Oxford Medical Case Reports最新文献

{"title":"The double-edged sword of daptomycin: a case of daptomycin-induced eosinophilic pneumonia.","authors":"Mohammed Najdat Seijari, Fayaz Khan, Taraneh Zamani, Shahla Mallick, Mohammad Nasser Affas, Stephen Beerman","doi":"10.1093/omcr/omag146","DOIUrl":"10.1093/omcr/omag146","url":null,"abstract":"<p><p>Daptomycin is an effective antibiotic for resistant gram-positive infections, including MRSA and VRE, but can rarely cause daptomycin-induced eosinophilic pneumonia (DIEP). We present a 73-year-old woman treated for prosthetic joint infection who developed acute hypoxemic respiratory failure and peripheral eosinophilia after 21 days of daptomycin therapy. Chest imaging showed bilateral upper lobe consolidations. Symptoms resolved rapidly after stopping daptomycin, without corticosteroid use. This case highlights the need for early recognition of DIEP in patients presenting with new respiratory symptoms and eosinophilia during daptomycin therapy, enabling timely discontinuation and reducing potential morbidity.</p>","PeriodicalId":45318,"journal":{"name":"Oxford Medical Case Reports","volume":"2026 8","pages":"omag146"},"PeriodicalIF":0.6,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13459500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713943","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":"Primary Burkitt lymphoma of the breast in a young north African woman: diagnostic challenge and benefit of early intensive chemotherapy.","authors":"Abouchabaka Ibtihal, Nouama Bouanani","doi":"10.1093/omcr/omag149","DOIUrl":"10.1093/omcr/omag149","url":null,"abstract":"<p><p>Burkitt lymphoma (BL) is a highly aggressive B-cell malignancy that rarely presents primarily in the breast. Its rapid progression and inflammatory features can mimic breast cancer or mastitis, leading to a delay in diagnosis. A 26-year-old nulliparous North African woman presented with a painful, rapidly growing breast mass that had appeared within the last four weeks. Clinical examination revealed an 8 cm mass accompanied by orange-peel skin. Imaging suggested a likely benign lesion (BI-RADS 3). However, histology showed a classic 'starry sky' pattern, a Ki-67 rate of 100% and positivity for CD20/CD10/BCL6 with negativity for BCL2/CD5/EBER. PET-CT revealed a solitary hypermetabolic lesion (SUV 32) without systemic involvement (stage IE, BL-IPI 1). Treatment with R-COPADM was initiated within 48 hours, resulting in complete remission. This case highlights that an early biopsy is essential in the presence of any atypical inflammatory breast mass, even when imaging appears reassuring.</p>","PeriodicalId":45318,"journal":{"name":"Oxford Medical Case Reports","volume":"2026 8","pages":"omag149"},"PeriodicalIF":0.6,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13459501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe Guillain-Barré syndrome after mRNA COVID-19 vaccination with rapid deterioration and recovery: a case report.","authors":"Raees Samli, Bara'a Al-Diri, Eyad Jamileh, Taghread Hudaib","doi":"10.1093/omcr/omag153","DOIUrl":"10.1093/omcr/omag153","url":null,"abstract":"<p><p>Guillain-Barré syndrome (GBS) is an acute immune-mediated polyneuropathy characterised by rapidly progressive weakness, sensory disturbance, and autonomic dysfunction, often requiring intensive supportive care. While most cases follow gastrointestinal or respiratory infections, rare cases have been reported after vaccination. A 72-year-old man developed progressive symmetrical weakness and areflexia three weeks after receiving an mRNA COVID-19 vaccine. His condition deteriorated to bulbar dysfunction and respiratory failure, requiring intubation, tracheostomy, and prolonged ventilatory support. Cerebrospinal fluid analysis demonstrated albuminocytologic dissociation, while neuroimaging excluded structural pathology. Intravenous immunoglobulin was initiated promptly, followed by intensive multidisciplinary rehabilitation, including hydrotherapy. He gradually improved, was successfully decannulated, and transferred to a rehabilitation facility. This case highlights a rare possible post-vaccination association while emphasising that causality remains uncertain. Early recognition, close respiratory monitoring, and comprehensive rehabilitation are essential, as meaningful recovery is achievable even after severe disease.