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Leucocytosis-induced artefactual hypoglycaemia in the setting of chronic neutrophilic leukaemia.
IF 0.6
BMJ Case Reports Pub Date : 2025-03-25 DOI: 10.1136/bcr-2024-264459
Katherine Drummond, Nisha Gupta, Elizabeth Mac Namara, Stavroula Christopoulos
{"title":"Leucocytosis-induced artefactual hypoglycaemia in the setting of chronic neutrophilic leukaemia.","authors":"Katherine Drummond, Nisha Gupta, Elizabeth Mac Namara, Stavroula Christopoulos","doi":"10.1136/bcr-2024-264459","DOIUrl":"https://doi.org/10.1136/bcr-2024-264459","url":null,"abstract":"<p><p>A man in his late 70s with newly diagnosed chronic neutrophilic leukaemia with marked leucocytosis was found to have recurrent low plasma glucose levels on routine bloodwork. Nevertheless, he did not exhibit any signs or symptoms of hypoglycaemia, and capillary blood glucose measurements taken at the same time were within normal limits. Time-dependent plasma glucose concentration decline with delayed processing confirmed the suspected diagnosis of artefactual hypoglycaemia secondary to hyperleucocytosis. This phenomenon is caused by excessive in vitro glycolysis, which can be mitigated by rapid sample processing or the use of tubes containing glycolysis inhibitors. This case report adds to the existing body of evidence on artefactual hypoglycaemia with the aim of raising awareness of this entity among healthcare professionals. In asymptomatic individuals with low glucose measurements, the possibility of spurious results should be considered prior to initiating further diagnostic work-up.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"18 3","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708527","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
Unravelling the clinical complexity of myelin oligodendrocyte glycoprotein antibody-associated acute disseminated encephalomyelitis in children: a comprehensive analysis.
IF 0.6
BMJ Case Reports Pub Date : 2025-03-25 DOI: 10.1136/bcr-2023-259190
Pradeep Kumar, Sweta Sweta, Giridhar Marithammanahalli Faneesha, Anagha Nair
{"title":"Unravelling the clinical complexity of myelin oligodendrocyte glycoprotein antibody-associated acute disseminated encephalomyelitis in children: a comprehensive analysis.","authors":"Pradeep Kumar, Sweta Sweta, Giridhar Marithammanahalli Faneesha, Anagha Nair","doi":"10.1136/bcr-2023-259190","DOIUrl":"https://doi.org/10.1136/bcr-2023-259190","url":null,"abstract":"<p><p>We present four different cases of acute disseminated encephalomyelitis (ADEM) within the Indian paediatric population. It is important to recognise how a single disease can manifest in various ways. Here, we emphasise the role of immunosuppression in treating ADEM. In all four cases, treatment was initiated based on clinical suspicion, even before confirming the demyelinating cause through laboratory or radiological tests. The degree of immunosuppression employed varied depending on the complexity of each case and their response to treatment. Case 1 demonstrated significant improvement in visual acuity after a 5-day course of high-dose methylprednisolone. In contrast, Case 4 represented a starkly different outcome, where despite undergoing therapeutic plasmapheresis, the disease remained uncontrollable, ultimately leading to the child's unfortunate demise. Cases 2 and 3 involved patients with severe clinical conditions necessitating intensive care and mechanical ventilation. They exhibited a remarkable response to immunosuppressive therapy, gradually regaining neurological function.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"18 3","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708442","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
Management of multiple splenic artery aneurysms in the setting of portal hypertension and splenomegaly.
