Global Journal of Medical Case Reports

Roseomonas mucosa is a slow-growing, pink-pigmented, Gram-negative coccobacillus historically considered an opportunistic pathogen in severely immunocompromised oncology patients. However, recent genomic and clinical data demonstrate its primary reservoir is the human skin microbiome, facilitating an evolving epidemiology. We report a case of R. mucosa bacteremia in a 69-year-old woman with short bowel syndrome (SBS) and total parenteral nutrition (TPN) dependence.... Roseomonas mucosa is a slow-growing, pink-pigmented, Gram-negative coccobacillus historically considered an opportunistic pathogen in severely immunocompromised oncology patients. However, recent genomic and clinical data demonstrate its primary reservoir is the human skin microbiome, facilitating an evolving epidemiology. We report a case of R. mucosa bacteremia in a 69-year-old woman with short bowel syndrome (SBS) and total parenteral nutrition (TPN) dependence. This case supports an emerging pattern: R. mucosa is increasingly identified in "device-compromised" hosts. Furthermore, this pathogen may present without elevated host-response biomarkers and exhibits intrinsic resistance to empiric broad-spectrum beta-lactams, complicating early management. Read more

Background: Morris syndrome, also known as androgen insensitivity syndrome (AIS), is a disorder of sex development caused by mutations in the androgen receptor gene in individuals with a 46,XY karyotype. The syndrome is typically diagnosed during adolescence due to primary amenorrhea, and early detection in childhood is uncommon. Prompt recognition is clinically important to guide multidisciplinary management and reduce the... Background: Morris syndrome, also known as androgen insensitivity syndrome (AIS), is a disorder of sex development caused by mutations in the androgen receptor gene in individuals with a 46,XY karyotype. The syndrome is typically diagnosed during adolescence due to primary amenorrhea, and early detection in childhood is uncommon. Prompt recognition is clinically important to guide multidisciplinary management and reduce the risk of gonadal malignancy. Case Description: We report the case of a one-year-old phenotypic female presenting with an irreducible, painful right inguinal hernia. Ultrasound suggested bilateral inguinal hernias containing ovary-like structures. During emergency surgical exploration, bilateral testes were unexpectedly identified within the inguinal canals. The testes were reduced into the abdominal cavity, and herniotomy with anterior wall repair was performed bilaterally. External genital examination revealed normally developed labia but absence of the hymenal ring and vaginal opening. The postoperative course was uneventful. Despite referral for karyotype analysis and multidisciplinary follow-up, the parents did not return for further evaluation. Conclusion: This case highlights the rare intraoperative diagnosis of Morris syndrome in early childhood. Awareness of AIS is essential for pediatric surgeons managing inguinal hernias in phenotypic females. Early detection allows timely planning of gonadectomy and long-term multidisciplinary management, minimizing the risk of malignant transformation of undescended testes and optimizing patient outcomes. Read more

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... 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. Read more

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,... 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. Read more

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... 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. Read more

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. 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... 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. 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. 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. 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. Read more