American Journal of Case Reports最新文献_第2页

A Rare Case of Metastatic Adrenocorticotrophic Hormone - Secreting Pancreatic Neuroendocrine Tumor Causing Ectopic Cushing Syndrome in a 46-Year-Old Woman.

IF 1

American Journal of Case Reports Pub Date : 2025-04-03 DOI: 10.12659/AJCR.945653

Jessica Y Huang, Nikitha A Cherayil, Paul Boyd, Maher Ali, Shazia Samanani

{"title":"A Rare Case of Metastatic Adrenocorticotrophic Hormone - Secreting Pancreatic Neuroendocrine Tumor Causing Ectopic Cushing Syndrome in a 46-Year-Old Woman.","authors":"Jessica Y Huang, Nikitha A Cherayil, Paul Boyd, Maher Ali, Shazia Samanani","doi":"10.12659/AJCR.945653","DOIUrl":"10.12659/AJCR.945653","url":null,"abstract":"BACKGROUND Adrenocorticotrophic hormone (ACTH)-secreting pancreatic neuroendocrine tumors (pNETs) are rare and poorly understood entities. Only 1-2% of pancreatic neoplasms are pNETs, and even fewer are hormone-secreting. They can present indolently or with overt Cushing syndrome. Their diagnosis involves complex multi-modal imaging and laboratory evaluation. Management includes medications, such as somatostatin analogs and ketoconazole, as well as surgical resection for definitive treatment. This report describes a 46-year-old woman who presented with overt Cushing syndrome and was ultimately diagnosed with a pNET. CASE REPORT This patient's initial symptoms and laboratory testing were consistent with Cushing syndrome. A high-dose dexamethasone suppression test suggested ectopic ACTH production, and magnetic resonance imaging (MRI) of the brain showed a pituitary microadenoma. However, computed tomography (CT) of the abdomen and endoscopic ultrasound-guided biopsy with immunohistochemistry confirmed a pancreatic mass as the source of ACTH production with potential hepatic metastasis. Her Cushing syndrome was managed with ketoconazole and octreotide. Subsequently, >99% of the pNET was surgically removed, resulting in reversal of her Cushing syndrome. Currently, she is being monitored closely for recurrence. CONCLUSIONS Our management of this ACTH-secreting pNET highlights the complexities of diagnosis and multidisciplinary treatment options, which are underrepresented in the current literature on this rare entity. This case emphasizes the challenges in evaluation, including the importance of early and precise diagnosis in the face of potential confounders.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e945653"},"PeriodicalIF":1.0,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774440","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

Two Case Reports of Interferon-γ Therapy in Patients with Aspergillus Tracheobronchitis Who Developed an Immunocompromised State After Severe Abdominal Sepsis.

IF 1

American Journal of Case Reports Pub Date : 2025-04-02 DOI: 10.12659/AJCR.945318

Teun Tramper, Jeroen Schouten, Matthijs Kox, Dorien Kiers

{"title":"Two Case Reports of Interferon-γ Therapy in Patients with Aspergillus Tracheobronchitis Who Developed an Immunocompromised State After Severe Abdominal Sepsis.","authors":"Teun Tramper, Jeroen Schouten, Matthijs Kox, Dorien Kiers","doi":"10.12659/AJCR.945318","DOIUrl":"10.12659/AJCR.945318","url":null,"abstract":"BACKGROUND Aspergillus tracheobronchitis is a rare, high mortality condition typically seen in immunocompromised patients. Although commonly associated with classic immunocompromising conditions, such as immunosuppression due to chemotherapy or corticosteroids, or neutropenia, it can also develop in patients with sepsis-induced immunoparalysis, which is the term used to describe an immunocompromised state that results of imbalances in the inflammatory response in sepsis. Immunostimulatory therapy with interferon (IFN)-γ can be a viable treatment option in these cases. CASE REPORT We present 2 cases of patients without relevant medical history who developed severe abdominal sepsis. In the subsequent weeks, both patients developed several infectious complications, including invasive Aspergillus tracheobronchitis. Both patients exhibited signs of sepsis-induced immunoparalysis, including low monocytic human leukocyte antigen DR expression. In a novel treatment approach, we administered IFN-γ immunotherapy alongside standard antifungal treatment to address the underlying immunoparalysis. This combined therapy successfully cleared the Aspergillus infection in both patients. However, 1 patient died of respiratory failure due to an obstruction of necrotic tissue in the trachea 15 weeks after the start of IFN-γ treatment. CONCLUSIONS We hypothesize that a combination of sepsis-induced immunoparalysis and local ischemia of the trachea may have predisposed these patients to develop an invasive Aspergillus tracheobronchitis. This case series demonstrates the potential efficacy of immunostimulatory therapy with IFN-γ in treating opportunistic fungal infections in the context of sepsis-induced immunoparalysis. Our findings thereby underscore the importance of considering immunomodulatory approaches in managing complex infections in critically ill patients with acquired immune dysfunction.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e945318"},"PeriodicalIF":1.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774446","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

