OpenMed/multicare-articles huggingface dataset:
Novel Antineuronal Autoantibodies With Somatodendritic Staining Pattern in a Patient With Autoimmune Psychosis
Authors: Dominique Endres, Sebastian Rauer, Alexander Pschibul, Patrick Süß, Nils Venhoff, Kimon Runge, Bernd Feige, Dominik Denzel, Kathrin Nickel, Tina Schweizer, Simon Maier, Karl Egger, Katharina Domschke, Philipp T Meyer, Harald Prüss, Ludger Tebartz van Elst
Journal: Front Psychiatry (2020)
Keywords: antibodies, autoimmune encephalitis, autoimmune psychosis, catatonia, encephalopathy, schizophrenia
MeSH terms: Case Reports

Background:
Autoimmune encephalitis, such as anti-NMDA-receptor encephalitis, typically presenting with subacute onset of neuropsychiatric symptoms, can be detected by antineuronal autoantibodies or inflammatory changes in the cerebrospinal fluid (CSF), as well as pathological alterations in electroencephalography (EEG), magnetic resonance imaging (MRI), or [18F]fluorodeoxyglucose positron emission tomography (FDG PET). For patients with predominant psychotic symptoms, the term autoimmune psychosis was proposed. Here, the authors present the case of a patient with probable autoimmune psychosis associated with unknown antineuronal antibodies.
Case presentation:
A 18-year-old male patient with preexisting autism spectrum disorder developed a severe catatonic syndrome over 2.5 years. The MRI showed normal findings, the EEG depicted intermittent slowing, and the independent component analyses showed additional sharp spikes. However, FDG PET, the basic laboratory analysis and testing of the serum/CSF for well-characterized antineuronal autoantibodies were unsuspicious. The serum and CSF "tissue-based assay" using indirect immunofluorescence on unfixed murine brain tissue revealed antineuronal autoantibodies against an unknown epitope in granule cells in the cerebellum and to neurites of hippocampal interneurons with a somatodendritic staining pattern. The immunosuppressive treatment with high-dose glucocorticoids, plasma exchange, and rituximab led to partial improvement.
Conclusion:
The patient probably suffered from autoantibody-associated autoimmune psychosis. The special features of the case were that the patient (1) presented with mostly inconspicuous basic diagnostics, except for the altered EEG in combination with the detection of CSF autoantibodies directed against a currently unknown epitope, (2) experienced an isolated and long-lasting psychotic course, and (3) had pre-existing autism spectrum disorder. The detection of a probable autoimmune pathophysiology in such cases seems important, as it offers new and more causal immunosuppressive treatment alternatives.
Retroperitoneal Abscess Formation as a Result of Spilled Gallstones during Laparoscopic Cholecystectomy: An Unusual Case Report
Authors: Grigoris Chatzimavroudis, Stefanos Atmatzidis, Basilis Papaziogas, Ioannis Galanis, Ioannis Koutelidakis, Triantafyllos Doulias, Petros Christopoulos, George Papadakis, Konstantinos Atmatzidis, John Makris
Journal: Case Rep Surg (2012)

One of the complications of laparoscopic cholecystectomy for gallstone disease that seems to exceed that of the traditional open method is the gallbladder perforation and gallstone spillage. Its incidence can occur in up to 40% of patients, and in most cases its course is uneventful. However in few cases an abdominal abscess can develop, which may lead to significant morbidity. Rarely an abscess formation due to spilled and lost gallstones may occur in the retroperitoneal space. We herein report the case of a female patient who presented with clinical symptoms of sepsis six months following laparoscopic cholecystectomy. Imaging investigations revealed the presence of a retroperitoneal abscess due to retained gallstones. Due to patient's decision to refuse abscess's surgical drainage, she underwent CT-guided drainage. The 24-month followup of the patient has been uneventful, and the patient remains in good general condition.
Central Venous Catheter-Related Bloodstream Infection with Kocuria kristinae in a Patient with Propionic Acidemia
Authors: Masato Kimura, Eichiro Kawai, Hisao Yaoita, Natsuko Ichinoi, Osamu Sakamoto, Shigeo Kure
Journal: Case Rep Infect Dis (2017)
MeSH terms: Case Reports

