American Journal of Case Reports最新文献_第4页

Vancomycin Treatment for Pneumobilia in Clostridioides difficile Infection: A Case Analysis. 万古霉素治疗难辨梭菌感染肺炎一例分析。

IF 1

American Journal of Case Reports Pub Date : 2025-05-13 DOI: 10.12659/AJCR.947628

Christos Vallilas, Alexandros Avdis, Olympia Alexandri, Georgia Philippa, Konstantinos Cardamakis, Penelope Lampropoulou, Aikaterini Touliatou

{"title":"Vancomycin Treatment for Pneumobilia in Clostridioides difficile Infection: A Case Analysis.","authors":"Christos Vallilas, Alexandros Avdis, Olympia Alexandri, Georgia Philippa, Konstantinos Cardamakis, Penelope Lampropoulou, Aikaterini Touliatou","doi":"10.12659/AJCR.947628","DOIUrl":"10.12659/AJCR.947628","url":null,"abstract":"BACKGROUND Pneumobilia is the presence of air within the biliary tree. It is a relatively rare condition, usually caused by an abnormal communication between the biliary system and the gastrointestinal tract, or by infection from gas-forming bacteria. Antibiotic agents such as fluoroquinolones have many adverse effects, including Clostridioides difficile infection manifesting as colitis. Metronidazole has been used in the past and vancomycin and fidaxomicin can have good therapeutic results. CASE REPORT A 20-year-old man presented to Gennimatas General Hospital in Athens, Greece due to multiple episodes of diarrhea. He had received a 7-day treatment of oral levofloxacin, a common antibiotic treatment often used to treat Clostridioides difficile infection, until 10 days before presentation to our hospital as an outpatient treatment for mild pneumonia. Blood test revealed neutropenia and thrombocytopenia, and biochemical tests revealed hypokalemia and elevated inflammation markers. A CT scan of the abdomen showed pneumobilia. Blood and urine cultures were sterile, whereas Clostridioides difficile toxins A+ and B+ were detected in stool culture. Treatment with oral vancomycin had excellent results. The patient improved clinically and remained afebrile, with cessation of diarrhea, correction of electrolytic disorders, and disappearance of pneumobilia on a repeat CT scan after 1 week. CONCLUSIONS Pneumobilia caused by Clostridioides difficile infection was effectively treated with orally administered vancomycin, which cured our patient's diarrhea and pneumobilia.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e947628"},"PeriodicalIF":1.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062534","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

Managing Necrotizing Soft-Tissue Infection in Breast Cancer: A Case of Emergency Toilet Mastectomy. 处理坏死性软组织感染的乳腺癌：一例紧急厕所乳房切除术。

IF 1

American Journal of Case Reports Pub Date : 2025-05-12 DOI: 10.12659/AJCR.946669

Jessica J Farzan, Jiddu A Guart, Nichita Kulkarni, Sarah Roberts, Gabriel De la Cruz-Ku, Donald R Czerniach, Kate H Dinh

