Brazilian Journal of Case Reports

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

Mon, 23 Sep 2024 00:00:00 +0000

High-Grade Cutaneous Fibrosarcoma

Wed, 02 Oct 2024 00:00:00 +0000

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

Tue, 18 Jun 2024 00:00:00 +0000

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

Mon, 24 Jun 2024 00:00:00 +0000

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

Thu, 27 Jun 2024 00:00:00 +0000

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

Sat, 29 Jun 2024 00:00:00 +0000

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, Shun Furukawa, Jun Aoyama, Meijin Nakayama — Sat, 29 Jun 2024 00:00:00 +0000

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

Sat, 29 Jun 2024 00:00:00 +0000

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

Wed, 10 Jul 2024 00:00:00 +0000

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, Dinis Zenzela, Domingos Ramos, Lino Gonçalves — Wed, 10 Jul 2024 00:00:00 +0000

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 — Fri, 12 Jul 2024 00:00:00 +0000

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, Enrique Medina-Acosta — Mon, 15 Jul 2024 00:00:00 +0000

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, Bárbarah Carolyne Moreira Rodrigues Antas, Géssika Gislainy — Mon, 22 Jul 2024 00:00:00 +0000

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

Wed, 24 Jul 2024 00:00:00 +0000

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

Thu, 08 Aug 2024 00:00:00 +0000

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

Mon, 12 Aug 2024 00:00:00 +0000

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

Wed, 14 Aug 2024 00:00:00 +0000

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, Alexandra Ferreira, Marta Lamas, Luis Cortez — Thu, 15 Aug 2024 00:00:00 +0000

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

Tue, 20 Aug 2024 00:00:00 +0000

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, Renata Viana — Tue, 03 Sep 2024 00:00:00 +0000

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

Mon, 16 Sep 2024 00:00:00 +0000

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

Wed, 18 Sep 2024 00:00:00 +0000

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

Wed, 25 Sep 2024 00:00:00 +0000

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

Wed, 02 Oct 2024 00:00:00 +0000

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.

Harnessing the Power of Scientific Research for Societal Progress

Howard Lopes Ribeiro Junior — Fri, 14 Jun 2024 00:00:00 +0000

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.