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Reports, Volume 7, Issue 4 (December 2024) – 17 articles

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6 pages, 913 KiB  
Case Report
Systemic Coagulation Derangement as an Early Sign of Oxygenator Failure in Veno-Venous Extracorporeal Membrane Oxygenation (VV ECMO) Without Anticoagulation
by Konstanty Szułdrzyński, Miłosz Jankowski and Magdalena Fleming
Reports 2024, 7(4), 97; https://doi.org/10.3390/reports7040097 - 12 Nov 2024
Viewed by 312
Abstract
Background and Clinical Significance: Veno-venous extracorporeal membrane oxygenation (VV ECMO) has become a widely accepted supportive treatment for severe acute respiratory distress syndrome (ARDS) in intensive care units (ICUs). Although it has gained popularity, some of its aspects, including optimal anticoagulation management [...] Read more.
Background and Clinical Significance: Veno-venous extracorporeal membrane oxygenation (VV ECMO) has become a widely accepted supportive treatment for severe acute respiratory distress syndrome (ARDS) in intensive care units (ICUs). Although it has gained popularity, some of its aspects, including optimal anticoagulation management and the best means of monitoring hemostasis, remain unresolved. Thrombosis and bleeding are still important complications of ECMO. Case Presentation: A 44-year-old male patient, with no underlying conditions, was diagnosed with severe acute respiratory distress syndrome (ARDS) due to AH1N1 influenza. He presented severe hypoxemia despite the use of mechanical ventilation, neuromuscular blocking agent infusion and prone position. VV ECMO was used, and coagulation was stopped on ECLS day 6 due to severe pulmonary hemorrhage. The systemic hemostatic disorders found in this patient were difficult to differentiate from disseminated intravascular coagulation (DIC) or sepsis-induced coagulopathy (SIC), improved transiently after circuit exchange, and resolved only after discontinuation of ECMO. The patient was discharged fully conscious and cooperative, with no apparent neurological deficit. Conclusions: Systemic hemostatic abnormalities may precede oxygenator failure and mimic DIC or SIC. Timely oxygenator exchange may therefore be considered. However, it is a high-risk procedure, especially in fully ECLS-dependent patients. Full article
(This article belongs to the Section Critical Care/Emergency Medicine/Pulmonary)
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8 pages, 8240 KiB  
Case Report
Oral Candidiasis in a Diabetic Patient Wearing Bar-Retained Provisional Overdenture: Clinical Case Report
by Christopher Diego Nicholson-Becerra, Mónica Orozco-Gallardo, Arturo Cisneros-Moya, Evangelina Gutiérrez-Cortés and Andréa Dolores Correia Miranda Valdivia
Reports 2024, 7(4), 96; https://doi.org/10.3390/reports7040096 - 11 Nov 2024
Viewed by 273
Abstract
Background: Denture stomatitis is a clinical manifestation of oral candidiasis, often seen in individuals wearing removable dentures that lead to the formation of sub-prosthetic stomatitis. This is particularly common in maladjusted appliances that have been in use for many years. Studies have [...] Read more.
Background: Denture stomatitis is a clinical manifestation of oral candidiasis, often seen in individuals wearing removable dentures that lead to the formation of sub-prosthetic stomatitis. This is particularly common in maladjusted appliances that have been in use for many years. Studies have shown that patients with systemic diseases such as diabetes, or other medical complexities, have a higher likelihood of developing denture stomatitis. To address this problem, the use of implant-retained dentures with different types of attachments has been introduced, providing increased comfort and hygiene for edentulous patients. However, this solution is not without its own set of challenges, being that the prolonged contact with mucosal surfaces can lead to challenges in cleaning and managing plaque depending on the attachment. Case Presentation: In this clinical case report, we present a female patient who developed bar-retained prosthetic stomatitis induced by oral candidiasis a few months after receiving her provisional prosthesis. Conclusions: In conclusion, this case report emphasizes the need to consider both systemic and local factors when preventing and treating denture stomatitis. By understanding the risk factors involved, healthcare professionals can provide their patients with the best possible care, helping to reduce the prevalence of oral candidiasis in individuals who use implant-retained dentures. Full article
(This article belongs to the Special Issue Clinical Research on Oral Diseases)
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7 pages, 1098 KiB  
Case Report
Biodegradable Stents: A Breakthrough in the Management of Complex Biliary Tract Injuries: A Case Report
by Ottavia Cicerone, Giulio Di Gioia, Maria Pajola, Anna Gallotti, Antonio Mauro D’Agostino, Nicola Cionfoli, Riccardo Corti, Pietro Quaretti and Marcello Maestri
Reports 2024, 7(4), 95; https://doi.org/10.3390/reports7040095 - 9 Nov 2024
Viewed by 288
Abstract
Background and Clinical Significance: Biliary tract injuries are a recognized complication of laparoscopic cholecystectomy. Early diagnosis and prompt management are crucial to minimize complications such as bile leaks, strictures, and fistula formation. This case report highlights the use of a biodegradable biliary [...] Read more.