{"title":"Managing Necrotizing Soft-Tissue Infection in Breast Cancer: A Case of Emergency Toilet Mastectomy.","authors":"Jessica J Farzan, Jiddu A Guart, Nichita Kulkarni, Sarah Roberts, Gabriel De la Cruz-Ku, Donald R Czerniach, Kate H Dinh","doi":"10.12659/AJCR.946669","DOIUrl":"10.12659/AJCR.946669","url":null,"abstract":"BACKGROUND This case report presents a rare instance of advanced breast cancer presenting with superimposed necrotizing soft-tissue infection (NSTI) and sepsis, uniquely managed with an emergency toilet mastectomy. Toilet mastectomies have become increasingly rare and controversial in modern surgical oncology and are generally limited to palliative indications. This report contributes to the limited literature on NSTI of the breast in the setting of malignancy and highlights the potential utility of toilet mastectomy as a palliative option for carefully selected patients with advanced breast cancer complicated by infection. CASE REPORT A 71-year-old woman presented with a large fungating right breast mass after 50 years of receiving no health care. She was septic, with clinical signs of NSTI. Emergency surgical intervention involved a toilet mastectomy with extensive debridement. Histopathological analysis confirmed high-grade invasive ductal carcinoma of the breast with skin involvement, ER/PR-positive, HER2-negative, pT4bN0Mx. Cultures were consistent with type 1 NSTI. The postoperative course was complicated, requiring prolonged ICU care, multiple debridements, and advanced wound management. Significant complications included septic shock, acute kidney injury, and wound dehiscence. CONCLUSIONS This case is notable for 3 key aspects: (1) NSTI and sepsis are rare but serious complications of advanced breast cancer, underscoring the need for clinicians to maintain a high index of suspicion for this condition; (2) timely and aggressive management of NSTI, regardless of its association with underlying malignancy, is critical for reducing morbidity and mortality; and (3) toilet mastectomy, although less commonly performed today, remains an appropriate palliative intervention in select cases.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e946669"},"PeriodicalIF":1.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040580","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

Enhancing Renal Stone Management: Tip-Flexible Ureteral Access Sheath in Cystine Stone Surgery. 加强肾结石管理：膀胱胱氨酸结石手术中尖端柔性输尿管通路鞘。

IF 1

American Journal of Case Reports Pub Date : 2025-05-12 DOI: 10.12659/AJCR.946800

Ting Xu, Kristine Joy Shan Kwan, Lin Xiong

{"title":"Enhancing Renal Stone Management: Tip-Flexible Ureteral Access Sheath in Cystine Stone Surgery.","authors":"Ting Xu, Kristine Joy Shan Kwan, Lin Xiong","doi":"10.12659/AJCR.946800","DOIUrl":"10.12659/AJCR.946800","url":null,"abstract":"BACKGROUND Cystinuria is a rare cause of urolithiasis. The condition is often inherited and controlled medically. A large symptomatic stone is indicated for surgery, and complete stone clearance is recommended to reduce the risk of infection and stone recurrence. CASE REPORT A 24-year-old healthy man was incidentally discovered to have multiple bilateral renal stones during a routine health examination. Upon admission to the Urology Department, preoperative computed tomography (CT) identified a large right renal stone measuring 30×25 mm and smaller, clinically insignificant stones in the left kidney. The patient opted to undergo removal of the right stone only, as he was asymptomatic and chose not to have the left stones extracted. He underwent right disposable digital flexible ureteroscopic lithotripsy using a tip-flexible suctioning ureteral access sheath, achieving complete stone clearance. His postoperative recovery was uneventful. At 1-month follow-up, stone composition analysis revealed that the stones were composed of L-cystine, leading to a diagnosis of cystinuria, a condition the patient was previously unaware of. He was prescribed urine alkalizing agents as part of his management. At the 6-month follow-up, CT confirmed that the right kidney remained stone-free. However, the left renal stones had significantly grown despite the use of urine alkalizing agents. To date, the patient has declined further surgical interventions for the left renal stones. CONCLUSIONS Early minimally-invasive intervention for cystine stones, including asymptomatic ones, may be necessary, as achieving complete stone clearance can improve prognosis by preventing complications associated with the stones.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e946800"},"PeriodicalIF":1.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052084","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

Anatomical Challenges in Laparoscopic Cholecystectomy: Five Arterial Branches from a Right Hepatic Caterpillar Hump. 腹腔镜胆囊切除术的解剖学挑战：来自右肝毛虫驼峰的五个动脉分支。

IF 1

American Journal of Case Reports Pub Date : 2025-05-11 DOI: 10.12659/AJCR.947240

Odysseas Mouzakis, Efstratios Konidis, Panagiotis Poulokefalos, Spyridon Stavros Arnaoutos

