International Journal of Case Reports

Background: There is a positive association between various types of cancer and diabetes. Duodenopancreatectomy is the treatment of choice for diabetic patients with duodenal tumors. Pancreatic resections may trigger endocrine insufficiency. There is an association between poor glycemic control and lower survival rates. Low carb diets appears to be an effective approach in the treatment of diabetic patients that require pancreatic resections. Case Presentation: We report the case of a type II diabetic diagnosed with resectable duodenum cancer. At the time of diagnosis he was jaundiced and with decompensated diabetes. The patient was submitted to a low carb diet for three weeks and, having improved its physiological and metabolic parameters, we performed a duodenopancreatectomy. The patient evolved without complications, with easy management of postoperative glycemia. Conclusions: Low carb diets can prove to be a powerful, inexpensive, and safe tool to add to our therapeutic arsenal before pancreatic resections.

IgG-4 related disease (IgG4-RD) is a chronic inflammatory condition characterized by tissues infiltration with lymphocytes and IgG4 secreting plasma cells, significant fibrosis and response well to steroids. It is typically a systemic disease that involves various organs. We are presenting a 57-year-old female who was found to have elevated serum creatinine, Proteinuria. An ultrasound scan revealed bilateral hydronephrosis and an abdominal computed tomography (CT) scan illustrated a large retroperitoneal mass. Further evaluation of the mass with whole-body positron emission tomography (PET CT) scan was suggestive of retroperitoneal fibrosis or lymphoma. A CT guided biopsy was done, and results were consistent with fibrosis in the context of IgG-4 related disease. IgG-4 serum levels were elevated. The patient was treated with oral steroids. Azathioprine and Rituximab. Renal function improved significantly and was stable upon 3 months follow up with a decrease in IgG-4 levels and with a significant reduction in the mass lesion.

Pneumoperitoneum is mainly caused by viscus perforation, in most cases by ulcer. However, it may be caused by non-surgical causes in 10 % of the cases, such as patients on respiratory support, renal dialysis, paracentesis, and anaerobic bacterial infections. In addition, there are some sporadic causes of pneumoperitoneum; one of them is wisdom tooth extraction, which is described in our case. In the literature review, there were many documented cases of subcutaneous emphysema, pneumothorax, and pneumomediastinum caused by wisdom tooth extraction. However, there was only one case that represented pneumoperitoneum after that procedure. In this case report, We are reporting a case of a 50-year-old male patient who presented one-week status post wisdom tooth extraction, with significant subcutaneous emphysema involving the face, neck, and upper chest; further workup and assessment showed that the patient has considerable pneumoperitoneum, pneumomediastinum, mild pneumothorax bilaterally, and extensive subcutaneous emphysema on computerized tomography. The patient was managed conservatively, with no need for any surgical intervention, and he was discharged home in a good general condition.

Calcium polystyrene sulfonate (CPS), also known as Kalimate, is a cationexchange resin (CER), commonly used to treat hyperkalemia. A case of a patient with chronic kidney disease (CKD) who underwent right hemicolectomy for colonic perforation due to intestinal necrosis secondary to oral CPS administration is presented. The histopathological findings confirmed the colonic ischemia and perforation and showed a luminal deposition of crystals with a fish scale pattern, compatible with CER (Kalimate). This report aims to present and discuss this unusual case considering the most updated scientific evidence.

Methicillin-Resistant Staphylococcus Aureus (MRSA) bacteraemia is associated with high morbidity and mortality. Early identification of a source of infection is critical for appropriate management. MRSA infection can affect any organ system, however infection of the biliary tract is a rare phenomenon. We report on a 67-year-old male who presented with atypical cholecystitis, intra-hepatic collections and MRSA bacteraemia. The patient was managed on a long course of antibiotics following cholecystectomy and surgical drainage of the collections. Our case highlights the importance of considering biliary sepsis as a potential source for MRSA bacteraemia, in order to expedite source control and prevent intra-hepatic abscess formation.

Introduction: Intrahepatic cholangiocarcinoma (ICC) is rare and often diagnosed in an advanced stage. Neoadjuvant therapy is not established and data on its value are in palliative intention. In the case of a recurrence patients often are offered systemic chemotherapy as the only treatment option. We report on a patient with advanced intrahepatic cholangiocarcinoma who underwent multimodal treatment leading to a long-term survival. Case report: A 61-year-old woman presented with an advanced intrahepatic cholangiocarcinoma of the right liver lobe without evidence of metastatic spread. She had already completed two cycles of chemotherapy of Cisplatin and Gemcitabine resulting in stable disease. An extended hemihepatectomy of the right lobe including segments I, IVa and partially IVb was performed. The TNM status (8th edition) was pT2b (3), pN0 (0/6), M0, V1, G2 and R0. Ten months later recurrence was diagnosed and treated with microwave ablation. Recurrence occurred again and the patient underwent repeated resection 22 months after primary resection. After detection of repeated recurrence once more, repeated resection was performed 46 months after initial resection. The patient is still alive and tumor-free 7 years after primary resection. Conclusion: Multimodal treatment including preoperative chemotherapy, complete resection and repeated resection of recurrence as well as microwave ablation led to long-term survival in a case of advanced intrahepatic cholangiocarcinoma. Close follow-ups were crucial to offer the best treatment options.

