European Journal of Medical Case Reports

Background: Despite traditionally affecting individuals with compromised immune systems, severe human adenoviruses (HAdV) infections have been observed in young adults without immunodeficiency over recent decades.
Case Presentation: This case study documents two young patients infected with HAdV who experienced multi-organ failure, manifesting as respiratory distress, vasoplegia, myocardial injury, and kidney impairment. The resolution of organ failure correlated with the clearance of viral load, suggesting a potential prognostic indicator for infection outcomes. While the first case demonstrated a positive outcome with the resolution of viremia, regrettably, the second case succumbed to myocardial infarction followed by cardiac arrest. The use of cardiac monitoring may aid in the identification of significant myocardial complications associated with HAdV. Although various treatments, including the antiviral CIDOFOVIR, have been reported for immunocompromised individuals, it was not administered to our patients due to the favorable trajectory of the first case.
Tragically, the second case passed away before any potential antiviral intervention could be initiated.
Conclusion: HAdV infections can cause severe acute respiratory distress syndrome with multi-organ failure including severe cardiac complications in young non-immunocompromised adults.

Background: Pilocytic astrocytomas (PA) are low-grade, benign gliomas classified as WHO grade I, representing 6% of all gliomas and commonly found in children. Intraventricular pilocytic astrocytomas (IVPA) are rare, accounting for only 4% of PA cases.

Case Presentation: We report a 42-year-old Saudi woman with recurrent positional headaches but no neurological deficits. MRI showed a 1.2-cm non-enhancing lesion near the foramen of Monro, initially thought to be a colloid cyst. The lesion was excised via an interhemispheric transcallosal approach. Histopathology confirmed PA with biphasic tissue, glomeruloid vessels, and strong GFAP positivity, classified as WHO grade I. No further chemotherapy or radiotherapy was required.

Postoperative Outcome: Post-surgery, the patient had transient short-term memory issues, partially resolving within six months, and her headaches ceased. Initial imaging showed pneumocephalus, which resolved after one month.

Discussion: IVPA typically remain asymptomatic until they cause hydrocephalus by obstructing cerebrospinal fluid pathways. Radiologically, they appear as well-defined lesions with mixed cystic and solid components. Complete surgical resection is crucial to minimize recurrence.

Conclusion: IVPA, though rare in adults, should be considered in the differential diagnosis of intraventricular lesions. This case highlights the significance of accurate diagnosis and surgical management for this uncommon tumor.

Background: Intracranial germ cell tumors (iGCTs) are a rare and heterogeneous group of neoplasms originating from germ cells within the central nervous system (CNS). These tumors are a subclass of CNS germ cell tumors (GCTs) that are typically observed in 1st to 2nd decades of life. They tend to occur in the midline, either at the pineal region or along the floor of the third ventricle/suprasellar region. Less commonly, both regions can be involved, presenting as bifocal tumors which usually carry a worse prognosis. Such bifocal lesions can be either two independent primary germinomas (GEs) (known as true bifocal GE) or it can be one primary GE with metastases (known as false bifocal GE). Bifocal presentation is mostly seen in GE, but some of the patients may have mixed GCT. Clinical features are mainly due to the mass effect and involvement of sellar and supra-sellar regions.
Case Presentation: A 21-year-old male presented with complaints of erectile dysfunction, lack of libido, headache, polydipsia,
polyuria, diplopia, and recent onset blurring of vision over the past 6 months to 1 year. Radiological investigations revealed
the presence of true bifocal iGCTs, which were confirmed to be β-human chorionic gonadotropin producing GEs upon
histopathological and immunohistochemical analysis. The patient showed complete resolution of the tumor following treatment.
Conclusion: Intracranial GEs are highly radiosensitive tumors often characterized by insidious symptoms, leading to a significant delay in diagnosis, with patients often seeking medical assistance only when their daily activities are severely impaired. However, this delay could be mitigated by obtaining a thorough patient history and maintaining a high index of suspicion for intracranial GEs, particularly in the appropriate age groups. Our case report emphasizes the importance of a multidisciplinary team approach in facilitating timely and informed decision-making for optimal patient management.

Background: Mycoplasma pneumoniae (M. pneumoniae) is one of the most common causes of atypical pneumonia in
pediatric and adult populations worldwide. It can also affect many other organs including neurological, cardiac, hematologic,
gastrointestinal, renal, osteoarticular, ocular, and cutaneous involvement. Mycoplasma pneumoniae-related cutaneous vasculitis is an infrequent manifestation. Several cases of secondary cutaneous leukocytoclastic vasculitis (LCV) associated with M. pneumoniae have been publicly reported in both English and foreign languages.
Case Presentation: This report details the case of a 44-year-old Thai male presented with high-grade fever accompanied by
generalized erythematous papules, patches, and some pustules for 3 days with no chest symptoms. He was treated with
ceftriaxone, doxycycline, and clindamycin for 5 days without clinical improvement. However, histopathological and direct
immunofluorescence tests later confirmed a diagnosis of LCV. Serological tests showed positivity for M. pneumoniae. The
regimen was then changed to azithromycin 500 mg daily for 5 days and the lesions showed remarked improvement without
scarring.
Conclusion: The importance of recognizing and addressing the atypical presentations of M. pneumoniae in febrile patients with cutaneous vasculitis is imperative to guide targeted treatment decisions, thus facilitating rapid clinical improvement.