Successful Treatment of a 42-Year-Old Man with Concurrent Anti-Glomerular Basement Membrane Disease and Anti-Phospholipase A2 Receptor Antibody-Positive Membranous Nephropathy: A Case Report.

IF 1

American Journal of Case Reports Pub Date : 2025-04-02 DOI: 10.12659/AJCR.946245

Cuirong Hu, Jinkun Wang, Yaping Zhan, Jifang Lu, Jinling Ye, Jianan Chen, Wenyan Zhou, Chaojun Qi, Minfang Zhang, Leyi Gu, Na Jiang

{"title":"Successful Treatment of a 42-Year-Old Man with Concurrent Anti-Glomerular Basement Membrane Disease and Anti-Phospholipase A2 Receptor Antibody-Positive Membranous Nephropathy: A Case Report.","authors":"Cuirong Hu, Jinkun Wang, Yaping Zhan, Jifang Lu, Jinling Ye, Jianan Chen, Wenyan Zhou, Chaojun Qi, Minfang Zhang, Leyi Gu, Na Jiang","doi":"10.12659/AJCR.946245","DOIUrl":"10.12659/AJCR.946245","url":null,"abstract":"BACKGROUND Anti-glomerular basement membrane (anti-GBM) disease is an autoimmune disease mediated by deposit of antibodies to collagen type IV in glomerular and alveolar basement membranes. Membranous nephropathy (MN) is characterized by thickening of the glomerular capillary walls due to immune complex deposition. Anti-GBM disease can occur in conjunction with a second disease. However, simultaneous presentation of anti-GBM disease with MN has rarely been described. Here, we present a case of a 42-year-old man with combined anti-GBM disease and anti-phospholipase A2 receptor (PLA2R) antibody-positive membranous nephropathy. CASE REPORT A 42-year-old man was admitted due to acute kidney injury and proteinuria. Serum anti-GBM antibody was positive and the patient was diagnosed with anti-GBM disease without alveolar hemorrhage on day 2. Double-filtration plasmapheresis (DFPP) was performed starting on day 3, and intravenous methylprednisolone and cyclophosphamide were administrated. Kidney biopsy was performed on day 24 and demonstrated co-existence of anti-GBM disease and PLA2R antibody-positive MN. After discharge, the patient continued to receive oral corticosteroid and serial injections of cyclophosphamide over a course of 6 months. His kidney function recovered and MN reached partial remission. CONCLUSIONS We report the case of a 42-year-old man with concurrent anti-GBM disease and PLA2R antibody-positive MN. Early diagnosis and prompt treatment with a combined regimen of corticosteroid, cyclophosphamide, and DFPP were essential factors in the patient's successful recovery.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e946245"},"PeriodicalIF":1.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765300","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 Complex Case of Testicular Choriocarcinoma in Cryptorchidism and Choriocarcinoma Syndrome: Clinical and Treatment Insights.

