Brazilian Journal of Case Reports

Endovascular Repair of Brachiocephalic Pseudoaneurysm

2025-11-09T14:45:04-05:00

Surgical Management of Left Anterior Descending Coronary Artery Aneurysm with Fistula: A Rare Case Report from Suriname

2025-07-13T14:41:37-04:00

Coronary artery aneurysm (CAA) and coronary artery fistula (CAF) are rare cardiovascular anomalies, and their simultaneous occurrence is exceedingly uncommon. This case highlights the diagnostic, therapeutic, and logistical challenges of managing such anomalies in a low-resource setting. We present a 56-year-old woman with diabetes, hypertension, and hypothyroidism who developed a non-ST-elevation myocardial infarction (NSTEMI) in May 2023, nearly two years after being diagnosed with a proximal left anterior descending (LAD) artery saccular aneurysm (15.5 × 19.2 mm) with two fistulous connections (31.9 mm and 20 mm). Initial conservative management was chosen due to patient stability and operating room limitations during the COVID-19 pandemic. Despite optimal medical therapy, aspirin 80 mg/day, clopidogrel 75 mg/day, simvastatin 40 mg/day, and bisoprolol 5 mg/day, worsening symptoms prompted urgent surgical repair. The aneurysm and fistulas were ligated, and a left internal mammary artery (LIMA) to LAD bypass was performed. Postoperative complications included pulmonary congestion and pneumonia, both of which were successfully treated. The patient remains asymptomatic at two-year follow-up. In anatomically complex coronary artery anomalies, surgical intervention may offer a definitive treatment option. Our case emphasizes the importance of adaptable, case-specific strategies for cardiovascular care in resource-limited environments.

Medial Patellofemoral Ligament Reconstruction Using a Peroneus Longus Tendon Graft Case Report

2025-02-06T14:14:06-05:00

Medial patellofemoral ligament (MPFL) reconstruction is commonly performed in the surgical treatment of patellar dislocation. In addition to conventional grafts, the peroneus longus (PL) tendon has also been efficiently used as an alternative. In this study, we describe the rare case of a patient with chronic patellar dislocation who underwent MPFL reconstruction using the PL tendon graft and anteromedialization of the tibial tuberosity. A 30-year-old male patient with a history of pain and instability in the left knee due to recurrent patellar dislocations over the past three years, previously treated conservatively. In the last month, he experienced an irreducible lateral patellar dislocation requiring open reduction, followed by another irreducible dislocation 20 days later. Physical examination and imaging revealed MPFL injury and a TT-TG distance of 22 mm. Open patellar reduction, MPFL reconstruction with part of the peroneus longus tendon, and tibial tuberosity anteromedialization were performed. After the usual preparation, the peroneus longus and brevis tendons were identified and isolated, and the former was harvested. Subsequently, patellar reduction and tibial tuberosity anteromedialization osteotomy were performed, followed by fixation of the PL graft at the anatomical femoral insertion point of the MPFL. After ligament reconstruction and osteotomy, the knee demonstrated satisfactory stability, with no dislocations during mobilization and no ankle pain complaints, while maintaining a preserved range of motion. Recent studies have shown favorable outcomes using the peroneus longus tendon in ligamentous knee reconstructions. Thus, the use of this tendon as a graft for MPFL reconstruction represents a viable and valuable alternative that should be mastered by orthopedic surgeons.

A 30-year-old male patient with a history of pain and instability in his left knee due to recurrent patellar dislocations over the past 3 years was treated conservatively. In the last month, he suffered an irreducible lateral dislocation of the patella, requiring open reduction, and another irreducible dislocation occurred 20 days later. Physical and imaging examinations indicated a 22-mm MPFL and TGT lesion. Open reduction of the dislocation was performed, reconstruction of the MPFL with part of the long peroneal tendon and anteromedialization of the ATT.

After the usual preparation, the long and short peroneal tendons were identified and isolated, and removed. Then, the patella was reduced and the ATT was anteromedialized osteotomy was performed, followed by fixation of the PL graft at the anatomical insertion point of the MPFL in the femur.

After ligament reconstruction and osteotomy, the stability of the knee was satisfactory, with no dislocations during mobilization and no complaints of pain in ankle mobility, in addition to the preserved range of motion.

Recent studies have shown good results with the use of the long peroneal tendon in knee ligament reconstructions. Therefore, the use of this as a graft for reconstruction of the medial patellofemoral ligament of the knee represents a viable and valuable alternative that should be mastered by the surgeon.

