Brazilian Journal of Case Reports

Endovascular Repair of Brachiocephalic Pseudoaneurysm

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

Perforating Reactive Collagenosis: A Rare Cutaneous Manifestation of Systemic Diseases

2025-12-09T14:41:16-05:00

Letter to the Editor Regarding “Epstein-Barr Virus and COVID-19 Induced Systemic Inflammatory Response Syndrome and Guillain-Barré Syndrome - A Novel Case Report”

2025-12-23T12:56:30-05:00

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.

Epstein-Barr Virus and COVID-19 Induced Systemic Inflammatory Response Syndrome and Guillain-Barré Syndrome - A Novel Case Report

2025-04-16T01:04:57-04:00

A 51-year-old

gentleman without any comorbidities was admitted to the hospital with complaints of fever and sore throat. On examination and investigation, he was found to have jaundice and acute kidney injury with biochemical pancreatitis. He was being treated conservatively with IV Fluids and IV Antibiotics. Investigations revealed that he was suffering from the Epstein-Barr virus, and he improved with the ongoing treatment. But on day 5 of admission, he suddenly developed bilateral facial nerve palsy with weakness of the bilateral lower limbs. The nerve conduction velocity test was suggestive of Guillain-Barré syndrome. Incidentally, on the same day, he also tested positive for COVID-19. He was then initiated on IV Immunoglobulin and showed a remarkable response, with improvement in limb power and facial weakness. He was discharged after completing 5 days of IV immunoglobulin treatment for further outpatient care, including continuation of physiotherapy at home.

Severe Recurrent Hyperinsulinemic Hypoglycemia Associated with Quetiapine in a Patient with Schizophrenia: A Case Report

2025-11-27T11:37:26-05:00

Atypical antipsychotics are frequently associated with metabolic disturbances such as weight gain, insulin resistance, and hyperglycemia. In contrast, drug-induced hypoglycemia is rarely described, particularly with quetiapine. We report a case of severe, recurrent hyperinsulinemic hypoglycemia temporally associated with quetiapine use in a patient with schizophrenia, with resolution following drug withdrawal. A 72-year-old man with schizophrenia was admitted for acute psychotic decompensation while receiving long-term haloperidol and quetiapine 150 mg/day. Shortly after admission, he developed recurrent, predominantly postprandial hyperinsulinemic hypoglycemia, with plasma glucose reaching 20–40 mg/dL, repeatedly asymptomatic. During a documented episode (glucose of 48 mg/dL), insulin and C-peptide were inappropriately elevated, confirming endogenous hyperinsulinemia. Adrenal insufficiency, hypothyroidism, insulinoma, IGF-2–secreting tumors, nesidioblastosis, hepatic dysfunction, and factitious hypoglycemia were systematically investigated, with no findings supporting these alternative diagnoses. Hypoglycemia resolved promptly after quetiapine discontinuation and recurred upon rechallenge. Replacement with tiapride led to full metabolic stabilization, with no further hypoglycemic events. This case highlights a rare but potentially life-threatening adverse effect of quetiapine. Clinicians should remain vigilant for hypoglycemia in susceptible individuals, particularly older patients or those with underlying glucose dysregulation, as early recognition and drug withdrawal can prevent serious complications.

Retropharyngeal Abscess: A Case Report

2025-10-29T02:22:58-04:00

Retropharyngeal abscess is a rare but potentially fatal condition, often misdiagnosed as other respiratory conditions in children due to its nonspecific symptoms. This case highlights the importance of clinical awareness and timely radiological evaluation to ensure early diagnosis and appropriate treatment, preventing severe complications like mediastinitis and ensure effective treatment.

Intra-Appendiceal Migration of a Copper Intrauterine Device: Case Report and Literature Review

2025-11-22T11:45:02-05:00

Extrauterine migration of intrauterine devices is rare, with an estimated incidence between 0.1% and 0.3%, and intra-appendiceal location represents an exceptional finding. We report the case of a 32-year-old patient who, after postpartum insertion of a copper intrauterine device, presented with pelvic pain and absence of retrieval strings on gynecological examination. Initial ultrasonography and magnetic resonance imaging did not localize the device, which was identified only three years later by plain abdominal radiography and confirmed by computed tomography, demonstrating migration to the appendix. The patient underwent videolaparoscopic appendectomy with complete removal of the device and had a favorable postoperative course. A systematic literature review was associated with the case report, identifying 17 patients described in 14 publications. Ages ranged from 21 to 44 years, with exclusive involvement of copper intrauterine devices. Most patients presented with abdominal pain, while a significant proportion were diagnosed incidentally. The interval between insertion and detection varied widely, reaching up to 12 years. Plain radiography was the most frequently used initial examination, while computed tomography confirmed the diagnosis in nearly all cases. Videolaparoscopic appendectomy was the predominant approach, associated with adequate recovery and a low complication rate. Intra-appendiceal migration should be considered in cases of non-visualization of intrauterine device strings or nonspecific abdominal symptoms. Immediate radiological investigation, initiated with plain radiography and complemented by computed tomography when necessary, is essential to avoid diagnostic delays. The laparoscopic approach remains a safe and effective treatment.