IF 0.6
BMJ Case Reports Pub Date : 2025-03-25 DOI: 10.1136/bcr-2024-260823
Varsha Sharma, Raleene Gatmaitan, Michael Neale, Jaswinder Samra
{"title":"Management of multiple splenic artery aneurysms in the setting of portal hypertension and splenomegaly.","authors":"Varsha Sharma, Raleene Gatmaitan, Michael Neale, Jaswinder Samra","doi":"10.1136/bcr-2024-260823","DOIUrl":"https://doi.org/10.1136/bcr-2024-260823","url":null,"abstract":"<p><p>Extrahepatic portal hypertension is commonly caused by portal vein thrombosis (PVT). Clinical manifestations of this may include splenomegaly, varices and ascites. Rare complications such as splenic artery aneurysms (SAAs) can present, especially in the presence of portal hypertension; however, such cases are poorly described in the literature and can therefore present a challenge in investigative work-up and management. The case of a young woman in her late 20s with chronic extrahepatic PVT from thrombophilic disease is presented in this report. She developed splenomegaly, thrombocytopaenia from hypersplenism, oesophageal varices and multiple large SAAs. She was successfully managed by splenic artery embolisation and creation of a portosystemic shunt followed by a splenectomy.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"18 3","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708536","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
Metatarsal transposition with interposition of autogenous structural graft of the phalanx as a reconstructive solution in severe traumatic injuries of the foot.
IF 0.6
BMJ Case Reports Pub Date : 2025-03-25 DOI: 10.1136/bcr-2024-264134
Goncalo Modesto, Marcos Carvalho, Pedro Sá Cardoso, Cristina Alves
{"title":"Metatarsal transposition with interposition of autogenous structural graft of the phalanx as a reconstructive solution in severe traumatic injuries of the foot.","authors":"Goncalo Modesto, Marcos Carvalho, Pedro Sá Cardoso, Cristina Alves","doi":"10.1136/bcr-2024-264134","DOIUrl":"https://doi.org/10.1136/bcr-2024-264134","url":null,"abstract":"<p><p>Acute lower limb trauma with bone loss is an uncommon occurrence. Injuries of this nature typically result from high-energy trauma and can result in significant functional impairment, with the potential for amputation.Nonetheless, it is recommended that salvage reconstructive procedures be attempted whenever feasible in the context of an emergency and even in cases of severe injury. Good outcomes may be achieved with creative solutions, as illustrated by this rare and particular case.We present an acute reconstructive solution involving the transposition of a foot ray and interposition of an autogenous phalangeal bone graft of a resected ray in a severe foot injury. At the 1 year follow-up, the patient exhibited symmetrical range of motion of the foot and ankle, full weight bearing and the ability to walk without external aids. This treatment modality demonstrates its efficacy in addressing severe bone defects, offering the prospect of positive functional outcomes and facilitating psychosocial adaptation.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"18 3","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708577","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
Pontine tuberculoma presenting as a true-localising abducens palsy.
IF 0.6
BMJ Case Reports Pub Date : 2025-03-25 DOI: 10.1136/bcr-2024-263879
Sripathi Kamath B, Madhurima A Nayak, Geover Joslen Lobo, Mahesh Mijar
{"title":"Pontine tuberculoma presenting as a true-localising abducens palsy.","authors":"Sripathi Kamath B, Madhurima A Nayak, Geover Joslen Lobo, Mahesh Mijar","doi":"10.1136/bcr-2024-263879","DOIUrl":"https://doi.org/10.1136/bcr-2024-263879","url":null,"abstract":"<p><p>An immunocompetent woman in her early 30s presented with a 3-day history of nausea, vomiting and horizontal diplopia. Examination revealed left-sided abducens paresis, with normal visual acuity, pupillary reactions and fundus. There was no papilloedema, neck rigidity or positive neurological signs. Magnetic resonance imaging (MRI) showed a central pontine T2 hypointense ring-enhancing lesion causing compression of the fourth ventricle. Magnetic resonance spectroscopy showed a lipid lactate peak leading to a diagnosis of pontine tuberculoma. The diagnosis was supported by a positive Mantoux and interferon-gamma release assay. There was no other systemic focus of tuberculosis. She was then started on antitubercular therapy (ATT) for 18 months. After 8 months of ATT, a repeat MRI showed a decrease in the volume of the tuberculoma. This case exemplifies a unique case of isolated abducens palsy in the absence of features of raised intracranial tension, which could localise the lesion to the pons.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"18 3","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708046","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
Rare encounter: Zoon's Vulvitis in clinical perspective.