Background and Clinical Significance: Biliary tract injuries are a recognized complication of laparoscopic cholecystectomy. Early diagnosis and prompt management are crucial to minimize complications such as bile leaks, strictures, and fistula formation. This case report highlights the use of a biodegradable biliary stent in managing a complex biliary injury and discusses the impact of delayed diagnosis on treatment outcomes. Case Presentation: We present the case of a 30-year-old male who sustained a Strasberg E2 biliary tract injury during a laparoscopic cholecystectomy. Initially misdiagnosed, the injury was only recognized on the fourth postoperative day. The patient underwent a Roux-en-Y hepaticojejunostomy and subsequently developed a postoperative biliary fistula, which was managed with percutaneous drainage. A biodegradable biliary stent was later placed to address a stricture and minimize the need for future interventions. One year later, the patient presented with symptoms of cholangitis, and radiological findings revealed a narrowing of the biliary lumen. The stricture was resolved and an endoscopic gastrojejunal shunt was placed to prevent further complications. The patient is currently in good condition with no signs of further complications. Conclusions: This case emphasizes the importance of early diagnosis in managing biliary tract injuries and highlights the potential of biodegradable stents to reduce the need for repeat interventions. Despite a delayed diagnosis necessitating complex surgical procedures, the use of a biodegradable stent proved effective in managing postoperative complications. Further studies are needed to evaluate the long-term efficacy of biodegradable stents in similar clinical scenarios. Full article
(This article belongs to the Section Surgery)
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10 pages, 934 KiB  
Case Report
Aggressive Intravenous Hydration and a Defined Plant-Based Diet Safely and Effectively Treated Type 5 Cardiorenal Syndrome with Stage E Heart Failure-Related Cardiogenic Shock: A Case Report
by Baxter Delworth Montgomery, Camille V. Owens, Rami Salim Najjar and Mawadda Saad
Reports 2024, 7(4), 94; https://doi.org/10.3390/reports7040094 - 8 Nov 2024
Viewed by 291
Abstract
Background and Clinical Significance: Heart failure and kidney diseases often coexist and are difficult to clinically manage. Dysfunction in either organ exacerbates dysfunction in the other, potentially leading to cardiorenal syndrome (CRS). CRS has five different subtypes, with CRS type 5 being [...] Read more.
Background and Clinical Significance: Heart failure and kidney diseases often coexist and are difficult to clinically manage. Dysfunction in either organ exacerbates dysfunction in the other, potentially leading to cardiorenal syndrome (CRS). CRS has five different subtypes, with CRS type 5 being the most problematic given that it consists of an acute insult superimposed upon chronic CRS. Additionally, type 5 CRS can be complicated by heart failure-related cardiogenic shock (HF-CS), which is associated with increased hospitalizations and has a high 1-year mortality rate. The standard treatment for patients with HF-CS consists of guideline-directed medical therapy for heart failure with reduced ejection fraction (HFrEF) as tolerated, along with inotropic therapies and surgical mechanical left ventricular (LV) support, guided by invasive hemodynamic monitoring. Case Presentation: This case study reports the presentation of a 57-year-old man who presented with type 5 CRS who rapidly decompensated to stage E HF-CS and was effectively and safely treated with aggressive intravenous hydration, a defined plant-based diet (DPBD), and reduction of guideline-directed prescription medications without invasive hemodynamic monitoring. Conclusions: Hydration, a DPBD, and a reduction in medication burden may be effective in CRS. Pilot studies are warranted to evaluate the efficacy of this intervention in CRS in a larger cohort. Full article
(This article belongs to the Section Cardiology/Cardiovascular Medicine)
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9 pages, 3272 KiB  
Case Report
Mural Unicystic Ameloblastoma of the Mandible: A Case Report
by Mina Al Azawi, Nikolaos Shinas, Vasileios Zisis, Dhurata Shosho, Athanasios Poulopoulos and Deeba Kashtwari
Reports 2024, 7(4), 93; https://doi.org/10.3390/reports7040093 - 7 Nov 2024
Viewed by 301
Abstract
Background and clinical significance: Among the odontogenic tumors, ameloblastoma is one of the most notorious, although it remains relatively rare, accounting for approximately one percent of all oral tumors. This neoplasm, derived from odontogenic epithelium, may arise from the developing enamel organ, [...] Read more.