Giant Cell Arteritis Presenting as Ischemic Stroke: A Case Report

2025-07-29T08:10:48-04:00

Giant cell arteritis (GCA) is the most common vasculitis over 50 years of age. GCA is an inflammatory condition affecting medium to large sized arteries. GCA is classified into a cranial form (c-GCA) and an extracranial/large vessel form (LV-GCA). Temporal artery doppler ultrasound (TADUS) has become the imaging modality of choice for GCA for rapid diagnosis. Glucocorticoids (GC) remain the primary treatment for GCA. We report the case of a 79-year woman with temporal headache, right hemiparesis and hypoesthesia. She had normocytic normochromic anemia, elevated c reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Brain resonance (BR) revealed bihemispheric infarction. She was diagnosed with left sensorimotor lacunar cerebrovascular accident. TADUS revealed hypoechoic halo in the temporal arteries. c-GCA was newly diagnosed as the aetiology of stroke and treated with GC with resolution of symptoms. Ischaemic stroke is a rare complication in GCA and is a life-threatening condition. This case stands out for the importance of GC as an effective therapy in GCA with symptomatic intracranial involvement, improving their prognosis. In daily practice the early diagnosis of GCA can be challenging.

Vitamin D Intoxication Caused by a Manufacturing Error in a Prescribed Vitamin D3 Supplement, Successfully Managed with Low-Dose Zoledronic Acid

2025-08-03T20:05:54-04:00

We describe a male toddler with a history of operated posterior urethral valves who developed vitamin D toxicity with hypercalcemia after he was prescribed orally 6,000 IU of cholecalciferol daily for two months for vitamin D deficiency. The disordered calcium metabolism was discovered during hospitalization in our hospital for a urinary tract infection, along with evidence of renal failure. Serum calcium on admission was 4.22 mmol/L, with an ionized calcium level of 2.26 mmol/L. The measured 25(OH)D level was extremely high (3,555 ng/mL), along with a low serum parathyroid hormone, suggestive of severe vitamin D overdose. Despite aggressive hydration, administration of corticosteroids, and a low calcium diet, he required the administration of a single dose of zoledronic acid for resolution of the hypercalcemia. It was later discovered that the patient received an oral solution of vitamin D3 that was recalled due to a higher content of vitamin D3 than stated on its label. Therapy with low-dose bisphosphonates is effective in cases of symptomatic hypercalcemia that does not respond to intravenous hydration, administration of corticosteroids, and elimination of oral calcium intake. Any child presenting with hypercalcemia and low parathyroid hormone should be investigated for the possibility of vitamin D toxicity.

Right Aortic Arch and Arterial Flow Steal: Case Report

2025-06-09T09:11:44-04:00

The aortic arch develops around the seventh week of gestation from the migration and regression of the branchial arches. The fourth arch gives rise to the aortic arch after the regression of the right dorsal root. When this regression occurs on the left side, it may result in a right aortic arch. This study reports a 32-year-old female patient with a right aortic arch who presented to the outpatient clinic with complaints of tingling and numbness in the left upper limb. On physical examination, there was a decrease in pulses in this limb during thoracic outlet maneuvers. Computed tomography identified the aortic arch and thoracic aorta on the right side, with tracheal stenosis and a retroesophageal course. CT angiography revealed more than 50% stenosis at the origin of the left subclavian artery. Duplex scan demonstrated flow with a retrograde meso-systolic component in the left vertebral artery, a finding compatible with a subclavian steal phenomenon. This is a rare case of right aortic arch with an aberrant left subclavian artery without Kommerell’s diverticulum. The case highlights the importance of correlating clinical findings with imaging studies in the investigation of vascular symptoms, contributing to accurate diagnosis and appropriate therapeutic decision-making.

Total Thyroidectomy Without Sternotomy for a Massive Retrosternal Goiter with Simultaneous Occurrence of Two Thyroid Carcinomas: Outcomes and Surgical Approach

2025-07-30T15:17:28-04:00

Retrosternal goiters often lead to compressive symptoms such as dyspnea, dysphagia, and neck fullness, and pose significant surgical challenges. The standard treatment is total thyroidectomy, though the need for sternotomy depends on the size and extension of the goiter. We present a case of a 51-year-old woman with a progressively enlarging anterior neck mass. Imaging revealed markedly enlarged thyroid lobes with retrosternal extension, causing tracheal deviation and narrowing. CT showed heterogeneous nodules with cystic, necrotic, and calcified components; the lobes measured 13×7×8.2 cm and 8.3×4.6×5.1 cm. No lymphadenopathy was noted. She underwent total thyroidectomy via a 6 cm collar incision, using careful dissection and manipulation despite deep intrathoracic extension. Gross pathology revealed intact capsules, and histopathology showed a thyroid collision carcinoma: a minimally invasive follicular carcinoma (pT3a, pN0a) on the left and an encapsulated angioinvasive oncocytic carcinoma (pT1b, pN0a) on the right. Postoperatively, the patient experienced transient hypoparathyroidism, which resolved with calcium supplements. This case highlights the feasibility of performing total thyroidectomy for giant retrosternal goiters without sternotomy, even when the goiter extends to the lung hilum. Avoiding sternotomy minimizes perioperative risks and recovery times. Histopathology revealed synchronous differentiated carcinomas of follicular origin, highlighting the importance of complete resection in retrosternal goiters.

