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Haemophagocytic lymphohistiocytosis triggered by Kikuchi-Fujimoto disease: a diagnostic challenge. 由菊池-藤本病引发的噬血细胞淋巴组织细胞增多症：一个诊断挑战。
IF 0.4
BMJ Case Reports Pub Date : 2026-10-06 DOI: 10.1136/bcr-2026-275078
Tanya Manish Arickatt, Fatima Memon, Anagha Harikumar, Claire Hemmaway, Khushnuma Mullanfiroze
{"title":"Haemophagocytic lymphohistiocytosis triggered by Kikuchi-Fujimoto disease: a diagnostic challenge.","authors":"Tanya Manish Arickatt, Fatima Memon, Anagha Harikumar, Claire Hemmaway, Khushnuma Mullanfiroze","doi":"10.1136/bcr-2026-275078","DOIUrl":"10.1136/bcr-2026-275078","url":null,"abstract":"<p><p>This report describes a gentleman, in his 40s, presenting with 3 weeks of fever, confusion, widespread erythematous crusted rash, weight loss and generalised lymphadenopathy. Secondary haemophagocytic lymphohistiocytosis (HLH) was diagnosed based on established criteria.Treatment with anakinra and dexamethasone (after lymph node biopsy) was initiated promptly. CT demonstrated extensive lymphadenopathy, raising concern of an underlying lymphoma. Autoimmune serology was positive but not diagnostic for a specific rheumatological disorder. Ultrasound-guided core needle lymph node biopsy ultimately confirmed Kikuchi-Fujimoto disease (KFD) as the underlying trigger of HLH. The patient demonstrated marked clinical improvement following immunosuppressive therapy.This case illustrates a rare association between KFD, a typically benign and self-limiting condition and secondary HLH. KFD should be considered in patients with fever of unknown origin and lymphadenopathy. This report highlights the diagnostic challenge posed by overlapping clinical and radiological features and emphasises that early recognition and treatment can significantly improve clinical outcomes.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"19 10","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104137","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
Approach to management of walled-off necrosis secondary to trauma-induced pancreatitis in a limited-resource setting. 资源有限的情况下外伤性胰腺炎继发壁闭塞性坏死的处理方法。
IF 0.4
BMJ Case Reports Pub Date : 2026-10-06 DOI: 10.1136/bcr-2026-272557
Sreelakshmi Pradeep, Daniston Ratnaraj, Dawn Kuruvilla, Siddharth M Babu, Sujith Philip, Philip Finny
{"title":"Approach to management of walled-off necrosis secondary to trauma-induced pancreatitis in a limited-resource setting.","authors":"Sreelakshmi Pradeep, Daniston Ratnaraj, Dawn Kuruvilla, Siddharth M Babu, Sujith Philip, Philip Finny","doi":"10.1136/bcr-2026-272557","DOIUrl":"10.1136/bcr-2026-272557","url":null,"abstract":"<p><p>Walled-off necrosis (WON) is a well-defined collection of necrotic tissue that arises as a long-standing complication of acute pancreatitis, developing more than four weeks after the initial episode. It contains liquid and solid necrotic material within a mature fibrous wall lacking an epithelial lining. This encapsulation forms through an inflammatory response that walls off necrotic tissue, creating a discrete entity that is distinguishable on imaging. WON is more prone to infection and requires prompt intervention.In this case, a patient who had trauma-induced pancreatitis developed a necrotic peripancreatic collection which formed a WON. Imaging showed a mature collection with necrotic debris. Due to persistent symptoms and nutritional decline, the patient underwent open cystogastrostomy for internal drainage and Stamm feeding jejunostomy for enteral nutrition. This surgical approach provided symptomatic relief, improved nutrition and reduced infection risk. Timely surgical intervention is vital in managing symptomatic or complicated cases, especially when less invasive methods are not feasible.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"19 10","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104056","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
Presumed transdermal superwarfarin toxicity in a pest control worker. 害虫防治工作人员的超华法林经皮毒性。
IF 0.4
BMJ Case Reports Pub Date : 2026-10-06 DOI: 10.1136/bcr-2026-275473
Liran Shechtman, Carolyn M Tan, Christophe Langlois, David Nelson Juurlink
