Pulmonary amyloidosis and multiple myeloma mimicking lymphoma in a patient with Sjogren’s syndrome: A case report

BACKGROUNDSjogren’s syndrome (SS), which affect salivary gland function, is an autoimmune disease. SS may involve extraglandular organs. Approximately 10 to 20 percent of SS patients have clinically significant lung disease, but presentation of pulmonary amylodosis is extremly rare. The incidence of benign monoclonal gammopathy in SS patients is high, but multiple myeloma is rare. No case involving the simultaneous occurrence of two rare diseases, pulmonary amyloidosis and multiple myeloma, in the same patient with SS has been reported so far. CASE SUMMARYA 41-year-old male patient was referred to our hematology department due to incidentally detected gastric plasmacytoma. He had been diagnosed with SS four years earlier. Multiple miliary nodules, ground glass opacity in both lung fields, and enlargement of both inguinal lymph nodes was observed on chest and abdomen computer tomography. Based on the pathological findings of lung and lymph node biopsied specimens, the patient was diagnosed with pulmonary amyloidosis and multiple myeloma. Pulmonary amyloidosis and multiple myeloma associated with SS has rarely been reported.CONCLUSIONThis is an extremely rare case of simultaneous pulmonary amyloidosis and multiple myeloma in the same patient with SS.     

Bilateral pneumothorax and pneumomediastinum during colonoscopy in a patient with intestinal Behcet’s disease: A case report

BACKGROUNDColonoscopy is essential for the diagnosis of intestinal Behcet’s disease (BD), which is characterized by a typical oval-shaped ulcer in the ileocecal region. However, potential risks of colonoscopy have rarely been reported.CASE SUMMARYHerein, we describe a patient with intestinal BD who presented with decreased oxygen saturation and shortness of breath during a diagnostic colonoscopy. Bilateral pneumothorax, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum and subcutaneous emphysema of the neck, chest, abdomen, back and scrotum were confirmed by computed tomography scan. The sudden change in condition was considered to be associated with iatrogenic bowel perforation. After receiving closed thoracic drainage and conservative therapy, the patient was discharged in stable condition.CONCLUSIONEndoscopists should be aware of the risks of colonoscopy in patients with intestinal BD and the possibility of pneumothorax associated with intestinal perforation and make adequate preparations before colonoscopy.     

Ischemic colitis after receiving the second dose of a COVID-19 inactivated vaccine: A case report

BACKGROUNDThe outbreak of the coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 has been the most important clinical challenge worldwide since January 2020. COVID-19 inactivated vaccines play a crucial role in reducing the rates of morbidity and mortality.CASE SUMMARYWe presented a 48-year-old woman from Haidian District, Beijing, China who developed ischemic colitis after receiving the second dose of COVID-19 inactivated vaccine. Computed tomography of the abdomen showed edema and bowel wall thickening with hypodensity in the sigmoid colon and descending colon. Colonoscopy revealed hyperemia, edema and erosion of the mucosa with superficial ulceration and a yellow-white coating at the descending colon and sigmoid colon. The symptoms were relieved after 1 wk of receiving pinaverium bromide (50 mg, tid) and aspirin enteric-coated tablets (0.1 g, qd).CONCLUSIONThe possible occurrence of ischemic colitis should be considered after administration of the COVID-19 inactivated vaccines.     

Amyloid β-related angiitis of the central nervous system occurring after COVID-19 vaccination: A case report

BACKGROUNDAlthough coronavirus disease 2019 (COVID-19) vaccines have been effective in controlling the COVID-19 pandemic, a variety of post-vaccination neurological complications have been reported worldwide. Amyloid β-related angiitis (ABRA) is a rare neurological disease. The underlying cause of ABRA is unknown, but several studies suggest that it is caused by an excessive immune response to amyloid-β deposited in blood vessels. In addition, limited attention has been paid to potential triggers of ABRA, such as infection or vaccination.CASE SUMMARYWe report a case of ABRA that developed 2 wk after COVID-19 vaccination. A 75-year-old woman developed a frontal headache after receiving a second dose of COVID-19 BNT162b2 vaccine (Pfizer-BioNTech). Diffusion-weighted magnetic resonance imaging (DW-MRI) of the head showed abnormal hyperintensity, suggesting cerebral infarctions in the left parietal and occipital lobes. We diagnosed her condition as ABRA based on a brain biopsy. We administered steroid pulse therapy and the patient’s symptoms and DW-MRI abnormalities improved. This case had a good outcome due to prompt diagnosis and treatment.CONCLUSIONWe report a case of ABRA that may have been triggered by COVID-19 vaccination.     

A case of post COVID‐19 multisystem inflammatory syndrome and Bell's palsy in a young adult

The clinician should put MIS‐A at the top of differential diagnoses of a patient with febrile illness and multiple organ dysfunction during the early post‐COVID‐19 period. Also, facial nerve palsy might follow COVID‐19, related to the autoimmune phenomenon.     