</p>","PeriodicalId":45318,"journal":{"name":"Oxford Medical Case Reports","volume":"2026 8","pages":"omag153"},"PeriodicalIF":0.6,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13459503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713963","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":"First clinical isolation of <i>Purpureocillium lilacinum</i> in a pediatric oncological patient in Ecuador.","authors":"Johana Salgado, Estefanía Mariño-Brito, Francisco Mosquera-Yuqui, Analia Ruales Guerra, Jennia Joanna Acebo Arcentales","doi":"10.1093/omcr/omag129","DOIUrl":"10.1093/omcr/omag129","url":null,"abstract":"<p><strong>Background: </strong><i>Purpureocillium lilacinum</i> is a ubiquitous environmental fungus widely utilized as an agricultural biocontrol agent, but it is increasingly recognized as an opportunistic human pathogen. While invasive fungal infections caused by this microorganism have been documented globally, disseminated systemic presentations in pediatric oncology remain exceptionally rare and carry high mortality rates.</p><p><strong>Case description: </strong>We report the case of an 11-year-old female patient with a high-grade osteosarcoma who developed high-risk febrile leukopenia during chemotherapy. Blood cultures from both a subcutaneous port and peripheral blood turned positive for both yeast-like and hyphal structures, which were further identified by DNA barcoding (ITS and EF1a regions) as <i>P. lilacinum</i>. The patient exhibited concurrent multiorgan dissemination, including hyperchromic scaling skin lesions in the perianal region and limbs, as well as diffuse bilateral pulmonary micronodules confirmed via video-thoracoscopy biopsy. Despite initial treatment with amphotericin B and fluconazole, clinical resolution was successfully achieved only after optimizing the antifungal regimen with oral voriconazole. The patient fully recovered and remains stable.</p><p><strong>Conclusions: </strong>To our knowledge, this represents the first clinical isolation and reported case of disseminated systemic <i>P. lilacinum</i> infection in a pediatric oncological patient in Ecuador. This case highlights the aggressive nature of this pathogen in immunosuppressed children, the challenge of its diagnosis due to the lack of specialized infrastructure for antifungal susceptibility testing, and the critical importance of a multidisciplinary approach and prompt, targeted first-line therapy with voriconazole to ensure survival.</p>","PeriodicalId":45318,"journal":{"name":"Oxford Medical Case Reports","volume":"2026 8","pages":"omag129"},"PeriodicalIF":0.6,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13444612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686068","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":"Ischemic stroke as the initial presentation of undiagnosed aortic coarctation in an adolescent: a case report.","authors":"Malegna Temesgen Garuma, Mihretie Jenber Tesfa, Leja Hamza Juhar, Tadele Zerga Chaka","doi":"10.1093/omcr/omag148","DOIUrl":"10.1093/omcr/omag148","url":null,"abstract":"<p><p>Coarctation of the aorta is a congenital cardiovascular anomaly that may remain undiagnosed until adolescence. Delayed diagnosis can result in serious complications, including systemic hypertension and cerebrovascular events. We report the case of a 16-year-old Ethiopian boy who presented with sudden-onset right-sided hemiparesis and expressive aphasia. Examination revealed a marked discrepancy between the upper and lower limb blood pressures and absent femoral pulses. Neuroimaging revealed a large left middle cerebral artery infarction. Transthoracic echocardiography and computed tomography angiography confirmed severe native coarctation of the aorta distal to the left subclavian artery, associated with a bicuspid aortic valve and extensive collateral circulation. The patient was treated for ischemic stroke and hypertensive urgency and was referred for definitive surgical correction. Ischemic stroke may be a rare initial manifestation of undiagnosed aortic coarctation in adolescents. Routine four-limb blood pressure measurements are essential for the early diagnosis and prevention of catastrophic outcomes.</p>","PeriodicalId":45318,"journal":{"name":"Oxford Medical Case Reports","volume":"2026 8","pages":"omag148"},"PeriodicalIF":0.6,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13430965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670784","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":"Protein-losing enteropathy in a child with hypoplastic left heart syndrome after Fontan palliation: a case report.","authors":"Sakeena Saife, Sarah Saife, Momen Zetawi","doi":"10.1093/omcr/omag145","DOIUrl":"10.1093/omcr/omag145","url":null,"abstract":"<p><p>Protein-losing enteropathy (PLE) is a rare but serious complication of the Fontan procedure in patients with single-ventricle physiology. It results from excessive loss of plasma proteins into the gastrointestinal tract, leading to hypoalbuminemia, edema, and ascites. We report the case of a 10-year-old girl with hypoplastic left heart syndrome who underwent