Mediastinal Mass: A Diagnostic Odyssey from Iron Deficiency Anaemia to Thymoma

2025-08-12T08:52:30-04:00

Thymic epithelial tumours represent a heterogeneous group of rare thoracic cancers. In adults, thymomas are the most common neoplasms arising in the thymus which is located in the anterior mediastinum. Mediastinal mass can be incidental findings on chest x-ray or present with systemic symptoms and/or direct effect of the mediastinal mass. The authors present the case of a 65-year woman with iron deficiency anaemia, hepatosplenomegaly, paravertebral node and mediastinal mass. Biopsy of the paravertebral node revealed extramedullary hematopoiesis (EMH). Biopsy of mediastinal mass revealed thymoma. She underwent video-assisted thoracoscopic surgery (VATS) thymectomy. The lesion was classified by the World Health Organization (WHO) system type B2 thymoma staging system of the tumor, node, metastasis (TNM) pT1a R0, Masaoka-Koga stage II. Three months later, thoracic computed tomography (CT) revealed a nodule inferior to the tumor site suspected of residual disease. The unexpected residual thymoma required treatment with radiotherapy. This case illustrates the difficulty of differentiating the etiology of anaemia. It highlights the current diagnostic approach to mediastinal mass.

Non-Hodgkin’s Lymphoma of the Breast: An Unusual Case Report

2025-08-12T08:51:33-04:00

Primary breast lymphoma is a rare condition accounting for less than 0.5% of all breast malignancies. It typically presents as a solitary mass in women aged 50–60, with clinical and imaging features mimicking breast carcinoma. We present the case of a 60-year-old woman with a right breast nodule diagnosed as marginal zone lymphoma (MZL) by histology. The patient was treated with R-CHOP immunochemotherapy followed by radiotherapy, achieving complete remission with 24 months of sustained follow-up. This case highlights the importance of early histological diagnosis, the occasional diagnostic role of surgery, and the controversies surrounding treatment strategies for breast MZL.

Effective Multimodal Therapy for Chemically Aggravated Androgenetic Alopecia: A Case Report using PRP and Mesotherapy

2025-09-02T15:31:15-04:00

Androgenetic alopecia (AGA) is a common condition characterized by progressive hair loss, closely associated with androgen hormone activity and genetic predisposition. Although platelet-rich plasma (PRP) therapy has gained attention for its regenerative potential and ability to stimulate follicular activity, the synergistic effect of combining PRP with mesotherapy remains unexplored. This case report presents a successful protocol involving a male patient with advanced AGA whose condition was further aggravated by chemical damage from a bleaching procedure. The therapeutic protocol included intradermal injections of PRP in combination with customized blends of active ingredients by mesotherapy, administered in multiple sessions. Quantitative photographic analysis revealed a visual increase in hair density, along with notable improvements in hair thickness and scalp health. The patient expressed great satisfaction with both the aesthetic results and scalp comfort. These results demonstrate the potential of an integrative PRP-mesotherapy approach as safe and effective treatment for patients with complex androgenetic alopecia.

Chronic Ulcer in Traumatic Lymphedema with Difficult Resolution: Treatment and Review

2025-08-24T16:16:50-04:00

The aim of the present study was to report the resolution of a chronic ulcer in a patient with traumatic lymphedema by Godoy Method®. Male, 30 years old, reports that he suffered a car accident 12 years ago with trauma to the middle third of the right leg and skin necrosis where he underwent a graft and subsequent partial loss of the graft resulting in ulcer and lymphedema. He underwent treatment for a period of ten years, including 120 sessions in a hyperbaric chamber with no improvement. The patient underwent intensive treatment for lymphedema by Godoy Method® for 10 days. Stimulation of ulcer granulation was observed, with approximately 40% reduction in area and reduction in limb volume. He was discharged to continue treatment at home, wearing a grosgrain stocking and RAGodoy® device, which led to complete healing of the ulcer. Godoy Method® is effective for healing ulcer that are difficult to resolve.