Kocuria kristinae is a catalase-positive, coagulase-negative, Gram-positive coccus found in the environment and in normal skin and mucosa in humans; however, it is rarely isolated from clinical specimens and is considered a nonpathogenic bacterium. We describe a case of catheter-related bacteremia due to K. kristinae in a young adult with propionic acidemia undergoing periodic hemodialysis. The patient had a central venous catheter implanted for total parenteral nutrition approximately 6 months prior to the onset of symptoms because of repeated acute pancreatitis. K. kristinae was isolated from two sets of blood cultures collected from the catheter. Vancomycin followed by cefazolin for 16 days and 5-day ethanol lock therapy successfully eradicated the K. kristinae bacteremia. Although human infections with this organism appear to be rare and are sometimes considered to result from contamination, physicians should not underestimate its significance when it is isolated in clinical specimens.
Lymph node infarction--a rare complication associated with disseminated intra vascular coagulation in a case of dengue fever
Authors: I Satish Rao, Anand C Loya, K S Ratnakar, V R Srinivasan
Journal: BMC Clin Pathol (2005)

Background:
Lymph node infarction is known to occur in association with many non-neoplastic and neoplastic conditions however its occurrence in association with DIC is not reported hitherto in the literature.
Case presentation:
We describe an unusual case of lymph node infarction in a twenty seven year old male following disseminated intravascular coagulation (DIC) in a case of dengue fever. Multiple sections of the infarcted and the surrounding non-infarcted lymph nodes failed to reveal any predisposing condition. How ever the parahilar vessels showed thrombotic occlusion, which must have been responsible for the infarction.
Conclusion:
Global infarction of the lymph node may mask the underlying pathology. Any malignancy especially lymphoma may coexist or follow lymph node infarction, therefore the patient needs constant surveillance.
Imaging diagnosis of isolated proximal interruption of the right pulmonary artery in a patient presenting with respiratory complications following travel to a high-altitude region
Authors: Kataveeranahally Shekar Manjunath, Hirennappa B Hudnur, Sengenahally Basavaraja Madhukumar
Journal: BJR Case Rep (2015)
MeSH terms: Case Reports

Proximal interruption of the pulmonary artery (PA) is a rare congenital vascular anomaly with an estimated prevalence of 1 in 200,000 young adults. Patients with isolated proximal interruption of the right PA are usually asymptomatic but can present with breathlessness, haemoptysis, recurrent chest infections, pulmonary hypertension or respiratory failure. Such symptoms may be unmasked by pregnancy or at high altitude. We present a case of an isolated interruption of the right PA in a 29-year-old male with a history of cough and breathlessness, requiring hospitalization and ventilator support after travel to a hilly region. Laboratory reports showed normal haemogram and normal renal and liver function tests. Screening test for deep vein thrombosis/pulmonary embolism were negative. Echocardiogram was normal and did not show any evidence of elevated PA pressures. All serial X-rays were reviewed and showed one consistent finding: right lung volume loss with transmediastinal herniation of the left lung to the right side. We discuss the radiological and clinical features along with treatment options for the condition.
Case report: Novel junctional sarcoplasmic reticulum protein 1 intergenic region -anaplastic lymphoma kinase fusion in a patient with lung adenocarcinoma responds to alectinib
Authors: Feng Xue, Shengyuan Xu, Cailing Jiang, Mafei Kang, Muhammad Usman, Lin Zhu
Journal: Front Oncol (2022)
Keywords: alectinib, case report, intergenic region-alk fusion, non-small cell lung cancer, targeted therapy
MeSH terms: Case Reports

Novel anaplastic lymphoma kinase (ALK) fusions are still being discovered in non-small cell lung cancer (NSCLC). Most patients with ALK+ NSCLC respond favorably to ALK tyrosine kinase inhibitors. In this case report, we identified a novel nonreciprocal ALK fusion, namely, junctional sarcoplasmic reticulum protein 1 (JSRP1) intergenic region-ALK fusion (Jintergenic: A20) via next-generation sequencing in a female patient initially diagnosed with stage IV B lung adenocarcinoma. Further examination of biopsy specimen and analysis of clinical samples by a multidisciplinary team confirmed the diagnosis of ALK+ NSCLC. At the 2- and 4-months follow-up after receiving alectinib, the patient responded rapidly, implying that alectinib had a remarkable therapeutic effect. We identified a novel JSRP1 intergenic region-ALK fusion as a carcinogenic mutation that responds to alectinib, thereby expanding the spectrum of ALK fusion partners in ALK + NSCLC. This study may help clinicians detect oncogenic mutations and provide timely treatment to patients with ALK+ NSCLC.
Neurophysiological Characteristics of Allgrove (Triple A) Syndrome: Case Report and Literature Review
Authors: Daniel I Weiman, Meredith K Gillespie, Taila Hartley, Matthew Osmond, Yoko Ito, Care4Rare Canada Consortium, Kym M Boycott, Kristin D Kernohan, Matthew Lines, Hugh J McMillan
Journal: Child Neurol Open (2021)
Keywords: achalasia, addisonianism alacrima syndrome, autonomic nervous system electromyography, muscle weakness, polyneuropathies pyramidal tracts
MeSH terms: Case Reports