{"title":"Presumed transdermal superwarfarin toxicity in a pest control worker.","authors":"Liran Shechtman, Carolyn M Tan, Christophe Langlois, David Nelson Juurlink","doi":"10.1136/bcr-2026-275473","DOIUrl":"10.1136/bcr-2026-275473","url":null,"abstract":"<p><p>A man in his early 60s presented with dyspnoea superimposed on a 2-month to 3-month history of spontaneous mucocutaneous bleeding. Laboratory testing revealed unmeasurably elevated international normalised ratio (INR) and activated partial thromboplastin time. CT of the neck demonstrated supraglottic soft tissue swelling with severe airway narrowing, requiring intubation for airway protection. Further history revealed occupational exposure to rodenticides during pest control work without consistent use of personal protective equipment. Markedly reduced activity of vitamin K-dependent clotting factors (II, VII, IX and X) supported a presumptive diagnosis of superwarfarin toxicity. Treatment with 4-factor prothrombin complex concentrate and vitamin K1 rapidly corrected the coagulopathy, although prolonged high-dose oral vitamin K1 was required because of recurrent INR elevation. He was discharged after 9 days and completed a 3-week vitamin K1 taper. This case highlights a rare presentation of presumed transdermal superwarfarin toxicity causing life-threatening coagulopathy and airway compromise.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"19 10","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104243","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
Immune-related colitis following head and neck reconstructive surgery in a patient receiving long-term nivolumab. 长期纳武单抗治疗患者头颈部重建手术后的免疫相关性结肠炎
IF 0.4
BMJ Case Reports Pub Date : 2026-10-06 DOI: 10.1136/bcr-2026-274848
Tatsuya Ito, Kohtaro Eguchi, Mitsuhiko Katoh, Go Omura, Chihiro Fushimi, Toshihiro Haga, Taisuke Mori, Hirokazu Shoji, Hidekazu Hirano, Seiichi Yoshimoto
{"title":"Immune-related colitis following head and neck reconstructive surgery in a patient receiving long-term nivolumab.","authors":"Tatsuya Ito, Kohtaro Eguchi, Mitsuhiko Katoh, Go Omura, Chihiro Fushimi, Toshihiro Haga, Taisuke Mori, Hirokazu Shoji, Hidekazu Hirano, Seiichi Yoshimoto","doi":"10.1136/bcr-2026-274848","DOIUrl":"10.1136/bcr-2026-274848","url":null,"abstract":"<p><p>Immune checkpoint inhibitors (ICIs) are increasingly incorporated into perioperative cancer treatment, raising challenges in distinguishing immune-related adverse events (irAEs) from postoperative complications. We report a case of postoperative immune-related colitis following head and neck reconstructive surgery in a patient receiving long-term nivolumab. A man receiving nivolumab for gastric cancer, who was maintained on prednisolone for prior immune-related myositis, underwent subtotal glossectomy for advanced tongue cancer. Despite perioperative steroid coverage, he developed grade 3 diarrhoea on postoperative day 4. After infectious causes were excluded and CT revealed diffuse colitis, empirical corticosteroid therapy was initiated, with rapid symptom resolution; colonoscopy and biopsy supported a diagnosis of immune-related colitis. This case illustrates that irAE colitis should remain in the differential diagnosis of postoperative diarrhoea in patients with prior ICI exposure. As perioperative use of ICIs expands, clinicians should maintain a high index of suspicion for irAEs in patients presenting with postoperative diarrhoea.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"19 10","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104129","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
Surgical and orthodontic management of class III malocclusion in monozygotic twins using bilateral sagittal split osteotomy. 双侧矢状面劈开截骨术治疗同卵双胞胎III类错牙合的外科和正畸治疗。
IF 0.4
BMJ Case Reports Pub Date : 2026-10-06 DOI: 10.1136/bcr-2025-266018
Tanu Sharma, Shruti Sharma, Anshul Singla, Amrita Puri
{"title":"Surgical and orthodontic management of class III malocclusion in monozygotic twins using bilateral sagittal split osteotomy.","authors":"Tanu Sharma, Shruti Sharma, Anshul Singla, Amrita Puri","doi":"10.1136/bcr-2025-266018","DOIUrl":"10.1136/bcr-2025-266018","url":null,"abstract":"<p><p>This case report discusses the genetic influence and treatment of class III malocclusion in identical twin sisters, in their early 20s, who presented with mandibular prognathism. Both exhibited concave profiles with hypodivergent growth patterns, but Sister A had a more pronounced concavity. Diagnosis revealed skeletal class III malocclusion with mandibular prognathism and negative overjet (9 mm in Sister A, 6 mm in Sister B). Treatment involved pre-surgical orthodontics, bilateral sagittal split osteotomy (BSSO) with mandibular setbacks (7 mm for Sister A, 5 mm for Sister B), followed by post-surgical orthodontics and retention. Both sisters achieved improved facial aesthetics, class I occlusion and functional stability. However, Sister B experienced transient paraesthesia and a bad split, leading to temporary splinting of the second molar. The case highlights the genetic basis of mandibular prognathism, the effectiveness of BSSO and the importance of meticulous surgical planning and interdisciplinary management for optimal long-term results.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"19 10","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104260","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
