Category Archives: Case Report

Laparoscopic right radical nephrectomy for locally advanced renal tumor: Case report

Rares Florin Vascul1, Orsolya Martha1,2, Raul Gherasim1, Tibor Reman1, Oliver Vida1,2, Daniel Porav-Hodade1,2, Calin Chibelean1,2, Veronica Maria Ghirca1,2, Ciprian Todea-Moga1,2

1. Mureș County Clinical Hospital, Clinic of Urology, Târgu Mureș, Romania
2. Department of Urology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2025-0038

Renal cell carcinoma (RCC) represents the most common solid malignancy of the kidney, comprising a broad spectrum of histopathological entities. Advances in diagnostic imaging, histopathological classification, and minimally invasive surgical techniques have improved early detection and treatment options. However, renal cell carcinoma with sarcomatoid dedifferentiation remains a challenge due to its aggressive nature and resistance to systemic therapies. We report the case management of a 69-year-old male with a history of significant comorbidities diagnosed with an advanced right renal cell carcinoma cT3aN1M0 who underwent a laparoscopic radical nephrectomy (LRN) and lymph node dissection with minimal blood loss in 110 minutes of surgery. The patient’s postoperative recovery went well, with no significant complications. Histopathological results revealed a renal carcinoma with sarcomatoid and rhabdoid dedifferentiation staged as pT3aN1, with metastases identified in two out of four retrocaval lymph nodes. This case underscores the feasibility of minimally invasive surgery in advanced renal cancer and the prognostic implications of aggressive histological subtypes.

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Multisystem clues pointing to thyroid storm: A case of new-onset hyperthyroidism with delayed recognition and severe systemic complications

Krisztina-Beata Antal1, Justin Gilles Henri Dodane1, Ioana-Maria Dodane1, Alexandra Lazăr2

1. Department of Anesthesiology and Intensive Care, Bistrița County Emergency Clinical Hospital, Bistrița, Romania
2. Anesthesiology and Intensive Care Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2025-0039

Introduction: Thyrotoxic crisis is a rare, but potentially fatal endocrine emergency resulting from a sudden surge in thyroid hormone activity. Early recognition is critical, however atypical or multisystem presentations can delay diagnosis and treatment.
Case Presentation: We present the case of a 39-year-old female who was referred to the Emergency Department with the symptoms of diarrhea, palpitations, and restlessness. On examination, she exhibited tachycardia, jaundice, mild pyrexia, and signs of heart failure with anasarca. Laboratory workup revealed severe anemia, pancytopenia, metabolic acidosis, and hyperbilirubinemia. Imaging findings were consistent with goiter, cardiomegaly, hepatomegaly, and ascites. Thyroid function tests showed markedly suppressed TSH and elevated free T3 and free T4 levels, with positive thyroid antibodies. Alongside with a score of 90 on the Burch-Wartofsky scale, the diagnosis of thyroid storm was confirmed. She was admitted to the Intensive Care Unit twice during hospitalization, first for thyrotoxic crisis, and later for sepsis with multiorgan dysfunction. Targeted endocrine, antimicrobial, and supportive therapy led to clinical improvement.
Conclusion: This case underscores the importance of considering thyroid storm in patients with unexplained multisystem involvement. A high index of suspicion, even in the absence of prior thyroid disease, is essential for timely diagnosis and improved outcomes.

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A case report of a complex case of advanced new HIV infection with CMV meningoencephalitis, Salmonella sepsis, and esophageal candidiasis: Diagnostic and therapeutic challenges

Alexandra Ioana Asztalos1, Tudor Fleseriu1,2,3, Akos Vince Andrejkovits1,2,3, Vlad Adrian Pop1, Anca-Meda Vasiesiu1,2

1. Infectious Diseases Clinic of Targu Mures, Mures County Clinical Hospital, Romania
2. Department of Infectious Diseases, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Doctoral School of Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2025-0037

