American Journal of Case Reports最新文献

Isolated Psychiatric Presentation of Cerebral Venous Thrombosis in a Patient Without Risk Factors: A Diagnostic Challenge. 无危险因素的脑静脉血栓患者的孤立精神病学表现：诊断挑战。

IF 0.8

American Journal of Case Reports Pub Date : 2026-09-05 DOI: 10.12659/AJCR.953812

Mahdi Abdulrahman Kanjo, Hanin Abdulbast AboTaleb, Asim Musaad Almalawi, Reham Jamal Balbaid

{"title":"Isolated Psychiatric Presentation of Cerebral Venous Thrombosis in a Patient Without Risk Factors: A Diagnostic Challenge.","authors":"Mahdi Abdulrahman Kanjo, Hanin Abdulbast AboTaleb, Asim Musaad Almalawi, Reham Jamal Balbaid","doi":"10.12659/AJCR.953812","DOIUrl":"https://doi.org/10.12659/AJCR.953812","url":null,"abstract":"BACKGROUND Cerebral venous thrombosis (CVT) is an uncommon form of stroke with highly variable clinical manifestations. Although headache and focal neurological deficits are typical presenting features, isolated psychiatric symptoms as an initial manifestation are exceptionally rare and may substantially delay diagnosis. CVT most commonly affects young adults and women with identifiable prothrombotic risk factors. CASE REPORT We report the case of a 37-year-old previously healthy woman with no identifiable thrombotic risk factors who presented with acute behavioral disturbances characterized by insomnia, agitation, emotional lability, and aggressive behavior. There was no history of prior psychiatric illness. Initial investigations, including brain magnetic resonance imaging (MRI), cerebrospinal fluid analysis, and infectious workup, were unremarkable, with no evidence of structural abnormalities on early neuroimaging. She was admitted with a working diagnosis of acute polymorphic psychotic disorder and started on psychiatric treatment. Six days later, she developed sudden loss of consciousness followed by generalized tonic-clonic seizures, prompting urgent neuroimaging. Imaging revealed a right high-parietal intracerebral hemorrhage, and subsequent venous imaging confirmed CVT involving the superficial superior cerebral vein. The patient was treated with antiepileptic therapy and anticoagulation, leading to gradual neurological and psychiatric improvement. CONCLUSIONS This case highlights an unusual presentation of CVT with isolated psychiatric manifestations, absence of classical risk factors, and initially normal neuroimaging findings, all of which contributed to delayed diagnosis. Abrupt neurological deterioration can occur despite non-specific early investigations. Early consideration of cerebral venous imaging may be warranted in atypical acute psychiatric presentations to avoid delayed diagnosis and potentially life-threatening complications.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"27 ","pages":"e953812"},"PeriodicalIF":0.8,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892634","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}

引用次数: 0

Left Atrial Thrombectomy Under Cardiopulmonary Bypass Without Aortic Cross-Clamping Using Rapid Ventricular Overdrive Pacing: A Case Report. 体外循环下无主动脉交叉夹持快速心室超速起搏左心房取栓一例。

