American Journal of Case Reports最新文献

{"title":"Necrotizing Fasciitis and Targeted Muscle Reinnervation in the Upper Extremity: A Case Report.","authors":"Joaquín Herrera Leigh, Carlos A Córdova, Sara Fischer","doi":"10.12659/AJCR.949459","DOIUrl":"https://doi.org/10.12659/AJCR.949459","url":null,"abstract":"<p><p>BACKGROUND Necrotizing fasciitis is a rare but increasingly prevalent, rapidly progressive soft tissue infection with high morbidity and mortality. While cases of lower limb involvement are more frequent, cases affecting the upper limb, especially leading to proximal major amputations, such as transhumeral amputation, are exceedingly rare. Targeted muscle reinnervation (TMR) is an innovative approach, aimed at improving postoperative outcomes and pain control. We report a case with sudden clinical presentation that was managed initially with emergency amputation. Postoperative neuroma-related pain was treated using TMR. CASE REPORT A 48-year-old man with untreated psoriasis sustained a right wrist crush injury. Initially discharged with mild contusion, he returned 48 h later with severe swelling, pain, and systemic symptoms. Imaging and laboratory test results indicated NF. Despite broad-spectrum antibiotics and ICU support, he developed septic shock and multi-organ failure. Six hours later, emergency transhumeral amputation was performed, with hemodynamic stabilization. After 2 additional debridements, he improved and was discharged. At 6 months, he had neuroma-related pain. TMR was performed, resolving the symptoms. He was in rehabilitation, awaiting prosthesis fitting and training, at the time of this report. CONCLUSIONS Upper limb NF is an uncommon but life-threatening condition requiring prompt diagnosis and aggressive treatment. The Laboratory Risk Indicator for Necrotizing Fasciitis score is a useful diagnostic tool, and early surgical intervention remains the cornerstone of therapy. When amputation is necessary, postoperative complications, including chronic and phantom limb pain, can occur. TMR is a promising surgical approach for reducing pain and improving function in upper limb amputees.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e949459"},"PeriodicalIF":0.7,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214228","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}

{"title":"Asystole Triggered by Swallowing: Insights From a Case of Infective Endocarditis in a 35-Year-Old HIV Patient.","authors":"Piotr Kalisz, Sabina Kostorz-Nosal, Magdalena Latos, Michał Zieliński, Bartłomiej Gałuszka, Krzysztof Irlik, Tomasz Hrapkowicz, Michał Glanowski, Krystian Jakimowicz, Szymon Skoczyński","doi":"10.12659/AJCR.947662","DOIUrl":"https://doi.org/10.12659/AJCR.947662","url":null,"abstract":"<p><p>BACKGROUND Asystole during swallowing is a rarely observed phenomenon attributable to several underlying factors. The present report documents a case of asystole during swallowing, caused by cardiac arrhythmias associated with infective endocarditis, resulting in diagnostic difficulties. CASE REPORT A man in his 30s infected with human immunodeficiency virus (HIV) was admitted to the hospital in serious condition due to pneumonia, decompensated type 1 diabetes, and systemic infection. His symptoms included chest discomfort, shortness of breath, elevated inflammatory markers, anemia, thrombocytopenia, and irregular, macular thickening in all lung fields on imaging tests, which suggested pneumocystosis. A subsequent angio-CT scan of the chest yielded a diagnosis of pulmonary embolism. Despite the implementation of both intensive and extensive treatment measures, his condition markedly deteriorated, further manifesting as asystole during swallowing. Echocardiography (ECG) revealed tricuspid valve vegetation, leading to a diagnosis of infective endocarditis. The patient received antibiotic treatment and further specialist care at a cardiac surgery center, including removal of tricuspid valve vegetation, which resulted in elimination of disruptions during swallowing. CONCLUSIONS Given the patient's atypical cardiac rhythm disturbances during swallowing, in conjunction with pneumonia, decompensated diabetes, and HIV, arriving at a diagnosis of endocarditis was a considerable challenge. This case study emphasizes the necessity of a comprehensive diagnostic assessment for patients with HIV, including ECG, even when the initial presentation is suggestive of pneumonia.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e947662"},"PeriodicalIF":0.7,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214251","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}