Background and clinical significance: Among the odontogenic tumors, ameloblastoma is one of the most notorious, although it remains relatively rare, accounting for approximately one percent of all oral tumors. This neoplasm, derived from odontogenic epithelium, may arise from the developing enamel organ, epithelial cell rests of dental lamina, epithelial lining of odontogenic cysts, and basal cells of oral epithelium. This is a case presentation of a mural unicystic ameloblastoma, the most aggressive subtype and the one with the highest chance of recurrence. Case presentation: A patient was referred by his dentist for root canal treatment at the Emergency Dental Clinic of Boston University. The patient complained of mandibular numbness. A panoramic radiograph was acquired, revealing a radiolucent lesion in the right mandible. Clinical examination detected a soft swelling perforating the buccal cortex in the area of #27–#30. A Cone-Beam CT (CBCT) was acquired in the Oral and Maxillofacial Radiology Clinic revealing a well-defined, partially corticated entity in the periapical area of teeth #27 through #30, with evidence of scalloping borders. The internal structure was unilocular and uniformly low-density. The entity caused interruption of the lamina dura of the associated teeth and inferior displacement of the inferior alveolar canal. Differential diagnoses included unicystic ameloblastoma (UA) and central giant cell granuloma as a second less likely diagnosis. An incisional biopsy was performed for further evaluation. Biopsy confirmed UA with mural involvement. Conclusions: UAs typically exhibit less aggressive behavior. However, cases like this one, where mural involvement is noted and no associated impaction is detected, underline the possibility of variable radiographic presentation and the significance of a multidisciplinary approach in correct diagnosis and treatment. Histological subtyping is crucial for guiding treatment. Full article
(This article belongs to the Special Issue Clinical Research on Oral Diseases)
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3 pages, 2708 KiB  
Interesting Images
Unexplained Giant Genital Enlargement: Is It Due to Inverse Psoriasis?
by Francesco Natale and Giovanni Cimmino
Reports 2024, 7(4), 92; https://doi.org/10.3390/reports7040092 - 7 Nov 2024
Viewed by 252
Abstract
A healthy 54-year-old man previously presented to vascular surgeons with a 4-year history of swelling of the penis and scrotum was scheduled for ultrasound evaluation in the angiology office in our department. At presentation, there was a giant enlargement of the penis and [...] Read more.
A healthy 54-year-old man previously presented to vascular surgeons with a 4-year history of swelling of the penis and scrotum was scheduled for ultrasound evaluation in the angiology office in our department. At presentation, there was a giant enlargement of the penis and scrotum, without swelling of the legs. Ultrasound evaluation was negative for vascular abnormalities. A diagnosis of chronic lymphatic disease was suspected; thus, a lymphoscintigraphy was performed. This test was normal showing, a good visualization of major lymphatics. The patients had a history of psoriasis with a documented previous event of flexural psoriasis involving his genitals with secondary infection 4 years before. Since that infection, his genitals progressively increased in size, and despite medical treatment and different surgical evaluations, the patient’s symptoms have not resolved, with marked disability associated with walking and sexual activity. Full article
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6 pages, 1637 KiB  
Case Report
Pembrolizumab Induced Recall Dermatitis Occurring 5 Years After Radiotherapy
by Caroline J. Cushman, Fuad Abaleka, Andrew F. Ibrahim, Kiran Yalamanchili, Seshadri Thirumala and Donald Quick
Reports 2024, 7(4), 91; https://doi.org/10.3390/reports7040091 - 4 Nov 2024
Viewed by 346
Abstract
Background and Clinical Significance: Radiation recall dermatitis (RRD) following immune checkpoint inhibitor (ICI) therapy has been infrequently reported. Case Presentation: We present a 47-year-old female patient who developed RRD of the breast following three doses of pembrolizumab administered as an adjuvant treatment post-nephrectomy [...] Read more.