IF 0.8

American Journal of Case Reports Pub Date : 2026-09-04 DOI: 10.12659/AJCR.953416

Tomohide Takei, Takeshi Nagaoka, Hitoshi Sato

{"title":"Left Atrial Thrombectomy Under Cardiopulmonary Bypass Without Aortic Cross-Clamping Using Rapid Ventricular Overdrive Pacing: A Case Report.","authors":"Tomohide Takei, Takeshi Nagaoka, Hitoshi Sato","doi":"10.12659/AJCR.953416","DOIUrl":"https://doi.org/10.12659/AJCR.953416","url":null,"abstract":"BACKGROUND Aortic cross-clamping is usually required to clearly visualize the surgical field in mini-thoracotomy because cardiac surgery without aortic cross-clamping can be challenging. However, certain patients may require alternative strategies for cardiovascular surgeries. CASE REPORT We report the case of a 73-year-old woman with prior valve replacement who underwent left atrial thrombectomy under cardiopulmonary bypass without aortic cross-clamping using rapid ventricular overdrive pacing. She was referred to our hospital for an evaluation of elevated C-reactive protein levels. Computed tomography coronary angiography revealed a large non-mobile mass in the left atrium that did not decrease after anticoagulation therapy. A high degree of adhesion was observed around the aortic root, making median sternotomy and aortic cross-clamping hazardous. Thrombectomy during perfused ventricular fibrillation was an option but is associated with other potential complications such as coagulopathy, arrhythmia, hyperglycemia, and disordered electrolytes that could further increase the total risk. Therefore, rapid ventricular overdrive pacing was selected to achieve temporary circulatory arrest, combined with a mini-thoracotomy approach. Rapid ventricular overdrive pacing was successfully maintained throughout the thrombectomy, and the patient was easily weaned from cardiopulmonary bypass. She was extubated in the operating room at the end of the surgery. She recovered without complications and was discharged walking independently. CONCLUSIONS Rapid ventricular overdrive pacing to achieve temporary circulatory arrest during cardiovascular surgery may be a new therapeutic option in patients with high risks associated with reoperation.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"27 ","pages":"e953416"},"PeriodicalIF":0.8,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888961","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}

引用次数: 0

CytoSorb Application for Successful Control of Life-Threatening Gastrointestinal Bleeding Following Rivaroxaban Administration. 应用CytoSorb成功控制利伐沙班后危及生命的胃肠道出血。

IF 0.8

American Journal of Case Reports Pub Date : 2026-09-04 DOI: 10.12659/AJCR.953201

Liliya Raeva, Miroslav Petrov, Mihail Cholakov, Aya Taha, Asen Petrov, Stoyan Handzhiev

{"title":"CytoSorb Application for Successful Control of Life-Threatening Gastrointestinal Bleeding Following Rivaroxaban Administration.","authors":"Liliya Raeva, Miroslav Petrov, Mihail Cholakov, Aya Taha, Asen Petrov, Stoyan Handzhiev","doi":"10.12659/AJCR.953201","DOIUrl":"https://doi.org/10.12659/AJCR.953201","url":null,"abstract":"BACKGROUND Direct oral anticoagulants (DOACs) are increasingly being prescribed to prevent thromboembolic events. They are preferred over warfarin due to their rapid action and because they do not require routine blood monitoring. However, they are associated with a risk of severe bleeding, particularly in elderly patients with multiple comorbidities. Managing major gastrointestinal hemorrhage in such patients remains challenging, especially when standard reversal agents are unavailable (due to high costs) or contraindicated based on hypersensitivity reactions. CASE REPORT We present the case of a 68-year-old man with an extensive cardiovascular and vascular surgical history who developed severe lower gastrointestinal bleeding while receiving rivaroxaban therapy (20 mg daily). He had a history of colonic diverticular disease. Conventional resuscitative and endoscopic measures were insufficient to control the hemorrhage, and emergency surgery was deemed extremely high risk. Our center did not have the specific reversal agent (andexanet alfa) for rivaroxaban on site due to its high cost, and the patient's condition was deteriorating rapidly, with evidence of ongoing bleeding. Hemoperfusion therapy using CytoSorb in combination with continuous renal replacement therapy was initiated as a rescue strategy. The patient achieved rapid hemodynamic stabilization and cessation of bleeding within hours, thus avoiding emergent colectomy. CONCLUSIONS This case study illustrates the potential of extracorporeal hemoperfusion as an adjunctive or alternative treatment for patients experiencing life-threatening bleeding associated with direct oral anticoagulants, particularly when reversal agents are unavailable. It provides rapid action and reduces the need for blood transfusions, potentially leading to a significantly shorter hospital stay for patients.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"27 ","pages":"e953201"},"PeriodicalIF":0.8,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892637","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}

