Category Archives: Case Report

Persistent severe cow’s milk protein allergy on strict dietary elimination: A case report and literature review

Luciana Arjoca1, Sebastian-Ionut Arjoca1, Teodora Nicola-Varo2,3, Corina Ureche2,3

1. George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Second Internal Medical Department, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Târgu Mureș, Romania
3. Clinical Emergency County Hospital, Târgu Mureș, Romania

DOI: 10.2478/amma-2026-0014

Objective: Cow’s milk protein allergy is among the most common food allergies in early childhood, yet its clinical spectrum can range from mild intolerance to life-threatening anaphylaxis. Rarely, affected children may react not only to ingestion but also to skin contact or inhalation of trace milk proteins. This report presents a detailed case of persistent and extreme hypersensitivity, illustrating the complex immunologic and psychosocial impact of the disease and highlighting the unmet need for refined preventive and therapeutic approaches.
Methods: A single pediatric case was analyzed through continuous clinical observation from infancy to seven years of age. The report integrates serial measurements of milk protein–specific immunoglobulin E, documentation of allergic reactions, dietary and environmental management, and psychosocial outcomes. The case description is complemented by a concise review of scientific literature on severe and airborne food allergies.
Results: The child exhibited immediate allergic reactions to early milk exposure and developed progressive sensitization over time, culminating in multiple anaphylactic episodes caused by minimal oral, contact, and airborne exposure. Laboratory assessments confirmed rising immunoglobulin E levels despite prolonged elimination of milk from the diet and environment. The literature review identified few comparable cases, confirming the rarity of such severe and persistent allergic phenotypes.
Conclusions: Extreme hypersensitivity to cow’s milk proteins challenges current concepts of allergy management and tolerance development. This case emphasizes the need for multidisciplinary care, structured education on anaphylaxis response, and greater community awareness to safeguard children with life-threatening food allergies.

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Intralobar pulmonary sequestration with an aneurysmal celiac arterial feeder coexisting with superior mesenteric artery syndrome: A case report and literature review

Shaymaa Khalid Abdulqader1, Wassan Nori2, Qays Ahmed Hassan1, Nabeeha Najatee Akram3

1. Department of Radiology, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq
2. Department of Obstetrics and Gynecology, College of Medicine, Mustansiriyah University, Baghdad, Iraq
3. Department of Pediatrics, Medical College of Al-Mustansiriyah University, Baghdad, Iraq

DOI: 10.2478/amma-2026-0013

Pulmonary sequestration is a rare bronchopulmonary foregut malformation characterized by the abnormal development of non-functional lung tissue enclosed by visceral pulmonary pleura, supplied by a systemic arterial blood supply, and lacking communication with the bronchial tree. The blood supply commonly arises from the thoracic or abdominal aorta. We reported a 44-year-old female who presented with vomiting and recent weight loss of about 20 kilograms in the last 6 months. The physical and biochemical examination was unremarkable. A contrast-enhanced abdominal CT scan reveals signs of superior mesenteric artery syndrome (SMAS), including a decreased aortomesenteric angle and aortomesenteric distance. The lower chest sections show an irregular consolidative lesion in the posterior segment of the Left lower lobe supplied by an aberrant aneurysmal vessel from the celiac artery, consistent with intralobar pulmonary sequestration (ILS). To our knowledge, co-occurrence of SMAS and ILS with a celiac aneurysmal feeder has not been previously reported, as both conditions affect organs of different locations and embryological origins. A literature review was conducted to examine the presentation and vascular supply of ILS.

