Brazilian Journal of Case Reports

Cutaneous T-cell lymphoma of the mycosis fungoides type: report of case series

Yan de Castro Souza — 2024-06-18

Cutaneous T-cell lymphomas represent a heterogeneous group of lymphoproliferative diseases characterized by skin infiltration by mature malignant T cells. More than 40% of cutaneous T-cell lymphomas are represented by mycosis fungoides. As they present non-specific cutaneous manifestations, they are often underdiagnosed. This article reports four cases of mycosis fungoides with different subtypes treated by a multidisciplinary team, highlighting aspects related to clinical heterogeneity and diagnostic, therapeutic and differential diagnostic challenges, followed by a brief review of the literature. The cases described demonstrate the heterogeneity of cutaneous and systemic clinical signs, with presentations that present a significant diagnostic challenge due to other diseases with similar manifestations, especially for non-specialist physicians in basic healthcare units. Mycosis fungoides continues to be a problematic diagnosis, as the cases described had varied presentations and numerous inconclusive biopsies. Low clinical suspicion and technical limitations in the analysis of biopsies of skin lesions were the main factors implicated. It is hoped that this series of cases will bring a better understanding of the diagnostic aspects of this disease.

Osseointegration of a displaced dental implant in the maxillary sinus: a 7-year follow-up case report

Marcelo Rodrigues Azenha — 2024-06-24

Foreign bodies into the maxillary sinus are rarely mentioned in literature. Many of them might be asymptomatic and an inadequate planning of the case or an unskilled professional can easily lead a dental implant into the maxillary sinus in a poor bone situation. We aim to present and discuss what is to our knowledge the first case and the management of a dental implant that has osseointegrated inside the maxillary sinus after its displacement. A patient had a dental implant placed immediately after upper molar extraction, but at the end of the procedure it was displaced into the sinus during healing cap adaptation. Images exams done after 1 day, 24 months, 36, and 84 months demonstrated a healthy maxillary sinus with the implant osseointegrated at the same site since its migration, surrounded and filled by mature bone. Due to an asymptomatic patient the removal of the implant is not planned until now.

Xanthogranulomatous Pyelonephritis: An Uncommon Form of Pyelonephritis Highlighted in a Case Report

Danielle Malavazi Oliveira — 2024-06-27

Xanthogranulomatous pyelonephritis is a rare and aggressive variant of pyelonephritis, characterized by chronic granulomatous inflammation that progresses to destruction of the renal parenchyma and renal failure. Early diagnosis is a challenge. We present the case of a 7-year-old girl with high fever, associated with low back pain, anorexia and vomiting for 30 days. After antibiotic therapy, radical nephrectomy was required for definitive treatment. Due to its rare and aggressive nature, which often leads to the loss of the affected kidney, it is essential to alert healthcare professionals about the importance of early diagnosis to prevent disease progression and improve the patient's prognosis. We will use a case report to explore the clinical, radiological and pathological aspects related to xanthogranulomatous pyelonephritis.

Pylephlebitis with Bacteremia from a Rare Bacterium: A Case Report of Septic Mesenteric-Portal Thrombophlebitis Associated with Acute Diverticulitis

Paula Heroso Moreira — 2024-06-29

Pylephlebitis, defined as septic thrombophlebitis of the portal vein, is a rare complication of intra-abdominal infections, particularly appendicitis and diverticulitis. Prompt diagnosis through laboratory tests and imaging, and the early institution of antibiotic therapy, with or without anticoagulation, considerably improve the prognosis. The authors present an atypical case of pylephlebitis associated with uncomplicated acute diverticulitis, with the isolation of a rare bacterium in peripheral blood, Sutterella wadsworthensis.

A case of facial vein rupture induced by coughing

Hiroshi Hyakusoku — 2024-06-29

Peritonsillar abscess, deep neck infection, epiglottitis, laryngeal edema, and upper airway foreign bodies are frequently encountered emergencies in otolaryngology wards. In contrast, spontaneous vascular rupture in the neck is rare. A 57-year-old man visited our hospital with left neck pain and sudden onset of submandibular neck swelling after coughing. Contrast-enhanced computed tomography revealed a poorly enhanced mass lesion located at the left upper neck. The most prominent swelling was observed around the facial vein. Exploration of the left mass lesion under general anesthesia was performed. A perforation and gusher were found at the branch of the left common facial vein. The perforation was ligated on both the central and peripheral sides. The rupture of the facial vein was presumed to be idiopathic, possibly caused by coughing. No evidence suggestive of vasculitis syndrome, hereditary predisposition, or symptoms indicating vascular fragility were found. We report the first case report of facial vein rupture possibly induced by coughing with massive swelling on the neck and oral floor. To prevent potential complications, such as airway stenosis due to neck swelling and the risk of hemorrhagic shock, it was necessary to promptly perform imaging diagnostics and surgical intervention to achieve hemostasis and remove the hematoma.

A case of a rare autoimmune disease: Vogt-Koyanagi-Harada disease

Banyama Marie Diabri — 2024-06-29

Vogt-Koyanagi-Harada (VKH) disease is a rare autoimmune disorder. It is exceptional in black sub-Saharan Africans. A 27-year-old dermatology patient with progressive segmental vitiligo associated with bilateral visual acuity loss, headache, and hearing loss. Hypocromic macules were noted extending to the inner surface of the upper lip and to the right jugal region. Examination of the skin revealed poliosis of the moustache and scalp. Slit-lamp inspection revealed numerous corneal keratic precipitates. Optical coherence tomography (OCT) revealed chorioretinitis scarring in the right eye and macular and papillary atrophy in the left. Tone luminance audiometry revealed a 1st degree major hearing loss of the bilateral mixed type. We made the diagnosis of VKH syndrome. The patient received a bolus of methylprednisolone followed by prednisone. VKH disease is not common in sub-Saharan Africa. It is essential to consider this disease in all cases of segmental vitiligo.

Trapdoor Fracture in a Child Following a Domestic Accident: Case Report

Marcelo Rodrigues Azenha — 2024-07-10

The trapdoor fracture is a subtype of orbital fracture and is considered a rare condition that occurs primarily in children and adolescents. The treatment consists of surgery to access and remove the trapped tissue in the floor of the orbit that prevents the movement of the eyes on the affected side. The aim of this article is to present a case of a trapdoor fracture in a 4-year-old child who suffered a domestic accident and underwent surgery under general anesthesia to release the muscles trapped in the orbital floor. The postoperative outcome was considered excellent, with complete recovery of visual and aesthetic functions, without the need for reconstruction of the fractured region with any type of fixation material.

Spontaneous Coronary Dissection in Late Puerperium: Now What? A Case Report

Miguel Vicente — 2024-07-10

Spontaneous coronary dissection is an infrequent cause of non-atherosclerotic or iatrogenic acute coronary syndrome, predominantly diagnosed in women under 50 years old during their reproductive phase, usually without associated cardiovascular risk factors. Various factors underlie its occurrence, ranging from connective tissue diseases to intense emotional stress, with fibromuscular dysplasia being a commonly associated nosological entity. Coronary angiography is the preferred diagnostic examination, and a conservative strategy is frequently recommended, especially in stable contexts. Invasive strategies, such as surgical revascularization or percutaneous coronary intervention, are reserved for more complex clinical situations involving severe arrhythmias or dissections involving the left coronary artery trunk, among others. We present the case of a postpartum woman with no known cardiovascular risk factors, diagnosed with spontaneous coronary dissection in the late puerperium of a twin pregnancy, resulting in a fatal outcome.

Infectious Cervical Pneumorachis with a Fatal Outcome: A Case Report

Dimitar Pazardzhikliev — 2024-07-12

Pneumorachis is the presence of gas in the spinal canal. It is usually a result of trauma or iatrogenic, where it is usually asympomatic and is managed conservatively. However, pneumorachis due to gangrenous inflammation in vicinity is extremely rare and may be considered a sign of poor outcome. Necrotizing soft tissue infections are fulminant and life-threatening entity. In contrast to the localized deep neck infections, they spread swiftly, invading adjacent areas. We present a rare case of retropharyngeal necrotizing infection with involvement of the spinal canal and pneumorachis that has not been published before.

Clinical Case Report: Secondary syphilis in a child with no history of sexual abuse

Regina Célia de Souza Campos Fernandes — 2024-07-15

This pediatric case report details the diagnostic and therapeutic challenges of secondary syphilis in a six-year-old child presenting with oral lesions and perianal condyloma lata. The diagnosis was confirmed through the Venereal Disease Research Laboratory (VDRL) test, and successful treatment was achieved with benzathine penicillin. The case presented significant diagnostic complexities, necessitating the evaluation of three potential transmission routes: late congenital syphilis, sexual abuse, and non-sexual transmission. Late congenital syphilis was excluded based on the absence of typical symptoms such as bone and dental abnormalities and neurosensorial deafness. Sexual abuse was thoroughly investigated and ruled out following an extensive four-month evaluation by a multidisciplinary team comprising a psychologist, nurse, social worker, and pediatric infectious disease specialist. Ultimately, non-sexual transmission, likely from an untreated family member, emerged as the most plausible cause, supported by the observation of overcrowded living conditions and inadequate hygiene practices in the child's environment. This case underscores the necessity of comprehensive diagnostic evaluations, including consideration of all possible transmission routes, in managing pediatric syphilis. Public health interventions focusing on improving living conditions and hygiene practices are essential to prevent similar cases.