Chronic posthypoxic myoclonus: Lance-Adams syndrome. 慢性后毒性肌阵挛：兰斯-亚当斯综合征。
IF 0.4
BMJ Case Reports Pub Date : 2026-10-06 DOI: 10.1136/bcr-2025-270605
Emily Dean, Samah Hussain, Eleanor Garstang, Thomas Woodcock, Joshua Harris, Matthew Moriarty, Gemma Claire Lee
{"title":"Chronic posthypoxic myoclonus: Lance-Adams syndrome.","authors":"Emily Dean, Samah Hussain, Eleanor Garstang, Thomas Woodcock, Joshua Harris, Matthew Moriarty, Gemma Claire Lee","doi":"10.1136/bcr-2025-270605","DOIUrl":"https://doi.org/10.1136/bcr-2025-270605","url":null,"abstract":"<p><p>Lance-Adams syndrome (LAS) is a rare condition described as chronic intentional myoclonus following prolonged hypoxia. With limited cases of the condition, no standardised diagnostic criteria, and features overlapping acute myoclonus status epilepticus (MSE), diagnosis and management are challenging.Our case is a man in his 20s, who was admitted to the intensive care unit following two in-hospital cardiac arrests. He consequently developed persistent generalised myoclonic seizures despite multiple antiepileptics and sedation. CT, MRI and electroencephalogram (EEG) ruled out a diagnosis of MSE, making LAS more likely. Ketamine was ultimately required to terminate the generalised myoclonic seizures after which antiepileptic drugs were optimised to reduce residual intention myoclonus.This report highlights key features prompting the clinical suspicion of LAS in a patient who has no significant evidence of brain injury, preserved consciousness with continued severe generalised myoclonus and outlines pharmacological and neurophysiological management.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"19 10","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104088","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
Same-day diagnosis and robotic resection of rare primary pulmonary melanoma: a robotic bronchoscopy-guided approach. 当日诊断和机器人切除罕见的原发性肺黑色素瘤：机器人支气管镜引导的方法。
IF 0.4
BMJ Case Reports Pub Date : 2026-10-06 DOI: 10.1136/bcr-2026-272596
Andres Fontaine-Nicola, Emiliano Gabriel Manueli Laos, Mario A Masrur, Kevin L Kovitz, Odile David, Khaled Abdelhady
{"title":"Same-day diagnosis and robotic resection of rare primary pulmonary melanoma: a robotic bronchoscopy-guided approach.","authors":"Andres Fontaine-Nicola, Emiliano Gabriel Manueli Laos, Mario A Masrur, Kevin L Kovitz, Odile David, Khaled Abdelhady","doi":"10.1136/bcr-2026-272596","DOIUrl":"10.1136/bcr-2026-272596","url":null,"abstract":"<p><p>This case report describes a rare presentation of pulmonary melanoma of unknown primary managed through a same-day robotic diagnostic and therapeutic approach. A man in his 70s with an incidentally detected lingular pulmonary nodule suspicious for non-small cell lung cancer underwent robotic navigation bronchoscopy for biopsy and dye marking, immediately followed by robotic-assisted thoracic surgery. Intraoperative frozen section revealed a malignant spindle cell neoplasm, prompting definitive surgical resection during the same anaesthetic event. Final histopathology and molecular analysis confirmed melanoma, with no identifiable cutaneous, mucosal or ocular primary. The patient subsequently received adjuvant immunotherapy and remains disease-free at 24 months. This case highlights the diagnostic challenge of pulmonary melanoma mimicking lung carcinoma and demonstrates how integration of robotic bronchoscopy and robotic surgery can enable rapid diagnosis, definitive management and streamlined care within a single operative session.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"19 10","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104222","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
Adamantinoma-like Ewing sarcoma of the bladder. 膀胱类金刚烷瘤尤文氏肉瘤。
IF 0.4
BMJ Case Reports Pub Date : 2026-10-06 DOI: 10.1136/bcr-2025-270671
Craig Cronin, Soum D Lokeshwar, Carla Calagua, Tyler S Garman, Max Kates, Jeanny B Aragon-Ching, Amin Benyounes, Armine K Smith