Background and Clinical Significance: Radiation recall dermatitis (RRD) following immune checkpoint inhibitor (ICI) therapy has been infrequently reported. Case Presentation: We present a 47-year-old female patient who developed RRD of the breast following three doses of pembrolizumab administered as an adjuvant treatment post-nephrectomy for Stage III renal cell carcinoma (RCC). Notably, the affected breast had previously undergone external beam radiotherapy 247 weeks earlier for Stage IA invasive ductal carcinoma. She had received no prior chemotherapy at any point. RRD manifested as breast induration, erythema, and peau d’orange, and contraction of breast volume was noted following three cycles of pembrolizumab on week 17 (400 mg dose every 6 weeks). The dermatitis responded rapidly to systemic corticosteroids and no treatment interruption was needed. Conclusions: To date, this is the longest reported interval from completion of radiotherapy to RRD. A literature search underscores the variability in presentation and management of ICI-associated RRD. Full article
(This article belongs to the Special Issue Advancements in Clinical Applications of Immune Checkpoint Inhibitors)
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6 pages, 949 KiB  
Case Report
First Case of Chryseobacterium gleum Post-COVID-19 in a Child with Recurrent Fever
by Manuela Colosimo, Filippo Luciani, Maria Novella Pullano, Diana Marisol Abrego-Guandique and Luca Gallelli
Reports 2024, 7(4), 90; https://doi.org/10.3390/reports7040090 - 2 Nov 2024
Viewed by 626
Abstract
Background and Clinical Significance: Chryseobacterium gleum is a Gram-negative opportunistic and emerging pathogen able to induce systemic manifestations (e.g., peritonitis, pneumonia, urinary tract infections, meningitis) in immunocompromised patients. No data on children have been published. Case Presentation: A 2-year-old child presented in [...] Read more.
Background and Clinical Significance: Chryseobacterium gleum is a Gram-negative opportunistic and emerging pathogen able to induce systemic manifestations (e.g., peritonitis, pneumonia, urinary tract infections, meningitis) in immunocompromised patients. No data on children have been published. Case Presentation: A 2-year-old child presented in the pediatric ambulatory room with recurrent fever, submandibular lymphadenopathy, and skin rash. Laboratory findings revealed the presence of microcytic anemia with an increase in c-reactive protein. Chest X-ray reported mild accentuation of the bronchial structure, especially on the right side and middle–lower zone. In the peripheral blood smear, anisopoikilocytosis and elliptical red cells were evident. Clinical evaluation revealed the presence of conjunctivitis and polymorphic erythema, hyperemic pharynx and tonsils, SPO2 99%, auscultation of the chest, harsh vesicular murmur all over the area, and some wheezing. Microbiological analysis of sputum and throat swabs revealed the presence of numerous colonies of Chryseobacterium gleum confirmed using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS score > 2.2). Conclusions: This is the first case of Chryseobacterium gleum post-COVID in a child. We suggest that a quick identification and an appropriate treatment represent the critical factors able to prevent the adverse outcomes related to C. gleum infection. Full article
(This article belongs to the Section Infectious Diseases)
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12 pages, 291 KiB  
Review
The Influence of Regional Anesthesia on the Systemic Stress Response
by Tomasz Reysner, Katarzyna Wieczorowska-Tobis, Grzegorz Kowalski, Monika Grochowicka, Monika Pyszczorska, Aleksander Mularski and Malgorzata Reysner
Reports 2024, 7(4), 89; https://doi.org/10.3390/reports7040089 - 2 Nov 2024
Viewed by 338
Abstract
Background: The systemic stress response to surgery is a complex physiological process characterized by neuroendocrine, sympathetic, and inflammatory activation. While necessary for survival, this response can lead to adverse outcomes such as hyperglycemia, immune suppression, cardiovascular complications, and delayed recovery. Regional anesthesia (RA) [...] Read more.
