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Reports, Volume 8, Issue 3 (September 2025) – 58 articles

Cover Story (view full-size image): Avatar Therapy (AT) for individuals with treatment-resistant auditory verbal hallucinations (AVHs) in schizophrenia aims to address emotional responses, beliefs about voices, self-perception, and coping strategies. This study focuses on three patients who, during AT, shifted their belief about the origin of their most distressing voice from an external source to a self-generated one. A session-by-session account was provided for the evolution of this reattribution during AT, along with each patient’s perceptions of it. This process led to the recognition that voices initially perceived as external were, in fact, internally generated thoughts, reflecting changes in self-perception. These findings suggest that AT can modify how individuals relate to their voices and may empower them to regain control over their AVHs. View this paper
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16 pages, 1087 KiB  
Review
The Role of Pharmacogenomics in Optimizing Ketamine Therapy for Post-Amputation Pain
by Alix Tappe, Emily Burzynski, Jhanvi Patel, Ithamar Cheyne and Małgorzata Mikaszewska-Sokolewicz
Reports 2025, 8(3), 156; https://doi.org/10.3390/reports8030156 - 22 Aug 2025
Abstract
Context and objective: Post-amputation pain (PAP) is an umbrella term that includes residual limb pain (RLP) and phantom limb pain (PLP), posing a significant challenge to recovery and quality of life after limb loss. Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, has gained interest [...] Read more.
Context and objective: Post-amputation pain (PAP) is an umbrella term that includes residual limb pain (RLP) and phantom limb pain (PLP), posing a significant challenge to recovery and quality of life after limb loss. Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, has gained interest for its potential to manage PAP, particularly in refractory cases. This narrative review explores the efficacy of ketamine for PAP and the emerging role of pharmacogenomics in guiding its use. Methods: A literature review of PubMed, Embase, and Cochrane databases was conducted, focusing on clinical trials, systematic reviews, and genetic influences on ketamine metabolism and response. Studies suggest that perioperative ketamine can reduce PAP severity and opioid use. However, outcomes vary, with some patients experiencing transient relief and others achieving prolonged benefit. Results: This variability may be linked to genetic differences in CYP2B6, CYP3A4/5, COMT Val158Met, SLC6A2, and KCNS1, which affect ketamine’s metabolism, efficacy and side effect profile. Understanding these pharmacogenomic factors could enable more personalized and effective ketamine therapy. Conclusion: Despite its promise, inconsistent dosing regimens and limited integration of genetic data hinder standardization. Further research into genotype-guided ketamine protocols may improve treatment outcomes and support precision analgesia in amputee care. Full article
(This article belongs to the Section Anaesthesia)
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20 pages, 312 KiB  
Review
The Ongoing Struggle to Find a Gold Standard for PJI Diagnosis
by Emanuel-Cristian Sandu, Catalin Cirstoiu, Sergiu Iordache, Mihai Aurel Costache, Georgian Longin Iacobescu and Adrian Cursaru
Reports 2025, 8(3), 155; https://doi.org/10.3390/reports8030155 - 21 Aug 2025
Abstract
Periprosthetic joint infection (PJI) is a devastating complication of joint arthroplasty surgery that is difficult to both diagnose and treat. Misdiagnosing a prosthetic infection has terrible consequences for both the patient and healthcare system. No currently used diagnostic test fulfills the requirements to [...] Read more.
Periprosthetic joint infection (PJI) is a devastating complication of joint arthroplasty surgery that is difficult to both diagnose and treat. Misdiagnosing a prosthetic infection has terrible consequences for both the patient and healthcare system. No currently used diagnostic test fulfills the requirements to be considered a gold standard. This shortcoming has been overcome through the implementation of multi-criteria diagnostic protocols elaborated by societies including the Infectious Diseases Society of America, International Consensus Meeting and European Bone and Joint Infection Society, using a combination of clinical, paraclinical and molecular findings in order to achieve the best accuracy in diagnosing PJI. This review aims to survey the current state of the techniques and technologies used for the diagnosis of PJI, investigating the accuracies of serum biomarkers (e.g., C-reactive protein, Interleukin-6, procalcitonin, D-dimers, Serum Intercellular Adhesion Molecule-1), synovial biomarkers (e.g., Antimicrobial peptides, lipocalin-2, leukocyte esterase, calprotectin), tissue biomarkers (e.g., Toll-like receptors, CD15) and advanced molecular techniques (e.g., Polymerase chain reaction, Metagenomic next-generation sequencing), as well as describing their ongoing limitations. In the search for an accurate, inexpensive and fast diagnostic test for PJI, we conclude that the accuracies of the currently studied biomarkers could be further enhanced through the development of novel detection technologies. Full article
(This article belongs to the Section Orthopaedics/Rehabilitation/Physical Therapy)
13 pages, 2090 KiB  
Case Report
Immune Checkpoint Inhibitor-Induced Ocular Toxicity: A Case of Pembrolizumab-Associated Corneal Ulceration and Evisceration
by Mario Caldarelli, Donatella Brisinda, Giuseppe De Matteis, Francesco De Vito, Gloria Gambini, Rossella Cianci and Giovanni Gambassi
Reports 2025, 8(3), 154; https://doi.org/10.3390/reports8030154 - 21 Aug 2025
Abstract
Background and Clinical Significance: Immune checkpoint inhibitors (ICIs) ushered in a new era in cancer treatment, but alongside their efficacy is an adverse event profile that involves the immune system as a whole and may impact several organs. Case Presentation: We present the [...] Read more.
Background and Clinical Significance: Immune checkpoint inhibitors (ICIs) ushered in a new era in cancer treatment, but alongside their efficacy is an adverse event profile that involves the immune system as a whole and may impact several organs. Case Presentation: We present the case of a 68-year-old woman with a diagnosis of cervical cancer treated with pembrolizumab who developed progressively steroid-refractory chronic diarrhea and ensuing visual problems. Topical antibiotics failed to heal a corneal ulcer in the left eye, necessitating evisceration. Imaging showed intestinal pneumatosis without ischemia, and there was immediate clinical improvement after initiation of corticosteroid therapy. This clinical picture—steroid-dependent colitis and immune-mediated uveitis associated with secondary bacterial infection—was coded as an immune-related adverse event (irAE) resulting from ICI treatment. Because of the prompt and complete regression of the symptoms upon corticosteroid therapy, this was considered as a criterion for the final diagnosis. Conclusions: The case highlights the complexity and potential severity of irAEs that need to be appropriately identified and promptly managed by multidisciplinary teams. Full article
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9 pages, 934 KiB  
Case Report
Pediatric Acute Megakaryoblastic Leukemia with a GATA2 Mutation and Monosomy 7: A Case Report and Clinical Management Challenges
by Gowri Joshi, Astil Jisho Anto, Md Maaz Mallick, Gwan Yong Lim and Łukasz Hutnik
Reports 2025, 8(3), 153; https://doi.org/10.3390/reports8030153 - 21 Aug 2025
Abstract
Background and Clinical Significance: Acute megakaryoblastic leukemia (AMKL) is a rare and aggressive hematologic malignancy. The presence of genetic abnormalities often increases the complexity of AMKL. Among these, patients with monosomy 7 constitute a high-risk group associated with a poorer prognosis and [...] Read more.
