Hafiz Muhammad Ali Raza, Atif Ibrahim, Manish Talwar, Vasanthi Balaraman, Anshul Bhalla, Barry M Wall, L Nicholas Cossey
{"title":"Crystalline Nephropathy Due to 2,8-Dihydroxyadeninuria in a Transplanted Kidney: 2 Case Reports.","authors":"Hafiz Muhammad Ali Raza, Atif Ibrahim, Manish Talwar, Vasanthi Balaraman, Anshul Bhalla, Barry M Wall, L Nicholas Cossey","doi":"10.12659/AJCR.946972","DOIUrl":"10.12659/AJCR.946972","url":null,"abstract":"<p><p>BACKGROUND The renal condition known as 2,8-dihydroxyadeninuria is an autosomal recessive disorder caused by adenine phosphoribosyl transferase (APRT) deficiency, which most commonly manifests as nephrolithiasis. APRT deficiency has also led to the development of chronic kidney disease and end-stage kidney disease in the absence of nephrolithiasis and has also been shown to recur following kidney transplantation. CASE REPORT This report aims to highlight the diagnostic and therapeutic challenges associated with APRT deficiency by presenting 2 patients with end-stage kidney disease who developed 2,8-dihydroxyadenine (DHA) crystalline nephropathy early in their post-transplant course. Neither patient had been diagnosed with APRT deficiency prior to transplantation, and one lacked a history of nephrolithiasis. Allograft biopsies revealed DHA crystal deposition with acute tubular injury, and genetic analysis confirmed APRT deficiency. Management included xanthine oxidase inhibitors, a low-purine diet, and modification of the immunosuppressive regimen with belatacept to reduce long-term tubulointerstitial injury. Both patients achieved stable long-term allograft function at 2 years, with follow-up biopsies at 1 year, showing a significant decrease in crystal deposition. CONCLUSIONS This case report underscores the importance of early recognition of APRT deficiency through timely biopsy, crystal identification, and genetic testing to guide effective treatment and prevent irreversible damage. It highlights the need for heightened clinical suspicion and tailored post-transplant management strategies in patients with recurrent DHA nephropathy.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e946972"},"PeriodicalIF":1.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12150807/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Emergency Radiation Therapy for Hemorrhage in Botryoides Sarcoma: A Pediatric Case Report.","authors":"Setyo Teguh Waluyo, Hariadi Yuseran, Ferry Armanza, Fendy Frans Elya Cohen Manalu","doi":"10.12659/AJCR.946434","DOIUrl":"10.12659/AJCR.946434","url":null,"abstract":"<p><p>BACKGROUND Botryoid rhabdomyosarcoma is a subtype of embryonal rhabdomyosarcoma and is a rare and highly vascular malignant childhood tumor, with the most common sites of origin being the vagina and cervix in young girls. This report describes the case of a 15-year-old girl presenting with vaginal hemorrhage due to botryoid rhabdomyosarcoma treated with emergency radiation therapy. Hemorrhage in botryoid rhabdomyosarcoma can present as a life-threatening emergency requiring immediate intervention. This case highlights the role of emergency external radiation therapy as a valuable adjunct in managing hemorrhage in botryoid rhabdomyosarcoma, especially when surgical options are limited. CASE REPORT We report a case of a 15-year-old girl who experienced repeated profuse episodes of vaginal bleeding and protruding mass in the vagina for 2 months. She had no significant medical history or family history of cancer. Magnetic resonance imaging (MRI) confirmed a massive malignant mass in the vaginal introitus that infiltrated the cervix, extending to the uterus. Based on the histopathology result, the diagnosis was botryoid rhabdomyosarcoma with a primary site located on the cervix, and due to the emergency situation and the risks associated with surgical intervention, emergency external radiation therapy was initiated. After 1 session of radiation therapy, the bleeding was significantly reduced. CONCLUSIONS Hemorrhage in botryoid rhabdomyosarcoma is a rare but critical complication. Emergency external radiation therapy helps stabilize the patient with acute bleeding caused by botryoid rhabdomyosarcoma. Further research is needed to find the optimal treatment strategies.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e946434"},"PeriodicalIF":1.