Allgrove or "Triple A" syndrome is characterized by alacrima, achalasia, and adrenocorticotropic hormone-resistant adrenal insufficiency, as well as central and peripheral nervous system involvement. Patients demonstrate heterogeneity with regard to their age of symptom onset, disease severity, and nature of clinical symptoms. Neurophysiological testing has also shown variability ranging from: motor neuron disease with prominent bulbar involvement, motor-predominant neuropathy, or sensorimotor polyneuropathy with axonal or mixed axonal and demyelinating features. We report an 11-year-old boy who presented with neurological symptoms of progressive spasticity and peripheral neuropathy. His neurophysiological testing confirmed a sensorimotor polyneuropathy with axonal and demyelinating features. Exome sequencing identified compound heterozygote variants in the AAAS gene. We summarize the neurophysiological findings in him and 29 other patients with Allgrove syndrome where nerve conduction study findings were available thereby providing a review of the heterogeneity in neurophysiological findings that have been reported in this rare disorder.
Evaluation of the transmission of SARS-CoV-2 through breast milk: a case series
Authors: Yayoi Murano, Shinya Yamahira, Hiromichi Shoji, Ken Hisata, Takuya Koshizaka, Tomoyuki Nakazawa, Toshiaki Shimizu, Mahbubur Rahman
Journal: Front Pediatr (2023)
Keywords: covid-19, sars-cov-2, breastfeeding, mother milk, pandemic

Whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is transmitted through breast milk remains controversial. This study aimed to determine the presence of SARS-CoV-2 in breast milk and assess its transmissibility to the child in infancy. Eleven samples were obtained from nine mothers with coronavirus disease 2019 (COVID-19). All but one sample had negative results on a reverse transcription-quantitative polymerase chain reaction. Among nine children, five were diagnosed with COVID-19, including one child whose mother's milk tested positive. Although SARS-CoV-2 RNA was detected in breast milk, its possible transmission via breastfeeding could not be established. Thus, we conclude that the physical attachment between mother and child is a conceivable transmission route.
Neurotoxic syndrome induced by clomipramine plus risperidone in a patient with autistic spectrum disorder: serotonin or neuroleptic malignant syndrome?
Authors: Kalliopi N Nikolaou, Rossetos Gournellis, Ioannis Michopoulos, Georgios Dervenoulas, Christos Christodoulou, Athanasios Douzenis
Journal: Ann Gen Psychiatry (2015)
Keywords: autism, clomipramine, neuroleptic malignant syndrome, risperidone, serotonin syndrome
MeSH terms: Case Reports

To the best of our knowledge, there are no case studies of serotonin syndrome (SS) in patients with autism spectrum disorder. We report the case of a 33-year-old male who presented SS under the combined use of clomipramine and risperidone. More specifically, within 2 days after clomipramine (10 mg/BID-two times a day) was added to risperidone (4 mg/OD-once a day), mirtazapine 45 mg/OD and alprazolam (0,5 mg/TID-three times a day) he began to present mental, neurological and autonomic symptoms. All his psychopathological manifestations and laboratory findings normalized after the above-mentioned drugs' discontinuation, and the administration of supportive medical care and lorazepam 2,5 mg/TID. The diagnosis of serotonin syndrome was challenging due to the relatively low dose of clomipramine, an increase of risperidone which had taken place before clomipramine administration and clinical symptoms which could be attributed to both serotonin and neuroleptic malignant syndrome.
Multiple liver metastases of pulmonary carcinoid successfully treated by two-stage hepatectomy combined with embolization of portal vein branches: Report of a case
Authors: Teppei Kamada, Shinji Onda, Yuki Takano, Taro Sakamoto, Ryo Kikuchi, Katsuhiko Yanaga
Journal: Int J Surg Case Rep (2020)
Keywords: liver metastases, portal vein embolization, pulmonary carcinoid, two-stage hepatectomy
MeSH terms: Case Reports

