Archive of clinical cases最新文献

{"title":"Tacrolimus associated Guillain-Barre syndrome.","authors":"Abdulrahman Nasiri, Tamam Alshammari, Alanood Alsolaihim, Huda Alfattah, Ali Alahmri","doi":"10.22551/2025.47.1202.10317","DOIUrl":"10.22551/2025.47.1202.10317","url":null,"abstract":"<p><p>Guillain-Barré syndrome (GBS) is a rare but serious neuropathy in hematopoietic stem cell transplant recipients. Immunosuppressants, particularly tacrolimus, have been implicated as potential triggers. We present a 27-year-old man with BCR-ABL-positive acute myeloid leukemia who developed an acute demyelinating polyneuropathy possibly related to tacrolimus therapy post-transplantation, highlighting diagnostic challenges and management considerations. The patient developed progressive ascending weakness, areflexia, sensory loss, and bulbar symptoms 58 days after an allogeneic stem cell transplant from an HLA-matched sibling donor. Cerebrospinal fluid (CSF) analysis showed elevated protein (1,900 mg/L) with lymphocytic pleocytosis (51 cells/μL), an atypical finding for GBS. Magnetic resonance imaging revealed subtle nerve root enhancement, and nerve conduction studies demonstrated markedly slowed conduction velocities and prolonged distal latencies consistent with an acute inflammatory demyelinating polyneuropathy. Extensive infectious work-up (including viral PCR panels and cultures) was negative, and no leukemic cells were seen in CSF. Tacrolimus was discontinued (trough level 3.1 ng/mL, below therapeutic range) and intravenous immunoglobulin (2 g/kg total over five days) initiated. The patient's neurological deficits improved rapidly, with near-complete recovery within four weeks. Notably, withdrawal of tacrolimus immunosuppression did not precipitate graft-versus-host disease, and the patient's acute leukemia remained in remission on ponatinib monotherapy. This case illustrates an acute demyelinating polyneuropathy in a post-transplant patient, associated with tacrolimus. It underscores the importance of careful diagnostic assessment of GBS in transplant recipients, including consideration of atypical CSF findings and alternative diagnoses. Prompt recognition and management - including immunosuppressant adjustment and immunotherapy - can achieve full neurological recovery without compromising transplant outcomes.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"12 2","pages":"75-79"},"PeriodicalIF":0.8,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144569","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":"A peculiar mimicker of gastro-entero-pancreatic neuroendocrine tumors: Malignant Gastrointestinal Neuroectodermal Tumor - literature review and one case report.","authors":"Alexandra Ondu, Vlad Herlea, Florin Botea, Gabriel Becheanu, Mihai-Mircea Diculescu","doi":"10.22551/2025.47.1202.10316","DOIUrl":"10.22551/2025.47.1202.10316","url":null,"abstract":"<p><p>Malignant gastrointestinal neuroectodermal tumor (GNET) is a distinctive and relatively newly described neoplasm that is seldom encountered in routine clinical practice. It is characterized by a predominantly monomorphic population of polyhedral to epithelioid cells, exhibiting pale eosinophilic or clear cytoplasm, rounded nuclei with vesicular chromatin, and occasionally prominent eosinophilic nucleoli. These cells are arranged in a heterogeneous pattern, forming small nests, compact solid areas, and pseudo-papillary or pseudo-microcystic structures. Within the tumor, osteoclast-like giant cells may be a notable feature, although their presence is variable. This tumor consistently demonstrates positivity for S100, SOX10, and vimentin, while it is invariably negative for Melan-A, HMB45, desmin, CD117, and pan-cytokeratin. Additionally, it exhibits variable expression of the following immunohistochemical markers: synaptophysin, chromogranin, CD56, neuron-specific enolase (NSE), and neurofilament protein (NFP). A specific mutation in the Ewing's sarcoma breakpoint region 1 (EWSR1) gene has been described for GNET, characterized by EWSR1-CREB1 and EWSR1-ATF1 fusions. This article discusses the clinical, pathological, immunophenotypic, and genetic features of one clinical case of GNET, followed by a literature review of 127 cases published in the PubMed database, for which full-length articles were accessible. According to this review, approximately 10% of GNETs have been initially misdiagnosed, with about 6% being misclassified as neuroendocrine tumors or neuroendocrine carcinomas.