Disseminated Paracoccidioidomycosis with Osteoarticular and Miliary Pulmonary Involvement: A Case Report

2025-11-16T13:09:23-05:00

Paracoccidioidomycosis (PCM) is a systemic fungal infection endemic in Latin America, primarily affecting the lungs and mucocutaneous tissues. Osteoarticular involvement is uncommon and may mimic bacterial or mycobacterial diseases. We describe a disseminated PCM case in an immunocompetent 37-year-old woman presenting with ankle monoarthritis and diffuse miliary pulmonary infiltrates. Histopathology confirmed multiple-budding yeast forms of Paracoccidioides spp., while cultures and serological tests were negative. The patient was treated with liposomal amphotericin B followed by oral itraconazole, achieving complete clinical and radiological recovery. PCM should be considered in endemic regions when musculoskeletal lesions coexist with pulmonary findings, even in immunocompetent hosts.

Unilateral Thyroid Involvement in Graves' Disease: A rare presentation of Graves’ Disease

2025-11-28T08:33:36-05:00

Graves' disease is a rare autoimmune disorder characterized by increased hormone production leading to clinical signs of hyperthyroidism, most cases present with different degrees of TSH suppression, accompanied by elevated FT4. Thyroid scintigraphy commonly reveals an enlarged goiter with diffuse increased iodine uptake. This study presents the case of a 50-year-old woman with a clinical history of Graves' disease presenting with suppressed TSH and elevated FT4 combined with clinical signs of hyperthyroidism (tachycardia and peripheral tremors). Thyroid imaging showed increased unilateral uptake on scintigraphy with no visible nodules on ultrasound. The patient showed an adequate initial response to methimazole, with disease relapses after dose reduction. The patient was able to maintain euthyroidism with continued antithyroid drug use. Single lobe involvement of Graves' Disease is a rare phenomenon attributed to the autoimmune process combined with acquired variations impacting a specific lobe. Clinically, patients are present with different degrees of hyperthyroidism. In most cases, the use of antithyroid drugs provides adequate disease control, with patients subjected to definitive treatment presenting a higher risk of disease recurrence in the contralateral lobe. This report shows a case with a favorable response to continue antithyroid drugs treatment after disease relapse. The findings highlight the rare occurrence of unilateral thyroid gland involvement in Graves' disease. Also, suggest a favorable response to continue antithyroid treatment for patients exhibiting relapses.

Peutz-Jeghers Syndrome Complicated by Intestinal Intussusception: A Case Report

2025-11-03T14:49:29-05:00

Peutz-Jeghers Syndrome (PJS) is a rare genetic condition characterized by the presence of hamartomatous polyps in the gastrointestinal tract and mucocutaneous hyperpigmentation. Intussusception is a relatively common complication in these patients, although progression to extensive intestinal necrosis is uncommon and potentially fatal. This report describes a 21-year-old woman with PJS diagnosed in childhood, admitted with acute abdominal pain, hyporexia, and vomiting. Computed tomography revealed extensive jejuno-ileal intussusception, and emergency laparotomy identified 90 cm of invaginated and necrotic small bowel caused by a hamartomatous polyp in the mid-jejunum. Segmental enterectomy with primary side-to-side anastomosis was performed, and the patient had a satisfactory postoperative recovery, being discharged on the fourth day. She remains under outpatient follow-up without signs of short bowel syndrome. This case highlights the importance of structured endoscopic surveillance and early surgical intervention in PJS, especially in settings where advanced enteroscopy techniques are not available.

Pulmonary Thromboembolism After Revision Total Knee Arthroplasty: A Report of Two Cases

2025-11-18T13:13:09-05:00

Two female patients (74 and 80 years old) underwent revision total knee arthroplasty surgery due to aseptic loosening. Patient 1 was obese, while patient 2 had history of abdominal surgery, cerebrovascular and autoimmune disease. They were both under anti-depressive medication. Intravenous tranexamic acid was administrated according to institutional protocol. Knee mobilization and enoxaparin in prophylactic dose was initiated at day 1 postoperatively. Both patients had pulmonary thromboembolism within the first 30 days after surgery. Individual risk factors predispose to pulmonary thromboembolism, while tranexamic acid way of administration does not seem to be responsible for the risk increase.

