OpenMed/multicare-articles huggingface dataset:
Case Report: Use of novel AR registration system for presurgical planning during vestibular schwannoma resection surgery
Authors: Joshua Olexa, Annie Trang, Rebecca Flessner, Mohamed Labib
Journal: Front Surg (2024)
Keywords: augmented reality, mixed reality, navigation, presurgical planning, vestibular schwannoma
MeSH terms: Case Reports

Background and importance:
Vestibular schwannomas are benign tumors and are the most common tumor found in the cerebellopontine angle. Surgical management of these lesions involves consideration of various operative approaches, which can have profound effects on procedural course and patient outcomes. Therefore, a comprehensive understanding of the location of the tumor and surrounding anatomical structures is vital for a positive outcome. We present a case of a 47-year-old female patient with vestibular schwannoma. A novel mixed reality (MR) system was used to register patient-specific 3D models onto the patient's head for operative planning and anatomical visualization.
Case description:
A 47-year-old female presented with a history of left-sided hearing loss, tinnitus, and episodic left facial tingling. Magnetic Resonance Imaging (MRI) demonstrated a 3.3 cm enhancing lesion in the left cerebellopontine angle at the with mass effect on the brachium pontis and medulla. Surgical resection was performed via retrosigmoid craniotomy.
Conclusions:
In this study, we report the use of Augmented Reality (AR) visualization for planning of vestibular schwannoma resection. This technology allows for efficient and accurate registration of a patient's 3D anatomical model onto their head while positioned in the operating room. This system is a powerful tool for operative planning as it allows the surgeon to visualize critical anatomical structures where they lie on the patient's head. The present case demonstrates the value and use of AR for operative planning of complex cranial lesions.
A rare presentation of a common carotid artery occlusion
Authors: Amber Demeuleneere, Julie Lambert, Jelle Demeestere, Robin Lemmens, Inge Fourneau, Sabrina Houthoofd, Pieter-Paul Schauwvlieghe, Julie Jacob, Catherine Cassiman
Journal: GMS Ophthalmol Cases (2023)
Keywords: common carotid artery occlusion, elevation paresis, internal carotid artery, visual loss
MeSH terms: Case Reports

Background:
A common carotid artery occlusion (CCAO) is very rare and the clinical features of CCAO have rarely been described. Since the blood supply of the eye and orbit is derived from the internal carotid artery, a CCAO may present with various ophthalmological symptoms, ranging from incidental findings to complete visual loss but also other neuro-ophthalmological abnormalities.
Case report:
A 61-year-old woman presented with acute monocular vision loss and an elevation deficit of the right eye. Fluorescein angiography showed delayed filling of both the retinal and choroidal vasculature, without occlusion/embolisms of the retinal arteries. Vascular imaging showed a right CCAO.
Conclusion:
CCAO has a variable presentation. In patients with acute unilateral visual loss a CCAO should be considered, especially when ocular motility deficits are present. Fluorescein angiography examination can aid in the localization and diagnosis of the vascular insult. Urgent referral for a systemic work-up is essential.
Metagenome next-generation sequencing plays a key role in the diagnosis and selection of effective antibiotics on the treatment of Nocardia pneumonia: a case report
Authors: Na Fan, Huang Fang, Fang Huang, Jie Zhou, Peng Liu, Meng-Jie Li, Ye-Ying Ding
Journal: Front Med (Lausanne) (2024)
Keywords: nocardia, immunocompetent patient, next-generation sequencing (ngs), otitidiscaviarum, pulmonary co-infection
MeSH terms: Case Reports