Background: Leptospirosis, a zoonotic infection caused by Leptospira bacteria, presents with symptoms ranging from mild flu-like signs to severe multiorgan failure. A rare but serious complication of leptospirosis is thrombotic microangiopathy (TMA). This case report discusses the treatment of a 52-year-old female with leptospirosis complicated by TMA, highlighting the effectiveness of plasma exchange and corticosteroids in her recovery.
Case Presentation: A 52-year-old female presented with a five-day history of fever and progressive shortness of breath. Upon
admission, she had tachypnoea, a partial pressure of oxygen in arterial blood (PaO2) to the fraction of inspiratory oxygen
concentration (FiO2) ratio of 61, and bilateral lung infiltrates, requiring invasive mechanical ventilation and prone positioning.
Laboratory tests revealed anemia, thrombocytopenia, schistocytes, and elevated lactate dehydrogenase, suggesting TMA. The
patient also showed elevated liver enzymes and signs of a potential diagnosis of thrombotic thrombocytopenic purpura, though serological tests for tropical infections, including leptospirosis, were initially negative. The patient was treated with plasma exchange and corticosteroids, leading to improvements in her hematological parameters and acute respiratory distress syndrome (ARDS). However, she developed unexplained blood pressure and heart rate fluctuations, and electroencephalogram confirmed focal seizures, which were treated with levetiracetam and propofol. Subsequent serological testing confirmed leptospirosis with positive Immunoglobulin M antibodies and Leptospira polymerase chain reaction testing. The patient was treated with doxycycline and ceftriaxone, resulting in significant improvement, successful extubation, and eventual discharge.
Conclusion: This case highlights the challenges of managing leptospirosis complicated by TMA and severe ARDS. Plasma
exchange and corticosteroids were essential in the patient’s recovery. The initial delay in diagnosis due to negative serological
tests underscores the importance of maintaining a high index of suspicion for leptospirosis in severe tropical illness cases with
TMA. The patient’s positive response to treatment, including resolution of seizures and hemodynamic instability, demonstrates
the value of prompt and targeted interventions. The case emphasizes the need for a multidisciplinary approach in managing
complex leptospirosis cases with severe complications.

Background: Kidney transplantation is the preferred treatment for end-stage renal disease (ESRD) due to its superior outcomes compared to dialysis. However, complications such as infection, wound dehiscence, incisional hernia (IH), and rarely, renal paratransplant hernia (RPH) can occur post-transplant. This study reported a case of a patient with a post-renal transplant who presented abdominal symptoms requiring urgent laparotomy for an obstructed hernia at the transplant site.
Case Presentation: A 57-year-old male with non-alcoholic fatty liver disease, ESRD secondary to IgA nephropathy, myelofibrosis, and renal stones underwent a renal transplant from his son. He presented to the emergency department 6 days after he was discharged with severe abdominal pain, vomiting, and a visible bulge at the transplant incision. Ultrasound confirmed an IH with small bowel obstruction. Exploratory laparotomy successfully managed the hernia, and postoperative care included antibiotics and supportive measures. The patient recovered uneventfully and was discharged in good condition.
Conclusion: RPH represents a significant but uncommon complication following kidney transplantation. Timely identification and surgical intervention are essential for favorable outcomes. Despite the immunosuppressive risks, the incidence of RPH remains relatively low. Careful surgical planning is crucial to mitigate complications, and ongoing research is needed to refine treatment strategies, particularly exploring laparoscopic approaches in select cases.

Background:
Mucormycosis (MCR) is an uncommon but frequently deadly fungal infection that typically affects individuals with weakened immune systems. Pulmonary mucormycosis, in particular, is most frequently observed in patients who have undergone stem cell or solid organ transplants. The incidence of mucormycosis in solid organ transplant recipients is reported to be 0.07% within the first year. In almost 40% of these transplant patients, including the case we examined, the infection is diagnosed within the first six months after the transplant.
Case Presentation:
We report a rare case of a 67-year-old man who developed pulmonary mucormycosis within six months after undergoing a heart transplant. A bronchoscopy was conducted, and RT-PCR along with cultures of the broncho-alveolar samples tested positive for Mucorales. After consulting with experts from thoracic and vascular surgery, cardiology, pulmonology, and microbiology, and adhering to the expert guidelines, a semi-urgent source control procedure was recommended. This involved performing a thoracoscopic exploration of the right pleura, which was subsequently converted to a lateral thoracotomy, culminating in the resection of the right lower lobe.
Conclusion:
Invasive mucormycosis (MCR) is a rare but serious fungal infection with a high risk of illness and death, particularly in people with underlying health issues or weakened immune systems. The clinical and imaging manifestations can vary among patients based on their immune status and how they contracted the infection. Despite these variations, it is vital to maintain a high level of suspicion for MCR, as early diagnosis and the rapid initiation of surgical and antifungal treatments are critical for improving survival chances.