IF 1

American Journal of Case Reports Pub Date : 2025-04-01 DOI: 10.12659/AJCR.946461

Nik Marina Nik Ibrahim, Salma Yasmin Mohd Yusuf, Khariah Mat Nor, Pei Yeing Teoh, Anis Safura Ramli

{"title":"A Complex Case of Testicular Choriocarcinoma in Cryptorchidism and Choriocarcinoma Syndrome: Clinical and Treatment Insights.","authors":"Nik Marina Nik Ibrahim, Salma Yasmin Mohd Yusuf, Khariah Mat Nor, Pei Yeing Teoh, Anis Safura Ramli","doi":"10.12659/AJCR.946461","DOIUrl":"10.12659/AJCR.946461","url":null,"abstract":"BACKGROUND Testicular choriocarcinoma is a rare, non-seminomatous germ cell tumor (NSGCTs) that accounts to less than 1% of all testicular malignancies. There are no clear criteria for its definitive management. Typically, cases of testicular choriocarcinoma have a grim prognosis, involving hematogenous spread to the lymph nodes, lungs, liver, bones and brain. CASE REPORT This report describes the case of a 52-year-old man with an untreated cryptorchidism who presented to a primary care clinic with a painless swelling in the right inguinal region, which was progressively increasing in size over 3 months. He was married and had 3 children. Physical examinations revealed a right inguinal swelling measuring 20 cm (length)×11 cm (width)×10 cm (depth), extending into the scrotum. Urgent referral to the urologist was made and investigations revealed markedly elevated beta human chorionic gonadotropin (bhCG) at 236 335 IU/L. The contrast-enhanced computed tomography (CECT) scans of the abdomen and pelvis confirmed testicular cancer with metastasis to the lymph nodes, liver, lungs and bones. The patient underwent 6 cycles of neoadjuvant chemotherapy, followed by orchidectomy and adjuvant chemotherapy. Histopathological results confirmed testicular choriocarcinoma with the presence of lymphovascular invasion, which indicates a poor prognosis. Despite initial response to treatment, he experienced seizures 2 months postoperatively, and subsequent computed tomography (CT) scans indicated brain metastasis. Unfortunately, 10 months after diagnosis he died due to the disease resulting from choriocarcinoma syndrome. CONCLUSIONS Testicular choriocarcinoma poses a significant clinical challenge due to its rarity and aggressiveness. Individualized and multidisciplinary management approaches are essential for effectively addressing this challenging condition.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e946461"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11970533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765297","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}

引用次数: 0

Early-Onset COPD and Lung Cancer: Case Studies Highlighting Diagnostic Challenges in Younger Patients.

IF 1

American Journal of Case Reports Pub Date : 2025-04-01 DOI: 10.12659/AJCR.946280

Robert Uliński, Piotr Korczyński, Joanna Domagała-Kulawik

{"title":"Early-Onset COPD and Lung Cancer: Case Studies Highlighting Diagnostic Challenges in Younger Patients.","authors":"Robert Uliński, Piotr Korczyński, Joanna Domagała-Kulawik","doi":"10.12659/AJCR.946280","DOIUrl":"10.12659/AJCR.946280","url":null,"abstract":"BACKGROUND The coexistence of lung cancer with COPD has received increasing attention in recent years. These 2 entities are attributed to older age, with a mean age of around 70 years old. Here, we present 3 fatal cases of lung cancer and COPD in uncommonly young patients (45-55 years old). CASE REPORT The first patient, 46-year-old man, reported progressive tiredness, and recurrent sub-febrile states, without recovery despite empiric treatment with 3 antibiotics. He was diagnosed with SCC and referred for chemoradiotherapy, but he died within 6 months. The second patient was 53-year-old women with hemoptysis, tiredness, loss of weight, spine pain, and cough, who was first diagnosed with pneumonia. Her first bronchoscopy was not diagnostic. A second bronchoscopy performed 2 weeks later was successful and she was diagnosed with large-cell carcinoma. She was referred for chemoradiotherapy, but died within 1 month. The third patient was 50-year-old women with chest pain radiating to her left shoulder and hoarseness. She was diagnosed with advanced SCLC, and was referred immediately for chemotherapy with immunotherapy, but did not respond well to treatment and died a few months later. CONCLUSIONS Age seems to be one of the factors that can delay cancer diagnosis. To the best of our knowledge, the literature contains no reports about young patients with coexistence of lung cancer and COPD. We emphasize the importance of these diseases in differential diagnosis in younger patients when reported with systemic symptoms.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e946280"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11970535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754564","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}

引用次数: 0

Overcoming Cytomegalovirus Induced Immune Thrombocytopenia in Immunocompetent Adults - A Case of Antiviral Therapy Efficacy.

