Clinical Case Reports

KEY CLINICAL MESSAGE: This case illustrates sarcoidosis as a potential complication of COVID-19, highlighting the need for a comprehensive diagnostic approach, including histopathology and prolonged monitoring, to distinguish it from post-COVID fibrosis. Further research is crucial to elucidate these associations and understand their underlying mechanisms. ABSTRACT: Severe Acute Respiratory Syndrome Coronavirus- 2 (SARS-CoV-2), a positive-sense single-stranded RNA virus, causes COVID-19 and has been linked to autoimmune disorders...

KEY CLINICAL MESSAGE: Adult-onset immunodeficiency (AOID) is an emerging acquired immunodeficiency, characterized by multiple opportunistic infections including non-tuberculous mycobacterium (NTM) due to the presence of anti-IFN-γ autoantibody (AIGA). This case highlights the challenges of accurate diagnosis of monoclonal gammaglobulinemia with NTM infection and favorable outcomes of anti-plasma cell therapy in AOID. ABSTRACT: Adult-onset immunodeficiency (AOID) is an emerging acquired immunodeficiency due to anti-IFN-γ autoantibody (AIGA) with low morbidity, frequent disseminated infections, a prolonged course, difficult diagnosis and treatment, and a poor prognosis...

Cholecystocolonic fistula occurring as a complication of colonic diverticular disease is a rarely encountered clinical entity in which the patient may remain asymptomatic or present with vague abdominal or systemic symptoms. Imaging studies are usually not very reliable or effective in detecting direct communication between gallbladder and colon. However, indirect signs such as pneumobilia, gallstones, gallbladder adherent to colon and colonic diverticulosis may help reach the diagnosis. Treatment of cholecystocolonic fistula in symptomatic patients is usually surgical...

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KEY CLINICAL MESSAGE: Systemic to pulmonary venous collaterals (SPVCs) are common findings in patients with Fontan and may be responsible for desaturation in this group of patients. In selected cases, percutaneous closure of SPVCs with coils or vascular plugs could be offered as a safe and effective treatment modality for these patients. ABSTRACT: A 27-year-old female patient who had operated primarily with Glenn operation and she underwent later a lateral tunnel Fontan operation...

This case highlights the rare and atypical presentation of giant, multiple pilomatricomas (PMs) with a pseudo-bullous appearance and lymphangiomatous pathology. It underscores the importance of considering PM in the differential diagnosis of atypical lesions, especially those mimicking cystic or hemorrhagic malignant conditions, to prevent misdiagnosis and ensure appropriate management.

An 80-year-old never-smoking woman, who underwent radiotherapy in combination with simultaneous intra-arterial chemotherapy for external auditory canal squamous cell carcinoma (SCC) 10 years ago, was referred to our department due to a painful huge chest wall tumor. We conducted surgical resection combined with the right upper lobe and chest wall including the 3rd to 5th ribs and affected serratus anterior muscle. Histologically, atypical keratotic cells with the same morphology as external auditory canal SCC proliferated without the figure of carcinoma in situ or squamous dysplasia of the bronchial epithelium of the lung parenchyma adjacent to the tumor...

Modafinil used for narcolepsy caused an atypical adverse reaction, as itchy acneiform lesions, subcutaneous nodules and superficial skin wounds after 2 years of use. After extensive examinations for 5 years, modafinil was discontinued, and the healing process began in 3 weeks with completion in 1.5 years.

KEY CLINICAL MESSAGE: Cystic artery pseudoaneurysm is a rare phenomenon associated with cholecystitis. We describe the successful management of angioembolisation and cholecystectomy. ABSTRACT: Cystic artery pseudoaneurysm (CAP) is a rare but clinically significant condition with various etiological factors. Cholecystitis is a prominent cause, often leading to inflammation-induced arterial wall erosion and pseudoaneurysm formation. CAP can present with a range of symptoms, including hemobilia, upper GI bleeding, and jaundice...