引用次数: 0

When Grief Strains the Heart: A Case of Reverse Takotsubo Cardiomyopathy Triggered by Mourning and Respiratory Failure. 当悲伤使心脏紧张：一个由哀悼和呼吸衰竭引发的逆行Takotsubo心肌病病例。

IF 0.8

American Journal of Case Reports Pub Date : 2026-09-03 DOI: 10.12659/AJCR.952896

Peter Cwalina, Ibrahim Rahmatullah, Ayesha Samad, Adam S Budzikowski

{"title":"When Grief Strains the Heart: A Case of Reverse Takotsubo Cardiomyopathy Triggered by Mourning and Respiratory Failure.","authors":"Peter Cwalina, Ibrahim Rahmatullah, Ayesha Samad, Adam S Budzikowski","doi":"10.12659/AJCR.952896","DOIUrl":"https://doi.org/10.12659/AJCR.952896","url":null,"abstract":"BACKGROUND Takotsubo cardiomyopathy is a transient stress-induced cardiomyopathy that can mimic acute coronary syndrome (ACS) but typically occurs without obstructive coronary disease. Reverse takotsubo is an uncommon variant characterized by basal hypokinesis with preserved apical contraction. We report an atypical case in which acute respiratory failure, rather than an abrupt emotional stressor, appeared to be the primary trigger. CASE REPORT A 69-year-old woman with coronary artery disease status after prior left anterior descending artery stent, hypertension, hyperlipidemia, and chronic obstructive pulmonary disease (COPD) presented with severe respiratory distress and became unresponsive, requiring emergency intubation. She tested positive for coronavirus OC43 and was managed in the intensive care unit (ICU) for COPD exacerbation with ventilator-dependent respiratory failure. High-sensitivity troponin rose from 56 ng/L to 937 ng/L initially, later peaking at 1928 ng/L after catheterization with ST-T changes on EKG, prompting cardiac evaluation. Transthoracic echocardiography revealed new segmental wall motion abnormalities consistent with stress cardiomyopathy and an estimated ejection fraction of 40%. Urgent coronary angiography demonstrated no obstructive coronary disease with a patent LAD stent; left ventriculography showed severe basal hypokinesis with preserved apical contraction, confirming reverse takotsubo. Further history-taking revealed ongoing grief after her sister's death 3 months earlier. CONCLUSIONS Reverse takotsubo should be considered in patients with ACS-like presentations during acute critical illness, including respiratory failure, even when emotional stressors are chronic rather than sudden. Recognizing basal hypokinesis with preserved apical function can help avoid misdiagnosis and guide appropriate supportive management and follow-up imaging.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"27 ","pages":"e952896"},"PeriodicalIF":0.8,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881865","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}

引用次数: 0

A Near-Fatal Leak: Acute Cardiac Tamponade From Contrast Extravasation via a Thrombosed Port-a-Cath. 一个几乎致命的泄漏：通过血栓形成的左心室导管造影剂外渗引起的急性心脏填塞。

IF 0.8

American Journal of Case Reports Pub Date : 2026-09-03 DOI: 10.12659/AJCR.953197

Hamza Janjua, Monica Wilbekin, Hira Janjua, Kushal Das, Zulfiqar Qutrio Baloch, Rehan Ishaque

