ResearchPad - case-report https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[Modified Puestow Procedure for Chronic Pancreatitis in a Child Due to Annular Pancreas and Duodenal Duplication: A Case Report]]> https://www.researchpad.co/article/elastic_article_14189 An 18-year-old woman with annular pancreas and duodenal duplication presented with recurrent acute pancreatitis and underwent a resection of duodenal duplication. However, the patient experienced recurrent abdominal pain after resection. Abdominal computed tomography and magnetic resonance imaging showed a dilatation of the peripheral pancreatic duct and stenosis and malformation of both the Wirsung's and Santorini's duct due to multiple stones. The modified puestow procedure was performed. The main pancreatic ducts in the body and tail were opened, and the intrapancreatic common bile duct was preserved. A Roux-en-Y pancreatico-jejunostomy was performed for reconstructing the pancreaticobiliary system after removing the ductal protein plug. The patient experienced no abdominal pain, no significant elevation of the serum amylase and lipase levels, and no stone formation during the 2 years of follow-up. This procedure is considered to be beneficial for pediatric patients with chronic pancreatitis due to annular pancreas and duodenal duplication.

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<![CDATA[A child with recurrent pyogenic arthritis with the PSTPIP1 mutation]]> https://www.researchpad.co/article/elastic_article_14171 Pyogenic arthritis, pyoderma gangrenosum, and acne syndrome is a rare disease, linked to an auto-inflammatory pathway. We report a 7-year-old boy with recurrent suppurative knee arthritis without signs of suppurative skin infection or ulcer; his younger brother had the same symptom. Genetic testing indicated the presence of proline-serine-threonine phosphatase interacting protein 1 gene mutation in both boys. Our patient’s grandfather had a history of recurrent pyoderma, and his father though a genetic carrier had no symptoms. Interestingly, our patient displayed markedly high levels of interleukin-6, while interleukin-1 and other cytokines were not elevated. These lab findings led to the treatment of pyogenic arthritis, pyoderma gangrenosum, and acne syndrome with tocilizumab. Previously reported cases of similar phenotypes of the syndrome have not presented in this fashion, nor have there been reported cases of pyogenic arthritis, pyoderma gangrenosum, and acne syndrome with a positive family history and an elevation in interleukin-6. The mutation site of proline-serine-threonine phosphatase interacting protein 1 in this incomplete pyogenic arthritis, pyoderma gangrenosum, and acne syndrome has not been reported before. It is possible that there are other pathogenic ways to trigger these auto-inflammatory disorders. Tocilizumab, which specifically targets interleukin-6, was effective in this case.

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<![CDATA[Synchronous squamous cell carcinoma and papillary thyroid carcinoma arising from the thyroglossal duct remnant: Case report and a review of the literature]]> https://www.researchpad.co/article/elastic_article_14157 Squamous cell carcinoma and papillary thyroid carcinoma simultaneously spreading from the thyroglossal duct remnant (TGDR) is a very rare event. The recognition of this condition allows a correct management and treatment, offering the best chances of cure to the patient. We describe the case of a 42-year-old woman who noticed a right-sided lump in her neck. An ultrasound scan confirmed multiple clusters of enlarged lymph nodes on the right side associated to a pre-hyoidal solid nodule. The thyroid gland was normal. Fine-needle aspiration cytology on two nodes revealed distinct metastases from squamous cell carcinoma and from papillary thyroid carcinoma. A careful screening for other head and neck tumors was negative. She underwent a Sistrunk procedure, total thyroidectomy and right lateral lymphadenectomy with en bloc jugular vein resection. On histology, a 2 cm papillary and a small squamous cell carcinoma of the TGDR were documented, with nodal metastases from both primaries. We report the overall management strategy, treatment and outcome at 26-month follow-up, and a review of the literature.