IF 1

American Journal of Case Reports Pub Date : 2025-03-31 DOI: 10.12659/AJCR.947070

Sujatha Baddam, Mrudula Thiriveedi, Siddharth Patel

{"title":"Overcoming Cytomegalovirus Induced Immune Thrombocytopenia in Immunocompetent Adults - A Case of Antiviral Therapy Efficacy.","authors":"Sujatha Baddam, Mrudula Thiriveedi, Siddharth Patel","doi":"10.12659/AJCR.947070","DOIUrl":"10.12659/AJCR.947070","url":null,"abstract":"BACKGROUND Cytomegalovirus (CMV) infection is typically asymptomatic in immunocompetent individuals but can cause severe complications, such as immune thrombocytopenic purpura (ITP). This case report describes an uncommon instance of CMV-induced ITP in a 36-year-old immunocompetent man who was refractory to steroids and intravenous immunoglobulin (IVIG) and responded to antiviral therapy. CASE REPORT A previously healthy 36-year-old White man presented with flu-like symptoms, including subjective fevers, anorexia, nausea, cough, and a 6.8-kg weight loss over 2 weeks. Initial laboratory test results revealed severe thrombocytopenia (platelet count 4×10⁹/L) alongside elevated lymphocyte counts and mild splenomegaly. Additional serology confirmed a positive CMV IgM antibody. The patient was identified as having ITP and was treated with high-dose methylprednisolone and platelet transfusion, leading to initial platelet recovery. However, he returned within a week with severe epistaxis and a critical drop in platelet count to 0×10⁹/L. Subsequent testing confirmed CMV infection, with a viral load of 8790 copies/mL viral load. After unsuccessful IVIG treatment, antiviral therapy with valganciclovir was initiated, leading to a sustained increase in platelet count and eventual symptom resolution. CONCLUSIONS CMV-induced ITP, although rare in immunocompetent individuals, should be considered in cases of refractory thrombocytopenia unresponsive to standard therapies. Prompt diagnosis and the initiation of targeted antiviral therapy are crucial for effective recovery, as they address the underlying viral etiology and can significantly improve patient outcomes. This case underscores the importance of including CMV in the differential diagnosis for persistent thrombocytopenia to ensure timely and appropriate treatment.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e947070"},"PeriodicalIF":1.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11970534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754695","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}

引用次数: 0

Endovascular Stenting and Factor Xa Inhibitors for Filter-Associated Chronic IVC Occlusion: A Case Series.

IF 1

American Journal of Case Reports Pub Date : 2025-03-31 DOI: 10.12659/AJCR.946402

Pengkai Cao, Xintong Luo, Ruijiao Gao, Yunsong Li, Liang Li, Yanrong Zhang, Xiangdong Liu

