American Journal of Case Reports最新文献

{"title":"A 29-Year-Old Man with Uncorrected Congenital Patent Ductus Arteriosus Presenting with Heart Failure and Pulmonary Artery Vegetations Removed During Surgery: A Case Report.","authors":"Charlotte Johanna Cool, Iwan Cahyo Santosa Putra, William Kamarullah, Norman Sukmadi, Miftah Pramudyo, Triwedya Indra Dewi, Pradana Pratomo Raharjo","doi":"10.12659/AJCR.947505","DOIUrl":"10.12659/AJCR.947505","url":null,"abstract":"<p><p>BACKGROUND Infective endocarditis (IE) involving isolated vegetations in the pulmonary artery is an exceedingly rare clinical entity. The absence of standardized guidelines regarding management and timing of intervention further complicates treatment decisions. This report describes the case of a 29-year-old man with uncorrected congenital patent ductus arteriosus (PDA) presenting with heart failure and pulmonary artery vegetations removed during PDA surgical ligation. CASE REPORT A 29-year-old man with a history of undiagnosed, untreated congenital heart disease presented with worsening symptoms of heart failure. Initial management included diuretic and empirical antibiotic therapy. Echocardiography and cardiac computed tomography revealed a large type C PDA with an 8.9 mm diameter, with multiple mobile vegetations in the pulmonary artery. Inflammatory markers and infection indicators showed significant improvement within 48 hours. On day 3, the patient underwent surgical evacuation of the pulmonary artery vegetations and PDA ligation. The surgery was successful, and vegetation cultures were negative, confirming blood culture-negative infective endocarditis. Given the potential for other difficult-to-culture bacterial infections, antibiotics were continued until 10 days postoperatively. The patient was discharged on day 10 in stable condition. Follow-up echocardiography showed significant improvement with reverse remodelling. CONCLUSIONS This case underscores the importance of aggressive surgical intervention for the removal of pulmonary artery vegetations, irrespective of their size, in reducing the risk of acute pulmonary embolism. The approach was safe, and no significant post-procedure adverse outcomes were noted, offering valuable insights into the management of IE with PDA and pulmonary artery involvement.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e947505"},"PeriodicalIF":1.0,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12153402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250084","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":"Efficacy of Hepatic Artery Infusion Chemotherapy with Bevacizumab and Sintilimab in Advanced Hepatocellular Carcinoma: A Case Report.","authors":"Chenguang Hua, Shanhe Huang, Bo Ding, Junru Chen, Chaofeng Ding","doi":"10.12659/AJCR.947317","DOIUrl":"10.12659/AJCR.947317","url":null,"abstract":"<p><p>BACKGROUND Hepatocellular carcinoma (HCC) with vascular invasion at advanced stage is not indicated for surgical options. Conversion therapy is used for unresectable HCC to downstage. Chemotherapy can be more precisely targeted to HCC by using hepatic artery infusion. Bevacizumab and sintilimab are available systemic therapies for HCC. This report describes a 50-year-old man with advanced HCC associated with multiple venous tumor thromboses treated with hepatic artery infusion chemotherapy (HAIC) combined with bevacizumab and sintilimab conversion therapy. CASE REPORT A 50-year-old man was admitted to the hospital due to elevated alpha-fetoprotein (AFP) level in July 2022. Abdominal computed tomography angiography (CTA) revealed a large HCC with multiple venous tumor thromboses. Pulmonary CTA detected arterial embolism and multiple solid nodules. He received HAIC combined with bevacizumab and sintilimab every 3 weeks, and achieved partial response after 3 cycles. However, in March 2023, levels of AFP and protein induced by vitamin K absence-II (PIVKA-II) were re-elevated, showing some pulmonary nodules were enlarged, which was confirmed as pulmonary metastases by positron emission tomography/computed tomography (PET/CT). Subsequently, transarterial chemoembolization (TACE) with bevacizumab and sintilimab was performed, and stereotactic body radiation therapy (SBRT) was used to treat pulmonary metastases. Skull metastasis appeared in March 2024, requiring further local radiotherapy. Despite this, the patient has survived for over 26 months, with a progression-free survival (PFS) of 8 months. CONCLUSIONS HAIC combined with bevacizumab and sintilimab can alleviate primary HCC and tumor thromboses, and further local radiotherapy can control the progression of distant metastases, prolonging the survival time of patients with advanced HCC.