Background: The systemic stress response to surgery is a complex physiological process characterized by neuroendocrine, sympathetic, and inflammatory activation. While necessary for survival, this response can lead to adverse outcomes such as hyperglycemia, immune suppression, cardiovascular complications, and delayed recovery. Regional anesthesia (RA) has been shown to modulate this stress response more effectively than general anesthesia (GA) by blocking nociceptive signaling and attenuating the release of stress mediators. Objectives: This review aims to elucidate how RA influences the systemic stress response, highlighting its clinical benefits in reducing postoperative pain, improving hemodynamic stability, minimizing inflammatory responses, and preserving immune function. Additionally, this review examines evidence from clinical trials supporting using RA to improve surgical outcomes, particularly in high-risk populations. Methods: A comprehensive narrative review of the literature was conducted to explore the physiological impact of RA on the systemic stress response and its associated clinical outcomes. Studies comparing RA to GA across various surgical procedures were evaluated, focusing on neuroendocrine modulation, sympathetic inhibition, inflammatory attenuation, and the implications for pain management, cardiovascular and pulmonary function, and immune preservation. Results: RA significantly attenuates the neuroendocrine response by reducing the release of cortisol and catecholamines, thereby improving hemodynamic stability and reducing myocardial oxygen consumption. RA also inhibits the sympathetic nervous system, leading to improved cardiovascular outcomes. Furthermore, RA mitigates the inflammatory response by reducing pro-inflammatory cytokine levels, reducing the risk of systemic inflammatory response syndrome (SIRS), sepsis, and pulmonary complications. Clinical studies and meta-analyses consistently demonstrate that RA reduces postoperative pain, opioid consumption, and the incidence of cardiovascular and pulmonary complications, particularly in elderly and high-risk patients. Conclusions: RA offers a significant advantage in modulating the systemic stress response to surgery, improving postoperative outcomes by reducing pain, enhancing cardiovascular stability, and preserving immune function. Its benefits are particularly pronounced in high-risk populations such as the elderly or those with pre-existing comorbidities. Given the growing evidence supporting its efficacy, RA should be considered a critical component of multimodal perioperative care strategies aimed at minimizing the systemic stress response and improving recovery. Future research should optimize RA techniques and identify patient-specific factors to enhance therapeutic benefits. Full article
(This article belongs to the Section Anaesthesia)
13 pages, 1161 KiB  
Article
Risk Factors for Acute Kidney Injury in Patients Undergoing Total Joint Arthroplasty
by Hazal Nur Kılıc, K. Sanem Cakar Turhan, Suheyla Karadag Erkoc and Merve Aral Kocaoglu
Reports 2024, 7(4), 88; https://doi.org/10.3390/reports7040088 - 31 Oct 2024
Viewed by 340
Abstract
Objective: The present study investigates the incidence of postoperative acute kidney injury (AKI) and related risk factors in patients undergoing total joint arthroplasty. Methods: Included in the study were patients undergoing joint arthroplasty in 2015–2020. The patients with acute or chronic [...] Read more.
Objective: The present study investigates the incidence of postoperative acute kidney injury (AKI) and related risk factors in patients undergoing total joint arthroplasty. Methods: Included in the study were patients undergoing joint arthroplasty in 2015–2020. The patients with acute or chronic renal failure were excluded. The participants’ demographical data, American Society of Anesthesiologist (ASA) score, Charlson Comorbidity Index (CCI), type of operation, duration of surgery, presence of comorbidities, preoperative anemia, preoperative albumin levels, use of nephrotoxic agents, number of transfusions during perioperative period, presence of AKI according to Kidney Disease Improving Global Outcome (KDIGO) scores, and length of hospital and intensive care unit stay were evaluated. Results: The study was initiated with 1780 patients: 113 patients were excluded due to chronic kidney failure, 108 patients were excluded due to acute kidney failure, 648 patients were excluded because their data could not be reached, and finally, 911 patients were included in the study. AKI was detected in 134 patients (14.7%), and the number of patients in the KDIGO1 and KDIGO2 groups were 120 and 14, respectively. When evaluated according to the variable significance test result and clinical significance, the model consists of variables such as ASA, CCI, hypertension, nonsteroidal anti-inflammatory drugs (NSAIDs), vancomycin, beta lactam, contrast material and preoperative anemia, operation type, and anesthesia management. Machine learning analyses were performed using 11 variables (10 independent and 1 dependent variable). Logistic regression, naive Bayes, multilayer perceptron, bagging, and random forrest approaches were used for evaluation of the predictive performance. In an evaluation of the true classification ratio, the best result was obtained with the logistic regression method at 85.2%. Conclusions: The study revealed advanced age, high ASA and CCI, presence of diabetes and hypertension, NSAID, vancomycin and contrast material, and the presence of preoperative anemia to be independent risk factors for AKI. Full article
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10 pages, 6099 KiB  
Case Report
Flexor Digitorum Longus Transfer in Chronic Plantar Plate Tears: Two Case Reports and Literature Review
by Antonio Córdoba-Fernández, Rocío Mateos-Carrasco, Antonio Jesús García-Gámez and Victoria Eugenia Córdoba-Jiménez
Reports 2024, 7(4), 87; https://doi.org/10.3390/reports7040087 - 29 Oct 2024
Viewed by 505
Abstract
Background and Clinical Significance: The plantar plate (PP) tear of the second metatarsophalangeal joint (MTPJ) is a common cause of forefoot pain in clinical practice. The PP is the main stabilizing structure of the joint and, together with the collateral ligaments, is the [...] Read more.