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"12 2","pages":"66-74"},"PeriodicalIF":0.8,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144413","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":"Sagittal sinus thrombosis - rare complication of nephrotic syndrome in a young child.","authors":"Catalin Ionut Lupu, Raluca Maria Vlad","doi":"10.22551/2025.46.1201.10313","DOIUrl":"10.22551/2025.46.1201.10313","url":null,"abstract":"<p><p>The nephrotic syndrome (NS) is caused by increased glomerular permeability. We report a case of NS in a 3-year-old girl, complicated with central nervous system venous thrombosis. Physical examination revealed anasarca (edema, pleurisy, and ascites), intensely foaming urine. The lab tests showed severe, non-selective proteinuria, marked hypoproteinemia, dyslipidemia; also associated with abnormal thyroid panel due to urinary binding protein loss. Once the diagnosis was established and pathogen-specific treatment was started, the clinical and paraclinical evolution were favorable. A prolonged right body seizure was the onset symptom of cerebral venous infarction due to sagittal sinus thrombosis. Short- and long-term outcomes of the thrombosis can be severe, so anticoagulant therapy was promptly initiated.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"12 1","pages":"54-58"},"PeriodicalIF":0.8,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712382","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":"Immunohistochemical insights into the pathogenesis of colonic sessile serrated lesions.","authors":"Maria-Alexandra Florea, Gabriel Becheanu, Andrei Niculae, Maria Dobre, Mariana Costache","doi":"10.22551/2025.46.1201.10307","DOIUrl":"10.22551/2025.46.1201.10307","url":null,"abstract":"<p><strong>Background: </strong>Sessile serrated lesions (SSLs) are recognized as precursor lesions in the pathogenesis of colorectal cancer, particularly in the context of microsatellite instability (MSI). This study evaluates the role of immunohistochemical (IHC) markers in understanding the molecular and immunologic characteristics of SSLs.</p><p><strong>Materials and methods: </strong>A retrospective analysis was performed on 45 colonic neoplastic lesions diagnosed as SSLs. An IHC staining panel was conducted, including MLH1, p53, CD44, CD3, CD8, MUC2, MUC5AC, MUC6, chromogranin and Ki67 antibodies.</p><p><strong>Results: </strong>MLH1 and p53 expressions showed correlations with dysplastic changes. Immunological markers CD3 and CD8 indicated a variable immune response, potentially reflecting the tumor's ability to evade immune surveillance in certain situations. CD44 was overexpressed in all SSLs. The number of neuroendocrine cells was overall reduced.</p><p><strong>Conclusions: </strong>SSLs are heterogeneous lesions, exhibiting a wide range of histological and molecular features. Using IHC might enhance diagnostic accuracy, particularly in lesions with ambiguous histological features, when dysplasia develops. Accurate identification of SSLs and understanding their molecular characteristics are crucial for assessing their malignant potential.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"12 1","pages":"22-28"},"PeriodicalIF":0.8,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712381","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":"Hemobilia due to hepatic artery pseudoaneurysm following biliary pigtail stent placement.","authors":"Serkan Ipek","doi":"10.22551/2025.46.1201.10309","DOIUrl":"10.22551/2025.46.1201.10309","url":null,"abstract":"<p><p>Hemobilia is a potentially fatal condition if not diagnosed and treated early. One of the rare causes of hemobilia is hepatic artery pseudoaneurysm. Herein, we present a case of hemobilia caused by hepatic artery pseudoaneurysm rupture. A patient with a benign stricture in the distal common bile duct who had undergone multiple endoscopic retrograde cholangiopancreatography (ERCP) procedures had a pigtail stent placed during the last ERCP. Ten days after the procedure, the patient presented to our emergency department with abdominal pain and was admitted with a diagnosis of acute pancreatitis. During follow-up, the patient underwent another ERCP due to suspected cholangitis, and severe hemobilia was observed following removal of the pigtail stent. Computed tomography (CT) angiography revealed a hepatic artery pseudoaneurysm, which was successfully treated with coil embolization. Patients with hemobilia may present with symptoms of upper gastrointestinal bleeding as well as conditions such as cholangitis and pancreatitis due to hepatic artery pseudoaneurysm rupture. Coil embolization is the first-line of interventional to stop bleeding. If this method is insufficient, surgical treatment may be considered.