Pulmonary Lymphangitic Carcinomatosis of Small Cell Lung Carcinoma: An Autopsy Case Report

2025-07-30T11:27:33-04:00

Pulmonary lymphangitic carcinomatosis is characterized by the involvement of pulmonary lymphatic vessels by tumor cells. This work reports the autopsy findings of a 53-year-old woman who presented with subacute constitucional symptoms and presence of numerous nodules throughout the body. Chest CT revealed heterogeneous posterior mediastinal mass involving thoracic structures and pulmonary findings suggestive of lymphangitic spread. Before further diagnostic evaluation could be performed, the patient suffered from rapid clinical deterioration, which resulted in her death. Autopsy revealed a posterior mediastinal mass with marked pulmonary lymphatic involvement by neoplastic cells. Immunohistochemical analysis demonstrated positivity for CAM5.6, CD56 and Ki67, consistent with a high-grade neuroendocrine tumor. Metastatic involvement was also observed in the heart, adrenal, pancreas, duodenum and bone marrow. The final autopsy diagnosis was pulmonary thromboembolism as the immediate cause of death, in the context of a highly aggressive small lung cell carcinoma with pulmonary lymphangitic spread.

Perilunate Carpal Dislocation: A Case Report

2025-09-04T09:12:26-04:00

Perilunate dislocations of the wrist occur due to instability in the ligaments that stabilize the carpal bones relative to each other. Despite their low incidence, these injuries are highly severe. The aim of this study is to report a case in which it is possible to demonstrate the trauma mechanism, clinical presentation, diagnosis, treatment, and follow-up. The patient is a male with a history of trauma from a fall, diagnosed with perilunate dislocation of the wrist through physical examination and imaging, requiring surgical treatment to restore carpal anatomy. It is concluded that accurate identification and diagnosis of the injury, as well as selection of the appropriate treatment, are essential for preserving limb function and preventing future complications, such as carpal instability, local fibrosis, carpal osteoarthritis, and avascular necrosis.

Case Report of Subclavian Artery Injury After Reduction of Right Shoulder Dislocation

2025-09-10T14:44:53-04:00

Shoulder dislocations are common in emergency settings; however, associated vascular injuries are rare, occurring in approximately 1–2% of cases. Among these, axillary and subclavian artery damage is particularly serious, with high morbidity and potential limb loss if not promptly recognized. We report the case of a 79-year-old male, hypertensive and dyslipidemic, who sustained a ground-level fall with right glenohumeral dislocation. Following an attempted closed reduction without sedation, he developed ischemic signs and an expanding hematoma. Initial workup with non-contrast tomography and bedside ultrasound suggested subclavian artery thrombosis. During brachial artery embolectomy, a complete subclavian artery rupture with a 7 cm gap was identified, requiring open repair with a 6 mm Dacron® graft. Postoperatively, the patient developed significant motor deficits of the right upper limb, confirmed by MRI and electromyography as brachial plexus injury. He was discharged on anticoagulation and remains under follow-up with partial functional recovery. This case highlights the importance of systematic neurovascular examination in shoulder dislocation, especially in elderly patients with comorbidities, as collateral circulation may mask early ischemia. Early use of contrast imaging and standardized emergency protocols are critical to improving outcomes. Although rare, subclavian artery injury during shoulder reduction must always be considered, requiring immediate diagnosis and intervention to preserve limb viability and function.

High Spinal Anesthesia in a Patient Recently Submitted to an Epidural Blood Patch: A Case Report

2025-09-04T09:11:41-04:00

Spontaneous intracranial hypotension (SIH) is a rare condition caused by cerebrospinal fluid (CSF) leakage, leading to orthostatic headache and associated symptoms such as nausea, vertigo, and visual disturbances. Epidural blood patch (EBP) is the first-line therapy for persistent symptoms. Neuraxial anesthesia after recent EBP poses unique challenges due to morphological changes in the epidural space. These changes, primarily caused by clot formation and subsequent fibrosis, can result in unpredictable epidural spread or excessive cephalad migration during spinal anesthesia. We report the case of a 30-year-old primigravida with SIH who underwent two EBPs during pregnancy and subsequently developed a high spinal block during elective cesarean delivery under spinal anesthesia. The patient experienced hypotension and bradycardia and sensitive blockade at C6, which were managed successfully, and both mother and newborn had an uneventful outcome. This case highlights the potential for erratic neuraxial block following recent EBP and provides a detailed discussion of the underlying mechanisms and management strategies. It underscores the importance of careful review of anesthetic history, individualized technique, and dosing adjustments. Evidence on the optimal timing and safety of neuraxial anesthesia after EBP is limited, and further research is needed to guide clinical decision-making in this setting.

