Late diagnosis of odontogenic sinusitis with near-fatal outcome - a case report.
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ABSTRACT:
SUBMITTER: Stevens EM
PROVIDER: S-EPMC4771853 | biostudies-other | 2016 Mar
REPOSITORIES: biostudies-other
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Project description:This study aimed to evaluate whether a specific interleukin-1 receptor-associated kinase-4 (IRAK4) gene polymorphism had any influence on the development of changes in maxillary sinus, particularly in the presence of etiological factors of dental origin.The study population included 153 Portuguese Caucasians that were selected from a database of 504 retrospectively analysed computed tomography (CT) scans. A genetic test was performed, and a model was created through logistic analysis and regression coefficients. The statistical methodologies included were the independent Chi test, Fisher's exact test, binary logistic regression and the receiver operating characteristic (ROC) curve.The estimated prevalence of IRAK4 gene polymorphism found in a Portuguese Caucasian population was 26.8 % (CI 95%) [20.1, 34.7 %]. A model to predict the inflammatory response in the maxillary sinus in the presence etiological factors of dental origin was constructed. This model had the following as variables: previously diagnosed sinusitis, sinus pressure symptoms, cortical bone loss observed on CT, positive genetic test result and radiographic examination that revealed the roots of the teeth communication with the maxillary sinus, which are interpreted as risk factors.The constructed model should be considered an initial clinical tool. The area under the ROC curve found, AUC?=?0.91, revealed that the model correctly predicts the outcome in 91.1% of cases.The clinical relevance of this study lies in trying to achieve a potential tool (a model) that may assist the clinician in the implementation of suitable dental treatment plans in complex cases, with probable involvement of the maxillary sinus.
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Project description:Introduction: Primordial odontogenic tumors are a rare recently described mixed odontogenic tumor composed histopathologically of dental papilla like tissue and enamel organ like tissue. Only nine cases have been documented worldwide and we are reporting the tenth case which is from Egypt. Clinical finding: A 2-year-old Egyptian boy that presented with an asymptomatic swelling of the mandible which appeared with multilocular radiolucency associated with an impacted developing tooth on a computerized tomography (CT) scan. Diagnoses, interventions, and outcomes: The lesion was excised and diagnosed as a primordial odontogenic tumor. The patient was followed up for two years with no recurrence. Conclusion: Differentiation of primordial odontogenic tumors from other odontogenic tumors, which resemble it histopathologically is crucial to avoid unnecessary aggressive treatment.
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Project description:IntroductionImmune checkpoint inhibitors have advanced the outcomes of many different types of cancer. A rare but extraordinarily severe complication of these agents resembles immune checkpoint inhibitor-related myocarditis, which typically occurs within the first few weeks after treatment initiation with a mortality of 25%-50%.Case reportA 57-year-old woman had uneventfully received pembrolizumab for metastatic non-small cell lung cancer for over 2.5 years and was admitted after an out-of-hospital cardiac arrest due to ventricular fibrillation. After successful cardiopulmonary resuscitation, the initial diagnostic work-up showed elevated cardiac enzymes and a limited left-ventricular ejection fraction, while coronary angiography did not show relevant stenosis. Despite cardiac MRI being unsuggestive of myocarditis, myocardial biopsies were obtained and histologically confirmed anti-PD-1 antibody-associated myocarditis. After the initiation of prednisone at 1 mg/kg body weight, the patient gradually recovered and was discharged three weeks later with markedly improved cardiac function.ConclusionThis case resembles the first description of a very late onset irMyocarditis, occurring over 2.5 years after the start of treatment. It demonstrates the importance of contemplating that severe immune-related toxicities with a sudden onset clinical presentation may occur even after long uneventful periods of anti-PD-1 immune checkpoint inhibitor treatment. Furthermore, it underlines the critical importance of myocardial biopsies in this setting, especially when cardiac MRI remains inconclusive. Moreover, it demonstrates the necessity and benefits of early immunosuppressive treatment if immune-related myocarditis is considered a differential diagnosis.
