BACKGROUND Oral squamous cell carcinoma (OSCC) is the most common malignant tumor in the head and neck. A free flap is often used to repair tissue defects left after surgery. Due to the existence of 2 surgical sites-the donor site and recipient site-cross-contamination should be prevented during the operation. This report presents a case of donor tumor implantation suspected to be caused by cross-contamination. CASE REPORT A 57-year-old Chinese man was admitted with a mass in the left floor of the mouth, first noticed 2 months before. The biopsy confirmed squamous cell carcinoma (SCC). Under general anesthesia, extended resection of the left floor of the mouth SCC and repair with a left anterolateral thigh free flap were performed. Five months after surgery, a mass was found in the scar on the left thigh. Extensive resection of the left thigh mass was performed, and postoperative pathology revealed metastatic SCC. At the same time, a tumor was found on the right back and another on the chest wall. These 2 tumors were resected at the same time and were also confirmed as SCC. Seven months after surgery, the patient gradually developed local recurrence and systemic multiple metastases, and he died 10 months after surgery. CONCLUSIONS The "no tumor left behind" principle should be strictly followed in malignant tumor surgery to avoid malignant tumor implantation. Oral and maxillofacial surgeons should be aware of this and use appropriate techniques to avoid such incidents.
BACKGROUND Vogt-Koyanagi-Harada (VKH) disease is a rare autoimmune disorder targeting melanocyte-rich tissues that often presents with bilateral ocular inflammation and multisystem involvement. Early manifestations, such as headache and optic disc edema, can mimic other conditions, leading to diagnostic delays. Clinician awareness is essential, particularly in high-risk populations, to ensure timely intervention. CASE REPORT We report the case of a 55-year-old Indian man who presented with a 20-day history of progressive bilateral visual loss, headache, and hearing impairment. Ophthalmologic examination revealed hand motion vision in both eyes, anterior chamber inflammation, disc edema, and serous retinal detachments. Spectral-domain optical coherence tomography confirmed neurosensory detachment and disc edema, whereas B-scan ultrasonography demonstrated pronounced choroidal thickening. Brain and orbital magnetic resonance imaging revealed bilateral focal nodular choroidal lesions. Laboratory investigations excluded infectious, malignant, and systemic inflammatory etiologies. A diagnosis of VKH disease was established based on the clinical presentation, multimodal imaging findings, and revised diagnostic criteria. The patient was treated with high-dose intravenous methylprednisolone followed by a prolonged oral taper; azathioprine was initiated early as a steroid-sparing agent to prevent relapse. CONCLUSIONS This case underscores the importance of prompt ophthalmologic evaluation and multimodal imaging in the diagnosis of VKH disease. Early initiation of intensive immunosuppressive therapy may help limit inflammatory progression and reduce long-term complications.
BACKGROUND Stasis dermatitis is a chronic inflammatory dermatosis secondary to chronic venous insufficiency. Treatment of refractory cases remains challenging. High-molecular-weight non-crosslinked hyaluronic acid (HMWNCHA) combined with succinic acid (SA) possesses anti-inflammatory and regenerative properties. We report 2 septuagenarian patients with refractory stasis dermatitis and psychosocial deterioration treated with intradermal HMWNCHA plus SA. CASE REPORT Case 1 involved a 77-year-old man with chronic venous insufficiency and refractory stasis dermatitis associated with severe symptoms, impaired mobility, and psychosocial deterioration. After failure of conventional therapies, he received 2 sessions of intradermal HMWNCHA plus SA administered 1 month apart, resulting in marked and sustained clinical and psychosocial improvement at 6-month follow-up. Case 2 involved a 75-year-old woman with refractory unilateral stasis dermatitis secondary to chronic venous insufficiency. Following the same treatment protocol, substantial improvement was observed after the first session, with near-complete lesion resolution after the second session and sustained remission at 6-month follow-up. No treatment-related adverse effects were reported. CONCLUSIONS In these 2 patients with refractory stasis dermatitis, intradermal HMWNCHA plus SA was associated with marked and sustained clinical improvements and enhanced quality of life. Further studies are warranted to confirm these findings.