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Sudden bilateral sensorineural hearing loss associated with severe dengue virus infection: Case report

Gelithza Fernanda Tole Puentes1, María Mercedes Araque Jiménez2, Cesar Augusto Mosquera Ortiz3, Jhonatan Andrés Portes Ortiz4

1. Family Medicine Residency Program, Fundación Universitaria Navarra, Neiva, Colombia; Clinical Epidemiology, Universidad Surcolombiana, Neiva, Colombia
2. Family Medicine Residency Program, Fundación Universitaria Navarra, Neiva, Colombia
3. Family Medicine Residency Program, Fundación Universitaria Navarra, Hospital Federico Lleras Acosta, Ibagué, Colombia; Otorhinolaryngology and Head and Neck Surgery; Otology and Neurotology Fundación Universitaria de Ciencias de la Salud, Bogota, Colombia
4. Family Medicine Residency Program, Fundación Universitaria Navarra,Neiva, Colombia; Family Medicine universidad el Bosque, Bogotá, Colombia, Clinical Epidemiology, Universidad Surcolombiana, Neiva, Colombia

DOI: 10.2478/amma-2026-0007

Introduction: Dengue is an arboviral disease transmitted by Aedes aegypti mosquitoes, prevalent in tropical regions, particularly in Latin America. Clinical manifestations range from mild illness to severe forms with multiorgan involvement. Idiopathic sudden sensorineural hearing loss (ISSNHL) is a sudden hearing impairment that can have multiple causes, significantly affecting functionality and quality of life, with a poor prognosis for recovery.
Case presentation: A 39-year-old woman with severe dengue, characterized by multiorgan dysfunction, developed auditory symptoms during hospitalization consistent with sudden bilateral sensorineural hearing loss. Audiological studies after discharge confirmed profound, irreversible hearing loss. No prior history or other causes were identified.
Conclusions: This case provides evidence of a possible association between severe dengue and sudden sensorineural hearing loss, likely due to immunoinflammatory and vascular mechanisms. It underscores the need for clinical vigilance for auditory symptoms in severe dengue and early intervention to prevent permanent hearing sequelae. Further studies are required to establish associations and pathophysiological mechanisms.

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Giant apocrine hidrocystoma of the scrotum: An uncommon benign tumor at an exceptional site

Mirsad Dorić, Nina Čamdžić

Department of Pathology, University of Sarajevo-Faculty of Medicine, Sarajevo, Bosnia and Herzegovina

DOI: 10.2478/amma-2026-0006

Introduction: Apocrine hidrocystoma (AH) is a rare, benign cystic tumour of apocrine glands, typically occurring in adults between 30 and 70 years of age without gender predilection. It most frequently affects the head and neck region, while genital localization, particularly in the scrotum, is exceedingly uncommon. To the best of our knowledge, this is the first reported case of giant scrotal apocrine hidrocystoma in an adult patient.
Case presentation: A 65-year-old male presented with a painless, translucent cystic nodule in the scrotal region gradually enlarging over several months. The lesion measured 45x30x25 mm and was surgically excised. Histopathological examination revealed a well-circumscribed, unencapsulated cystic lesion within the dermis, lined by two cell layers: an inner layer of apocrine cells exhibiting decapitation-type secretion and an outer myoepithelial layer. Immunohistochemical staining demonstrated AE1/AE3 positivity in luminal cells, and p63 expression in myoepithelial cells, confirming the diagnosis of AH.
Conclusion: Apocrine hydrocystoma of the scrotum is an extremely rare benign lesion and therefore represents a diagnostic challenge. Awareness of this entity is essential to avoid misdiagnosis with other cystic or adnexal lesions.

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Case report: Respiratory distress syndrome, recurrent pneumothorax, and multisystem complications in a late preterm neonate

Mihaela-Maria Celsie1, Irina Bachis1, Manuela Camelia Cucerea2,3

1. Neonatology Department, Bistrita Emergency County Clinical Hospital, Bistrita, Romania
2. Neonatology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
3. Neonatology Department, Targu Mures, Mures Clinical County Hospital, Romania