Junctional bradycardia in a patient with COVID-19: A case report

BACKGROUNDCardiac arrhythmias, including bradyarrhythmias, have been described as manifestations of coronavirus disease 2019 (COVID-19). Herein, we present a case of junctional bradycardia secondary to possible sinus node dysfunction in a patient with COVID-19.CASE SUMMARYThe patient was a 32-year-old woman with no significant medical history. On the third day of hospitalization, she developed junctional bradycardia while being hemodynamically stable. The episodes of nodal dysrhythmia with a low heart rate persisted for the next few days and were associated with elevated levels of systemic inflammatory markers. The patient received antiviral and anti-inflammatory treatments for the viral infection but no antiarrhythmic medications. She had a normal sinus rhythm on day 12.CONCLUSIONCardiac rhythm monitoring, focusing on the association between cardiac arrhythmias and the systemic inflammatory response, is important in COVID-19 patients.     

Transient ischemic attack after mRNA-based COVID-19 vaccination during pregnancy: A case report

BACKGROUNDThrombocytopenia with thrombosis syndrome has been reported after vaccination against severe acute respiratory syndrome coronavirus 2 with two mRNA vaccines. The syndrome is characterized by thrombosis, especially cerebral venous sinus thrombosis, and may lead to stroke. Pregnant women with stroke show higher rates of pregnancy loss and experience serious pregnancy complications. We present the case of a 24-year-old pregnant woman with a transient ischemic attack (TIA) that developed after vaccination with the Moderna mRNA-1273 vaccine (at 37 2/7 wk).CASE SUMMARYTIA occurred 13 d following the coronavirus disease vaccination. At 39 1/7 wk of pregnancy, the patient presented with sudden onset of right eye blurred vision with headache, dizziness with nausea, right-hand weakness, anomia, and alexia. The symptoms lasted 3 h; TIA was diagnosed. Blood test results revealed elevated D-dimer, cholesterol, and triglyceride levels. Brain magnetic resonance imaging showed no acute hemorrhagic or ischemic stroke. At pregnancy 37 6/7 wk, she was admitted for cesarean delivery to reduce subsequent risk of stroke during labor. Body mass index on admission was 19.8 kg/m². Magnetic resonance angiography and transesophageal echocardiography showed no abnormalities. The next day, a mature female baby weighing 2895 g and measuring 50 cm was delivered. Apgar scores were 8 and 9 in the first and fifth minutes. D-dimer levels decreased on postoperative day 4. After discharge, the autoimmune panel was within normal limits, including antinuclear and antiphospholipid antibodies. CONCLUSIONTIA might be developed after the mRNA vaccines in pregnant women.     

Primary extraskeletal Ewing’s sarcoma of the lumbar nerve root: A case report

BACKGROUNDEwing’s sarcoma (ES) is a highly aggressive bone malignancy. Extraskeletal ES (EES) originating in the spinal canal is extremely rare. Herein, we report on a rare case of EES with a primary lumbar spinal nerve root including the complete diagnosis and treatment.CASE SUMMARYA young female patient presented with a complaint of right lower limb pain for 1 mo. Magnetic resonance imaging (MRI) revealed an 11 mm × 14 mm × 31 mm mass in the lumbar epidural region extending at the fifth lumbar spine (L5) level toward the right L5 neural foramen. Our initial diagnosis was an epidural schwannoma. The patient underwent total laminectomy, tumor resection and pedicle screw internal fixation and the L5 root tumor was found to have been completely removed intraoperatively. Histopathological examination of the lesion showed a typical ES with a large number of small, round cells. Immunohistochemistry analysis indicated positive CD99 and S100. After surgery, the patient received chemotherapy and radiotherapy with a 1 year of follow-up and no recurrent tumors or new lesions were found upon spine MRI and positron emission tomography/computed tomography reexamination.CONCLUSIONClinically, ES outside the bone should be considered when nerve root tumors are encountered inside and outside the spinal canal and the diagnosis should be determined by pathological biopsy. After surgical resection, chemotherapy and radiotherapy should be performed. After treatment, active follow-up and regular review should be completed.     

Wilkie’s syndrome as a cause of anxiety-depressive disorder: A case report and review of literature

BACKGROUNDSuperior mesenteric artery syndrome is a disease with a complex diagnosis, and it is associated with complications that make it even harder to identify. Currently, a frequent association with psychiatric disorders has been noted. Despite numerous case reports and case series, the variability of the disease has not allowed the development of protocols regarding diagnosis and management.CASE SUMMARYA 33-year-old woman presented with abdominal pain, nausea, and bile vomiting over the last 15 mo, associated with a 15-kg weight loss over the last three months. After the onset of the symptoms, the patient was diagnosed with anxiety-depressive disorder and treated appropriately. Standard examinations excluded an organic cause, and the cause of the symptoms was considered psychogenic. The persistence of symptoms, even under treatment, prompted a computer tomography angiography examination of the abdomen and pelvis. The examination identified emergence at a sharp angle of 13.7° of the superior mesenteric artery, with a reduced distance between the artery and the anterior wall of the aorta up to a maximum of 8 mm. A diagnosis of aortomesenteric clamp was established. Surgical treatment by laparoscopic duodenojejunostomy was performed. Postoperative evolution was marked by a patent anastomosis at 1 mo, with a 10-kg weight gain and improvement of the associated anxiety.CONCLUSIONThis case report underlines two major aspects. One aspect refers to the predisposition of patients with superior mesenteric artery syndrome to develop psychiatric disorders, with an excellent outcome when proper treatment is administered. The second aspect underlines the key role of a multidisciplinary approach and follow-up.     