Effectiveness of the Therasuit Method in the Management of Chronic Non-evolving Encephalopathy: Case Report in Pediatrics

Thaís Alves Andrade — 2024-07-22

Cerebral palsy (CP) is a non-progressive neurological condition that affects motor and postural ability, resulting from a static brain lesion. Early and intensive physical therapy intervention can promote significant improvements in the functionality and quality of life of affected individuals. To report the case of a girl with GMFCS level IV spastic quadriparesis, highlighting the clinical evolution and benefits of an intensive physicaltherapy approach from the first months of life. A female patient diagnosed with cerebral palsy started physiotherapy at three months of age, with an intervention plan that included sessions two to five times a week. Gross motor function was assessed using the GMFM scale, as well as qualitative analysis of videos and progress records. The patient showed significant improvements in her motor skills, including the ability to crawl, sit without support, and transfer positions independently. The patient's case report illustrates the positive impact of early and intensive physiotherapeutic intervention in children with cerebral palsy. This case underlines the importance of continued follow-up adapted to individual needs, emphasizing the capacity for neuroplasticity and the functional improvement that can be achieved, reinforcing the need for personalized and intensive treatment strategies to maximize developmental potential in patients with CP.

Malignant Rhabdoid Tumor of the Kidney in an 11-Month-Old Child: Case Report and Literature Review

Laura Mendes Lopes — 2024-07-24

Malignant renal tumors represent about 6% of childhood tumors, with rhabdoid tumors (RT) being rare, accounting for approximately 2% of pediatric renal tumors. These tumors are notoriously aggressive, with a five-year survival rate of only 22%, and are often diagnosed at a metastatic stage. RT is associated with mutations in the SMARCB1 gene, but recent studies have identified relevant epigenetic characteristics. Treatment approaches include radiotherapy, chemotherapy, and surgery. Despite significant advancements in understanding these tumors in recent years, RT still presents considerable challenges in terms of treatment and prognosis, which remains poor. This case describes an atypical presentation of invasion and tumor expansion in a rare pediatric renal tumor, resulting in alterations in the patient's venous drainage, a condition that has not been previously documented in the literature.

Acute Obstructive Abdomen Due to Gallstone Ileus: Case Report and Literature Review

Fabricio Grenteski — 2024-08-08

Gallstone Ileus is a rare complication of cholelithiasis and one of the rarest forms of mechanical intestinal obstruction. It occurs in 0.3% to 0.5% of patients with cholelithiasis and is responsible for 1% to 4% of cases of mechanical obstruction. It is caused by the impaction of gallstones in the gastrointestinal tract after passing through biliary-enteric fistulas. The diagnosis is often delayed or missed due to the non-specificity of symptoms, leading to a reserved prognosis with high mortality and morbidity rates. Although the treatment and management of gallstone ileus remain controversial, the primary therapeutic goal is the extraction of the stone through a surgical approach. This case aims to describe a rare instance of intestinal obstruction due to gallstone ileus, where the stone was eliminated with clinical measures combined with surgery to correct a choledochoduodenal fistula.

Multiple endocrinopathies acquired using a checkpoint inhibitor - Pembrolizumab: A Case Report

Gustavo César Sola Barreto Marcelino — 2024-08-12

Immunotherapy with checkpoint inhibitors (ICIs) has been increasingly employed for the treatment of many malignancies, and endocrinopathies are one of their most frequent side effects. This case report describes a 70-year-old man who faced many endocrinopathies (primary hypothyroidism, secondary adrenal insufficiency, and diabetes mellitus) after initiation of immunotherapy with an ICI (pembrolizumab) for treatment of urothelial bladder cancer. We discuss the prevalence, physiopathology, screening, and diagnosis of each of these abnormalities. Clinicians need to be aware of these endocrine complications of ICI therapy and be ready for early diagnosis and appropriate management.

Briefly highlighting some unseen evidence of two comorbid COVID-19 patients

Abdullah — 2024-08-14

In recent years, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused substantial morbidity and mortality worldwide. Comorbidities have negatively impacted the pandemic of coronavirus disease 2019 (COVID-19). This case report discusses the data of two deceased individuals with COVID-19 and pre-history of chronic infections in Pakistan. COVID-19 positivity of the patients was based on RT-PCR at early hospitalization. Similarly, the patients were undergone through the chest X-ray, which exposed COVID-19 pneumonia with left lung effusion. All laboratory parameters including hematologic (e.g., total leucocyte count and hematocrit) and inflammatory biomarkers (e.g., C-reactive protein, prothrombin time, activated partial thromboplastin clotting time, D-dimer and serum ferritin) of the deceased candidates were highly abnormal on day one onward. Septic shock, neutrophilia, lymphopenia, thrombocytopenia and leukocytosis were evident in both cases. Despite giving full-fledged treatments, patients conditions deteriorated rapidly, retaining CO2 with low oxygen saturation. Blood pressure and oxygen saturation markedly dropped and turned to cardiopulmonary arrest at the final stages in each case. These findings confirm the impact of comorbidities on COVID-19 severity, based on remarkable changes in laboratory parameters. Current report suggests extensive monitoring of COVID-19 comorbid individuals to reduce morbidity and mortality.

Colorectal anastomosis dehiscence - a solution with quality of life – Case Report

Fabíola Amado — 2024-08-15

Rectal cancer is the fifth most frequent neoplasm in both sexes in Portugal. Anterior rectal resection has become the gold standard in the treatment of this condition and surgical treatment is the only cure. The rate of low rectal anastomotic leak (AL) is approximately 10% of all ALs in colorectal surgery. Management of AL is variable and could be challenging. Endo-SPONGE (a type of endoscopic vacuum therapy (EVT)) has been applied in the management of ALs after colorectal surgery. In the literature, EVT has been shown to accelerate wound healing by increasing local blood flow, reducing bacterial load and stimulating the growth of granulation tissue; it has the advantages of being less invasive than surgery, reducing hospital stay time and reducing the risk of complications; however, it can present some risks such as bleeding, infection, intestinal perforation and intestinal obstruction. In this paper, we describe EVT as a method for treating AL after rectal resection that appears to be a minimally invasive, safe and effective treatment modality for patients with a significant colorectal leak without any generalized peritonitis with high clinical and technical success rates.

Pancreatobiliary diseases in a patient with spontaneous perforation of duodenal diverticulum: a case report

Lucas Terasoto — 2024-08-20

Duodenal diverticula are most found in the second portion of the duodenum. They may be associated with pancreatobiliary diseases, such as choledocholithiasis and acute pancreatitis, though the understanding of this relationship remains limited. Other complications, such as spontaneous perforation of these diverticula, are rare and severe, often requiring surgical intervention and carrying high morbidity and mortality rates. In this article, we review the literature on this topic and describe the case of a patient with biliary acute pancreatitis and choledocholithiasis associated with retroperitoneal air due to duodenal diverticulum perforation. The patient was managed with conservative treatment for the perforation and clinical management of the pancreatitis, followed by endoscopic treatment of the choledocholithiasis.

Hand Rejuvenation with Novel Calcium Hydroxyapatite Dermal Filler (Stiim): a Case Report

Matheus Kasai — 2024-09-03

The report investigates hand rejuvenation using a novel dermal filler based on calcium hydroxyapatite. Hands undergo aging due to environmental factors and age-related changes. We present a case report of a patient who received applications of the product on the dorsum of the hand, exhibiting visible improvement in volume and reduced visibility of veins and tendons. Aesthetic evaluation indicates a 'very much improved' outcome, both for the physician and the patient. This report highlights the promising application of the novel dermal filler for hand rejuvenation.

Liver Abscess Secondary to Duodenal Perforation After Fishbone Ingestion: A Case Report

Fernanda Pombo Rodriguez — 2024-09-16

Even though ingestion of a foreign body is a common situation in the emergency department, the complications of a perforation of the gastrointestinal tract that develops into a liver abscess are rare. Early suspicion and diagnosis lead to lower morbidity and mortality. This case involves a 63-year-old man who had a history of swallowing a fish bone, followed by abdominal pain, fever and vomiting. The diagnosis of liver abscess due to possible perforation of the duodenum was made on abdominal tomographic imaging. Far from removal, the usual treatment for foreign bodies in the gastrointestinal tract, the decision was made in this case to leave the stent in situ, combined with transhepatic percutaneous drainage of the abscess and endovenous antibiotics. The patient developed well with early discharge from hospital and outpatient follow-up care.

Test With Oral Administration of Clomiphene May Add to Differential Diagnosis of Severe Hyperandrogenism in Postmenopausal Women - A Case Report

Yasmin Rodrigues de Camargo Sartori — 2024-09-18

A 62-year-old female patient, in menopause since the age of 47, presented with severe and virilizing hyperandrogenism condition that had been progressing for 10 years, with plasma testosterone levels above 500 ng/dL. Medical history included Cushing 's disease in remission since hypophysectomy in 2014 and obesity. On imaging tests, there was an adenoma in the left adrenal gland with normal ovaries. Serum DHEA-sulfate concentrations, however, were normal and pelvic ultrasound and magnetic resonance imaging showed no ovarian lesions. Given the etiological doubt of hyperandrogenism, ovarian or adrenal, an additional test was necessary. However, serum gonadotropin concentrations were low, preventing testing with a GnRH analogue. A test was carried out with Clomiphene - a selective estrogen receptor modulator that stimulates the secretion of gonadotropins - at a dose of 50 mg/day orally for 5 days. Serum testosterone concentrations increased from 670 ng/dL, pre-use, to 893 ng/dL post-use, suggesting ovarian origin. The patient underwent bilateral oophorectomy and a Leydig cell tumor was confirmed. Therefore, we suggest that in women with hyperandrogenism of undefined origin, with suppressed concentrations of plasma gonadotropins, a clomiphene administration test be performed. The significant increase in plasma testosterone concentrations is indicative of the ovarian origin of the condition.