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12150811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144226998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Non-Invasive Detection of Recurrent Intracranial Pressure via Optical Coherence Tomography: A Case Report.","authors":"Barbara Nowacka, Wojciech Lubiński","doi":"10.12659/AJCR.947484","DOIUrl":"10.12659/AJCR.947484","url":null,"abstract":"<p><p>BACKGROUND Papilledema is a common sign of increased intracranial pressure (ICP). However, detecting relapse of increased ICP is difficult because once optic nerve atrophy is present, re-swelling of the optic nerve head is not expected to be visible on fundoscopy. CASE REPORT This report describes the case of a 23-year-old woman with a ventriculoperitoneal shunt implanted at the age of 11 years due to idiopathic hydrocephalus presenting swelling of the peripapillary nerve fiber layer (pRNFL) on optical coherence tomography (OCT) without visible papilledema. She had been having headaches, nausea, and visual acuity deterioration. A neurological examination and fundus evaluation of both eyes showed pallor of the optic nerves without clinically visible disc edema, and magnetic resonance imaging (MRI) of the head did not reveal any signs of increased intracranial pressure. In the following days, after bilateral abducens nerve palsy occurred, a lumbar puncture removing cerebrospinal fluid was performed to temporarily reduce ICP. After the procedure, all her symptoms were resolved, visual acuity improved, and pRNFL swelling was reduced. CONCLUSIONS Optical coherence tomography is a quick, non-invasive, sensitive, and objective in vivo method for monitoring recurrence of increased ICP and treatment response. Therefore, OCT should be performed in all patients suspected to have high ICP when an ophthalmological examination does not reveal papilledema, especially in all cases with optic atrophy.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e947484"},"PeriodicalIF":1.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12150812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Xiaohui Li, Ningbo Zhao, Lin Zhong, Yu Zhang, Yongfang Luo
{"title":"Local Injection of Fluid Gelatin Under Contrast-Enhanced Ultrasound Guidance for Treating Active Bleeding From the Inferior Epigastric Artery: A Case Report.","authors":"Xiaohui Li, Ningbo Zhao, Lin Zhong, Yu Zhang, Yongfang Luo","doi":"10.12659/AJCR.947297","DOIUrl":"10.12659/AJCR.947297","url":null,"abstract":"<p><p>BACKGROUND Injury to the inferior epigastric artery is a major complication of abdominal puncture, and continuous active bleeding from this artery can lead to hemorrhagic shock. Several studies have reported the use of contrast-enhanced ultrasound (CEUS) to diagnose active bleeding in parenchymal organs. Fluid gelatin is a new hemostatic material that can be injected into the bleeding site by using a puncture needle under the precise guidance of CEUS, which enables the implementation of local minimally invasive and appropriate hemostatic treatment. Here, we report the case of a patient in whom CEUS was used to accurately locate the bleeding site before surgery and guide local injection of fluid gelatin with a puncture needle to successfully achieve nonsurgical treatment of hemostasis. CASE REPORT A 62-year-old man with post-hepatitis B cirrhosis underwent a successful liver transplant surgery. After surgery, abdominal puncture and drainage were performed because of a large amount of peritoneal effusion due to nephrotic syndrome. The drainage fluid was bright red bloody liquid. CEUS revealed many contrast agent microbubbles extravasating from the inferior epigastric artery into peritoneal effusion along the abdominal puncture tract. Surgical suturing and applying a compression bandage failed to achieve satisfactory results. After receiving the patient's consent, thrombin and hemostatic glue were injected locally under the guidance of CEUS. Finally, hemostasis was successfully achieved. CONCLUSIONS CEUS-guided injection of fluid gelatin is a safe and effective treatment method and could serve as an effective measure for nonsurgical treatment and postoperative supplementary treatment of active bleeding from the inferior epigastric artery.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e947297"},"PeriodicalIF":1.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12147519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fanjie Meng, Yan Zhang, Hongfei Cai, Fanyu Meng, Bohao Liu, Yang Li