Background and Clinical Significance: The plantar plate (PP) tear of the second metatarsophalangeal joint (MTPJ) is a common cause of forefoot pain in clinical practice. The PP is the main stabilizing structure of the joint and, together with the collateral ligaments, is the key to maintaining the stability of the MTPJ. Many surgical procedures have been described to repair PP tears. Currently, there is still controversy regarding which is the surgical superior option (direct versus indirect PP repair techniques). Transfer of the flexor digitorum longus tendon to the dorsum of the proximal phalanx is one of the surgical techniques described to treat PP tears associated with MTPJ instability. Case Presentation: We present two cases that developed instability of the second MTPJ secondary to chronic PP tear with symptoms resolved after transfer of the flexor digitorum longus (FDL). Conclusions: Currently, the literature review shows that the procedure seems to be the most consistent surgical option in chronic cases of PP tears. Full article
(This article belongs to the Section Surgery)
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10 pages, 2431 KiB  
Case Report
Multinodular Vacuolating Neuronal Tumors: Symptomatic Presentation Versus Incidental Finding: Case Series and Literature Review
by Arturs Balodis, Sintija Strautmane, Paula Mežvinska and Sergejs Pavlovičs
Reports 2024, 7(4), 86; https://doi.org/10.3390/reports7040086 - 23 Oct 2024
Viewed by 529
Abstract
Background: Multinodular Vacuolating Neuronal Tumors (MVNTs) are mixed glial–neuronal brain lesions classified as World Health Organization (WHO) CNS grade 1 tumors, often associated with long-term epilepsy. First described by Huse et al. in 2013 and included in the WHO CNS classification in 2016, [...] Read more.
Background: Multinodular Vacuolating Neuronal Tumors (MVNTs) are mixed glial–neuronal brain lesions classified as World Health Organization (WHO) CNS grade 1 tumors, often associated with long-term epilepsy. First described by Huse et al. in 2013 and included in the WHO CNS classification in 2016, MVNTs present a range of clinical manifestations, from symptomatic to asymptomatic. They typically affect young to middle-aged adults and exhibit diverse presentations. Radiologically, MVNTs are usually supratentorial, frequently located in the temporal lobe but also observed in the frontal and parietal lobes. MRI is essential for diagnosis, revealing multiple coalescing subcortical or cortical nodules with hyperintense signals on T2-weighted/FLAIR sequences, often without peripheral edema or mass effects. Case Reports: This paper presents two cases: one symptomatic MVNT with significant clinical manifestations, and the other documenting an incidental finding of MVNT in an asymptomatic patient. One case shows typical temporal lobe localization, while the other highlights a rare frontal lobe localization, with clear radiological findings on T2/FLAIR sequences. Conclusions: These cases illustrate the varied clinical presentations of MVNTs and emphasize MRI’s critical role in diagnosis and management. Asymptomatic cases often require conservative management, stressing the avoidance of unnecessary invasive procedures and the importance of regular monitoring. Full article
(This article belongs to the Section Oncology)
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7 pages, 5038 KiB  
Case Report
Pseudo-Hyperaldosteronism Arising from Licorice Cough Syrup Self-Ingestion: A Case Report
by Chien-Chun Liao and Kun-Te Lin
Reports 2024, 7(4), 85; https://doi.org/10.3390/reports7040085 - 14 Oct 2024
Viewed by 510
Abstract
Background: Licorice (glycyrrhiza glabra) cough syrup intoxication is manifested with refractory hypokalemia, hypertension, and metabolic alkalosis. The transformation of glycyrrhiza glabra metabolic into glycyrrhetic acid after ingestion further inhibits the 11-β-hydroxysteroid dehydrogenase-2 enzyme, impeding the conversion of cortisol into cortisone. The accumulation [...] Read more.