Nocardia disease is an opportunistic infection, the occurrence is rare and mostly occurs in patients with immune deficiency. Even if the patient is immunocompetent, it can still be life-threatening. This case report describes a previously healthy 78-year-old male farmer with lung lesions discovered on a computerized tomography scan. Combined with the patient's history of fever and the results of elevated laboratory markers associated with inflammation, the patient was diagnosed with a lung infection. After escalating empirical broad-spectrum antibiotics, antiviral and antifungal therapy, the patient continued to deteriorate to septic shock. In the meanwhile, the patient's sputum was cultured repeatedly, and no obvious positive pathogenic bacteria were found. Considering the patient was elderly and that these lesions were solid with burr signs, as well as the progression after antimicrobial therapy cancer was considered in the differential diagnosis. Artificial intelligence (YITU, Hangzhou Yitu Medical Technology Limited Company) was also applied, and it also calculated that these lesions were cancerous. The patient received a puncture biopsy of the largest lung lesion. During the puncture pus was withdrawn from largest lung lesion. Culture and metagenome next-generation sequencing (mNGS) detection performed on pus indicated Nocardia otitidiscaviarum. The test report of the mNGS is also attached with a susceptibility report of commonly used clinical antibiotics to this Nocardia spp. Using this result, the patient's disease was quickly controlled after selecting the targeted drug compound sulfamethoxazole and intravenous meropenem for treatment. In view of the high misdiagnosis rate and poor sensitivity of culture for Nocardia spp., this case emphasized mNGS playing a key role in the diagnosis and selection of effective antibiotics for the treatment of Nocardia spp. lung infections.
Atlantoaxial Subluxation as the Initial Presentation of Rheumatoid Arthritis: A Case Report
Authors: Ryuichi Ohta, Junji Iwasa, Chiaki Sano
Journal: Cureus (2024)
Keywords: atlanto-axial subluxation, diagnostic imaging, elderly, primary health care, rheumatoid arthritis, rural health services
MeSH terms: Case Reports

Rheumatoid arthritis (RA) is known for its diverse manifestations, although atlantoaxial subluxation is a rare complication. This case report sheds light on the complexity of RA diagnosis, especially in the elderly, and emphasizes the significance of primary care in identifying atypical presentations. A 68-year-old male with a history of chronic obstructive pulmonary disease, hypertension, prior traumatic neck spinal injury, and lumbosacral stenosis presented to a rural community hospital with neck pain, bilateral numbness, and arm weakness. Initially diagnosed with degenerative cervical spondylosis, his condition later progressed to include swollen, painful wrists and metacarpophalangeal joints. Diagnostic tests revealed elevated rheumatoid factor and C-reactive protein, and hand X-ray showed bone erosions. An MRI confirmed an atlantoaxial subluxation. He was diagnosed with RA based on the American College of Rheumatology/European League Against Rheumatism 2010 criteria with a score of 7. The patient underwent cervical fusion surgery and rehabilitation, leading to significant functional improvement. This case underscores the importance of a comprehensive diagnostic approach in primary care for elderly patients presenting with non-specific symptoms. It highlights the need for heightened awareness among general practitioners of atypical RA manifestations, such as atlantoaxial subluxation. The case advocates for continued research into early detection and management strategies for such rare presentations to enhance patient outcomes in RA.
Primary leiomyosarcoma with osteosarcomatous differentiation of the breast
Authors: Ekta Sethi, Sunayana Misra, Arvind Ahuja
Journal: Autops Case Rep (2024)
Keywords: breast, leiomyosarcoma, mastectomy, sarcoma
MeSH terms: Case Reports

Primary leiomyosarcoma with osteosarcomatous differentiation of the breast is an uncommon entity. We present the case of a 37-year-old female who presented with a lump in the breast and pulmonary lesions on PET-CT, for which she underwent a toilet mastectomy. Histopathological examination revealed a tumor with cells arranged in sheets. These tumor cells had moderate eosinophilic cytoplasm, highly pleomorphic, irregular hyperchromatic nuclei, coarse chromatin, and prominent nucleoli. Areas with spindle-cell morphology were noted. Osteoid was seen intermingling with the tumor along with numerous osteoclast-like multinucleate giant cells. A wide panel of Immunohistochemistry was applied, and Desmin, h-Caldesmon, SMA, and Vimentin were positive. The patient died 3 months post-surgery and had a recurrence at the surgical site.
One health approach to mitigate anthrax in Ghana
Authors: Malik O Oduoye, Godfred Y Scott, Tirth Dave, Akanbi-Hakeem H Bolanle, Alexandra D Mwinbong, Olajide O Modupeoluwa
Journal: Health Sci Rep (2024)
Keywords: bacillus anthracis, ghana, one health, anthrax, public health, zoonotic disease
MeSH terms: Case Reports

