American Journal of Case Reports最新文献

{"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}

{"title":"Prosthetic Knee Joint Infection with Haemophilus influenzae 1 Year After Total Knee Arthroplasty: A Case Report and Literature Review.","authors":"Ahmed AlSharakhat, Safiya AlMusawi, Ahmed Husain, Wafa Hasan, Nisha Chandran Vijayamma, Feras AlMarzooq","doi":"10.12659/AJCR.950298","DOIUrl":"10.12659/AJCR.950298","url":null,"abstract":"<p><p>BACKGROUND Haemophilus influenzae is a gram-negative bacterium that normally inhabits the mucosal surfaces of the upper-respiratory tract system of many healthy individuals. The capsular types of H. influenzae are found to be responsible of invasive infections such as meningitis, epiglottitis, orbital cellulitis, and bacteremia. H. influenzae is rarely described as a causative agent of periprosthetic joint infection (PJI). Here, we report a case of H. influenzae causing prosthetic knee joint infection 1 year after total knee arthroplasty. CASE REPORT A 59-year-old woman was admitted with a 1-day history of a painful right knee and inability to bear weight. She had undergone a unilateral total knee arthroplasty 1 year ago. She reported a history of recurrent upper-respiratory tract infections, with the most recent episode occurring 3 months prior to the current presentation. H. influenzae grew on 2 knee aspirate specimens and a peripheral blood culture. The isolated H. influenzae strain was beta-lactamase-negative and identified as a non-type B by the public health laboratory. The patient was successfully treated with intravenous ceftriaxone for a total of 30 days followed by oral cefuroxime for 14 days. She underwent a first-stage revision of the right total knee arthroplasty, debridement, irrigation, and spacer placement; subsequently, second-stage revision was performed. CONCLUSIONS The findings of this case report, coupled with a thorough review of the literature, demonstrate the pathogenic potential of H. influenzae in periprosthetic joint infection (PJI). The diagnosis of PJI can be difficult and the management needs a multidisciplinary team.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e950298"},"PeriodicalIF":0.7,"publicationDate":"2025-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12492993/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182297","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":"Restoration of Cardiac Function in Left Bundle Branch Block-Induced Cardiomyopathy via Conduction System Pacing: A Case Report.","authors":"Jing Wang, Bing Han, Xiaojuan Wang, Zixian Chen, Wenqiang Li","doi":"10.12659/AJCR.948576","DOIUrl":"10.12659/AJCR.948576","url":null,"abstract":"<p><p>BACKGROUND Left bundle branch block (LBBB) is not uncommon. In certain cases, patients with LBBB exhibit a deterioration of cardiac function, ultimately progressing to a clinical phenotype resembling cardiomyopathy in the absence of an alternative etiology, a condition referred to as left bundle branch block-induced cardiomyopathy (LIC). We present a case of a 57-year-old woman who developed LIC 1 year after the onset of new LBBB. Following conduction system pacing (CSP), her cardiac function was completely restored. CASE REPORT A 57-year-old woman presented with normal electrocardiograms (ECGs) and heart function 1 year prior. After developing LBBB, she experienced progressive dyspnea and reduced exercise tolerance over the subsequent year, during which her left ventricular ejection fraction (LVEF) declined from 55% to 31%. A comprehensive diagnostic workup revealed interventricular mechanical dyssynchrony and excluded ischemic or structural etiologies, which is consistent with LIC. Guideline-directed medical therapy was initiated; however, her symptoms persisted after 6 months of therapy. Following CSP for cardiac resynchronization therapy, the patient's LVEF improved to 54% at 6 months and further increased to 56% at 30 months, approaching normalization. CONCLUSIONS LIC is a recently identified condition wherein patients with LBBB experience left ventricular dysfunction and mechanical dyssynchrony without an alternative etiology. Emerging evidence indicates that CSP may effectively correct the electrical dyssynchrony associated with LBBB. We present a case of a patient diagnosed with LIC within 1 year of symptom onset, who exhibited significant improvement following CSP treatment. This case highlights the critical importance of early diagnosis and timely intervention.