Monday, June 21, 2021

Acute inferior myocardial infarction in a young man with testicular seminoma: A case report

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World J Clin Cases. 2021 Jun 6;9(16):4040-4045. doi: 10.12998/wjcc.v9.i16.4040.

ABSTRACT

BACKGROUND: Atherosclerosis represents the main cause of myocardial infarction (MI); other causes such as coronary embolism, vasospasm, coronary-dissection or drug use are much rarely encountered, but should be considered in less common clinical scenarios. In young individuals without cardiovascular risk factors, the identification of the cause of MI can sometimes be found in the medical history and previous treatments undertaken.

CASE SUMMARY: We present the case of a 34-year-old man presenting acute inferior ST-elevation MI without classic cardiac risk factors. Seven years ago, he suffered from orchidopexy for bilateral cryptorchidism, and was recently diagnosed with right testicular seminoma for which he had to undergo surgical resection and chemotherapy with bleomycin, etoposide and cisplatin. Shortly after the first chemotherapy treatmen t, namely on day five, he suffered an acute MI. Angiography revealed a mild stenotic lesion at the level of the right coronary artery with suprajacent thrombus and vasospasm, with no other significant lesions on the other coronary arteries. A conservative treatment was decided upon by the cardiac team, including dual antiplatelets therapy and anticoagulants with good further evolution. The patient continued the chemotherapy treatment according to the initial plan without other cardiovascular events.

CONCLUSION: In young individuals with no cardiovascular risk factors undergoing aggressive chemotherapy, an acute MI can be caused by vascular toxicity of several anti-cancer drugs.

PMID:34141764 | PMC:PMC8180225 | DOI:10.12998/wjcc.v9.i16.4040

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Dynamic magnetic resonance imaging features of cavernous hemangioma in the manubrium: A case report

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World J Clin Cases. 2021 Jun 16;9(17):4262-4267. doi: 10.12998/wjcc.v9.i17.4262.

ABSTRACT

BACKGROUND: Osseous hemangiomas, especially those located in the manubrium, are rare benign tumors. In a review of the literature, only three case reports of sternal hemangioma were found. A precise diagnosis is difficult because of their nonspecific findings on computed tomography (CT)/magnetic resonance imaging (MRI).

CASE SUMMARY: An 88-year-old woman was suffering from a progressively enlarging mass in the manubrium. Chest CT images showed an osteolytic and expansile lesion with cortical destruction. Vascular malformation was suspected after CT-guided biopsy. On the dynamic MRI scans, the mass showed a bright signal on the T2-weighted image, peripheral nodular enhancement on the early-phase images and progressive centripetal fill-in on the delayed-phase images. Cavernous hemangioma was suspected preoperatively based on the MRI features a nd finally confirmed by histopathologic analysis.

CONCLUSION: This uncommon case demonstrates the possible characteristic features of manubrium cavernous hemangioma on dynamic MRI scans; knowledge about these features may prevent patients from developing catastrophic complications, such as rupture or internal hemorrhage, caused by biopsy or surgery.

PMID:34141789 | PMC:PMC8173419 | DOI:10.12998/wjcc.v9.i17.4262

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Parotid mammary analogue secretory carcinoma: A case report and review of literature

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World J Clin Cases. 2021 Jun 6;9(16):4052-4062. doi: 10.12998/wjcc.v9.i16.4052.

ABSTRACT

BACKGROUND: Mammary analogue secretory carcinoma (MASC) is a rare low-grade malignant salivary gland tumor. The morphological and immunohistochemical features of MASC closely resemble those of breast secretory carcinoma. The key characteristics of the lesion are a lack of pain and slow growth. There is no obvious specificity in the clinical manifestations and imaging features. The diagnosis of the disease mainly depends on the detection of the MASC-specific ETV6-NTRK3 fusion gene.

CASE SUMMARY: This report describes a rare case of a 32-year-old male patient who presented with a gradually growing lesion that was initially diagnosed as breast-like secretory carcinoma of the right parotid gland. Imaging and histological investigations were used to overcome the diagnostic difficulties. The lesion was managed with right parotidectomy, facia l nerve preservation, biological patch implantation to restore the resulting defect, and postoperative radiotherapy. On postoperative follow-up, the patient reported a mild facial deformity with no complications, signs of facial paralysis, or Frey's syndrome.