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e947317"},"PeriodicalIF":1.0,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12153404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250086","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":"Successful Correction of Lower-Limb Malunions Using Intramedullary Nailing and Chipping Osteotomy: A Case Series.","authors":"Ryota Nishida, Tomoaki Fukui, Takahiro Niikura, Yohei Kumabe, Yutaka Matsumiya, Yuya Yamamoto, Hyuma Kondo, Jonathan Jonathan, Genta Fukumoto, Ryosuke Kuroda, Keisuke Oe","doi":"10.12659/AJCR.947845","DOIUrl":"10.12659/AJCR.947845","url":null,"abstract":"<p><p>BACKGROUND Lower-limb fracture malunion can result in angular deformity that requires surgical correction. Chipping corrective osteotomy (CCO) is a novel method that involves a chipping technique at the center of rotation of angulation, followed by single-stage internal fixation. This case series describes 3 cases of correction of fracture malunion of the lower limb managed using combined CCO and intramedullary nail stabilization. CASE REPORT Case 1: A 47-year-old man with a 17° varus deformity of the left tibia from a past accident had left knee pain. CCO was performed, achieving bone union in 4 months. The Mikulicz line improved from -11% to 23%, and his knee became pain-free. Case 2: A 59-year-old man with a 19° valgus deformity of the right tibia from a past accident had right knee pain. CCO was performed, achieving bone union in 11 months. The Mikulicz line improved from 119% to 72%, and he could perform daily activities pain-free. Case 3: A 59-year-old man with a complex left distal femoral deformity (25° varus and 15° internal rotation) from a past accident had left knee pain. CCO was performed, achieving bone union in 8 months. The Mikulicz line improved from -52% to 4%, and he started enjoying jogging. CONCLUSIONS We performed CCO combined with intramedullary nail stabilization in 3 cases of post-traumatic angular and rotational malunion, achieving good clinical outcomes. This single-stage surgery is advantageous for bone healing and is cost-effective, making it a viable option for correcting long-bone malunion.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e947845"},"PeriodicalIF":1.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12150809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235487","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":"Crystalline Nephropathy Due to 2,8-Dihydroxyadeninuria in a Transplanted Kidney: 2 Case Reports.","authors":"Hafiz Muhammad Ali Raza, Atif Ibrahim, Manish Talwar, Vasanthi Balaraman, Anshul Bhalla, Barry M Wall, L Nicholas Cossey","doi":"10.12659/AJCR.946972","DOIUrl":"10.12659/AJCR.946972","url":null,"abstract":"<p><p>BACKGROUND The renal condition known as 2,8-dihydroxyadeninuria is an autosomal recessive disorder caused by adenine phosphoribosyl transferase (APRT) deficiency, which most commonly manifests as nephrolithiasis. APRT deficiency has also led to the development of chronic kidney disease and end-stage kidney disease in the absence of nephrolithiasis and has also been shown to recur following kidney transplantation. CASE REPORT This report aims to highlight the diagnostic and therapeutic challenges associated with APRT deficiency by presenting 2 patients with end-stage kidney disease who developed 2,8-dihydroxyadenine (DHA) crystalline nephropathy early in their post-transplant course. Neither patient had been diagnosed with APRT deficiency prior to transplantation, and one lacked a history of nephrolithiasis. Allograft biopsies revealed DHA crystal deposition with acute tubular injury, and genetic analysis confirmed APRT deficiency. Management included xanthine oxidase inhibitors, a low-purine diet, and modification of the immunosuppressive regimen with belatacept to reduce long-term tubulointerstitial injury. Both patients achieved stable long-term allograft function at 2 years, with follow-up biopsies at 1 year, showing a significant decrease in crystal deposition. CONCLUSIONS This case report underscores the importance of early recognition of APRT deficiency through timely biopsy, crystal identification, and genetic testing to guide effective treatment and prevent irreversible damage. It highlights the need for heightened clinical suspicion and tailored post-transplant management strategies in patients with recurrent DHA nephropathy.