Delayed inflammatory response evoked in nasal alloplastic implants after COVID-19 vaccination: A case report

BACKGROUNDDelayed inflammatory reactions (DIRs) in alloplast rhinoplasty are a rare complication that may occur several months to years after surgery. The exact causes and mechanisms are unclear, but several triggering factors, including infections, trauma, dental procedures, and vaccination, have been reported.CASE SUMMARYA 39-year-old male patient who had undergone augmentation rhinoplasty 8 years ago had DIRs after the administration of the first dose of the mRNA Pfizer coronavirus disease 2019 (COVID-19) vaccine. He suddenly had tender, erythematous swelling on his face 6 d after vaccination. As there was no improvement in the patient’s condition after the conservative treatment, surgical removal of an alloplastic nasal implant was performed. Immediately after the surgery, the DIRs and accompanying symptoms ameliorated rapidly. A histological study conducted during surgery was fibrosis and small fragments of the hyaline cartilage.CONCLUSIONThe correlation between DIRs and COVID-19 vaccination has not been reported yet and the exact mechanism is unclear. Because the uncontrolled inflammatory reactions on the nose leave serious sequelae, surgeons should be conscious of the correlation between COVID-19 vaccines and DIRs associated with nasal alloplastic implants. And further histological or microbiological studies should be performed to determine the cause of DIRs.     

Resection with limb salvage in an Asian male adolescent with Ewing’s sarcoma: A case report

BACKGROUNDEwing’s sarcoma is a highly malignant primary bone tumor that commonly affects children. For young patients, multidisciplinary treatment and limb salvage are recommended, and surgical plans considering the growth potential and bone activity after tumor resection are essential.CASE SUMMARYAn 11-year-old Asian boy had a 1-mo history of a right-sided limping gait. Imaging revealed a proximal tumor with bone destruction and physeal involvement over the right femoral neck. He was diagnosed with stage IV (T1N0M1aG3) Ewing’s sarcoma with bilateral lung metastases. Neoadjuvant chemotherapy decreased the tumor size and confined it to the metaphyseal region. The patient underwent four stages of surgery: wide tumor excision plus reconstruction with vascular fibular bone graft plus internal fixation; repeat open reduction and internal fixation; femoral lengthening with orthosis after physeal maturity; and orthosis removal and bone elongation (approximately 6 cm). Following surgery, he could walk without discomfort and had almost equal-sized bilateral femoral heads, indicating physis preservation. The surgery was successful, and normal femoral head growth was achieved after complete remission. The patient was able to resume normal activities with equal length of the bilateral lower limbs.CONCLUSIONTumor treatment and reconstruction following resection are important in skeletally immature patients with Ewing’s sarcoma to improve quality of life.     

COVID-19 patient with an incubation period of 27 d: A case report

BACKGROUNDAs a highly contagious disease, coronavirus disease 2019 (COVID-19) is wreaking havoc around the world due to continuous spread among close contacts mainly via droplets, aerosols, contaminated hands or surfaces. Therefore, centralized isolation of close contacts and suspected patients is an important measure to prevent the transmission of COVID-19. At present, the quarantine duration in most countries is 14 d due to the fact that the incubation period of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) is usually identified as 1-14 d with median estimate of 4-7.5 d. Since COVID-19 patients in the incubation period are also contagious, cases with an incubation period of more than 14 d need to be evaluated. CASE SUMMARYA 70-year-old male patient was admitted to the Department of Respiratory Medicine of The First Affiliated Hospital of Harbin Medical University on April 5 due to a cough with sputum and shortness of breath. On April 10, the patient was transferred to the Fever Clinic for further treatment due to close contact to one confirmed COVID-19 patient in the same room. During the period from April 10 to May 6, nucleic acid and antibodies to SARS-CoV-2 were tested 7 and 4 times, respectively, all of which were negative. On May 7, the patient developed fever with a maximum temperature of 39℃, and his respiratory difficulties had deteriorated. The results of nucleic acid and antibody detection of SARS-CoV-2 were positive. On May 8, the nucleic acid and antibody detection of SARS-CoV-2 by Heilongjiang Provincial Center for Disease Control were also positive, and the patient was diagnosed with COVID-19 and reported to the Chinese Center for Disease Control and Prevention. CONCLUSIONThis case highlights the importance of the SARS-CoV-2 incubation period. Further epidemiological investigations and clinical observations are urgently needed to identify the optimal incubation period of SARS-CoV-2 and formulate rational and evidence-based quarantine policies for COVID-19 accordingly.