Background: Tracheal mucoepidermoid carcinoma is a rare form of non-small cell lung carcinoma and is defined as a tumor characterized by a combination of squamous, mucus-secreting, and intermediate cell types. This carcinoma is usually located in the lobar or segmental bronchus. Currently, surgery is the preferred treatment for this disease, which includes pneumonectomy, lobectomy, and sleeve lobectomy. Case presentation: A 50-year-old Chinese male presented with cough, shortness of breath and hemoptysis, and the effect of antibiotic therapy was not good. Subsequently, the airway occupied lesion was found by chest CT, and he was transferred to our hospital for surgical resection. Histologically, the tumor contained squamous epidermal cells, mucoepidermoid cells and intermediate cells. Immunohistochemistrically, the tumor cells were positive for p63, CK5/6, CK7 and Ki67. However, the tumor is generally negative for TTF-1 and neuroendocrine markers. The patient had no recurrence 15 months after the surgery. Conclusions: We report a rare case of mucoepidermoid carcinoma in the distal trachea in which the surgery was difficult and could not be performed like a traditional pulmonary resection. We first provide a comprehensive description of airway management and anesthesia intubation. After surgery, we reviewed the literature and found that PD-1/PD-L1 detection had never been reported in tracheal mucoepidermoid carcinoma. Therefore, we studied the PD-1/PD-L1 pathway in this patient, and the results were negative, which may indicate that potential adjuvant therapy with immune checkpoint inhibitors (ICIs) is not useful in this case.

Covid 19 pandemic has taken away millions of lives. Our understanding of this disease, till to date, is not complete. This disease has a wide variety of neurological manifestations. Acute transverse myelitis is one such rare neurological complication of Covid 19. The exact etiology is not clear. Auto immunity might be one of the possible mechanisms. We report a case of 39-year-old lady, who had recent history of high-grade fever and cough. This was followed by weakness of both legs and in- ability to pass urine. SARS-CoV-2 (PCR) from nasopharyngeal swab was positive. She was found to have features of acute non compressive myelopathy. MRI brain and MRI cervical spine with contrast was normal. MRI dorso lumbar spine with contrast was suggestive of diffuse hyper intensity of conus medullaris with contrast enhancement suggestive of conus myelitis. CSF analysis ruled out infection and autoimmune causes. She was pulsed with high dose steroids. There was some transient improvement in symptoms. Learning points: 1) Physicians should not consider Covid as a respiratory illness only. It can present with a variety of extra pulmonary manifestations. 2) Acute transverse myelitis is a rare complication of Covid 19 infection. Timely recognition and treatment can prevent permanent neurological damage and residual disability. 3) Conus myelitis might not present with classic upper motor neuron signs. Any new onset bladder dysfunction in a setting of a recent covid infection should be taken seriously and requires urgent imaging of the spine.

Polycythemia vera (PV) is one of Myeloproliferative neoplasm which has common and uncommon mode of presentations. Myocardial infarction (MI) is rare at initial presentation. Here we report 55-year-old women presented with MI and found to have PV in whom, coronary intervention was delayed as there is no evidence based literature guidance in cases of acute MI and PV.

The COVID-19 pandemic has unfolded and merged across 220 countries, territories worldwide. Recent studies conclude that obesity is an independent significant risk factor for COVID-19 infection. Thus, obesity is an epidemic disease. Any obesity allied with COVID-19 ARDS is life-threatening, heading to respiratory life support associated with several complications and mortality. In this clinical setting, the World health organization (WHO) and Extracorporeal Life Support Organization (ELSO) provide interim guidelines that Veno-Venous extracorporeal membrane oxygenation (VV- ECMO) can be beneficial in selective COVID-19 patients. However, the benefit of extracorporeal membrane oxygenation (ECMO) in Obesity and Severe Obesity remains controversial. Although a few studies favored ECMO in Obesity associated with COVID-19. In contrast, its benefit in extreme super-super obese (class v) is unknown to the present day. Herein we report our successful early VV- ECMO and its retrieval challenges in an extreme super-super obese of Body mass index (BMI >65 kg/m2). Our report describes our institutional practice, clinical characteristics, and early VV- ECMO induction to enhance patients’ speedy recovery and survival. ECMO is a limited resource and must be used selectively, particularly during a pandemic when all resources are scarce.