{"title":"Lung Transplant Success in Severe Diquat Poisoning: A Case Report.","authors":"Fanjie Meng, Yan Zhang, Hongfei Cai, Fanyu Meng, Bohao Liu, Yang Li","doi":"10.12659/AJCR.947421","DOIUrl":"10.12659/AJCR.947421","url":null,"abstract":"<p><p>BACKGROUND Diquat is a commonly used herbicide in China, which has the potential to induce severe or fatal poisoning in humans. Diquat is extremely lethal to humans and there is no antidote available. CASE REPORT We report the case of a 26-year-old woman who experienced nausea, vomiting, coughing, and general fatigue after ingesting 80 mL of 20% diquat. Due to the toxic effects of diquat, the patient's condition progressed rapidly, resulting in sequential impairments of liver and kidney function, as well as the development of pulmonary fibrosis. Prior to the surgical procedure, she was supported by extracorporeal membrane oxygenation (ECMO) to manage the preoperative dyspnea. On the 28th day, she a double-lung transplant. On the 8th postoperative day, she was diagnosed with a pulmonary embolism and subsequently accepted right upper-lobe resection surgery. On the 175th postoperative day, she patient was diagnosed with airway stenosis and then underwent tracheal covered stent implantation. Following the lung transplantation, she participated in an active rehabilitation program, complied with the prescribed anti-rejection medication regimen, attended regular follow-up appointments, and had a favorable prognosis. CONCLUSIONS Lung transplantation is currently the most effective treatment for pulmonary fibrosis, and ECMO serves as a temporary support mechanism for patients who have experienced severe diquat poisoning and are awaiting lung transplantation. The complex perioperative complications of the diquat itself can be successfully managed by a multidisciplinary team. The clinicians should be aware of the risk of pulmonary embolism after lung transplantation.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e947421"},"PeriodicalIF":1.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12144919/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"An Innovative Endovascular Approach to Pancreatic Transplant Artery Y-Graft Aneurysm Complications Using Elective Endovascular Techniques: A Case Report.","authors":"Pooja Krishnaswamy, Ming Yii","doi":"10.12659/AJCR.946786","DOIUrl":"10.12659/AJCR.946786","url":null,"abstract":"<p><p>BACKGROUND Pancreatic transplant is the only definitive treatment to restore normoglycemia for autoimmune type 1 diabetes, but it is associated with significant morbidity due to its complexity from the index operation and sequelae. Vascular complications, including thrombosis and pseudoaneurysms, can have significant impacts on pancreatic transplant graft function. CASE REPORT Pancreatic transplant artery aneurysm is a rare complication of pancreas transplant. Vascular complications of transplants, including aneurysm rupture, are life-threatening and can require transplant pancreatectomy. We present a rare case of a chronic pancreatic transplant Y-graft arterial pseudoaneurysm of unknown etiology, 20 years after the initial simultaneous pancreas and kidney transplant. Due to the chronicity, previous significant adhesiolysis from a cholecystectomy, unlikelihood of a mycotic aneurysm, and concern for thrombus propagation leading to graft dysfunction, an endovascular approach was used. A combination of covered endovascular stents was deployed to maintain adequate blood flow to the pancreas allograft. Following endovascular Y-stenting, the patient maintained pancreatic graft function with no signs of allograft rejection. CONCLUSIONS Endovascular stenting can be used to treat chronic transplant pancreatic artery aneurysms and offers a less invasive treatment alternative to open surgery.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e946786"},"PeriodicalIF":1.0,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12143180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Zaid Al-Deerawi, Ali Shaladi, Anton G Borg, Matt Stanislas, Husham Barrak