{"title":"Endovascular Stenting and Factor Xa Inhibitors for Filter-Associated Chronic IVC Occlusion: A Case Series.","authors":"Pengkai Cao, Xintong Luo, Ruijiao Gao, Yunsong Li, Liang Li, Yanrong Zhang, Xiangdong Liu","doi":"10.12659/AJCR.946402","DOIUrl":"10.12659/AJCR.946402","url":null,"abstract":"BACKGROUND Chronic inferior vena cava (IVC) occlusion is a serious long-term complication of inferior vena cava filters (IVCFs) placement, which can lead to severe post-thrombotic syndrome (PTS). Endovascular management associated with anticoagulation may be one of limited options. Here, we present 3 patients with chronic filter-associated IVC occlusion managed with endovascular stenting and Factor Xa inhibitor infusion. CASE REPORT Case 1: A 48-year-old man who presented bilateral lower-extremity swelling, hyperpigmentation, and refractory venous ulcerations with a permanent IVCFs placements 16 years before admission was diagnosed as having filter-associated chronic IVC occlusions. Recanalization was performed through endovascular therapy, and factor Xa inhibitor was selected for antithrombotic therapy. Although in-stent occlusion was discovered on the left limb during 1-year follow-up, relief of symptoms was achieved at 36-month follow-up. Case 2: A 75-year-old man with a 6-year history of bilateral lower-extremity swelling, hyperpigmentation, and refractory venous ulcerations was found to have chronic IVC occlusions due to permanent IVCFs. Endovascular therapy and factor Xa inhibitor were chosen for revascularization, and symptomatic relief and stents patency were maintained until the last follow-up (30 months). Case 3: A 46-year-old man diagnosed with filter-associated chronic IVC occlusions underwent endovascular stenting and factor Xa inhibitor infusion. Improvement was shown during the first-year follow-up, but recurrence of symptoms and in-stent occlusions were discovered at 18-month follow-up for anticoagulation withdrawal. CONCLUSIONS Despite risks of in-stent occlusions, factor Xa inhibition associated with endovascular may be a safe and feasible management of filter-associated chronic IVC occlusion.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e946402"},"PeriodicalIF":1.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11970536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754586","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}

引用次数: 0

Multidisciplinary Management of Pregnancy in Bladder Exstrophy: A Case Report.

IF 1

American Journal of Case Reports Pub Date : 2025-03-30 DOI: 10.12659/AJCR.946782

Marija Batkoska, Polona Pečlin

{"title":"Multidisciplinary Management of Pregnancy in Bladder Exstrophy: A Case Report.","authors":"Marija Batkoska, Polona Pečlin","doi":"10.12659/AJCR.946782","DOIUrl":"10.12659/AJCR.946782","url":null,"abstract":"BACKGROUND Classic bladder exstrophy (CBE) is a rare congenital condition affecting multiple organs, primarily the urinary and musculoskeletal systems. Management involves multiple reconstructive surgical procedures and aims to maintain renal function, achieve urinary continence, and support normal reproductive health. Pregnancies in women with CBE can be complicated by recurrent urinary tract infections, pelvic prolapse, and a higher risk of preterm birth. CASE REPORT We report the case of a 33-year-old woman with a history of CBE, admitted at 32 weeks of pregnancy with fever and symptoms of a urinary tract infection. Her medical history included multiple surgeries, including formation of neovesica from the cecum with appendicovesicostomy to the abdominal wall. The pregnancy was complicated by recurrent urinary tract infections, anemia, gestational diabetes, and stage IV uterine prolapse. A multidisciplinary team managed her care, with imaging revealing altered abdominal anatomy and breech fetal presentation. At 37 weeks, due to concerns about fetal growth restriction, breech position, and potential prolapse exacerbation, an elective cesarean delivery with median relaparotomy and vertical uterine fundal incision was performed to avoid emergency intervention. Both the delivery and postpartum recovery were uneventful despite the complexity of the case. CONCLUSIONS Managing pregnancy in patients with CBE requires close, multidisciplinary collaboration to address potential complications. Detailed delivery planning and vigilant monitoring are crucial to ensure maternal and fetal safety.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e946782"},"PeriodicalIF":1.0,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11964332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754587","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}

引用次数: 0

Andexanet Alfa in Urgent Cardiac Surgery: A Case Report of Edoxaban Reversal for Acute Hemopericardium.

