Efficacy and safety of 308-nm Excimer lamp combined with Tacrolimus 0.1% ointment vs Tacrolimus 0.1% ointment as monotherapy in treating children with limited vitiligo: a randomized controlled trial

OBJECTIVE

This study aims to assess the efficacy and safety of combining the 308-nm Excimer lamp with Tacrolimus 0.1% ointment, compared to Tacrolimus 0.1% ointment monotherapy, for treating pediatric vitiligo involving less than 10% of the body surface area.

METHODS

Fifty pediatric patients with vitiligo were randomly assigned to two groups. Group A received Tacrolimus 0.1% ointment twice daily and Excimer light at 308-nm twice weekly, while Group B received Tacrolimus 0.1% ointment alone, administered twice daily. Repigmentation percentages were evaluated after 30, 90, and 180 days using the rule of nine.

RESULTS

Group A exhibited a significant improvement in repigmentation, increasing from 10% after one month to 65% after six months. In contrast, Group B observed an increase from 10% to 30% over the same timeframe. The efficacy of the treatment was significantly higher in Group A at both the 3-month and 6-month follow-up points (p-value < .001). Moreover, Group A achieved notably higher repigmentation rates in the face, trunk, and lower limbs.

CONCLUSION

The combination of Tacrolimus and the 308-nm excimer lamp yielded superior repigmentation results compared to Tacrolimus monotherapy in pediatric vitiligo patients. This combined approach may offer an effective new treatment protocol for pediatric vitiligo.

Managing Pulmonary Embolism With Right Ventricular Thrombus in In Vitro Fertilization-Related Pregnancy: A Clinical Insight

This case study provides an insightful examination of the management of high-risk pulmonary embolism (PE) in a 27-year-old pregnant patient following in vitro fertilization (IVF). Overlapping symptoms of PE and typical pregnancy manifestations, coupled with concerns about radiation exposure from diagnostic imaging, presented unique diagnostic challenges. Despite the heightened risk of thrombosis during pregnancy and elevated D-dimer levels, a conservative approach was strategically employed. This involved therapeutic anticoagulation using low-molecular-weight heparin, leading to significant patient improvement without the need for invasive interventions. This case highlights the imperative for a judicious yet proactive approach in managing PE among pregnant patients, meticulously considering both maternal and fetal health risks.

Massive Localized Lymphedema: Two Case Studies and Diagnostic Challenges

Massive localized lymphedema (MLL) is an emerging clinical phenomenon predominantly observed in morbidly obese individuals. It presents both diagnostic and therapeutic challenges to clinicians due to its characterization by large, pendulous masses in the abdomen or thigh. MLL may resemble malignant conditions, such as liposarcoma, leading to unnecessary invasive interventions. This study presents two case studies: a 74-year-old male who succumbed to postoperative complications and a 56-year-old female who experienced successful recovery. These cases highlight the urgent need for robust diagnostic criteria and evidence-based management approaches for MLL. In addition, further research exploring the pathogenesis, risk factors, and potential connections among MLL, hypothyroidism, and angiosarcoma is essential.

Clinical Dilemmas in Immune Thrombocytopenic Purpura With Diffuse Alveolar Hemorrhage: Diagnosis, Treatment, and Outcomes

This report elucidates a unique case of a 39-year-old female with immune thrombocytopenic purpura (ITP) who developed a rare and severe complication: diffuse alveolar hemorrhage (DAH). Despite initial treatments for ITP, the patient experienced fluctuating platelet (PLT) counts and shortness of breath, which were later identified as symptoms of DAH. An urgent splenectomy improved the patient's platelet counts and overall condition. This case underscores the imperative to recognize DAH as a possible ITP complication, requiring clinicians' vigilance for prompt diagnosis and intervention. The intricate nature of ITP in adults necessitates individualized, patient-centered treatment approaches to enhance outcomes. This report provides invaluable insights into the clinical understanding and management of ITP and its complications through detailed analysis and documentation of the patient's treatment journey.

Navigating the Dry Tap Conundrum: A Successful Spinal Anesthesia for a Cesarean Section

A "dry tap" in spinal anesthesia is characterized by the lack of cerebrospinal fluid (CSF) after needle insertion and poses unique challenges for anesthesiologists. We present an uncommon case of a 30-year-old female undergoing a cesarean section who experienced this situation. Despite the absence of CSF after several attempts, the patient's sensory alterations post-anesthesia administration confirmed intrathecal placement. This successful administration of spinal anesthesia in the face of a dry tap emphasizes the value of clinical observation and adaptability, offering an innovative perspective on addressing such rare occurrences.

Unforeseen Complications: A Case of Subdural Anesthesia Post-epidural Insertion

Subdural anesthesia, although rare, is a significant complication of epidural anesthesia. This case report presents a 28-year-old female patient who developed sudden unconsciousness following epidural anesthesia administration for labor pain. Despite no evident contraindications to epidural anesthesia, she lost consciousness shortly after the initial test dose, leading to an emergency cesarean section under general anesthesia. The neonate showed signs of fetal bradycardia post-epidural and required intensive care. The patient made a complete recovery with no postpartum complications. This report underlines the need for vigilant monitoring and the importance of swift interventions in case of complications arising from epidural anesthesia.