DOI: 10.2478/amma-2026-0002

Introduction: Pneumothorax in premature neonates remains a significant clinical issue, especially when linked to respiratory distress syndrome and systemic inflammation. Providing early respiratory support and customized interventions is essential to prevent life-threatening complications.
Objective: To present the complex and evolving management of a late preterm neonate with respiratory distress syndrome, bilateral recurrent pneumothorax, congenital pneumonia, and intraventricular hemorrhage.
Methods: A female newborn born at 36 weeks via cesarean due to placenta previa and uterine scarring showed worsening respiratory distress soon after birth. Her condition required various levels of respiratory support, including intratracheal surfactant, high-frequency oscillatory ventilation, and surgical pleural drainage. A suspected congenital infection caused a systemic inflammatory response, leading to extended, targeted antimicrobial treatment.
Results: Despite multiple episodes of respiratory decompensation and radiologically confirmed recurrent pneumothorax, the patient responded well to high-frequency oscillatory ventilation and surgical pleural drainage. Gradual clinical improvement allowed for stopping respiratory support by day twelve, leading to full recovery without additional complications.
Conclusion: This case highlights the critical importance of personalized, step-by-step management in preterm neonates with respiratory distress syndrome complicated by recurrent pneumothorax and infectious comorbidities, emphasizing the therapeutic benefits of early surfactant therapy, high-frequency oscillatory ventilation, surgical pleural drainage, and targeted antimicrobial treatment.

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Ameloblastic fibroodonto sarcoma – An extremely rare case report with clinical and radiological insights

Sivan Sathish, Upender Malik, Haritma Nigam, Shilpi Srivastava, Tabiha Khan, Vaishali Malik

Department of Oral Medicine and Radiology, Teerthanker Mahaveer Dental College and Research Centre, Teerthanker Mahaveer University, Moradabad, Uttar Pradesh, India

DOI: 10.2478/amma-2025-0058

Background: Ameloblastic fibro-odontosarcoma (AFOS) is a rare malignant odontogenic tumor with benign epithelial and malignant mesenchymal components. It typically affects younger individuals, with a predilection for the posterior mandible. With fewer than 25 cases reported globally, it remains a diagnostic challenge due to overlapping features with other odontogenic lesions and limited documented information.
Case presentation: This is a case of a 21-year-old male who presented with a progressively enlarging swelling on the right side of his face, painful growth in the posterior mandible, and numbness in the right lower lip. Clinical examination revealed a bony hard swelling with an ulcerative lesion in the mandibular alveolar mucosa. Cone-beam computed tomography showed a heterogeneously hypodense, expansile lesion with bicortical expansion, cortical erosion, and hyperdense masses resembling enamel and dentin. Histopathological analysis confirmed AFOS, showing benign odontogenic epithelial islands within a malignant mesenchymal stroma. The patient underwent surgical resection with wide margins, followed by radiotherapy and chemotherapy to address metastatic lymph node involvement.
Conclusion: This case highlights the diagnostic complexities and aggressive behavior of AFOS. A multidisciplinary approach integrating clinical, radiographic, and histopathological findings is critical for accurate diagnosis and effective management.

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Maternal car accidents during pregnancy and their impact on newborns

Claudia Kosztelnik1, Manuela Camelia Cucerea2,3

1. Neonatology Department, Bistrita Emergency County Clinical Hospital, Bistrita, Romania
2. Neonatology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Neonatology Department, Mures Clinical County Hospital, Targu Mures, Romania

DOI: 10.2478/amma-2025-0047

Introduction: Car accidents are among the most common causes of fetal trauma during pregnancy. The most frequent maternal complications include placental abruption, uterine rupture, and hypovolemic shock, while fetal complications include premature birth, cranial injuries, skull fractures, and even death.
Objective: To examine how car accidents affect pregnant women and their newborns.
Methods: Three cases of newborns delivered by mothers involved in car accidents during pregnancy were analyzed. The data were collected from the medical records of the neonatology department.
Results: These three clinical cases demonstrate the significant impact of maternal trauma from car accidents on perinatal outcomes and neonatal development, with a wide range of clinical manifestations, from transient neonatal complications to neonatal death. Properly using seatbelts during pregnancy is essential to prevent injuries to both the mother and the fetus.
Conclusions: Maternal motor vehicle accidents can have severe and diverse consequences for newborns, ranging from transient complications to congenital malformations and neonatal death. Proper and correct use of seatbelts during pregnancy is a critical preventive measure to reduce maternal and fetal injuries. Immediate neonatal resuscitation and thorough post-trauma evaluation, are essential for improving outcomes. Long-term pediatric monitoring is recommended due to the risk of delayed complications. Further research is needed to develop standardized protocols for trauma management in pregnancy and to better understand the effects of intrauterine trauma on fetal development.