Anthrax outbreaks in Ghana have become a pressing public health concern, posing threats to human health, the agricultural sector, and social well-being. This letter to the editor highlights the gravity of the anthrax situation in Ghana and advocates for comprehensive interventions using a One Health approach. The epidemiology of anthrax, including its historical roots and modes of transmission, is discussed. The consequences of anthrax outbreaks, such as severe illness, economic losses, and social distress, are outlined. To combat this complex issue, the letter emphasizes the importance of enhanced awareness, prevention, accurate diagnosis, and timely treatment. Recommendations include vaccination of animals and humans, education campaigns, proper disposal of infected carcasses, strengthening healthcare systems, surveillance, and early detection. Collaboration and coordination among professionals in the human, animal, and environmental sectors are crucial. By adopting a One Health approach and implementing these measures, Ghana can effectively mitigate the impact of anthrax outbreaks and safeguard the health and well-being of its population and livestock.
Pneumococcal Septic Shock Syndrome: A Deadly Condition Despite Vaccination
Authors: Liliana Costa, Sofia Silva, Núria Jorge, André Silva-Pinto, José-Artur Paiva
Journal: Cureus (2024)
Keywords: asplenia, invasive pneumococcal disease, pneumococcal conjugate vaccine, septic shock (ss), streptococcus pneumoniae
MeSH terms: Case Reports

Invasive pneumococcal disease is a serious infection with an elevated case-fatality rate that can be even higher among patients with asplenia. Its impact has been blunted by the widespread use of vaccines; even recently, in 2021, two new pneumococcal conjugate vaccines emerged. The authors present a case of a 58-year-old male, splenectomised with the immunisation schedule complete, who died of invasive pneumococcal disease with a fulminant course. It is highlighted that fever in a patient with impaired splenic function is an emergency, and despite the success of immunisation in reducing pneumococcal carriage and invasive disease, serotypes continue to change. Also, the local epidemiology may help guide situations where the immunisation recommendations are dubious regarding the implementation of the new vaccines.
Activity of pazopanib in EWSR1-NFATC2 translocation-associated bone sarcoma
Authors: Mohamed A Gouda, Maria A Zarzour, Ara A Vaporciyan, Kalevi Kairemo, Hubert H Chuang, Vivek Subbiah
Journal: Oncoscience (2023)
Keywords: pazopanib, precision oncology, sarcoma
MeSH terms: Case Reports

Pazopanib is a multi-kinase inhibitor that is currently approved for treatment of advanced renal cell carcinoma and chemotherapy-refractory soft tissue sarcoma. In this case report, we discuss the case of a patient with a EWSR1-NFATC2 fusion positive bone sarcoma who had exceptional tumor control through using pazopanib and surgery for an overall duration exceeding 5 years. We also review the literature on EWSR1-NFATC2 translocation-associated sarcomas and use of pazopanib in bone sarcomas.
Nortriptyline-Induced Room Tilt Illusion
Authors: Bernard A Sarmiento, Rojan Varghese, Richa Vijayvargia, Matthew Gunther, Adam Fusick, Shixie Jiang
Journal: Cureus (2024)
Keywords: adverse drug effect, major depressive disorder, major depressive disorder with psychotic features, nortriptyline, room tilt illusion, tricyclic anti-depressants, verticality, visual tilt
MeSH terms: Case Reports

Room tilt illusion (RTI) is a rare and transient perceptual disturbance in which an individual perceives their surroundings as having been rotated or tilted, usually at 90 or 180 degrees. Primarily linked with vestibular disorders and neurological lesions, this report details the only reported occurrence of the RTI phenomena in nortriptyline use for treatment-refractory depression. The patient developed RTI six days after starting the medication and the disturbance resolved after medication cessation. Although the mechanism behind such a phenomenon with medication use has not been elucidated, its etiology may rest on the effect of tricyclic antidepressants on the vestibulo-thalamo-cortical system and visual-vestibular integration. Clinicians should be aware of the potential for such a medication-induced perceptual disturbance, especially in the workup for more serious etiologies in elderly patients with co-morbidities.
Unusual Cases of Monoclonal Gammopathy of Renal Significance
Authors: Anjellica Chen, Anna-Ève Turcotte, Sarah Higgins, Michel Pavic, Vincent Ethier, Vincent Lévesque Dion
Journal: Case Rep Nephrol (2024)
MeSH terms: Case Reports