Primary T-Cell Lymphoma of the Prostate in a Dog – Case Report

Marina Laudares Costa — 2024-09-25

The prostate gland is considered an accessory sexual organ of the male reproductive system which in dogs can vary in size influenced by age, weight and breed. The most frequent anomalies found in the canine prostate are due to Benign prostatic hyperplasia, prostatitis, abscesses, prostatic and paraprostatic cysts, squamous metaplasia and prostate neoplasia in adult and geriatric dogs. Prostate lymphoma, unlike some neoplasms, is not routinely seen. An abnormal prostate is presumptively diagnosed based on the patient’s history and clinical signs, blood markers and abnormal anatomical outline detected on palpation and imaging. The present report describes the case of a 13-year-old male, 26 kg, intact dog, referred to the Centro Universitário Barão de Mauá Veterinary Campus manifesting dysuria and diagnosed with primary prostatic lymphoma.

Obstructive Jaundice Due to Hydatid Cyst: Case Report

Beatriz Cuiabano Arruda Borges — 2024-10-02

Hydatid cyst is a parasitic disease caused by Echinococcus granulosus, common in endemic regions and characterized by the development of cysts in the liver or lungs. This report describes the case of a 25-year-old patient from a rural area in southern Brazil who presented with obstructive jaundice caused by a large hepatic hydatid cyst. The diagnosis was confirmed through imaging exams (MR cholangiography) and serology. Treatment consisted of albendazole administration followed by successful surgical excision of the cyst, with no complications. The patient showed positive progress and was discharged on the tenth postoperative day. This case underscores the importance of early diagnosis and proper management of hydatidosis, as well as the need for control strategies in endemic areas.

Septic Shock Caused by Aeromonas veronii in a Patient with Chronic Liver Disease: a Case Report

Débora Lopes — 2024-10-06

Aeromonas species are gram-negative bacilli found in freshwater or brackish water. This infection is acquired in the community through the consumption of contaminated water and food, as well as through traumatic wounds in contact with contaminated soil or water. A 44-year-old man, with a history of chronic liver disease and significant alcohol consumption, was brought to the Emergency Department (ED) with complaints of nausea and food-related vomiting, associated with jaundice, fever, and night sweats for 5-6 days, as well as epistaxis. He denied other complaints. A few days prior, he had gone fishing and, on physical examination, presented with multiple cuts on both feet. Laboratory tests revealed hematological, renal, and hepatic dysfunction. Microbiological screening showed positive blood and urine cultures for Aeromonas veronii. The patient was admitted to the Intensive Care Unit (ICU) with septic shock and multiorgan dysfunction, progressing to refractory septic shock, and eventually passed away. Aeromonas veronii bacteremia was associated with gastrointestinal symptoms, such as abdominal pain, presented by the patient. Sepsis caused by this bacterium is more frequent in immunocompromised patients, such as those with chronic liver disease, and is associated with a higher mortality rate.

Glomus Tumor in the Tracheal Region: Case Report

Leonardo Rodrigues Fusco de Souza — 2024-10-17

This report presents a rare case of a glomus tumor in the mediastinal trachea. A 53-year-old man with tracheal stenosis underwent invasive procedures until the discovery of a benign tracheal lesion in the form of a glomus tumor. Diagnosis was made through bronchoscopy and chest tomography, and the patient was treated surgically with bronchoscopy and cryoablation. After recurrence, a mediastinal tracheoplasty was performed. In addition to the rarity of this type of tracheal lesion, we found it important to report this case, as remembering glomus tumor in benign lesions may assist the medical community involved in treating this condition in making the correct therapeutic decisions for this surgical pathology.

Bispectral analysis in a patient scheduled for thoracic aortic aneurism surgery: spurious values?

Plinio de Oliveira Holanda — 2024-10-21

Bisspectral analysis (BIS®) may be the most used way to measure the depth of anesthesia. As a simple device, the monitor can show doctors values captured by a sensor attached to the patient's forehead. These values vary from zero (very deep anesthesia) to 100 (awake patient). Ideally, BIS® should be between 40 and 60 during general anesthesia, but spurious values have been described in some articles, and in this case report, we show a situation that may never been reported in the literature.

Bilateral Comminuted Mandibular Fracture Caused by Gunshot Wound: Case Report Using Prototyping to Assist Surgical Planning

Julia Tavares Palmeira — 2024-10-27

The mandible is one of the facial bones most frequently affected in maxillofacial trauma, and firearm projectiles have shown an increase in incidence among the etiological factors of these fractures. Choosing the optimal timing for surgical intervention is challenging, given the degree of bone comminution and the potential complications that these fractures can present. This paper reports the case of a 36-year-old male patient, with poorly controlled diabetes, admitted to an intensive care unit in a municipal tertiary hospital of the public network in Fortaleza, Ceará, Brazil, as a victim of multiple gunshot wounds. Facial computed tomography showed a comminuted bilateral mandibular body fracture with the presence of metallic structures compatible with projectile fragments. The treatment plan was staged in two surgical phases, beginning with surgical debridement and maxillomandibular fixation. Next, pre-molded 2.4 mm reconstruction plates were installed on a 3D-printed prototype. The patient progressed without complications or clinical complaints and remained under clinical and radiographic follow-up during the postoperative period. Thus, it can be concluded that the use of three-dimensional prototypes for pre-molding reconstruction plates is an excellent tool for achieving proper plate adaptability to the bone profile and for reducing intraoperative time.

Tamoxifen Retinopathy. An Uncommon but Serious Complication: Case Report

Lucas Linhares Pierre — 2024-10-29

Tamoxifen is a selective estrogen receptor modulator most widely used in the treatment of hormone-dependent breast cancer. We describe a case of a 51-year-old woman treated with tamoxifen for 4 years who had gradual diminution of vision in both eyes of three months duration. On examination, visual acuity was 20/40 in the right eye and 20/50 in the left eye. A fundus examination revealed bilateral symmetric crystalline deposits in the macula. There were characteristic structural changes on spectral domain-optical coherence tomography, including abnormalities of the ellipsoid zone and outer nuclear layer. Subsequently, tamoxifen was switched to anastrozole. Despite cessation of tamoxifen, her vision did not improve. The clinical presentation of tamoxifen retinopathy is discussed, along with the importance of regular ophthalmic examination for individuals receiving tamoxifen, even in low doses.

Freiberg’s Infraction in the Context of Systemic Lupus Erythematosus

Dilara Bulut Gökten — 2024-11-01

Freiberg disease is a rare but clinically significant form of osteonecrosis that can affect the heads of all metatarsal bones, with a particular tendency to involve the second metatarsal. This disease was first identified in 1914, when Alfred Freiberg reported cases of infraction in the second metatarsal head. Several mechanisms have been proposed to explain the cause of the disease, with the most widely accepted being microtrauma, vascular insufficiency, and systemic diseases. Systemic lupus erythematosus (SLE), diabetes mellitus and hypercoagulability are the diseases most frequently cited as contributing to Freiberg’s disease. This report discussed two female patients diagnosed with SLE and presented with pain and swelling in feet, following clinical examination and radiographic evaluation, the patients were diagnosed with Freiberg disease. An orthopedist was consulted, and a multidisciplinary treatment approach was prescribed. Among the osteonecroses associated with SLE, no studies specifically addressing Freiberg's disease have been found in the literature. This case differs from those in the literature as it specifically describes Freiberg infarction in two patients diagnosed with SLE. This rare condition can complicate the course of systemic diseases and diminish patients' quality of life. Early recognition by clinicians and ongoing monitoring may help slow disease progression.

A Case of Quadruple Trouble: SLE's Multi-System Onslaught

Marwa Morgom — 2024-11-07

This case report presents a diagnostic challenge in a 27-year-old Sudanese female with no past medical history who presented to the emergency department with progressive shortness of breath and pleuritic chest pain. Investigations revealed a constellation of findings suggestive of systemic lupus erythematosus (SLE) with serositis, pleuritic chest pain, pericardial effusion, pleural effusion, and positive autoimmune markers. However, the case became further complicated by the development of acute kidney injury (AKI) and the discovery of a fixed inferior vena cava (IVC) thrombosis during her hospitalization. This report highlights the complexities of SLE presentation, particularly the potential for coexisting diagnoses and the importance of a comprehensive diagnostic approach.