Chronic Pneumocystosis: Differential Diagnosis of Pulmonary Cystic Lesions

2025-06-09T09:22:41-04:00

Pneumocystis jirovecii pneumonia is an opportunistic fungal disease that typically presents with a subacute onset of fever, cough, and progressive dyspnea, accompanied by a characteristic diffuse bilateral ground-glass pattern on imaging. However, a minority of patients may have an indolent course and atypical radiological features, such as diffuse pulmonary cysts. Diagnosis should be suspected mainly in immunosuppressed individuals and relies on direct visualization of the fungus through bronchoalveolar lavage, sputum examination, or, less commonly, histopathology in uncertain cases. Although new diagnostic methods are under investigation, they remain costly, non-standardized, and difficult to access. Treatment consists of high-dose trimethoprim-sulfamethoxazole for 21 days, with corticosteroid therapy in selected cases (e.g., PaO₂ < 70 mmHg and increased alveolar-arterial gradient). This disease gained prominence during the HIV pandemic in the 1980s and 1990s. Most studies date from that period and are limited to case series and observational designs, lacking controlled randomized trials, which means treatment still relies on established clinical practice.

This pathology gained prominence particularly after the 1980s and 1990s due to the HIV virus pandemic. The main studies date back to that period and are limited to case series and observational studies, lacking controlled and randomized trials, making its treatment based on historical clinical practice.

Anaplastic Large Cell Lymphoma, ALK-Negative: A Rare Case with Histopathological and Immunohistochemical Features

2025-08-28T13:07:57-04:00

We report a case of anaplastic large cell lymphoma (ALCL), ALK-negative, diagnosed in a 27-year-old patient presenting with diffuse lymphadenopathy and constitutional symptoms. Histopathological examination revealed sheets of large pleomorphic lymphoid cells, and immunohistochemistry demonstrated CD30 positivity with ALK negativity. This case highlights the diagnostic and therapeutic challenges associated with this rare subtype of T-cell lymphoma and contributes to the growing body of literature on ALCL ALK-negative.

Intraparenchymal Hemorrhage in a patient with Post-Traumatic Craniectomy and Severe Thrombocytopenia Due to Fatal Acute Dengue: A Case Report

2025-09-23T14:26:50-04:00

Intracranial complications in dengue fever are uncommon but have been increasingly reported in severe cases. Dengue fever is a mosquito-borne viral illness caused by the dengue virus, which usually presents mild symptoms such as fever, headache, and myalgia. In a minority of cases, the disease can progress to more severe forms characterized by plasma leakage, severe thrombocytopenia, and bleeding. Although neurological manifestations are not typical in dengue infections, factors such as severe thrombocytopenia and previous neurosurgical interventions may predispose patients to intracranial hemorrhagic events. This case report presents an 18-year-old female with a fatal intraparenchymal hemorrhage, occurring in the context of severe dengue and a history of prior post-traumatic craniectomy. This case illustrates how dengue-related thrombocytopenia and endothelial dysfunction can trigger catastrophic intracranial bleeding in areas of prior structural brain injury. Considering preexisting neurosurgical lesions as potential sites of secondary hemorrhage in dengue patients with severe thrombocytopenia.

Innovative Hemofiltration Approach to Protamine-Induced Shock After Cardiac Surgery in a Low-Resource Environment: A Case Report

2025-09-02T15:31:55-04:00

Protamine sulfate is routinely administered to reverse heparin anticoagulation following cardiopulmonary bypass (CPB). Although generally well tolerated, protamine may elicit severe hypersensitivity reactions, including anaphylaxis. Managing such complications is especially challenging in resource-limited settings where access to blood products and advanced supportive therapies is constrained. A 61-year-old man with multiple comorbidities underwent elective coronary artery bypass grafting (CABG). Following a 50 mg test dose of protamine sulfate after CPB, the patient developed profound hypotension and refractory shock unresponsive to vasopressors. Cardiac arrest ensued, prompting reheparinization and emergent reinstitution of CPB. Protamine was withheld after the second decannulation. Postoperatively, the patient experienced massive hemorrhage (~7 liters over 3 hours). Autologous blood was salvaged using a gravity-driven hemofiltration system (HemoClear®), with reinfusion of washed, platelet-rich red blood cells. Four units of FFP and albumin were administered. After stabilization, a reduced protamine dose (0.5 mg/kg) was safely administered for 2 hours postoperatively. The patient recovered without recurrence of adverse events. This case illustrates the importance of early recognition and tailored management of protamine-induced hypersensitivity reactions. In low-resource settings, gravity-driven hemofiltration may offer a feasible method of autologous blood salvage during critical hemorrhagic events.

