Case Reports in Clinical Practice

A Case of Myelofibrosis Masquerading as Pericarditis, The Role of Hematologic Evaluation in Systemic Inflammation: A Case Report

2025-12-02T13:00:32+00:00

This case report describes a middle-aged female with untreated hypertension who was released from the hospital with signs and symptoms of sharp pleuritic chest pain, with a concern for a cardiac issue. Following the concern for a cardiac diagnosis, diagnostic testing determined profound ST elevations across the ECG, severe anemia (hemoglobin 9.6 g/dL), and inflammatory activity (ESR 93 mm/hr, CRP 77.7 mg/L), with high LDH (2185 U/L). There was evidence on imaging of left atrial enlargement, hepatosplenomegaly, liver lesions, and mineralized bone changes, with myelofibrosis (MF) confirmed through marrow biopsy showing marrow fibrosis and atypical megakaryocytes. This case illustrates the diagnostic considerations of MF, which can present with various differential diagnoses. Treatment of the patient consisted of managing symptoms with aspirin; the possible options of treatment included long- term therapy with a JAK2 inhibitor or stem cell transplant. This case underscores the importance of considering MF in patients with unexplained cytopenias, splenomegaly, and systemic inflammation.

The Association Between Varicella and Acute Appendicitis: A Rare Case Report and Literature Review

2025-12-02T13:00:31+00:00

Varicella-zoster virus, the causative agent of chickenpox, is typically a self-limiting disease. However, in rare cases, it has been associated with atypical complications. Here, we report a unique case of acute appendicitis following varicella infection in an otherwise healthy individual. The possible mechanisms linking varicella to appendiceal inflammation remain unclear, but viral-induced immune dysregulation and secondary bacterial infection have been suggested. In our study, we aim to highlight this rare association, discuss potential pathophysiological mechanisms, and review the existing literature on similar cases.

Unmasking Idiopathic Secondary Hemophagocytic Lymphohistiocytosis in a Young Female: A Diagnostic Challenge Presenting as Pyrexia of Unknown Origin

2025-12-02T13:00:30+00:00

Hemophagocytic lymphohistiocytosis (HLH) is a hyperinflammatory syndrome that can present as prolonged fever of unknown origin (FUO). We describe the case of a 26-year-old woman who presented with two months of intermittent high-grade fever, joint pain, and transient salmon-colored skin rashes. Laboratory investigations revealed cytopenia, elevated triglycerides, abnormal liver enzymes, and a markedly elevated serum ferritin level (>10,000 ng/mL). Extensive evaluation for infectious and autoimmune causes was negative. Whole-body PET-CT demonstrated diffusely increased marrow activity with small mesenteric lymph nodes, while bone marrow examination confirmed hemophagocytosis. The patient met six of the HLH-2004 diagnostic criteria, and her HScore was calculated at 228, indicating a high probability of HLH. In the absence of any identifiable trigger, a diagnosis of idiopathic secondary HLH was made. She was treated with dexamethasone monotherapy, which led to rapid resolution of fever, normalization of laboratory parameters, and sustained remission at three-month follow-up. This case underscores the importance of considering HLH early in adults with unexplained fever, cytopenia, and extreme hyperferritinemia, and highlights that corticosteroid monotherapy may be sufficient in selected idiopathic cases.

A Multidisciplinary Approach to Managing Pregnancy- Associated Spinal Schwannoma: Case Report of Neurological and Obstetric Challenges with Surgical Management

2025-12-02T13:00:29+00:00

Spinal schwannomas are rare during pregnancy and pose unique diagnostic and therapeutic challenges, as their symptoms may mimic common gestational complaints. We report the case of a 28-year-old woman, gravida 3 para 2, who presented at 33 weeks + 1 day of gestation with progressive left lower limb weakness. Magnetic resonance imaging (MRI) performed at 33+5 weeks revealed an extradural tumor at the D9 vertebral level, causing significant spinal cord compression. A multidisciplinary team—including obstetrics, neurosurgery, anesthesiology, and neonatology—developed a sequential management strategy. At 34 weeks gestation, the patient experienced spontaneous preterm premature rupture of membranes. Labor was induced using a Foley catheter, and she delivered a healthy female infant weighing 2.15 kg, with Apgar scores of 7 and 8 at one and five minutes, respectively. At 34+4 weeks, she underwent D9 laminectomy and complete tumor excision under general anesthesia. Histopathological examination confirmed a benign schwannoma. Postoperatively, her neurological deficits improved markedly, and by day 11 she had regained near-normal strength in her lower limbs. This case underscores the importance of early recognition of neurological deficits during pregnancy, the utility of MRI for timely diagnosis, and the critical role of multidisciplinary collaboration. Individualized planning and well-coordinated obstetric and neurosurgical interventions can lead to favorable outcomes for both mother and child in these rare but high-risk clinical situations.