IF 1

American Journal of Case Reports Pub Date : 2025-03-30 DOI: 10.12659/AJCR.945265

Mohammad Al Mawed, Helmut Warkentin, Johannes P Brockmeier, René Schramm, Jan Gummert, Vera von Dossow, Stephan Gielen

{"title":"Andexanet Alfa in Urgent Cardiac Surgery: A Case Report of Edoxaban Reversal for Acute Hemopericardium.","authors":"Mohammad Al Mawed, Helmut Warkentin, Johannes P Brockmeier, René Schramm, Jan Gummert, Vera von Dossow, Stephan Gielen","doi":"10.12659/AJCR.945265","DOIUrl":"10.12659/AJCR.945265","url":null,"abstract":"BACKGROUND Antidotes to non-vitamin K oral anticoagulants (NOAK) like idarucizumab and andexanet alfa have been approved for reversing the effects of dabigatran and apixaban/rivaroxaban, respectively. However, andexanet alfa is not approved for reversing edoxaban. Current guidelines recommend using specific reversal agents in emergencies, but they do not support andexanet alfa for edoxaban reversal. This study illustrates the off-label use of andexanet alfa for edoxaban reversal in a case of acute hemopericardium requiring urgent cardiac surgery, addressing the practical challenges and clinical outcomes. CASE REPORT We report the case of a 71-year-old woman who required urgent cardiac surgery following acute pericardial tamponade caused by hemopericardium during right-heart catheterization. After emergency pericardiocentesis, andexanet alfa was administered to address any residual effects of edoxaban (Lixiana), along with protamine to reverse the effects of heparin. The patient was transferred in stable condition for cardiac surgery, where a right ventricular perforation responsible for the hemopericardium was sutured, and mitral valve replacement was performed via cardiopulmonary bypass (CPB) due to severe mitral valve regurgitation. No adverse cerebrovascular, hemorrhagic, or thromboembolic events were observed. CONCLUSIONS This case demonstrates an unconventional off-label use of andexanet alfa to stabilize a patient on edoxaban. Although the patient did not have any adverse effects, the thromboembolic risks of andexanet alfa and potential heparin resistance warrant cautious use, especially before cardiac surgery. Successful management was achieved through a multidisciplinary approach. Further research is needed to evaluate the safety and efficacy of andexanet alfa in patients on edoxaban therapy.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e945265"},"PeriodicalIF":1.0,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11964330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754561","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}

引用次数: 0

High Creatine Kinase Levels in Viral Myositis: A Case of Rhabdomyolysis-Induced Renal Failure.

IF 1

American Journal of Case Reports Pub Date : 2025-03-29 DOI: 10.12659/AJCR.946551

Sujatha Baddam, Mrudula Thiriveedi, Heather Haley

{"title":"High Creatine Kinase Levels in Viral Myositis: A Case of Rhabdomyolysis-Induced Renal Failure.","authors":"Sujatha Baddam, Mrudula Thiriveedi, Heather Haley","doi":"10.12659/AJCR.946551","DOIUrl":"10.12659/AJCR.946551","url":null,"abstract":"BACKGROUND Viral infections can cause a spectrum of muscle involvement, from mild myalgia to severe conditions like rhabdomyolysis. While benign muscle pain is common, viral myositis complicated by rhabdomyolysis and acute kidney injury is an uncommon but serious occurrence. If not promptly recognized and treated, these complications can result in significant morbidity and even mortality. Timely diagnosis and intervention are crucial to mitigating the risks. CASE REPORT We present the case of a 47-year-old man with a history of recent flu-like symptoms, who developed generalized muscle pain and weakness. Upon further evaluation, he was diagnosed with acute viral myositis. His condition was complicated by severe rhabdomyolysis, as evidenced by a markedly elevated creatine phosphokinase (CPK) level of 880 300 U/L, which subsequently led to acute kidney injury. Despite immediate intervention with aggressive intravenous fluid resuscitation, he required emergency hemodialysis secondary to electrolyte imbalances. Over the course of several weeks, he required ongoing dialysis, but with continued treatment his renal function gradually improved, and dialysis was discontinued after 1 month. CONCLUSIONS This case highlights the importance of early recognition and treatment of viral myositis complicated by rhabdomyolysis and acute renal failure. Aggressive management, including fluid resuscitation and hemodialysis, is crucial in preventing life-threatening complications.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e946551"},"PeriodicalIF":1.0,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11964331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743972","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}

引用次数: 0