European Journal of Medical Case Reports

Background: This case report highlights a rare iatrogenic complication of pericardiocentesis and discusses its clinical management. In most cases, pneumopericardium is usually self-limiting and does not require any specific treatment. Therefore, a timely diagnosis and urgent treatment are required. Currently, there are only a few reports regarding pneumopericardium following therapeutic pericardiocentesis.

Case Presentation: We present a case of an 81-year-old woman who developed pneumopericardium following pericardiocentesis for pericardial effusion, a rare association reported in the literature.

Conclusion: Pneumopericardium may develop iatrogenically after Pericardiocentesis. Attention should be paid to the puncture site and angle during pericardial puncture, especially in weak patients.

Background: Bronchogenic cysts (BCs) are cysts formed by abnormal budding of the tracheobronchial tree during embryological development and are less common in adults. They are often located in the mediastinal region or lung parenchyma, but they can rarely be seen extrathoracically. BCs may not be detected radiologically on direct radiography most of the time. However, the diagnosis can be made by thorax Computer Tomography in 97% of lesions. Although they are usually benign, they can lead to severe airway symptoms in patients if they grow large enough to compress the lungs or airway. After this stage, surgical 
treatment should be planned to prevent recurrences with extraluminal compression and tracheal narrowing that may lead to negative consequences by making the right treatment plan.

Case Presentation: In our case, although we recommended the operation at the age of 18, surgical excision was planned for the patient, who did not accept it and developed dyspnea symptoms during follow-up and increased the size of the BC seen on thoracic CT during follow-up. In our patient, hybrid thoracotomy was decided to intervene effectively in the close proximity of the lesion to the superior vena 
cava and possible complications.

Conclusion: Although BCs are usually asymptomatic, surgical excision should be performed because they may cause compression symptoms to the respiratory tract due to an increase in size and recurrence may occur if they are not completely excised. Minimally invasive methods such as video-assisted thoracoscopic surgery and robot-assisted thoracoscopic surgery for surgical resection, or wedge resection and lobectomy with thoracotomy may be considered a good choice for intraparenchymal BCs.

Background: Lupus podocytopathy (LP) is a rare histopathological diagnosis of renal biopsies performed in the context of systemic lupus erythematosus (SLE) with renal involvement. Steroid-induced psychosis is a well-documented phenomenon. 

Case Presentation: A 55-year-old woman, diagnosed with SLE, went to the emergency department due to asthenia, inflammatory polyarthritis, and decreased urinary output. The blood panel showed hypoalbuminemia and acute kidney injury and the protein/creatinine ratio was elevated. She was admitted with a diagnosis of probable lupus nephritis (LN) and pulses of methylprednisolone were started. During hospitalization, an amplified study was conducted. A 24-hour urine sample showed proteinuria in the nephrotic range. Renal biopsy was conducted and the results showed aspects suggestive of class II lupus nephropathy and the suspicion of LP was therefore high. Despite favorable evolution with high-dose corticosteroid oral therapy, the patient began to experience behavioral changes with delusional and persecutory thoughts, compatible with psychosis, which led to the introduction of tacrolimus and the rapid reduction in steroid doses. During follow-up consultation, the diagnosis of podocytopathy was confirmed by electron microscopic evaluation, with a diffuse fusion of the podocyte pedicels and without subepithelial deposits or organized structures.

Conclusion: LP is a rare histopathological diagnosis and should be suspected in cases of LN with nephrotic proteinuria. Kidney biopsy and electron microscopy are essential in confirming the diagnosis. It is mandatory to recognize and manage steroid induced psychosis during high-dose corticosteroid therapy. The use of tacrolimus is an important alternative treatment option in such cases.

 Background: Atrial myxomas are the rare slow-growing tumors of the heart and are often found in the left atrium; they most commonly present with symptoms of thromboembolic disease and have rarely been associated with respiratory symptoms.

 Case Presentation: We present the case of a 71-year-old woman who attended the emergency department with a 72-hour history of shortness of breath, a cough, and wheeze. She had been diagnosed with chronic obstructive pulmonary disease in the community recently but had never had any spirometry testing. She was treated for an exacerbation of airways disease with nebulized bronchodilators, steroids, and antibiotics. She deteriorated after 24 hours to the point of requiring intubation and ventilation, despite escalating her to extensive bronchodilator therapy she did not improve and the wheeze was persistent. Subsequently, an echocardiogram was performed at the bedside which revealed a large left atrial mass which led to discussion with local cardiologists and cardiothoracic surgeons. The mass was resected and confirmed to be an atrial myxoma on histology. The patient had a good recovery and, when seen in the follow-up clinic, reported that her breathing had returned to normal, with no wheeze present.

 Conclusion: This case highlights the dangers of making a premature diagnostic judgment when a patient presents with a pre existing diagnosis, as in our case it was considering an alternative pathology that led to the final diagnosis. It also demonstrates the importance of considering cardiac disease as a differential for wheeze and using echocardiography in the assessment of the patient with respiratory failure.

Background: Among extranodal non-Hodgkin lymphomas, primary cutaneous lymphomas rank as the second most prevalent.
These lymphomas can originate from T cells, B cells, or natural killer cells. Cutaneous T cell lymphomas (CTCLs) form a diverse
group of lymphomas that display clinical distinctions from systemic lymphomas, despite potential similarities in histology Mycosis fungoides (MF) stands out as the most prevalent subtype of CTCL. Pierre-Antoine-Ernest Bazin outlined the transformation from patches - defined as non-infiltrated lesions exhibiting erythema, scaling, and atrophy - to infiltrated plaques and tumors. Histologically, this progression is marked by the increase of small to medium-sized epidermotropic CD4+ T lymphocytes that have folded nuclei.
Case Presentation: We present a case of an 85-year-old man with a known history of vascular dementia who presented with a
lesion on his left posterior thigh. After no improvement with a potent steroid cream, a punch biopsy of the lesion was done and confirmed the diagnosis of MF, tumor stage. However, due to the patient’s poor clinical frailty and ECOG performance score, the intent of treatment was palliation.
Conclusion: This case report aims to discuss the challenges in the diagnosis and management of cancer in elderly patients with significant comorbidities. We will also highlight the management pathway of MF.