{"title":"Accessory Nerve Palsy as the Initial Manifestation of Chronic Lymphocytic Leukemia: A Case Report.","authors":"Zaid Al-Deerawi, Ali Shaladi, Anton G Borg, Matt Stanislas, Husham Barrak","doi":"10.12659/AJCR.948534","DOIUrl":"10.12659/AJCR.948534","url":null,"abstract":"<p><p>BACKGROUND Chronic lymphocytic leukemia is the most common leukemia affecting adults, classically presenting with painless lymphadenopathy or diagnosed incidentally on routine full blood count. Neurological complications rarely arise in chronic lymphocytic leukemia and the underlying causes for such complications remain poorly understood. Cranial nerve involvement is uncommon and there are currently no reported cases of accessory nerve palsy as the first presentation of chronic lymphocytic leukemia. CASE REPORT A woman in her 40s presented with a 4-week history of left-sided neck swelling and pain associated with left shoulder restriction. Left trapezius weakness and scapular winging was found on examination, consistent with a left accessory nerve palsy. Examination also revealed multiple tender lymph nodes in the left posterior triangle of the neck. Investigations included a staging CT scan, flexible nasendoscopy, nerve conduction studies, and a full blood count showing lymphocytosis. A work-up involving Ear, Nose, and Throat Surgery, Hematology, and Orthopedic Surgery led to the diagnosis of chronic lymphocytic leukemia. There was no evidence of Richter's transformation. A multidisciplinary team approach was used to treat the patient, and there was complete resolution of her neurological symptoms on follow-up. CONCLUSIONS This report describes an unusual first presentation of chronic lymphocytic leukemia. It serves as a reminder to consider hematological malignancies in cases of accessory nerve palsy associated with a neck swelling. Early input from Hematology and multidisciplinary involvement can aid early diagnosis and prevent unnecessary investigations. Further research is warranted to explore the neurological spectrum of CLL.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e948534"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12139459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144226997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Granulomatosis with Polyangiitis Presenting as Pancreatic Pseudotumor and Peripancreatic Lymphadenitis: Diagnostic Challenges and Review of 55 Cases.","authors":"Camille Beniada, Yann Coattrenec, Sahar Mack, Alexis Ricoeur, Volkan Adsay, Giacomo Puppa, Jörg D Seebach","doi":"10.12659/AJCR.945741","DOIUrl":"10.12659/AJCR.945741","url":null,"abstract":"<p><p>BACKGROUND The spectrum of anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) encompasses granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA). These pathologies predominantly affect small to medium-sized vessels, with frequent involvement of the ear, nose, and throat (ENT) sphere, lungs, and kidneys. Pancreatic involvement, an exceedingly rare manifestation of AAV, manifests as pancreatitis, a pancreatic mass, or a cystic lesion. This study reports a new case of pancreatic GPA and reviews the literature to characterize its clinical, radiological, and histological features. CASE REPORT A 54-year-old woman with severe epigastric pain, vomiting, and weight loss presented with a pancreatic mass and peripancreatic lymphadenitis on imaging studies, raising high suspicion for cancer. Repeated endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) biopsies were inconclusive. Distal pancreatectomy with splenectomy was performed. Histopathology demonstrated granulomatous inflammation with necrosis and vasculitis, and anti-PR3 ANCA testing was positive. A diagnosis of GPA was made and treatment with corticosteroids and rituximab resulted in clinical remission. We identified 54 additional cases of pancreatic AAV in the literature and analyzed their clinical features. CONCLUSIONS In cases of unexplained pancreatitis or pancreatic masses/pseudocysts, AAV should be considered. A targeted evaluation - including ANCA testing, imaging, biopsies, and a systematic search for ENT, lung, kidney, and skin manifestations - is essential to identify key clinical, serological, and radiological clues of pancreatic AAV. We propose to classify this as type 4 autoimmune pancreatitis. A corticosteroid-based regimen, with or without additional immunosuppressants, offers effective disease control, making pancreatic surgery unnecessary.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e945741"},"PeriodicalIF":1.0,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12135710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192317","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}
Taylor Brooke Kenneda, Teagan L Willard, Ryan Demkowicz, Megan Willard