IF 0.6
BMJ Case Reports Pub Date : 2025-03-25 DOI: 10.1136/bcr-2024-262578
Somya Kaushik, Santanu Acharya, Mumba Everisto
{"title":"Rare encounter: Zoon's Vulvitis in clinical perspective.","authors":"Somya Kaushik, Santanu Acharya, Mumba Everisto","doi":"10.1136/bcr-2024-262578","DOIUrl":"https://doi.org/10.1136/bcr-2024-262578","url":null,"abstract":"<p><p>This case study presents the clinical journey of an elderly woman in her late 70s seeking medical attention for vulvar discomfort. Upon observing a red area on the vulvar region, initial management involved the use of clobetasol due to suspicion of lichen sclerosus, a condition linked to vulvar discomfort and erythematous patches.After 1 year, the patient reported symptom improvement, but a persistent red area on the labia minora prompted a biopsy. Surprisingly, the biopsy revealed Zoon's Vulvitis, a diagnosis not anticipated due to the unusual clinical presentation. This case underscores the significance of considering rare conditions, such as Zoon's Vulvitis, even in vulvar abnormalities with atypical features. Further research is warranted to enhance our understanding of the varied clinical presentations of Zoon's Vulvitis.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"18 3","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708055","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
Osmotic nephropathy triggered by sodium-glucose cotransporter 2 inhibitors in a patient with IgA nephropathy.
IF 0.6
BMJ Case Reports Pub Date : 2025-03-25 DOI: 10.1136/bcr-2024-263859
Christopher Thiam Seong Lim, Kar Wah Fuah, Chia Ling Chew
{"title":"Osmotic nephropathy triggered by sodium-glucose cotransporter 2 inhibitors in a patient with IgA nephropathy.","authors":"Christopher Thiam Seong Lim, Kar Wah Fuah, Chia Ling Chew","doi":"10.1136/bcr-2024-263859","DOIUrl":"https://doi.org/10.1136/bcr-2024-263859","url":null,"abstract":"<p><p>A woman with biopsy-confirmed IgA nephropathy (IgAN) presented with persistent non-nephrotic range proteinuria and stage 3b chronic kidney disease (CKD). Her treatment regimen included the initiation of a sodium-glucose cotransporter 2 inhibitor (SGLT2i), dapagliflozin, starting at 5 mg daily and later titrated to 10 mg daily after several months. Following the dose increase, she developed significant acute-on-chronic kidney injury. Despite discontinuing the SGLT2i, her renal function did not recover. A subsequent kidney biopsy revealed findings consistent with osmotic tubulopathy with worsening IgAN. This case highlights a rare but important adverse effect of SGLT2i, particularly in patients with pre-existing CKD. While initial expert guidance advised against routine renal function monitoring to avoid premature discontinuation due to the expected transient rise in creatinine, evolving clinical experience suggests that individualised monitoring may be necessary in high-risk patients. Future guidelines will need to clarify how to balance these considerations to optimise patient outcomes.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"18 3","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708116","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
Innovative surgical repair of severe pectus carinatum using 3D surgical planning and advanced rib fixation techniques.