Burkitt´s Lymphoma with Prior Varicella Infection Presenting with Guillain–Barré Syndrome: A Case Report

2025-12-02T13:00:28+00:00

Burkitt’s lymphoma (BL) emerges as the most prevalent subtype of non-Hodgkin lymphoma (NHL) in pediatric populations. Several studies have demonstrated a connection between certain viral infections and Burkitt’s lymphoma, suggesting a potential correlation between these factors. Although BL typically presents with lymph node involvement, neurological manifestations are quite rare. In this report, we detail the case of a 13-year-old male patient who initially presented with a varicella zoster infection, accompanied by neurological symptoms consistent with Guillain-Barré syndrome (GBS), and subsequently developed a substantial submandibular mass. Diagnostic imaging, along with biopsy, confirmed a diagnosis of high-grade B-cell lymphoma consistent with BL.

Gaucher Disease - From Textbook Obscurity to Clinical Reality: A Case Report with Diagnostic and Therapeutic Implications at Moi Teaching and Referral Hospital

2025-12-02T13:00:27+00:00

Gaucher’s disease is a rare lysosomal storage disorder caused by a deficiency of the enzyme β-glucocerebrosidase, leading to progressive accumulation of glucocerebroside within macrophages. Clinical presentations vary widely, often resulting in misdiagnosis, particularly in resource-limited settings where advanced diagnostics are unavailable. A 1-year-old female presented to Moi Teaching and Referral Hospital (MTRH), Kenya, with a 2-month history of progressive, painless abdominal swelling, without fever, vomiting, jaundice, or weight loss. She had been misdiagnosed with sickle cell disease and treated with hydroxyurea, without improvement. Examination revealed pallor, massive splenomegaly (20 cm), and hepatomegaly (4 cm), with no lymphadenopathy or bone deformities. Laboratory tests showed anemia, thrombocytopenia, and elevated LDH. Bone marrow biopsy revealed Gaucher cells, confirming Type 1 GD. The patient was managed supportively with transfusions, nutritional support, and infection prevention, and referred for enzyme assays, enzyme replacement therapy, and follow- up. This case highlights the diagnostic challenges in low-resource settings, where advanced enzyme assays and molecular testing are often unavailable, and treatment options such as enzyme replacement therapy (ERT) remain inaccessible. It emphasizes the need for heightened clinical suspicion, improved diagnostic infrastructure, and advocacy for affordable therapeutic access in sub-Saharan Africa.

Pure Posterior Cord Injury Management: Case Report Study

2025-12-02T13:00:26+00:00

Brachial plexus injuries are common; however, pure posterior cord injuries are rare and present with exclusive clinical manifestations that require specialized surgical approaches to achieve acceptable outcomes. Here, we present our experience with these unique cases. Four patients with lacerated pure posterior cord injuries were included in the study. All cases underwent brachial plexus exploration, and nerve grafts were used for reconstruction. After completing physiotherapy, demographic, medical, and surgical data were collected and evaluated. All four patients were referred due to brachial plexus injury. One patient had sustained a gunshot wound and had undergone arterial reconstruction with a vein graft one week prior. The remaining patients had penetrating injuries. Surgical exploration confirmed pure posterior cord injury in all cases. Sural nerve grafts were used to repair the nerve injuries and bridge the gaps. Patients participated in intensive physiotherapy programs for approximately 12 months, followed by motor and sensory evaluations. Three patients achieved excellent outcomes, while the patient with the gunshot wound had a poor result. There are numerous approaches to managing brachial plexus injuries, including non-surgical treatments, nerve repair, nerve grafting, nerve transfer, and muscle neurotization, depending on the condition and surgeon preference. In cases with clearly defined proximal and distal nerve ends, nerve grafting is preferred. Posterior cord injuries have recognizable clinical manifestations, and appropriate surgical techniques may yield good to excellent outcomes. Although pure posterior cord injuries are rare, meticulous exploration and effective nerve grafting can improve final results.

