination of the 595 nm wavelength with a fractional CO₂ laser to ensure skin resurfacing and the best possible result.</p><p><strong>Case description: </strong>For this study, 31 patients presenting vascularized acne scars were considered. They ranged between 20 and 35 years old. The therapeutical approach usually started with two dye laser treatments and two CO₂ laser sessions. In this study, the dye laser was mainly used for the resolution of skin inflammation and vascularization while CO₂ was used for skin remodelling. To guarantee the best and safest outcome, a skin contact sensor was included with the device. Using a 4-point Global Aesthetic Improvement Scale (GAIS) (none: 0, slight: 1, mild: 2, excellent: 3) to assess the treatment outcomes, 77% of patients claimed it was \"excellent\", 16% \"mild\" and 7% \"slight\".</p><p><strong>Conclusions: </strong>The combination of different laser devices can be a promising therapeutic alternative for acne resolution. Remodelling the skin with the CO₂ laser wavelength and reducing the inflammation and vascularization with the dye laser could be particularly helpful, especially for patients who do not respond to or cannot tolerate other therapies.</p>","PeriodicalId":29752,"journal":{"name":"AME Case Reports","volume":"9 ","pages":"36"},"PeriodicalIF":0.7,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053872/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998982","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":"Ultrasound, Doppler and other signs during drug-free transition from subclinical hypothyroidism to euthyroidism: a case report.","authors":"Andrey Valerievich Ushakov","doi":"10.21037/acr-24-59","DOIUrl":"10.21037/acr-24-59","url":null,"abstract":"<p><strong>Background: </strong>It is known that subclinical hypothyroidism (SCH) often converts to euthyroidism. However, the mechanism of such changes is unclear and can only be speculated. This difficulty is likely due to limitations in diagnostic guidelines and their interpretation. Therefore, in the presented case, important diagnostic criteria that can improve understanding of the essence and pathogenesis of primary hypothyroidism are shown and explained.</p><p><strong>Case description: </strong>A 15-year-old female patient experienced a transition from SCH to euthyroidism against the background of highly normal values of thyroid hormones, the full state of the thyroid parenchyma and significantly increased blood flow in the Doppler mode. She did not take medications. Conditions likely to trigger SCH included acute respiratory illness, living in a cold climate, and mental stress due to prolonged preparation for exams. The transition to euthyroidism occurred after sufficient stay in the conditions of a southern resort in the summer and mental comfort.</p><p><strong>Conclusions: </strong>As a result, it was revealed that the amount of thyroid-stimulating hormone (TSH) depends on the intensity of energy expenditure of the body in accordance with living conditions. The increased intensity of blood flow in the thyroid during SCH and euthyroidism shows the leading role of the autonomic nervous system and the auxiliary importance of TSH. The concentration of thyroid hormones at the maximum limit of normal in SCH, together with the significantly increased Doppler blood flow, suggests common elements of pathogenesis with Graves' disease through the autonomic nervous system. With many months of thyroid overstrain, ultrasound shows signs of corresponding depletion in the form of hypoechogenicity of the lobules, but the preservation of a sufficient amount of hormone-producing tissue.</p>","PeriodicalId":29752,"journal":{"name":"AME Case Reports","volume":"9 ","pages":"32"},"PeriodicalIF":0.7,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047933","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":"Infected mesh salvaging using negative pressure wound therapy with instillation (NPWTi): a case report.","authors":"Nicolò Fabbri, Riccardo Soverini, Antonio Pesce, Ledian Garunja, Gina Bilotta, Salvatore Greco, Carlo Vittorio Feo","doi":"10.21037/acr-24-49","DOIUrl":"https://doi.org/10.21037/acr-24-49","url":null,"abstract":"<p><strong>Background: </strong>Abdominal wall wound dehiscence with mesh exposure is a dangerous adverse event with an incidence of 0.4-1.2% and a mortality rate of up to 25%. To date, there are no standard protocols for the optimal duration of negative pressure wound therapy with instillation (NPWTi) for specific clinical settings and the decision to treat a polypropylene mesh infection with NPWTi has only been made in rare case reports. Moreover, recent studies show contrasting results regarding the reduction of hospital stay for abdominal wall dehiscence with exposed mesh, treated with NPWTi and dwell time or traditional negative pressure wound therapy (NPWT).