Background and Clinical Significance: Acute megakaryoblastic leukemia (AMKL) is a rare and aggressive hematologic malignancy. The presence of genetic abnormalities often increases the complexity of AMKL. Among these, patients with monosomy 7 constitute a high-risk group associated with a poorer prognosis and greater chemoresistance. We report the case of a 10-year-old boy who had AMKL along with monosomy 7 and familial GATA2 deficiency. The case highlights the diagnostic and therapeutic challenges faced, as well as the critical importance of early genetic screening and timely hematopoietic stem cell transplantation (HSCT). Case Presentation: A 10-year-old boy presented with easy bruising and pancytopenia. AMKL was diagnosed with the help of a bone marrow biopsy and immunophenotyping. Genetic testing showed a GATA2 mutation and monosomy 7. Two induction cycles with daunorubicin and cytarabine were administered but failed to eliminate residual disease. The patient also developed pneumonia of a fungal origin. HSCT was delayed due to liver toxicity and elevated minimal residual disease (MRD). Azacitidine and venetoclax stabilized the disease, thereby allowing for successful haploidentical HSCT. The patient achieved complete remission with full donor chimerism. Conclusions: This case emphasizes the importance of early molecular diagnostics in pediatric AMKL. Identifying GATA2 mutations and monosomy 7 early can help guide risk stratification and the timing of HSCT. Multimodal therapy, which includes the use of infection control and targeted agents, is important for improving the outcomes in high-risk patients. Full article
(This article belongs to the Section Haematology)
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20 pages, 6885 KiB  
Case Report
Twice the Leak: Managing CSF Fistulas in a Recurrent Thoracic Arachnoid Cyst—A Case Report
by Federica Bellino, Leonardo Bradaschia, Marco Ajello and Diego Garbossa
Reports 2025, 8(3), 152; https://doi.org/10.3390/reports8030152 - 21 Aug 2025
Abstract
Background and Clinical Significance: Spinal arachnoid cysts are rare lesions that may become symptomatic through progressive spinal cord compression. We present a complex case of a thoracic extradural SAC in a 17-year-old male, managed through a stepwise, multidisciplinary approach. Case Presentation: [...] Read more.
Background and Clinical Significance: Spinal arachnoid cysts are rare lesions that may become symptomatic through progressive spinal cord compression. We present a complex case of a thoracic extradural SAC in a 17-year-old male, managed through a stepwise, multidisciplinary approach. Case Presentation: The patient presented with progressive lower limb weakness, right knee paresthesia, and urinary hesitancy following physical exertion. MRI revealed a large posterior extradural SAC extending from T2–T3 to T8, with associated spinal cord compression. Initial management involved T8 laminectomy and cyst fenestration under intraoperative neurophysiological monitoring, with partial clinical improvement. However, early recurrence with pseudomeningocele formation prompted a second surgery, including external CSF drainage. Persistent cerebrospinal fluid (CSF) leakage led to targeted epidural blood patching, followed by temporary stabilization. Due to continued cyst enlargement and spinal cord compression, definitive surgical repair was undertaken: fistula clipping at T3 and embolization with platinum coils inside the cystic cavity, combined with a new blood patch. This novel technique resulted in radiological improvement and clinical stabilization. Conclusions: This case highlights the diagnostic and therapeutic challenges of managing symptomatic extradural SACs, particularly in young patients. Our experience underscores the utility of a staged approach involving surgical decompression, neuroimaging-guided interventions, and definitive dural repair. The combination of fistula clipping and coil embolization may offer a promising strategy for refractory cases, potentially reducing recurrence and preserving neurological function. Full article
(This article belongs to the Section Surgery)
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15 pages, 1583 KiB  
Brief Report
Oral Health Status and Parental Awareness in Children with X-Linked Hypophosphatemic Rickets: A Case-Control Study
by Victoria Zlateva, Krasimir Hristov, Zdravka Todorova and Ralitsa Bogovska-Gigova
Reports 2025, 8(3), 151; https://doi.org/10.3390/reports8030151 - 20 Aug 2025
Abstract
X-linked hypophosphatemic rickets (XLH) is a rare genetic disorder with a frequency of 1:20,000, caused by mutations in the PHEX gene, resulting in impaired phosphate metabolism and bone mineralization. There is an association between hypophosphatemia and dental issues, though this link is not [...] Read more.
X-linked hypophosphatemic rickets (XLH) is a rare genetic disorder with a frequency of 1:20,000, caused by mutations in the PHEX gene, resulting in impaired phosphate metabolism and bone mineralization. There is an association between hypophosphatemia and dental issues, though this link is not definitively established. This study aims to evaluate the dental status, including oral hygiene, caries prevalence, and malocclusions, as well as parental awareness of dental complications, in children with XLH in Bulgaria, particularly those receiving or about to begin burosumab treatment, and to compare their oral health status with that of healthy children. Eleven children with XLH (seven girls, four boys, aged 2.5–17 years), nine receiving burosumab, were assessed and compared with eleven age- and gender-matched healthy children (seven girls, four boys, aged 2.5–17 years) without XLH or systemic conditions affecting dental health. Parental awareness of dental implications was assessed via a questionnaire, revealing no awareness of potential complications. Oral hygiene, measured using the Oral Hygiene Index-Simplified (OHI-s), was poor in 66.67% of children, with an average of 6.45 ± 5.80 carious lesions per child, and was highest in the 11–16 age group. Malocclusions were observed in 63.64% of children, and spontaneous endodontic infections occurred in 18.18%. Compared with healthy children, patients with XLH had significantly worse oral hygiene (p = 0.013) and a higher caries prevalence (p = 0.001). Children with XLH exhibit poor oral hygiene, a high caries burden, and frequent malocclusions, compounded by a lack of parental awareness of dental risks. These findings underscore the need for targeted dental interventions and education in XLH management, including the integration of routine dental assessments and structured parental education programs into existing clinical protocols to improve oral health outcomes. Full article
(This article belongs to the Special Issue Oral Disorders in the Pediatric Population)
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8 pages, 1681 KiB  
Case Report
A Case of Success: Guidelines-Based Treatment to Control Atrial Fibrillation-Induced Cardiomyopathy—Atrioventricular Node Ablation and Cardiac Resynchronization Therapy to the Rescue
by Neda Jonaitienė, Grytė Ramantauskaitė and Jolanta Laukaitienė
Reports 2025, 8(3), 150; https://doi.org/10.3390/reports8030150 - 20 Aug 2025
Viewed by 105
Abstract
Background and Clinical Significance: Heart failure with reduced ejection fraction (HFrEF) and atrial fibrillation (AF) frequently coexist, creating a complex clinical interplay that exacerbates morbidity and mortality. AF can directly precipitate or worsen HFrEF through mechanisms such as tachycardia-induced cardiomyopathy, loss of [...] Read more.
Background and Clinical Significance: Heart failure with reduced ejection fraction (HFrEF) and atrial fibrillation (AF) frequently coexist, creating a complex clinical interplay that exacerbates morbidity and mortality. AF can directly precipitate or worsen HFrEF through mechanisms such as tachycardia-induced cardiomyopathy, loss of atrial contribution to ventricular filling, and irregular ventricular response. The use of evidence-based therapies improves clinical outcomes in patients with HFrEF. Case Presentation: We present a clinical case of a 58-year-old man with left bundle branch block (LBBB), tachysystolic AF, and the aforementioned induced HFrEF. The patient’s medical treatment was optimized according to recent guidelines. Subsequent to the improvements in HF treatment, the patient’s echocardiographic data showed a higher left ventricle ejection fraction (LVEF); however, it remained below 35%. Moreover, tachysystolia persisted and was not sufficiently controlled with medications. Therefore, an upgrade of the pacemaker to cardiac resynchronization therapy (CRT) following the destruction of the AV node was performed to control tachysystolic AF and worsening of HF. After the treatment adjustments, the patient’s symptoms regressed, and echocardiography showed improved LVEF up to 41%. Conclusions: This case highlights the successful identification and timely application of intensive heart rate control management and heart failure induced by AF treatment. Full article
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9 pages, 5551 KiB  
Case Report
Is Semaglutide Linked to NAION? A Case Report on a Rare Ocular Complication
by Dina Lešin Gaćina, Tomislav Vidović, Nikolina Vlajić Oreb, Lovorka Matković and Sonja Jandroković
Reports 2025, 8(3), 149; https://doi.org/10.3390/reports8030149 - 20 Aug 2025
Viewed by 148
Abstract
Background and Clinical Significance: Ischemic optic neuropathies (IONs) are significant causes of vision loss resulting from compromised blood flow to the optic nerve. Diabetes mellitus (DM) exacerbates the risk of IONs through chronic hyperglycemia and associated vascular dysfunction. Recently, semaglutide, a glucagon-like [...] Read more.