Pilomatrixoma of the Arm: A Case Report and Review of Literature

Pilomatrixoma (PMX), also known as calcifying epithelioma of Malherbe, is a rare benign neoplasm that arises from the hair matrix cells, commonly in the head, neck, and upper trunk regions, infrequently affecting upper and lower extremities. It has to two peaks of presentation: under 20 years of age or between 50 and 65 years of age, slightly more common in females. The neoplasm exhibits diverse clinical manifestations and is frequently subject to misdiagnosis with alternative dermatological diseases. We present an atypical case of PMX affecting the upper extremity of a 62-year-old female patient. Surgical removal of the affected tissue under local anesthesia was performed, and subsequent histopathological analysis confirmed the presence of PMX. Based on the literature search we performed, we found out that this pathology is underreported in Jordan, with only one study published describing this tumor in the maxillofacial region. Physicians should be aware of this condition and its different presentations to include it in the differential diagnosis of suspected cases to provide the appropriate management and follow-up.

A Sporadic Giant Mesenteric Desmoid-Type Fibromatosis in a Teenage Female: A Report of a Rare Case

Mesenteric desmoid-type fibromatosis (DTF) is a rare benign yet aggressive neoplasm that has an unpredictable biological behavior ranging from spontaneous regression to extensive local infiltration and has a high tendency for recurrence. The presenting symptoms are usually nonspecific and mostly related to the large size of the tumor compressing adjacent organs. Imaging studies can be suggestive of the diagnosis, but confirmation is based on histopathological and immunohistochemical examination. The lack of knowledge on the etiology and pathogenetic behavior of this tumor leads to therapeutic and prognostic challenges. Future genetic studies may help in advancing our understanding of this neoplasm and in formulating the proper management and follow-up plan. Here we present a case of a 14-year-old female who presented to the emergency room complaining of diffuse abdominal pain and distention. A computed tomography (CT) scan showed a large mass occupying most of the abdominal cavity and compressing adjacent organs. Exploratory laparotomy with resection and anastomosis was performed, and the histopathological and immunohistochemical examination of the resected mass was consistent with mesenteric DTF.

Frantz's Tumor in Focus: The Tale of a 34-Year-Old Yemeni Female Patient

A solid pseudopapillary tumor (SPT) of the pancreas, which mainly occurs in young women, is an uncommon pancreatic tumor that often presents diagnostic and therapeutic dilemmas. This case study discusses the symptoms and treatment approach for a 34-year-old woman from Yemen diagnosed with SPT. The patient was diagnosed through abdominal and pelvis CT scan, followed by ultrasound-guided biopsy confirming the presence of SPPT. Management through the Whipple procedure and portal vein reconstruction proved successful, with no recurrence or metastasis noted in a year-long follow-up. The importance of comprehensive understanding and surgical expertise in handling SPT is emphasized.

When the Gut Tells a Story: Bezoars in a Neglected Autistic Child

This case study delves into the unique presentation of bezoars in a 14-year-old autistic female who exhibited chronic diarrhea and abdominal pain. While trichobezoars, masses formed from ingested hair, are rare, they are predominantly seen in young females and are associated with psychiatric conditions. Through rigorous diagnostic procedures, including a computed tomography imaging of the abdomen and pelvis (CTAP) scan, fecal impaction, and multiple bezoars, including hair and non-biological items, were identified. The background revealed significant neglect, emphasizing the importance of a comprehensive approach that integrates medical, surgical, and psychosocial care.

Beyond the Norm: Unveiling a Dermoid Cyst in an Inguinal Hernia Case

This case report focuses on a rare presentation of a dermoid cyst within an inguinal hernia in a 15-year-old male patient. The patient presented with a four-day history of a persistent, non-reducible, physical exertion-related bulge in the left groin area, which improved upon lying supine. Ultrasound investigations revealed a complex cystic structure resembling a dermoid cyst within a left direct inguinal hernia. Post-operative histopathology confirmed the dermoid cyst with no signs of malignancy. This case emphasizes the need for a high degree of suspicion when dealing with inguinal swellings, as rare entities like epidermal cysts may mimic more common conditions like inguinal hernias.

A Man's Struggle With Idiopathic Intracranial Hypertension: A Unique Case Study

We report a unique case of a 53-year-old male with idiopathic intracranial hypertension (IIH), predominantly affecting overweight young women. The patient, known to have diabetes mellitus, familial Mediterranean fever, and dyslipidemia, presented with blurred vision and throbbing headaches. Clinical examination, brain MRI/MRV, and a lumbar puncture confirmed the IIH diagnosis. Management with acetazolamide improved the patient's symptoms significantly. This case highlights the potential for IIH occurrence in men and underscores the need for early diagnosis and intervention to prevent potential visual impairment, typically more severe in male patients.