Background: Licorice (glycyrrhiza glabra) cough syrup intoxication is manifested with refractory hypokalemia, hypertension, and metabolic alkalosis. The transformation of glycyrrhiza glabra metabolic into glycyrrhetic acid after ingestion further inhibits the 11-β-hydroxysteroid dehydrogenase-2 enzyme, impeding the conversion of cortisol into cortisone. The accumulation of cortisol can also stimulate mineralocorticoid receptors, which leads to a pseudo-hyperaldosteronism-like effect. Case Presentation: We report a 60-year-old male patient with licorice intoxication due to the chronic consumption of licorice cough syrup. He exhibited a transient seizure lasting approximately one minute. Initially, hypokalemia (potassium level was 2.0 mmol/L), metabolic alkalosis, and QT interval prolongation with premature ventricular complexes were demonstrated on his electrocardiogram. Despite the administration of both intravenous and oral potassium supplements over two days, there was no significant improvement in hypokalemia. Spironolactone, an aldosterone receptor antagonist, was administered in addition to ongoing potassium supplementation from the 3rd day. This intervention led to a rapid normalization of hypokalemia in one day. The patient was ultimately discharged on the 6th day without any subsequent complications. Conclusions: The licorice-induced chronic intoxication, which led to pseudo-hyperaldosteronism and refractory hypokalemia, was successfully managed with aggressive potassium supplementation and spironolactone treatment. Full article
(This article belongs to the Section Endocrinology/Metabolism)
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7 pages, 480 KiB  
Case Report
Diaphragmatic Palsy Due to a Paraneoplastic Autoimmune Syndrome Revealed by Checkpoint Inhibitors
by Jean-Baptiste Destival, Jean-Marie Michot, Cécile Cauquil, Nicolas Noël, Salima Hacein-Bey-Abina, Pascale Chrétien and Olivier Lambotte
Reports 2024, 7(4), 84; https://doi.org/10.3390/reports7040084 - 11 Oct 2024
Viewed by 583
Abstract
Background and Clinical Significance: Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment but may underlie diverse and potentially life-threatening immune-related adverse events (irAEs). They may cause various conditions leading to respiratory failure, including myasthenic syndromes and myositis. However, diaphragmatic paralysis (DP) has rarely been [...] Read more.
Background and Clinical Significance: Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment but may underlie diverse and potentially life-threatening immune-related adverse events (irAEs). They may cause various conditions leading to respiratory failure, including myasthenic syndromes and myositis. However, diaphragmatic paralysis (DP) has rarely been reported. To describe patients with diaphragmatic paralysis in a pharmacovigilance registry, we searched the prospective REISAMIC registry at the Gustave Roussy Cancer Center (Villejuif, France) for cases of diaphragmatic palsy (DP) occurring from September 2014 to December 2021. Case Presentation: We identified three patients, in whom DP was confirmed by diaphragmatic ultrasonography, pulmonary function tests, and/or diaphragmatic electroneuromyogram. Diaphragmatic palsy was life-threatening in all patients, as it caused respiratory failure requiring mechanical ventilation. In all cases, a pre-existing subclinical paraneoplastic syndrome was detected. Onconeural antibodies (anti-titin and anti-VGCC) were detected in these patients before and after the initiation of ICI therapy, suggesting a mixed paraneoplastic syndrome with features overlapping those of myasthenic syndrome (myasthenia gravis in one patient and Lambert–Eaton syndrome in another) and myositis. Conclusions: Diaphragmatic palsy is a severe irAE potentially resulting from different mechanisms, including myositis and neuromuscular junction involvement (myasthenia gravis, Lambert–Eaton). Antineuronal antibodies associated with such conditions were already present in our patients prior to immunotherapy initiation, suggesting ICIs could trigger flare-ups of pre-existing silent paraneoplastic autoimmune conditions. Full article
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8 pages, 1883 KiB  
Case Report
Prolonged Neurological and Musculoskeletal Symptoms Following Shingrix Vaccination
by Sabrina Hollar, Amna Khalid, Benjamin D. Brooks and Michael Wons
Reports 2024, 7(4), 83; https://doi.org/10.3390/reports7040083 - 9 Oct 2024
Viewed by 958
Abstract
Background: The recombinant zoster vaccine (Shingrix) helps prevent shingles and its complications in adults 50 and older. While minor side effects are common, severe adverse reactions are thought to be rare, and long-term side effects are not well documented. Case Presentation: A 50-year-old [...] Read more.
