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Severe hypophosphataemia and hypocalcaemia following intravenous ferric derisomaltose and denosumab administration.
IF 0.6
BMJ Case Reports Pub Date : 2024-12-18 DOI: 10.1136/bcr-2024-262595
Justin Kritzinger, Jonathan Wyse, Andrew Karaplis
{"title":"Severe hypophosphataemia and hypocalcaemia following intravenous ferric derisomaltose and denosumab administration.","authors":"Justin Kritzinger, Jonathan Wyse, Andrew Karaplis","doi":"10.1136/bcr-2024-262595","DOIUrl":"10.1136/bcr-2024-262595","url":null,"abstract":"<p><p>Serum calcium and phosphorus levels are tightly regulated by the calciotropic hormone parathyroid hormone, fibroblast growth factor 23 and 1,25(OH)<sub>2</sub> vitamin D. Commonly prescribed therapies for iron-deficiency anaemia (IDA) such as ferric carboxymaltose and ferric derisomaltose (FDM) have been shown to disrupt phosphorus homeostasis, resulting in hypophosphataemia. Similarly, denosumab use can result in hypocalcaemia due to the inhibition of osteoclastic maturation, activity and survival. Here, we report the development of severe hypophosphataemia and hypocalcaemia in a patient with osteoporosis and IDA following treatment with denosumab and FDM. The patient remained asymptomatic; however, supplementation with calcium, phosphorus and calcitriol replacement was required prior to eventual normalisation of serum levels. Often concomitantly prescribed, little guidance exists regarding electrolyte disturbances following the administration of FDM and denosumab. While hypophosphataemia and hypocalcaemia are relatively uncommon when prescribed individually, synergistic effects likely exist that warrant regular monitoring and occasional supplementation.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"17 12","pages":""},"PeriodicalIF":0.6,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11660047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142852668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Late onset paediatric dacryoadenitis associated with SARS-CoV-2 confirmed by histological analysis.
IF 0.6
BMJ Case Reports Pub Date : 2024-12-18 DOI: 10.1136/bcr-2023-257615
Koji Yokoyama, Yasuharu Sato, Yuka Suimon, Satoru Kase
{"title":"Late onset paediatric dacryoadenitis associated with SARS-CoV-2 confirmed by histological analysis.","authors":"Koji Yokoyama, Yasuharu Sato, Yuka Suimon, Satoru Kase","doi":"10.1136/bcr-2023-257615","DOIUrl":"https://doi.org/10.1136/bcr-2023-257615","url":null,"abstract":"<p><p>We report a case of chronic dacryoadenitis associated with SARS-CoV-2, confirmed by histological analysis. A previously healthy school-aged boy was admitted to the paediatric department with a 1 month history of both eyebrow swelling and very mild pain in the upper parts of both eyelids. Gadolinium-enhanced T1-weighted MRI revealed enlargement of both lacrimal glands. Clinicopathological analysis confirmed bilateral chronic dacryoadenitis. Topical steroids were given, resulting in slow resolution over 2 months, and clinical stability at 10 months. The patient had experienced mild respiratory symptoms and tested positive for SARS-CoV-2 antigen via PCR testing, diagnosed as SARS-CoV-2, 3 months prior to the onset of dacryoadenitis. Inflammatory cells around the lacrimal gland demonstrated immunoreactivity for SARS-CoV-2 nucleocapsid protein. However, PCR testing of lacrimal fluid for SARS-CoV-2 was negative. This case illustrates protean complications and suggests a probable pathogenetic mechanism of dacryoadenitis associated with SARS-CoV-2.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"17 12","pages":""},"PeriodicalIF":0.6,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142852648","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
Lower limb necrotising fasciitis descending from malignant colonic perforation: a rare pattern.
IF 0.6
BMJ Case Reports Pub Date : 2024-12-18 DOI: 10.1136/bcr-2024-262470
Elliot Robbie, Seema Desai, Ashok Ramavath
{"title":"Lower limb necrotising fasciitis descending from malignant colonic perforation: a rare pattern.","authors":"Elliot Robbie, Seema Desai, Ashok Ramavath","doi":"10.1136/bcr-2024-262470","DOIUrl":"10.1136/bcr-2024-262470","url":null,"abstract":"<p><p>Necrotising fasciitis (NF) is a rare surgical emergency characterised by soft tissue necrosis and systemic compromise. Typically it originates following adjacent skin and soft tissue insult; however, our unusual case required a high index of clinical suspicion to avert potential mortality. A man in his 60s with diabetes mellitus presented with 2 weeks of knee pain, swelling and necrotic skin on the posterior calf. X-ray demonstrated subcutaneous emphysema. Initial debridement confirmed extensive necrotising fasciitis of the whole lower limb with tracking through femoral canal into the abdomen. CT confirmed sigmoid colon perforation. Both life-saving Hartmann's and hip disarticulation procedures were performed with good outcomes. Histology confirmed locally invasive sigmoid colon adenocarcinoma. Our case highlights lower limb necrotising fasciitis as a rare complication secondary to sigmoid perforation associated with malignancy. In cases where the infection nidus cannot be identified, an abdominal source should be considered.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"17 12","pages":""},"PeriodicalIF":0.6,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11667148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142852651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Limb salvage in Christmas disease masquerading as fungating aneurysmal bone cyst.