Bilateral Deep Vein Thrombosis (DVT) as a Harbinger of Lung Adenocarcinoma: A Rare Presentation

Oncologic disorders, such as lung adenocarcinoma, can intricately interplay with the coagulation cascade, often leading to thromboembolic events, of which deep vein thrombosis (DVT) stands out prominently. In this report, we present a unique case of a 50-year-old non-smoking Jordanian male who exhibited bilateral DVT as an unexpected preliminary manifestation of an aggressive lung adenocarcinoma. Although the patient did not possess common risk factors for DVT, the bilateral presentation drew attention to the possibility of an underlying malignancy. Subsequent investigations revealed a stage 4 primary lung adenocarcinoma. This case underscores the imperative of maintaining a broad differential in cases of DVT, especially when presenting bilaterally and without evident etiology. Such early detection and intervention, accompanied by collaborative medical strategies and specialized care, can play a pivotal role in enhancing patient prognosis and survival rates. This case exemplifies the potential of DVT, particularly when bilateral, as a harbinger of a more sinister underlying pathology like lung adenocarcinoma.

Vacuum-Assisted Closure Therapy: A Lifesaver in a Case of Neck Necrotizing Fasciitis

Necrotizing fasciitis (NF) is a severe and rare soft tissue infection with a high potential for mortality, particularly in cases related to odontogenic infections in immunocompromised patients. The conventional treatment for NF includes broad-spectrum antibiotics and aggressive surgical debridement. This report presents a unique case of a 34-year-old healthy male who developed NF following a lower left wisdom tooth extraction. The infection extended into the superior mediastinum, requiring emergency surgical intervention. The therapeutic management included vacuum-assisted closure (VAC), a treatment modality showing promise in managing complex soft tissue infections, in combination with other adjunct treatments. The patient showed a satisfactory healing process and no signs of recurrence during the six-month follow-up period. This case underlines the importance of early diagnosis and the potential benefit of VAC therapy in managing advanced NF, emphasizing the need for further research and clinical application.

Gluteal Mystery: A Case Report of Superficial CD34-Positive Fibroblastic Tumor

The case at hand involves a 25-year-old woman suffering from a gradual enlargement of a gluteal mass over a five-year period. This rare medical condition is classified as superficial CD34-positive fibroblastic tumor (SCPFT), an intermediate form of mesenchymal malignancy, originally identified in medical literature in 2014. Initial physical examination revealed a 10 x 10 cm lump in the right upper gluteal region. Magnetic resonance imaging demonstrated a well-circumscribed lesion within the right gluteus maximus muscle. The patient had the lump removed surgically. Examination under a microscope revealed tumor cells with extensive pleomorphism, high cytokeratin (CK) and CD34 positivity, and a low Ki67 index, all of which are consistent with SCPFT. Postoperatively, the patient showed marked improvement, and ongoing monitoring was initiated due to the potential for local recurrence. This case reinforces the importance of considering SCPFT in the differential diagnosis of soft tissue masses, emphasizing the role of immunohistochemical staining in reaching a correct diagnosis. Given the rarity of SCPFT, more studies are necessary to refine our understanding and treatment approaches.

Pediatric Ileosigmoid Knotting: A Rare Culprit of Acute Abdominal Pain

The present study focuses on ileosigmoid knotting (ISK), an infrequent but potentially lethal surgical emergency. ISK is more frequently observed in males and is prevalent in regions with high rates of sigmoid volvulus. The current medical scenario revolves around the intricate intertwining of the ileum and sigmoid colon, leading to a complicated volvulus. This condition often results in acute intestinal obstruction, which can subsequently cause bowel necrosis. The clinical presentation of the condition is characterized by symptoms such as abdominal distention, pain, vomiting, and obstipation, which can be misleading as they are similar to other common abdominal conditions. A delay in definitive diagnosis and intervention is likely, which can lead to severe consequences such as peritonitis, bowel necrosis, sepsis, and even septic shock. Our case report discusses an instance of ISK presenting as an acute abdomen requiring an emergency laparotomy and detorsion of the volvulus-knotted segment, followed by an elective sigmoidectomy. The significance of a heightened level of suspicion, prompt decision-making, and timely surgical intervention in achieving better patient outcomes cannot be overstated. The objective is to enhance the medical community's understanding of ISK, focusing on early diagnosis and effective treatment of this rare but life-threatening disease.

Mullerian Cyst Presenting as an Inguinal Mass: A Rare Case Report

Mullerian cysts are rare cystic lesions that represent remnants of Mullerian ducts. The clinical presentation usually involves swelling or symptoms of large cyst-size compression of adjacent structures. The preoperative diagnosis is very challenging due to the lack of specific features, and the precise diagnosis is reached with histopathological examination. In this report, we discuss a case involving a 26-year-old woman who visited our clinic with complaints of swelling in her left inguinal region. The patient was operated on as a case of a suspected left inguinal hernia, but the histopathological examination of the excised mass was consistent with the diagnosis of a Mullerian cyst.