Introduction: Co-occurrence of multiple systemic diseases, particularly in late presenters, can obscure diagnosis and delay appropriate treatment. This work aims to highlight the complex clinical presentation, diagnostic and treatment challenges of a late presenter with new human immunodeficiency virus infection, complicated by Salmonella sepsis, oropharyngeal candidiasis, and Cytomegalovirus meningo-encephalitis, as well as the importance of a comprehensive diagnostic approach in immunocompromised patients with polymorphic symptoms.
Material and Methods: We report the case of a 43-year-old male who presented with systemic symptoms, including fever, wasting syndrome, urinary and neurological complaints. Clinical, microbiological, imaging, and molecular diagnostic tools were used to evaluate the patient. Diagnostic investigations included blood and urine cultures, human immunodeficiency virus and syphilis serology, cerebrospinal fluid analysis via molecular detection tools, and imaging studies.
Results: The patient was diagnosed with Human Immunodeficiency Virus-1 infection, Salmonella enterica group B sepsis emerging from a urinary infection, oropharyngeal and esophageal Candidiasis, and cytomegalovirus meningoencephalitis confirmed via polymerase chain reaction testing of cerebrospinal fluid. He was treated with a combination of antibacterial (Ceftriaxone), antifungal (Fluconazole), and antiviral therapy (Ganciclovir/Valganciclovir), alongside supportive care and initiation of antiretroviral therapy. After 29 days of hospitalization, he exhibited notable clinical improvement, including weight gain, neurological recovery, and resolution of oropharyngeal lesions.
Conclusions: This case illustrates the diagnostic and therapeutic complexity of managing patients with advanced Human Immunodeficiency Virus infection and multiple opportunistic complications. The prompt use of diagnostic tools, a multidisciplinary approach, and the staged initiation of antiretroviral therapy were fundamental for achieving favorable outcomes. Early recognition of late presenters remains essential to prevent life-threatening complications.

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Innovative approach on monitoring methotrexate induced hepatotoxicity in psoriasis patients – A case report

Ana-Maria Sandu1, Oana Mirela Tiucă2, Radu Stan1, Adina-Maria Andone3, Robert Aurelian Tiucă4, Ovidiu Simion Cotoi5, Silviu Horia Morariu2

1. Dermatology Department, Mures County Hospital, Targu Mures, Romania
2. Dermatology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Gastroenterology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
4. Endocrinology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
5. Pathophysiology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2025-0034

Introduction: Methotrexate is often used as the first line of systemic treatment in patients with moderate to severe psoriasis and psoriatic arthritis.
Case report: We present the case of a 44-year-old male patient with moderate plaque psoriasis who was treated with Methotrexate and diagnosed with mild hepatic steatosis during the first month of treatment. Using FIB-4 (Fibrosis Index Based on 4 factors) as a noninvasive method for assessing the risk of liver fibrosis, the patient was able to take Methotrexate safely, with close monitoring of liver function.
Conclusions: FIB-4 can be used to assess the risk of liver fibrosis in psoriasis patients treated with Methotrexate to ensure better adherence to the treatment.

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Sensory restoration of the critical border of the small finger by an emergency heterodigital nerve transfer after circular saw injury

Bogdan Ioncioaia1, Andreea Mironica2, Claudiu Ioan Filip1,2

1. 1st Surgical Clinic, County Emergency Hospital, Cluj-Napoca, Romania
2. Faculty of Medicine, University of Medicine “Iuliu Hatieganu” Cluj-Napoca, Cluj-Napoca, Romania

DOI: 10.2478/amma-2025-0032

Traumatic nerve injuries involving the distal part of the upper extremity may significantly affect the function of the hand if left untreated. An alternative to nerve autografts for treating digital nerve injuries are nerve transfers. We present the surgical management of a 2.5 cm nerve defect to the proper digital ulnar nerve of the small finger after circular saw injury to the palm of the hand with multiple neurovascular involvement and the use of a non-critical heterodigital nerve transfer for restoration of the critical functional border of the small finger. At 14 months postoperative the sensory recovery grading scale was S4 for the 4th finger and radial border of the 5th finger (primary repair) and S3+ for the ulnar border of the 5th finger (nerve transfer). Donor site morbidity consisted of anesthesia of the ulnar sided tip of the middle finger. Emergency nerve transfer of the proper ulnar digital nerve of the middle finger is a feasible surgical technique for the restoration of the critical ulnar digital border of the small finger after traumatic injuries but with the disadvantage of an insensate donor site.