CONCLUSION: The imaging and histological diagnostic challenges for MASC are discussed.

PMID:34141766 | PMC:PMC8180236 | DOI:10.12998/wjcc.v9.i16.4052

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Diagnosis and treatment of pediatric anaplastic lymphoma kinase-positive large B-cell lymphoma: A case report

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World J Clin Cases. 2021 Jun 16;9(17):4268-4278. doi: 10.12998/wjcc.v9.i17.4268.

ABSTRACT

BACKGROUND: Anaplastic lymphoma kinase-positive (ALK+) large B-cell lymphoma (LBCL) is a rare type of lymphoma with high invasiveness and rapid progression. It occurs in all age groups, but is extremely rare in children. The lesions mainly involve the lymph nodes and may present with extra-nodal involvement. Response to conventional chemotherapies and local radiotherapy is poor, with a 5-year overall survival of less than 40%. Recently, the use of ALK inhibitors for the treatment of this disease has been reported.

CASE SUMMARY: We present a case of a 12-year-old boy diagnosed with ALK+LBCL. The patient had a 2-mo medical history of a calvarial mass, extensive systemic involvement, and positive bone marrow clathrin heavy chain (CLTC)-ALK fusion gene. Complete remission 1 (CR1) was achieved using the modified LMB89 Group C regime n followed by autologous stem cell transplantation. The patient relapsed 3 mo later. He then achieved CR2 with three short courses of chemotherapy (COP, reduced-dose ICE, low-dose Ara-c+VP16) and continuous alectinib targeted therapy. Afterward, allogeneic hematopoietic stem cell transplantation (allo-HSCT) was performed. At 16 mo after the allo-HSCT, the patient was still in CR2.

CONCLUSION: The modified LMB89 Group C regimen and ALK inhibitors are effective. Allo-HSCT should be performed after remission.

PMID:34141790 | PMC:PMC8173411 | DOI:10.12998/wjcc.v9.i17.4268

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Spinal epidural abscess due to coinfection of bacteria and tuberculosis: A case report

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World J Clin Cases. 2021 Jun 6;9(16):4072-4080. doi: 10.12998/wjcc.v9.i16.4072.

ABSTRACT

BACKGROUND: Spinal epidural abscess (SEA) is a rare condition that mostly results from infection with either bacteria or tuberculosis. However, coinfection with bacteria and tuberculosis is extremely rare, and it results in delays in diagnosis and antimicrobial treatment causing unfavorable outcomes.

CASE SUMMARY: A 75-year-old female visited the hospital with low back pain, and magnetic resonance imaging (MRI) revealed an SEA at the lumbosacral segment. Staphylococcus hominis and methicillin-resistant Staphylococcus epidermidis were identified from preoperative blood culture and intraoperative abscess culture, respectively. Thus, the patient underwent treatment with vancomycin medication for 9 wk after surgical drainage of the SEA. However, the low back pain recurred 2 wk after vancomycin treatment. MRI revealed an aggravated S EA in the same area in addition to erosive destruction of vertebral bodies. Second surgery was performed for SEA removal and spinal instrumentation. The microbiological study and pathological examination confirmed Mycobacterium tuberculosis as the pathogen concurrent with the bacterial SEA. The patient improved completely after 12 mo of antitubercular medication.

CONCLUSION: We believe that the identification of a certain pathogen in SEAs does not exclude coinfection with other pathogens. Tubercular coinfection should be suspected if an SEA does not improve despite appropriate antibiotics for the identified pathogen.

PMID:34141768 | PMC:PMC8180206 | DOI:10.12998/wjcc.v9.i16.4072

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Stevens-Johnson syndrome and concurrent hand foot syndrome during treatment with capecitabine: A case report

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World J Clin Cases. 2021 Jun 16;9(17):4279-4284. doi: 10.12998/wjcc.v9.i17.4279.

ABSTRACT

BACKGROUND: Capecitabine is used in combination with lapatinib as palliative treatment for human epidermal growth factor receptor 2 - positive metastatic breast cancer. The most frequently reported adverse events attributed to capecitabine include diarrhea, hyperbilirubinemia, and hand-foot syndrome (HFS). A number of cutaneous adverse events have been attributed to capecitabine, including Stevens-Johnson syndrome (SJS) as a rare and potentially life-threatening mucocutaneous condition. We report the first case involving concurrent SJS and HFS after capecitabine and lapatinib treatment.

