International Journal of Case Reports

  • Treatment of oversize and recurrent pancreatic pseudocyst after an episode of acute pancreatitis: a case report and review management

    Pancreatic cysts are being diagnosed more frequently because of the increasing usage of multiple noninvasive imaging modalities. Moreover, pancreatic pseudocysts (PPs) present a challenging problem for physicians dealing with pancreatic disorders, especially in cases where their treatment will be required. The diagnosis of a PP needs imaging with ultrasonography, Computed Tomography (CT) scan or Magnetic Resonance Imaging (MRI). In most cases, pancreatic pseudocysts are asymptomatic and resolve spontaneously. [1-3] Asymptomatic PPs up to 6 cm in diameter can be safely observed and monitored with serial imaging.[1] If they evolve and increase in size, they become symptomatic through compression of the adjacent organs and need interven-tion.[1, 4-6] Their management demands the cooperation of surgeons, radiologists and gastroenterolo-gists. The treatment of PPs has evolved considerably over the past decade, moving from what was once open surgical management to increasingly minimally invasive techniques, both by surgery and by endoscopy. Thus, many studies have reported successful drainage through the use of various techniques.[1, 3, 4] However, the absence of a large number of cases as well as guidelines for dealing with them raise even today dilemmas regarding the treatment of choice. Here we present a case of a large pancreatic pseudocyst and a brief review of the literature.

  • Posterolateral uterine rupture in scarred uterus complicated by external iliac vein injury

    Uterine wall rupture is a rare yet catastrophic complication of pregnancy with a high mortality rate of both the mother and the fetus. The condition could be classified according to etiology into primary unscarred uterus, and secondary scarred uterus or according to the site of rupture. Our case presented with scarred uterine rupture through a posterolateral injury. The patient had history of 3 previous CS and a D&C procedure. The rupture was complicated by EIV injury. Uterine rupture does not always present with profound manifestations of shock especially in posterior wall rupture and timely management ensures the best possible outcome. Finally, meticulous examination of the anatomically related structures and vessels, and the repair of any associated injuries, is essential.

  • Bilateral acute renal infarction treated by endovascular therapy: A case report and literature review

    Renal infarction is a rare emergency and the estimated incidence is extremely low according to the literature. In addition, simultaneous bilateral renal infarction was only about 20% in these rare cases. Herein we reported a case of acute renal failure related to bilateral renal infarction and successfully treated by endovascular therapy including angioplasty and catheter-directed thrombolysis. His renal function also significantly improved after the intervention. This rare case reminds physician that early endovascular therapy might improve renal function and result in better renal outcome for patients with simultaneous bilateral renal infarction.

  • Cardiogenic Shock Due to Acute Myocarditis Following AZD1222 Vaccine Administration: a Case Report

    Aim: A number of cases of SARS-CoV-2-related myocarditis have been reported since the outbreak of the Covid-19 pandemia, with autoimmune-mediated damage due to molecular mimicry proposed as the virus’ direct mechanism of injury. After commencing with a worldwide mass vaccination program, there have also been reports of myocarditis in the context of Covid-19 immunization. However, myocarditis is still not recognized as a potential side effect of the AZD1222 (ChAdOx1-S recombinant) vaccine administration by the health authorities. Methods: In this article we report a case of myocarditis and further complications after vaccination for Covid-19 using the AZD1222 vaccine. Conclusion: Even though it is hard to demonstrate the etiology of acute myocarditis, considering the cases reported around the world, the temporal association, the absence of other plausible causes, and the serological pattern described, it seems reasonable to assume that there is a genuine possibility of myocarditis being a side effect of AZD1222 vaccine administration.

  • Spontaneous Oculomotor and Abducens Nerve Palsy as Initial Presentation of Lymphoma of the Cavernous Sinus: Case Report

    Primary lymphomas of the skull base are rare (1% of lymphomas in adults); they can originate from the cavernous sinus and the parasellar region. Diffuse large B-cell lymphoma is the most common histologic subtype. Currently, the origin of these lymphomas is controversial, and their clinical characteristics are not very specific. There are various treatments for these lesions with a variable response; therefore, the prognosis of these lesions is variable. Clinical case: We present the case of a 52-year-old man who spontaneously presented with diplopia. Physical examination revealed a limitation in adduction of the right eye, right palpebral ptosis, and limitation in the abduction of the left eye. Brain magnetic resonance imaging revealed a well-defined and homogeneous extra-axial lesion at the cavernous sinus level. The patient was biopsied and diagnosed with B-cell lymphoma; received chemotherapy and radiotherapy. In this article, we present a clinical case that considers the characteristics of the diagnosis and is the first B-cell lymphoma at the cavernous sinus level reported in Mexico. Conclusion: Skull base lymphomas have a broad clinical spectrum. Minimally invasive surgery for biopsy purposes is the gold standard for diagnosis, and the treatment with the best results is chemotherapy.