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e946972"},"PeriodicalIF":1.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12150807/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250085","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":"Emergency Radiation Therapy for Hemorrhage in Botryoides Sarcoma: A Pediatric Case Report.","authors":"Setyo Teguh Waluyo, Hariadi Yuseran, Ferry Armanza, Fendy Frans Elya Cohen Manalu","doi":"10.12659/AJCR.946434","DOIUrl":"10.12659/AJCR.946434","url":null,"abstract":"<p><p>BACKGROUND Botryoid rhabdomyosarcoma is a subtype of embryonal rhabdomyosarcoma and is a rare and highly vascular malignant childhood tumor, with the most common sites of origin being the vagina and cervix in young girls. This report describes the case of a 15-year-old girl presenting with vaginal hemorrhage due to botryoid rhabdomyosarcoma treated with emergency radiation therapy. Hemorrhage in botryoid rhabdomyosarcoma can present as a life-threatening emergency requiring immediate intervention. This case highlights the role of emergency external radiation therapy as a valuable adjunct in managing hemorrhage in botryoid rhabdomyosarcoma, especially when surgical options are limited. CASE REPORT We report a case of a 15-year-old girl who experienced repeated profuse episodes of vaginal bleeding and protruding mass in the vagina for 2 months. She had no significant medical history or family history of cancer. Magnetic resonance imaging (MRI) confirmed a massive malignant mass in the vaginal introitus that infiltrated the cervix, extending to the uterus. Based on the histopathology result, the diagnosis was botryoid rhabdomyosarcoma with a primary site located on the cervix, and due to the emergency situation and the risks associated with surgical intervention, emergency external radiation therapy was initiated. After 1 session of radiation therapy, the bleeding was significantly reduced. CONCLUSIONS Hemorrhage in botryoid rhabdomyosarcoma is a rare but critical complication. Emergency external radiation therapy helps stabilize the patient with acute bleeding caused by botryoid rhabdomyosarcoma. Further research is needed to find the optimal treatment strategies.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e946434"},"PeriodicalIF":1.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12150811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144226998","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":"Non-Invasive Detection of Recurrent Intracranial Pressure via Optical Coherence Tomography: A Case Report.","authors":"Barbara Nowacka, Wojciech Lubiński","doi":"10.12659/AJCR.947484","DOIUrl":"10.12659/AJCR.947484","url":null,"abstract":"<p><p>BACKGROUND Papilledema is a common sign of increased intracranial pressure (ICP). However, detecting relapse of increased ICP is difficult because once optic nerve atrophy is present, re-swelling of the optic nerve head is not expected to be visible on fundoscopy. CASE REPORT This report describes the case of a 23-year-old woman with a ventriculoperitoneal shunt implanted at the age of 11 years due to idiopathic hydrocephalus presenting swelling of the peripapillary nerve fiber layer (pRNFL) on optical coherence tomography (OCT) without visible papilledema. She had been having headaches, nausea, and visual acuity deterioration. A neurological examination and fundus evaluation of both eyes showed pallor of the optic nerves without clinically visible disc edema, and magnetic resonance imaging (MRI) of the head did not reveal any signs of increased intracranial pressure. In the following days, after bilateral abducens nerve palsy occurred, a lumbar puncture removing cerebrospinal fluid was performed to temporarily reduce ICP. After the procedure, all her symptoms were resolved, visual acuity improved, and pRNFL swelling was reduced. CONCLUSIONS Optical coherence tomography is a quick, non-invasive, sensitive, and objective in vivo method for monitoring recurrence of increased ICP and treatment response. Therefore, OCT should be performed in all patients suspected to have high ICP when an ophthalmological examination does not reveal papilledema, especially in all cases with optic atrophy.