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Recurrent incomplete Kawasaki disease with small-joint-predominant arthritis during the acute phase. 急性期复发性不完全性川崎病伴小关节为主关节炎。
IF 0.4
BMJ Case Reports Pub Date : 2026-09-02 DOI: 10.1136/bcr-2026-272465
Kentaro Suzuki, Soichiro Ishimaru, Yuka Mihara, Satoru Kisohara
{"title":"Recurrent incomplete Kawasaki disease with small-joint-predominant arthritis during the acute phase.","authors":"Kentaro Suzuki, Soichiro Ishimaru, Yuka Mihara, Satoru Kisohara","doi":"10.1136/bcr-2026-272465","DOIUrl":"https://doi.org/10.1136/bcr-2026-272465","url":null,"abstract":"<p><p>An adolescent boy was admitted on illness day 6 with fever and left cervical lymphadenopathy. He had been treated for complete Kawasaki disease (KD) approximately a decade earlier. He subsequently developed painful swelling of the left wrist and bilateral finger and toe interphalangeal joints, impairing grip strength; ultrasonography confirmed synovitis. Although fever resolved by illness day 12, arthritis persisted. New conjunctival injection, lip erythema and a secondary rise in C-reactive protein led to a diagnosis of incomplete KD on illness day 18, followed by intravenous immunoglobulin. Arthritis rapidly improved and he was discharged without residual joint symptoms or coronary artery abnormalities. KD-associated arthritis may vary by disease phase, with acute-phase polyarthritis sometimes involving small joints and later arthritis affecting larger joints. Distinguishing this presentation from systemic juvenile idiopathic arthritis can be challenging; serial reassessment of the clinical course and treatment response is essential.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"19 9","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Life-threatening multisystem sarcoidosis with neurological, renal, ocular and autoimmune haemolytic manifestations treated with intravenous immunoglobulin, plasma exchange, cyclophosphamide and infliximab. 静脉注射免疫球蛋白、血浆置换、环磷酰胺和英夫利昔单抗治疗危及生命的多系统结节病，伴有神经、肾脏、眼部和自身免疫性溶血症状。
IF 0.4
BMJ Case Reports Pub Date : 2026-09-02 DOI: 10.1136/bcr-2026-275128
Kalpa Jayanatha, Mark Sapsford, Alexandra Chaptynova, Ajay Kumar
{"title":"Life-threatening multisystem sarcoidosis with neurological, renal, ocular and autoimmune haemolytic manifestations treated with intravenous immunoglobulin, plasma exchange, cyclophosphamide and infliximab.","authors":"Kalpa Jayanatha, Mark Sapsford, Alexandra Chaptynova, Ajay Kumar","doi":"10.1136/bcr-2026-275128","DOIUrl":"https://doi.org/10.1136/bcr-2026-275128","url":null,"abstract":"<p><p>Multisystem sarcoidosis is uncommon and presentation as a stroke mimic with severe renal impairment and concurrent haemolysis has not previously been described. Evidence for the use of plasma exchange (PLEX) in sarcoidosis is limited. This case describes a patient with multisystem sarcoidosis who presented with encephalopathy, acute tubulointerstitial nephritis, optic neuritis and autoimmune haemolytic anaemia. Extensive immunological investigations were non-diagnostic. The patient's neurological and haematological manifestations improved rapidly with intravenous methylprednisolone, intravenous immunoglobulin and PLEX. Her clinical course was complicated by sight-threatening steroid-induced glaucoma, adrenocortical insufficiency and diabetes mellitus. Her extra-ocular, extra-renal manifestations responded to oral glucocorticoid and intravenous cyclophosphamide therapy, while complete remission of ocular and renal disease was achieved with infliximab therapy at 12 and 24 months, respectively.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"19 9","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Rapidly progressive glomerulonephritis in rheumatoid arthritis: an early presentation of ANCA-associated vasculitis. 快速进展的肾小球肾炎在类风湿关节炎：早期表现的anca相关血管炎。
IF 0.4
BMJ Case Reports Pub Date : 2026-09-02 DOI: 10.1136/bcr-2026-272069
Jegadis Sreeneyasan, Roberta Dewar, Seema Rana, Jamil Choudhury, Helen Alderson, Sarang Chitale