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<![CDATA[ <i>Candida auris</i> infection in the central catheter of a patient without sepsis symptoms]]> https://www.researchpad.co/article/elastic_article_14146 Candida auris is an emerging yeast frequently reported as resistant to multiple antifungal drugs commonly used to treat Candida infections. This specie can colonize the patient’s skin and has great ability for producing outbreaks in hospitals. C. auris is phylogenetically related to other Candida species, can be misidentified using conventional biochemical or commercial methods and requires specific technology for its identification. Case report: We report the first isolate of C. auris in Cali, Colombia, from a central venous catheter in a 37-year-old patient with rheumatoid arthritis and endocarditis who did not have symptoms of sepsis. The yeast was initially misidentified as C. haemulonii using the Phoenix system and subsequently identified as C. auris by matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry (MALDI-TOF MS). The broth microdilution method was used to determine the minimum inhibitory concentration; the isolate was susceptible to fluconazole, itraconazole, voriconazole and amphotericin B.Conclusions: This report contributes to knowledge of the epidemiology of C. auris infections in individuals with underlying disease and describes an isolate with a behavior different from what is usually reported. ]]> <![CDATA[Removal of 132-pound ovarian mucinous cystadenoma: A case report]]> https://www.researchpad.co/article/elastic_article_14131 Ovarian masses larger than 100 pounds are rarely encountered in developed countries given advancements in early diagnosis and treatment. Their successful resections pose unique surgical and anesthetic challenges. An otherwise healthy 38-year-old para 1 woman developed a 50 × 60 cm pelvic mass. An exploratory laparotomy, left salpingo-oophorectomy and anterior abdominal wall reconstruction were performed. A total of 60 L of cystic fluid were drained. Close monitoring of hemodynamics and massive volume resuscitation required intensive care. Inpatient physical rehabilitation reinstated independent mobility. Final pathology revealed benign ovarian mucinous cystadenoma. A multidisciplinary approach in the preoperative, intraoperative and postoperative stages of management optimizes patient outcomes.

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<![CDATA[Gynecomastia: A Rare Adverse Effect of Methylphenidate in an Adolescent Boy]]> https://www.researchpad.co/article/elastic_article_14123 Gynecomastia is a benign condition developing in association with localized fat deposition and glandular tissue proliferation in the breast in males, and characterized by breast growth. Drug is one of the most important factors in the etiology of gynecomastia. Methylphenidate is a commonly preferred and well-tolerated drug in the treatment of attention deficit hyperactivity disorder in children and adolescents. Gynecomastia is an uncommon side-effect of methylphenidate use. We report a case of bilateral gynecomastia developing in a dose-dependent manner during methylphenidate monotherapy and resolving with discontinuation of medication in a 15-year-old patient with a history of a similar side-effect during previous use of the drug. To the best of our knowledge this is one of the few case reports of gynecomastia developing in association with methylphenidate.

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<![CDATA[A novel approach to resolve severe mediastinal and subcutaneous emphysema occurring in Pneumocystis jirovecii pneumonia using vacuum-assisted closure therapy]]> https://www.researchpad.co/article/elastic_article_14115 A 50-year-old human immunodeficiency virus positive patient who was diagnosed with Pneumocystis jirovecii pneumonia developed severe subcutaneous and mediastinal emphysema, which was progressive despite low pressure mechanical ventilation. Infraclavicular skin incisions and vacuum-assisted closure therapy were used to resolve the emphysema. The subcutaneous emphysema decreased significantly, and after 1 week the vacuum-assisted closure therapy was ended successfully. This technique has previously been described in several case reports, where it is a promising treatment in severe subcutaneous emphysema, but it is not yet widely used. This case report supports the further use of vacuum-assisted closure therapy in subcutaneous emphysema. Successful treatment of severe mediastinal and subcutaneous emphysema in Pneumocystis jirovecii pneumonia can be achieved by vacuum-assisted closure therapy on infraclavicular skin incisions.