IF 0.6
BMJ Case Reports Pub Date : 2024-12-18 DOI: 10.1136/bcr-2024-262163
Sandeep Sehrawat, Love Kapoor, Tulika Seth, Venkatesan Sampath Kumar
{"title":"Limb salvage in Christmas disease masquerading as fungating aneurysmal bone cyst.","authors":"Sandeep Sehrawat, Love Kapoor, Tulika Seth, Venkatesan Sampath Kumar","doi":"10.1136/bcr-2024-262163","DOIUrl":"https://doi.org/10.1136/bcr-2024-262163","url":null,"abstract":"<p><p>A boy in middle childhood presented with complaints of swelling and pain in his right forearm for 4 months. He had previously undergone left above-elbow amputation due to a suspected malignant tumour in that arm. Radiological imaging revealed a locally aggressive bone tumour of the right distal radius. Two biopsies failed to provide a diagnosis, and in the meantime the lesion became fungating. Consequently, it was decided to perform wide resection together with wrist arthrodesis. Postoperatively, on day 4, the patient developed wound dehiscence and impending compartment syndrome. During revision surgery, a significant quantity of blood clots was removed, without any active bleeders. Due to the uncertain diagnosis, thromboelastography (TEG) analysis was done, which showed a fibrinolytic pattern, and the patient's factor IX level was found to be 4% of the normal value. As a result, a diagnosis of haemophilia B was established. The patient was started on tranexamic acid and factor IX replacement therapy.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"17 12","pages":""},"PeriodicalIF":0.6,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142852649","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
Endovascular treatment of high-flow carotid-cavernous fistula secondary to rupture of a carotid-cavernous aneurysm post-flow diverter stent placement.
IF 0.6
BMJ Case Reports Pub Date : 2024-12-18 DOI: 10.1136/bcr-2024-262386
Fausto A Vásconez Muñoz, Manuel Moreu, Santiago Rosati, Jossué M Vásconez Muñoz
{"title":"Endovascular treatment of high-flow carotid-cavernous fistula secondary to rupture of a carotid-cavernous aneurysm post-flow diverter stent placement.","authors":"Fausto A Vásconez Muñoz, Manuel Moreu, Santiago Rosati, Jossué M Vásconez Muñoz","doi":"10.1136/bcr-2024-262386","DOIUrl":"https://doi.org/10.1136/bcr-2024-262386","url":null,"abstract":"<p><p>Carotid-cavernous aneurysms (CCAs) have the potential for growth, and their risk of rupture can lead to severe complications. Treatment is typically recommended to prevent these complications, with endovascular therapy being the preferred approach due to the challenging surgical access. This case presents a rare instance of rupture of a CCA that had been previously treated with a flow-diverting stent, which resulted in the development of a carotid-cavernous fistula, requiring venous access endovascular treatment. Our patient experienced persistent neurological deficits following treatment, specifically paralysis of the IV cranial nerve and palpebral ptosis, underscoring the complex nature of such cases and the potential for lasting complications despite intervention.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"17 12","pages":""},"PeriodicalIF":0.6,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142852643","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
Fresh osteochondral allograft transplantation of the medial femoral condyle in an elite football player.
IF 0.6
BMJ Case Reports Pub Date : 2024-12-18 DOI: 10.1136/bcr-2024-262374
João Pedro Oliveira, João Castro Mendes, Fernando Fonseca
{"title":"Fresh osteochondral allograft transplantation of the medial femoral condyle in an elite football player.","authors":"João Pedro Oliveira, João Castro Mendes, Fernando Fonseca","doi":"10.1136/bcr-2024-262374","DOIUrl":"https://doi.org/10.1136/bcr-2024-262374","url":null,"abstract":"<p><p>We present an elite footballer in his 20s with a large and symptomatic osteochondral lesion of the weight-bearing area of the medial femoral condyle, who was proposed for a single plug fresh osteochondral allograft transplantation. The lesion was due to repetitive micro traumas and had become highly symptomatic being responsible for making the football practice at a professional level almost impossible, reaching a point that keeping an elite sports career was compromised. Six months after surgery, the athlete returned to sports and, at a 3-year follow-up, still participated in elite high-level football, with a Tegner Activity Scale 10/10, IKDC 93.1, KOOS 97 and Lysholm Scoring 100.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"17 12","pages":""},"PeriodicalIF":0.6,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142852644","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
Pancreatic pseudocyst after acute pancreatitis in children.