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"12 1","pages":"34-36"},"PeriodicalIF":0.8,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712379","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":"Bilateral simultaneous proximal femoral fractures on dissimilar anatomical regions.","authors":"Pamela Zace, Alastair Stephens, Antonios Konstantinidis, Manoj Kumar, Ibrahim Inzarul Haq, Anca Duca, Asterios Dramis","doi":"10.22551/2025.46.1201.10308","DOIUrl":"10.22551/2025.46.1201.10308","url":null,"abstract":"<p><p>Simultaneous presentation of bilateral proximal femoral fractures following a traumatic event are considered very rare injuries. A literature search revealed that the fracture pattern in bilateral simultaneous proximal femoral fractures is most commonly similar to the anatomical region. We report a case of traumatic bilateral proximal femoral fractures with dissimilar pattern and anatomical location following a low energy trauma. A 90-year-old female presented with a right extracapsular - intertrochanteric neck of femur fracture and a left intracapsular - subcapital neck of femur fracture following a fall. The surgical plan was to fix the right side with a dynamic hip screw (DHS), directly followed by left cemented hip hemiarthroplasty on the left. Anesthetic concerns were raised towards the end of the first procedure hence the hemiarthroplasty was postponed. Following medical optimization, a bipolar cemented hip hemiarthroplasty was performed 4 days later. The patient was discharged after 16 days with carers support at home. Careful planning should take place in cases of simultaneous bilateral hip fracture given increased morbidity and mortality. Operation of both sides in a single stage is acceptable to reduce the risk of anesthetic complications and reduce costs. Dissimilar or asymmetrical bilateral hip fractures present a unique challenge, primarily because of the need to change the patient's position. Communication between the surgical and the anesthetic team throughout any procedure is important, but even more so in high-risk cases. To our knowledge, dissimilar or asymmetrical bilateral proximal hip fractures in the elderly presenting simultaneously have only been described twice in literature. Their rarity necessitates careful preoperative planning. The aim should be to address both injuries in a single operation, however contingency planning is important.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"12 1","pages":"29-33"},"PeriodicalIF":0.8,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712377","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":"Functional dyspepsia assessment - current diagnostic methods and new promising techniques.","authors":"Vadim Rosca, Liliana Gheorghe, Diana Floria, Radu Vulpoi, Georgiana Emanuela Gilca Blanariu, Camelia Eliza Salloum Cojocariu, Oana Barboi","doi":"10.22551/2025.46.1201.10310","DOIUrl":"10.22551/2025.46.1201.10310","url":null,"abstract":"<p><p>Functional Dyspepsia (FD) is a disorder of gut-brain interaction (DGBI) characterized by chronic symptoms without an organic cause. Diagnosis follows the Rome IV criteria, requiring symptoms for at least six months. FD affects up to 20% of the population, significantly impacting the quality of life and healthcare systems. Upper gastrointestinal endoscopy is often performed to rule out organic disorders but has limited utility in typical FD cases. FD's etiology involves gastric motility alterations, dysbiosis, and immune and central nervous system dysfunction. This review summarizes FD diagnostic methods. A PubMed search was conducted using keywords: Functional Dyspepsia, Gastric Motility Assessment, ROME IV, and Gastric Emptying (GE). Relevant studies were manually reviewed, excluding those unrelated to FD or gastric motility assessment. Despite extensive research on organic gastrointestinal diseases, FD's pathophysiology remains unclear, necessitating further studies. Diagnostic methods include the rapid water and nutrient drink tests for assessing impaired gastric accommodation, hypersensitivity, and delayed gastric emptying. Drinking-ultrasonography and three-dimensional ultrasound evaluate gastric motor and sensory functions. MRI-based assessments provide detailed stomach volume and geometry insights. Gastric emptying scintigraphy and the 13C-gastric emptying breath test measure gastric emptying rates. High-resolution electrogastrography (HR-EGG) assesses gastric myoelectrical activity, while EndoFLIP measures sphincter function. Functional MRI and PET scans analyze brain activity related to FD symptoms.  These methodologies enhance the understanding and management of FD by providing objective measures of gastric motility, accommodation, and sensory function. The integration of these advanced techniques into clinical practice holds the potential to move beyond symptom-based diagnosis, allowing for a more precise, individualized approach to treatment. Standardizing these diagnostic modalities will be crucial in optimizing patient care and alleviating the burden of FD on healthcare systems.