{"title":"Identifying 17-β-HSD3 Deficiency in Patients with Karyotype 46,XY Misdiagnosed with Androgen Insensitivity Syndrome: A Pediatric Case Report.","authors":"Beshaier Almulhem, Fatimah Mouayed AlJishi, Mohammad Al-Qahtani","doi":"10.12659/AJCR.948210","DOIUrl":"https://doi.org/10.12659/AJCR.948210","url":null,"abstract":"<p><p>BACKGROUND Defects in androgen synthesis, such as 17-beta-hydroxysteroid dehydrogenase type 3 (17-ß-HSD3) deficiency, can lead to ambiguous genitalia in people with karyotype 46,XY due to impaired testosterone and dihydrotestosterone production. This condition may be initially diagnosed as androgen insensitivity syndrome (AIS), an X-linked disorder characterized by female external genitalia, absence of Mullerian structures, inguinal testes, and primary amenorrhea in adolescence. This report describes the case of a 13-year-old phenotypic female with 46,XY karyotype and a history of virilization due to 17-ß-HSD3 deficiency, previously diagnosed with AIS. CASE REPORT We report the case of a 13-year-old phenotypic female who was initially diagnosed with AIS during early childhood at a rural hospital. Several years later, she presented to a pediatric endocrinology clinic with progressive signs of virilization, including hirsutism, deepening of the voice, and severe facial acne. Laboratory evaluation, including a human chorionic gonadotropin (hCG) stimulation test, revealed a markedly low testosterone-to-androstenedione (T/AND) ratio of 0.1, strongly suggestive of 17ß-HSD3 deficiency. Whole-exome sequencing identified a homozygous missense variant of uncertain significance in exon 4 of the HSD17B3 gene. As the patient had been raised as a female, the parents chose to maintain her female gender assignment. Subsequently, the patient underwent bilateral orchiectomy along with clitoroplasty and labioplasty at another medical center. CONCLUSIONS Genetic and hormonal testing play a crucial role in differentiating among various types of disorders of sex development, thereby reducing the risk of diagnostic uncertainty. Early referral to a pediatric endocrinologist is essential to ensure accurate diagnosis and appropriate management of affected individuals.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e948210"},"PeriodicalIF":0.7,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208089","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}

{"title":"Paraneoplastic Dermatomyositis in Patient with Primary Biliary Cirrhosis and Hepatocellular Carcinoma: A Case Report.","authors":"Stefka Neycheva, Daniela Stoyanova","doi":"10.12659/AJCR.949810","DOIUrl":"10.12659/AJCR.949810","url":null,"abstract":"<p><p>BACKGROUND Dermatomyositis is an autoimmune disease characterized by distinctive skin changes, muscle involvement, and, in many cases, damage to various organs, such as interstitial lung disease, arthritis, and myocarditis. The association between dermatomyositis and malignancies is well established. The most common cancers that manifest with a dermatomyositis are neoplasms of the breast, lungs, cervix, and gastrointestinal tract. Primary biliary cirrhosis is a slowly progressive autoimmune disease characterized by a triad of chronic cholestasis, positive specific autoantibodies, and characteristic imaging or pathomorphological findings. Regardless of etiology, cirrhosis is considered as a major risk factor for development of hepatocellular carcinoma. This type of liver neoplasm is rarely associated with dermatomyositis. CASE REPORT We report the case of a 64-year-old woman with comorbid primary biliary cirrhosis, hepatocellular carcinoma, and dermatomyositis as a paraneoplastic syndrome. Pathognomonic skin lesions of dermatomyositis, such as heliotrope rash, Gottron papules, Gottron sign, V-sign, and proximal muscle weakness preceded the diagnosis of biliary cholangitis and hepatocellular carcinoma by more than a year but were not initially recognized. The failure to identify the symptoms of dermatomyositis, combined with the lack of pronounced and specific signs of primary biliary cirrhosis and hepatocellular carcinoma, contributed to delayed diagnoses. The patient died due to severe, decompensated heart failure. CONCLUSIONS This case report emphasized the importance of precise interpretation of pathogenetic findings by all specialists involved. In patients with multiple comorbidities, close collaboration between specialists and an interdisciplinary approach are essential for timely diagnosis and the selection of appropriate treatment, which can significantly improve prognosis and outcome.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e949810"},"PeriodicalIF":0.