staged surgical palliation including the Norwood procedure, bidirectional Glenn shunt, and extracardiac Fontan completion. She presented with progressive abdominal distension, peripheral edema, and severe hypoalbuminemia (albumin 2.3 g/dl). Echocardiography and cardiac catheterization demonstrated a patent Fontan circuit with normal pulmonary artery pressures and no significant obstruction, although the inferior vena cava pressure was mildly elevated at approximately 16 mmHg. The patient was managed with intravenous albumin replacement, diuretics, anticoagulation, sildenafil, and oral budesonide. This case highlights the diagnostic challenges of PLE and emphasizes the importance of early recognition and multidisciplinary management, even in the absence of significant Fontan circuit obstruction, as elevated systemic venous pressure and lymphatic dysfunction may both contribute to disease development.</p><p><strong>Key clinical message: </strong>Protein-losing enteropathy is a rare but potentially life-threatening complication of Fontan circulation. It should be suspected in patients with a history of Fontan palliation who present with unexplained hypoalbuminemia, edema, or ascites, even when no significant Fontan circuit obstruction is identified, as elevated systemic venous pressure and lymphatic abnormalities may contribute to disease development. Early recognition and multidisciplinary management are essential to improve clinical outcomes and guide further evaluation of underlying lymphatic abnormalities.</p>","PeriodicalId":45318,"journal":{"name":"Oxford Medical Case Reports","volume":"2026 8","pages":"omag145"},"PeriodicalIF":0.6,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13430966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670821","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":"Rifampin-induced fluvastatin toxicity: a case report and review of literature.","authors":"Ahmed Farghali, Hesham Mahmoud, Muhammad Salem","doi":"10.1093/omcr/omag144","DOIUrl":"10.1093/omcr/omag144","url":null,"abstract":"<p><p>Fluvastatin is extensively metabolized by CYP2C9, which is induced by rifampin over several weeks, leading to a concentration decline. However, since rifampin is a potent inhibitor of the primary first-pass hepatic statin uptake transporter, the organic anion transporting polypeptide 1B1 (OATP1B1), simultaneous administration has been shown to significantly increase statin exposure. We report a previously fluvastatin-tolerant 63-year-old woman with nonalcoholic steatohepatitis who developed statin-induced rhabdomyolysis four weeks after the initiation and co-administration of rifampin for tuberculosis. After both medications were stopped, the patient showed clinical and biochemical improvement. While this report is the first to describe a clinical outcome of this interaction, multiple pharmacokinetic studies have demonstrated opposing, time-dependent rifampin effects on statin concentrations. Safe management of this challenging interaction includes statin dose reduction and/or separate administration upon rifampin initiation until the anticipated onset of CYP induction, followed by careful and gradual dose titration with monitoring of both effectiveness and toxicity.</p>","PeriodicalId":45318,"journal":{"name":"Oxford Medical Case Reports","volume":"2026 8","pages":"omag144"},"PeriodicalIF":0.6,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13430968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670732","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":"Hydromorphone-induced choreiform dyskinesia in a patient with homozygous sickle cell disease: a reversible adverse effect.","authors":"Sakeena Saife, Michael El Masry, Islam Rajab, Rayan A Rahman, Nader Ghobrial","doi":"10.1093/omcr/omag142","DOIUrl":"10.1093/omcr/omag142","url":null,"abstract":"<p><strong>Background: </strong>Sickle Cell Disease (SCD) is a type of chronic hemoglobinopathy with vaso-occlusive pain crises that requires aggressive pain management with opioids.Hydromorphone is commonly used in the management of pain in patients with SCD, particularly when vaso-occlusive crises require prolonged opioid therapy. While opioid-induced neurotoxicity is a well-recognized complication, usually presenting as delirium, agitation, or myoclonus, choreiform dyskinesias are rare and only infrequently reported. New-onset involuntary movements in patients with SCD may be concerning for cerebrovascular or metabolic complications, prompting extensive diagnostic evaluations. Recognition of opioid-induced choreiform dyskinesia is important, since symptoms are usually reversible with opioid dose reduction or discontinuation, thus offering early management and the avoidance of unnecessary investigations.