BACKGROUND Cerebral venous thrombosis (CVT) is an uncommon form of stroke with highly variable clinical manifestations. Although headache and focal neurological deficits are typical presenting features, isolated psychiatric symptoms as an initial manifestation are exceptionally rare and may substantially delay diagnosis. CVT most commonly affects young adults and women with identifiable prothrombotic risk factors. CASE REPORT We report the case of a 37-year-old previously healthy woman with no identifiable thrombotic risk factors who presented with acute behavioral disturbances characterized by insomnia, agitation, emotional lability, and aggressive behavior. There was no history of prior psychiatric illness. Initial investigations, including brain magnetic resonance imaging (MRI), cerebrospinal fluid analysis, and infectious workup, were unremarkable, with no evidence of structural abnormalities on early neuroimaging. She was admitted with a working diagnosis of acute polymorphic psychotic disorder and started on psychiatric treatment. Six days later, she developed sudden loss of consciousness followed by generalized tonic-clonic seizures, prompting urgent neuroimaging. Imaging revealed a right high-parietal intracerebral hemorrhage, and subsequent venous imaging confirmed CVT involving the superficial superior cerebral vein. The patient was treated with antiepileptic therapy and anticoagulation, leading to gradual neurological and psychiatric improvement. CONCLUSIONS This case highlights an unusual presentation of CVT with isolated psychiatric manifestations, absence of classical risk factors, and initially normal neuroimaging findings, all of which contributed to delayed diagnosis. Abrupt neurological deterioration can occur despite non-specific early investigations. Early consideration of cerebral venous imaging may be warranted in atypical acute psychiatric presentations to avoid delayed diagnosis and potentially life-threatening complications.
BACKGROUND Aortic cross-clamping is usually required to clearly visualize the surgical field in mini-thoracotomy because cardiac surgery without aortic cross-clamping can be challenging. However, certain patients may require alternative strategies for cardiovascular surgeries. CASE REPORT We report the case of a 73-year-old woman with prior valve replacement who underwent left atrial thrombectomy under cardiopulmonary bypass without aortic cross-clamping using rapid ventricular overdrive pacing. She was referred to our hospital for an evaluation of elevated C-reactive protein levels. Computed tomography coronary angiography revealed a large non-mobile mass in the left atrium that did not decrease after anticoagulation therapy. A high degree of adhesion was observed around the aortic root, making median sternotomy and aortic cross-clamping hazardous. Thrombectomy during perfused ventricular fibrillation was an option but is associated with other potential complications such as coagulopathy, arrhythmia, hyperglycemia, and disordered electrolytes that could further increase the total risk. Therefore, rapid ventricular overdrive pacing was selected to achieve temporary circulatory arrest, combined with a mini-thoracotomy approach. Rapid ventricular overdrive pacing was successfully maintained throughout the thrombectomy, and the patient was easily weaned from cardiopulmonary bypass. She was extubated in the operating room at the end of the surgery. She recovered without complications and was discharged walking independently. CONCLUSIONS Rapid ventricular overdrive pacing to achieve temporary circulatory arrest during cardiovascular surgery may be a new therapeutic option in patients with high risks associated with reoperation.
BACKGROUND Cardiac tamponade caused by intrapericardial contrast extravasation is a rare but life-threatening iatrogenic complication associated with central venous access devices (CVADs) during power injection. CVADs, including implanted ports (port-a-caths), are susceptible to fibrin sheath formation and mural thrombosis over time, which can tether the catheter tip against the vessel wall and predispose it to erosion or perforation. When high-pressure contrast is injected through a compromised device, contrast may bypass the vessel lumen entirely and accumulate within the pericardial sac, producing acute obstructive shock. CASE REPORT We report a 61-year-old woman with a history of diabetes mellitus, cerebrovascular accident, and an indwelling port-a-cath who underwent computed tomography (CT) angiography because of difficult peripheral venous access. Immediately after contrast administration, she developed sudden cardiovascular collapse and cardiac arrest. CT imaging demonstrated a large hyperdense pericardial effusion with superior vena cava thrombosis adjacent to the catheter tip, suggesting catheter-related vessel wall injury and direct contrast extravasation into the pericardial sac. Bedside echocardiography confirmed tamponade physiology with right ventricular diastolic collapse and chamber compression. Emergent pericardiocentesis drained 1 L of contrast-containing serosanguinous fluid and resulted in immediate hemodynamic recovery after cardiac arrest. CONCLUSIONS Contrast extravasation through a long-term indwelling port-a-cath is a rare but catastrophic cause of acute cardiac tamponade. Sudden cardiovascular collapse during or after contrast-enhanced CT in a patient with a long-term central venous device should prompt immediate suspicion for this diagnosis. Additionally, echocardiography enables rapid confirmation, and emergent pericardiocentesis is life-saving.