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<![CDATA[Ectopic hepatocellular carcinoma mimicking a retroperitoneal tumor: A case report]]> https://www.researchpad.co/article/elastic_article_14114 An ectopic hepatocellular carcinoma (EHCC) arises from the ectopic liver which is defined as a hepatic organ or tissue not connected to surrounding tissues. EHCC is a rare disease and it is difficult to diagnose preoperatively. Furthermore, the clinical features are not fully elucidated.CASE SUMMARYA retroperitoneal tumor (6 cm) was located at the dorsal side of the pancreas head on abdominal ultrasonography in an 81-year old woman positive for hepatitis C virus antibody. Contrast enhanced-computed tomography and gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging showed viable HCC patterns with early enhancement and delayed washout. The tumor markers — serum alpha-fetoprotein and alpha-fetoprotein-L3% — were increased to 30.1 ng/mL and 83.1%, respectively. Protein induced by vitamin K absence or antagonist-II was within normal levels (17 mAU/mL). Positron emission tomography-computed tomography showed strong accumulation into the tumor (Standardized Uptake Value max: 13.8), and the tumor cytology following endoscopic ultrasound-guided fine needle aspiration showed poorly differentiated carcinoma. Tumor extirpation was performed, and operative findings showed that the retroperitoneal tumor was disconnected from the pancreas and the liver. Swollen lymph nodes near the tumor were histologically normal. On histological examination, the tumor was finally diagnosed as EHCC with Arginase-1 positive expression.CONCLUSIONWe report our experience of a rare EHCC which was difficult to diagnose, and we present a review of the literature. ]]> <![CDATA[Linear porokeratosis presenting in adulthood: A diagnostic challenge: A case report]]> https://www.researchpad.co/article/elastic_article_14089 Linear porokeratosis is a rare variant of porokeratosis that most often presents in newborns and children; development of this porokeratosis variant in adulthood is far less common. We report the case of a 25-year-old female who presented with a progressive eruption on the proximal upper extremity of 6-year duration, which was ultimately diagnosed as adult-onset linear porokeratosis and safely treated with oral isotretinoin. We propose that a sporadic mutation resulting in mosaicism after birth may explain the development of linear porokeratosis in adulthood, although the exact trigger of such a somatic mutation is not known. This case also describes a unique clinical presentation, with linear porokeratosis lesions originating on the proximal extremity rather than on the more common distal extremity. This demonstrates a distinctive clinical presentation not seen in the pediatric forms of disease.

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<![CDATA[Successful Electroconvulsive Therapy for a 74-year-old Female with Major Depressive Disorder and Tardive Tremor: A Case Report and Literature Review]]> https://www.researchpad.co/article/elastic_article_14074 Tardive tremor is an infrequently form of tardive syndrome that is developed from prolonged treatment with dopamine receptor blocking agents. This condition presents as a prominent tremor that may cause significant distress but currently lacks effective treatment. Electroconvulsive therapy (ECT) has been applied to treat tardive syndrome. In this study, we report a 74-year-old female patient with major depressive disorder, whose tardive tremor and depressive symptoms showed remarkable improvement after receiving 10 sessions of ECT treatment.

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<![CDATA[Methylphenidate-induced Exacerbation of Chorea in a Child Resolved with Switching to Atomoxetine]]> https://www.researchpad.co/article/elastic_article_14068 Choreiform movements have been reported with stimulant medications, especially in adults. There is only limited evidence on the management of such reactions in children with attention deficit hyperactivity disorder. Hereby, we present the exacerbation of chorea with long-acting methylphenidate use in a 6-year-old child with acute rheumatic fever which resolved with switching to atomoxetine.

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<![CDATA[Chair-side CAD/CAM fabrication of a single-retainer resin bonded fixed dental prosthesis: a case report]]> https://www.researchpad.co/article/elastic_article_14053 This clinical report describes designing and fabricating a single-retainer resin-bonded fixed dental prosthesis with a chair-side computer-aided design/computer-aided manufacturing system. The whole procedure, from tooth extraction to final placement of the prosthesis, was completed in one day, and a single clinic visit. No clinical complications were found at the 2-year follow-up after placement of the restoration, and satisfactory functional and esthetic results were achieved.

