Global Journal of Medical Case Reports

Nodal Marginal Zone Lymphoma with IgG and IgM Secretion of Kappa Light Chain: Case Report

Kaoutar Jamal, Dounia El moujtahide, El-houcine Sebbar, Mohammed Choukri — Sat, 12 Jul 2025 00:00:00 +0000

Nodal marginal zone lymphomas are indolent and rare non-Hodgkin lymphomas, most often diagnosed at an advanced stage. Their clinical presentations are typically insidious, which can lead to delayed diagnosis. The concomitant secretion of IgM and IgG immunoglobulins with kappa light chains constitutes an exceptional feature in this type of lymphoma, as illustrated by our case. We report the case of a 62-year-old man with a history of treated syphilis and inferior vena cava thrombosis managed with rivaroxaban, who presented with a left inguinal mass evolving over three months, accompanied by fever, night sweats, and weight loss. Clinical examination revealed non-inflammatory left inguinal lymphadenopathy without other abnormalities. Laboratory tests showed non-regenerative anemia, leukopenia, and elevated LDH levels. Protein electrophoresis revealed a monoclonal peak in the gamma region, confirmed by serum immunofixation showing two monoclonal bands of IgG kappa and IgM kappa types. Biopsy of the inguinal lymph node revealed histological and immunohistochemical features consistent with a small B-cell marginal zone lymphoma, staged as IV based on the extension workup. A chemotherapy regimen consisting of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) was initiated, resulting in a partial response after four cycles. The coexpression of IgM and IgG kappa light chains in nodal marginal zone lymphomas, which are already rare, is an unusual finding. This particularity warrants multicenter studies to better assess its diagnostic, prognostic, and therapeutic implications.

Propranolol induced Raynaud phenomenon and facial edema in a patient with Hyperthyroidism: A case report

ÇERMA Adishah, POSHI Klodiana, TOTI Florian — Thu, 26 Dec 2024 00:00:00 +0000

Background: Propranolol is a non-cardio-selective beta-blocker, commonly used in patients with hyperthyroidism to treat the hyperadrenergic symptoms but also for its additional effect of blocking the peripheral conversion of inactive T4 to active T3. However, propranolol has many side effects, one of them being secondary Raynaud phenomenon. Case presentation: S.K., 55 years old was hospitalized in the Endocrinology Department as an untreated hyperfunctioning goiter with typical clinical manifestations such as fatigue, anxiety, palpitations, heat intolerance, difficulties in swallowing and breathing. Unimazole 5 mg (2-2-2 tb) and Propranolol 40 mg (¼ -0- ¼ tb) were prescribed. Thirty minutes after taking Propranolol (the dose 40 mg), she had difficulties breathing, was agitated, sweating and had nausea. Her face was hyperemic and edematous and her extremities were getting blue and cold. Her vitals remained stable and her airways were opened, as evaluated from laryngoscopy and CT-scan of the neck. 8 hours later, her clinical manifestations got worse: her facial edema spread in her lips and submandibular region. On both cases, she clinically improved after prednisolone administration. 12 hours after taking propranolol, she showed no more signs of cyanosis or edema. Propranolol was replaced by Nebivolol, with no side effects. Conclusion: Secondary Raynaud phenomenon is a common side effect of beta-blockers and should be taken in consideration in very patient presenting with cold and cyanotic peripherals. In these cases, propranolol should be stopped and replaced. Further studies on beta-blockers side effects in patients with hyperthyroidism should be made.

Atypical Presentation of Lemierre’s Syndrome Masquerading as Gastroenteritis Lemierre’s Syndrome Mimicking Gastroenteritis

Asli Haykir Solay, Dilek Bulut, Pelin Beyza Ünal, Semanur Kuzi — Thu, 24 Jul 2025 00:00:00 +0000

