Journal of Clinical Case Reports

Background: Precursor B-cell lymphoblastic lymphoma is a rare subtype of acute lymphoblastic lymphoma and sometimes presents as lytic bone lesions. Diagnosis and treatment of lytic bone lesions are always challenging. This is a rare case of delayed leukemic change of precursor B-cell acute lymphoblastic lymphoma presented with a rapid hip bone destruction.
Case presentation: A 12-year-old Japanese girl presented with progressive left hip pain, and bone destruction of her left hip two months after the onset of symptoms. She had no past medical or family history of malignancy and had no genetic abnormality. Radiograph and MRI examination showed bone destruction and osteolytic lesions in her left femoral neck and pelvis. Blast cells were not found in our initial examination of the peripheral blood and aspirated bone marrow cells. The case was finally diagnosed as Precursor B-cell lymphoblastic lymphoma as the results of bone biopsy, and blast cells were then detected after preforming multiple bone marrow aspirations. She also had pathological femoral neck fracture, but after treatment regimen by chemotherapy, her osteolytic lesions cured with obtainment of femoral neck fusion. She could walk at the final period.
Conclusion: This case highlights the importance of early diagnosis of this disease for greater curing rates. Diagnosis of Precursor B-cell lymphoblastic lymphoma was finally made based on the results of biopsy of tissues because of the delayed appearance of leukemic changes. Orthopaedic surgeons should be aware of Precursor B-cell lymphoblastic lymphoma, when making diagnosis of patients exhibiting a rapid hip bone destruction.

Rosai-dorfman disease (RDD) is a histiocytic proliferative disorder and considered to be extremely rare in the CNS. In this paper, we reported a patient confirmed as isolated intracranial RDD in a 58-year-old woman. MRI imaging without contrast enhancement two years ago found nothing at the onset of the symptoms. Follow-up CT and MRI imaging one year later showed dynamic changes of the lesion from scratch. This report suggests that the symptoms of RRD are earlier than imaging findings. Moreover, we made a systematic literature review on the disease to better understand it.

Rosacea is a common skin disease with a predilection for the face. Patients suffer from symptoms like flushing, redness of the face, telangiectasia, pustules, or papules. A more acute form is rosacea fulminans that occurs preferentially in women. Hormonal fluctuations as during a pregnancy can aggravate existent rosacea. The case of a female patient is presented, who was in the 26th week of her pregnancy. She discontinued her usual rosacea medication when she became pregnant. The patient developed rosacea fulminans, which was treated with systemic corticosteroids as recommended. She responded well to clarithromycin 250 mg for three times a week in combination with topical treatment using metronidazole 0.75% creme, continuing this regimen until a stable result was obtained. Based on the observations in this case study the therapy of rosacea fulminans with clarithromycin can help to reduce the symptoms, especially since treatment with systemic isotretinoin and doxycycline is contraindicated during pregnancy.

Cholinergic urticaria (ChU) is a type of induced urticaria characterized by small and pruritic wheals which are triggered by specific stimuli such as physical exercise thus significantly impairing the quality of life. The goal of treatment is to ensure prompt and prolonged control of symptoms, thus enabling the return to normal social activities. The traditional options are antihistamines, leukotriene inhibitors and immunosuppressive agents. We present a case of refractory cholinergic urticaria who had an adequate response to danazol and ketotifen. Evaluating it by number of wheals, quality of life (Dermatology Life Quality Index (DLQI)), severity of pruritus (12-Item Pruritus Severity Score (12-PSS)) and pulse controlled, thereby proving to be an effective therapy in patients who don´t respond to conventional therapy and without access to biological treatment.

Tumors of the heart are a very rare disease in cardiology practice. They are more frequently benign. Neonatal diagnosis is possible, but the accidental late discovery of a cardiac mass remains the most common situation. We report a case of a cardiac tumor in a 15-year-old patient symptomatic of palpitations. The belonging of the tissue to the cardiac muscle was confirmed on echocardiography and on other radiological findings. Regular monitoring was chosen at first then surgical resection was decided as an increase in the tumor’s size was noted on the echocardiographic control.