Bilateral Extracranial Internal Carotid Artery Dissection: Interventional Management – A Case Report

Payam Sasannejad — 2024-11-16

Traumatic internal carotid artery dissection (ICAD), particularly in bilateral cases, is a rare but life-threatening condition that poses diagnostic and therapeutic challenges. The cervical segment of the internal carotid artery (ICA) is especially vulnerable to injury following blunt trauma, often leading to significant neurological sequelae. Despite established guidelines advocating conservative management as the initial approach, the optimal timing and criteria for endovascular intervention remain areas of ongoing investigation. We report the case of a 38-year-old female who presented with bilateral extracranial ICAD following a motor vehicle accident. Initially, the patient exhibited right hemiparesis and aphasia, and imaging confirmed left extracranial ICAD without critical stenosis or pseudoaneurysm formation. Conservative management with dual antiplatelet therapy was guided by imaging findings and risk assessment and led to temporary symptomatic improvement. However, the patient returned on the eighth day with left hemiplegia and loss of consciousness, prompting further imaging that revealed bilateral dissection and right anterior cerebral artery infarction. Given the failure of medical therapy, endovascular stenting was performed, achieving successful revascularization and symptomatic improvement. The management of traumatic ICAD, particularly bilateral cases, necessitates careful risk assessment and timely intervention. Our case highlights the importance of imaging in guiding the decision-making process and balancing conservative versus invasive management strategies. Endovascular stenting, although effective, should be reserved for cases with progressive symptoms or when medical management fails. This report contributes to the limited literature on bilateral traumatic ICAD and underscores the need for further research to establish evidence-based guidelines for the management of such cases. Future studies should compare the outcomes of conservative, surgical, and endovascular interventions to optimize patient care and improve prognostic outcomes.

Aortic Trauma: A Rare Case Report

Carolina Lacerda Rodrigues — 2024-11-17

Blunt aortic trauma (BAT) is a rare but critical condition in emergency medicine, with a high mortality rate ranging from 75% to 90%. This trauma typically results from high-energy impacts, such as car accidents, falls from great heights, or severe chest trauma, causing significant damage to the aorta, including lacerations, dissections, intramural hematomas, or even complete aortic rupture. Advanced imaging technologies, such as computed tomography (CT) and transesophageal echocardiography, have recently improved the accuracy of diagnosing aortic injuries, especially in hemodynamically unstable patients. However, the optimal treatment for BAT remains a topic of debate. While endovascular repair is generally preferred due to lower procedural risks and better long-term outcomes, open surgery is still recommended in specific cases, particularly when the injury is extensive or located in critical areas of the aorta, such as the aortic arch. This case report discusses the clinical decisions for a patient with blunt aortic trauma, detailing the choice of open surgery and exploring the challenges of postoperative treatment. Our aim is to contribute to the existing literature by providing insights and recommendations that may assist healthcare professionals in managing similar cases.

Lymphedema due to Podoconiosis in Brazil

José Maria Pereira de Godoy — 2024-11-18

Podoconiosis is a neglected tropical disease that causes a type of progressive, non-infectious tropical lymphedema. Aim: The aim is reported one case of the one woman that presented always having problems with allergies and “lumps” appeared on the hallux of the right foot; it resembled a callus, which never disappeared and increased in size. The physical exam revealed several hardened nodular lesions in both feet involving the soles. The patient was submitted to intensive treatment for lymphedema using the Godoy Method® for the lower limbs for five days. The nodules were hardened and constant from the beginning. However, intensive treatment led to a reduction in the volume of the lesions, enabling better plantar flexion and extension as well as a gain in ambulation. However, the characteristics of the evolution of the condition, symptoms and the occurrence of nodules on velvety skin with a mossy kept appearance because are characteristics of podoconiosis. Podoconiosis may have other causes beyond those reported in literature, likely related to the exposure of the limb and associated immunological abnormalities.

Alternative Treatment for Iatrogenic Dermatoporosis

Fernanda Cassain — 2024-11-21

A healthy 60-year-old female patient, with a history of Quervain's Syndrome, presented with corticosteroid-induced dermatoporosis after receiving intra-articular corticosteroid injections. She experienced skin fragility and aesthetic discomfort due to dermal atrophy and a violaceous macule at the injection site. Treatment with calcium hydroxyapatite (CaHA) biostimulator was initiated, resulting in significant improvements in skin quality and pigmentation. Following two sessions, the patient reported enhanced self-esteem and satisfaction with the treatment outcomes. This case underscores the potential of CaHA as an effective therapeutic option for managing early stages of dermatoporosis.

Neonatal Chlamydial Conjunctivitis

Nathalia da Cruz Assad Monteiro — 2024-11-21

Infection with Chlamydia trachomatis (CT) during pregnancy can result in serious outcomes, including miscarriage, stillbirth, low birth weight, prematurity, neonatal conjunctivitis, and neonatal pneumonia. Despite these risks, routine screening for CT during pregnancy remains infrequent, limiting the opportunity for timely intervention. This report describes a case of neonatal conjunctivitis due to CT in a 9-day-old infant born vaginally to a 15-year-old primigravida. The infant was presented with purulent discharge, eyelid edema, and pustules on the face and neck. The mother had significant risk factors, including adolescence, multiple sexual partners, and untreated vaginal discharge during pregnancy. The conjunctivitis appeared five days postpartum, with a diagnosis confirmed via real-time PCR from conjunctival scrapings. Treatment with intravenous oxacillin, ceftriaxone, and clarithromycin led to full recovery without the development of pneumonia. This case underscores the need to identify maternal risk factors, such as adolescent age, multiple sexual partners, and untreated vaginal discharge during pregnancy, and highlights the importance of enhancing prenatal screening and implementing routine STI testing to prevent neonatal complications.

Thromboembolectomy in a Patient with Acute Arterial Occlusion in the Lower Limb and Complex Postoperative Evolution: Challenges in Emergency Hospital Practice

Juan Manuel Yampara Guarachi — 2024-11-21

We report the case of an elderly patient presenting with acute arterial occlusion of the lower limb, diagnosed and treated with emergency thromboembolectomy. The patient experienced postoperative complications, including reperfusion syndrome with acute kidney injury requiring dialysis support, as well as a urinary tract infection treated with antibiotic therapy. The clinical and laboratory evolution was closely monitored, culminating in discharge with recommendations for outpatient follow-up. This case highlights the challenges of managing acute arterial occlusions in elderly patients, focusing on complications associated with the procedure and prolonged hospitalization.

Case report: The use of Venovenous Extracorporeal Membrane Oxygenation in the Treatment of Acute Respiratory Distress Syndrome in Severe Leptospirosis

Fernando de Oliveira e Silva Neto — 2024-11-22

Leptospirosis is a globally distributed zoonosis with a clinical spectrum ranging from mild febrile illness to life-threatening disease, that can result in acute kidney injury (AKI) and severe pulmonary complications such as alveolar hemorrhage and acute respiratory distress syndrome (ARDS). We present the case of a 20-year-old man with fever and respiratory distress, diagnosed with ARDS and AKI. Venovenous (VV), extracorporeal membrane oxygenation (ECMO) and sustained low-efficiency daily dialysis (SLED) were initiated. The patient showed significant respiratory improvement after eight days and renal recovery after seventeen days. Leptospirosis serological conversion confirmed the diagnosis. This case highlights the potential of VV ECMO as an effective supportive therapy in severe respiratory failure secondary to leptospirosis. Early recognition and aggressive management, including ECMO and daily dialysis, may enhance outcomes in severe pulmonary leptospirosis.

Anesthetic Management of a Patient with ARC Syndrome - Arthrogryposis, Renal Dysfunction, and Cholestasis: A Case Report

Beatriz Figueiredo Mota Diniz Costa — 2024-11-25

ARC Syndrome, characterized by arthrogryposis, renal dysfunction, and cholestasis, is a rare genetic disorder often resulting in early mortality due to complications such as bleeding. This report details the anesthetic management of a 14-year-old male with type 1 ARC Syndrome, scheduled for gastrostomy and incisional hernioplasty due to severe malnutrition. The patient was presented with minor but relevant oral bleeding during surgery and, after receiving desmopressin, platelets transfusion and tranexamic acid, was able to be safely extubated. This case underscores the importance of thorough pre-anesthetic evaluation and tailored management strategies to address unique challenges presented by ARC Syndrome, particularly concerning coagulopathy and airway management. While existing literature on anesthetic approaches for ARC patients is limited, strategies such as desmopressin and tranexamic acid may offer benefits in managing bleeding tendencies, warranting further investigation into their effectiveness in this context.

Femoral Shaft Fracture with Popliteal Artery Injury: A Case Report of a Gunshot Wound

Noémie Fourcroy Maillard — 2024-11-25

This study reports the case of a 28-year-old male patient with a femoral shaft fracture and popliteal artery injury following a gunshot wound. Initial evaluation revealed the absence of pedal pulse and delayed capillary refill, with radiography performed to confirm the fracture and Doppler ultrasound for vascular assessment. The patient had a dynamic condylar screw (DCS) plate installed during a previous surgery, adding complexity to the treatment. Surgical intervention included repair of the femoral artery and vein and popliteal artery anastomosis. This report highlights the importance of early diagnosis, including the use of Doppler ultrasound to detect typical vascular injuries, and a multidisciplinary approach to ensure restored perfusion and prevent postoperative complications.

The Cardiac pathophysiology of Covid-19

Hubert Daisley — 2024-11-27

The heart is a key target organ in SARS-CoV-2 infection. During the illness stage of acute Covid-19, fibrin thrombi frequently form within the coronary microcirculation, including the vasa vasorum. These thrombi are predominantly located in the abluminal spaces, the sites of pericyte location, of the vessel wall, in both the microvascular and epicardial vessels. A hallmark histopathological finding is the presence of diffuse, focal fibrin deposits surrounding myocardial fibres, which exhibit varying degrees of degeneration and atrophy. This process contributes to myocardial injury, which is reflected both biochemically and clinically in the acute and long-term phases of Covid-19. Myocardial fibrosis results from this pathological cascade, without a concurrent cellular inflammatory response associated with the myocardial stromal fibrin deposits. During the convalescent stage of acute Covid-19, focal myocardial fibrosis and the presence of thrombi within myocardial vessels remain apparent but sparse. Vascular changes, such as fibrin thrombi within the cardiac microcirculation, exhibit similarities to those observed in the pulmonary microcirculation in Covid-19.