Lemierre’s syndrome (LS) is a rare clinical condition characterized by septic thrombophlebitis of the internal or external jugular vein, usually following an oropharyngeal infection. Here, we present a 20-year-old male patient who developed diarrhea, nausea, and vomiting after receiving clarithromycin for an upper respiratory tract infection. On admission, he had fever, hypotension, and elevation in acute phase reactants (WBC: 20,410/µL, CRP: 197 mg/L). Empirical treatment with ceftriaxone and metronidazole was initiated. Stool and throat cultures were negative. On the second day, abdominal tenderness developed; direct abdominal radiograph showed dilated bowel loops, but toxic megacolon was excluded during follow-up. Thoracic CT revealed septic emboli in the lungs. Due to persistent fever despite ceftriaxone and metronidazole therapy, treatment was escalated to meropenem on the fifth day. On the same day, blood cultures grew Fusobacterium necrophorum, raising suspicion of LS. Doppler ultrasound detected a thrombus in the left external jugular vein. Anticoagulant therapy with low-molecular-weight heparin and clopidogrel was initiated. The fever resolved by the seventh day of full antibiotherapy After three weeks of intravenous therapy, follow-up imaging showed regression of the thrombus. The patient completed a four-week course of antibiotics and anticoagulants and was discharged with full recovery. This case highlights the diagnostic challenge of LS presenting with gastrointestinal symptoms and emphasizes the importance of early blood cultures and imaging. External jugular vein involvement due to F. necrophorum is rare and should be considered in patients presenting with septic emboli.

Late-Onset Rabies: A Case Report Highlighting the Importance of Prompt Medical Attention

Tue, 18 Feb 2025 00:00:00 +0000

Rabies is a virus present in more than 150 nations and territories worldwide, but it can be prevented through vaccination. Each year, tens of thousands of people die from rabies, primarily in Asia and Africa, with children under the age of 15 representing 40% of these fatalities. Up to 99% of rabies transmissions to humans occur through dog bites, making dogs the leading cause of rabies-related deaths in humans. We present a fatal case of rabies after a 5-month exposure incident. The patient, a 55-year-old Nigerian missionary from Enugu state, Nigeria presented with restlessness, hydrophobia, occasional barking gestures, abdominal discomfort and agitation. His condition was said to have progressively worsened as patients was unable to eat and drink fluids for days. His wife reported that the patient had experienced a bite from a stray dog on his right arm 5 months before presentation, for which no antirabies prophylaxis was given. The patient died on the second day of admission to the hospital (within 7 days of symptom onset).

Biopsy-Negative Giant Cell Arteritis Presenting as Stroke Mimic with Vision Loss and Complex Vascular Disease

Mohamed M. Khamis, Daniel Goering — Tue, 09 Sep 2025 00:00:00 +0000

A man in his 60s with multiple vascular comorbidities presented with sudden, painless vision loss in one eye. Although he had a high risk for atherosclerotic events, initial evaluation for stroke was negative for acute ischemia, but found to have markedly elevated inflammatory markers. Accordingly, giant cell arteritis was investigated and Ophthalmologic findings and fulfillment of the 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria supported the diagnosis of giant cell arteritis, despite a negative temporal artery biopsy. Management included high-dose glucocorticoids and delayed tocilizumab initiation due to the need for multiple vascular surgeries. Vision loss was irreversible, but systemic symptoms resolved and vascular interventions were successful. This case highlights the diagnostic and management complexities of biopsy-negative giant cell arteritis in patients with severe atherosclerotic vascular disease, emphasizing the importance of clinical judgment and established classification criteria when imaging and biopsy results are inconclusive.

Between Ptosis and Mandibular Contraction, there is a Hidden Marcus Gunn Syndrome