Idarucizumab is a monoclonal antibody which has been shown to be effective for rapid, durable, and safe reversal of the anticoagulant effect of dabigatran. We will describe herein the third case reported so far on the use of idarucizumab in a patient on dabigatran for nonvalvular atrial fibrillation and an indication for emergency lumbar puncture for suspected meningitis.

Aim: Assessment of the Cushing reflex developing during mechanical thrombectomy in a case presenting with acute ischemic stroke.
Case: A 59-year-old male patient had CT angio tests due to speaking disorder and right lateral weakness developing 5 hours earlier. Acute infarctus was observed in the left MCA irrigation area with M1 segment occlusion observed in the left MCA. The decision was made to treat the patient with mechanical thrombectomy and he was transferred to the interventional neuroradiology unit. Under general anesthesia during navigation of the thromboaspiration catheter to the clot localization as the procedure was technically advancing routinely, with sudden development of bradycardia and hypertension the neuroradiology team was warned, and 1 mg IV atropine was administered for bradycardia.
Simultaneously contrast material injection through the guide catheter showed the MCA M1 segment had ruptured and extravasation had developed.
Conclusion: The Cushing reflex is a situation characterized by bradycardia and hypertension in cerebrovascular events causing sudden intracranial pressure increases. The most common situations observed during treatment of cerebrovascular diseases via the endovascular route is intracranial hemorrhage linked to arterial rupture. Prevention of the mortality and morbidity linked to hemorrhagic complications developing during endovascular treatment is based on early awareness and rapid treatment. Additionally, as extravasation is commonly not observed radiologically, the anesthesia team should be on the alert for the Cushing reflex and when variations of hemodynamic parameters in accordance with the Cushing response are observed, informing the operation team immediately has vital importance.

Spontaneous regression (SR) is extremely rare in small cell lung cancer (SCLC). The present study reports a rare case of SCLC accompanied by partial SR in a 68-year-old man. The patient was scheduled to receive chemoradiotherapy for SCLC. Computed tomography (CT) simulation images for radiotherapy revealed partial regression of the primary tumor, while lymph node metastasis progression was observed. On 18F-fluorodeoxyglucose (FDG) positron emission tomography/CT, an abnormally high uptake of FDG was not observed in the primary exhibiting SR, while an extremely high uptake was identified in the lymph node metastases. The patient also presented with bilateral double vision, which suggested neurological paraneoplastic syndrome. He received chemoradiotherapy and a complete response was obtained. Until the last follow-up (58 months since the initiation of chemoradiotherapy), the patient was free from tumor progression.

Introduction: Dressler’s syndrome (delayed pericarditis) is considered as a secondary form of pericarditis resulting in the inflammation of the sac surrounding heart (pericardium).

Case Presentation: A 56-year-old male was admitted to the cardiology department due to left sided chest pain associated with breathlessness, palpitation and sweating. patient had a past history of CAD-AWMI, moderate left ventricular(LV) dysfunction (diagnosed 2 months back). Percutaneous transluminal coronary angioplasty (PTCA) with stent to CAD done 2 months back. ECHO shows mild to moderate pericardial effusion, mild pulmonary arterial hypertension(PAH), moderate mitral regurgitation (MR), moderate LV dysfunction.

Conclusion: This reveals that the patient is diagnosed with Dressler’s syndrome, a rare disease in the age of reperfusion therapy.

Duodenal perforation is a common cause of acute abdomen which is complication of peptic ulcer disease. The pathogenesis is considered complex and involves imbalance between defensive mechanisms of intestinal mucosa and aggravating factors to which a person is exposed.

Drug induced aseptic meningitis (DIAM) is an uncommon condition that can mimic infectious process. DIAM constitutes a diagnostic and management challenge. We report a case of a 23-year-old female presenting with aseptic meningitis, two days after commencing a course of intravenous immunoglobulins (IVIG) treatment.