{"title":"A Near-Fatal Leak: Acute Cardiac Tamponade From Contrast Extravasation via a Thrombosed Port-a-Cath.","authors":"Hamza Janjua, Monica Wilbekin, Hira Janjua, Kushal Das, Zulfiqar Qutrio Baloch, Rehan Ishaque","doi":"10.12659/AJCR.953197","DOIUrl":"https://doi.org/10.12659/AJCR.953197","url":null,"abstract":"BACKGROUND Cardiac tamponade caused by intrapericardial contrast extravasation is a rare but life-threatening iatrogenic complication associated with central venous access devices (CVADs) during power injection. CVADs, including implanted ports (port-a-caths), are susceptible to fibrin sheath formation and mural thrombosis over time, which can tether the catheter tip against the vessel wall and predispose it to erosion or perforation. When high-pressure contrast is injected through a compromised device, contrast may bypass the vessel lumen entirely and accumulate within the pericardial sac, producing acute obstructive shock. CASE REPORT We report a 61-year-old woman with a history of diabetes mellitus, cerebrovascular accident, and an indwelling port-a-cath who underwent computed tomography (CT) angiography because of difficult peripheral venous access. Immediately after contrast administration, she developed sudden cardiovascular collapse and cardiac arrest. CT imaging demonstrated a large hyperdense pericardial effusion with superior vena cava thrombosis adjacent to the catheter tip, suggesting catheter-related vessel wall injury and direct contrast extravasation into the pericardial sac. Bedside echocardiography confirmed tamponade physiology with right ventricular diastolic collapse and chamber compression. Emergent pericardiocentesis drained 1 L of contrast-containing serosanguinous fluid and resulted in immediate hemodynamic recovery after cardiac arrest. CONCLUSIONS Contrast extravasation through a long-term indwelling port-a-cath is a rare but catastrophic cause of acute cardiac tamponade. Sudden cardiovascular collapse during or after contrast-enhanced CT in a patient with a long-term central venous device should prompt immediate suspicion for this diagnosis. Additionally, echocardiography enables rapid confirmation, and emergent pericardiocentesis is life-saving.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"27 ","pages":"e953197"},"PeriodicalIF":0.8,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888891","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}

引用次数: 0

Co-Occurring EGFR L858R Mutation and HER2 Amplification in NSCLC Identified by Stepwise Molecular Profiling. 非小细胞肺癌中共同发生的EGFR L858R突变和HER2扩增

IF 0.8

American Journal of Case Reports Pub Date : 2026-09-02 DOI: 10.12659/AJCR.953829

Rabiga Kadyrbayeva, Dilyara Kaidarova, Aisha Moldasheva, Kaldygul Kabakovna Smagulova, Innara Turkpenova, Madina Orazgalieva, Saniya Omirkhanovna Ossikbayeva, Elvira Satbayeva, Valeriy Makarov

{"title":"Co-Occurring EGFR L858R Mutation and HER2 Amplification in NSCLC Identified by Stepwise Molecular Profiling.","authors":"Rabiga Kadyrbayeva, Dilyara Kaidarova, Aisha Moldasheva, Kaldygul Kabakovna Smagulova, Innara Turkpenova, Madina Orazgalieva, Saniya Omirkhanovna Ossikbayeva, Elvira Satbayeva, Valeriy Makarov","doi":"10.12659/AJCR.953829","DOIUrl":"https://doi.org/10.12659/AJCR.953829","url":null,"abstract":"BACKGROUND The coexistence of multiple oncogenic drivers in non-small cell lung cancer (NSCLC) is a rare and diagnostically challenging molecular configuration. Conventional polymerase chain reaction (PCR)-based testing may fail to detect co-occurring genomic alterations, potentially limiting therapeutic options, particularly in resource-constrained settings. CASE REPORT We describe the case of a 54-year-old non-smoking woman diagnosed with Stage IIIA lung adenocarcinoma in 2020. Initial PCR-based molecular testing was negative for EGFR mutations. Following disease progression with brain metastases and severe chemotherapy toxicity, stepwise molecular profiling in a resource-limited setting identified HER2 (ERBB2) amplification via fluorescence in situ hybridization (FISH). The patient achieved 23 months of clinical and radiological stabilization on trastuzumab. Subsequent next-generation sequencing (NGS) analysis of archived tissue revealed a previously undetected estimated glomular filtration rate (EGFR) L858R mutation. In late April 2025, new lesions appeared in the lungs, indicating disease progression. Based on the previously verified EGFR L858R mutation, the treatment strategy was revised and gefitinib was initiated in May 2025. CONCLUSIONS This case illustrates that co-occurring EGFR and HER2 alterations can remain undetected following initial limited molecular testing, and that stepwise molecular profiling in a resource-constrained setting can facilitate identification of therapeutically actionable targets. The sequential clinical responses observed are consistent with the biological relevance of both alterations, although broader conclusions regarding diagnostic strategy or driver hierarchy cannot be drawn from a single observation.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"27 ","pages":"e953829"},"PeriodicalIF":0.8,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148875948","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}