In Covid-19, the vascular findings of fibrin thrombi deposits within the cardiac micro vascular circulation are like those seen within the pulmonary microcirculation.

Effects of Low-Level Laser Therapy in a Black Patient Victim of Facial Burn: A Case Report

Iago Barbosa Vidal — 2024-11-30

Burns are injuries resulting from exposure to thermal, chemical, or electrical sources, ranging from small blisters to deep lesions affecting the skin, subcutaneous tissues, tendons, muscles, and bones. Although Low-Level Laser Therapy (LLLT) is widely recognized in the literature as an adjunctive treatment for burns, its application in Black patients remains limited. This case report describes the treatment of a Black patient with facial burns using LLLT with infrared laser (4 Joules per point) and red laser (1 Joule per point), both at a power of 100mW. The results indicated that LLLT is promising, reducing the length of hospital stay, minimizing infections, and improving quality of life, while also providing analgesia, comfort, and accelerating healing. The technique also contributed to aesthetic and functional rehabilitation, enhancing the patient’s self-esteem. However, due to the scarcity of studies in the literature regarding this therapy in Black patients, there is a pressing need for irradiation protocols supported by robust clinical trials, including significant samples that consider the severity of burns, skin color, age, and location of the injuries.

Management of Gunshot-Induced Mandibular Fracture in a Young Patient Using External Fixation: A Case Report

Diego Learth Lima — 2024-11-30

The management of gunshot wounds to the face represents a significantly complex challenge due to the need for meticulous surgical interventions. This study aims to report the efficacy of external fixators in treating comminuted mandibular fractures caused by gunshot trauma in a 16-year-old patient. The patient presented to an Oral and Maxillofacial Surgery and Traumatology service with edema, malocclusion, mandibular mobility, spontaneous pain, oral mucosal laceration, paresthesia in the mandibular region, and multiple entry and exit gunshot wounds on the face. Facial computed tomography revealed a frontal sinus fracture, comminuted mandibular body fracture, left zygomatic arch fracture, and right zygoma fracture, in addition to fragments consistent with firearm projectiles adjacent to the right and left mandible, glabella region, and soft tissues on the left side of the face. Given the patient’s clinical complaints, the proposed treatment involved surgical removal of the projectiles under general anesthesia and the use of an external fixator for mandibular fracture stabilization. The patient progressed without complications or clinical complaints, with follow-up over six months showing bone consolidation, satisfactory occlusion, and no clinical or imaging signs of infection. It is concluded that the use of external fixators in comminuted mandibular fractures is an effective approach, ensuring good recovery, preserving aesthetic and functional outcomes, and minimizing the risk of infections and other complications.

Adult T-Cell Leukemia/Lymphoma in the Interior of Bahia: A Case Report

Guilherme Oliveira Santos — 2024-12-01

Adult T-cell leukemia/lymphoma (ATLL) is a peripheral T-cell neoplasm caused by HTLV-1, most common in endemic regions such as Japan, the Caribbean, and Latin America. This report describes the fatal case of a male patient in the state of Bahia, Brazil. ATLL is an aggressive disease with a poor prognosis, diagnosed by HTLV-1 serology and hematologic analysis. Treatment includes combination chemotherapy and antiretrovirals, but the response is usually unsatisfactory. This case highlights the importance of early diagnosis and targeted treatments. It is essential to develop more effective treatment protocols and longitudinal studies to better understand and manage the disease.

An Uncommon and Severe Presentation of a Common Virus – A Case of Varicella Zoster Virus Pneumonia

Cátia Gorgulho — 2024-12-14

Chickenpox is a maculovesicular-papular exanthematic disease caused by primary infection with varicella zoster virus (VZV) and pneumonia is one of its most severe complications, associated with significant morbidity and mortality. A 46-year-old male presented to the emergency department with fever, dyspnea, myalgia and asthenia for the past 24 hours. He had a pruritic maculovesiculo-papular rash on the trunk and scalp, evolving over 4 days, and his 5-year-old daughter had recently been diagnosed with chickenpox. Initial imaging revealed diffuse bilateral pulmonary infiltrates, raising suspicion of viral pneumonia. Based on clinical presentation, radiological findings and epidemiological link, aciclovir therapy was initiated. During the first 24 hours, the patient’s worsening hypoxemia and increased respiratory effort required intensive care unit admission for high-flow nasal cannula oxygen therapy. Polymerase chain reaction (PCR) testing for VZV of skin vesicles and respiratory secretions confirmed the diagnosis. The patient showed clinical improvement within 5 days and was discharged 10 days after admission. This case underscores the importance of high clinical suspicion for VZV pneumonia and prompt treatment. PCR testing remains the gold standard for diagnosis. Early recognition and treatment of VZV-related complications are essential to reduce mortality.

High clinical suspicion and early treatment in patients with VZV infection can significantly reduce associated mortality. It is crucial to consider uncommon viruses that can cause severe respiratory infections, even in immunocompetent individuals.

Blunt Thoracoabdominal Trauma with Multiple Injuries in a Motorcycle Accident: A Complex Case Report in the Emergency Room

Ana Paula de Carvalho Miranda Rosati Rocha — 2024-12-23

This report describes the case of a 53-year-old male involved in a motorcycle collision in Itaboraí, RJ, in August 2024. The patient was admitted to the emergency room in hypovolemic shock and received fluid resuscitation with 1000 ml of Ringer's lactate, resulting in hemodynamic improvement. Initial tests showed a normal hematocrit of 38% and hemoglobin of 12 mg/dl; however, a second test revealed a hematocrit drop to 32%. Contrast-enhanced computed tomography (CT) revealed solid organ injuries, including a grade IV renal injury and a grade III splenic injury, as well as rib fractures and a small left-sided hemothorax. Due to the patient’s hemodynamic stability and the absence of peritoneal irritation signs, non-operative management (NOM) was chosen, with admission to the intensive care unit (ICU) for close monitoring. This report discusses the importance of contrast-enhanced CT for accurate lesion diagnosis and ICU monitoring in NOM cases for complex injuries, highlighting the critical role of the trauma surgeon in patient management.

The Crack Lung – A Case Report

Débora Lopes — 2024-12-24

Cocaine is an alkaloid extracted from the leaves of Erythroxylon coca and was first isolated in 1859. Cocaine induces both acute and chronic toxicity, affecting virtually every organ system. A 32-year-old male patient, with a history of post-traumatic epilepsy and substance abuse involving cannabinoids and cocaine, presented to the Emergency Department (ED) following self-limited seizures. Arterial blood gas analysis revealed hypoxemic respiratory failure, while blood tests showed no significant abnormalities. A thoracic computed tomography (CT) scan demonstrated extensive consolidations in most of the lower, middle, and upper pulmonary lobes. Transthoracic ultrasound suggested signs of non-compacted cardiomyopathy, and pulmonary ultrasound revealed a B-line pattern bilaterally. The patient was admitted to the Intensive Care Unit (ICU), due to respiratory insufficiency requiring invasive ventilation. Over time, his respiratory failure progressively improved, allowing extubation on the eighth day of hospitalization. He was discharged after two weeks and referred for follow-up consultations in Neurology, Psychiatry, and Cardiology. A follow-up CT scan performed three weeks after discharge showed resolution of the pulmonary consolidations and ground-glass opacities. Furthermore, a cardiac magnetic resonance imaging (MRI) study conducted five weeks post-discharge ruled out non-compacted cardiomyopathy. Cocaine-induced lung alterations are diverse and often nonspecific, making their diagnosis reliant on thorough clinical and radiological correlation. In this case, pulmonary parenchymal changes observed on the CT scan and severe respiratory failure raised suspicion for crack lung. Other potential diagnoses, such as cardiogenic and neurogenic pulmonary edema, were excluded.

When Pulmonary Tuberculosis Leads to Pneumothorax: An Unusual Presentation

Catarina Bettencourt Giesta — 2024-12-28

Spontaneous secondary pneumothorax (SSP) is a rare but serious complication of pulmonary tuberculosis (TB), often resulting from cavitary lung disease. A 38-year-old male presented with pleuritic chest pain and fever, with imaging revealing a left-sided pneumothorax and cavitary lesions. Diagnosis was confirmed via sputum analysis positive for Mycobacterium tuberculosis. The patient was treated with standard anti-TB therapy and a chest drain, leading to clinical improvement. SSP in TB occurs due to ruptured subpleural lesions, requiring prompt management of both pneumothorax and TB. Early diagnosis and integrated treatment are essential, particularly in high-prevalence settings.

Anatomical Variations of Bilateral Posterior Circulation and Anterior Cerebral Artery: Case Report and Literature Review

Jonnathan Vianna — 2025-01-06

It is not uncommon to find anatomical variations in the Circle of Willis in healthy individuals. These variations are typically singular or, more rarely, dual, and by definition, would not cause symptoms in the patient. However, reports in the literature suggest that these so-called "arterial variations" may be associated with the development of aneurysms, hemorrhages, and cerebral abnormalities, as well as increasing the risk of vascular insufficiency and severe brain damage during thromboembolic events. We present the case of a 64-year-old woman with complaints of refractory headache, whose magnetic resonance angiography demonstrated the association of three anatomical variations: azygos anterior cerebral artery, true fetal origin posterior cerebral artery, and complete fetal origin posterior cerebral artery.