BACKGROUND Takotsubo cardiomyopathy is a transient stress-induced cardiomyopathy that can mimic acute coronary syndrome (ACS) but typically occurs without obstructive coronary disease. Reverse takotsubo is an uncommon variant characterized by basal hypokinesis with preserved apical contraction. We report an atypical case in which acute respiratory failure, rather than an abrupt emotional stressor, appeared to be the primary trigger. CASE REPORT A 69-year-old woman with coronary artery disease status after prior left anterior descending artery stent, hypertension, hyperlipidemia, and chronic obstructive pulmonary disease (COPD) presented with severe respiratory distress and became unresponsive, requiring emergency intubation. She tested positive for coronavirus OC43 and was managed in the intensive care unit (ICU) for COPD exacerbation with ventilator-dependent respiratory failure. High-sensitivity troponin rose from 56 ng/L to 937 ng/L initially, later peaking at 1928 ng/L after catheterization with ST-T changes on EKG, prompting cardiac evaluation. Transthoracic echocardiography revealed new segmental wall motion abnormalities consistent with stress cardiomyopathy and an estimated ejection fraction of 40%. Urgent coronary angiography demonstrated no obstructive coronary disease with a patent LAD stent; left ventriculography showed severe basal hypokinesis with preserved apical contraction, confirming reverse takotsubo. Further history-taking revealed ongoing grief after her sister's death 3 months earlier. CONCLUSIONS Reverse takotsubo should be considered in patients with ACS-like presentations during acute critical illness, including respiratory failure, even when emotional stressors are chronic rather than sudden. Recognizing basal hypokinesis with preserved apical function can help avoid misdiagnosis and guide appropriate supportive management and follow-up imaging.
BACKGROUND Endo-periodontal lesions (EPL), particularly those manifesting as primary periodontal lesions with secondary endodontic involvement, pose unique clinical challenges when accompanied by odontogenic maxillary sinusitis (OMS). Furthermore, limited case reports document the nonsurgical management of such complex conditions in maxillary molars exhibiting rare multi-rooted and multi-canal variations (prevalence <0.103%). CASE REPORT A 31-year-old woman presented with pain and grade III mobility in the right maxillary first molar, with an intact crown, a deep palatal periodontal pocket, and a negative cold testing response on clinical examination. Periapical radiography indicated multi-rooted anatomy and extensive bone loss, and cone beam computed tomography (CBCT) confirmed 4 separate roots (mesiobuccal, distobuccal, mesiopalatal, distopalatal), a fifth centrally located pulp chamber canal orifice, a periapical lesion communicating with a periodontal defect, and ipsilateral maxillary sinus mucosal thickening. Nonsurgical root canal treatment for all 5 canals was performed under a dental operating microscope with ultrasonic activation (3% NaOCl) and bioceramic sealer, combined with concurrent supportive periodontal therapy. At the 8-month follow-up, the tooth was asymptomatic with reduced mobility and probing depths; CBCT revealed marked reduction in periapical lesions and significant improvement in maxillary sinus mucosal thickening (ENT consultation advised). CONCLUSIONS This case unequivocally demonstrates that meticulous nonsurgical endodontic treatment with ultrasonic activation and bioceramic sealer, in conjunction with targeted periodontal therapy and occlusal management, is a highly effective tooth-preserving strategy for maxillary molars with complex anatomic variations complicated by primary periodontal lesions with secondary endodontic involvement and secondary OMS, achieving excellent clinical and radiological outcomes.
BACKGROUND The coexistence of multiple oncogenic drivers in non-small cell lung cancer (NSCLC) is a rare and diagnostically challenging molecular configuration. Conventional polymerase chain reaction (PCR)-based testing may fail to detect co-occurring genomic alterations, potentially limiting therapeutic options, particularly in resource-constrained settings. CASE REPORT We describe the case of a 54-year-old non-smoking woman diagnosed with Stage IIIA lung adenocarcinoma in 2020. Initial PCR-based molecular testing was negative for EGFR mutations. Following disease progression with brain metastases and severe chemotherapy toxicity, stepwise molecular profiling in a resource-limited setting identified HER2 (ERBB2) amplification via fluorescence in situ hybridization (FISH). The patient achieved 23 months of clinical and radiological stabilization on trastuzumab. Subsequent next-generation sequencing (NGS) analysis of archived tissue revealed a previously undetected estimated glomular filtration rate (EGFR) L858R mutation. In late April 2025, new lesions appeared in the lungs, indicating disease progression. Based on the previously verified EGFR L858R mutation, the treatment strategy was revised and gefitinib was initiated in May 2025. CONCLUSIONS This case illustrates that co-occurring EGFR and HER2 alterations can remain undetected following initial limited molecular testing, and that stepwise molecular profiling in a resource-constrained setting can facilitate identification of therapeutically actionable targets. The sequential clinical responses observed are consistent with the biological relevance of both alterations, although broader conclusions regarding diagnostic strategy or driver hierarchy cannot be drawn from a single observation.