Individual risk factors predispose to pulmonary thromboembolism, while tranexamic acid way of administration does not seem to be responsible for the risk increase.

Hydrocephalus Due to Neurocysticercosis in the Cerebral Aqueduct: Case Report

2025-12-04T14:19:12-05:00

Neurocysticercosis (NCC) is the leading cause of parasitic infection of the central nervous system, resulting from infestation by the larval stage of Taenia solium. Intraventricular forms of the disease, although less frequent, are associated with high morbidity and mortality, mainly due to obstruction of cerebrospinal fluid flow and consequent hydrocephalus. We report the case of a patient previously diagnosed with NCC who presented with acute clinical deterioration secondary to obstruction of the cerebral aqueduct by a cyst compatible with a cysticercus, a location rarely described in the literature. The patient underwent emergency neurosurgical intervention with good clinical outcome. Antiparasitic therapy was not initiated, considering the high number of viable lesions and the risk of an exacerbated inflammatory response. This case report reinforces the importance of early diagnosis of complications associated with NCC, particularly ventricular forms, and expands knowledge of atypical topographic presentations, contributing to improved clinical recognition and appropriate management of the disease.

Sacrococcygeal Teratoma in an Adult: A Case Report and Systematic Review of the Literature

2025-12-10T07:39:59-05:00

Sacrococcygeal teratomas are germ cell tumors derived from pluripotent cells and are rarely diagnosed in adults, accounting for less than 10% of reported cases. Clinical manifestations are generally nonspecific, and imaging studies are essential for diagnosis and therapeutic planning. We report the case of a 30-year-old female patient with chronic pelvic pain and sacrococcygeal discomfort. Pelvic magnetic resonance imaging revealed a large solid–cystic, multilobulated, and septated lesion with predominantly adipose content, located in the presacrococcygeal space, measuring 8.3 × 10.1 × 9.6 cm, without bone invasion or gynecological involvement. The main diagnostic hypothesis was a mature sacrococcygeal teratoma, with indication for elective surgical resection. A systematic review of the literature was conducted in accordance with PRISMA 2020 guidelines and Cochrane methodology, including 15 studies with 28 adult patients. There was a predominance of females (82.1%), with ages ranging from 19 to 56 years. Pelvic or sacrococcygeal pain was the most frequent symptom (67.8%), and magnetic resonance imaging was used in all cases. All patients underwent surgical resection, with coccygectomy performed in 64.2%, without severe complications or recurrence in cases followed after coccygectomy. Sacrococcygeal teratomas in adults are rare entities that require a high degree of clinical suspicion and imaging investigation. This case reinforces the role of magnetic resonance imaging in the differential diagnosis of pelvic masses and supports complete surgical resection, with or without coccygectomy, as the treatment of choice. The absence of coccygectomy was associated with a higher risk of recurrence during long-term follow-up, although not universally.

Bainbridge-Ropers Syndrome in a Brazilian Child Associated with Duplicated Pyelocaliceal System: A Case Report

2025-12-10T14:21:15-05:00

Bainbridge-Ropers syndrome (BRPS) is a rare neurodevelopmental disorder caused by pathogenic variants in ASXL3. We report the first Brazilian pediatric case of BRPS associated with a duplicated pyelocaliceal system, adding evidence to a possible, but still poorly understood, relationship between ASXL3 mutations and urinary system developmental abnormalities. The patient presented typical BRPS features, including hypotonia, severe developmental delay, feeding difficulties requiring gastrostomy, seizures, and craniofacial dysmorphisms. Additionally, renal imaging revealed a duplicated pyelocaliceal system, with preserved renal function. Whole-exome sequencing identified a de novo truncating ASXL3 variant. This case reinforces the expanding phenotypic spectrum of BRPS and highlights the importance of comprehensive systemic assessment, including increased vigilance and consideration of renal evaluation, in children with syndromic features and global developmental delay. Early genetic testing remains essential to diagnostic confirmation and management planning.