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12499631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201721","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":"A Non-Stenting Approach to Left Main Thrombus in an Oncology Patient with Acute Heart Failure: A Case Report.","authors":"Vasileios Bouratzis, Christos S Katsouras, Christos Floros, Katerina K Naka, Lampros Lakkas, Aidonis Rammos, Spyridon-Athanasios Sioros, Eftychia Papaioannou, Ilias K Gartzonikas, Lampros K Michalis","doi":"10.12659/AJCR.947359","DOIUrl":"10.12659/AJCR.947359","url":null,"abstract":"<p><p>BACKGROUND Managing acute coronary syndrome in cancer patients poses significant challenges for cardiologists, who often encounter various complications. However, there are multiple therapeutic strategies available. The key lies in identification of the target lesion and early restoration of antegrade blood flow in cases in which it is affected. CASE REPORT We present a case of a 70-year-old man with a medical history of hypertension, type II diabetes mellitus, bioprosthetic aortic valve, coronary artery disease with prior PCI to the LAD, and metastatic prostate cancer who presented with chest pain and shortness of breath. The patient was hemodynamically unstable, with elevated lactates and troponin levels. He was diagnosed with cardiogenic shock secondary to N-STEMI. Coronary angiography revealed a high thrombotic burden at the LM bifurcation, which was managed with balloon angioplasty and medical therapy without stent implantation. Intravascular imaging with IVUS was performed 2 days later, which showed no dissections or significant stenosis. A conservative management strategy was implemented. CONCLUSIONS Cardiogenic shock is a life-threatening complication of N-STEMI, necessitating urgent coronary angiography and immediate revascularization. In certain cases, particularly those involving active malignancy, plain balloon angioplasty combined with optimal medical therapy can be a viable alternative to stent placement. Intravascular imaging assists in making the final decision. Cancer should not be considered a contraindication for invasive treatment in patients presenting with acute coronary syndrome.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e947359"},"PeriodicalIF":0.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12499628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207937","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":"Disseminated Peritoneal Leiomyomatosis of the Peritoneum Following Laparoscopic Supracervical Hysterectomy with Morcellation: A Case Report.","authors":"Jakub Młodawski, Marcin Majczak, Anna Zmelonek-Znamirowska, Jakub Kabza, Marta Młodawska, Zdzisław Domagała, Nina Zbylut, Piotr Lewitowicz, Grzegorz Świercz","doi":"10.12659/AJCR.948218","DOIUrl":"10.12659/AJCR.948218","url":null,"abstract":"<p><p>BACKGROUND Disseminated peritoneal leiomyomatosis is a rare complication of laparoscopic procedures involving uterine morcellation. These fibroid-like lesions, which derive their blood supply from non-uterine sources, may develop after myomectomy, supracervical hysterectomy, or total laparoscopic hysterectomy - particularly when mechanical morcellation is used. Although the incidence is low, disseminated leiomyomatosis should be considered in the differential diagnosis of abdominal or pelvic pain in patients with a history of such surgeries. CASE REPORT A 40-year-old woman presented with intermittent lower abdominal pain. She had undergone a laparoscopic supracervical hysterectomy with salpingectomy 5 years earlier due to abnormal uterine bleeding, during which uncontained mechanical morcellation was performed. At present, transvaginal ultrasound revealed a solid mass adjacent to the bladder with features suggestive of a leiomyoma. Magnetic resonance imaging (MRI) showed multiple lesions, including a polycyclic mass located above the bladder and additional foci near the sigmoid colon and the bladder dome. Laparoscopy confirmed the presence of leiomyomas on the anterior abdominal wall, sigmoid colon adventitia, and bladder dome. All lesions were excised using laparoscopic techniques, and the postoperative course was uneventful. Histopathological examination confirmed leiomyomas with positive estrogen and progesterone receptor expression. CONCLUSIONS This case underscores the importance of considering disseminated peritoneal leiomyomatosis in the differential diagnosis of abdominal or pelvic pain in patients with a history of laparoscopic hysterectomy with morcellation. It also emphasizes that this condition can mimic malignancy on imaging studies and highlights the essential role of histopathological examination in diagnosing this benign disease.