</p><p><strong>Case description: </strong>A 54-year-old woman with a history of obesity, hypertension, and diabetes underwent surgery for a recurrent post-incisional hernia. Despite the initial plan for a laparoscopic procedure, adhesions necessitated a laparotomy, and a polypropylene mesh was implanted. Postoperatively, complications arose, including a treated subcutaneous fluid collection. However, further subsequent issues emerged, such as fever, wound dehiscence, and mesh exposure. The patient underwent surgical debridement and an attempt to salvage the prosthesis using NPWTi with sodium hypochlorite. After 20 days, inflammatory markers normalized, the wound improved, and the prosthesis did not need to be removed.</p><p><strong>Conclusions: </strong>Based on our experience, which complements the limited literature currently available, NPWTi may represent an effective treatment option for infected wound dehiscence after abdominal wall prosthetic surgery, in individuals at high risk of complications from prosthesis removal.</p>","PeriodicalId":29752,"journal":{"name":"AME Case Reports","volume":"9 ","pages":"42"},"PeriodicalIF":0.7,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053839/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019274","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":"Giant thymolipoma in a 16-year-old girl with multimodal diagnostic approach and surgical management: a case report.","authors":"Ziwei Wang, Jicheng Xiong, Lin Peng, Xiaobo Wu, Yongtao Han, Yi Zhu, Xuefeng Leng","doi":"10.21037/acr-24-157","DOIUrl":"10.21037/acr-24-157","url":null,"abstract":"<p><strong>Background: </strong>Thymolipomas are rare benign mediastinal tumors primarily occurring in young adults, although they can also present in pediatric populations. These tumors are often asymptomatic, but their substantial size can create significant diagnostic and therapeutic challenges, necessitating careful evaluation and management.</p><p><strong>Case description: </strong>A teenage girl was diagnosed with a giant thymolipoma, which was discovered incidentally during a routine chest radiograph. Notably, the patient remained asymptomatic despite the tumor's considerable size and its apparent impact on surrounding thoracic structures. To facilitate a thorough preoperative assessment, a multimodal imaging approach was employed, including contrast-enhanced ultrasound (CEUS), computed tomography (CT), and magnetic resonance imaging (MRI). These advanced imaging techniques played a crucial role in delineating the tumor's extent, characteristics, and relationship to adjacent anatomical structures, thereby informing surgical planning. Ultimately, the tumor was successfully excised through a median sternotomy. Postoperative pathological examination confirmed the diagnosis of thymolipoma. Remarkably, after a follow-up period of five years, the patient showed no signs of recurrence and maintained a healthy status.</p><p><strong>Conclusions: </strong>This case underscores the effectiveness of a multimodal imaging strategy for the diagnosis and preoperative assessment of pediatric thymolipomas. It emphasizes the feasibility of complete surgical resection, even for large tumors, leading to a favorable prognosis. Moreover, it highlights the importance of tailored management strategies for pediatric patients with rare thoracic tumors, as evidenced by this successful clinical outcome.</p>","PeriodicalId":29752,"journal":{"name":"AME Case Reports","volume":"9 ","pages":"25"},"PeriodicalIF":0.7,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759932/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048101","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":"Giant right atrial myxoma complicated with massive pulmonary embolism and right-sided heart failure: a case report.","authors":"Duolikun Mutailifu, Abudousaimi Aini, Abudunaibi Maimaitiaili","doi":"10.21037/acr-24-145","DOIUrl":"https://doi.org/10.21037/acr-24-145","url":null,"abstract":"<p><strong>Background: </strong>About 75% of myxomas occur in the left atrium and 10-20% in the right atrium. Right atrium myxomas producing a wide range of potential symptoms and complications, from asymptomatic to serious presentations with acute pulmonary embolism (PE) or cardiogenic shock. Early diagnosis and prompt surgical intervention are critical.