Background and Clinical Significance: Ischemic optic neuropathies (IONs) are significant causes of vision loss resulting from compromised blood flow to the optic nerve. Diabetes mellitus (DM) exacerbates the risk of IONs through chronic hyperglycemia and associated vascular dysfunction. Recently, semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, has been linked to ocular complications, including non-arteritic anterior ischemic optic neuropathy (NAION), potentially due to the rapid glycemic changes or vascular effects. Case Presentation: A 55-year-old female with type 2 DM, hypertension, and hyperlipidemia presented with blurred vision and optic disc edema after four months of semaglutide therapy (Ozempic®, Sydney, Australia). Initially diagnosed with diabetic papillopathy (DP), her condition progressed to NAION, leading to partial visual recovery with corticosteroid treatment and improved glycemic management. Diagnostic evaluations, including visual field testing, optical coherence tomography, and fluorescein angiography, supported the diagnosis. Conclusions: This case report describes the clinical course of a diabetic patient treated with a semaglutide who developed an ischemic optic event. The timing of symptom onset in relation to the initiation of semaglutide therapy raises the possibility of a causal association between the drug and this rare ocular complication. Close monitoring of ocular health is crucial for patients on GLP-1 receptor agonists, particularly those with pre-existing vascular risk factors. Further research is needed to elucidate the underlying mechanisms and guide clinical practice. Full article
(This article belongs to the Section Ophthalmology)
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9 pages, 2776 KiB  
Case Report
Extensive Cholesteatoma Compromising the Entire Ipsilateral Skull Base: Excision Through a Multi-Corridor Surgical Technique
by Lyubomir Rangachev, Julian Rangachev, Tzvetomir Marinov, Sylvia Skelina and Todor M. Popov
Reports 2025, 8(3), 148; https://doi.org/10.3390/reports8030148 - 18 Aug 2025
Viewed by 183
Abstract
Background and Clinical Significance: Petrous bone cholesteatoma is a rare and complex condition that poses significant challenges in terms of its diagnosis and treatment. This benign yet locally aggressive lesion can cause extensive destruction of the surrounding structures, potentially leading to serious [...] Read more.
Background and Clinical Significance: Petrous bone cholesteatoma is a rare and complex condition that poses significant challenges in terms of its diagnosis and treatment. This benign yet locally aggressive lesion can cause extensive destruction of the surrounding structures, potentially leading to serious complications. Case Presentation: We present a case of extensive petrous bone cholesteatoma involving nearly the entire skull base. High-resolution CT and MRI were used to assess the extent of the lesion and its relationship with critical neurovascular structures. The cholesteatoma extended from the petrous apex to the clivus, involving the internal auditory canal and Meckel’s cave, encasing the internal carotid artery, and compressing the brainstem. The surgical strategy included combined endoscopic transsphenoidal and transclival techniques with a retrolabyrinthine approach. The endoscopic component provided access to the anterior and central skull base regions, whereas the retrolabyrinthine approach allowed us to gain access to the posterior petrous area. Careful dissection was performed to separate the cholesteatoma from the internal carotid artery and the brainstem. Neuromonitoring was performed throughout the procedure to ensure cranial nerve integrity. This combined approach enabled gross total resection, and postoperative imaging confirmed successful tumor removal. The patient’s recovery was uneventful, and no new neurological deficits were observed. Conclusions: The successful management of this complex case demonstrates the efficacy and safety of combining endoscopic surgical approaches for extensive skull base cholesteatomas. This multi-corridor approach allows for maximal tumor resection while also minimizing the risks to critical neurovascular structures. Full article
(This article belongs to the Section Otolaryngology)
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9 pages, 1128 KiB  
Case Report
Methamphetamine-Associated Corneal Ulcer: Case Report
by Amy Conner and Brian K. Foutch
Reports 2025, 8(3), 147; https://doi.org/10.3390/reports8030147 - 17 Aug 2025
Viewed by 298
Abstract
Background and Clinical Significance: This case report highlights the rare but potentially sight-threatening presentation of corneal ulcers associated with methamphetamine abuse. Identifying the signs of illicit drug use is critical, as ocular complications may be overlooked without proper social history or lab confirmation. [...] Read more.
Background and Clinical Significance: This case report highlights the rare but potentially sight-threatening presentation of corneal ulcers associated with methamphetamine abuse. Identifying the signs of illicit drug use is critical, as ocular complications may be overlooked without proper social history or lab confirmation. Case Presentation: A 48-year-old Hispanic male presented with progressive bilateral vision loss over four weeks, describing his condition as “blind vision.” Two weeks earlier, he had visited the emergency room after a fall caused by impaired vision and was prescribed insulin, metronidazole, and fluoroquinolone drops. At ophthalmology follow-up, visual acuity was 20/400 OD and 20/800 OS. Examination revealed bilateral stromal corneal ulcers with infiltrates. Notable systemic signs—pockmarks, poor dentition, thin body habitus, and jittery behavior—raised suspicion for methamphetamine use. He was treated with bandage contact lenses, dehydrated amniotic membranes, and a steroid-antibiotic combination drop. Conclusions: This case underscores the importance of recognizing physical signs of methamphetamine abuse, even in the absence of disclosed history. Emergency room laboratory testing confirmed methamphetamine use. Awareness of drug-induced ocular effects allows for appropriate patient education, timely intervention, and referral to addiction services. Patients should be warned that continued drug use may result in irreversible vision loss. Full article
(This article belongs to the Section Ophthalmology)
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12 pages, 1044 KiB  
Case Report
A Case Report of Tissue Mosaicism in 45,X0/46,XY: Diagnostic Complexity in a Newborn with Ambiguous Genitalia
by Mariola Krzyścin, Agnieszka Brodowska, Dominika Pietrzyk, Katarzyna Zając and Elżbieta Sowińska-Przepiera
Reports 2025, 8(3), 146; https://doi.org/10.3390/reports8030146 - 15 Aug 2025
Viewed by 281
Abstract
Background and Clinical Significance: The 45,X0/46,XY mosaic karyotype is categorized as a disorder of sex development and can lead to atypical sexual development. Latent mosaicism involving Y chromosomal segments may be much more prevalent than previously assumed, according to a growing number [...] Read more.
Background and Clinical Significance: The 45,X0/46,XY mosaic karyotype is categorized as a disorder of sex development and can lead to atypical sexual development. Latent mosaicism involving Y chromosomal segments may be much more prevalent than previously assumed, according to a growing number of findings. This primarily depends on how sensitive cytogenetic methods are—such as traditional karyotype screening, FISH methods, or molecular analyses. Case Presentation: We present the case of a 10-week-old infant with hermaphroditic external genitalia. During pregnancy, ultrasonography revealed severe fetal development difficulties, including severe widespread edema. An abnormal 45,X0/46,XY mosaic karyotype was discovered during a genetic amniocentesis conducted during the 16th week of pregnancy. The infant was born in average general condition at 39 + 6 weeks of gestation. Physical examination of the infant revealed features of facial dysmorphia, webbed neck, and hermaphroditic external genitalia. The testicle was palpable on the left side, but the gonad was absent on the right. Laboratory tests revealed a typical hormonal profile of the mini-puberty period in boys. Moreover, a hormone panel and thyroid ultrasound were performed; congenital hypothyroidism was diagnosed. Three separate independent sources of biological material were used in cytogenetic analysis to determine the karyotype: skin fibroblasts (to confirm tissue mosaicism), oral epithelial cells (FISH), and peripheral blood lymphocytes. It showed that a mosaic occurred very early in embryogenesis by confirming the existence of karyotypes 45,X and 46,XY in various tissues (mosaic tissue distribution). Conclusions: Tissue mosaicism should be compared to the analysis of tissues from other embryonic origins, including blood and oral tissue. Support for gender identity and treatment decisions, including the prediction of the future risk of gonadoblastoma, as well as multidisciplinary care, is necessary. Full article
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8 pages, 920 KiB  
Case Report
Personalized Management of Hydroxyquinoline Hypersensitivity in Pessary Care: A Case-Based Approach to Tailored Treatment
by Nadege Assassi, Lindsay Robinson, Cathy Zhang and Jill Maura Rabin
Reports 2025, 8(3), 145; https://doi.org/10.3390/reports8030145 - 15 Aug 2025
Viewed by 231
Abstract
Background and Clinical Significance: Many women use pessaries to manage their symptoms of pelvic organ prolapse. Hydroxyquinoline is the active ingredient in gels and ointments that are often used to lubricate a pessary prior to vaginal insertion and to provide antimicrobial effects [...] Read more.