Neuroendocrine tumors of the bladder are rare, accounting for less than 1% of all bladder tumors. Among these, large cell neuroendocrine carcinoma is an extremely uncommon subtype. We report on a histologically confirmed case of mixed both large and small cells neuroendocrine tumor of the bladder in a 64-year-old male with a history of bilharzial cystitis. The diagnosis was made after radical cystectomy with Immunohistochemical staining revealing positivity for synaptophysin, CD56, and AE1/3. While bilharzia is commonly linked to squamous cell carcinoma in the bladder, the potential relationship with neuroendocrine tumors is still relatively unexplored in this context...

Destroyed lung syndrome is a recognized devastating complication of pulmonary tuberculosis (TB) that affects the quality of life of patients. Clinicians in TB-endemic countries should be aware of this complication aiming at prevention. TB control programs should intensify efforts at early detection and treatment and also provide interventions for post-TB complications.

KEY CLINICAL MESSAGE: This case highlights the significant challenges in the diagnosis and management of eumycetoma, particularly in regions like Sudan, where socioeconomic factors and ongoing conflict severely impact patient care. Delayed diagnosis and inadequate access to effective treatment can lead to poor adherence to prescribed therapies, prompting patients to resort to unproven self-treatment methods. Comprehensive, multidisciplinary approaches that include education, improved accessibility to care, and addressing the impact of social determinants on health are essential to enhance the management of mycetoma, reduce disability rates, and improve patient outcomes in underserved communities...

Psilocybin shows promise as a treatment for CRPS, offering significant pain relief and functional improvement in a patient with refractory symptoms. This case highlights the need for further research into psilocybin's efficacy and optimal dosing for chronic pain management.

KEY CLINICAL MESSAGE: A self-insertion of the styrofoam in urinary bladder is relatively rare. The diagnosis might be missed due to concealing the history of self-insertion of the foreign body and the presence of gas in the bladder on CT and MRI. Younger patients with lower urinary tract symptoms should raise the index of suspicion. ABSTRACT: Transurethral self-insertion of a foreign body into the bladder is the most common type of bladder foreign body, which is unlikely to be misdiagnosed...

Perianal alveolar rhabdomyosarcoma is a rare sarcoma that requires a high index of suspicion along with tissue biopsy for accurate diagnosis. Successful treatment, even in the setting of recurrence, requires a multidisciplinary approach.

Deep margin elevation (DME) is a conservative treatment of a tooth with extensive subgingival caries. It is an alternative approach to more invasive restorative procedures. The DME enables successful tooth isolation to do root canal treatments and enables performing indirect restorations, improving dental function and patient comfort without complications.

Hepatocellular carcinoma (HCC) is one of the most common types of cancer. More focus is being placed on clinical presentations of distant metastasis from HCC. Head masses should be investigated even when no concerning symptoms are found in patients with prior history of alcohol abuse and liver comorbidities.

KEY CLINICAL MESSAGE: High-dose acarbose may increase the risk of diabetic ketosis/diabetic ketoacidosis in Asian patients on sodium-glucose cotransporter-2 inhibitors. Healthcare providers and patients should be cautious to avoid this combination. ABSTRACT: Low-calorie diets should be avoided in patients receiving sodium-glucose cotransporter-2 (SGLT-2) inhibitors to decrease the risk of diabetic ketoacidosis (DKA). High-dose acarbose can decelerate carbohydrate absorption...

Gas-containing renal stones are a rare condition. There is an association between renal stones containing gas, urinary tract infection, and renal fusion anomalies, so it is essential to know the radiographic features for prompt diagnosis and treatment.

KEY CLINICAL MESSAGE: Herpes simplex virus (HSV) infection can present atypically in immunosuppressed patients, such as renal transplant recipients, often mimicking conditions like condyloma acuminata. This case report of a 39-year-old male renal transplant recipient underscores the importance of maintaining a high level of clinical suspicion and employing thorough diagnostic techniques, including skin biopsy and polymerase chain reaction, to accurately diagnose chronic lesions and those not responding to initial therapies in these patients...