{"title":"Adamantinoma-like Ewing sarcoma of the bladder.","authors":"Craig Cronin, Soum D Lokeshwar, Carla Calagua, Tyler S Garman, Max Kates, Jeanny B Aragon-Ching, Amin Benyounes, Armine K Smith","doi":"10.1136/bcr-2025-270671","DOIUrl":"10.1136/bcr-2025-270671","url":null,"abstract":"<p><p>Adamantinoma-like Ewing sarcoma (ALES) is an exceedingly rare neoplasm, typically arising in the head and neck. We present a case of bladder tumour initially diagnosed as urothelial carcinoma on transurethral resection, which after neoadjuvant dose-dense methotrexate, vinblastine, doxorubicin and cisplatin and subsequent radical cystoprostatectomy was reclassified as ALES with no residual urothelial carcinoma.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"19 10","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104026","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
Duplicated spermatic cord encountered during inguinal hernia repair. 腹股沟疝修补术中遇到的重复精索。
IF 0.4
BMJ Case Reports Pub Date : 2026-10-06 DOI: 10.1136/bcr-2025-270040
Mohamed Abdelrahman Ahmed Ragab, Shauq Rashid Al-Maawali, Alaa Eldin Yassin, Elhaytham Eldirdiry Mohemad
{"title":"Duplicated spermatic cord encountered during inguinal hernia repair.","authors":"Mohamed Abdelrahman Ahmed Ragab, Shauq Rashid Al-Maawali, Alaa Eldin Yassin, Elhaytham Eldirdiry Mohemad","doi":"10.1136/bcr-2025-270040","DOIUrl":"10.1136/bcr-2025-270040","url":null,"abstract":"<p><p>A male patient in his seventh decade underwent elective open right inguinal hernia repair. Intraoperatively, we discovered complete spermatic cord duplication-two separate structures, each containing a vas deferens and neurovascular bundle. The hernia repair was successfully completed with careful preservation of both cord structures. To our knowledge, this represents the first reported case of true complete spermatic cord duplication encountered during open inguinal hernia repair. Postoperative ultrasonography confirmed anatomical duplication and vascular patency. This case highlights a critical anatomical variant that demands intraoperative recognition and modified surgical technique to prevent iatrogenic injury and testicular ischaemia, providing a clear management strategy for this rare anomaly.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"19 10","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646525/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104051","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
Hepatitis A-associated oxidative haemolysis in a patient with glucose-6-phosphate dehydrogenase deficiency with co-inherited sickle cell trait. 6-磷酸葡萄糖脱氢酶缺乏症伴共同遗传镰状细胞特征患者的甲型肝炎相关氧化性溶血
IF 0.4
BMJ Case Reports Pub Date : 2026-10-06 DOI: 10.1136/bcr-2026-274743
Poshika Dhingra, Paige Shelemey, Rahima Bhanji
{"title":"Hepatitis A-associated oxidative haemolysis in a patient with glucose-6-phosphate dehydrogenase deficiency with co-inherited sickle cell trait.","authors":"Poshika Dhingra, Paige Shelemey, Rahima Bhanji","doi":"10.1136/bcr-2026-274743","DOIUrl":"10.1136/bcr-2026-274743","url":null,"abstract":"<p><p>An adult male patient in his late teens presented with pruritus, nausea and progressive jaundice after travel to West Africa. He did not get a pre-travel hepatitis A vaccination or malaria chemoprophylaxis. Laboratory testing demonstrated hepatocellular injury with alanine aminotransferase (ALT) 4002 U/L (reference <60), marked hyperbilirubinaemia (total bilirubin 632 µmol/L, reference <20) and a mildly prolonged international normalised ratio (INR). Concurrently, he developed non-immune haemolysis with undetectable haptoglobin, elevated lactate dehydrogenase and reticulocytosis, as well as bite and blister cells on blood film with a negative direct antiglobulin test. Acute hepatitis A virus infection was confirmed and enzymatic testing showed glucose-6-phosphate dehydrogenase deficiency. Haemoglobin electrophoresis also identified sickle cell trait. He improved with supportive care, avoidance of oxidant medications and close monitoring without renal injury or need for transfusion. This case illustrates an approach to jaundice in a returning traveller, the recognition of oxidative haemolysis at the bedside and preventive opportunities.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"19 10","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104175","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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