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e948218"},"PeriodicalIF":0.7,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12495898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193405","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 Liver Dysfunction Within 48 Hours of Thionamide Therapy in Thyrotoxicosis: A Case Report.","authors":"Christopher Annabi, Laila Noor, Jamie A Mullally","doi":"10.12659/AJCR.948822","DOIUrl":"10.12659/AJCR.948822","url":null,"abstract":"<p><p>BACKGROUND Thionamides, including methimazole and propylthiouracil, are medications used to treat hyperthyroidism and have rarely been associated with liver failure. We present a case of fulminant liver failure within 2 days of initiation of high-dose methimazole and propylthiouracil. CASE REPORT A middle-aged woman with Graves disease was found to have biochemical hyperthyroidism and SARS-CoV-2 infection. She was started on methimazole, metoprolol, dexamethasone, and remdesivir. On hospital day 2, she developed atrial fibrillation with rapid ventricular response and flash pulmonary edema, requiring intubation. Methimazole was switched to propylthiouracil. On hospital day 3, severe elevations in aspartate aminotransferase, alanine aminotransferase, and total bilirubin levels were noted. Propylthiouracil was held, and liver biopsy demonstrated findings consistent with drug-induced liver injury. Liver function tests gradually improved over the subsequent weeks, with supportive measures. Once stabilized, the patient underwent a successful and uneventful total thyroidectomy and ultimately recovered fully. Most notable in our patient was the rapid onset of fulminant liver failure within 48 h of thionamide initiation, a finding that has yet to be reported elsewhere. CONCLUSIONS This case demonstrates an earlier timeframe for liver injury from thionamide use than is typically expected. Risk factors may include high-dose methimazole and propylthiouracil exposure as well as concurrent SARS-CoV-2 infection and brief treatment with remdesivir.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e948822"},"PeriodicalIF":0.7,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12495896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201724","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 Myoclonus Masking Thyroid Storm Following Etomidate Administration: A Case Report.","authors":"Ting Wang, Yun Wang, Xiaoning Zhu","doi":"10.12659/AJCR.947735","DOIUrl":"10.12659/AJCR.947735","url":null,"abstract":"<p><p>BACKGROUND Etomidate administration can induce thyroid storm-like symptoms, including tachycardia, palpitations, muscle weakness, tremors, hypermetabolism, and excessive sweating. The incidence of myoclonus after etomidate use is 50-80%, necessitating vigilant monitoring and management of patients. In contrast, thyroid storm is a critical complication of hyperthyroidism, involving a sudden surge in thyroid hormone levels, causing high fever, hypertension, severe arrhythmia, nervous system disturbances, and gastrointestinal symptoms, which require prompt medical attention to avert fatal outcomes. CASE REPORT A 37-year-old man underwent electronic bronchoscopy under general anesthesia due to pulmonary infection. Following induction with etomidate, he had severe myoclonus coupled with marked tachycardia, with a heart rate of 160-180 beats per minute. Despite intensifying the anesthesia, there was no notable amelioration in the myoclonus or tachycardia. Repeated administration of beta-blockers only managed to reduce the heart rate to approximately 150 beats per minute. The severe myoclonus and tachycardia persisted for about 20 minutes. Initially, we suspected that the severe myoclonus was a reaction to the etomidate injection. However, after conducting a more thorough history and laboratory tests, he was diagnosed with hyperthyroidism. On the first postoperative night, he had severe hypokalemia and bilateral lower-limb weakness, with muscle strength rated at 2 out of 5. Consequently, we concluded that this case involved severe myoclonus triggered by etomidate during general anesthesia, which obscured the symptoms of a thyroid storm. CONCLUSIONS This case provides a profound lesson and emphasizes the need for a comprehensive and vigilant approach in managing patients with hyperthyroidism undergoing surgical procedures.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e947735"},"PeriodicalIF":0.