European Journal of Medical Case Reports

Background: Adrenal malignancy is a rare entity of diseases that has a low incidence, vague symptoms, and variable prognosis. Due to its rarity, case series studies from around the world can contribute to a better understanding of the disease.
Aims and Objectives: To analyze the similarities and differences in this adrenal malignancy spectrum within the Middle East.
Settings: This retrospective case series was conducted at the Royal Hospital, Muscat, Oman.
Methods: The medical records of the patients diagnosed with primary adrenal malignancies were reviewed from January 2014 to December 2023.
Results: A total of 15 patients with a mean age of 52 years were included, with a male-to-female ratio of 1:2.7. The majority of patients (80%) had a personal medical history, and the most common condition was hypertension. Four patients (26.6%) presented with abdominal pain that required computed tomography imaging to determine the cause. Left-sided malignancy was predominant (60%); however, the majority of male patients had right-sided tumors (75%) (p-value = 0.235). The largest tumor measured 169 mm, with no statistically significant difference in tumor size between males and females: 87.3 ± 10.6 mm in males
versus 91.8 ± 47.4 mm in females (p-value = 0.77). Laboratory investigations revealed that 53% of the patients had elevated hormone levels, including aldosterone, cortisol, testosterone, and metanephrines.
Conclusion: With the rarity of this spectrum of diseases, more studies are needed for a better evaluation of its impact on the community. Hopefully, more advanced technology, especially at the molecular level, can allow a better understanding of its
behavior.

Background: Acute poststreptococcal glomerulonephritis (APSGN) pediatric disorder, usually with hematuria, hypertension, and edema following group A beta-hemolytic streptococcus. Recurrence is very rare, and only a few cases have been reported worldwide. This case highlights an unusual recurrence of APSGN in a child, underscoring the importance of long-term follow-up despite apparent recovery.
Case Presentation: A 6-year-old boy complained of macroscopic hematuria and high ASO (antistreptolysin O) titers (650 IU/ml) after a respiratory infection. He had hypocomplementemia (C3: 0.30 g/l) and mild acute kidney injury (creatinine: 64 μmol/l). Two months later, renal function returned to normal without treatment. Six months later, recurrent hematuria (ASO (antistreptolysin O): 770 IU/ml, C3: 0.6 g/l) developed after another respiratory infection. Even with recurrence, renal function was stable, and symptoms disappeared spontaneously. Kidney biopsy was delayed due to a mild clinical course.
Conclusion: This case demonstrates that recurrent APSGN, although rare, can occur after new streptococcal infections and may present with milder features. Conservative management was effective, but the report underscores the need for continued followup and clinical vigilance in pediatric patients even after apparent full recovery.

Background: Scedosporium spp is an established cause of multisystemic clinical disease in immunocompromised patients. Invasive lung disease has been reported in immunocompetent hosts, the majority of whom have pre-existent structural lung disease.
Case Presentation: We present a case of a 31-year-old African American man who presented with cough and hemoptysis for four months. Lung imaging revealed bilateral multilobar cavitary infiltrates. Bronchial alveolar lavage fungal cultures resulted in positive for Scedosporium spp. Work up for alternative causes of cavitary pneumonias, including Mycobacterium tuberculosis, as well as immunodeficiency syndromes, was negative. He achieved complete symptom resolution with radiological improvement on voriconazole therapy.
Conclusion: Scedosporium spp is emerging as a possible rare cause of cavitary pneumonias in immunocompetent patients without pre-existing lung disease. An accurate diagnosis is important as treatment involves a long course of antifungal therapy

Background: Thrombophagocytosis refers to the phagocytosis of platelets by neutrophils or monocytes and is an uncommon finding, most often reported in bacterial infections. It may be linked to ethylenediaminetetraacetic acid (EDTA)-induced conformational changes in platelet membrane glycoproteins, which expose cryptantigens and promote immune-mediated interactions, resulting in platelet clumping, satellitism, and phagocytosis. If unrecognized, these in vitro artifacts can cause falsely low platelet counts, leading to pseudothrombocytopenia.

Case presentation: A 1-day-old neonate, born to a mother with a history of liver transplant on long-term immunosuppression, presented with normal initial blood values. However, the automated hematology analyzer flagged the sample, prompting microscopic review, which revealed thrombophagocytosis by neutrophils and, to a lesser extent, monocytes along with platelet satellitism. Repeat analysis of the same sample after 4 hours showed a marked decrease in platelet levels (160 × 10⁹/l to 88 × 10⁹/l), consistent with ongoing in vitro thrombophagocytosis. Maternal blood showed no abnormalities, and neither mother nor
neonate had signs of infection.

Conclusion: This case illustrates neonatal thrombophagocytosis in the absence of infection, suggesting the phenomenon is not exclusively infection-related. Our findings illustrate that delayed sample analysis can significantly lower platelet counts, risking misdiagnosis of thrombocytopenia. Awareness of EDTA-related artifacts is therefore essential for accurate laboratory interpretation and clinical decision-making.

Background: Avascular osteonecrosis (AVN) is an idiopathic condition characterised by subchondral ischemia leading to subsequent articular collapse. It can manifest as primary, secondary, or post-surgical. Bone marrow aspirate and concentrate (BMAC) represents a composite of mesenchymal stem cells with robust self-renewal and differentiation capabilities, employed as a surgical adjunct to enhance the healing process.
Case Presentation: Presented herein is a case of a 16-year-old male with a history of acute lymphocytic leukemia and extended corticosteroid therapy, developing AVN in the lateral femoral condyle and concurrent articular cartilage delamination. Arthroscopic repositioning of the chondral fragment was undertaken, complemented by the application of BMAC. Rehabilitation efforts focused on reinstating joint mobility and fostering knee proprioception. At the 1-year postoperative follow-up, the patient reported a pain level of 2/10 on the visual analog scale, an International Knee Documentation Committee score of 88 points, and radiographic evidence indicating consolidation.
Conclusion: The integration of BMAC in knee AVN, coupled with subchondral decompression and chondral fragment repositioning, emerges as a viable treatment option, yielding promising short-term clinical outcomes.