{"title":"Rapidly progressive glomerulonephritis in rheumatoid arthritis: an early presentation of ANCA-associated vasculitis.","authors":"Jegadis Sreeneyasan, Roberta Dewar, Seema Rana, Jamil Choudhury, Helen Alderson, Sarang Chitale","doi":"10.1136/bcr-2026-272069","DOIUrl":"https://doi.org/10.1136/bcr-2026-272069","url":null,"abstract":"<p><p>Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis is a multisystem autoimmune disease that may present diagnostic challenges, particularly in patients with coexisting autoimmune conditions. Although the coexistence of rheumatoid arthritis and ANCA-associated vasculitis is recognised, vasculitis more commonly develops several years after rheumatoid arthritis onset. We describe a 68-year-old man who developed rapidly progressive glomerulonephritis due to myeloperoxidase (MPO)-ANCA-associated microscopic polyangiitis within 6 months of a diagnosis of seropositive rheumatoid arthritis. The diagnosis was established following an acute deterioration in renal function, positive MPO-ANCA serology and renal biopsy demonstrating pauci-immune necrotising crescentic glomerulonephritis. This case emphasises the importance of considering ANCA-associated vasculitis in patients with rheumatoid arthritis who develop acute kidney injury, even early in the disease course.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"19 9","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Subacute aortic dissection presenting as heart failure due to aortic valve insufficiency and right coronary artery dissection. 亚急性主动脉夹层表现为心力衰竭，由于主动脉瓣功能不全和右冠状动脉夹层。
IF 0.4
BMJ Case Reports Pub Date : 2026-09-02 DOI: 10.1136/bcr-2026-272319
Hediyeh Vaseli, Rosalind Groenewoud, Edward Percy, Christina Luong
{"title":"Subacute aortic dissection presenting as heart failure due to aortic valve insufficiency and right coronary artery dissection.","authors":"Hediyeh Vaseli, Rosalind Groenewoud, Edward Percy, Christina Luong","doi":"10.1136/bcr-2026-272319","DOIUrl":"https://doi.org/10.1136/bcr-2026-272319","url":null,"abstract":"<p><p>Subacute thoracic aortic aneurysm dissection (TAAD) often presents with a clinical profile distinct from its acute form, which can closely mimic common cardiac conditions, risking diagnostic delay. We report a case of subacute TAAD presenting initially with progressive dyspnoea due to severe aortic regurgitation (AR), culminating in congestive heart failure with reduced left ventricular ejection fraction. Diagnosis was confirmed with CT angiography. Surgical repair was performed using the Hemi-Yacoub technique. The postoperative course was complicated by paroxysmal atrial fibrillation, which necessitated pacemaker implantation. At the 6-month follow-up, the patient demonstrates recovery of left ventricular ejection fraction to 50%. This case highlights the importance of considering aortic pathology in patients with heart failure of unclear origin, particularly when accompanied by a new diastolic murmur or echocardiographic evidence of significant AR.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"19 9","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Rapid progression of a small penetrating aortic ulcer to rupture in the setting of Staphylococcus aureus bacteraemia. 在金黄色葡萄球菌菌血症的情况下，小的穿透性主动脉溃疡迅速发展为破裂。
IF 0.4
BMJ Case Reports Pub Date : 2026-09-02 DOI: 10.1136/bcr-2026-274076
Agnieszka Mijalska, Sylwia Barańska, Mateusz Jadeszko, Jerzy Głowiński
{"title":"Rapid progression of a small penetrating aortic ulcer to rupture in the setting of <i>Staphylococcus aureus</i> bacteraemia.","authors":"Agnieszka Mijalska, Sylwia Barańska, Mateusz Jadeszko, Jerzy Głowiński","doi":"10.1136/bcr-2026-274076","DOIUrl":"https://doi.org/10.1136/bcr-2026-274076","url":null,"abstract":"<p><p>An octogenarian woman with heart failure, atrial fibrillation and asthma was admitted with a cervical phlegmon and methicillin-sensitive <i>Staphylococcus aureus</i> bacteraemia. Initial CT angiography (CTA) showed a small infrarenal penetrating aortic ulcer without rupture, peri-aortic haematoma or pseudoaneurysm and conservative management was adopted. Three weeks later, she developed acute abdominal pain and anaemia. Repeat CTA showed rapid progression of the lesion to a contained rupture. Emergency endovascular repair was performed using a straight AFX VELA infrarenal endograft component. At 18-month follow-up, she had recovered clinically and CTA showed a stable endograft without endoleak or radiological features indicative of stent-graft infection.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"19 9","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Retained naso-orbital wooden foreign body: diagnostic challenge and management. 鼻眶木质异物：诊断挑战及处理。