{"title":"Anatomical Challenges in Laparoscopic Cholecystectomy: Five Arterial Branches from a Right Hepatic Caterpillar Hump.","authors":"Odysseas Mouzakis, Efstratios Konidis, Panagiotis Poulokefalos, Spyridon Stavros Arnaoutos","doi":"10.12659/AJCR.947240","DOIUrl":"10.12659/AJCR.947240","url":null,"abstract":"BACKGROUND Caterpillar hump, also referred to as Moynihan's hump, is a right hepatic artery with tortuous course within the Calot's triangle, which carries a major risk of accidental injury and ligation during laparoscopic cholecystectomy. Its already rare incidence (about 3.81%), in association with the typical presence of 1 or 2 cystic arteries, makes our case unique since it involves a caterpillar hump with 5 distinct arterial branches. CASE REPORT We report a case of caterpillar hump detected during elective laparoscopic cholecystectomy for symptomatic cholelithiasis in a 49-year-old man. A large vessel-like structure with an uncertain termination was initially identified after the hepatocystic triangle dissection. The structure was eventually discovered to have a helical route and re-enter the liver. Although more than 2 elements entered the gallbladder, which exceeded the 'critical view of safety' requirements, a thorough dissection was performed. The surgery is successfully completed when all branches end up in the gallbladder. CONCLUSIONS This report summarizes the clinical and surgical importance of the caterpillar hump, highlighting the necessity for precise anatomical knowledge and the implementation of a \"culture of safety\" to prevent complications. The concept of \"structure\" in achieving the \"critical view of safety\" must encompass its variations and anomalies. Therefore, surgeons must be aware of the potential for multiple arterial branches supplying the gallbladder.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e947240"},"PeriodicalIF":1.0,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12080282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043479","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

A 43-Year-Old Man with a 30-Year History of a Retained Glass Intraocular Foreign Body Presenting with Retinal Detachment. 43岁男性，30年眼内玻璃异物积存，视网膜脱离。

IF 1

American Journal of Case Reports Pub Date : 2025-05-10 DOI: 10.12659/AJCR.947369

Jilin Zhou, Sahil Thakur, Chaoxu Qian

{"title":"A 43-Year-Old Man with a 30-Year History of a Retained Glass Intraocular Foreign Body Presenting with Retinal Detachment.","authors":"Jilin Zhou, Sahil Thakur, Chaoxu Qian","doi":"10.12659/AJCR.947369","DOIUrl":"10.12659/AJCR.947369","url":null,"abstract":"BACKGROUND This report describes the case of a 43-year-old man with a 30-year history of a retained glass intraocular foreign body (IOFB) presenting with retinal detachment. CASE REPORT We describe this case using patient history, ocular examination, and imaging, including anterior segment photographs, fundus photographs, and B-scan ultrasonography. A 43-year-old man presented with retinal detachment in the right eye. Medical history revealed that the patient had suffered an explosive injury to the right eye 30 years ago, for which he underwent surgical repair at the time of the incident. However, a glass IOFB was left in the eye, either due to an oversight during the initial treatment or an intentional decision by the treating physician. On examination, indirect ophthalmoscopy revealed a half-disc-sized retinal hole at the 9 o'clock position in the peripheral retina, along with long-standing atrophic lesions extending from 12 to 2 o'clock. Temporal macular-involving retinal detachment extending from 6 to 11 o'clock was observed. B-scan ultrasonography confirmed the presence of the glass IOFB. The patient subsequently underwent surgical treatment, including pars plana vitrectomy, removal of the IOFB, retinal reattachment, photocoagulation, and silicone oil tamponade. CONCLUSIONS Patients with open globe injuries should be carefully evaluated with the presumption of an IOFB. IOFBs may remain asymptomatic for decades, underscoring the importance of regular follow-up for patients with retained IOFBs. If complications such as retinal detachment occur, they can be managed routinely.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e947369"},"PeriodicalIF":1.0,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12077246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057160","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

Rhabdomyolysis Induced by Parainfluenza 2 Virus in a Healthy 18-Year-Old Male Patient: A Case Study. 副流感病毒2型诱导的18岁健康男性患者横纹肌溶解：一个病例研究