Introduction:
Monoclonal gammopathy of renal significance (MGRS) is a rare entity describing patients with renal impairment related to the secretion of immunoglobulins without hematological criteria for treatment of a specific disease. We present 3 cases of MGRS identified at our center that were either rare or difficult to diagnose. Case Presentations. The first patient presented with monoclonal membranoproliferative glomerulonephritis in the context of known chronic lymphocytic leukemia (CLL), diagnosed about 10 years prior. She presented with nephritic syndrome with serum protein electrophoresis revealing an IgG/lambda peak of less than 1 g/L, stable from the last few years. A renal biopsy confirmed a diagnosis of monoclonal membranoproliferative glomerulonephritis with granular IgG and C3 deposits of various sizes. The second patient presented with renal TMA in the context of IgM MGUS. The patient was admitted for acute nephritic syndrome and thrombotic microangiopathy. Serum protein electrophoresis demonstrated IgM/kappa paraprotein at 1.8 g/L, with a kappa/lambda ratio of 5.48. Renal biopsy demonstrated endocapillary proliferative glomerulonephritis associated with the presence of numerous monotypic IgM/kappa intracapillary pseudothrombi. Characteristic changes of thrombotic microangiopathy were also described. The third patient presented with immunotactoid glomerulonephritis likely from small B-cell lymphoma that later transformed to DLBCL. The patient presented with acute renal failure with IgM/kappa paraprotein of less than 1 g/L on electrophoresis and with a kappa/lambda ratio of 7.09. A diagnosis of immunotactoid glomerulonephritis was made on renal biopsy. Bone marrow with limited specimen revealed a B-cell infiltrate. Biopsy of a breast lesion was compatible with diffuse large B-cell lymphoma (DLBCL). Lymphomatous cells expressed IgM/kappa, thus confirming paraprotein-associated renal lesion.
Conclusion:
We described 3 different cases of MGRS, highlighting the diversity of renal pathohistological presentations and different associated lymphoproliferative disorders. Biopsy should rapidly be considered, as early diagnosis of MGRS is essential to initiate clone-directed therapy promptly to prevent progression to ESRD or hematologic progression to malignancy.
Chronic pericarditis and recurrent pericardial effusion of unknown origin in a kitten: a case report
Authors: Nicole Weingand, Chang He, Llorenç Grau-Roma, Katja-Nicole Adamik
Journal: Front Vet Sci (2024)
Keywords: cardiopulmonary arrest, cardiopulmonary resuscitation, feline, pericardial effusion, pericarditis
MeSH terms: Case Reports

A 3-month-old kitten was presented after successful cardiopulmonary resuscitation, including a presumed intracardial injection by its primary care veterinarian. Throughout the subsequent hospitalization in the intensive care unit, the cat exhibited recurrent hemorrhagic pericardial effusions, along with concurrent pleural and abdominal effusions, resulting in multiple clinical deteriorations, necessitating pericardiocentesis and thoracocentesis. Despite more than 3 days of intensive care, the cat experienced another cardiopulmonary arrest with unsuccessful attempts to achieve the return of spontaneous circulation. Necropsy and histopathological findings revealed diffuse chronic-active pericarditis and hemorrhagic pericardial effusion, a condition that has not been documented in the context of cardiopulmonary resuscitation or pericardiocentesis.
An elderly low-grade fibromyxoid sarcoma patient with early postoperative recurrences and metastases: a case report and literature review
Authors: Xiaoyue Zhang, Yongkang Qiu, Jixin Zhang, Zhao Chen, Qi Yang, Wenpeng Huang, Lele Song, Lei Kang
Journal: Front Med (Lausanne) (2024)
Keywords: pet/ct, low-grade fibromyxoid sarcoma, magnetic resonance imaging, metastasis, postoperative recurrences
MeSH terms: Case Reports