Multisystemic Adverse Reactions to Amlodipine Mimicking Vasculitis

2025-05-11T11:02:34-04:00

A 52-year-old lady, with hypothyroidism and hypertension for the last 2 months, presented with complaints of low-grade fever, gum hypertrophy, abdominal pain, palpable purpura, bilateral knee joint swelling, and bruising of both lower legs for the last 1 month. She had a significant fall in haemoglobin, a high Reticulocyte count, increased bilirubin level, and persistently high potassium with a positive Direct Coombs test. After the initial assessment, she was clinically diagnosed with an Adult-onset Henoch-Schonlein Purpura. She underwent skin biopsy, suggestive of Drug Rash- Amlodipine being implicated as the drug causing multisystemic manifestations. She was treated conservatively. Amlodipine was discontinued, and oral ketone and bilastine were started. She had a complete recovery.

Physiotherapy Management Following Surgical Neurolysis for a Peroneal Nerve Injury: A Case Report

2025-09-23T14:31:43-04:00

The peroneal nerve becomes superficial near the head of the fibula, increasing its exposure to injury mechanisms. There is a need to improve knowledge on the influence of physiotherapy on peripheral nerve injury rehabilitation. The case involves a woman with 47 years who suffered a cut in the region of distal third of right common peroneal nerve. This injury resulted in the loss of sensitivity, strength, foot drop, and neuropathic pain after suturing. These symptoms persisted for six weeks, and she had to undergo surgery six weeks after the accident. Physiotherapy was initiated 1 month after the surgical intervention, incorporating manual therapy, electrical stimulation, functional and aerobic exercise, and patient education. The patient experienced sensory alterations, pain was eliminated, and functional recovery of gait and running was achieved. However, there were residual weaknesses in hallux extensor and dorsiflexors. This case study contributes to the development of peroneal nerve rehabilitation interventions.

Periapical Actinomycosis of the Mandible in Diabetic Patient: Comprehensive Case Report and Literature Review

2025-08-17T12:18:11-04:00

Periapical actinomycosis is an uncommon infection that may lead to osteomyelitis, especially in immunocompromised individuals like those with uncontrolled diabetes mellitus. This case involves a 22-year-old male with type 1 diabetes who presented with recurrent dental abscesses, pain, and tooth mobility. Imaging revealed extensive periapical lesions in the anterior mandible. Biopsy identified Actinomyces spp., MRSA, and Streptococcus viridans. Due to severe bone destruction, the patient underwent full-mouth extractions, marginal mandibulectomy, and mandibular reconstruction using a microvascular iliac crest flap. A postoperative mandibular fracture necessitated further resection and reconstruction with a custom titanium plate. Vestibuloplasty with a split-thickness skin graft improved soft tissue adaptation, and two implants were placed in the parasymphysis region to support an overdenture. The aggressive infection, worsened by diabetes, required a multidisciplinary approach. The iliac crest flap offered structural support and enabled early prosthetic rehabilitation. This case highlights the need for early diagnosis and integrated treatment to achieve functional and aesthetic success.

The Role of the Autopsy During the COVID-19 Pandemic in a Case of Sudden Death with Fatal Hemorrhage and Thrombosis Post chAdox1nCoV-19 VACCINE - A Case Review

2025-08-24T16:19:47-04:00

This case report describes an elderly patient who experienced sudden death from fulminant pulmonary, gastrointestinal and nasal hemorrhage one day after receiving his second dose of the AstraZeneca ChAdox1nCoV-19 vaccine, during the SARS-CoV-2 pandemic. The patient was PCR negative for SARS-CoV-2, but had thrombocytopenia, erythroblastosis and markedly elevated D-Dimer levels. The clinical diagnoses considered included hypovolemic shock, Vaccine-Induced Immune Thrombotic Thrombocytopenia (VITT), PCR negative SARS-CoV-2 infection, Vaccine-Associated Enhanced Disease (VAED), Vaccine-induced Covid-19 mimicry Syndrome and Adenovirus induced thrombocytopenia and thrombosis. The autopsy findings revealed diffuse pulmonary hemorrhage, thrombosis of the microvascular system of the lungs, myocardium and kidneys, together with metastatic foamy cell prostate carcinoma to the lung and bone marrow. Disseminated Intravascular coagulation (DIC) secondary to advanced prostate cancer remained a significant differential diagnosis. This case report highlights the complexity of diagnosing (VITT) and the importance of considering other potential causes of thrombocytopenia and thrombosis, including the presence of solid tumors, particularly in elderly patients. The autopsy provided crucial insights into the patient’s condition.