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Effective wound healing with the Vivano Negative Pressure Wound Therapy system: A case-based review

Iasmina Maria Santa1, Bogdan Suciu2, Dorin Constantin Dorobantu3, Georgeta Liliana Cif3

1. George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Department of Anatomy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Department of Plastic Surgery, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2025-0027

Objective: This article intends to illustrate the clinical qualification of the Vivano Negative Pressure Wound Therapy system through a detailed case study involving a patient with post-abdominoplasty wound complications.
Methods: A 35-year-old female patient presented with wound dehiscence, necrosis, and infection following cosmetic abdominoplasty performed abroad. After initial conservative management failed, surgical debridement and repeated application of Vivano Negative Pressure Wound Therapy at varying pressure settings led to rapid granulation tissue development, infection control, and successful integration of a split-thickness skin graft. Its role in supporting graft adherence was especially critical, culminating in complete wound closure and recovery within a four-week inpatient period.
Results: The use of Vivano Negative Pressure Wound Therapy contributed considerably to wound stabilization, bacterial clearance, and post-grafting support, leading to complete wound healing and hospital discharge within four weeks of active intervention.
Conclusion: This case underscores the value of Vivano Negative Pressure Wound Therapy in managing complex post-operative wounds, commencement of treatment using this device results in a significantly faster rate of wound healing compared to standard care.

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Bipolar affective disorder – Clinical manifestations and treatment approaches

Mariana Sîrbu, Alina Bologan

Department of Mental Health, Medical Psychology, and Psychotherapy, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova

DOI: 10.2478/amma-2025-0020

Introduction: Bipolar affective disorder is a chronic psychiatric illness characterized by alternating episodes of elevated and depressed mood. Its clinical presentation varies widely, requiring a nuanced diagnostic approach. Differentiating between type one and type two forms remains essential for appropriate treatment planning.
Presentation of case series: This case series describes three patients diagnosed with bipolar affective disorder, each presenting distinct clinical patterns. The first patient exhibited a classic manic episode with psychotic features, requiring inpatient stabilization and combination pharmacotherapy. The second case involved a depressive episode with a prior history of hypomania, consistent with bipolar type two. The third patient presented a mixed episode marked by agitation, emotional instability, and suicidal ideation. All cases included a family history of mood disorders, supporting genetic predisposition. Therapeutic interventions consisted of mood stabilizers, antipsychotics, and psychoeducation. Clinical evolution was favorable in patients with high adherence and social support.
Conclusions: Bipolar affective disorder presents with diverse and sometimes atypical symptoms. Early recognition and accurate subtype differentiation are crucial for effective management. Case-based observation highlights the importance of individualized treatment, psychosocial support, and long-term monitoring.

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Giant Brunner glands hyperplasia of the duodenum: Case report of an uncommon malignancy mimicker

Georgian-Nicolae Radu1, Adela Nechifor-Boilă2, Emőke – Andrea Szász1,2

1. Department of Pathology, Mureș County Clinical Hospital, Târgu Mureș, Romania
2. Department of Histology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Târgu Mureș, Romania

DOI: 10.2478/amma-2025-0019

Introduction: Brunner’s glands hyperplasia (BGH) is an uncommon benign proliferative lesion found in the proximal duodenum. It is typically discovered incidentally during surgery or endoscopic examinations, and it can often be mistaken for a malignant process.
Case presentation: We report the case of a 59 years-old man who presented in the surgical department with a 5-days history of upper gastrointestinal tract symptoms associated with mild increase in serum amylase level. An esophagogastroduodenoscopy was performed, which showed a large infiltrating-type mass located in the proximal duodenum rising the suspicion for a pancreatic head tumor with duodenal wall involvement. Consequently, Whipple procedure was conducted. The resection specimen was further sent and processed in the Pathology department of Mureș County Clinical Hospital. On macroscopy a large polypoid-sessile mass located in the proximal duodenum was described, while the adjacent pancreatic tissue exhibited areas of extensive necrosis and hemorrhage. Microscopic evaluation revealed a benign proliferation composed of closely packed clusters of Brunner’s glands separated by thin fibrous septa located in the duodenal submucosa, with no evidence of atypia or mitotic figures.
Conclusions: Large diffuse BGH is a rare benign condition that poses diagnostic challenges due to its potential to mimic malignant processes. Given the indolent character of the lesion, it is crucial to consider BGH as part of the differential diagnosis in routine pathological activity when evaluating lesions of the duodeno-pancreatic region.