BACKGROUND The therapeutic margin of colchicine is narrow, and toxicity occurs easily. No standard treatment exists because its toxicokinetics are poorly understood. Symptoms are usually gastrointestinal, and dehydration occurs easily. Few reports have monitored serum and urinary colchicine levels. CASE REPORT A man in his 20s presented with nausea, vomiting, diarrhea, drowsiness, and dyspnea. He ingested 2 dried Colchicum autumnale bulbs (estimated colchicine: 6.24-15.6 mg) with an energy drink. Activated charcoal with laxative was administered at 27 hours post ingestion (h-PI), followed by multiple-dose activated charcoal (MDAC) every 6 hours (13 doses, 27-101 h-PI), high-volume fluid infusion (Ringer's acetate), and blood purification (hemodialysis [HD] at 48-52 h-PI; hemodiafiltration [HDF] at 71-75 and 98-102 h-PI). Serum colchicine was measured at 16 time points and urine at 11 time points. Serum colchicine at 27 h-PI was 50.3 ng/mL, and was temporally associated with a rapid decrease to 21.2 ng/mL at 35 h-PI, coinciding with initiation of infusion and activated charcoal. A secondary rise to 17.74 ng/mL occurred at 77 h-PI, approximately 2.4 hours after HDF1 completion. Urine colchicine was 110.0 ng/mL at 29 h-PI, then gradually decreased. Serum colchicine changed modestly (12.16 to 5.46 ng/mL) during HD. CONCLUSIONS In this case of severe colchicine poisoning, serial serum and urine concentration monitoring provided a time-resolved profile across concurrent interventions. The observed temporal associations support hypothesis generation regarding the potential roles of renal elimination and MDAC-mediated interruption of enterohepatic recirculation in colchicine clearance, while recognizing that concurrent therapies preclude attribution of effects to any single intervention.
BACKGROUND Anterior cutaneous nerve entrapment syndrome is an underrecognized cause of abdominal wall pain and may be overlooked, particularly in patients with advanced cancer, in whom abdominal pain is often attributed to malignancy-related causes. Failure to identify coexisting non-cancer-related pain mechanisms can result in inadequate pain control and functional decline. CASE REPORT A 51-year-old woman with advanced sigmoid colon cancer and peritoneal metastasis presented with severe movement-related abdominal pain that was refractory to high-dose opioid therapy. Although tumor lesions were present near the umbilicus, she reported minimal pain at rest, with marked exacerbation during sitting and ambulation. Physical examination revealed multiple localized tender points along the lateral borders of the rectus abdominis muscle and a positive Carnett's sign, suggesting abdominal wall pain. Based on these findings, anterior cutaneous nerve entrapment syndrome was suspected. Ultrasound-guided bilateral rectus sheath blocks were performed at the tender points, resulting in immediate pain relief. Although the initial analgesic effect was transient, repeated blocks led to sustained pain reduction beyond the expected duration of local anesthetic action, enabling recovery of mobility and activities of daily living. CONCLUSIONS This case shows that anterior cutaneous nerve entrapment syndrome can coexist with cancer-related pathology and is a treatable cause of refractory abdominal pain in patients with advanced cancer. Careful assessment of pain characteristics and physical examination, even in the presence of tumor lesions at the pain site, can facilitate recognition and treatment of non-cancer-related pain and improve functional outcomes and quality of life in palliative care settings.
BACKGROUND Septic abortion is a serious, life-threatening uterine infection that can occur before, during, or after a miscarriage or termination, and when it is associated with an intrauterine fetal death (IUFD), the retained fetal tissue can be a focus for bacterial infection. This report describes the case of a 34-year-old woman with septic abortion associated with IUFD at 8 weeks of gestation, complicated by myometritis and bilateral psoas muscle abscess. CASE REPORT A 34-year-old female patient presented with severe lower back pain radiating to the right lower extremity. Diagnostic workup initially ruled out neurological lesions but identified an impending septic spontaneous abortion due to IUFD at 8.7 weeks. Following cervical ripening with misoprostol and subsequent uterine curettage, she developed persistent fever and methicillin-resistant Staphylococcus aureus bacteremia. Abdominal and pelvic computed tomography (CT) documented fluid collections involving both iliopsoas muscles bilaterally at their distal insertion, alongside smaller collections in the right external obturator and thigh musculature. No surgical drainage was required due to the limited size of the abscesses. Targeted treatment consisting of a 28-day course of intravenous vancomycin resulted in full clinical and radiographic resolution. CONCLUSIONS Iliopsoas abscess is a complex clinical entity whose diagnosis can be challenging, even more in a pregnancy context. Very few cases of psoas abscess during pregnancy have been reported in the literature, and even fewer have been bilateral. Timely diagnosis and broad-spectrum antibiotic coverage are the cornerstones of treatment.