IF 1

American Journal of Case Reports Pub Date : 2025-05-09 DOI: 10.12659/AJCR.947909

Mustafa K Al Nuaimi, Sara Ubosy, Hakeem A Mohammed, Kwabena Ayesu, Mario Madruga, Stephen J Carlan

{"title":"Rhabdomyolysis Induced by Parainfluenza 2 Virus in a Healthy 18-Year-Old Male Patient: A Case Study.","authors":"Mustafa K Al Nuaimi, Sara Ubosy, Hakeem A Mohammed, Kwabena Ayesu, Mario Madruga, Stephen J Carlan","doi":"10.12659/AJCR.947909","DOIUrl":"10.12659/AJCR.947909","url":null,"abstract":"BACKGROUND Rhabdomyolysis is a medical condition characterized by the cellular breakdown of skeletal muscle tissue, leading to the release of basic muscle components into the bloodstream. Multiple causes have been reported, including infections that involve skeletal muscle cells. One of the most common classes of infections causing rhabdomyolysis is viral in origin. Clinically, the patient usually reports a short latency period consisting of malaise followed by muscle soreness, myalgia, and even an antalgic gait. Higher degrees of skeletal muscle damage result in higher levels of serum myoglobin. When the levels of myoglobin exceed the protein binding capacity, the molecule can precipitate during glomerular filtration and damage the kidneys. CASE REPORT An 18-year-old healthy, active male patient was brought to the Emergency Department (ED) after experiencing 5 days of generalized malaise and 2 days of progressively debilitating skeletal muscle pain and malfunction, leading to the inability to walk. He had dismissed the symptoms until he was non-ambulatory. On arrival at the ED, his creatine kinase (CK) level was elevated at 6859 U/L (reference, 10-70 U/L), and parainfluenza type 2 virus was identified by a nasopharyngeal respiratory polymerase chain reaction panel. He received symptomatic treatment including acetaminophen, methocarbamol, and diuresis. He was discharged on day 5, and his CK level returned to normal by day 12 of his disease. CONCLUSIONS Parainfluenza virus is a rare cause of rhabdomyolysis. If the myalgia of a common \"cold or flu\" progresses to muscle swelling and tenderness, especially in the lower extremities, and impairs ambulation, urgent medical evaluation should be considered.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e947909"},"PeriodicalIF":1.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050347","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

A Case of Undifferentiated Connective Tissue Disease with Bilateral Auricular Polychondritis Manifestations: A Rare Clinical Association. 未分化结缔组织病合并双侧耳廓多软骨炎一例：罕见的临床关联。

IF 1

American Journal of Case Reports Pub Date : 2025-05-08 DOI: 10.12659/AJCR.946827

Angelo Nigro, Pasquale Santarcangelo, Antonio Bonelli, Serena Digregorio, Giuseppe Nicoletti

{"title":"A Case of Undifferentiated Connective Tissue Disease with Bilateral Auricular Polychondritis Manifestations: A Rare Clinical Association.","authors":"Angelo Nigro, Pasquale Santarcangelo, Antonio Bonelli, Serena Digregorio, Giuseppe Nicoletti","doi":"10.12659/AJCR.946827","DOIUrl":"10.12659/AJCR.946827","url":null,"abstract":"BACKGROUND Undifferentiated connective tissue disease (UCTD) is a heterogeneous autoimmune condition characterized by clinical features of connective tissue involvement without meeting the full classification criteria for a defined connective tissue disease (CTD). It often includes arthralgias, Raynaud's phenomenon, and serologic abnormalities. In rare cases, UCTD presents with features resembling relapsing polychondritis, raising questions about a possible overlap syndrome or a shared immunopathogenic mechanism. This case report describes an atypical presentation of UCTD with bilateral auricular inflammation and its therapeutic management. CASE REPORT A 45-year-old man diagnosed with UCTD initially presented with acral cyanosis and inflammatory arthralgias, which responded well to hydroxychloroquine and low-dose prednisone. Over time, he developed progressive bilateral auricular pain, erythema, and nodular swelling, mimicking polychondritis. In the absence of systemic features of relapsing polychondritis, this was considered an unusual manifestation within the UCTD spectrum rather than a distinct overlap syndrome. His symptoms improved significantly following an increase in corticosteroid therapy. CONCLUSIONS This case highlights the importance of recognizing atypical inflammatory manifestations in UCTD and adjusting treatment accordingly. The findings suggest auricular inflammation is part of the broader UCTD spectrum rather than a separate disease entity. These observations underscore the role of shared autoimmune pathways in connective tissue disorders and the need for individualized treatment approaches.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e946827"},"PeriodicalIF":1.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989771","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