Inferior Vena Cava Mesenchymal Tumor with Intracardiac Extension Mimicking an Atrial Myxoma in a Young Adult: A Case Report

2025-12-29T09:23:25-05:00

Mesenchymal tumors originating from the inferior vena cava with cranial extension into the right atrium are rare and may closely mimic primary cardiac tumors, particularly atrial myxoma, leading to diagnostic and surgical pitfalls. A 29-year-old previously healthy man was referred for cardiac surgery after a large right atrial mass was detected by transthoracic echocardiography and interpreted as an atrial myxoma. No preoperative cross-sectional imaging was performed. Intraoperatively, the lesion was identified as cranial extension of a tumor arising from the inferior vena cava, prompting partial intracardiac resection. Subsequent magnetic resonance imaging demonstrated a large infiltrative right retroperitoneal mass with extensive inferior vena cava tumor thrombosis. The patient underwent definitive staged multidisciplinary surgery including retroperitoneal tumor resection, inferior vena cava tumor thrombectomy, and caval reconstruction with a vascular graft. Histopathology demonstrated a smooth muscle neoplasm with cellular atypia, diffuse smooth muscle marker expression, Ki-67 labeling index of approximately 15%, and p53 positivity, without tumor necrosis or mitotic activity, supporting classification as a tumor of uncertain malignant potential. This case highlights the critical importance of systematic inferior vena cava assessment in patients presenting with right atrial masses, as misdiagnosis may lead to inadequate surgical planning and increased perioperative risk. It also illustrates the diagnostic complexity of vascular smooth muscle tumors with atypical features and underscores the need for complete surgical resection, long-term anticoagulation with rivaroxaban after caval reconstruction, and structured oncologic surveillance in tumors of uncertain malignant potential.

Triple-Negative Mucinous Breast Carcinoma: A Case Report

2025-09-23T14:21:37-04:00

Mucinous breast carcinoma (MBC) is a rare histological type, accounting for 1% to 6% of breast neoplasms. It is more frequent in older women and generally associated with a favorable prognosis. This paper reports on the case of a 52-year-old patient who initially presented with edema associated with mastalgia and nipple retraction in the left breast and was admitted to our service with only a routine mammogram. Initial staging examinations and biopsy with immunohistochemistry, followed by the need for panel expansion, initially suggested a primary site in the gastrointestinal tract; however, subsequent investigation revealed a primary triple-negative mucinous breast neoplasm. Thus, this report describes an uncommon case of triple-negative MBC, with few similar cases reported in the literature, as well as its diagnostic workup, definitive diagnosis, instituted treatments, and therapeutic response.

Varicella Zoster Encephalitis in an Immunocompetent Traveler

2026-01-01T15:32:16-05:00

Varicella-zoster virus (VZV) is a frequent cause of encephalitis in adults, particularly in elderly and immunocompromised individuals. In young immunocompetent patients without cutaneous manifestations, it represents a rare presentation. We report the case of a 35-year-old previously healthy man who developed VZV encephalitis during a ten-month trip across Latin America. While in Nicaragua, he presented with bitemporal and left suboccipital headache, pulsatile in nature, insidious in onset, daily, and with progressive worsening. After five days, he sought medical care due to language disturbance (paraphasia). He denied fever, seizures, paresis, or systemic symptoms. Physical examination revealed only language impairment, with no skin lesions. Magnetic resonance imaging demonstrated hyperintensity in the left temporal lobe. Cerebrospinal fluid analysis showed hypoglycorrhachia, hyperproteinorrhachia, and hyperlactatorrhachia. Molecular testing (PCR) detected VZV DNA. Intravenous acyclovir was initiated for eight days, followed by oral acyclovir for six days, resulting in complete resolution of symptoms without residual deficits. Investigation for immunodeficiency, including HIV testing, lymphocyte immunophenotyping, immunoglobulin levels, and complement assessment, was negative. As prophylaxis, vaccination with the recombinant inactivated herpes zoster vaccine was recommended. This case illustrates an atypical presentation of VZV encephalitis, reinforcing the importance of molecular testing in the investigation of acute neurological syndromes and of early antiviral treatment for a favorable prognosis.

Ultrasound-Guided Bilateral Superior Laryngeal Nerve Block for Laryngospasm Prophylaxis in a Child with COVID-19: A Clinical Case Report

2025-11-13T06:36:30-05:00

Laryngospasm is a constant worry in pediatric anesthesia, especially when dealing with children who have active or recent upper airway infections. The internal branch of the superior laryngeal nerve (SLN) is the primary sensory pathway for the supraglottis and triggers the glottic closure reflex. We report on the case of a 3-year-old girl, ASA I, scheduled for tympanostomy while testing positive for SARS-CoV-2. Because of her high risk for respiratory complications, we performed a prophylactic ultrasound-guided bilateral SLN block at the end of the surgery using 1.5 mL of 1% lidocaine on each side. The patient woke up and was extubated without any coughing, desaturation, or laryngospasm. While SLN blocks are usually meant for awake intubations, this case suggests that using the block for prophylaxis could be a helpful strategy for reflex control in high-risk children. We believe these findings are suggestive observations that need further validation through controlled studies to confirm safety and efficacy in pediatrics.

