Журнал клинических случаев

Actinomycosis is a rare bacterial infection caused by Actinomyces species, gram-positive, microaerophilic bacteria, which, under normal circumstances, colonize oral flora within gingival cervices and tonsillar crypts, gastrointestinal tract and genital microbiota. Firstly in humans, A. israelii was isolated and described in 1878 by James Israel. So far, more than 30 species of Actinomyces have been identified in humans, out of which most frequently isolated species in infections is Actinomyces israelii.

The internal morphology of the maxillary first molar has been heavily studied and reported in the literature. In classic literature, the root canal anatomy of maxillary first molars has been described as three roots with three canals and the most common variation is the presence of a second mesiobuccal canal (MB2).

Immune Checkpoint Inhibitors induced Myocarditis is a serious adverse event. The clinical manifestation can be quite variable and the classic features of myocarditis are not always found. Although challenging, the diagnosis remains necessary in this potentially life-threatening complication. We present the case of a patient treated with nivolumab who developed a late immune checkpoint inhibitor induced myocarditis, without positive diagnostic findings in cardiac magnetic resonance imaging. Early initiation of corticosteroid therapy resulted in good outcome.

Intrathecal drug delivery a method of directly administering opioid and spasmolytic medication to the site of action, the spinal cord. Efficacy and safety of this delivery system is well documented in cancer pain, spasticity as well as non-malignant pain. However, there are a number of recognised potential complications with this therapy. One of the most serious of which is the formation of a granuloma occurring at the intrathecal catheter tip, which appears to be related to the concentration and drug type being delivered. Evidence has indicated that delivery of high dose morphine can lead to the formation of these granulomas. Occurring in less than 3% of all patients with an intrathecal catheter, granulomas can present as an inflammatory mass on imaging with some resulting in compression of the spinal cord. Patients may present with a host of neurological symptoms dependent on the location of cord compression caused by the granuloma, including neurological deficits, myelopathy and radiculopathy.

Colorectal venous malformation is a rare condition that can cause massive rectal bleeding. This is the first report of colorectal venous malformation complicated with massive bleeding and lowers limb deep vein thrombosis, and the two life-threatening conditions were both treated successfully.

Introduction: Parotid metastases of breast cancer are extremely rare. Only 31 cases have been reported between the years of 1982 and 2019.

Case report: We report the case of 41 years-old woman who’s parotidian metastasis has been revealed 4 years after the diagnosis of her breast cancer.

Discussion and Conclusion: Any parotid mass occurring in a patient with a history of breast cancer should be considered metastatic until proven otherwise, and a multimodal care should be started as soon as possible.

Introduction: Catatonia is a neuropsychiatric syndrome with motor and behavioral symptoms. In addition to psychiatric illnesses, this syndrome can also be associated with general medical conditions. Few cases of catatonia associated with autoimmune disorders have been reported.

Case report: We report the case of a 56-year-old female patient diagnosed with Hashimoto's encephalitis, who presented firstly with mystical delusions and tachypsychia. Despite the proper treatment for psychosis, the symptoms worsened and she developed catatonia. Complementary investigations showed high titers of anti-thyroperoxidase antibodies. Hashimoto encephalitis was suspected and intravenous prednisolone was started. As there was an only partial improvement in psychiatric symptoms, plasmapheresis was chosen. The patient evolved with a drastic improvement in symptoms after the third session of plasmapheresis.

Conclusion: An organic etiology should always be considered in cases of catatonia, especially in those with no previous psychiatric history. Doctors should always think about measuring thyroid function when faced with a case of catatonia.