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Spindle cell angiosarcoma as primary cutaneous tumor – Case report and brief literature review

Andreea Cătălina Tinca1,2, Bianca Andreea Lazar2, Carmen Friciu3, Ovidiu Simion Cotoi1,2

1. Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Pathology Department, Mures Clinical County Hospital, Targu Mures, Romania
3. Plastic Surgery Department, Mures Clinical County Hospital, Targu Mures, Romania

DOI: 10.2478/amma-2025-0012

Angiosarcoma is a rare, aggressive malignant tumor of vascular origin, often characterized by rapid growth and infiltrative behavior. While it commonly occurs in the skin, particularly on the scalp of elderly patients, it can also affect other regions. We present a case of a 76-year-old male with a rapidly growing, well-demarcated nodule on the dorsum of the hand, which was excised for pathological examination. Histopathological analysis revealed spindle-shaped tumoral cells with a storiform pattern, poor vascularization, and immunohistochemistry positivity for CD31 and CD34. The case underscores the importance of distinguishing angiosarcoma from other spindle-cell tumors, such as leiomyosarcoma and atypical fibroxanthoma, and highlights the essential role of immunohistochemistry in achieving an accurate diagnosis. Early detection and appropriate surgical management are crucial for optimal outcomes in patients with this aggressive malignancy.

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Endovascular intervention in hemorrhage from oropharyngeal tumors: Case presentation of embolization of the lingual artery with coils

Despina Maria Hedes1, Monica Manisor1,2, Marius Rosian1,2, Petru Coltea1,2

1. Faculty of Medicine, Lucian Blaga University of Sibiu, Romania
2. Radiology and Medical Imaging Compart-ment, County Clinical Emergency Hospital of Sibiu, Romania

DOI: 10.2478/amma-2025-0008

Oropharyngeal tumors represent a multidisciplinary challenge in terms of localization, potential local invasion, and associated symptoms. When patients present with active bleeding from the tumor, endovascular intervention may be essential to control the bleeding and stabilize the patient. Lingual neoplasm is a complex entity associated with significant morbidity, especially when it progresses with ulceration. In cases where the oropharyngeal tumor presents with active hemorrhage, endovascular embolization is an important therapeutic option for immediate hemorrhage control, thus contributing to hemodynamic stabilization and allowing the initiation of oncological treatment strategies.
This case report presents a 60-year-old chronic smoker with a known lingual neoplasm who presented to the emergency department with active oropharyngeal hemorrhage. On examination, the patient showed signs of significant bleeding from the base of the tongue and had an ECOG-PS of 3 (Eastern Cooperative Oncology Group Performance Status). Immediate intervention was necessary to control the bleeding and prevent further complications. After initial stabilization, the patient underwent angiographic evaluation, which identified active bleeding from the right lingual artery. Following the failure of conventional hemostatic methods, selective embolization of the lingual artery with permanent coil embolization material was decided. Post-procedural monitoring confirmed the absence of bleeding.
This case highlights the importance of prompt and precise multidisciplinary management of complex cases, which has a significant impact on patient outcomes. Initial management focused on hemorrhage control, which could impede the use of conventional oncological therapy known for its potential to negatively affect the healing process and tissue integrity. As an alternative to invasive surgical treatments and as a preliminary step in transitioning to oncological therapy, this paper recommends embolization as a valuable therapeutic option in similar circumstances. By effectively controlling hemorrhage, this procedure allows oncologists to proceed with cancer treatment strategies, minimizing delays and reducing the risk of further complications. Given the high incidence of smoking, increasing awareness and the use of these advanced interventional techniques are crucial for improving outcomes and reducing associated complications.

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