Subcutaneous Phaeohyphomycosis in a Patient with Metabolic Comorbidities: A Rare Diagnostic Alert in a Low-Resource Setting

2025-10-06T07:49:45-04:00

Phaeohyphomycosis is a rare subcutaneous fungal infection caused by melanized (dematiaceous) fungi, usually linked to trauma and, in some cases, to immunosuppression. We report the case of a farm worker living in a remote area of Maranhão, Brazil, with limited access to specialized health services. The patient had systemic arterial hypertension and insulin-dependent type 2 diabetes mellitus, metabolic comorbidities that may increase susceptibility and influence the course of infection. He developed multiple subcutaneous nodules and long-standing fistulized, draining masses on the right upper limb. The diagnostic pathway was prolonged, reflecting challenges in areas with limited health infrastructure, where general practitioners often have little training in endemic fungal diseases because they are perceived as uncommon in routine practice. An initial biopsy led to an incorrect diagnosis of chromoblastomycosis. The definitive diagnosis was established after referral to a specialized hospital, with magnetic resonance imaging (MRI) showing multiple nodular subcutaneous lesions, direct microscopy revealing septate dematiaceous hyphae, and fungal culture isolating Exophiala spp. Treatment with itraconazole at 400 mg/day led to progressive clinical improvement and a marked reduction in lesion size. This case highlights the importance of early clinical suspicion of subcutaneous phaeohyphomycosis, even in patients without classic immunosuppression, particularly when metabolic comorbidities are present.

Transverse Tibial Cortex Transport in the Treatment of Kawasaki Disease

2026-01-05T07:37:17-05:00

Kawasaki disease is a systemic primary vasculitis of medium-sized vessels, predominantly affecting children, whose diagnosis and management in adulthood remain challenging, particularly in the presence of rare peripheral vascular manifestations. Severe ischemic limb lesions in adult patients with sequelae of the disease have limited therapeutic options, with amputation often being indicated. This study reports the first case described in the literature of the use of Transverse Tibial Cortex Transport (TTT) as a limb-salvage strategy in an adult patient with Kawasaki disease and critical lower limb ischemia. A 38-year-old female patient, with a history of spontaneous resolution of the disease in childhood, evolved with severe chronic ischemia, a trophic lesion with bone exposure, absence of a distal runoff bed, and failure of conventional clinical therapies. Given the impossibility of revascularization and a prior indication for amputation, TTT was performed. A significant clinical improvement in perfusion was observed, evidenced by increased ankle pressure, reduced capillary refill time, progressive wound healing, and recovery of functional ambulation. Follow-up computed tomography angiography demonstrated neovascularization and the development of collateral circulation previously absent. TTT proved to be a viable and effective alternative for limb preservation in this pioneering case of Kawasaki disease, suggesting potential application in other primary vasculitides associated with critical ischemia. Prospective studies are needed to better define its indications, pathophysiological mechanisms, and long-term outcomes.

Multimodal Diagnosis of Cervical Spinal Cord Compression in a Dog: The Role of Accessible Imaging in Complex Decision-Making

2026-01-13T19:33:54-05:00

Intervertebral disc disease (IVDD) is a leading cause of spinal cord compression in dogs, frequently affecting the cervical region. This case report describes the diagnostic approach and imaging findings in a geriatric Shih-Tzu presenting cervical pain and progressive neurological signs, highlighting the importance of accessible diagnostic tools in clinical routine. Initial clinical evaluation and plain radiography suggested cervical disc involvement, revealing a narrowed intervertebral space at a single segment. Due to the persistence and worsening of clinical signs, myelography was performed in conjunction with cerebrospinal fluid (CSF) analysis, allowing for the exclusion of inflammatory or infectious central nervous system disorders. Myelography revealed two cervical regions with extradural compression. Subsequently, computed tomography (CT) demonstrated three affected cervical intervertebral spaces, including disc extrusion and protrusions with varying degrees of spinal cord compression. Although advanced imaging modalities offer greater diagnostic accuracy, this report demonstrates that contrast radiography and CSF analysis, when correctly indicated and interpreted, remain relevant and viable diagnostic tools in veterinary practice. Despite the confirmation of multifocal cervical IVDD, the owner opted against surgical treatment.

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.