IF 0.4
BMJ Case Reports Pub Date : 2026-09-01 DOI: 10.1136/bcr-2026-274781
Rahul Bansal, Prem Sagar, Ramaneeshwaran Murugesan, Sindhura Thanneru, Nivedhitha M, Rajeev Kumar
{"title":"Retained naso-orbital wooden foreign body: diagnostic challenge and management.","authors":"Rahul Bansal, Prem Sagar, Ramaneeshwaran Murugesan, Sindhura Thanneru, Nivedhitha M, Rajeev Kumar","doi":"10.1136/bcr-2026-274781","DOIUrl":"https://doi.org/10.1136/bcr-2026-274781","url":null,"abstract":"<p><p>A retained wooden foreign body in the naso-orbital region is rare and poses significant diagnostic challenges. We report a case of a young male presenting with an alleged history of trauma followed by pain and visual disturbance. Clinical examination and detailed radiologic evaluation led to the diagnosis of retained foreign body in the naso-orbital complex. The foreign body was successfully removed via a tailored surgical approach with multidisciplinary involvement. Wooden foreign bodies carry a high risk of infection being organic nature, necessitating prompt removal and adequate antimicrobial therapy. This case highlights the importance of considering retained organic foreign bodies in atypical presentations, recognising radiological pitfalls and adopting an appropriate surgical strategy to ensure complete removal without complications.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"19 9","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Focal nodular hyperplasia: a rare benign liver tumour in early childhood without predisposing factors. 局灶性结节性增生：一种罕见的儿童早期良性肝脏肿瘤，无易感因素。
IF 0.4
BMJ Case Reports Pub Date : 2026-09-01 DOI: 10.1136/bcr-2025-270129
Nishant Agarwal, Tarun Kumar, Priya Mathew, Basant Kumar
{"title":"Focal nodular hyperplasia: a rare benign liver tumour in early childhood without predisposing factors.","authors":"Nishant Agarwal, Tarun Kumar, Priya Mathew, Basant Kumar","doi":"10.1136/bcr-2025-270129","DOIUrl":"https://doi.org/10.1136/bcr-2025-270129","url":null,"abstract":"<p><p>Focal nodular hyperplasia (FNH) is a rare benign hepatic lesion in children, particularly under 5 years of age. Most paediatric liver tumours in this age group are malignant, making an accurate diagnosis essential. We report a case of FNH involving the left hepatic lobe in a healthy child with no prior history of liver disease, chemotherapy or systemic illness. The child presented with a gradually enlarging abdominal mass and early satiety. Imaging with contrast-enhanced triple-phase CT demonstrated classical features of FNH, including arterial enhancement and a central scar. Due to the lesion's large size and associated symptoms, a left lateral segmentectomy was performed. Histopathology confirmed the diagnosis of FNH. Postoperative recovery was uneventful, and the patient remains well on long-term follow-up. This case highlights the diagnostic challenges of FNH in early childhood and the importance of considering benign hepatic lesions in the differential diagnosis of paediatric liver masses.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"19 9","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Li-Fraumeni syndrome presenting with temporomandibular chondroblastic osteosarcoma following recurrent glioma. Li-Fraumeni综合征表现为复发性胶质瘤后的颞下颌软骨母细胞骨肉瘤。
IF 0.4
BMJ Case Reports Pub Date : 2026-09-01 DOI: 10.1136/bcr-2026-273397
Sujeeth Kumar Shetty, Sonakshi Prakash, Devika M Krishna