Rare Coexisting Hepatocellular and Gallbladder Carcinomas: A Case Report. 罕见的肝细胞癌和胆囊癌并存1例。

IF 1

American Journal of Case Reports Pub Date : 2025-05-07 DOI: 10.12659/AJCR.946739

Kristína Cmarková, Lenka Nosakova, Miroslav Pindura, Roman Kyčina, Juraj Marcinek, Juraj Miklušica

{"title":"Rare Coexisting Hepatocellular and Gallbladder Carcinomas: A Case Report.","authors":"Kristína Cmarková, Lenka Nosakova, Miroslav Pindura, Roman Kyčina, Juraj Marcinek, Juraj Miklušica","doi":"10.12659/AJCR.946739","DOIUrl":"https://doi.org/10.12659/AJCR.946739","url":null,"abstract":"BACKGROUND Multiple primary malignancies in a single patient are considered to be quite rare. However, due to the wider availability of advanced imaging methods and, more regular check-ups, they are becoming more common in clinical practice. To determine the diagnosis of multiple primary malignancies, each tumor must be completely separate and cannot be from metastasis of one or the other. Coexisting hepatocellular carcinoma and gallbladder carcinoma are extremely rare, with only a few case reports published. We believe that to determine the most effective therapeutic management, the results of as many cases as possible should be documented. Regardless of limited data, curative resection may be the most beneficial treatment option in terms of overall survival. CASE REPORT We present the case of a 64-year-old man first diagnosed with hepatocellular carcinoma with possible infiltration of the gallbladder wall as appeared on a CT scan. However, the definitive histopathologic examination revealed the coexistence of hepatocellular carcinoma and gallbladder carcinoma. In this case report, we offer an insight into the entire diagnostic process, as well as the chosen surgical approach and adjuvant therapy. Moreover, we present our approach to preoperative biopsy, the decision-making process throughout the whole diagnostic and therapeutic course, and the achieved results. CONCLUSIONS In cases of double primary malignancies, the choice of therapeutic strategy depends on the type and stage of both malignancies, but procedures with curative intent are superior. We present the outcome and overall survival of the patient after the surgery and adjuvant chemotherapy for synchronous hepatocellular carcinoma and gallbladder carcinoma. Since the liver is the organ most commonly affected by metastatic dissemination of primary tumors, exclusion of metastatic disease is particularly important.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e946739"},"PeriodicalIF":1.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054890","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

A Rare Case of Hypoxia and Cyanosis Secondary to Multifactorial Medication-Induced Sulfhemoglobinemia. 多因素药物致硫血红蛋白血症继发缺氧、发绀1例。

IF 1

American Journal of Case Reports Pub Date : 2025-05-07 DOI: 10.12659/AJCR.947587

Megan M Mansour, Robert M Seby, Aya Elalfy, Mario El Hayek, Tuhama S Rihani, Edson J Mwakyanjala, Libardo Rueda Prada