Background and Clinical Significance: Many women use pessaries to manage their symptoms of pelvic organ prolapse. Hydroxyquinoline is the active ingredient in gels and ointments that are often used to lubricate a pessary prior to vaginal insertion and to provide antimicrobial effects while the pessary is in situ. Case Presentation: A 74-year-old woman with multiple medication allergies develops vulvovaginal erythema and pruritus after increasing vaginal Trimo-San application frequency for pessary care and maintenance. These symptoms are deemed to be consistent with an allergic reaction to hydroxyquinoline, the active ingredient in Trimo-San. Conclusions: This report highlights the importance of personalized treatment in pessary management. It also demonstrates how personalized medicine can optimize outcomes and improve treatment adherence among individuals with complex medical histories. Full article
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22 pages, 2225 KiB  
Case Report
Comprehensive Fertility Management After Pituitary Adenoma Surgery: Lessons from a Rural Japanese Case and Practical Review
by Daisuke Numahata, Kosuke Kojo, San-e Ishikawa, Takumi Kuramae, Ayumi Nakazono, Kaoru Yanagida, Hiroyuki Nishiyama and Tatsuya Takayama
Reports 2025, 8(3), 144; https://doi.org/10.3390/reports8030144 - 15 Aug 2025
Viewed by 366
Abstract
Background and Clinical Significance: Pituitary adenomas, also termed pituitary neuroendocrine tumors, pose a significant risk of hypogonadotropic hypogonadism (HH) after surgical resection, with profound consequences for fertility and sexual function in young patients. Case Presentation: We present the case of a 29-year-old man [...] Read more.
Background and Clinical Significance: Pituitary adenomas, also termed pituitary neuroendocrine tumors, pose a significant risk of hypogonadotropic hypogonadism (HH) after surgical resection, with profound consequences for fertility and sexual function in young patients. Case Presentation: We present the case of a 29-year-old man from rural Japan who developed severe HH and azoospermia following two transsphenoidal resections for a large pituitary adenoma. Despite early engagement with neurosurgery teams, fertility management was delayed by the absence of on-site endocrinology expertise and limited local oncofertility resources. After comprehensive endocrine evaluation and counseling, the patient began combined human chorionic gonadotropin and recombinant follicle-stimulating hormone therapy, resulting in full recovery of sexual function and normalization of semen parameters, ultimately leading to spontaneous conception and the birth of a healthy child. Building on this real-world case, we provide a narrative review of current practical management strategies for HH after pituitary surgery, including the utility of hormone-stimulation tests, Japanese guideline-based subsidy systems, and best-practice approaches to hormonal replacement. Conclusions: This case underscores not only the necessity for early, interdisciplinary collaboration and preoperative counseling but also highlights a rare instance in which a patient with a benign tumor received care that did not address his fertility-related needs, emphasizing that such considerations should be integrated into preoperative counseling even for non-malignant conditions. Strengthening regional oncofertility networks and improving healthcare providers’ awareness of fertility-preservation options remain essential for improving outcomes. Full article
(This article belongs to the Section Oncology)
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8 pages, 4462 KiB  
Case Report
Postpartum Endometritis and Sepsis Associated with Gardnerella vaginalis and Anaerococcus tetradius: Case Report and Literature Review
by Justina Martikaitytė, Agnė Bartulevičienė, Virginija Paliulytė, Darius Dasevičius and Diana Ramašauskaitė
Reports 2025, 8(3), 143; https://doi.org/10.3390/reports8030143 - 10 Aug 2025
Viewed by 559
Abstract
Background and Clinical Significance: Anaerococcus tetradius (A. tetradius) and Gardnerella vaginalis (G. vaginalis) are rare etiological factors for postpartum endometritis and are typically associated with bacterial vaginosis. However, in some cases, G. vaginalis and A. tetradius can cause [...] Read more.
Background and Clinical Significance: Anaerococcus tetradius (A. tetradius) and Gardnerella vaginalis (G. vaginalis) are rare etiological factors for postpartum endometritis and are typically associated with bacterial vaginosis. However, in some cases, G. vaginalis and A. tetradius can cause serious postpartum endometritis with complications such as sepsis. Case Presentation: 26-year-old pregnant woman expecting monochorionic diamniotic twins presented to the hospital at 35 weeks and 3 days of gestation and two male infants were delivered via the Cesarean section. On the fifth day after delivery, the patient began to complain of intense abdominal pain, a fever of 37.9 °C, and overall weakness. Blood tests revealed neutrophilic leukocytosis, increased C-reactive protein (CRP) of 225.4 mg/L. Upon examination, abdominal distension, tenderness on palpation, and positive symptoms of peritoneal irritation were present and the site of the abdominal incision was inflamed with flowing foul-smelling greenish pus. Ultrasound examination revealed free fluid collection in the peritoneal cavity, under the liver, and around the uterus. Later, the condition of the patient worsened with progressing hypotension and respiratory distress. As a result, suppurative peritonitis and sepsis was suspected and the patient underwent urgent total hysterectomy without oophorectomy. Acute endometritis, focal myometritis, and chronic cervicitis were concluded from histopathological examination of the removed uterus. Microbiological tests showed the most abundant growth of A. tetradius in the wound cultures and great abundance of G. vaginalis in the abdominal cavity cultures. After trying three different treatment schemes and difficulties with determining the antibiotic sensitivity tests for pathogens, the antibacterial therapy was escalated to Meropenem, which was found to be effective, and the patient was discharged home. Conclusions: This case report highlights the severity of complications of postpartum endometritis that can be caused by rare pathogens (such as G. vaginalis and A. tetradius), and strategies for how to manage it. The clinical presentation of a patient should be monitored closely for several days after Cesarean section and if endometritis is suspected, microbiological cultures are necessary to determine the cause of infection and implement an appropriate treatment. Full article
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17 pages, 11304 KiB  
Case Report
Radiologic and Pathologic Insights in Combined Hepatocellular–Cholangiocarcinoma: A Report of Three Cases
by Katrīna Marija Konošenoka, Nauris Zdanovskis, Aina Kratovska, Artūrs Šilovs and Veronika Zaiceva
Reports 2025, 8(3), 142; https://doi.org/10.3390/reports8030142 - 8 Aug 2025
Viewed by 227
Abstract
Background and Clinical Significance: Combined hepatocellular–cholangiocarcinoma (cHCC-CC) is a rare primary liver malignancy exhibiting both hepatocellular and cholangiocellular features. Due to overlapping clinical, imaging, and pathological characteristics with hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (iCC), diagnosis remains challenging. Early and accurate differentiation [...] Read more.