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Challenges in the management of a preterm neonate with respiratory distress and pneumothorax: A case report

Mihaela Maria Celsie1, Manuela Cucerea2,3

1. Bistrita Emergency County Clinical Hospital, Bistrita, Romania
2. Neonatology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Neonatology Department, Mures Clinical County Hospital, Targu Mures, Romania

DOI: 10.2478/amma-2025-0048

Introduction: Pneumothorax is a potentially life-threatening complication in preterm neonates, frequently associated with respiratory distress syndrome (RDS). Prompt diagnosis and individualized respiratory support are essential to avoid invasive interventions.
Objective: To describe the successful conservative management of a preterm neonate with respiratory distress syndrome complicated by pneumothorax and congenital infection, emphasizing the role of early respiratory support and infection control.
Methods: A male infant was born prematurely with clinical signs of systemic inflammation and respiratory distress. Initial management in the delivery room included thermal stabilization, tactile stimulation, and continuous positive airway support. Blood gas analysis revealed mild mixed acidosis. Chest radiography confirmed pneumothorax and respiratory distress syndrome. The patient was managed conservatively with intratracheal surfactant (100 mg per kilogram per dose), right lateral positioning and high-frequency oscillatory ventilation, without pleural drainage.
Results: The patient responded favorably to supportive management. Respiratory status improved progressively. Oxygen requirements decreased rapidly, and the pneumothorax resolved without invasive intervention. Extubation was achieved on the second day of life, and oxygen therapy was stopped by day six. The patient remained hemodynamically stable, tolerated enteral feeding, and showed appropriate weight gain. On day seven, he was transferred to the neonatal prematurity unit for continued monitoring of growth and jaundice.
Conclusions: This case supports the safety and effectiveness of conservative management in selected preterm neonates with pneumothorax. Early surfactant administration combined with high-frequency oscillatory ventilation (HFOV) can facilitate recovery while avoiding the risks associated with pleural drainage [2]. Tailored respiratory strategies and early control of systemic infection are essential for optimizing outcomes in vulnerable neonates.

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Beyond the skin: A case report of vaginal melanoma

Ana-Maria Sandu1, Oana Mirela Tiucă2, Mihai Emil Căpâlnă3, Liliana Maria Chira4, Cezara-Anca-Denisa Moldovan1, Alexandra-Maria Pop3, Silviu Horia Morariu2

1. Dermatology Department, Mureș County Hospital, Targu Mures, Romania
2. Dermatology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. First Obstetrics and Gynecology Clinic, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
4. Pathology Department, Emergency Clinical County Hospital of Targu Mures, Romania

DOI: 10.2478/amma-2025-0045

Introduction: Vaginal melanomas account for less than 3% of vaginal neoplasms and are characterized by poor prognosis.
Case report: We present the case of a 65-year-old patient with a history of invasive breast carcinoma and BRAF-negative vaginal melanoma, showing positive immunostaining for S100, SOX-10, PRAME, and vimentin, who was referred to the Dermatology Clinic of Mureș County Clinical Hospital for an erysipelas-like skin reaction on the upper limb affected by chronic lymphedema secondary to axillary lymphadenectomy. Clinical examination revealed diffuse melanosis cutis, acanthosis nigricans, and tripe palms. The patient also exhibited stigmata of Cushing syndrome, with a recent history of systemic corticosteroid therapy. Dermoscopy was performed and revealed dark brown, well defined, round macules on the genital mucosa, while the vaginal mass exhibited dermoscopic signs suggestive of melanoma.
Conclusions: Clinical examination and dermoscopy are essential for patients with mucosal melanomas, as they can uncover details that are critical for creating a comprehensive picture.

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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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