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<![CDATA[Spontaneously ruptured hepatocellular carcinoma in Fontan-associated liver disease: A case report]]> https://www.researchpad.co/article/elastic_article_14040 The prognosis of congenital heart disease is dramatically improved by cardiac surgery. The Fontan procedure is the definitive palliative operation for patients with single-ventricle physiology. In parallel with the longer survival time achieved with the Fontan procedure, the incidence of Fontan-associated liver disease is increasing. A 40-year-old man who underwent Fontan procedures at the ages of 9 was referred to our hospital for further evaluation of multiple hepatic tumors. Enhanced computed tomography showed large hepatocellular carcinomas with portal thrombi (Vp3). Spontaneous hepatocellular carcinoma rupture occurred 2 weeks after the first visit to our hospital, and emergent transcatheter arterial embolization of the hepatic artery was performed. Three months later, the patient died of liver failure. Autopsy findings showed moderately differentiated hepatocellular carcinoma with a cirrhotic liver characterized by centrilobular fibrosis and sinusoidal dilation similar to that in Fontan-associated liver disease. We reported the first case of spontaneously ruptured hepatocellular carcinoma treated by emergent transcatheter arterial embolization in Fontan-associated liver disease. As the early diagnosis of liver cirrhosis and hepatocellular carcinoma results in better patients’ outcome, cardiologists and hepatologists should be aware of Fontan-associated liver disease and advise patients to have regular follow-up of the liver.

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<![CDATA[Successful treatment of painful chronic wounds with amniotic and umbilical cord tissue: A case series]]> https://www.researchpad.co/article/elastic_article_14038 Patients with chronic wounds may experience persistent, debilitating pain that cannot be adequately managed with analgesics and that negatively impacts their quality of life. In this case series, three painful chronic and ischemic wounds that were caused by polyarteritis nodosa vasculitis (n = 1) and peripheral arterial disease (PAD) (n = 2) were successfully treated with cryopreserved umbilical cord tissue and/or amniotic membrane and umbilical cord particulate, resulting in notable reduction in pain within 7 days followed by expedited wound closure. No adverse events related to these tissue products were observed. These preliminary data demonstrate its safety and efficacy in reducing pain and promoting wound healing in painful chronic and ischemic wounds.

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<![CDATA[Basal cell carcinoma stroma as a mimicker of lymphatic invasion: A case report]]> https://www.researchpad.co/article/elastic_article_14037 Basal cell carcinoma metastases are rare. We report a case of an 83 year-old male with recurrent cutaneous infiltrative basal cell carcinoma on the right vertex with tumor aggregates of infiltrative basal cell carcinoma in the lymphatic vessels of the superficial dermis strongly suspected on pathology slide evaluation during Mohs micrographic surgery. D2-40 immunohistochemical stain allows the detection of lymphatic invasion by highlighting endothelial cells. Further histologic review and D2-40 stains performed on the paraffin-embedded sections did not reveal an endothelial cell lining in favor of lymphatic invasion. What was identified as lymphatic invasion was the result of a peculiar basal cell carcinoma stroma. Correct identification of basal cell carcinoma stroma as a mimicker of lymphatic invasion would prevent potentially invasive investigation as well as associated costs. This is of great importance as the prognostic and therapeutic implications can be of significant value for the patient.

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<![CDATA[Tumor of the epididymis: an uncommon presentation of disseminated coccidioidomycosis]]> https://www.researchpad.co/article/elastic_article_14036 Coccidioidomycosis is an endemic disease of arid regions in the Western hemisphere. Its clinical presentation varies from asymptomatic nodules on chest x-rays to disseminated disease. We present the case of a 48-year-old man with a hard and heterogeneous tumor in the posterior aspect of the right testis. Color flow doppler testicular ultrasonography was performed and two nodular masses in the tail of the right epididymis were identified. An epididymectomy was performed and histopathological examination revealed coccidioidomycosis. After diagnosis, the patient was successfully treated with fluconazol.