Background and Clinical Significance: Combined hepatocellular–cholangiocarcinoma (cHCC-CC) is a rare primary liver malignancy exhibiting both hepatocellular and cholangiocellular features. Due to overlapping clinical, imaging, and pathological characteristics with hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (iCC), diagnosis remains challenging. Early and accurate differentiation is critical for optimal treatment planning. Case Presentation: We report three histologically confirmed cases of cHCC-CC with different imaging features, biomarker profiles, treatment strategies, and clinical outcomes. Patient 1, a 69-year-old female, presented with a large centrally located liver mass exhibiting iCC-like imaging features and mildly elevated AFP and CA 19-9 levels. Biopsy confirmed poorly differentiated cHCC-CC. Treatment involved palliative chemotherapy, with a survival of 16 months following diagnosis. Patient 2, an 80-year-old female with a small lesion in a cirrhotic liver, demonstrated an HCC-like enhancement pattern but normal AFP levels. Surgical resection was performed, and histology confirmed cHCC-CC with a dual phenotype. Despite initial remission, intrahepatic recurrence developed, treated with TACE and systemic therapy. The patient later transitioned to palliative care due to progression and survived 36 months. Patient 3, a 67-year-old male with chronic hepatitis C, presented with an HCC-like lesion and elevated AFP. Due to comorbidities, surgical resection was not feasible, and the patient was treated with percutaneous microwave ablation as a safer alternative. Biopsy during ablation confirmed cHCC-CC; follow-up was ongoing at submission. Conclusions: These cases highlight the diagnostic complexity and clinical variability of cHCC-CC. Imaging may be misleading, and tumor markers do not reliably predict subtype or prognosis. Histological confirmation is essential, particularly in patients with atypical imaging or discordant biomarker profiles. Individualized management, informed by tumor biology and patient condition, remains critical. Further research is needed to refine diagnostic criteria and develop tailored therapeutic strategies for this challenging tumor entity. Full article
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10 pages, 1748 KiB  
Case Report
An Unusual Case of Membranoproliferative Glomerulonephritis: Is the Role of Vaccination in Immune Reactivation a Casual or Causal Effect?
by Celia Rodríguez Tudero, Alberto Martín Arribas, Marco Dominguez Davalos, Elena Jiménez Mayor and José Carlos De La Flor
Reports 2025, 8(3), 141; https://doi.org/10.3390/reports8030141 - 8 Aug 2025
Viewed by 277
Abstract
Background and Clinical Significance: Membranoproliferative glomerulonephritis (MPGN) is a rare and heterogeneous pattern of immune-mediated glomerular injury, often associated with infections, autoimmune disorders, or monoclonal gammopathies. Idiopathic cases remain a diagnostic challenge and frequently require empirical immunosuppressive treatment. There is increasing interest in [...] Read more.
Background and Clinical Significance: Membranoproliferative glomerulonephritis (MPGN) is a rare and heterogeneous pattern of immune-mediated glomerular injury, often associated with infections, autoimmune disorders, or monoclonal gammopathies. Idiopathic cases remain a diagnostic challenge and frequently require empirical immunosuppressive treatment. There is increasing interest in environmental triggers that may activate the immune system in genetically or immunologically predisposed individuals. We report an unusual case of idiopathic immune complex-mediated MPGN with a relapsing course potentially associated with vaccine-induced immune reactivation. Case Presentation: A 35-year-old male with no significant medical history aside from untreated dyslipidemia and active smoking presented with a hypertensive emergency and acute kidney injury (AKI). Laboratory investigations revealed nephrotic-range proteinuria, microscopic hematuria, and reduced estimated glomerular filtration rate (eGFR). Kidney biopsy demonstrated type I immune complex-mediated MPGN with a diffuse endocapillary proliferative pattern and granular subendothelial deposits (IgG+++, C3+++, C1q++). An extensive work-up ruled out secondary causes, supporting a diagnosis of idiopathic MPGN. Immunosuppressive therapy with corticosteroids and mycophenolate mofetil led to a partial clinical response. However, after receiving multiple vaccinations, the patient experienced clinical deterioration. A second biopsy revealed persistent proliferative changes and new deposits of IgM++, C4d++, and both kappa and lambda light chains. This prompted a reintroduction of immunosuppressive therapy, which resulted in subsequent clinical improvement. Conclusions: This case supports the hypothesis that vaccine-induced immune reactivation may serve as a potential trigger for disease relapse in idiopathic MPGN. Clinicians should remain alert to environmental stimuli that may influence disease activity in immune-mediated glomerulopathies. Further research is needed to elucidate the underlying immunopathogenic mechanisms. Full article
(This article belongs to the Section Nephrology/Urology)
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12 pages, 1873 KiB  
Case Report
Adaptive Servo-Ventilation for Central Sleep Apnea in an Anemic Patient with Cardiac Disease: A Case Report
by Bianca Domokos-Gergely, Gabriel-Flaviu Brișan and Doina Todea
Reports 2025, 8(3), 140; https://doi.org/10.3390/reports8030140 - 7 Aug 2025
Viewed by 350
Abstract
Background and Clinical Significance: Obstructive sleep apnea (OSA) is a common comorbidity in patients with cardiac and metabolic disorders. The coexistence of central sleep apnea with Cheyne–Stokes breathing (CSA-CSB) in heart failure patients, especially those with preserved ejection fraction (HFpEF), represents a [...] Read more.
Background and Clinical Significance: Obstructive sleep apnea (OSA) is a common comorbidity in patients with cardiac and metabolic disorders. The coexistence of central sleep apnea with Cheyne–Stokes breathing (CSA-CSB) in heart failure patients, especially those with preserved ejection fraction (HFpEF), represents a diagnostic and therapeutic challenge. Data on continuous positive airway pressure (CPAP) failure and successful adaptation to servo-ventilation (ASV) in the context of complex comorbidities remain limited. Case Presentation: We present the case of a 74-year-old male with a history of type 2 diabetes mellitus, paroxysmal atrial fibrillation, HFpEF, essential hypertension, and bladder carcinoma. He was referred for pre-operative OSA screening, reporting excessive daytime sleepiness, insomnia, and witnessed apneas. Initial respiratory polygraphy revealed severe sleep-disordered breathing with dominant CSA-CSB and moderate OSA. Laboratory investigations also revealed severe iron-deficiency anemia, which was managed with parenteral iron supplementation. The patient underwent CPAP titration, which led to modest improvement and residual high apnea–hypopnea index (AHI). After persistent symptoms and an inadequate CPAP response, an ASV device was initiated with significant clinical and respiratory improvement, demonstrating normalization of hypoxic burden and optimal adherence. Conclusions: CSA-CSB in HFpEF patients with anemia poses unique therapeutic difficulties. This case highlights the importance of individualized diagnostic and therapeutic strategies, including transitioning to ASV in CPAP-refractory cases, which can lead to improved adherence, reduced hypoxia, and better overall outcomes in high-risk patients. Full article
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Case Report
Osteonevus of Nanta—A Rare Case Report of a Cellular Blue Nevus with Ossification
by Camilla Soendergaard Kristiansen, Anna Louise Norling, Birgitte Bols and Christian Lyngsaa Lang
Reports 2025, 8(3), 139; https://doi.org/10.3390/reports8030139 - 6 Aug 2025
Viewed by 222
Abstract
Background and Clinical Significance: Osteonevus of Nanta is a rare histological phenomenon characterized by bone formation within a benign melanocytic nevus, most commonly in intradermal nevi of the head and neck. Although osteonevus of Nanta is rare, ossification in a cellular blue [...] Read more.