{"title":"Li-Fraumeni syndrome presenting with temporomandibular chondroblastic osteosarcoma following recurrent glioma.","authors":"Sujeeth Kumar Shetty, Sonakshi Prakash, Devika M Krishna","doi":"10.1136/bcr-2026-273397","DOIUrl":"https://doi.org/10.1136/bcr-2026-273397","url":null,"abstract":"<p><p>A man in his 20s with recurrent glioma developed rapid-onset trismus and left temporomandibular swelling. Imaging revealed condylar destruction with a mineralised mass. Initial biopsy suggested chondroblastic osteosarcoma; germline testing confirmed Li-Fraumeni syndrome with a pathogenic <i>TP53</i> variant. He underwent segmental resection with temporomandibular joint disarticulation, facial-nerve sacrifice and vascularised free fibular flap reconstruction. The case underscores the need for germline testing in young patients with multiple primary malignancies and adherence to oncological principles despite challenging anatomy.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"19 9","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Suspected menopause nutraceutical-induced eosinophilic ascites: a rare clinical presentation. 怀疑更年期营养保健品引起的嗜酸性腹水：罕见的临床表现。
IF 0.4
BMJ Case Reports Pub Date : 2026-09-01 DOI: 10.1136/bcr-2026-272658
Gemma Vicens-Novell, Alejandro Alonso-Galera, Rosa Muñoz-Cano, Joaquín Sáez-Peñataro
{"title":"Suspected menopause nutraceutical-induced eosinophilic ascites: a rare clinical presentation.","authors":"Gemma Vicens-Novell, Alejandro Alonso-Galera, Rosa Muñoz-Cano, Joaquín Sáez-Peñataro","doi":"10.1136/bcr-2026-272658","DOIUrl":"https://doi.org/10.1136/bcr-2026-272658","url":null,"abstract":"<p><p>A middle-aged woman presented with a 2-month history of ascites without associated symptoms. She reported taking no regular medication, except for a menopause supplement for the preceding 4 months. Initial blood investigation revealed marked peripheral eosinophilia (49%) but was otherwise unremarkable. Analysis of the ascitic fluid demonstrated a predominance of eosinophils (90%) with no evidence of malignancy.Abdominal ultrasonography identified liver lesions; however, malignancy was excluded by CT. Gastroscopy findings were normal and biopsies showed no malignant features. Tumour markers were within normal limits, except for an elevated CA-125 level. Autoimmune and infectious causes were excluded and no other underlying cause for the ascites was identified.Following discontinuation of the dietary supplement, both the ascites and eosinophilia resolved within a month without specific treatment. The temporal relationship and subsequent clinical improvement after withdrawal highlight the supplement as a possible contributing factor to eosinophilic ascites and hypereosinophilia.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"19 9","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Systemic amyloidosis diagnosed by labial salivary gland biopsy. 通过唇唾液腺活检诊断系统性淀粉样变性。
IF 0.4
BMJ Case Reports Pub Date : 2026-09-01 DOI: 10.1136/bcr-2025-270079
Fiona Lam Guan, Conor O'Gorman, Simon Rajendran, Amanda Willis
{"title":"Systemic amyloidosis diagnosed by labial salivary gland biopsy.","authors":"Fiona Lam Guan, Conor O'Gorman, Simon Rajendran, Amanda Willis","doi":"10.1136/bcr-2025-270079","DOIUrl":"https://doi.org/10.1136/bcr-2025-270079","url":null,"abstract":"<p><p>A patient in his 60s presented to the local emergency department with symptoms of acute decompensating heart failure. Following initial investigations under cardiology he was transferred to haematology, where a provisional diagnosis of cardiac amyloidosis was established. Unfortunately, it was not possible to obtain an appropriate tissue sample for confirmation of diagnosis, and the patient was referred to oral medicine for consideration of a buccal fat pad biopsy. A labial salivary gland (LSG) biopsy was undertaken and demonstrated amyloid deposits staining salmon pink with Congo red under light microscopy and an apple-green birefringence with polarised light. The blocks were transferred to the National Amyloidosis Centre where a diagnosis of amyloid light-chain amyloidosis was made. LSG biopsy is a minimally invasive and effective method in the diagnosis of systemic amyloidosis.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"19 9","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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