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e947484"},"PeriodicalIF":1.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12150812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235486","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":"Local Injection of Fluid Gelatin Under Contrast-Enhanced Ultrasound Guidance for Treating Active Bleeding From the Inferior Epigastric Artery: A Case Report.","authors":"Xiaohui Li, Ningbo Zhao, Lin Zhong, Yu Zhang, Yongfang Luo","doi":"10.12659/AJCR.947297","DOIUrl":"10.12659/AJCR.947297","url":null,"abstract":"<p><p>BACKGROUND Injury to the inferior epigastric artery is a major complication of abdominal puncture, and continuous active bleeding from this artery can lead to hemorrhagic shock. Several studies have reported the use of contrast-enhanced ultrasound (CEUS) to diagnose active bleeding in parenchymal organs. Fluid gelatin is a new hemostatic material that can be injected into the bleeding site by using a puncture needle under the precise guidance of CEUS, which enables the implementation of local minimally invasive and appropriate hemostatic treatment. Here, we report the case of a patient in whom CEUS was used to accurately locate the bleeding site before surgery and guide local injection of fluid gelatin with a puncture needle to successfully achieve nonsurgical treatment of hemostasis. CASE REPORT A 62-year-old man with post-hepatitis B cirrhosis underwent a successful liver transplant surgery. After surgery, abdominal puncture and drainage were performed because of a large amount of peritoneal effusion due to nephrotic syndrome. The drainage fluid was bright red bloody liquid. CEUS revealed many contrast agent microbubbles extravasating from the inferior epigastric artery into peritoneal effusion along the abdominal puncture tract. Surgical suturing and applying a compression bandage failed to achieve satisfactory results. After receiving the patient's consent, thrombin and hemostatic glue were injected locally under the guidance of CEUS. Finally, hemostasis was successfully achieved. CONCLUSIONS CEUS-guided injection of fluid gelatin is a safe and effective treatment method and could serve as an effective measure for nonsurgical treatment and postoperative supplementary treatment of active bleeding from the inferior epigastric artery.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e947297"},"PeriodicalIF":1.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12147519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217169","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":"Lung Transplant Success in Severe Diquat Poisoning: A Case Report.","authors":"Fanjie Meng, Yan Zhang, Hongfei Cai, Fanyu Meng, Bohao Liu, Yang Li","doi":"10.12659/AJCR.947421","DOIUrl":"10.12659/AJCR.947421","url":null,"abstract":"<p><p>BACKGROUND Diquat is a commonly used herbicide in China, which has the potential to induce severe or fatal poisoning in humans. Diquat is extremely lethal to humans and there is no antidote available. CASE REPORT We report the case of a 26-year-old woman who experienced nausea, vomiting, coughing, and general fatigue after ingesting 80 mL of 20% diquat. Due to the toxic effects of diquat, the patient's condition progressed rapidly, resulting in sequential impairments of liver and kidney function, as well as the development of pulmonary fibrosis. Prior to the surgical procedure, she was supported by extracorporeal membrane oxygenation (ECMO) to manage the preoperative dyspnea. On the 28th day, she a double-lung transplant. On the 8th postoperative day, she was diagnosed with a pulmonary embolism and subsequently accepted right upper-lobe resection surgery. On the 175th postoperative day, she patient was diagnosed with airway stenosis and then underwent tracheal covered stent implantation. Following the lung transplantation, she participated in an active rehabilitation program, complied with the prescribed anti-rejection medication regimen, attended regular follow-up appointments, and had a favorable prognosis. CONCLUSIONS Lung transplantation is currently the most effective treatment for pulmonary fibrosis, and ECMO serves as a temporary support mechanism for patients who have experienced severe diquat poisoning and are awaiting lung transplantation. The complex perioperative complications of the diquat itself can be successfully managed by a multidisciplinary team. The clinicians should be aware of the risk of pulmonary embolism after lung transplantation.