Background and Clinical Significance: Osteonevus of Nanta is a rare histological phenomenon characterized by bone formation within a benign melanocytic nevus, most commonly in intradermal nevi of the head and neck. Although osteonevus of Nanta is rare, ossification in a cellular blue nevus is even more uncommon. To date, only one case of a cellular blue nevus with ossification has been documented. This case report adds to the limited literature and emphasizes the clinical importance of recognizing this rare phenomenon, as osteonevus of Nanta has been potentially associated with malignant melanoma. Case Presentation: A 72-year-old woman presented with an asymptomatic, pigmented scalp lesion that had recently increased in size. On clinical examination, the tumor appeared as a well-demarcated, firm, and nodular mass with dark blueish to violet pigmentation that measured 15 × 12 × 7 mm. To ensure a definitive diagnosis and rule out malignancy, the lesion was excised with narrow margins. Histological examination revealed a cellular blue nevus with prominent osseous metaplasia. Due to the absence of clear margins, a wider re-excision was performed. No residual tumor was found, and the patient remained asymptomatic with no recurrence. Conclusions: This case represents only the second published example of a cellular blue nevus with ossification. While osteonevus of Nanta is benign, its potential association with malignant melanoma, as well as its clinical resemblance to malignant entities such as nodular melanoma, malignant blue nevus, and pigmented basal cell carcinoma, underscores the need for thorough clinical and histopathologic evaluation. Full article
(This article belongs to the Section Dermatology)
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Case Report
Multidisciplinary Care Approach to Asymptomatic Brugada Syndrome in Pregnancy: A Case Report
by Isabella Marechal-Ross and Kathryn Austin
Reports 2025, 8(3), 138; https://doi.org/10.3390/reports8030138 - 5 Aug 2025
Viewed by 271
Abstract
Background and Clinical Significance: Brugada syndrome (BrS) is a rare inherited cardiac channelopathy, often associated with SCN5A loss-of-function mutations. Clinical presentations range from asymptomatic to malignant arrhythmias and sudden cardiac death. Physiological and pharmacological stressors affecting sodium channel function—such as pyrexia, certain medications, [...] Read more.
Background and Clinical Significance: Brugada syndrome (BrS) is a rare inherited cardiac channelopathy, often associated with SCN5A loss-of-function mutations. Clinical presentations range from asymptomatic to malignant arrhythmias and sudden cardiac death. Physiological and pharmacological stressors affecting sodium channel function—such as pyrexia, certain medications, and possibly pregnancy—may unmask or exacerbate arrhythmic risk. However, there is limited information regarding pregnancy and obstetric outcomes. Obstetric management remains largely informed by isolated case reports and small case series. A literature review was conducted using OVID Medline and Embase, identifying case reports, case series, and one retrospective cohort study reporting clinical presentation, obstetric management, and outcomes in maternal BrS. A case is presented detailing coordinated multidisciplinary input, antenatal surveillance, and intrapartum and postpartum care to contribute to the growing evidence base guiding obstetric care in this complex setting. Case Presentation: A 30-year-old G2P0 woman with asymptomatic BrS (SCN5A-positive) was referred at 31 + 5 weeks’ gestation for multidisciplinary antenatal care. Regular review and collaborative planning involving cardiology, anaesthetics, maternal–fetal medicine, and obstetrics guided a plan for vaginal delivery with continuous cardiac and fetal monitoring. At 38 + 0 weeks, the woman presented with spontaneous rupture of membranes and underwent induction of labour. A normal vaginal delivery was achieved without arrhythmic events. Epidural block with ropivacaine and local anaesthesia with lignocaine were well tolerated, and 24 h postpartum monitoring revealed no abnormalities. Conclusions: This case adds to the limited but growing literature suggesting that with individualised planning and multidisciplinary care, pregnancies in women with BrS can proceed safely and without complication. Ongoing case reporting is essential to inform future guidelines and optimise maternal and fetal outcomes. Full article
(This article belongs to the Section Obstetrics/Gynaecology)
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Case Report
Fatal Cytokine Collision: HLH–AIHA in Advanced AIDS—Case Report and Literature Review
by Xiaoyi Zhang, Maria Felix Torres Nolasco, Wing Fai Li, Toru Yoshino and Manasa Anipindi
Reports 2025, 8(3), 137; https://doi.org/10.3390/reports8030137 - 4 Aug 2025
Viewed by 511
Abstract
Background and Clinical Significance: Hemophagocytic lymphohistiocytosis (HLH) and autoimmune hemolytic anemia (AIHA) are both life-threatening hematologic syndromes that rarely present together outside of malignancy. Advanced acquired immunodeficiency syndrome (AIDS) creates a milieu of profound immune dysregulation and hyperinflammation, predisposing patients to atypical [...] Read more.
Background and Clinical Significance: Hemophagocytic lymphohistiocytosis (HLH) and autoimmune hemolytic anemia (AIHA) are both life-threatening hematologic syndromes that rarely present together outside of malignancy. Advanced acquired immunodeficiency syndrome (AIDS) creates a milieu of profound immune dysregulation and hyperinflammation, predisposing patients to atypical overlaps of these disorders. Case Presentation: A 30-year-old woman with poorly controlled AIDS presented with three weeks of jaundice, fever, and fatigue. Initial labs revealed pancytopenia, hyperbilirubinemia, and elevated ferritin level. Direct anti-globulin testing confirmed warm AIHA (IgG+/C3d+) with transient cold agglutinins. Despite intravenous immunoglobulin (IVIG), rituximab, and transfusions, she developed hepatosplenomegaly, extreme hyperferritinemia, and sIL-2R > 10,000 pg/mL, meeting HLH-2004 criteria. Bone marrow biopsy excluded malignancy; further work-up revealed Epstein–Barr virus (EBV) viremia and cytomegalovirus (CMV) reactivation. Dexamethasone plus reduced-dose etoposide transiently reduced soluble interleukin-2 receptor (sIL-2R) but precipitated profound pancytopenia, Acute respiratory distress syndrome (ARDS) from CMV/parainfluenza pneumonia, bilateral deep vein thrombosis (DVT), and an ST-elevation myocardial infarction (STEMI). She ultimately died of hemorrhagic shock after anticoagulation despite maximal supportive measures. Conclusions: This case underscores the diagnostic challenges of HLH-AIHA overlap in AIDS, where cytopenias and hyperferritinemia mask the underlying cytokine storm. Pathogenesis likely involved IL-6/IFN-γ overproduction, impaired cytotoxic T-cell function, and molecular mimicry. While etoposide remains a cornerstone of HLH therapy, its myelotoxicity proved catastrophic in this immunocompromised host, highlighting the urgent need for cytokine-targeted agents to mitigate treatment-related mortality. Full article
(This article belongs to the Section Allergy/Immunology)
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Case Report
Boomerang Sign in the Splenium of the Corpus Callosum After Vestibullar Schwannoma Treatment: Case Report and Review of the Literature
by Maciej Laskowski, Bartłomiej Błaszczyk, Marcin Setlak, Adam Rudnik, Ewa Warmuz-Uhma and Jan Herzyk
Reports 2025, 8(3), 136; https://doi.org/10.3390/reports8030136 - 4 Aug 2025
Viewed by 276
Abstract
Background and Clinical Significance: The term “boomerang sign” refers to a boomerang-shaped area of cytotoxic edema in the splenium of the corpus callosum. It is seen as hyperintense lesions on T2-weighted images, FLAIR and DWI in MRI. No specific pathomechanism leading to [...] Read more.
Background and Clinical Significance: The term “boomerang sign” refers to a boomerang-shaped area of cytotoxic edema in the splenium of the corpus callosum. It is seen as hyperintense lesions on T2-weighted images, FLAIR and DWI in MRI. No specific pathomechanism leading to these changes in the splenium have been yet found; however, authors have listed a variety of potential causes. Case Presentation: The case presents a 38-year-old male patient after left cerebellopontine angle tumor resection with an abnormal, increased signal intensity within the corpus callosum (boomerang sign) in FLAIR MRI sequence. In the case of our patient, unlike the patients described in the literature, the changes in the commissure persist. Conclusions: These lesions could be caused by several factors such as the development of cerebellar edema and subarachnoid bleeding or hypertonic salt usage while in the intensive care unit. Full article
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12 pages, 5519 KiB  
Case Report
Spinal Gout: A Rare but Serious Mimicker of Spinal Pathology—Report of Two Cases
by Muhammad Ishfaq, Rajeesh George and Rohan De Silva
Reports 2025, 8(3), 135; https://doi.org/10.3390/reports8030135 - 3 Aug 2025
Viewed by 380
Abstract
In this report of two cases, we describe two patients with spinal involvement of gout. The first case involved a 67-year-old female who presented to the emergency department with a one-week history of weakness in both the upper and lower limbs, despite no [...] Read more.