Introduction:
The prognosis of atypical pulmonary carcinoid with liver metastases is extremely poor, and patients with multiple liver metastases are often treated using non-surgical therapies. We report a case with multiple liver metastases from atypical pulmonary carcinoid that was successfully treated using two-stage hepatectomy combined with embolization of portal vein branches.
Presentation of case:
A 48-year-old man was referred to our department after multiple liver tumors were detected in both liver lobes on computed tomography. He had undergone right upper lobectomy of the lung for atypical pulmonary carcinoid (T2a, N0, M0; Stage IB) 2 years previously. Positron emission tomography-computed tomography showed no extrahepatic tumor manifestations. The tumors were located in segment 2, 3, 5/8 and the right hepatic vein drainage area. We planned complete resection of metastases in a two-stage hepatectomy. The first stage comprised concomitant left lateral segmentectomy, partial hepatectomy of segment 5/8 and portal vein embolization of the posterior segmental branches. The second stage comprised resection of the right hepatic vein drainage area, performed 21 days after the first surgery. Histopathological diagnosis was liver metastases of atypical pulmonary carcinoid. Postoperative bile leak developed, which was treated with endoscopic retrograde biliary drainage and percutaneous bile leak drainage. He has been followed for 24 months postoperatively without tumor recurrence.
Discussion:
Two-stage hepatectomy may represent an option for bilobar multiple liver metastases from atypical pulmonary carcinoid.
Conclusion:
We successfully treated a patient with multiple liver metastases of atypical pulmonary carcinoid using a two-stage hepatectomy combined with portal vein embolization of the posterior segmental branches.
A Case of Thyrotoxicosis due to Simultaneous Occurrence of Subacute Thyroiditis and Graves' Disease
Authors: Kazunori Kageyama, Noriko Kinoshita, Makoto Daimon
Journal: Case Rep Endocrinol (2018)
MeSH terms: Case Reports

Subacute thyroiditis is an inflammatory disorder of the thyroid. Graves' disease is an autoimmune thyroid disease in which thyroid hormones are overproduced. Here we present a rare case of thyrotoxicosis due to the simultaneous occurrence of both diseases. Prompt diagnosis and therapy are required to prevent complications in patients with thyrotoxicosis.
A Teething Problem: Artefactual X-Ray Appearances of Odontoid Fracture due to Superimposed Incisor
Authors: Matthew Crocker, Maeve E Crocker
Journal: Case Rep Emerg Med (2012)
MeSH terms: Case Reports

We report a case of artefactual C2 fracture caused by a superimposed incisor tooth in a seven-year-old boy. CT refuted the diagnosis. Trauma clinicians should be aware of this entity to guide correct interpretation of trauma X-rays.
Diagnosis and Conservative Management of Ureteral Orifice Injury During Robotic Prostatectomy for a Large Prostate with a Prominent Median Lobe
Authors: Fevzi Bedir, Murat Keske, Saban Oguz Demirdogen, Huseyin Kocaturk, Ali Fuat Atmaca, Abdullah Erdem Canda
Journal: J Endourol Case Rep (2019)
Keywords: median lobe, prostate cancer, robotic prostatectomy, ureter orifice injury
MeSH terms: Case Reports

Introduction: Robot-assisted laparoscopic radical prostatectomy (RALRP) is now considered the standard treatment for localized prostate cancer. However, challenges may arise when dealing with large prostates with a prominent median lobe because the ureteral orifices may not always be visible during dissection and maybe injured in the process. We describe our experience on the diagnosis and conservative management of ureteral orifice injury in this situation. Case: A Gleason score 3 + 3 prostatic adenocarcinoma was detected during 12-quadrant prostate biopsy performed after measurement of a serum prostate specific antigen value of 8.1 ng/mL in a 65-year-old man presenting with lower urinary tract symptoms. The left ureter orifice was observed to have been injured by scissors at dissection of the neck of the bladder and enlarged median lobe at RALRP. An online video call was made to more experienced robotic surgeons for advice. Diagnosis and management of the ureteral injury are presented. Conclusion: Ureteral orifice injury during an RALRP may be managed conservatively with intraoperative ureteral stenting without the need for reimplantation nor conversion to open surgical techniques. Online video call with experienced robotic surgeons is helpful in the decision process.
In Vivo Confocal Microscopy and Anterior Segment Optical Coherence Tomography Analysis of the Microcystic Keratitis
Authors: Michał Dembski, Anna Nowińska, Klaudia Ulfik, Sławomir Teper, Edward Wylęgała
Journal: J Ophthalmol (2020)
MeSH terms: Case Reports