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Project description:Accurate diagnoses are crucial in determining the most effective treatment across different cancers. In challenging cases, morphology-based traditional pathology methods have important limitations, while molecular profiling can provide valuable information to guide clinical decisions. We present a 35-year female with lung cancer with choriocarcinoma features. Her disease involved the right lower lung, brain, and thoracic lymph nodes. The pathology from brain metastasis was reported as “metastatic choriocarcinoma” (a germ cell tumor) by local pathologists. She initiated carboplatin and etoposide, a regimen for choriocarcinoma. Subsequently, her case was assessed by pathologists from an academic cancer center, who gave the diagnosis of “adenocarcinoma with aberrant expression of β-hCG” and finally pathologists at our hospital, who gave the diagnosis of “poorly differentiated carcinoma with choriocarcinoma features”. Genomic profiling detected a KRAS G13R mutation and transcriptomics profiling was suggestive of lung origin. The patient was treated with carboplatin/paclitaxel/ipilimumab/nivolumab followed by consolidation radiation therapy. She had no evidence of progression to date, 13 months after the initial presentation. The molecular profiling could facilitate diagnosing of challenging cancer cases. In addition, chemoimmunotherapy and local consolidation radiation therapy may provide promising therapeutic options for patients with lung cancer exhibiting choriocarcinoma features.
2024-03-14 | GSE261551 | GEO
Project description:Background: Cerebral infarction is a rare neurological complication of Kawasaki disease (KD) and occurs in the acute or subacute stage. There have been no reported cases of late-onset fatal cerebral infarction presenting over 1 year after the onset of KD. Case Presentation: A 5-month-old male patient with KD received timely intravenous immunoglobulin therapy; however, extensive coronary artery aneurysms (CAA) and coronary artery thrombosis (CAT) developed 1 month later. Anticoagulation and thrombolytic agents were suggested, but the child's parents refused. Fifteen months after KD onset, an attack of syncope left him with left hemiplegia; brain computerized tomography (CT) scans revealed cerebral infarction of the right basal ganglion without hemorrhage. Magnetic resonance angiography (MRA) revealed severe stenosis of the right middle cerebral artery, and a series of tests were performed to exclude other causes of cerebral infarction. Considering the cerebral infarction and CAT, combination therapy with urokinase and low-molecular-weight heparin (LMWH) was initiated within 24 h of syncope onset, together with oral aspirin and clopidogrel. Five days later, his clinical symptoms partially regressed and he was discharged. Unfortunately, 5 days after discharge, his clinical condition suddenly deteriorated. Repeat brain CT showed hemorrhagic stroke involving the entire left cerebral area, in addition to the previous cerebral infarction in the right basal ganglion, with obvious secondary cerebral swelling and edema, which might have been caused by previous thrombolysis. Severe cerebral hernias developed quickly. Regrettably, the patient's parents abandoned treatment because of economic factors and unfavorable prognosis, and he died soon after. Conclusions: Cerebral infarction and cerebral artery stenosis can develop late, even 1 year after the onset of KD. Pediatricians should be aware of the possibility of cerebrovascular involvement in addition to cardiac complications during long-term follow-up of KD patients. Prompt anticoagulation therapy and regular neuroimaging evaluation are essential for the management of patients with KD with giant CAA and/or CAT.
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Project description:BACKGROUND:A primordial odontogenic tumor (POT) is a rare, benign, mixed epithelial and mesenchymal odontogenic tumor that has been included as a new entity in the latest World Health Organization (WHO) classification (2017). POT consists of dental papilla-like myxoid connective tissue covered with a delicate membrane of ameloblastic epithelium. Only 15 cases have been documented worldwide, and here, we report the sixteenth case and the first one of South Korea. CASE PRESENTATION:An asymptomatic lesion was discovered as an incidental radiographic finding in a 10-year-old boy. The patient had no complaints about the lesion. Cone-beam computerized tomograms revealed a round cavity with a defined cortical border measuring approximately 5?×?5?×?5?mm in size. The lesion was a POT. The patient was treated with enucleation. The tumor showed no recurrence for one year. CONCLUSION:This is the first report of POT in South Korea using the novel diagnosis of POT after it was recognized and defined in the latest WHO classification. This novel diagnosis will be useful for pathologists and clinicians in diagnosing and differentiating this new and rare disease from other odontogenic tumors.