Acute Acalculous Cholecystitis Associated with Severe Malaria – A Case Report

Teresa Oliveira — 2025-01-07

We present the case of a 29-year-old male diagnosed with severe malaria admitted to the Intensive Care Medicine Service. While undergoing treatment with quinine dihydrochloride and doxycycline, he developed an acute case of acalculous cholecystitis on the fourth day. Conservative treatment with antibiotic therapy was performed, and the patient showed favorable progression. Gastrointestinal complications associated with malaria are common; however, acute acalculous cholecystitis linked to malaria is an extremely rare complication, scarcely described in the literature, and its evolution can be catastrophic.

Mandibular Reconstruction with a Free Rib Graft: Case Report and Literature Review

Kariny Oliveira Silva — 2025-01-07

The reconstruction of mandibular defects is essential to restore facial function and aesthetics in patients undergoing mandibular resections, a treatment indicated in approximately 41.8% of ameloblastoma cases. This study presents a secondary approach to partial mandibular reconstruction using a rib bone graft in the left mandibular body region of an adult female patient who underwent surgical resection of an ameloblastoma in 2019. Ten months postoperatively, the patient has shown reasonable maintenance of bone graft volume. The rib graft proved to be a viable surgical technique for mandibular reconstructions in centers lacking specialized teams for harvesting from other donor sites, as evidenced by this case and cited literature.

The Challenge of Urogenital Tuberculosis Diagnosis in Elderly Patients

Carolina Seabra — 2025-01-14

Recurrent urinary tract infections (UTIs) in elderly patients with comorbidities can present diagnostic challenges. Extrapulmonary tuberculosis, particularly urogenital tuberculosis, is a rare but important cause of persistent genitourinary symptoms. We describe the case of an 83-year-old female with hypertension, diabetes, chronic kidney disease, and obesity who was repeatedly hospitalized for UTIs. In December 2023, she presented with progressive weakness, suprapubic pain, and altered urine despite prior antibiotic treatment. Imaging showed important bilateral pyelocalyceal dilation. She was diagnosed with urinary retention and remained catheterized. In February 2024, the patient was readmitted with multi-organ dysfunction, and Mycobacterium tuberculosis was eventually isolated from a urine culture. Despite being referred for treatment, the patient died. This case emphasizes: 1) the need to consider urogenital tuberculosis in elderly patients with recurrent UTIs, particularly in regions where tuberculosis is prevalent; 2) the importance of early diagnosis for appropriate and timely treatment, fundamental for a favorable outcome of a treatable disease. This case highlights the importance of implementing structured diagnostic protocols and educational initiatives to raise awareness of urogenital tuberculosis in elderly patients. Clinicians should prioritize early use of diagnostic tools like urine cultures for Mycobacterium tuberculosis and nucleic acid amplification tests, particularly in high-risk populations, to mitigate diagnostic delays and improve patient outcomes.

Pseudoaneurysm of Muscular Artery in the Thigh Following Low-Energy Trauma: A Case Report

Luis Fernando Rosati — 2025-01-14

This report presents the case of a 38-year-old female who developed a pseudoaneurysm in the left thigh two years after a low-energy fall. Progressive thigh swelling prompted further evaluation. Initial computed tomography (CT) revealed a large vascular lesion, approximately 15 cm, but lacked definitive pseudoaneurysm characteristics. Doppler ultrasound provided diagnostic clarity, demonstrating the characteristic "yin-yang" sign indicative of bidirectional blood flow. The patient underwent successful surgical resection, with an aspirative drain removed on the tenth postoperative day. This case emphasizes the diagnostic complexities of pseudoaneurysms, particularly in delayed trauma presentations, and underscores the vital role of Doppler ultrasound in identifying vascular flow dynamics. Additionally, it highlights the necessity of a multidisciplinary approach in managing complex vascular lesions, combining diagnostic precision and tailored therapeutic strategies.

Surgical Management of Extensive Facial Laceration: A Case Report

Emanoel Italo de Almeida Silva — 2025-01-15

Tissue injuries are common consequences in the care of polytraumatized patients, with traffic accidents, falls, physical assaults, and animal bites being the main etiological factors. This study aims to report the surgical management of extensive facial laceration. A 42-year-old man was admitted to a referral hospital for emergency care in the state of Ceará, Brazil, following a motorcycle accident. On initial examination, the patient was unconscious, under mechanical ventilation via a definitive airway, and presented with multiple facial lacerations, including the midface, lateral border, lingual dorsum, and lower lip. Emergency surgical intervention was indicated for laceration suturing in the operating room. The procedure began with irrigation, debridement, and hemostatic control of the injuries. Sutures were performed sequentially, starting with the lingual dorsum and lateral border, followed by the lower lip, and concluding with layered sutures of the midface lacerations, beginning intraorally and continuing extraorally. A Penrose drain was placed on the right side due to involvement of the parotid gland in the laceration. The patient has been followed up in an outpatient setting for nine months, presenting satisfactory healing without pain or functional complaints. A meticulous understanding of facial anatomy and injury patterns is crucial to ensuring both function and aesthetics for the patient.

Ischemic Stroke in a Child with Sickle Cell Anemia, Patent Foramen Ovale and Moya-Moya Syndrome: The Challenges of Implementing a Secondary Prevention Strategy

Ednaldo França de Oliveira — 2025-01-18

Strokes, traditionally regarded as conditions affecting adults, can also occur in the pediatric population, where their rarity often delays diagnosis. This report describes the case of a seven-year-old boy with sickle cell anemia who was admitted with left-sided motor deficits. The patient had been febrile and recumbent the previous day. Laboratory tests revealed severe anemia (hemoglobin 6.7 g/dL). During hospitalization, a transthoracic echocardiogram identified a patent foramen ovale (PFO) with left-to-right atrial flow and dilation of the left heart chambers. Brain imaging revealed lesions in the vascular border zones, while cerebral angiography confirmed severe stenosis in the internal carotid artery and a Moyamoya pattern. Following an etiological investigation, the symptoms were attributed to an ischemic stroke. Empirical antimicrobial therapy, blood transfusions, and antiplatelet therapy were initiated. Two potential mechanisms for the stroke were identified: PFO and Moya-Moya syndrome (MMS). The coexistence of these rare conditions in a pediatric patient presented unique diagnostic and therapeutic challenges. MMS was considered the primary cause of the stroke due to characteristic imaging findings and the patient’s history of sickle cell anemia. This case highlights the complexities of managing pediatric strokes with dual pathologies and the importance of a multidisciplinary approach. It advances clinical understanding by demonstrating how PFO complicates secondary prevention in MMS and emphasizes the need for individualized treatment strategies and long-term follow-up to optimize outcomes.

Ramsay Hunt Syndrome – Case Report

Joana Freitas Ribeiro — 2025-01-19

Ramsay Hunt Syndrome (RHS) results from the reactivation of the varicella-zoster virus (VZV). Its incidence is approximately 5 per 100,000 people per year. The clinical presentation is variable, with the most common manifestation being ipsilateral facial paralysis, otalgia, and vesicular rash. Several factors increase the risk of herpes zoster and, consequently, the incidence of RHS. A 60-year-old woman presented with left-sided peripheral facial paralysis, otalgia, and vesicles on the ipsilateral auricle and external auditory canal. Laboratory tests and cranioencephalic computed tomography showed no significant acute changes. She was diagnosed with RHS and treated accordingly, subsequently showing a favorable evolution. Studies to date demonstrate the benefit of combined antiviral and corticosteroid therapy. Early treatment initiation, within the first 72 hours, is associated with a better prognosis and minimizes the risk of permanent neurological damage.

Lemierre Syndrome Due to Staphylococcus Aureus Infection and Presenting with Periorbital Cellulitis and Bilateral Abducens Nerve Palsy

Lara Linhares Pierre — 2025-01-18

Lemierre syndrome is an uncommon and potentially fatal condition characterized by head or neck infection, thrombosis/thrombophlebitis of the internal jugular vein, and septic embolization to distant organs. This case report describes a 56-year-old male patient who made a home pimple drainage that resulted in periorbital cellulitis with progression to internal jugular vein thrombosis and septic embolism. Ophthalmological examination revealed bilateral abducens nerve palsy. Blood culture was positive for Staphylococcus aureus. He was managed with broad-spectrum antibiotics and anticoagulation. Response to treatment was satisfactory. Lemierre syndrome should be suspected in patients with bacteremia and radiologic imaging of pulmonary embolism or internal jugular vein thrombosis/ thrombophlebitis, even in the absence of signs and symptoms of oropharyngeal infection. Furthermore, uncommon pathogens should be considered conditions, based on the suspected source of primary infection.

Platypnea-Orthodeoxia Syndrome: A Rare Cause of Dyspnea

Joana Freitas Ribeiro — 2025-01-25

Platypnea-Orthodeoxia Syndrome (POS) is a rare and underdiagnosed condition characterized by dyspnea and hypoxia in the upright and sitting positions, which resolve in the supine position. The authors report the case of a 79-year-old woman with progressively worsening dyspnea over three days. In the emergency department, dyspnea and desaturation were observed, requiring increasing oxygen therapy when standing. Laboratory tests, electrocardiogram, and chest computed tomography revealed no abnormalities to explain the condition. Transthoracic and transesophageal echocardiograms identified a right-to-left shunt caused by a large atrial septal aneurysm, which was treated with closure using an Atriasept – CARDIA™ prosthesis. The procedure led to immediate symptom resolution. POS diagnosis is primarily clinical. While cardiac catheterization is the gold standard for diagnosis, echocardiography plays a crucial role in identifying the underlying etiology. Treatment depends on the cause, and this condition is associated with a good prognosis.