Monophasic Paravertebral Lumbar Synovial Sarcoma in an Adult Patient: Case Report

2025-10-25T06:35:02-04:00

Synovial sarcoma is a rare malignant soft-tissue tumor, accounting for about 8–10% of sarcomas and is frequently diagnosed in young adults. It most commonly arises in the lower limbs, with paravertebral location being uncommon. We report the case of a 46-year-old female patient with a progressively enlarging right lumbar mass, initially considered benign. Magnetic resonance imaging revealed a solid right paravertebral lesion with signs of aggressiveness. Biopsy confirmed a monophasic synovial sarcoma, grade 2 (WHO, 2022), with a mitotic index of 5 mitoses per 10 high-power fields and no necrosis. Staging was T2N0M0, stage IIIA. The patient underwent wide resection of the mass in the lumbar paravertebral musculature, with clear margins. She remains under clinical-oncologic follow-up and is being evaluated for adjuvant chemotherapy. This case highlights the importance of differential diagnosis in paravertebral tumors and reinforces the role of multidisciplinary management in the treatment of synovial sarcoma.

Spontaneous Cholecystocutaneous Fistula: A Case Report

2025-09-29T16:23:39-04:00

Cholecystocutaneous fistula (CCF) is defined as a pathological communication between the gallbladder and/or its ducts directly with the skin. It is a rare complication of chronic calculous cholecystopathy. Its clinical presentation ranges from gastrointestinal symptoms such as nausea and vomiting, abdominal pain, jaundice, and acute pancreatitis to the drainage of biliary secretion and gallstones through the abdominal wall. The mainstay of treatment involves surgical reconstruction of the biliary anatomy. The incidence of new CCF cases appears to be decreasing due to earlier medical intervention and definitive treatments. This case report presents a patient with acute-on-chronic calculous cholecystitis who developed a CCF with externalization of a gallstone, requiring surgical management.

Radioiodine Treatment and The Development of Pretibial Myxedema: A Series of Three Cases

2025-09-27T03:23:25-04:00

Graves’ disease presents itself clinically with signs of hyperthyroidism and autoimmune manifestations like Graves’ dermopathy, mainly the pretibial myxedema, treatment for Graves’ disease relies on the use of antithyroid medications and radioiodine treatment (RAI) in which case the thyroid cell destruction and subsequent antigen release aggravates the autoimmune response leading to TRAb mediated mucin and glycosaminoglycan deposition in the pretibial area. This report presents 3 cases of pretibial myxedema after radioiodine treatment for Graves’ Disease combined with a brief literature review. This paper suggests that Graves’ dermopathy could be due to an exacerbation of thyroid autoimmunity after RAI treatment. Physicians and patients' awareness of skin complaints or alterations play a key role in early diagnosis and treatment.

Prolonged Fasting as a Trigger for Adrenal Crisis in a Non-Muslim Sub-Saharan African: Case Report

2025-10-25T06:30:49-04:00

Addison’s disease, or primary adrenal insufficiency, is a rare but potentially life-threatening endocrine disorder. Adrenal crisis may occur when patients are exposed to physiological stressors such as infection, trauma, or fasting, especially in the context of poor treatment adherence. Although fasting-related adrenal crisis is typically associated with Muslim patients during Ramadan, reports among non-Muslim individuals are exceedingly rare. We describe a 37-year-old black male, Christian, from sub-Saharan Africa, with a known diagnosis of Addison’s disease on oral glucocorticoid therapy, who presented with worsening asthenia, hypotension, and vomiting after a prolonged fasting period motivated by personal religious beliefs. The patient reported irregular medication adherence and had not increased the glucocorticoid dose during the fasting period. The patient was diagnosed with adrenal crisis secondary to prolonged fasting and poor adherence and improved rapidly after intravenous hydrocortisone and fluid replacement. Our case suggests that patients with Addison’s Disease are at higher risk of developing adrenal crisis during fasting periods. Close monitoring and adjustments of the therapy are recommended.

Posterior Mediastinal Ganglioneuroma Identified After Investigation of Persistent Cough in a Child: A Case Report

2025-10-29T02:21:44-04:00

Ganglioneuroma (GN) is a neuroblastic tumor originating from neural crest cells. These tumors are rare, benign, and often asymptomatic, presenting symptoms primarily when adjacent structures are compressed. In this report, the authors describe a case of persistent cough in a three-year-old boy with an extensive thoracic mass, ultimately diagnosed as a posterior mediastinal ganglioneuroma, emphasizing the key aspects involved in diagnosing this condition. This case highlights the importance of imaging evaluation in refractory pediatric respiratory symptoms and underscores the need to include neuroblastic tumors in the differential diagnosis.