IF 0.6
BMJ Case Reports Pub Date : 2024-12-18 DOI: 10.1136/bcr-2024-263245
Simona Terleckytė, Dovilė Malinauskaitė, Mindaugas Dženkaitis, Rūta Rokaitė
{"title":"Pancreatic pseudocyst after acute pancreatitis in children.","authors":"Simona Terleckytė, Dovilė Malinauskaitė, Mindaugas Dženkaitis, Rūta Rokaitė","doi":"10.1136/bcr-2024-263245","DOIUrl":"https://doi.org/10.1136/bcr-2024-263245","url":null,"abstract":"<p><p>Acute pancreatitis in children is a rare condition; however, the incidence of this acute condition has been increasing over the past few decades. In most cases, acute pancreatitis does not cause severe complications in children, but in some cases, it can be complicated by fluid accumulation, fistulas and vascular pathologies, but the most common complication remains the formation of pseudocysts. This article describes the clinical case of a 11-year-old girl from Lithuania, which effectively illustrates a rare condition in children-acute pancreatitis and its developed complication-the formation of a pancreatic pseudocyst. The article discusses the frequency of acute pancreatitis and its complication, pancreatic pseudocyst in children, and the clinical expression of the disease and methods of diagnostics and treatment.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"17 12","pages":""},"PeriodicalIF":0.6,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142852664","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
Long-term sequelae of stage 4A ROP after successful management with lens-sparing vitrectomy.
IF 0.6
BMJ Case Reports Pub Date : 2024-12-18 DOI: 10.1136/bcr-2024-261741
Sonia Bariya, Subina Narang, Varsha Jindal, Reetika Negi
{"title":"Long-term sequelae of stage 4A ROP after successful management with lens-sparing vitrectomy.","authors":"Sonia Bariya, Subina Narang, Varsha Jindal, Reetika Negi","doi":"10.1136/bcr-2024-261741","DOIUrl":"https://doi.org/10.1136/bcr-2024-261741","url":null,"abstract":"<p><p>We present an unusual case of a macular lesion, possibly a spontaneously closed macular hole, at a 4-year follow-up visit, after lens-sparing vitrectomy (LSV) in stage 4A retinopathy of prematurity (ROP). Optical coherence tomography scans of the macula were suggestive of a spontaneously closed macular hole and fibrovascular proliferation at the equator. We hypothesise that tangential traction by residual posterior hyaloid could lead to late macular hole formation after LSV in ROP. There is a need to document this finding as this could throw some light on the late sequelae of LSV.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"17 12","pages":""},"PeriodicalIF":0.6,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142852650","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
Intravenous thrombolysis in a stroke patient with a repaired aortic dissection.
IF 0.6
BMJ Case Reports Pub Date : 2024-12-18 DOI: 10.1136/bcr-2024-262995
Dylan Ryan, Michelle Maher, Wayne Feng, Swaroop Pawar
{"title":"Intravenous thrombolysis in a stroke patient with a repaired aortic dissection.","authors":"Dylan Ryan, Michelle Maher, Wayne Feng, Swaroop Pawar","doi":"10.1136/bcr-2024-262995","DOIUrl":"https://doi.org/10.1136/bcr-2024-262995","url":null,"abstract":"<p><p>Acute aortic dissection is considered a contraindication to the use of intravenous thrombolysis in patients presenting with acute ischaemic stroke, but less has been described about previously repaired dissections. We present a case of a woman in her 50s presenting with acute left hemiparesis with a known history of aortic dissection within the thrombolysis window. After multidisciplinary discussion with cardiothoracic surgery and discussion with the patient, she was treated with intravenous thrombolysis without complication. In patients with previously repaired aortic dissection without evidence of redissection, intravenous thrombolysis can be considered.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"17 12","pages":""},"PeriodicalIF":0.6,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142852647","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
Clofazimine-induced crystalline keratopathy in a leprosy patient.
IF 0.6
BMJ Case Reports Pub Date : 2024-12-18 DOI: 10.1136/bcr-2024-262182
Richa Agarwal, Alka Tripathi, Shadman Parveen, Kritika Agnihotri
{"title":"Clofazimine-induced crystalline keratopathy in a leprosy patient.","authors":"Richa Agarwal, Alka Tripathi, Shadman Parveen, Kritika Agnihotri","doi":"10.1136/bcr-2024-262182","DOIUrl":"https://doi.org/10.1136/bcr-2024-262182","url":null,"abstract":"<p><p>A young male in his late 20s presented with brownish discolouration of the conjunctiva and periocular area of both eyes. He was diagnosed as a case of lepromatous leprosy with recurrent type II lepra reaction 4 years ago and was started on multidrug therapy-multi bacillary, which included clofazimine. The best-corrected visual acuity was 20/20 in both eyes. Examination revealed reddish-brown discolouration of the facial skin including the periorbital area and the eyelids, brownish discolouration of the conjunctiva with shiny sub-conjunctival deposits and multiple polychromatic refractile crystalline corneal deposits. Both eyes had clear lenses with normal fundus. On follow-up after 4 months of discontinuing clofazimine and again after 1 year, the deposits had decreased than previous visits, but they had not totally disappeared. Few studies documented similar ocular side effects of this drug. When diagnosing crystalline deposits in the cornea and conjunctiva, one should rule out clofazimine-induced crystalline keratopathy especially in a leprosy patient.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"17 12","pages":""},"PeriodicalIF":0.6,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142852639","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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