{"title":"Histoplasma-Induced Esophageal Ulcers in HIV/AIDS Patient: A Case Report.","authors":"Taylor Brooke Kenneda, Teagan L Willard, Ryan Demkowicz, Megan Willard","doi":"10.12659/AJCR.948028","DOIUrl":"10.12659/AJCR.948028","url":null,"abstract":"<p><p>BACKGROUND Patients with HIV/AIDS can develop opportunistic infections of the esophagus. While Candida frequently causes infectious esophagitis in this population, other opportunistic infections, like cytomegalovirus and herpes simplex virus, can cause esophagitis, and in some cases, esophageal ulcers. Less frequent opportunistic infections of the esophagus include histoplasmosis. CASE REPORT A 58-year-old man with a history of HIV presented to the hospital with esophageal dysphagia. He had a history of disseminated histoplasmosis and was on itraconazole. Upper endoscopy done for the dysphagia revealed large, deeply cratered esophageal ulcers, a common cause of esophageal dysphagia. Ulcer biopsies were obtained, with routine staining negative for HIV, cytomegalovirus, yeast, or fungal organisms. He was started on acid suppressive therapy, with no improvement in dysphagia. Laboratory test results were significant for subtherapeutic levels of itraconazole therapy and positive urine Histoplasma antigen. These new findings raised concern for histoplasmosis being the cause of the patient's esophageal ulcers. Therefore, the team conducted specialized Grocot-Gomori methenamine silver staining on tissue from the esophageal ulcers, which revealed Histoplasma. For disseminated histoplasmosis treatment, he was admitted for intravenous amphotericin, and his outpatient dose of itraconazole was adjusted. Dysphagia subsequently improved, and follow-up upper endoscopy revealed esophageal ulcers had resolved. CONCLUSIONS This case underscores Histoplasma capsulatum as a rare but significant cause of esophageal ulceration in patients with HIV/AIDS. Proper diagnostic approaches, including specialized staining techniques, are critical when routine examinations fail to identify a pathogen. In patients with HIV/AIDS, clinicians should be keen to consider alternate, less common, causes of esophageal ulcers.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e948028"},"PeriodicalIF":1.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12131946/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182793","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}
Rida Altaf, Mousa Thalji, Jose Serriera, Madison French, Mario Madruga, Stephen J Carlan
{"title":"Cerebral Venous Thrombosis Following a Lumbar Puncture in a Patient Using NuvaRing.","authors":"Rida Altaf, Mousa Thalji, Jose Serriera, Madison French, Mario Madruga, Stephen J Carlan","doi":"10.12659/AJCR.947368","DOIUrl":"10.12659/AJCR.947368","url":null,"abstract":"<p><p>BACKGROUND Lumbar puncture (LP) is a key diagnostic tool for various pathologies but can lead to complications, including post-LP headache (PLPH). Post-LP cerebral venous thrombosis (CVT) is a rare but serious complication with an annual incidence of 1.16 to 2.02 per 100 000 population. It is more common in females, with a ratio of 3: 1 compared to males. Exogenous estrogen use is an antecedent risk factor for thrombosis. CASE REPORT A 29-year-old woman, gravida 0 with a 3-year history of using etonogestrel/ethinyl estradiol vaginal ring (NuvaRing) for contraception, presented to the emergency room with 2 days of fever, altered mental status, and body aches. Her initial imaging showed no abnormalities, including head computed tomography (CT), CT angiography, and head magnetic resonance imaging (MRI). An LP was negative. A persistent headache prompted placement of an epidural blood patch 6 days later, and a subsequent MRI revealed a thrombus in the superior sagittal sinus and a cortical infarct. Use of the NuvaRing was discontinued, and the patient was treated with anticoagulants. Follow-up imaging showed chronic venothrombotic changes but no new thrombosis. The diagnosis of the condition leading to the original admission and workup was never determined. CONCLUSIONS Post-LP cerebral venous thrombosis can be life-threatening if not promptly diagnosed and treated. Persistent headaches, new neurological deficits, and unexplained symptoms after LP should prompt investigation for cerebral venous thrombosis. Early diagnosis with MRI with magnetic resonance venography (MRV) and appropriate anticoagulation therapy are crucial for managing this complication. The combination of a NuvaRing and LP temporally associated with a CVT is unreported and likely increased her risk of thrombosis.</p>","PeriodicalId":39064,"journal":{"name":"American Journal of Case Reports","volume":"26 ","pages":"e947368"},"PeriodicalIF":1.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12131945/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180403","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}