CASE SUMMARY: A 70-year-old woman with a history of breast cancer treatment visited our hospital for evaluation of painful skin lesions. Six weeks earlier, she had been prescribed capecitabine plus lapatinib as treatment for metastatic breast cancer. She subs equently developed worsening erythema and bullae on her palms and soles, as well as reddish macules on her back and chest wall. Histopathological evaluation of the chest wall lesions revealed extensive eosinophilic epidermal necrosis and separation of the epidermis from the dermis. The capecitabine plus lapatinib treatment was discontinued immediately and treatment was started using systemic steroids. This treatment resolved most lesions, although the lesions on her palms and soles required Vaseline gauze dressings, which resulted in re-epithelialization. Therefore, we determined that the patient had concurrent SJS and HFS. Although the dermatological problems resolved, the patient ultimately died because of multiple organ failure.

CONCLUSION: Oral capecitabine treatment carries a risk of both HFS and also life-threatening adverse cutaneous drug reactions, such as SJS.

PMID:34141791 | PMC:PMC8173406 | DOI:10.12998/wjcc.v9.i17.4279

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Thymosin as a possible therapeutic drug for COVID-19: A case report

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World J Clin Cases. 2021 Jun 6;9(16):4090-4094. doi: 10.12998/wjcc.v9.i16.4090.

ABSTRACT

BACKGROUND: There are no effective antiviral therapies for coronavirus disease 2019 (COVID-19) at present. Although most patients with COVID-19 have a mild or moderate course of disease, up to 5%-10% of patients may have a serious and potentially life-threatening condition, indicating an urgent need for effective therapeutic drugs. The therapeutic effect of thymosin on COVID-19 has not been previously studied. In this paper, for the first time we report a case of thymosin treatment of COVID-19.

CASE SUMMARY: A 51-year-old man with imported COVID-19 was admitted with definite symptoms of chest tightness, chest pain, and fatigue. The polymerase chain reaction results for severe acute respiratory syndrome coronavirus 2 were negative. The antibody test was positive, confirming the diagnosis of COVID-19. As many orally administered drugs were not well tolerated due to gastrointestinal symptoms, an emergency use of thymosin, a polypeptide consisting of 28 amino acids, was administered by injection. Finally, after the implementation of the treatment program, symptoms and lung imaging improved significantly.

CONCLUSION: In this case report, it is confirmed that thymosin may help alleviate the severity of COVID-19 symptoms.

PMID:34141770 | PMC:PMC8180217 | DOI:10.12998/wjcc.v9.i16.4090

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Rosai-Dorfman disease with lung involvement in a 10-year-old patient: A case report

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World J Clin Cases. 2021 Jun 16;9(17):4285-4293. doi: 10.12998/wjcc.v9.i17.4285.

ABSTRACT

BACKGROUND: Rosai-Dorfman disease (RDD) is a rare benign proliferative disease whose etiology is not clear and may be related to infection or unexplained immune dysfunction. The authors present a case of RDD with lung involvement in a 10-year-old patient.

CASE SUMMARY: A 10-year-old girl found that her left cervical lymph nodes were enlarged for more than 7 mo, and the largest range was about 6.5 cm × 5.9 cm × 8.1 cm. Cervical magnetic resonance imaging showed multiple masses in the left neck, with low signal intensity on T1-weighted images and high signal intensity on T2-weighted images. A malignant tumor, with a high possibility of lymph node metastasis, was initially considered. At the same time, lung computed tomography showed multiple nodules of different sizes scattered on both sides of the lung, with uniform internal density. Thus, a possible metastatic tumor was considered. Finally, RDD was diagnosed by pathology and immunohistochemistry. According to the antibiogram, clindamycin was administered for 2 wk, and prednisone acetate was administered for 7 wk. Nine months later, the ulcer in the left neck was better than before, but the imaging showed that the lesion was not controlled.

CONCLUSION: The diagnosis of RDD cannot be made by a single tool and its treatment is a long-term exploratory process. Follow-up is necessary.