Posterior Chordae Rupture of the Tricuspid Valve due to Myocardial Infarction: A Rare Entity Among Tricuspid Valve Pathologies

Endri Balla — 2025-01-28

The tricuspid valve is rarely affected by myocardial infarction. The right ventricle has a lower systolic pressure compared to the left ventricle making the papillary muscles of the tricuspid valve more resistant to ischemia. The right coronary artery is the main blood supply to tricuspid papillary muscles, chordae rupture of the tricuspid valve may occur following myocardial infarction. Here, we present a rare case of a 70-year-old male with severe tricuspid regurgitation, a completely occluded right coronary artery (RCA), 70% stenosis of the left main coronary artery (LMCA), and 100% occlusion of the left anterior descending artery (LAD). The patient’s ejection fraction (EF) was reduced to 30%. Treatment included tricuspid valve repair using the bicuspidization technique and a five-vessel coronary artery bypass graft (CABG). This case demonstrates that, although rare, myocardial infarction can involve the tricuspid valve and that the surgery of the valve with full revascularization proved to be an effective treatment strategy in our patient.

Neuropsychological Profile in Hutchinson-Gilford Syndrome: Analysis of a Rare Case

Marina Maria Barbieri de Souza — 2025-02-11

Hutchinson-Gilford Syndrome, also known as Progeria Syndrome, is a rare genetic disorder that leads to premature aging and accelerates the cellular aging process, affecting the cognitive, motor, and social functions of affected children. This study presents the neuropsychological assessment of two 3-year-old patients diagnosed with the syndrome, aiming to map their cognitive, emotional, and behavioral profiles. The evaluation included interviews with family members, clinical observation, and the application of tests such as the Bayley-III Scale and the Son-R Test. The results indicated significant delays in cognitive, motor, and communicative abilities in both patients, with developmental ages below their respective chronological ages. Based on these findings, a multidisciplinary approach involving speech therapy, occupational therapy, and physical therapy is recommended to stimulate the affected areas and develop family support strategies to promote better social and functional adaptation.

Rehabilitation of the Atrophic Maxilla with the Hybrid All-on-Four Technique Associated with Pterygoid Implants: Case Report

Breno Silva do Amaral — 2025-02-14

The rehabilitation of the atrophic maxilla is a challenge in implant dentistry, requiring effective and minimally invasive techniques. The All-on-Four technique is a well-established alternative, characterized by the placement of four implants in the anterior and posterolateral regions of the edentulous maxilla, providing support for a full-arch implant-supported prosthesis. This approach reduces costs, morbidity, and treatment time. In cases of poor bone quality, adapting the protocol by including pterygoid implants—referred to as the hybrid All-on-Four technique—offers an effective and predictable solution with high success rates. This study presents the rehabilitation of a patient with an atrophic maxilla using the hybrid All-on-Four technique. Six implants, including pterygoid implants, were placed, eliminating the need for bone grafting. The rehabilitation was completed with a full-arch implant-supported prosthesis, ensuring adequate functionality and aesthetics. It was concluded that the hybrid All-on-Four technique associated with pterygoid implants is a safe and efficient alternative for the rehabilitation of atrophic maxillae, particularly in patients with limited bone quality.

Double-Block for Cesarean Section and Hysterectomy in a Patient with Severe Placenta Accreta Spectrum: Are Neuraxial Blocks a Better Option Nowadays? A Case Report

Plínio Holanda — 2025-02-16

The Placenta Accreta Spectrum is an anomaly in the placenta that adheres to the uterus and fails to separate from it at delivery, which can lead to massive hemorrhage. For the anesthesiologist, the decision between general anesthesia (risks of pulmonary aspiration and difficult airway) or neuraxial block (worsening of hemorrhagic shock) is challenging. Vascular surgeons have helped reduce the bleeding for many years, and some techniques are more efficient. Is this the moment to prefer a neuraxial block? We expect to show that both methods are possible, but since the advent of vascular devices, neuraxial blocks are less harmful as these devices can reduce bleeding rates.

Hospital Dentistry Approach to a Patient with Mucormycosis treated with Amphotericin B: Case Report

George Matos Ferreira Gomes Júnior — 2025-02-18

This study addresses rhino-orbito-cerebral mucormycosis, a serious and opportunistic fungal infection, especially in immunosuppressed patients, such as those with type II diabetes mellitus. The study highlights the importance of a multidisciplinary approach in diagnosing and treating this condition, emphasizing collaboration between medical and dental specialties. Through a clinical case, it demonstrates how early and coordinated intervention can minimize the devastating consequences of the infection, underscoring amphotericin B, especially in its liposomal form, as the preferred treatment and the need for surgical debridement. The study reinforces the vigilance and early recognition of mucormycosis symptoms, particularly in patients with risk factors such as uncontrolled diabetes, illustrating the importance of integration between different medical fields in managing complex diseases.

Chronic Quadriceps Lesion with Peroneus Longus Autograft - A Case Report

Diego Escudeiro de Oliveira — 2025-02-23

Chronic quadriceps tendon ruptures are challenging lesions due to persistent inflammation, scarring, and tendon retraction. Although this is a disabling injury, few surgical techniques have been reported for such cases. We describe a 50-year-old Caucasian male who suddenly experienced pain in the anterior region of the knee during skating practice, with no history of direct trauma or known risk factors for associated diseases. He was treated with a modified Wave Puvertalf technique and extensor autograft reconstruction using the peroneus longus tendon.

Clinical Efficacy of Medicinal Plants Formulations for the Prevention of Androgenetic Alopecia in Korean Individuals

Neha Kaushik — 2025-02-25

Androgenetic alopecia (AGA) is the most prevalent form of nonscarring alopecia, characterized by a distinct pattern of gradual hair loss. Despite its non-lethal nature, AGA can exert a profound psychosocial impact, particularly on women and younger men, affecting their quality of life. Standard therapeutic approaches for AGA commonly involve the use of finasteride and minoxidil; however, these treatments are often associated with adverse side effects, particularly with prolonged use. In this study, we present the successful management of AGA in a cohort of Korean individuals, comprising both male and female subjects (totaling 52 participants, with 12 exclusions). Significant reductions in the affected AGA area were observed across the cohort, yielding highly satisfactory outcomes. These findings suggest that the treatment modality employed in this study offers a promising alternative for AGA management in the population, demonstrating efficacy irrespective of gender.

Clinical Repercussions of Guillain-Barré Syndrome: A Case Study and Systematic Review

Lígia Maria Oliveira de Souza — 2025-02-25

Guillain-Barré Syndrome (GBS) is part of a heterogeneous group of immune-mediated polyneuropathies characterized by segmental demyelination accompanied by mononuclear infiltrates in the endoneural tissue and myelin sheaths. It is a rare neurological disorder that primarily affects adults. Its origin is often post-infectious, triggered by an autoimmune response against the peripheral nervous system, which leads to the classic triad: paresthesia, progressive and ascending muscle weakness with areflexia, and, in severe cases, paralysis. Its onset is related to previous infections, often caused by Campylobacter jejuni, cytomegalovirus, or the Epstein-Barr virus. The diagnosis is generally straightforward and is determined through a complete medical history, a neurological examination focusing on identifying the triad, and complementary tests such as electromyography and cerebrospinal fluid analysis. Within days, the cerebrospinal fluid often shows elevated protein levels, while the cellular content remains largely unchanged, resulting in albuminocytologic dissociation. Treatment includes respiratory support in severe cases, intravenous immunoglobulin, or plasmapheresis. Recovery depends on several factors and may take weeks or even months. This study presents the case of a 46-year-old man who developed GBS following a prior infection. The case highlights the diagnostic challenges, clinical progression, and the implementation of treatment.

Its onset is related to previous infections, often caused by Campylobacter jejuni, cytomegalovirus, or the Epstein-Barr virus. The diagnosis is generally straightforward and is determined through a complete medical history, a neurological examination focusing on identifying the triad, and complementary tests such as electromyography and cerebrospinal fluid analysis. Within days, the cerebrospinal fluid often shows elevated protein levels, while the cellular content remains largely unchanged, resulting in albuminocytologic dissociation. Treatment includes respiratory support in severe cases, intravenous immunoglobulin, or plasmapheresis. Recovery depends on several factors and may take weeks or even months.

This study presents the case of a 46-year-old man who developed GBS following a prior infection. The case highlights the diagnostic challenges, clinical progression, and the implementation of treatment.

6q2.31q23.3 Interstitial Deletion: A Rare Prenatal Diagnosis

Beatriz Palmeira — 2025-03-04

Interstitial deletions in the proximal region of the long arm of chromosome 6 are a rare finding, and only a few cases were published. The severity of the condition and the signs and symptoms depend on the size and location of the deletion and which genes are involved. These cases are mainly diagnosed with children or adults presenting various signs and symptoms, such as intellectual disability, developmental delay, growth retardation, cardiac anomalies, and dysmorphic features. Its diagnosis at a prenatal level is an even more rare finding. We present a case of a 29-year-old pregnant woman who was submitted to a chorionic villus biopsy due to a nuchal translucency above the 99th centile. The Array Comparative Genomic Hybridization revealed a pathogenic interstitial deletion of the chromosome 6 at 6q22.31q23.3, involving the EYA4 gene.