IF 0.6
BMJ Case Reports Pub Date : 2025-03-25 DOI: 10.1136/bcr-2024-263174
Christopher Clinker, Jack Scaife, Rami Shorti, Thomas W White, Katie W Russell
{"title":"Innovative surgical repair of severe pectus carinatum using 3D surgical planning and advanced rib fixation techniques.","authors":"Christopher Clinker, Jack Scaife, Rami Shorti, Thomas W White, Katie W Russell","doi":"10.1136/bcr-2024-263174","DOIUrl":"https://doi.org/10.1136/bcr-2024-263174","url":null,"abstract":"<p><p>This case describes an early adolescent boy with severe pectus carinatum, managed with a complex surgical approach after bracing was deemed unfeasible. A multidisciplinary team collaborated, using advanced three-dimensional (3D) imaging, digital segmentation and a patient-specific 3D-printed model to plan and rehearse the surgery. The operation involved sternum repositioning and rib plating with polyether ether ketone plates. The procedure resulted in favourable chest stability and minimal blood loss. Postoperatively, the patient's pain was well-controlled, and he was discharged on day 7. The patient expressed satisfaction with the outcome and resumed normal activities within a month.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"18 3","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708489","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
Renaming Twiddler's syndrome: an argument for change to reflect a diverse set of aetiologies, patients and devices.
IF 0.6
BMJ Case Reports Pub Date : 2025-03-25 DOI: 10.1136/bcr-2024-263681
Kalkidan Yekuno, Donna Funk, Maria Marsans, Farrokh Farrokhi, John Roberts
{"title":"Renaming Twiddler's syndrome: an argument for change to reflect a diverse set of aetiologies, patients and devices.","authors":"Kalkidan Yekuno, Donna Funk, Maria Marsans, Farrokh Farrokhi, John Roberts","doi":"10.1136/bcr-2024-263681","DOIUrl":"https://doi.org/10.1136/bcr-2024-263681","url":null,"abstract":"<p><p>Twiddler's syndrome is a rare complication where the leads attached to cardiac pacemakers or deep brain stimulator (DBS) implantable pulse generators (IPG) become twisted from device rotation. The medical lore has traditionally suggested that patients manipulate the device, with 'twiddling' being more common in elderly and obese individuals due to increased loose subcutaneous tissue, which facilitates device rotation.This report describes a case of a woman in her late 60s with DBS for Parkinson's disease who sustained trauma that presumably caused dislodgement of IPG anchoring stitches, leading to rotation of the IPG without manipulation by the patient. It aims to augment the existing literature on this syndrome and suggests that device rotation can occur without deliberate movement by the patient, challenging the conventional understanding of the syndrome's aetiology. We propose a new name for the syndrome, PETS: <b>P</b>ulse generator <b>E</b>lectrode <b>T</b>wisting <b>S</b>yndrome, which is more inclusive of its causes.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"18 3","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708408","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
Urogenital infection with M. bovis BCG most probably as a result of BCG instillation 21 years ago.
IF 0.6
BMJ Case Reports Pub Date : 2025-03-25 DOI: 10.1136/bcr-2024-260496
Michael Zenger, Tobias Zellweger, Zita Belényesi, Mario Kurz
{"title":"Urogenital infection with <i>M</i>. <i>bovis</i> BCG most probably as a result of BCG instillation 21 years ago.","authors":"Michael Zenger, Tobias Zellweger, Zita Belényesi, Mario Kurz","doi":"10.1136/bcr-2024-260496","DOIUrl":"10.1136/bcr-2024-260496","url":null,"abstract":"<p><p>We present the case of a man in his late 70s who developed urogenital infection with <i>M. bovis</i> BCG most probably following BCG instillation for bladder cancer, a surprising 21 years after the BCG treatment had ended.The patient presented with an indolent testicular swelling initially presumed to be testicular cancer. After surgical exploration, the swelling proved to be a <i>M. bovis</i> BCG-infected granuloma. Treatment consists of ethambutol, rifampicin and isoniazid over several months, which can cause severe side effects.We conclude that any unclear lesion or tumour in a patient who has had BCG instillation should be tested for mycobacteria along standard histological and microbiological analyses.</p>","PeriodicalId":9080,"journal":{"name":"BMJ Case Reports","volume":"18 3","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11937887/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708443","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
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