Background:
Low-grade fibromyxoid sarcoma (LGFMS) is a rare type of soft tissue sarcoma that often involves the deep soft tissue of the extremities and trunk in young and middle-aged adults. It is uncommon in the elderly. Here we discuss a case of LGFMS in an elderly patient who had recurrence and metastasis within 2 years of resection of the primary tumor.
Case report:
A 71-year-old LGFMS patient was presented with a mass in the left forearm accompanied by pain and numbness from the left upper arm to fingers. The patient subsequently underwent 3 surgical resections, although she had 3 recurrences within 6 months after the initial diagnosis. Considering the malignant biological behavior of the tumor, an amputation at 5 cm above the elbow was eventually performed. However, recurrence in the extremity of the stump and chest wall metastasis were observed 2 years after amputation. Then resection of the metastases, radiotherapy and particle implantation therapy were performed. The patient is currently undergoing follow-up and has no evidence of recurrence.
Conclusion:
In our case, multiple early postoperative recurrences may be associated with a positive margin at initial operation. The patient underwent a total of 5 operations including local resection of the primary tumor, twice wide resections, amputation and metastatic surgery with 4 early postoperative recurrences and metastases within 4 years, suggesting that LGFMS may have highly invasive biological behavior. Our case demonstrated that early aggressive surgical treatment is recommended for LGFMS patients with a positive margin at initial operation and patients who had recurrence even after wide resection rather than local resection. Further research is needed to develop more effective treatment options for rapidly progress and highly aggressive LGFMS.
Case report and literature review: exploration of molecular therapeutic targets in recurrent malignant meningioma through comprehensive genetic analysis with Todai OncoPanel
Authors: Kenta Ohara, Satoru Miyawaki, Hirofumi Nakatomi, Atsushi Okano, Yu Teranishi, Yuki Shinya, Daiichiro Ishigami, Hiroki Hongo, Shunsaku Takayanagi, Shota Tanaka, Aya Shinozaki-Ushiku, Shinji Kohsaka, Hidenori Kage, Katsutoshi Oda, Kiyoshi Miyagawa, Hiroyuki Aburatani, Hiroyuki Mano, Kenji Tatsuno, Nobuhito Saito
Journal: Front Neurol (2023)
Keywords: todai oncopanel, actionable gene aberration, comprehensive genomic analysis, malignant meningioma, malignant progression
MeSH terms: Case Reports

Background:
Despite accumulating research on the molecular characteristics of meningiomas, no definitive molecularly targeted therapy for these tumors has been established to date. Molecular mechanisms underlying meningioma progression also remain unclear. Comprehensive genetic testing approaches can reveal actionable gene aberrations in meningiomas. However, there is still limited information on whether profiling the molecular status of subsequent recurrent meningiomas could influence the choice of molecular-targeted therapies.
Case presentation:
We report a case of meningioma with malignant progression and multiple recurrences. We performed matched tumor pair analysis using the Todai OncoPanel to investigate the possibility of additional standard treatments. The loss of several chromosomal regions, including NF2 and CDKN2A, which is associated with aggressive meningiomas, was considered a significant driver event for malignant progression. Using additional matched tumor pair analysis, mutations in TRAF7, ARID1A, and ERBB3 were identified as subclonal driver events at the time of recurrence. No genetic aberrations were found for which evidence-based targeted therapy was applicable. We also reviewed previous reports of molecular therapies in meningioma to discuss issues with the current molecular testing approach.
Conclusion:
Gene panel testing platforms such as the Todai OncoPanel represent a powerful approach to elucidate actionable genetic alterations in various types of tumors, although their use is still limited to the diagnosis and prediction of prognosis in meningiomas. To enable targeted molecular therapy informed by gene-panel testing, further studies including matched tumor pair analyses are required to understand the molecular characteristics of meningiomas and develop treatments based on genetic abnormalities.