Purpose:
To describe the findings of in vivo confocal microscopy (IVCM) and anterior segment optical coherence tomography (AS-OCT) in a case of bilateral acute microcystic epitheliopathy after daily soft contact lens wear.
Methods:
IVCM and AS-OCT were used in the course of the bilateral epitheliopathy of a 23-year-old patient at the acute stage of the disease and at recovery after four days of treatment. The images were analyzed and compared.
Results:
On AS-OCT of the right eye, general hyperreflectivity and the increased thickness of the central corneal epithelium to 150 μm with numerous hyporeflective small, oval cysts were revealed and resolved completely at day 4 after diagnosis and treatment. AS-OCT scans of the left eye revealed oval shaped, hyperreflective material within the corneal epithelium. IVCM of both eyes showed numerous microcysts of different sizes filled with hyperreflective material mostly within superficial epithelial layers. Epithelial cells showed a polymorphism along with disruption of a cytoarchitecture. Basal epithelial cells and anterior stroma showed inflammatory changes. Posterior corneal stroma and endothelium presented normal morphology.
Conclusions:
Microcystic keratitis appeared as localized microcystic inflammation of epithelium on AS-OCT, which was confirmed by IVCM. Both IVCM and AS-OCT are helpful diagnostic instruments in case of cystic inflammation of corneal epithelium.
The unexpected pitter patter: new-onset atrial fibrillation in pregnancy
Authors: Sarah White, Janna Welch, Lawrence H Brown
Journal: Case Rep Emerg Med (2015)

Background. Atrial fibrillation is a relatively uncommon but dangerous complication of pregnancy. Emergency physicians must know how to treat both stable and unstable tachycardias in late pregnancy. In this case, a 40-year-old female with a cerclage due to incompetent cervix and previous preterm deliveries presents in new-onset atrial fibrillation. Case Report. A previously healthy 40-year-old African American G2 P1 female with a 23-week twin gestation complicated by an incompetent cervix requiring a cervical cerclage presented to the emergency department with intermittent palpitations and shortness of breath for the past two months. EMS noted the patient to have a tachydysrhythmia, atrial fibrillation with rapid ventricular response. She was placed on a diltiazem drip, which was titrated to 15 mg/hr without successful rate control. Her heart rate remained in the 130s and the rhythm continued to be atrial fibrillation with RVR. Digoxin was then added as a second agent, and discussions about the potential risks of cardioversion in pregnancy ensued. Fortunately, the patient converted to sinus rhythm before cardioversion became necessary. The digoxin was discontinued; the diltiazem was also discontinued after the patient subsequently developed hypotension. "Why Should Emergency Physicians Be Aware of This?" New-onset atrial fibrillation is rare in pregnancy but can increase the mortality and morbidity of the mother and fetus if not treated promptly.
Primary biliary cholangitis with contemporary presence of anti-mithocondrial and anti-rods and rings autoantibodies: literature first case
Authors: Roberto Assandri
Journal: Gastroenterol Hepatol Bed Bench (2019)
Keywords: anti-mitochondrial autoantibodies, primary biliary cholangitis, the rods and rings (r&r) autoantibodies
MeSH terms: Case Reports

Primary biliary cholangitis, previously known as primary biliary cirrhosis (PBC), is the most common autoimmune diseases of the liver (ALD). Patients with PBC may present with typical biliary pattern symptoms. Also the presence of anti-mitochondrial autoantibodies (AMAs) is the laboratory hallmark of PBC, which molecular target antigens are members of 2-oxoacid dehydrogenase complex of enzymes. In recent years, autoantibodies (Aab) targeting subcellular structures described as the rods and rings (R&R) pattern in HEp-2 ANA have been presented as a unique and particular case of Aab generation. These R&R structures are composed of inosine monophosphate dehydrogenase type 2 (IMPDH2), and their formation can be induced in vitro by several small-molecule inhibitors. Aab targeting these relatively unknown structures have been almost exclusively observed in hepatitis C virus (HCV) patients who have undergone treatment with pegylated interferon-a/ribavirin (IFN/RBV) therapy. Literature showed that anti-RR Aab have not been found in no treatment-naïve HCV patients or in patients from any other disease. Now we present and characterized a case patient with contemporary presence of AMAs and R&R Aab in PBC, without any laboratory evidence of HCV and/or other hepatic virus infection. For our knowledge, this is the first case described in the Literature. R&R Aab in patients without any clinical/laboratory signs or symptoms of Hepatitis virus and without pharmacological therapy open the window to the alternative scenario: the association of these Aab to ALD. Our work demonstrated that R&R Aab can be present in PBC case. The interesting idea suggested that R&R Aab may be present also in AMA-negative PBC and they can considered a new possible diagnostic tool in this specific clinical condition. Other study and cases are needed but the presence of R&R Aab linked with AMAs and PBC may be explained by alterations in immune regulation caused by autoimmunity in a particular genetic background.