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e947421"},"PeriodicalIF":1.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12144919/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209737","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":"An Innovative Endovascular Approach to Pancreatic Transplant Artery Y-Graft Aneurysm Complications Using Elective Endovascular Techniques: A Case Report.","authors":"Pooja Krishnaswamy, Ming Yii","doi":"10.12659/AJCR.946786","DOIUrl":"10.12659/AJCR.946786","url":null,"abstract":"<p><p>BACKGROUND Pancreatic transplant is the only definitive treatment to restore normoglycemia for autoimmune type 1 diabetes, but it is associated with significant morbidity due to its complexity from the index operation and sequelae. Vascular complications, including thrombosis and pseudoaneurysms, can have significant impacts on pancreatic transplant graft function. CASE REPORT Pancreatic transplant artery aneurysm is a rare complication of pancreas transplant. Vascular complications of transplants, including aneurysm rupture, are life-threatening and can require transplant pancreatectomy. We present a rare case of a chronic pancreatic transplant Y-graft arterial pseudoaneurysm of unknown etiology, 20 years after the initial simultaneous pancreas and kidney transplant. Due to the chronicity, previous significant adhesiolysis from a cholecystectomy, unlikelihood of a mycotic aneurysm, and concern for thrombus propagation leading to graft dysfunction, an endovascular approach was used. A combination of covered endovascular stents was deployed to maintain adequate blood flow to the pancreas allograft. Following endovascular Y-stenting, the patient maintained pancreatic graft function with no signs of allograft rejection. CONCLUSIONS Endovascular stenting can be used to treat chronic transplant pancreatic artery aneurysms and offers a less invasive treatment alternative to open surgery.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e946786"},"PeriodicalIF":1.0,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12143180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200268","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":"Accessory Nerve Palsy as the Initial Manifestation of Chronic Lymphocytic Leukemia: A Case Report.","authors":"Zaid Al-Deerawi, Ali Shaladi, Anton G Borg, Matt Stanislas, Husham Barrak","doi":"10.12659/AJCR.948534","DOIUrl":"10.12659/AJCR.948534","url":null,"abstract":"<p><p>BACKGROUND Chronic lymphocytic leukemia is the most common leukemia affecting adults, classically presenting with painless lymphadenopathy or diagnosed incidentally on routine full blood count. Neurological complications rarely arise in chronic lymphocytic leukemia and the underlying causes for such complications remain poorly understood. Cranial nerve involvement is uncommon and there are currently no reported cases of accessory nerve palsy as the first presentation of chronic lymphocytic leukemia. CASE REPORT A woman in her 40s presented with a 4-week history of left-sided neck swelling and pain associated with left shoulder restriction. Left trapezius weakness and scapular winging was found on examination, consistent with a left accessory nerve palsy. Examination also revealed multiple tender lymph nodes in the left posterior triangle of the neck. Investigations included a staging CT scan, flexible nasendoscopy, nerve conduction studies, and a full blood count showing lymphocytosis. A work-up involving Ear, Nose, and Throat Surgery, Hematology, and Orthopedic Surgery led to the diagnosis of chronic lymphocytic leukemia. There was no evidence of Richter's transformation. A multidisciplinary team approach was used to treat the patient, and there was complete resolution of her neurological symptoms on follow-up. CONCLUSIONS This report describes an unusual first presentation of chronic lymphocytic leukemia. It serves as a reminder to consider hematological malignancies in cases of accessory nerve palsy associated with a neck swelling. Early input from Hematology and multidisciplinary involvement can aid early diagnosis and prevent unnecessary investigations. Further research is warranted to explore the neurological spectrum of CLL.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e948534"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12139459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144226997","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}