Uncontrollable Rectal Bleeding Following Wegener’s Granulomatosis: A Case Report

2025-12-02T13:00:25+00:00

Wegener’s granulomatosis is an autoimmune vasculitis affecting small and medium vessels, typically involving the respiratory tract and kidneys. Gastrointestinal manifestations are rare and pose diagnostic and therapeutic challenges. A 65-year- old man presented with severe abdominal pain and melena. He developed renal failure requiring dialysis and underwent multiple plasmapheresis sessions. During hospitalization, he experienced massive rectal bleeding and suspected hemoptysis. Endoscopy and colonoscopy revealed no obvious lesions, but CT angiography demonstrated reduced abdominal blood flow, leading to surgical resection of necrotic tissue. Despite intervention, bleeding persisted, and enteroscopy showed multiple ulcers in the jejunum and ileum. Gastrointestinal bleeding in Wegener’s granulomatosis may result from vascular damage or tissue necrosis and can cause life-threatening complications such as anemia and shock. Early recognition and timely treatment are essential to reduce morbidity and mortality.

A Case of Granulomatosis with Polyangiitis Complicated by Ganciclovir-Resistant Cytomegalovirus Central Nervous System Infection

2025-12-02T13:00:23+00:00

This case report describes a 72-year-old female with a confirmed diagnosis of Granulomatosis with Polyangiitis (GPA), who developed a complex and ultimately fatal clinical course complicated by refractory cytomegalovirus (CMV) meningoencephalitis. Despite initial immunosuppressive treatment for GPA and subsequent antimicrobial therapies for suspected bacterial and fungal infections, the patient presented with recurrent fevers, delirium, and cerebrospinal fluid (CSF) pleocytosis. Repeated CSF analyses and imaging revealed a perplexing picture, with a final diagnosis of CMV infection of the central nervous system (CNS) confirmed by PCR. The infection proved resistant to first-line antiviral therapy with ganciclovir, necessitating the addition of foscarnet. The patient’s condition deteriorated, culminating in aspiration pneumonia, hemodynamic instability, and death. This case highlights the diagnostic challenges of CNS infections in immunosuppressed patients and the potential for severe, treatment-resistant viral opportunistic infections in the context of GPA and its treatment.

Presentation of a Neuroendocrine Tumor in a Child with Perforated Appendicitis: A Case Report

2025-12-02T13:00:22+00:00

Neuroendocrine tumors (NETs) are rare neoplasms that arise from neuroendocrine cells, with a significantly lower incidence in children compared to adults. In the pediatric population, appendiceal NETs are particularly notable, accounting for approximately 87.5% of cases, while the overall incidence of NETs in children is estimated at about 1.14 to 5.4 cases per million, compared to around 5.25 per 100,000 in adults. This illustrates the rarity of NETs in children and the difficulties in diagnosing them. These tumors often display symptoms similar to acute appendicitis, leading to their accidental detection during appendectomy. The vague clinical features of appendiceal NETs make preoperative diagnosis and management challenging. In children, these tumors are usually well-differentiated and have a positive outlook; however, the absence of specific pediatric guidelines has led to an excessive reliance on adult treatment protocols, which may be overly aggressive. This case study recounts the experience of a 10-year-old girl who exhibited symptoms suggestive of acute perforating appendicitis. Surgical intervention revealed a neuroendocrine tumor within the mid-portion of the appendix lumen, highlighting the crucial role of histopathological examination in such instances. The findings underscore the need for increased awareness among clinicians about the potential for neuroendocrine tumors to imitate common surgical conditions like appendicitis. Additionally, this case emphasizes the importance of developing pediatric-specific management guidelines to enhance care and minimize unnecessary surgical interventions for this distinct patient group.