</p><p><strong>Case description: </strong>A 43-year-old man presented with progressive dyspnea, fatigue, and palpitations, imaging revealed a large mobile right atrial myxoma (78 mm × 52 mm) causing intermittent tricuspid valve obstruction and multifocal pulmonary emboli. Laboratory tests showed elevated B-type natriuretic peptide (BNP) and D-dimer levels. The patient was diagnosed with a benign cardiac tumor, PE, and New York Heart Association (NYHA) Class III heart function. Open-chest surgery with cardiopulmonary bypass resulted in successful tumor resection and emboli extraction. Postoperatively, the patient showed significant symptom improvement and no tumor recurrence at the 6-month follow-up. It is such giant right atrial myxomas that speak for the need for early diagnosis with surgical intervention.</p><p><strong>Conclusions: </strong>This case is illustrative of the practical outcome brought about by multidisciplinary involvement. These cases are rare, and the possibility of embolizing makes them inevitable for a meticulous clinical assessment with enhanced imaging, preferably with the help of computed tomography pulmonary angiography (CTPA) techniques, for diagnosis and management of these complex conditions. Early recognition and intervention are paramount to mitigating the risk of life-threatening complications such as pulmonary hypertension and embolism. Timely surgical intervention can prevent severe hemodynamic disturbances and improve patient outcomes.</p>","PeriodicalId":29752,"journal":{"name":"AME Case Reports","volume":"9 ","pages":"41"},"PeriodicalIF":0.7,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050578","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":"The diagnosis of eosinophilic granulomatosis with polyangiitis has been 'masked' by asthma: a case report.","authors":"Hua Xie, Xiaojun Zhang, Junli Zhang, Meicen Liu, Xiangqian Che","doi":"10.21037/acr-24-79","DOIUrl":"10.21037/acr-24-79","url":null,"abstract":"<p><strong>Background: </strong>Patients with asthma exhibit a significantly heightened susceptibility to eosinophilic granulomatosis with polyangiitis (EGPA) when compared to the general population. Vigilance for EGPA manifestations is crucial, especially in cases where asthma remains poorly controlled despite high-dose corticosteroid therapy or when eosinophil counts exceed 5%. The diagnosis of EGPA can be complex due to the absence of definitive biomarkers, as indicated by the American College of Rheumatology (ACR)'s 1990 classification criteria. EGPA is categorized as an antineutrophil cytoplasmic antibody (ANCA) associated vasculitis, with updated classification criteria released in 2022, which require a cumulative score of 6 or more for the diagnosis of small and medium vessel vasculitis. Enhancing knowledge of EGPA facilitates its early detection and effective management.</p><p><strong>Case description: </strong>The patient was initially diagnosed with allergic rhinitis in 2006 and developed cough and wheezing in 2016. In 2017, EGPA was diagnosed based on ACR criteria, with a cumulative score of 14 according to the 2022 ACR and the European League Against Rheumatism (ACR/EULAR) criteria, indicating small and medium vessel vasculitis. The patient showed myocardial, gastric, and neurological involvement, reflecting generalized EGPA. Prognostic assessments should use the five-factor score (FFS), which indicates a 46% 5-year mortality rate for those with an FFS of 2 or higher. This patient had an FFS of 3, tested negative for ANCA, and cardiac emission computed tomography (ECT) confirmed myocardial involvement. However, as EGPA was diagnosed only 13 months after the onset of wheezing, the patient had been undergoing glucocorticoid therapy, as of today (7 years later), has effectively managed the symptoms and facilitated normal daily activities.</p><p><strong>Conclusions: </strong>If asthma symptoms persist despite intensive corticosteroid treatment or the eosinophil count exceeds 5%, consider the possibility of EGPA. The presence of ANCA exerts a substantial impact on the prognostic outcomes in EGPA. ANCA-negative patients typically exhibit reduced survival rates, primarily attributed to a higher incidence of cardiac involvement. Nevertheless, advancements in early diagnosis and therapeutic interventions have led to improved survival rates, even in cases complicated by cardiac and pulmonary manifestations.</p>","PeriodicalId":29752,"journal":{"name":"AME Case Reports","volume":"9 ","pages":"31"},"PeriodicalIF":0.7,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11760517/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047815","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}