</p><p><strong>Case report: </strong>A 33-year-old African American woman with homozygous sickle cell disease (HbSS) was admitted for pleuritic chest pain, fever, abdominal pain, and sweating, suspected to be acute chest syndrome or a vaso-occlusive pain crisis. She had a history of recurrent vaso-occlusive crises requiring hospitalizations and opioid therapy. She had no history of cerebrovascular events, movement disorders, psychiatric illness, or exposure to dopamine-modulating medications. She had no significant family history.On day 25 of hospitalization, she developed new, involuntary, non-rhythmic choreiform movements affecting the upper limbs and face while on high-dose IV hydromorphone. She remained alert and oriented without any focal neurologic signs or metabolic issues. The hydromorphone was stopped, and the movements completely resolved within 24 hours. When trying a lower dose, the movements did not recur. Neurology advised that no further imaging or testing was needed given the rapid, full improvement.</p><p><strong>Conclusions: </strong>Dyskinesia is a rare but reversible complication of opioid therapy and may be caused by hydromorphone. It is important to recognize this side effect to prevent unnecessary testing, particularly in patients with sickle cell disease, who may otherwise undergo an extensive neurologic workup.</p>","PeriodicalId":45318,"journal":{"name":"Oxford Medical Case Reports","volume":"2026 7","pages":"omag142"},"PeriodicalIF":0.6,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13403555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148608568","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":"Osmotic demyelination without hyponatremia: the role of glycemic variability in a complex patient with diabetes.","authors":"Juliana Pineda-Ortega, María Juliana Soto-Chavez, Ana María Gómez","doi":"10.1093/omcr/omag138","DOIUrl":"10.1093/omcr/omag138","url":null,"abstract":"<p><p>Osmotic demyelination syndrome (ODS) is classically associated with rapid correction of hyponatremia; however, non-sodium osmotic shifts remain underrecognized. We report a young man with poorly controlled type 1 diabetes and extreme glycemic variability (13-486 mg/dL), admitted with cardiorenal syndrome requiring dialysis, who developed progressive neurological deficits. Brain MRI demonstrated findings consistent with extrapontine ODS despite stable sodium levels. Alternative etiologies were excluded, supporting glycemic variability and osmotic instability as key contributors, potentially exacerbated by dialysis disequilibrium. This case expands the pathophysiological spectrum of ODS and highlights glycemic variability as a clinically relevant, yet overlooked, risk factor.</p>","PeriodicalId":45318,"journal":{"name":"Oxford Medical Case Reports","volume":"2026 7","pages":"omag138"},"PeriodicalIF":0.6,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13403551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148608330","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":"Successful treatment of noninfectious hemorrhagic cystitis with intravesical hyaluronic acid in a 5-year-old boy: a case report.","authors":"Zlatan Zvizdic, Asmir Jonuzi, Mubina Hakulija, Semir Vranic","doi":"10.1093/omcr/omag133","DOIUrl":"10.1093/omcr/omag133","url":null,"abstract":"<p><p>Hemorrhagic cystitis (HC) in children is most associated with infection or treatment-related toxicity, whereas other cases remain uncommon. We report a 5-year-old boy presenting with recurrent painless gross hematuria in whom a structured, stepwise evaluation excluded glomerular, infectious, structural, and systemic causes. Cystoscopy revealed diffuse mucosal inflammation with focal hemorrhagic changes involving the bladder neck and posterior wall, consistent with noninfectious HC. In the absence of an identifiable etiology and with persistent symptoms, management was directed toward restoring urothelial barrier integrity using intravesical hyaluronic acid (HA). The clinical response was rapid, with resolution of gross hematuria after the first instillation, followed by sustained remission and progressive endoscopic improvement. The treatment was well tolerated, and the patient remained disease-free at 12 months of follow-up. This case highlights the diagnostic complexity of unexplained hematuria in children and supports a potential role of urothelial barrier dysfunction in the pathogenesis of noninfectious HC.</p>","PeriodicalId":45318,"journal":{"name":"Oxford Medical Case Reports","volume":"2026 7","pages":"omag133"},"PeriodicalIF":0.6,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13403561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148608326","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}