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<![CDATA[A rare case of adrenal collision tumor: Myelolipoma and schwannoma in the adrenal gland]]> https://www.researchpad.co/article/elastic_article_14033 Adrenal collision tumors refer to coexistence of two adjacent, but histologically distinct, neoplasms involving the adrenal gland without histologic admixture at the interface. Myelolipoma is a rare but benign neoplasm. As its name implies, displays both mature adipose tissue and hematopoietic elements. These are usually unilateral and asymptomatic. Schwannomas, tumors derived from the peripheral nerve sheath, are also uncommon lesions in the adrenal gland. Here, we present a rare case of a 65-year-old male with clinical history of abdominal aortic aneurysm who was found to have a 13-cm “incidentaloma” by interventional radiologist during his aortic endograft control. Giving the size of the mass, team decided to excise it, and histopathological examination was performed. While most incidentally discovered adrenal tumors are benign, surgical excision is recommended in large lesions to exclude malignancy, avoid hemorrhage, and/or acute adrenal insufficiency. Given the rarity of such entity, its clinical course and prognosis remains unclear.

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<![CDATA[Myositis as an Initial Presentation of Ulcerative Colitis before Gastrointestinal Symptoms]]> https://www.researchpad.co/article/elastic_article_14032 The musculoskeletal system can be involved as an extra-intestinal manifestation of inflammatory bowel disease. Among these, myositis in ulcerative colitis (UC) is very rare. A 14-year-old girl was admitted due to severe shoulder tenderness. She had complained of left jaw pain and swelling for the past 10 days. Inflammatory markers were elevated with no evidence of infectious etiology. Myositis was suspected by shoulder magnetic resonance imaging. Three days after admission, she developed hematochezia. Muscle biopsy and colonoscopy was performed due to worsening left mandibular area pain and persistent hematochezia. Colonoscopy showed consistent findings with UC. She was finally diagnosed with UC with myositis as an extra-intestinal manifestation. She showed a dramatic response to UC treatment. Gastrointestinal symptoms were well-controlled. After 14 months, UC symptoms and muscle pain were aggravated, which were relieved after steroid and cyclosporin treatment. We report a unique case of UC initially presented with myositis, preceding gastrointestinal symptoms.

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<![CDATA[Granulocytic/myeloid sarcoma with trisomy 21 presented as an epididymal tumor: A case report and review of the literature]]> https://www.researchpad.co/article/elastic_article_14028 Myeloid sarcoma is an extramedullary tumor composed of immature myeloid cells and occurs in various extramedullary sites. We report a 48-year-old man diagnosed with myeloid sarcoma in the epididymis. He was admitted to our hospital due to a painless right intrascrotal mass. Magnetic resonance imaging showed a 30 mm tumor in the right epididymis, and we subsequently performed right high orchiectomy. The pathological diagnosis was myeloid sarcoma. Bone marrow aspiration and biopsy revealed no hematological disease, and cytogenetic analysis in the bone marrow showed normal karyotype. He was diagnosed with isolated myeloid sarcoma in the epididymis. Six months after the operation, myeloid sarcoma recurred in the para aorta and left sub-diaphragm. Bone marrow examination revealed myelodysplastic syndrome, and cytogenetic analysis showed 46, XY. We performed surgical resection of the recurrent mass, and cytogenetic analysis showed 47, XY, +21. He was diagnosed with recurrent MS with adult-onset trisomy 21. Although the effect of trisomy 21 on prognosis is unknown, the patient is currently undergoing systemic chemotherapy with maintained remission.

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<![CDATA[Cephalosporin-resistant typhoid]]> https://www.researchpad.co/article/elastic_article_14020 Typhoid fever is endemic in developing countries like India. An increasing prevalence of resistance to cephalosporins and fluoroquinolones by Salmonella isolates is seen. We present an 8-month-old boy with invasive Salmonella typhi disease. Blood culture showed S. typhi sensitive to ampicillin–sulbactam and cotrimoxazole but resistant to fluoroquinolones and third-generation cephalosporins. Cerebrospinal fluid examination revealed an aseptic meningitic picture. He was treated with intravenous meropenem and azithromycin following which his condition improved. This case highlights the need for improvement in environment sanitation and hygiene combined with early vaccination against typhoid fever and antimicrobial stewardship to help reduce the emerging resistance to cephalosporins and fluoroquinolones.

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