Oral Lesions as the First Clinical Sign of Multifocal Paracoccidioidomycosis: A Case Report

2025-11-01T03:30:36-04:00

To report a multifocal case of paracoccidioidomycosis (PCM) with oral, pulmonary, and adrenal involvement, highlighting diagnostic challenges and the role of dental professionals in early detection. A 50-year-old Brazilian man, smoker, and alcohol user presented with oral ulcers, weight loss, and respiratory symptoms. Clinical, histopathological, and imaging analyses confirmed PCM by Paracoccidioides brasiliensis with pulmonary and adrenal dissemination. Treatment included liposomal amphotericin B, hydrocortisone replacement, and photodynamic therapy (PDT) for oral lesions, followed by sulfamethoxazole-trimethoprim maintenance. Combined therapy led to resolution of oral and cutaneous lesions, respiratory improvement, and adrenal stabilization. After 10 months, the patient showed weight gain and no recurrence. Despite Brazil’s high PCM prevalence, delayed diagnosis remains common due to non-mandatory reporting and limited professional awareness. Oral manifestations preceded systemic symptoms, emphasizing the dentist’s role in early diagnosis. PCM is an underdiagnosed systemic mycosis with potentially severe outcomes. Recognition of oral lesions as early indicators enables timely intervention and prevents systemic complications. Strengthening awareness among dental and medical professionals, along with improved epidemiological surveillance, is essential to enhance prognosis and reduce morbidity.

Fungemia Due to the Fusarium solani Species Complex in Coinfection with Aspergillus terreus After Haploidentical Hematopoietic Stem Cell Transplantation for Severe Aplastic Anemia

2025-10-13T14:53:30-04:00

Invasive fungal infections (IFIs) represent an important cause of morbidity and mortality in patients undergoing hematopoietic stem cell transplantation (HSCT), particularly in the setting of profound and prolonged immunosuppression. Among the emerging etiological agents, filamentous fungi, especially Aspergillus spp. and Fusarium spp., stand out, and although coinfection is rare, it poses a significant diagnostic and therapeutic challenge. We report the first known case of coinfection by Aspergillus terreus and the Fusarium solani species complex in a patient with severe aplastic anemia who underwent haploidentical HSCT. The patient developed a clinical presentation consistent with disseminated fungal infection, characterized by Fusarium fungemia and necrotic skin lesions, despite combined antifungal therapy. Graft failure and prolonged neutropenia were the main determinants of the unfavorable outcome. This case highlights the complexity and severity of invasive fungal coinfections in immunocompromised hosts, emphasizing the need for rigorous microbiological surveillance, early diagnosis, and new integrated therapeutic approaches coupled with effective immune recovery.

A Rare Complication of Biliary Pancreatitis Forming a Radiological Mass Mimicking a Klatskin’s Tumor

2025-10-13T15:02:40-04:00

A Klatskin tumor, a type of cholangiocarcinoma that develops where the right and left hepatic bile ducts join to form the common bile duct. These tumors, first identified by Altemeier et al. in 1957 and later elaborated upon by Klatskin in 1965, typically occur within 2 cm of the hilar confluence and account for 50–70% of all cholangiocarcinomas. It is important to differentiate Klatskin tumours from various benign conditions and other malignant lesions that can mimic both the clinical presentation and radiological appearance, often termed Klatskin-like lesions. There have been multiple reports of hilar strictures initially diagnosed as cholangiocarcinoma and it has been found that 5-15% of these cases ultimately exhibit benign lesions upon final histopathological examination. To our knowledge there is no case of a complication of biliary pancreatitis leading to the formation of a radiological lesion mimicking a Klatskin’s like tumor, being reported in the literature. Therefore, this case report represents the first documented instance of this intriguing occurrence.

Clinical Case Reports as a Tool for Advancing Personalized Medicine: Is this real?

2025-08-09T09:55:06-04:00

Personalized medicine recognizes that diseases manifest and respond to treatment differently in each patient. While large trials provide general evidence, they often miss real-world variability. Case reports, long considered low-level evidence, are vital for documenting rare diseases, atypical presentations, and unique therapeutic responses that inform individualized care. Historically, case reports have led to major discoveries, embracing variability to reveal new mechanisms. In rare diseases, each report can serve as an “N-of-1” study, while in common conditions they help identify unusual patterns, reduce misdiagnosis, and define subgroups needing tailored management. They also record exceptional responders, non-responders, and rare adverse effects, advancing pharmacogenomics. Despite their value, challenges include patient privacy, publication bias, and inconsistent quality, which require robust consent and adherence to CARE guidelines. Future integration into searchable databases and AI analysis could amplify their impact, confirming that case reports remain central to the precision medicine era.