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12494298/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193458","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":"Complex Ocular Adverse Events Following Oxaliplatin Treatment: A Case Report.","authors":"Chao-Yang Zhao, Chang-Sheng Liao, Zi-You Yuan, Chen-Yue Zhao, Shao-Feng Hao, Hui-Lin Li","doi":"10.12659/AJCR.949346","DOIUrl":"10.12659/AJCR.949346","url":null,"abstract":"<p><p>BACKGROUND Ocular adverse events related to systemic chemotherapy are relatively rare and often underrecognized in clinical practice. We describe a unique case of severe ocular toxicity associated with oxaliplatin-based chemotherapy, presenting as multiple iris cysts, anterior chamber inflammation, retinal detachment, and lens opacity, ultimately resulting in significant vision loss. CASE REPORT A 47-year-old woman with adenocarcinoma of the esophagogastric junction underwent laparoscopic radical gastrectomy on March 4, 2024. Postoperatively, she was started on adjuvant oxaliplatin-based chemotherapy on April 7, 2024. After completing 3 cycles by May 18, 2024, she developed acute bilateral vision loss. Ophthalmologic evaluation revealed multiple iris cysts, anterior chamber inflammation, exudative retinal detachment, and bilateral dense cataracts. Laboratory investigations demonstrated markedly elevated systemic and aqueous humor IL-6 levels, while orbital CT and MRI excluded ocular metastasis. The patient was initially prescribed oral prednisone, but treatment was unsuccessful due to poor adherence. Subsequently, her regimen was modified to oxaliplatin monotherapy. Surgical interventions were performed in both eyes, leading to partial restoration of vision. However, postoperative examinations continued to show persistent retinal detachment and iris cysts, indicating incomplete recovery. CONCLUSIONS This case underscores the potential for oxaliplatin to induce severe and complex ocular toxicities, mimicking metastatic or inflammatory ocular diseases. Early recognition, comprehensive ophthalmologic evaluation, and interdisciplinary collaboration are essential to distinguish drug-induced events from tumor-related manifestations. Moreover, prompt adjustment of chemotherapy and timely ophthalmic intervention can mitigate irreversible visual impairment. Increased awareness of such complications can aid clinicians in tailoring management strategies and improving quality of life in patients receiving oxaliplatin-based chemotherapy.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e949346"},"PeriodicalIF":0.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12492991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186987","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":"Eosinophilic Fasciitis in a 78-Year-Old Man Following Pembrolizumab Treatment for Bladder Cancer.","authors":"Ibiyemi Oke, Aleksander Lenert, Brian L Swick, Petar Lenert","doi":"10.12659/AJCR.948323","DOIUrl":"10.12659/AJCR.948323","url":null,"abstract":"<p><p>BACKGROUND Immune checkpoint inhibitors (ICI) like pembrolizumab are increasingly used in cancer treatment and have become the standard of care for certain types of malignancies. Expanded use of these medications has led to more frequent recognition of immune-related adverse events (irAEs), including those presenting with sclerosing skin conditions such as eosinophilic fasciitis (EF). This case report describes the clinical presentation and management of a 78-year-old man with a history of bladder cancer who developed eosinophilic fasciitis after 6 months of treatment with an ICI. CASE REPORT Following 6 months of treatment with pembrolizumab, the patient developed capillary-leakage syndrome (CLS), which was treated with intravenous immunoglobulin (IVIG) and steroids. Several months after the resolution of his CLS, he developed painful hardening of the skin in his extremities and back, with notable induration of the skin and restricted range of motion across his elbows on physical examination. Laboratory workup revealed elevated inflammatory markers and eosinophilia. Skin biopsy revealed fibrosis of subcutaneous tissue and deep fascia, with multifocal collections of lymphocytes and plasma cells, consistent with eosinophilic fasciitis. Pembrolizumab was discontinued, and he received treatment with prednisone, mycophenolate mofetil, hydroxychloroquine, and benralizumab, with some improvement in his skin lesions. CONCLUSIONS This case report supports the need to have a high index of suspicion and investigate for eosinophilic fasciitis in cancer patients treated with anti-PD-1 medications who present with symmetric, painful hardening of the skin.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e948323"},"PeriodicalIF":0.7,"publicationDate":"2025-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12492994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186963","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}