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"12 1","pages":"37-43"},"PeriodicalIF":0.8,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11922155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665587","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":"Breaking the stone and beating the bug: managing ureterolithiasis with <i>Enterococcus faecium</i> in a high-risk patient.","authors":"Flavia Coman, Catrinel-Ana Codău, Bogdan Novac","doi":"10.22551/2025.46.1201.10312","DOIUrl":"10.22551/2025.46.1201.10312","url":null,"abstract":"<p><p>Ureteral lithiasis in high-risk patients demands a personalized approach due to the interplay of multiple comorbidities and procedural risks. This case report examines a 66-year-old female with recurrent lower ureteral stones resistant to multiple extracorporeal shock wave lithotripsy sessions, complicated by multidrug-resistant <i>Enterococcus faecium</i> infections, chronic coronary syndrome, heart failure with preserved ejection fraction, diabetes mellitus, and a history of ischemic stroke. The failure of conservative treatments required a shift to ureteroscopic laser lithotripsy, preceded by cardiovascular risk optimization and targeted antimicrobial therapy based on advanced microbial diagnostics. Postoperative imaging confirmed complete stone clearance and correct stent placement, ensuring ureteral patency. This case underscores the necessity of multidisciplinary management, integrating precise infection control, cardiovascular stabilization, and minimally invasive techniques to achieve a favorable outcome in a complex patient.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"12 1","pages":"51-53"},"PeriodicalIF":0.8,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11922156/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665585","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":"When cancer reaches the heart: a case series on rare myocardial and endocardial metastases from squamous cell carcinoma.","authors":"Ahmed Basuoni, Ikram Burney, Z Al-Hashami, Marwa Ahmed, Amany Hany Mohamed Kamel, Airton Leonardo de Oliveira Manoel, Yarab Al Bulushi, Waleed Dawelbeit","doi":"10.22551/2025.46.1201.10311","DOIUrl":"10.22551/2025.46.1201.10311","url":null,"abstract":"<p><p>Cardiac metastases are rare but devastating complications of malignancies. Squamous cell carcinoma (SCC), particularly from non-pulmonary origins, infrequently metastasizes to the heart, making its cardiac involvement an unusual and underreported phenomenon. We present a case series of four patients diagnosed with myocardial and endocardial metastases from SCC at our center over two years. Clinical presentation, imaging modalities, suspected metastatic pathways, management strategies, and outcomes were analyzed. Patients (ages 41-74, three males, one female) had primary SCC in the vulva, tongue, buccal mucosa, and lung. Symptoms varied, including dyspnea, hypotension, chest pain, and stroke. All patients had elevated troponin levels. Echocardiography was crucial for initial detection, while PET/CT confirmed metastases, with one patient undergoing cardiac MRI. Hematogenous spread was likely metastatic pathway in most cases. Treatment was primarily palliative; only one patient received chemotherapy post-diagnosis. Survival post-cardiac metastasis diagnosis ranged from a few days to six months. Myocardial and endocardial metastases from SCC are rare and often indicate advanced disease with poor prognosis. Early recognition through multimodal imaging and biomarkers such as troponin may facilitate timely palliative interventions. Increased collaboration between oncology and cardiology may improve supportive care and symptom management in these patients.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"12 1","pages":"44-50"},"PeriodicalIF":0.8,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11922157/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665590","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":"Spontaneous resolution of pemphigus vulgaris-induced desquamative gingivitis. A case report and brief review of the literature.","authors":"Dante Migliari","doi":"10.22551/2025.46.1201.10304","DOIUrl":"10.22551/2025.46.1201.10304","url":null,"abstract":"<p><p>Desquamative gingivitis (DG) is important in oral medicine because it is not a pathologic entity itself; rather, it is a clinical manifestation of dermatological disease most frequently associated with chronic inflammatory (e.g., oral lichen planus) and autoimmune diseases, mainly pemphigus vulgaris and mucous membrane pemphigoid, and several cases have been reported till date. Herein, we describe a case of pemphigus vulgaris-associated DG with unusual clinical behavior, in which the gingival lesions spontaneously resolved after consistently showing no response to various treatments. Additionally, a brief review of the literature focusing on the management of DG is provided.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"12 1","pages":"1-4"},"PeriodicalIF":0.8,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384215","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}