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e948576"},"PeriodicalIF":0.7,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12490278/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145179177","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":"SMARCA4-Deficient Undifferentiated Carcinoma: A Report of 2 Cases.","authors":"Sa-Hong Kim, Kyoyoung Park, Jane Chungyoon Kim, Jeesun Kim, Do-Joong Park, Hyuk-Joon Lee, Han-Kwang Yang, Yoonjin Kwak, Seong-Ho Kong","doi":"10.12659/AJCR.949989","DOIUrl":"10.12659/AJCR.949989","url":null,"abstract":"<p><p>BACKGROUND SMARCA4-deficient undifferentiated carcinoma (SMARCA4-DUC) is a rare and aggressive malignancy caused by inactivation of the SMARCA4 (SWI/SNF-related, matrix-associated, actin-dependent regulator of chromatin subfamily A member 4) gene, a critical component of the SWI/SNF chromatin-remodeling complex. Initially identified in thoracic tumors, it is increasingly recognized in extrathoracic sites, including the gastrointestinal tract. These tumors often mimic other malignancies, such as poorly differentiated adenocarcinomas, malignant melanoma, hematolymphoid malignancies, or sarcomas, complicating diagnosis. Histologically, SMARCA4-DUC shows expression loss of BRG1 (the protein encoded by SMARCA4) on immunohistochemistry (IHC). SMARCA4-DUC exhibits rapid progression, local invasion, and poor prognosis due to its undifferentiated morphology and high proliferative capacity. CASE REPORT Case 1 was a 71-year-old woman with a 13.6-cm gastric tumor involving GE junction, with direct invasion to pancreas and transverse mesocolon. Initial impression suggested gastrointestinal stromal tumor (GIST) of stomach or sarcoma. Endoscopic biopsy followed by targeted next-generation sequencing revealed a pathogenic SMARCA4 mutation. After confirming SMARCA4-DUC, she underwent extensive open surgery followed by postoperative adjuvant paclitaxel-carboplatin chemotherapy. She developed recurrence and was transferred to hospice care. Case 2 was an 80-year-old man with a 9.0-cm gastric tumor at cardia, directly invading the pancreas. Endoscopic biopsy revealed poorly differentiated tubular adenocarcinoma. Following laparoscopic gastrectomy, the specimen showed a predominantly undifferentiated malignant tumor with focal adenocarcinoma components. IHC demonstrated loss of BRG1 expression in the undifferentiated tumor component, confirming SMARCA4-DUC. He completed several cycles of adjuvant XELOX, without recurrence. CONCLUSIONS These 2 cases of SMARCA4-DUC of the stomach underscore the importance of molecular diagnostics and multidisciplinary management to avoid delayed diagnosis and to establish appropriate therapeutic strategies.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e949989"},"PeriodicalIF":0.7,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12490279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182293","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":"Temporary Cemented Spacer for Complex Radial Head Fractures: A Case Report.","authors":"César Alejandro Jiménez-Aroche, Mishelle Pérez de León, Arturo Saldivar-Moreno, Mariela Hernández-Pavón","doi":"10.12659/AJCR.948197","DOIUrl":"10.12659/AJCR.948197","url":null,"abstract":"<p><p>BACKGROUND The management of comminuted and displaced radial head fractures (Mason III), particularly when associated with dislocation (Mason IV) or Essex-Lopresti injury, presents a complex surgical challenge. Treatment options include conservative management, surgical fixation, arthroplasty, or radial head resection; however, no consensus exists regarding the optimal approach for all injury types. Radial head resection is often preferred in complex cases with multiple fragments where reconstruction is unfeasible. While functional and radiological outcomes vary widely, there is a growing trend toward the use of prosthetic implants as the initial treatment to maintain elbow function and stability, with temporary implants employed when definitive ones are unavailable. CASE REPORT We present the case of a 46-year-old patient who underwent radial head resection and received a cemented radial head spacer as temporary management due to the unavailability of a definitive implant. Functional status was monitored over a 21-month period. Our aim was to identify a readily available operating room material capable of effectively neutralizing valgus and axial forces. Since the spacer is intended as a temporary solution, it must be removed or replaced with a definitive implant approximately 4-6 months postoperatively, once stability is reestablished. Beyond this period, bone lysis has been observed. CONCLUSIONS The significance of this case report lies in highlighting alternative options for radial head replacement in complex, irreparable fractures, proposing an easily accessible solution available in any orthopedic operating room. It is further distinguished by its extended follow-up period (21 months) and by providing evidence of the long-term tolerability of cemented spacers - an aspect that has been infrequently reported.