PMID:34141792 | PMC:PMC8173431 | DOI:10.12998/wjcc.v9.i17.4285

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Delayed pseudoaneurysm formation of the carotid artery following the oral cavity injury in a child: A case report

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World J Clin Cases. 2021 Jun 6;9(16):4104-4109. doi: 10.12998/wjcc.v9.i16.4104.

ABSTRACT

BACKGROUND: An impalement injury of the oral cavity is a common traumatic injury in children. In most cases, it is not accompanied by sequelae, but if foreign body residues are not found due to a minor injury, they may result in inflammatory responses and delayed vascular injuries in the surrounding tissues. Without early diagnosis and appropriate initial management, residual foreign bodies can cause serious complications and even mortality in some cases.

CASE SUMMARY: A 9-year-old boy suffered an intra-oral injury by a wooden chopstick, and the patient was discharged from the hospital after receiving conservative treatment for the injury. However, the patient was readmitted to the hospital due to intra-oral bleeding, and since neck hematoma and right internal carotid artery pseudoaneurysm formation were detected on computed tomography, emerg ency surgery was performed. A remnant fragment of a wooden chopstick was found during the operation, and a delayed rupture of the internal carotid artery caused by the foreign body was also found.

CONCLUSION: The failure of early detection and diagnosis of a residual foreign body may result in delayed vascular rupture.

PMID:34141772 | PMC:PMC8180207 | DOI:10.12998/wjcc.v9.i16.4104

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Acute myocardial infarction in twin pregnancy after assisted reproduction: A case report

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World J Clin Cases. 2021 Jun 16;9(17):4294-4302. doi: 10.12998/wjcc.v9.i17.4294.

ABSTRACT

BACKGROUND: Acute myocardial infarction (AMI) during pregnancy is rare, especially in twin pregnancy, and it can endanger the lives of the mother and children. Except for conventional cardiovascular risk factors, pregnancy and assisted reproduction can increase the risk of AMI during pregnancy. AMI develops secondary to different etiologies, such as coronary spasm and spontaneous coronary artery dissection.

CASE SUMMARY: A 33-year-old woman, with twin pregnancy in the 31st week of gestation, presented to the hospital with intermittent chest tightness for 12 wk, aggravation for 1 wk, and chest pain for 4 h. Combined with the electrocardiogram and hypersensitive troponin results, she was diagnosed with acute ST-elevation myocardial infarction. Although the patient had no related medical history, she presented several risk factors, s uch as age greater than 30 years, assisted reproduction, and hyperlipidemia. After diagnosis, the patient received antiplatelet and anticoagulant treatment. Cesarean section and coronary angiography performed 7 d later showed stenosis and thrombus shadow of the right coronary artery. After receiving medication, the patient was in good condition.

CONCLUSION: This case suggests that, with the widespread use of assisted reproductive technology, more attention should be paid to perinatal healthcare, especially when chest pain occurs, to facilitate early diagnosis and intervention of AMI, and the etiology of AMI in pregnancy needs to be differentiated, especially between coronary spasm and spontaneous coronary artery dissection.

PMID:34141793 | PMC:PMC8173408 | DOI:10.12998/wjcc.v9.i17.4294

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Is it time to put traditional cold therapy in rehabilitation of soft-tissue injuries out to pasture?

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World J Clin Cases. 2021 Jun 16;9(17):4116-4122. doi: 10.12998/wjcc.v9.i17.4116.

ABSTRACT

Cold therapy has been used regularly as an immediate treatment to induce analgesia following acute soft-tissue injuries, however, a prolonged ice application has proved to delay the start of the healing and lengthen the recovery process. Hyperbaric gaseous cryotherapy, also known as neurocryostimulation, has shown the ability to overcome most of the limitations of traditional cold therapy, and meanwhile promotes the analgesic and anti-inflammatory effects well, but the current existing studies have shown conflicting results on its effects. Traditional cold therapy still has beneficial effect especially when injuries are severe and swelling is the limiting factor for recovery after soft-tissue injuries, and therefore no need to be entirely put out to pasture in the rehabilitation practice. Strong randomized controlled trials with good methodologica l quality are still needed in the future to evaluate the effects of different cryotherapy modalities.

PMID:34141774 | PMC:PMC8173427 | DOI:10.12998/wjcc.v9.i17.4116

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