Sat, 08 Mar 2025 00:00:00 +0000

INTRODUCTION Marcus Gunn syndrome or unilateral trigemino-oculomotor syncinesis is a very rare autosomal dominant genetic disorder characterised by a combination of congenital ptosis and mandibulopalpebral syncinesis during certain mandibular movements. The Marin Amat phenomenon is an autosomal dominant disorder which is the reverse of Marcus Gunn syndrome, i.e. the closure of one eye caused by a wide opening of the mouth, was described by Marin Amat in 1918. OBJECTIVES AND METHODS This is a description of a case series from the ophthalmology department of the CHU Mohammed VI d'Oujda, with the aim of describing the etiopathogenic, clinical and therapeutic aspects of Marcus Gunn syndrome. OBSERVATIONS We report a series of two cases of children with Marcus Gunn syndrome. Case 1: A 5-year-old boy with no previous pathological findings presented with unilateral ptosis of the left upper eyelid at the age of 4 months. His visual acuity was 10/10 in right eye on the right and 5/10 in left eye. Appendages showed ptosis on the left with no upper palpebral crease, and no associated oculomotor paralysis or strabismus. Examination of the anterior and posterior segments was unremarkable in both eyes. We observed retraction of the upper eyelid when opening the mouth and chewing. Second case: a 7-year-old girl, brought in by her parents for a ptosis of the left eye noted at birth. This is a 7-year-old girl brought in by her parents for ptosis of the left eye, diagnosed at birth. She had no particular pathological antecedents. Her visual acuity was 10/10 in right occlusion and 3/10 in left occlusion. Adnexal findings included partial ptosis of the left eye, with retraction of the upper eyelid when opening the mouth and chewing. The rest of the ophthalmological examination was unremarkable. We noted amblyopia on the left, and the somatic examination was unremarkable in both children. Orbital and head CT scans were normal in both children. Both children had undergone sectioning of the superior levator muscle with frontal suspension using prolene sutures, with good progression, followed by total optical correction and treatment of the amblyopia. DISCUSSION Marcus Gunn syndrome is a very rare condition, affecting 2-13% of cases of congenital ptosis. The first case was described by British physician Robert Marcus Gunn in 1883 as the “blinking jaw phenomenon”. It is characterized by unilateral ptosis associated with mandibulo-palpebral synkinesis, i.e. ptosis that is corrected by mouth opening or mandibular diduction. It may be isolated or associated with oculomotor disorders. Our two cases present a clinical picture that corroborates the description in the literature. Marcus Gunn syndrome is an autosomal dominant genetic disorder, but it can also occur under certain conditions (following childhood trauma, inflammatory processes or even tumour lesions). The etiopathogenesis is poorly understood, but is probably due to aberrant innervation of the levator muscle of the upper eyelid by trigeminal motor fibers, according to the literature. The result is a congenital brainstem lesion that leads to disinhibition of mandibulo-palpebral co-contraction, which is physiologically very weak and inhibited. Stimulation of the trigeminal nerve by contraction of the pterygoid jaw muscles excites the branch of the oculomotor nerve that innervates the levator of the upper eyelid, causing rhythmic upward jerking of the upper eyelid. CONCLUSION Marcus Gunn syndrome is a rare condition characterized by congenital ptosis and mandibulo-palpebral syncinesia. Its etiopathogeny remains poorly elucidated. Its management is an absolute emergency, as the occurrence of amblyopia depends on it. The choice of surgical technique is difficult, as it must correct both ptosis and syncinesia. BIBLIOGRAPHICAL REFERENCE 1. Awan KJ.Marcus Gunn (jaw-winking) syndrome. Am J Ophthalmol. 1976 Sep;82(3):503-4. Google 2. Nan Xiang, Wei-Kun Hu, Bin Li, Rong Liu. Management of morderate-to-severe Marcus-Gunn syndrome by anastomosis of levator and frontal muscles. Int J Ophthalmol. 2010;3(4):342-345. Google 3. 4. Beard D C. A new treatment for severe unilateral congenital ptosis and for ptosis with jaw-winking. Am J Ophthalmol. 1965 Feb;59:252-8. Google 5. Altman K. The Marcus Gunn (jaw-winking) phenomen: a case report. Br J Oral Maxillofac Surg. 1990 Feb;28(1):53-4. PubMed | Google Scholar

A Case of Severe Pulmonary Aspergillosis Successfully Treated by Isavuconazole

Masafumi Seki — Sat, 08 Mar 2025 00:00:00 +0000

Isavuconazole (ISCZ) is a novel antifungal agent that is expected to be effective against severe fungal diseases. A case of chronic pulmonary aspergillosis that was refractory to existing agents, such as micafungin, but was successfully treated by ISCZ, is presented.