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e948197"},"PeriodicalIF":0.7,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12482758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145179192","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":"Diagnostic Challenges in Diffuse Large B-Cell Lymphoma in a Young Liver Transplant Patient with Ulcerative Colitis: A Case Report.","authors":"Maria Kopoń, Aleksandra Wileńska, Marek Zdrenka, Łukasz Szylberg, Jarosław Koza","doi":"10.12659/AJCR.948652","DOIUrl":"10.12659/AJCR.948652","url":null,"abstract":"<p><p>BACKGROUND Diffuse large B-cell lymphoma (DLBCL) is the most common form of malignant lymphoma. The hypothesis that age-related immune decline plays a role in the development of lymphoma is well established and exemplified by the association between Epstein-Barr virus (EBV) and DLBCL. This report describes a 22-year-old liver transplant patient with ulcerative colitis (UC) presenting with ileus and diffuse large B-cell lymphoma (DLBCL). Because of the symptoms, an exacerbation of UC was initially suggested, which contributed to a delay in definitive diagnosis. CASE REPORT A 22-year-old patient with a medical history of ulcerative colitis, liver transplantation, and use of immunosuppressive drugs presented gradually progressive abdominal pain, bloating, and, eventually, lack of bowel movements. Initially, abdominal X-ray revealed the presence of radiological features consistent with sub-ileus/ileus. Then, the serological tests for EBV in the IgG class yielded positive results. Subsequently, the contrast-enhanced abdominal and pelvic computed tomography (CT) scans revealed the presence of enlarged lymph nodes forming a conglomerate. A percutaneous thick-needle biopsy of a conglomerate of lymph nodes in the abdominal cavity was performed, which revealed DLBCL. After diagnosis, the patient underwent 6 cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) chemotherapy, achieving remission. CONCLUSIONS This case report emphasizes that clinicians need to consider the risk of oncogenesis associated with the prolonged use of immunosuppressive agents and EBV-seropositive infection status. Screening for EBV before initiating immunosuppressive therapy should be compulsory. EBV-negative patients on immunosuppression must especially avoid EBV infection, while EBV-positive patients must be monitored more closely due to higher oncological risk.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e948652"},"PeriodicalIF":0.7,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12483543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151399","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":"Native Aortic Valve Endocarditis Caused by Rothia mucilaginosa, Initially Misidentified as Neisseria sicca.","authors":"Tiffany S Liu, Austin Scro, Mustafa Awayda, Maroun Bou Zerdan","doi":"10.12659/AJCR.948231","DOIUrl":"10.12659/AJCR.948231","url":null,"abstract":"<p><p>BACKGROUND Infective endocarditis is a potentially life-threatening disease predominantly affecting the heart valves. Common causative pathogens include Staphylococcus aureus and Streptococcus viridans. However, it can be caused by atypical organisms such as Rothia species (spp.). When Rothia spp. cause endocarditis, the organism often affects prosthetic valves and rarely native ones. We report a case of native aortic valve subacute endocarditis caused by R. mucilaginosa, initially misidentified as Neisseria sicca, in an immunocompromised middle-aged patient. CASE REPORT A 54-year-old man with histories of hemochromatosis, diabetes, hypertension, alcohol abuse, and smokeless tobacco use presented with 7 days of fever, intermittent cough, and headache. Diagnostic workup revealed a new systolic murmur, blood cultures positive for N. sicca, and a vegetation on the aortic valve noted on a transesophageal echocardiogram. He was diagnosed with subacute infective endocarditis using Duke criteria and discharged on 6 weeks of intravenous ceftriaxone. However, 1 day later, he presented to another facility with a new fever and had a chest X-ray showing atypical pneumonia. The initial blood isolates were re-identified as R. mucilaginosa. His hospital course was complicated by a small intraparenchymal hemorrhage and 2 embolic infarcts. He continued ceftriaxone and eventually recovered to baseline. CONCLUSIONS We present a case of an immunocompromised middle-aged man who developed subacute infective endocarditis caused by an atypical organism, R. mucilaginosa. Infective endocarditis should always be a differential diagnosis in patients presenting with fever of an unknown source.