In this report of two cases, we describe two patients with spinal involvement of gout. The first case involved a 67-year-old female who presented to the emergency department with a one-week history of weakness in both the upper and lower limbs, despite no prior history of gout. Cervical spine MRI revealed spinal cord compression at the C4 level from a posterior lesion. During surgery, chalky white deposits consistent with gouty tophi were observed in the ligamentum flavum within the epidural space at C4. These intraoperative findings correlated with elevated serum uric acid levels. The second case concerned a 68-year-old male who presented with a five-day history of right lower limb pain along with bilateral knee discomfort. Radiologic and laboratory evaluations revealed elevated inflammatory markers, negatively birefringent crystals in knee joint aspirate, spondylodiscitis at the L5-S1 level, and a right-sided synovial cyst at the T10–T11 level causing spinal cord compression. Following the initiation of anti-gout therapy, the patient experienced significant clinical improvement, normalization of inflammatory markers, and radiologic resolution of the thoracic synovial cyst. Full article
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15 pages, 1548 KiB  
Case Report
Catatonia in a Possible Case of Moderate Neuroleptic Malignant Syndrome: A Case Report
by Daniel Ungureanu, Patricia-Ștefania Mitrea, Silvina Iluț, Aurora Taloș and Cătălina-Angela Crișan
Reports 2025, 8(3), 134; https://doi.org/10.3390/reports8030134 - 2 Aug 2025
Viewed by 332
Abstract
Background and Clinical Significance: Neuroleptic malignant syndrome (NMS) is a life-threatening condition usually caused by the exposure to antipsychotics. This case report presents a catatonia syndrome that may have developed in the context of a moderate NMS. Case Presentation: An 18-year-old [...] Read more.
Background and Clinical Significance: Neuroleptic malignant syndrome (NMS) is a life-threatening condition usually caused by the exposure to antipsychotics. This case report presents a catatonia syndrome that may have developed in the context of a moderate NMS. Case Presentation: An 18-year-old male patient presented with a treatment-resistant catatonia syndrome that debuted 2 weeks prior to the presentation (creatin kinase levels = 4908 U/L, maximum temperature = 38.9°C, white blood count = 13.20 × 109/L, Bush–Francis Catatonia Rating Scale = 30 points). Possible organic causes of catatonia were ruled out, according to the negative results obtained. The patient’s condition improved under benzodiazepine treatment and he was later discharged. After discharge, the catatonia was attributed to a possible NMS with moderate severity. The diagnosis was supported by NMS Diagnosis Criteria Score = 85 points and the presence of Levenson’s triad. Conclusions: This case highlights the concomitant manifestation of both catatonia and NMS in the same patient and the difficulty of establishing a correct diagnosis involving both entities. Full article
(This article belongs to the Section Mental Health)
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Case Report
Percutaneous Peripheral Nerve Stimulation in Chemotherapy-Induced Neuropathy: A Case Report
by Sara Mogedano-Cruz, Carlos Romero-Morales, Mónica de la Cueva-Reguera, Kristin L. Campbell and Pablo Herrero
Reports 2025, 8(3), 133; https://doi.org/10.3390/reports8030133 - 1 Aug 2025
Viewed by 425
Abstract
Background and Clinical Significance: Chemotherapy-induced peripheral neuropathy (CIPN) is a frequent and limiting complication of oncological treatment, particularly in patients receiving oxaliplatin. Its onset can significantly affect the quality of life and compromise the continuity of the antineoplastic therapy. Due to the [...] Read more.
Background and Clinical Significance: Chemotherapy-induced peripheral neuropathy (CIPN) is a frequent and limiting complication of oncological treatment, particularly in patients receiving oxaliplatin. Its onset can significantly affect the quality of life and compromise the continuity of the antineoplastic therapy. Due to the limited efficacy of available pharmacological therapies, percutaneous electrical nerve stimulation (PENS) has been proposed as a non-invasive alternative for symptom management. Case presentation: We report the case of a 75-year-old woman with colorectal adenocarcinoma who developed CIPN following oxaliplatin administration. She underwent a 12-week course of PENS targeting the median nerve, with weekly sessions conducted without interruption of chemotherapy and without adverse effects. The patient showed progressive improvement in neurosensory symptoms, as measured by the EORTC QLQ-CIPN20 questionnaire. Quantitative sensory testing revealed normalization of thermal and vibratory sensitivity and improved mechanical detection thresholds. The cumulative oxaliplatin dose was maintained throughout treatment. Conclusions: PENS may offer an effective and safe therapeutic option for managing CIPN, enabling symptom control without compromising oncological treatment. This case supports the need for controlled clinical trials to confirm efficacy and establish standardized protocols. Full article
(This article belongs to the Section Oncology)
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Case Report
Management of a Complicated Crown Fracture in a 16-Year-Old Patient: A Case Report
by Ralitsa Bogovska-Gigova
Reports 2025, 8(3), 132; https://doi.org/10.3390/reports8030132 - 1 Aug 2025
Viewed by 356
Abstract
Background and Clinical Significance: Traumatic dental injuries, particularly complicated crown fractures of permanent incisors, are common in adolescents, with maxillary central incisors most frequently affected due to their prominent position. These injuries, often resulting from sports or accidents, require prompt management to [...] Read more.
Background and Clinical Significance: Traumatic dental injuries, particularly complicated crown fractures of permanent incisors, are common in adolescents, with maxillary central incisors most frequently affected due to their prominent position. These injuries, often resulting from sports or accidents, require prompt management to prevent complications such as pulp necrosis or infection, which can compromise long-term prognosis. Fragment reattachment offers a conservative, esthetically favorable approach when the fractured segment is intact, with outcomes comparable to composite restorations. This case report underscores the importance of timely intervention and advanced restorative techniques in pediatric dentistry. Case Presentation: A 16-year-old male presented with a complicated crown fracture of the upper left central incisor sustained during a soccer game. The fracture extended subgingivally with pulp exposure. The patient preserved the fragment in saline. Treatment involved fragment reattachment using a dentin bonding agent and flowable composite resin, followed by single-visit root canal therapy due to delayed presentation (48 h). A glass fiber post was placed to reinforce the restoration due to significant coronal loss. Three years of follow-up visits (1, 3, 6, 12, 24, and 36 months) revealed no clinical or radiographic complications, with the tooth remaining asymptomatic and functional. Conclusions: This case underscores the effectiveness of fragment reattachment when combined with meticulous technique and long-term monitoring. Full article
(This article belongs to the Special Issue Oral Disorders in the Pediatric Population)
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12 pages, 3016 KiB  
Case Report
Blue Nevi and Melanoma Arising in Blue Nevus: A Comparative Histopathological Case Series
by Hristo Popov, Pavel Pavlov and George S. Stoyanov
Reports 2025, 8(3), 131; https://doi.org/10.3390/reports8030131 - 1 Aug 2025
Viewed by 282
Abstract
Background and Clinical Significance: Blue nevi are a dubious pigmented lesion. While somewhat common throughout the population, they are significantly less common than other melanocytic neoplasms, and both their morphology and development bring them closer to true hamartomas than neoplasms. An exceedingly rare [...] Read more.