{"title":"A Rare Case of Hypoxia and Cyanosis Secondary to Multifactorial Medication-Induced Sulfhemoglobinemia.","authors":"Megan M Mansour, Robert M Seby, Aya Elalfy, Mario El Hayek, Tuhama S Rihani, Edson J Mwakyanjala, Libardo Rueda Prada","doi":"10.12659/AJCR.947587","DOIUrl":"https://doi.org/10.12659/AJCR.947587","url":null,"abstract":"BACKGROUND Fatigue and dyspnea, especially with hypoxia, are common in acute care and can indicate various conditions. Sulfhemoglobinemia is a rare but important consideration when a large saturation gap is present, as most blood gas analyzers do not detect it. Medication exposure, particularly to phenazopyridine and other oxidant drugs, is a leading cause. Early recognition of this diagnosis is crucial, as recurrence is likely with re-exposure to the precipitating agent. CASE REPORT A 37-year-old woman presented with acute dyspnea, lethargy, and hypoxia after exposure to severe oxidizing agents, including first-time use of trimethoprim-sulfamethoxazole and phenazopyridine, as well as lidocaine during a recent dental procedure (not her first exposure). Shortly thereafter, she developed tachycardia, tachypnea, and hypoxia, with concurrent hemolytic anemia. Despite oxygen therapy, she had a persistent elevated saturation gap. Arterial blood gas confirmed dyshemoglobinemia, and further testing identified sulfhemoglobinemia (1.3%). She was treated with blood transfusion and discontinuation of oxidizing agents to prevent further hypoxia. CONCLUSIONS Sulfhemoglobinemia is a rare and often missed diagnosis, as most blood gases analyzers do not measure sulfhemoglobin. Despite this, this diagnosis requires great clinical suspicion, as patients are at high risk for repeated exposure to offending agents and recurrence of life-threatening hypoxia.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e947587"},"PeriodicalIF":1.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051354","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

Iron Deficiency Anemia Linked to Severe Pediculosis Capitis in a 12-Year-Old Boy. 12岁男孩严重头癣与缺铁性贫血有关。

IF 1

American Journal of Case Reports Pub Date : 2025-05-06 DOI: 10.12659/AJCR.947139

Kaylie N Nichols, Spencer B Price, Jonathan D Duhamell, Megan E Williams, Amruta Padhye, Alicia Bach, Tyler Severance

{"title":"Iron Deficiency Anemia Linked to Severe Pediculosis Capitis in a 12-Year-Old Boy.","authors":"Kaylie N Nichols, Spencer B Price, Jonathan D Duhamell, Megan E Williams, Amruta Padhye, Alicia Bach, Tyler Severance","doi":"10.12659/AJCR.947139","DOIUrl":"https://doi.org/10.12659/AJCR.947139","url":null,"abstract":"BACKGROUND Head lice is a common condition in school-age children caused by Pediculus humanus capitis. Although typically associated with scalp itching and discomfort, chronic or severe infestations can occasionally lead to more severe health consequences. This report describes a 12-year-old boy from Missouri, USA, presenting with iron deficiency anemia (IDA) and a severe head lice infestation. IDA is characterized by insufficient iron to meet the body's needs, typically due to blood loss, nutritional deficiencies, or malabsorption. While there is no established causative relationship between head lice and IDA, several case reports have suggested a co-occurrence, often in the absence of other identifiable causes. This raises the possibility that significant lice burden may contribute to or exacerbate IDA, particularly through blood loss from lice feeding on the host's scalp. CASE REPORT A 12-year-old boy presented to his pediatrician with fatigue, pallor, and weakness. Initial outpatient laboratory test data revealed a hemoglobin of 3.4 g/dL, necessitating urgent transportation to the emergency department (ED). Upon examination in the ED, a severe Pediculus humanus capitis infestation was incidentally discovered. Despite extensive inpatient workup, no other source of anemia was identified. The patient was treated with blood transfusions and topical pediculicides to address his anemia and head lice, respectively. Remarkably, his anemia and symptoms resolved without recurrence following these interventions. CONCLUSIONS Prolonged pediculosis capitis with high lice burden should be considered as a potential etiologic factor in patients with unexplained IDA and a negative anemia workup. Further research is warranted to explore the mechanisms linking these 2 conditions.","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e947139"},"PeriodicalIF":1.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052560","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