Background: The recombinant zoster vaccine (Shingrix) helps prevent shingles and its complications in adults 50 and older. While minor side effects are common, severe adverse reactions are thought to be rare, and long-term side effects are not well documented. Case Presentation: A 50-year-old woman with Crohn’s disease developed joint pain, effusion, and neurological symptoms such as numbness and tingling shortly after receiving the first dose of the recombinant zoster vaccine. Symptoms waxed and waned but persisted for over a year despite anti-inflammatories and specialist referrals. Diagnostic imaging and labs were unrevealing. Conclusions: This case of prolonged somatic and neurological symptoms associated temporally with Recombinant zoster vaccine administration reinforces the critical need for thorough pharmacovigilance and investigation of possible long-term adverse vaccine reactions. Provider documentation and reporting of individual experiences can help improve the detection of rare vaccine-related risks, elucidate potential risk factors, and refine safety screening. Diligent monitoring and research into longitudinal vaccine outcomes remain paramount, especially following recent emergency authorizations. Full article
(This article belongs to the Section Epidemiology/Public Health)
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8 pages, 2953 KiB  
Case Report
Tuberculosis-Induced Immune-Mediated Necrotizing Myopathy: A Challenging Case Scenario in a Non-Endemic Country
by Agnese Colpani, Davide Astorri, Andrea De Vito, Giordano Madeddu, Sandro Panese and Nicholas Geremia
Reports 2024, 7(4), 82; https://doi.org/10.3390/reports7040082 - 24 Sep 2024
Viewed by 710
Abstract
Background: Tuberculosis (TB) poses a significant global health challenge; although low–middle income countries carry the heaviest burden, its diagnosis and treatment can be challenging in any country. The clinical picture can be complex and vary from person to person, with autoimmune complications [...] Read more.
Background: Tuberculosis (TB) poses a significant global health challenge; although low–middle income countries carry the heaviest burden, its diagnosis and treatment can be challenging in any country. The clinical picture can be complex and vary from person to person, with autoimmune complications that can hinder TB diagnosis and treatment. Case Presentation: We report the case of a 38-year-old man from Bangladesh who had recently arrived in Italy through the Balkan route. He presented with TB in the cervical lymph nodes and long-standing chronic myalgias. While a wide range of TB-triggered autoimmune entities can be found in the literature, this case is the first to describe immune-mediated necrotizing myopathy (IMNM) triggered by active TB. Conclusions: IMNM has been previously associated only with other infections like SARS-CoV-2 and Dengue. The successful diagnosis and management of TB-induced IMNM was achieved through a collaborative, multidisciplinary approach involving rheumatologists, immunologists, and infectious diseases specialists, showcasing an innovative treatment strategy and adding new insights into the complexities of TB and IMNM. Full article
(This article belongs to the Collection Health Threats of Climate Change)
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Case Report
Endoscopic Guided Dilations without Intralesional Corticosteroid Injections: Pediatric Crohn’s Patients Case Series
by Leo Fawaz, Yousif Slim and Peter N. Freswick
Reports 2024, 7(4), 81; https://doi.org/10.3390/reports7040081 - 24 Sep 2024
Viewed by 833
Abstract
Background: The treatment for pediatric Crohn’s disease (CD) has shifted over the years from steroids and immunomodulators to biologics with the goal of histological and clinical remission. Endoscopic balloon dilation (EBD) has been utilized for stricturing disease, even in the pediatric population. EBD [...] Read more.
Background: The treatment for pediatric Crohn’s disease (CD) has shifted over the years from steroids and immunomodulators to biologics with the goal of histological and clinical remission. Endoscopic balloon dilation (EBD) has been utilized for stricturing disease, even in the pediatric population. EBD has been shown to be effective and minimally invasive, though historically, has been performed on patients with persistent mucosal inflammation. As such, intralesional corticosteroid (ILC) injections have been traditionally utilized during EBD. However, intralesional corticosteroid efficacy among pediatrics patients in deep endoscopic remission is unknown. Case Presentation: We report four patients that demonstrated at least initial successful dilations without intralesional steroid injections. Conclusions: The use of ILC injections during routine EBDs in pediatric patients should be further explored in randomized control trials. Full article
(This article belongs to the Section Gastroenterology)
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