引用次数: 0

Management of a Rare 4-Rooted Maxillary First Molar With 5 Canals and an Endo-Periodontal Lesion: A Case Report. 罕见4根上颌第一磨牙伴5根管及牙周内病变1例。

IF 0.8

American Journal of Case Reports Pub Date : 2026-09-02 DOI: 10.12659/AJCR.953554

Yifan Wang, Hong Jiang, Yanhong Hao, Zhen Fang, Shige Liu, Jie Pan, Huan Jing

{"title":"Management of a Rare 4-Rooted Maxillary First Molar With 5 Canals and an Endo-Periodontal Lesion: A Case Report.","authors":"Yifan Wang, Hong Jiang, Yanhong Hao, Zhen Fang, Shige Liu, Jie Pan, Huan Jing","doi":"10.12659/AJCR.953554","DOIUrl":"https://doi.org/10.12659/AJCR.953554","url":null,"abstract":"BACKGROUND Endo-periodontal lesions (EPL), particularly those manifesting as primary periodontal lesions with secondary endodontic involvement, pose unique clinical challenges when accompanied by odontogenic maxillary sinusitis (OMS). Furthermore, limited case reports document the nonsurgical management of such complex conditions in maxillary molars exhibiting rare multi-rooted and multi-canal variations (prevalence <0.103%). CASE REPORT A 31-year-old woman presented with pain and grade III mobility in the right maxillary first molar, with an intact crown, a deep palatal periodontal pocket, and a negative cold testing response on clinical examination. Periapical radiography indicated multi-rooted anatomy and extensive bone loss, and cone beam computed tomography (CBCT) confirmed 4 separate roots (mesiobuccal, distobuccal, mesiopalatal, distopalatal), a fifth centrally located pulp chamber canal orifice, a periapical lesion communicating with a periodontal defect, and ipsilateral maxillary sinus mucosal thickening. Nonsurgical root canal treatment for all 5 canals was performed under a dental operating microscope with ultrasonic activation (3% NaOCl) and bioceramic sealer, combined with concurrent supportive periodontal therapy. At the 8-month follow-up, the tooth was asymptomatic with reduced mobility and probing depths; CBCT revealed marked reduction in periapical lesions and significant improvement in maxillary sinus mucosal thickening (ENT consultation advised). CONCLUSIONS This case unequivocally demonstrates that meticulous nonsurgical endodontic treatment with ultrasonic activation and bioceramic sealer, in conjunction with targeted periodontal therapy and occlusal management, is a highly effective tooth-preserving strategy for maxillary molars with complex anatomic variations complicated by primary periodontal lesions with secondary endodontic involvement and secondary OMS, achieving excellent clinical and radiological outcomes.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"27 ","pages":"e953554"},"PeriodicalIF":0.8,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881823","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}

引用次数: 0

Anterior Cutaneous Nerve Entrapment Syndrome in a 51-Year-Old Woman With Advanced Colon Cancer, Successfully Treated With Repeated Ultrasound-Guided Rectus Sheath Blocks: A Case Report. 51岁晚期结肠癌女性前皮神经卡压综合征，超声引导直肌鞘阻滞成功治疗1例。