  • Non-resolving acute sinusitis due to nasal hamartoma: a case report

    The paranasal sinuses are closely related to vital structures, and therefore, rhinosinusitis may lead to various dangerous complications. Nasal chondromesenchymal hamartoma is a rare benign lesion of the sinonasal tract in children and adolescents. We report the case of a 15-year-old patient with antibiotic-refractory acute sinusitis in whom a nasal tumor was identified and histopathologically diagnosed as a hamartoma. Therefore, the tumor was removed surgically to alleviate the patient’s symptoms. This case highlights the necessity of investigating the underlying cause if conventional treatment fails to resolve a mild disease like acute sinusitis. To the best of our knowledge, this is the first reported case of a chondro-osseous respiratory epithelial adenomatoid hamartoma presenting with acute sinusitis.

  • Gas in the Inferior Mesenteric Vein – successful non operative management of a rare complication of diverticulitis

    Septic phlebitis (also known as pyelephlebitis) because of diverticulitis is a rare but important complication. Many previous cases have mandated urgent surgical management for fear of further deterioration. This case report details one of the first cases where septic phlebitis was successfully managed conservatively, and details important clinical lessons clinicians should be aware of.

  • Macrophage Activation Syndrome:A case series;From Sepsis to Malignancy: Early diagnosis and treatment

    NTRODUCTION: Haemophagocytic lymphohistiocytosis (HLH) or macrophage activation syndrome(MAS) is a syndrome of fulminant cytokine storm leading to multiorgan dysfunction and high mortality rate. HLH may be Familial or Primary(fHLH) and Secondary (sHLH).FHLH is due to mutation in gene coding for perforin or NK cell of CD8 lymphocytes. sHLH may be associated with hematological malignancies, autoimmune disorders like SLE,Still’s diseae, kawasaki disease, infections and sepsis of various etiology starting from bacteria ,viral protozoal ,fungal and zoonotic infection. Main presenting features are fever, hepatospleenomegly, cytopenia,high ferritin level, high serum triglyceride and haemophagocytosis in bone marrow spleen or lymphnode. MATERIAL AND METHOD: In this series we describe Five cases ,(two cases of SLE,one B-Cell lymphoma, one case of scrub typhus,one case of kleibsiella pneumoniae presenting as sepsis ) with their clinical, laboratory investigations, management and outcome with special correlation of ferritin level and HS score with the prognosis. All patients managed with I.V.Methyl prednisolone 30 mg/kg/day for three consecutive days and out come is assessed. CONCLUSION: MAS in SLE and sepsis is a life threatening unrecognised condition, early diagnosis and treatment can increase the survival rate by many folds . a drop of ferritin level by 15% after 48 hrs of treatment is a surrogate marker of good prognosis. From H scoring cut off value 169 corresponds to sensitivity of 93% and specificity of 86%.

  • Efficacy of an oral appliance in an adult Marfan syndrome patient with obstructive sleep apnea

    Marfan’s syndrome (MFS) is an autosomal dominant disorder that affects the body’s connective tissue, characterized by changes in three major connective tissue systems: the musculoskeletal, ocular, and cardiovascular systems. Individuals with MFS can develop severe cardiovascular complications., and the life expectancy of patients with MFS is markedly reduced as the effects of the disease on the aorta often lead to progressive dilatation, with subsequent dissection and rupture. Obstructive sleep apnea (OSA) is highly prevalent in patients with cardiovascular diseases. There is a high prevalence of OSA in patients with MFS due to craniofacial dysmorphism and increased upper airway collapsibility. A high prevalence of OSA has been reported in patients with MFS. To date, however, there are only a few case reports regarding the treatment of OSA in MFS patients. We present a treatment in an adult MFS patient with OSA using an oral appliance (OA). The patient was a 48-year-old Japanese woman of MFS, diagnosed with moderate OSA (apnea hypopnea index [AHI] = 27.0; lowest oxygen saturation [SaO2] = 78%; maximum apnea time = 114 s]). An OA was selected as the treatment option, and post-treatment sleep study indicated a reduction in AHI to 8.8/h with an improvement in other factors (lowest SaO2 = 84%; maximum apnea time = 66 s). Additionally, the treatment resulted in a reduction in BNP levels (81.3 from 110.2 pg/ml), and the patient’s cardiac function was stable over the period in which the patient received OA treatment. This study provides a basis for the future appropriate understanding and management of OSA of MFS patients.

  • Early effectivity of teduglutide for the treatment of short bowel sydrome – our first clinical experience

    Background Short bowel syndrome is an uncommon malabsorptive condition most frequently caused by massive surgical resection of the small intestine. Standard of care is home parenteral nutrition. Teduglutide, glucagon like peptide 2 analog, was approved to treat patients with short bowel syndrome, who are stable following a period of post-surgery intestinal adaptation. Case presentation We report two cases of patients with short bowel syndrome on home parenteral nutrition, treated with teduglutide, novel advanced therapy. We monitored the effectiveness and tolerance of the new treatment. Conclusion Teduglutide increases intestinal absorption, causes cryptal hyperplasia, villous hypertrophy, angiogenesis, and allows weaning from parenteral nutrition. We confirmed the early onset of treatment effectiveness in the 4th month. Early effectiveness of treatment allowed a reduction in the volume of home parenteral nutrition with an improvement in quality of life.