We present a case of a 29-year-old pregnant woman who was submitted to a chorionic villus sampling due to a nuchal translucency above the 99th centile. The Array Comparative Genomic Hybridization revealed a pathogenic interstitial deletion of the chromosome 6 at 6q22.31q23.3, involving the EYA4 gene.

Anesthetic Implications of Aortic Arch Aneurysm Repair with Deep Hypothermic Circulatory Arrest and Selective Cerebral Perfusion - A Case Report and an Updated Review

Caio Levate Amaral — 2025-03-07

Deep hypothermic circulatory arrest (DHCA) is a well-established technique offering cerebral protection and optimal surgical conditions for complex cardiovascular and neurological procedures. By cooling the body to 18–20°C, DHCA reduces cerebral metabolic demand, allowing up to 40 minutes of safe circulatory arrest. Extended DHCA is supported by selective antegrade cerebral perfusion (SACP) or retrograde cerebral perfusion (RCP), with SACP preferred for its reliable global oxygenation. Continuous hemodynamic and neurological monitoring, including arterial and central venous pressure, cardiac output, and cerebral oxygenation (NIRS and BIS), is critical for patient safety. This case describes a 62-year-old female undergoing repair of a chronic type I aortic dissection. DHCA with bi-hemispheric SACP was employed, accompanied by hypothermia induction, pharmacological neuroprotection, and tight hemodynamic management. Postoperative outcomes were favorable, with no neurological deficits. Discussion highlights the importance of tailored acid-base, glycemic, and coagulation management strategies. Pharmacological agents, such as barbiturates and corticosteroids, show promise but require further evidence. Combining advanced monitoring techniques enhances safety and outcomes, emphasizing the need for individualized protocols to optimize DHCA efficacy and minimize complications.

This case describes a 62-year-old female undergoing repair of a chronic type I aortic dissection. DHCA with bi-hemispheric SACP was employed, accompanied by hypothermia induction, pharmacological neuroprotection, and tight hemodynamic management. Postoperative outcomes were favorable, with no neurological deficits.

Discussion highlights the importance of tailored acid-base, glycemic, and coagulation management strategies. Pharmacological agents, such as barbiturates and corticosteroids, show promise but require further evidence. Combining advanced monitoring techniques enhances safety and outcomes, emphasizing the need for individualized protocols to optimize DHCA efficacy and minimize complications.

Supernumerary Tooth in Ectopic Position in the Mandible: Case Report

Daiana Arruda do Arruda — 2025-03-10

Ectopic and impacted teeth represent distinct conditions that, when combined, can lead to significant complications, such as damage to adjacent structures. Supernumerary teeth can also cause functional and aesthetic alterations, primarily related to the eruption of permanent teeth. The diagnosis of these conditions requires a clinical and radiographic examination, as well as surgical planning. This article aims to report a clinical case of the surgical removal of an impacted supernumerary tooth, located in an inverted intraosseous position in the mandibular body near the basal cortical bone. A 15-year-old female patient was referred to the Oral and Maxillofacial Surgery and Traumatology service. Computed tomography revealed that the tooth was in continuity with the mandibular base and in close contact with the mental nerve. Surgery is often the treatment of choice to prevent complications such as mandibular fractures and cystic lesions. Each case should be planned individually, and the dental surgeon must be aware of the treatment options and complementary exams to ensure a safe and effective outcome for the patient.

The Importance of Early Initiation of Prenatal Care: A Case Report

Valéria Ronsom Bilinski — 2025-03-26

Accurate determination of gestational age is essential for proper prenatal care management, directly impacting maternal and fetal health. This study addresses the importance of a detailed medical history and thorough physical examination in estimating gestational age. The patient was initially classified as being in an early gestational stage; however, due to the absence of a meticulous clinical examination, the actual gestational age was underestimated. The case highlights the need for a complementary diagnostic approach when clinical uncertainties arise, ensuring more accurate follow-up. Early recognition of pregnancy and correct estimation of gestational age are crucial to reducing complications and improving maternal-fetal outcomes. Therefore, this study aims to reinforce the importance of early physical examination and the support of complementary investigations.

Crohn's Disease with Gastric Involvement: A Case Report

Amanda Gabriele Alves Cobiniano de Melo — 2025-04-02

Inflammatory bowel disease (IBD) encompasses acute or chronic inflammatory processes affecting the gastrointestinal tract, primarily comprising Crohn’s disease (CD) and ulcerative colitis (UC). CD is a transmural and recurrent condition that can affect any segment of the gastrointestinal tract, with gastric involvement being rare, occurring in less than 5% of cases. This report aims to describe a rare case of Crohn’s disease with exclusive gastric manifestation, highlighting the diagnostic challenges and therapeutic strategies employed. A comprehensive clinical and laboratory investigation was conducted, including outpatient interview, laboratory tests, upper gastrointestinal endoscopy, and computed tomography. The findings were analyzed to rule out other diseases with similar symptoms. The diagnosis of Crohn’s disease confined to the stomach was confirmed in a patient whose only complaint was nausea. The treatment was managed clinically and pharmacologically, with no indication for surgical intervention. During follow-up, up to the time of this report, the patient remained free of relapses or complications. Therefore, gastric Crohn’s disease is a rare and diagnostically challenging condition that requires a multidisciplinary approach to exclude other pathologies. Appropriate clinical management allowed disease control and the avoidance of complications, underscoring the importance of early diagnosis and continuous follow-up.

Primary Small Cell Neuroendocrine Carcinoma of the Mediastinum: Case Report of a Rare Entity

Magno Giovani Zanellato — 2025-04-07

Small neuroendocrine carcinoma of the mediastinum (SCNCM) is a rare subtype of neuroendocrine malignancy characterized by its aggressive behavior and high rates of recurrence and metastasis. The diagnosis of this carcinoma is challenging, requiring confirmation through histopathological and immunohistochemical analysis, as well as specific imaging studies. This study reports a case of primary SCNCM that resulted in the death of a 59-year-old female patient treated at the Clinical Hospital, School of Medicine, Botucatu. The diagnostic proposal of primary small cell neuroendocrine carcinoma of the mediastinum was confirmed after a detailed analysis of the organs in an autopsy examination.

Surgically Assisted Maxillary Expansion and Orthognathic Surgery in the Treatment of Hypoplastic Maxilla: An Ortho-Surgical Case Report

Camila Lopes Rocha — 2025-04-16

Skeletal Class III malocclusion, when associated with a moderate to severe discrepancy, compromises not only occlusal and masticatory function but also facial aesthetics, often resulting in a concave profile. In such cases, orthognathic surgery is the treatment of choice. In addition to the maxillary deficiency in the anteroposterior direction, transverse impairment is also common, leading to unilateral or bilateral posterior crossbite. In adult patients, due to skeletal maturation and ossification of the midpalatal suture, Surgically Assisted Rapid Maxillary Expansion (SARME) becomes an effective and indicated alternative. This paper aims to report the clinical case of a young female patient with Class III dentoskeletal deformity associated with maxillary atresia, treated through an orthodontic-surgical approach involving SARME followed by orthognathic surgery. Despite the complexity of the treatment, which included two surgical procedures, it was completed in 20 months—shorter than the average time reported in the literature. This outcome is attributed to the patient's high adherence to treatment and the coordinated effort of a multidisciplinary team.

Harnessing the Power of Scientific Research for Societal Progress

Howard Lopes Ribeiro Junior — 2024-06-14

In an era of rapid technological advancements and complex global challenges, the role of scientific research has never been more critical. Scientific articles are fundamental in disseminating knowledge, guiding policy decisions, and addressing societal issues. The COVID-19 pandemic highlighted the importance of timely and accessible scientific publications in managing public health crises, underscoring the need for rigorous peer review and interdisciplinary research. Evaluating the societal impact of research requires a multifaceted approach that goes beyond traditional academic metrics, embracing open access and alternative metrics. Effective science communication and teaching young scientists about societal impact are essential for fostering a responsible scientific community. The Brazilian Journal of Case Reports is dedicated to promoting the importance of scientific research and invites authors to contribute.

Alternative Method for Airway Approach in Anesthesia of a Newborn with Occipital Encephalocele

Thatiane Noel Ximenes — 2024-09-23

High-Grade Cutaneous Fibrosarcoma

Beatriz Cuiabano Arruda Borges — 2024-10-02

Eagle's Syndrome: from Diagnosis to Treatment

Pedro Abecasis — 2024-10-14

A Rare Case of Pyoderma Gangrenosum Associated with Acute Myeloid Leukemia

Joana Freitas Ribeiro — 2025-01-22

Open-Lip Schizencephaly in Adulthood

Joana Freitas Ribeiro — 2025-01-22

Colloid Cyst of the Third Ventricle – A Rare Cause of Headache

Joana Freitas Ribeiro — 2025-01-22

From Chest X-Ray to CT: Diagnosing Right Aortic Arch with Kommerell´s Diverticulum

Humberto Morais — 2025-03-08

Neurological Symptoms in Cirrhotic Patients – Not Always Encephalopathy

Bárbara Silva — 2025-03-17

Extensive Left Ventricular Thrombosis in a Young Patient: An Unexpected Threat

Humberto Morais — 2025-04-17

Recurrent Spontaneous Coronary Dissection: When the Conservative Strategy Fails

Miguel Bernardino Antunes Vicente — 2025-04-22