Background and Clinical Significance: Blue nevi are a dubious pigmented lesion. While somewhat common throughout the population, they are significantly less common than other melanocytic neoplasms, and both their morphology and development bring them closer to true hamartomas than neoplasms. An exceedingly rare occurrence is the development of melanoma from a preexisting blue nevus. This nosological unit, defined as melanoma arising in a blue nevus, also known as malignant blue nevus, blue naevus–like melanoma, melanoma ex-blue naevus, and melanoma mimicking cellular blue naevus, is required to either originate from an area of previously excised blue nevus or have a blue nevus remnant adjacent to it. Due to the spindle cell morphology of melanoma arising in blue nevus, the terminology is often misused by some authors to include spindle cell melanomas, which exhibit a distinct pathogenesis and, although morphologically similar, have differing molecular profiles as well. Case presentations: The following manuscript discusses comparative morphological features in a case series of blue nevi and melanoma arising in blue nevi. Discussion: Blue nevi present with unique morphological features, with melanomas originating from them having a unique molecular pathology profile, which significantly differs from other cutaneous melanomas and is closer to that of uveal melanomas. Full article
(This article belongs to the Section Dermatology)
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Case Report
Melanotrichoblastoma: A Histopathological Case Report of a Rare Pigmented Variant of Trichoblastoma
by George S. Stoyanov, Ivaylo Balabanov, Svetoslava Zhivkova and Hristo Popov
Reports 2025, 8(3), 130; https://doi.org/10.3390/reports8030130 - 1 Aug 2025
Viewed by 188
Abstract
Background and clinical significance: Trichoblastomas are rare, mixed epithelial tumors with a mesenchymal component and hair follicle differentiation. Case presentation: Herein, we present a case report of a 51-year-old female patient presenting to the obstetrics and gynecology department with complaints of edema and [...] Read more.
Background and clinical significance: Trichoblastomas are rare, mixed epithelial tumors with a mesenchymal component and hair follicle differentiation. Case presentation: Herein, we present a case report of a 51-year-old female patient presenting to the obstetrics and gynecology department with complaints of edema and erythema of the right Bartholin gland, and a lesion measuring 2 cm on the right lateral edge of the mons pubis, towards the inguinal fold. Marsupialization of the Bartholin gland was performed, as well as an incision into the pubo-inguinal lesion, which the patient depicted as grossly resembling an ingrown hair. Upon incision into the pubic–inguinal lesion, it was dark brown in color and spontaneously popped out of the subcutis, without an attempt at enucleation. Histology and subsequent immunohistochemistry of the lesion showed a blue basaloid tumor with an extensive pigment component located deep in the dermis that was sharply demarcated from the surrounding tissues. Conclusion: Immunohistochemistry was diffusely and strongly positive for epithelial markers; melanocytic markers were positive only in dendritic melanocytes dispersed within the tumors, and the proliferative index was low. As such, the tumor was identified as melanotrichoblastoma. Full article
(This article belongs to the Section Dermatology)
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Case Report
Is Spinal Analgesia or Anesthesia Safe After Labor Epidural Analgesia? Reporting Two Cases of High Neuraxial Block and Mini-Review of the Literature
by Arsen Uvelin, Marijana Cavrić-Dragičević, Borislava Pujić, Lidija Jovanović, Teodora Tubić and Radmila Popović
Reports 2025, 8(3), 129; https://doi.org/10.3390/reports8030129 - 1 Aug 2025
Viewed by 314
Abstract
Background and Clinical significance: Single-shot spinal anesthesia for intrapartum Cesarean section has recently been incriminated in carrying a high risk of high neuraxial block (HNB) occurrence in parturients receiving labor epidural analgesia. The so-called volume effect of the epidurally injected solution causes a [...] Read more.
Background and Clinical significance: Single-shot spinal anesthesia for intrapartum Cesarean section has recently been incriminated in carrying a high risk of high neuraxial block (HNB) occurrence in parturients receiving labor epidural analgesia. The so-called volume effect of the epidurally injected solution causes a contraction of the dural sack and unexpected HNB. Case presentation: We present two cases of HNB in parturients receiving epidural analgesia. The first case describes the 36-year-old patient G3P2, who was administered a repeated rescue analgesia single-shot spinal injection with low-dose local anesthetic (levobupivacaine, 3 mg) following non-functional combined spinal–epidural analgesia. The second case describes the 28-year-old parturient G1P0, who experienced HNB after single-shot spinal anesthesia with hyperbaric bupivacaine (7.5 mg) following labor epidural analgesia. Conclusions: Intrathecal administration of local anesthetic for the purpose of spinal analgesia or anesthesia in a parturient with epidural analgesia can cause unexpected HNB and could occur even at low doses of intrathecally administered medications. The interplay of numerous variables and circumstances in the specific case can result in the occurrence of HNB. We assume that in our first case, the volume effect and repeated dural puncture, and in the second case, the low height of the parturient coupled with the volume effect, played significant role in the occurrence of HNB. Full article
(This article belongs to the Section Anaesthesia)
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Case Report
Gastric Sarcina ventriculi: A Report on Two Cases
by Yaomin Chen, Yu Liu and Zhiyan Fu
Reports 2025, 8(3), 128; https://doi.org/10.3390/reports8030128 - 1 Aug 2025
Viewed by 285
Abstract
Background and Clinical SignificanceSarcina ventriculi is a rare Gram-positive coccus that thrives in acidic environments such as the human stomach. It has been increasingly identified in individuals with delayed gastric emptying and has been reported in association with various gastric disorders. [...] Read more.
Background and Clinical SignificanceSarcina ventriculi is a rare Gram-positive coccus that thrives in acidic environments such as the human stomach. It has been increasingly identified in individuals with delayed gastric emptying and has been reported in association with various gastric disorders. However, its exact pathogenic role is not fully understood and remains controversial. Case Presentation: We present two cases of patients, one with a small bowel obstruction and the other with epigastric pain, both diagnosed with Sarcina ventriculi infection by histological examination of gastric biopsies. The patients were managed with a combination of antibiotics and a proton pump inhibitor, resulting in symptom resolution and clearance of Sarcina ventriculi upon follow-up examinations. Conclusions: This report explores the pathogenicity of Sarcina ventriculi by documenting its presence in symptomatic patients without other identifiable pathogens and demonstrating complete symptom resolution following targeted therapy. These findings raise the possibility of Sarcina ventriculi’s pathogenic potential under specific clinical conditions, suggesting it may act as more than a benign colonizer. Full article
(This article belongs to the Section Gastroenterology)
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11 pages, 1118 KiB  
Case Report
Infective Endocarditis with Gerbode Defect and DRESS Syndrome: A Rare Case Report
by Corina Ureche, Diana Lavinia Moldovan, Ionel Vița, Valeria Guila and Teodora Nicola-Varo
Reports 2025, 8(3), 127; https://doi.org/10.3390/reports8030127 - 31 Jul 2025
Viewed by 328
Abstract
Background and Clinical Significance: Infective endocarditis (IE) is a serious condition with rising incidence, frequently caused by Staphylococcus aureus. However, cases involving rare congenital anomalies such as Gerbode’s defect are uncommon. Case Presentation: This report presents the first documented case of IE [...] Read more.
Background and Clinical Significance: Infective endocarditis (IE) is a serious condition with rising incidence, frequently caused by Staphylococcus aureus. However, cases involving rare congenital anomalies such as Gerbode’s defect are uncommon. Case Presentation: This report presents the first documented case of IE in a patient with a congenital Gerbode defect complicated by DRESS syndrome—a severe, drug-induced hypersensitivity reaction typically triggered by antibiotics like oxacillin. A 65-year-old woman developed infective endocarditis involving vegetations on the cardiac device lead, the tricuspid valve, and adjacent to a Gerbode defect. The diagnosis was confirmed by positive blood cultures and echocardiographic findings. She received treatment with oxacillin. Subsequently, she exhibited clinical features consistent with DRESS syndrome, including rash, eosinophilia, and multi-organ involvement. Rapid recognition and management, including corticosteroid therapy and antibiotic modification, led to clinical improvement. Conclusions: This case highlights the importance of vigilance for DRESS syndrome in prolonged antibiotic therapy for IE, especially in the context of rare congenital cardiac anomalies. In addition, guidelines are needed to optimize the diagnosis and treatment of this potentially lethal complication. Full article
(This article belongs to the Section Cardiology/Cardiovascular Medicine)
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