IF 0.8

American Journal of Case Reports Pub Date : 2026-09-01 DOI: 10.12659/AJCR.953662

Yoko Shimamoto-Nagahira, Ryuichi Nakanuno

{"title":"Anterior Cutaneous Nerve Entrapment Syndrome in a 51-Year-Old Woman With Advanced Colon Cancer, Successfully Treated With Repeated Ultrasound-Guided Rectus Sheath Blocks: A Case Report.","authors":"Yoko Shimamoto-Nagahira, Ryuichi Nakanuno","doi":"10.12659/AJCR.953662","DOIUrl":"https://doi.org/10.12659/AJCR.953662","url":null,"abstract":"BACKGROUND Anterior cutaneous nerve entrapment syndrome is an underrecognized cause of abdominal wall pain and may be overlooked, particularly in patients with advanced cancer, in whom abdominal pain is often attributed to malignancy-related causes. Failure to identify coexisting non-cancer-related pain mechanisms can result in inadequate pain control and functional decline. CASE REPORT A 51-year-old woman with advanced sigmoid colon cancer and peritoneal metastasis presented with severe movement-related abdominal pain that was refractory to high-dose opioid therapy. Although tumor lesions were present near the umbilicus, she reported minimal pain at rest, with marked exacerbation during sitting and ambulation. Physical examination revealed multiple localized tender points along the lateral borders of the rectus abdominis muscle and a positive Carnett's sign, suggesting abdominal wall pain. Based on these findings, anterior cutaneous nerve entrapment syndrome was suspected. Ultrasound-guided bilateral rectus sheath blocks were performed at the tender points, resulting in immediate pain relief. Although the initial analgesic effect was transient, repeated blocks led to sustained pain reduction beyond the expected duration of local anesthetic action, enabling recovery of mobility and activities of daily living. CONCLUSIONS This case shows that anterior cutaneous nerve entrapment syndrome can coexist with cancer-related pathology and is a treatable cause of refractory abdominal pain in patients with advanced cancer. Careful assessment of pain characteristics and physical examination, even in the presence of tumor lesions at the pain site, can facilitate recognition and treatment of non-cancer-related pain and improve functional outcomes and quality of life in palliative care settings.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"27 ","pages":"e953662"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867205","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}

引用次数: 0

Combination of Multiple-Dose Activated Charcoal and Infusion Therapy That Led to Favorable Outcomes in Colchicine Poisoning: A Case Report. 多剂量活性炭联合输注治疗秋水仙碱中毒的疗效：1例报告。

IF 0.8

American Journal of Case Reports Pub Date : 2026-09-01 DOI: 10.12659/AJCR.953541

Manabu Eiraku, Kazuyuki Miyamoto, Keisuke Suzuki, Kazumasa Abe, Tatsuro Tamatsukuri, Asuka Kaizaki-Mitsumoto, Kazuki Kikuchi, Masaharu Yagi, Satoshi Numazawa, Kenji Dohi

{"title":"Combination of Multiple-Dose Activated Charcoal and Infusion Therapy That Led to Favorable Outcomes in Colchicine Poisoning: A Case Report.","authors":"Manabu Eiraku, Kazuyuki Miyamoto, Keisuke Suzuki, Kazumasa Abe, Tatsuro Tamatsukuri, Asuka Kaizaki-Mitsumoto, Kazuki Kikuchi, Masaharu Yagi, Satoshi Numazawa, Kenji Dohi","doi":"10.12659/AJCR.953541","DOIUrl":"https://doi.org/10.12659/AJCR.953541","url":null,"abstract":"BACKGROUND The therapeutic margin of colchicine is narrow, and toxicity occurs easily. No standard treatment exists because its toxicokinetics are poorly understood. Symptoms are usually gastrointestinal, and dehydration occurs easily. Few reports have monitored serum and urinary colchicine levels. CASE REPORT A man in his 20s presented with nausea, vomiting, diarrhea, drowsiness, and dyspnea. He ingested 2 dried Colchicum autumnale bulbs (estimated colchicine: 6.24-15.6 mg) with an energy drink. Activated charcoal with laxative was administered at 27 hours post ingestion (h-PI), followed by multiple-dose activated charcoal (MDAC) every 6 hours (13 doses, 27-101 h-PI), high-volume fluid infusion (Ringer's acetate), and blood purification (hemodialysis [HD] at 48-52 h-PI; hemodiafiltration [HDF] at 71-75 and 98-102 h-PI). Serum colchicine was measured at 16 time points and urine at 11 time points. Serum colchicine at 27 h-PI was 50.3 ng/mL, and was temporally associated with a rapid decrease to 21.2 ng/mL at 35 h-PI, coinciding with initiation of infusion and activated charcoal. A secondary rise to 17.74 ng/mL occurred at 77 h-PI, approximately 2.4 hours after HDF1 completion. Urine colchicine was 110.0 ng/mL at 29 h-PI, then gradually decreased. Serum colchicine changed modestly (12.16 to 5.46 ng/mL) during HD. CONCLUSIONS In this case of severe colchicine poisoning, serial serum and urine concentration monitoring provided a time-resolved profile across concurrent interventions. The observed temporal associations support hypothesis generation regarding the potential roles of renal elimination and MDAC-mediated interruption of enterohepatic recirculation in colchicine clearance, while recognizing that concurrent therapies preclude attribution of effects to any single intervention.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"27 ","pages":"e953541"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148875861","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}