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e948231"},"PeriodicalIF":0.7,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12482780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151424","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":"Subdural Hematoma After Lumbar Puncture in Patients with Coagulation Disorders: A Case Report and Pathogenetic Implications.","authors":"Chenyuan Ding, Yueqi Du, Penghao Liu, Zhuofan Xu, Yuanchen Cheng, Wanru Duan","doi":"10.12659/AJCR.948707","DOIUrl":"10.12659/AJCR.948707","url":null,"abstract":"<p><p>BACKGROUND To report the clinical events and intraoperative imaging features of a subdural hematoma after lumbar puncture in a patient with coagulation disorder following sinus thrombosis. The pathogenesis was discovered during the removal of a subdural hematoma by emergency neurospinal surgery. We also discuss how these factors could be avoided. CASE REPORT A 15-year-old girl received treatments in the Emergency Department of Neurology of Xuanwu Hospital, Capital Medical University, in May 2024. She was treated with anticoagulation for cerebral venous sinus thrombosis developed into an intraspinal hematoma after a lumbar puncture. She had cranial hypertension and was finally treated for the removal of an intraspinal hematoma. During the operation for removal of the intraspinal hematoma, the lumbar puncture needle penetrated the dorsal and ventral dura, presumably puncturing the anterior vertebral venous plexus. Due to the rapid release of a large amount of cerebrospinal fluid, negative pressure developed in the spinal canal, resulting in massive bleeding and intraspinal hematoma. She had neurological impairment before emergency surgery, but the neurological dysfunction improved after surgery, and no sequelae remained. CONCLUSIONS In patients with coagulopathy, if a lumbar puncture examination must be performed, it is necessary to pay attention to the puncture depth, while avoiding subdural blood inhalation due to the massive release of cerebrospinal fluid after penetrating the dorsal and ventral dura and damaging the anterior sacral venous plexus.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e948707"},"PeriodicalIF":0.7,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12482757/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139096","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":"Management of Cesarean Section Uterine Scar Ectopic Pregnancy Type 2 Using Methotrexate: Insights from a Case Report.","authors":"Taylor Pigg, Susan Fields, Amalia Brawley, R Paul Roddenberry, Padmashree C Woodham","doi":"10.12659/AJCR.948357","DOIUrl":"10.12659/AJCR.948357","url":null,"abstract":"<p><p>BACKGROUND Cesarean section uterine scar ectopic pregnancies (CSEP) are rare occurrences in which an embryo implants along uterine scar tissue from previous hysterotomies. These cases carry high morbidity and mortality, including risk of significant hemorrhage and uterine rupture. Society for Maternal-Fetal Medicine guidelines suggest either medical or surgical termination of these pregnancies; however, there are no current definitive recommendations for the management of these cases. Here, we present the case of a 36-year-old patient with a first-trimester CSEP who was managed with local intra-gestational methotrexate (MTX) and 6-month follow-up with beta-human chorionic gonadotropin (ß-hCG) monitoring. CASE REPORT We describe the case of a stable, asymptomatic 36-year-old patient with 2 previous low transverse cesarean sections, presenting in the early first trimester with a visualized CSEP on ultrasound. The patient was presented with medical and surgical options for management. After extensive counseling, she opted for a medical abortion with an intra-gestational MTX injection. She was monitored with serial quantitative ß-hCG measurements for 6 months before complete resolution of the terminated pregnancy, an interval significantly longer than typically observed in similar cases. She did not require additional medication doses or surgical intervention. CONCLUSIONS After a prolonged surveillance, this patient safely reached undetectable ß-hCG levels. There is great variability in the presentation, treatment, and long-term outcome of CSEPs, and management requires extensive provider-patient communication. Medical management with intra-gestational MTX, followed by close monitoring, is a viable option for treating stable, type 2 CSEP in patients who have access to reliable follow-up care.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e948357"},"PeriodicalIF":0.7,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12477966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139002","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}