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Project description:BackgroundGlandular odontogenic cyst (GOC) is an extremely rare developmental jawbone cyst, tending to recurrence owing to its aggressive behavior. There has been no reported case of presence of GOC simultaneous with odontoma. We presented a case of GOC associated with odontoma with special reference to the diagnostic imaging and the histopathological features.Case presentationA 42-year-old Chinese man presented with swelling and pain in the anterior mandible for the past 3 months. Panoramic scan showed a large multiocular well-circumscribed radiolucency accompanied by toothlike morphological abnormality. Histological findings confirmed a GOC associated with odontoma.ConclusionThis case demonstrates GOC with multiple clinical spectrum, and its association with odontoma might enhance the existing knowledge of this rare jawbone cyst.
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Project description:BackgroundInfective endocarditis is a relatively common disease in a cardiologist's daily practice. Nowadays more detailed information about pathogens is provided to us by diagnostics such as MALDI Biotyper Massa Spectrometer. We present a case of endocarditis lenta in which Streptococcus sinensis was identified in the Netherlands for the first time.Case summaryA 58-year-old man was admitted with high suspicion of endocarditis lenta complicated by severe kidney dysfunction and anaemia. He was treated with penicillin and gentamycin. Transthoracic echocardiogram revealed a large vegetation at the mitral valve and MALDI Biotyper Massa Spectrometer (Microflex) revealed S. sinensis as the pathogen. The patient refused to receive blood transfusions or surgery. Due to cerebral infarction with haemorrhagic transformation, the patient died 8 days after admission.DiscussionStreptococcus sinensis was described in Hong Kong for the first time and is associated with endocarditis in rheumatic heart disease. To our knowledge, this is the first case reporting a fatal outcome of endocarditis due to this bacterium in the acute phase. In this case, late discovery, disease severity, and under treatment all contributed to the poor outcome. We want to share the knowledge on the existence of this bacteria.
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Project description:BACKGROUND:An orbitocranial injury with a penetrating Intraorbital Foreign Body (IOFB) is listed as a rare cause of penetrating trauma. Since this type of trauma is considered a surgical emergency, taking a thorough history along with careful examination to find out the mechanism and cause of the trauma is crucial towards correct diagnosis and management of the disease. CASE PRESENTATION:A 35-year-old male patient was presented to the ER with an occupational craniofacial injury because of an IOFB. The patient underwent an extra-dural orbitocranial craniotomy procedure to remove the foreign body. Interestingly, a plastic foreign body (a piece of a plastic pipe) was removed from the orbital cavity, which was suspected to be a fractured orbital bone, at first place. CONCLUSION:In this study, we demonstrated that plastics could mimic bone structure in a Computerized Tomography (CT) scan leading to possible initial misdiagnosis. Hence high clinical suspicion is necessary for the correct diagnosis of such cases. However, despite the prompt intervention, our patient ended up with permanent vision loss in his injured eye.
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Project description:BackgroundTakotsubo cardiomyopathy (TC) usually manifests as transient apical ballooning of the left ventricle and may mimic acute coronary syndrome. Concomitant right ventricle involvement may occur in about a third of the cases. Recurrence had been observed in up to 10% of TC with variable ventricular involvement. Despite this knowledge, there had been no report of a patient with multiple biventricular TC in the literature to date. In this study, we describe a rare case of a patient who presented twice with biventricular TC.Case summaryA 52-year-old man with a previous episode of biventricular TC 5 months ago presented to our hospital with a 1 day history of shortness of breath and wheeze. He was treated initially for infective exacerbation of chronic obstructive airway disease. He was eventually intubated following a trial of non-invasive ventilation. He became hypotensive post-intubation and required intensive care support. An inpatient echocardiogram revealed biventricular apical ballooning. Invasive coronary angiogram showed no coronary artery disease. A repeat echocardiogram 14 days post-admission demonstrated full recovery of both ventricles. These findings were consistent with a second biventricular TC. Two months later, he was found deceased in the community seemingly from an unrelated cause.DiscussionThis case describes a middle-aged gentleman who suffered recurrent biventricular TC with no consistent triggers and an unrelated fatal sequel. None of these features were typical, and to our best knowledge had not been reported before. We hypothesize that his recurrent chronic obstructive pulmonary disease exacerbations and various substance misuse might have predisposed him to this unusual presentation.
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