引用次数: 0

Radiation Associated Undifferentiated Pleomorphic Sarcoma of the Neck 2 Decades After External Beam Radiation for Medullary Thyroid Carcinoma: A Case Report and Literature Review. 放射相关的颈部未分化多形性肉瘤2 在外部放射治疗甲状腺髓样癌几十年后：一个病例报告和文献复习。

IF 0.8

American Journal of Case Reports Pub Date : 2026-08-31 DOI: 10.12659/AJCR.953580

Tanya Odisho, Sedighe Esmaeilzade, Alexander Laskaris, Sungmi Jung, James Man Git Tsui, Sinziana Dumitra, Elliot Mitmaker

{"title":"Radiation Associated Undifferentiated Pleomorphic Sarcoma of the Neck 2 Decades After External Beam Radiation for Medullary Thyroid Carcinoma: A Case Report and Literature Review.","authors":"Tanya Odisho, Sedighe Esmaeilzade, Alexander Laskaris, Sungmi Jung, James Man Git Tsui, Sinziana Dumitra, Elliot Mitmaker","doi":"10.12659/AJCR.953580","DOIUrl":"10.12659/AJCR.953580","url":null,"abstract":"BACKGROUND Radiation therapy is critical for treating many solid tumors but increases the risk of secondary malignancies due to DNA damage. Radiation-associated sarcomas (RAS) occur in 0.03% to 0.8% of irradiated patients, typically 5 to 20 years after treatment. Undifferentiated pleomorphic sarcoma (UPS) is a common RAS subtype with poor 5-year survival (12%-14%). Risk rises with doses ≥50 Gy and is especially concerning in previously irradiated head and neck regions, where surgery is challenging. Germline mutations in DNA repair genes (eg, ATM) further increase susceptibility. CASE REPORT A 54-year-old man treated in 2003 for multifocal medullary thyroid carcinoma (thyroidectomy, bilateral neck dissection, adjuvant 59.4 Gy radiation) presented 22 years later with a painless neck mass. Imaging showed a 1.9-cm enhancing lesion within the prior radiation field. Excision revealed a 4-cm, FNCLCC grade 3 intramuscular UPS meeting the modified Cahan criteria for RAS. Immunohistochemistry excluded recurrent thyroid carcinoma. Margins were positive, but re-excision and re-irradiation were not feasible. The sarcoma tumor board recommended close surveillance and germline testing. This case involved high-grade UPS arising 2 decades after neck irradiation. Compared with sporadic UPS, RAS-associated UPS has worse disease-specific survival (~52% vs 76%) and higher local recurrence (~55% vs 24%), emphasizing the importance and difficulty of achieving negative margins in previously irradiated fields. CONCLUSIONS As cancer survival improves, lifelong vigilance for RAS remains essential. New masses in irradiated areas require prompt evaluation. Multidisciplinary management and consideration of genetic testing are critical, as treatment options are often limited by prior therapy.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"27 ","pages":"e953580"},"PeriodicalIF":0.8,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867236","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}

引用次数: 0