OpenMed/multicare-articles huggingface dataset:
To treat or not to treat tuberculosis -clinical decision making in patients with previous pulmonary tuberculosis using 18F-FDG PET/CT
Authors: Gunar Günther, Nebal Abu-Hussain, Peter M Keller, Reto Guler, Sandra L Mukasa, Karen Wolmarans, Friedrich Thienemann
Journal: Respir Med Case Rep (2023)
Keywords: 18f-fdg pet/ct, false-positive, tuberculosis, recurrent
MeSH terms: Case Reports

Post-tuberculosis (TB) radiological changes and symptoms can mimic TB. PCR-based diagnostic tests can show positive results, suggesting the presence of Mycobacterium tuberculosis DNA in the absence of viable bacteria. We present a case with two episodes of previous TB. Despite workup including trace to low positive PCR results, after performing sputum analysis, bronchoalveolar lavage analysis, cyto-brush and 18F-FDG PET/CT guided transthoracic biopsy, no culturable mycobacteria were detected. 18F-FDG PET/CT showed a high metabolic activity of the biopsied lesions. More accurate strategies and tools in patients with previous TB and positive PCR results are required to make appropriate treatment decisions.
Painful Limb Ulcers: A Case Report on Ulcerative Discoid Lupus Erythematosus
Authors: Shreya N Gupta, Bhushan Madke, Shivani D Jangid, Drishti M Bhatt, Arshiya Khan
Journal: Cureus (2024)
Keywords: anti-nuclear antibodies, connective tissue disorder, discoid lupus erythematosus, pyoderma gangrenous, scarring disorders
MeSH terms: Case Reports

Lupus erythematosus is an autoimmune disorder with varied clinical features. Discoid Lupus Erythematosus (DLE) presents as erythematous, raised plaques. The patients might present with photosensitivity, arthralgia, and nail changes. However, dermoscopy, clinical features, and laboratory markers like high titers of Antinuclear antibodies (ANA) help in clenching the diagnosis. We report a patient in her mid-60s presented with non-healing ulcers oozing pus discharge associated with pain and joint stiffness. Thus, a series of investigations, treatment modifications, and the healing progression of the lesions highlight the importance of retrospective diagnosis.
Acupuncture as adjunctive treatment for linezolid-induced peripheral neuropathy: a case series report
Authors: Yuping Mo, Fan Nie, Jiahui Wu, Linna Li, Zhu Zhu, Guofang Deng, Liang Fu
Journal: Front Neurol (2024)
Keywords: acupuncture, case report, linezolid, multidrug-resistant tuberculosis, peripheral neuropathy

Background:
The treatment of multidrug-resistant tuberculosis (MDR-TB) and pre-extensively drug-resistant tuberculosis (pre-XDR-TB) remains challenging due to the limited availability of effective drugs. Linezolid has emerged as a promising therapeutic option for these cases. However, its long-term use can lead to complications such as peripheral and optic neuropathies. Acupuncture, a cornerstone of traditional Chinese medicine, has been shown to be effective in the treatment of peripheral neuropathy (PN). This study examines the potential benefits of acupuncture in the treatment of linezolid-induced peripheral neuropathy (LIPN).
Methods:
Four patients, aged 27 to 60 years, diagnosed with LIPN, underwent daily acupuncture treatments. The main endpoint was to assess the efficacy of acupuncture in reducing neuropathic pain associated with LIPN in patients. This was primarily measured using changes in the Short Form McGill Pain Questionnaire (SF-MPQ) scores before and after acupuncture treatment.
Results:
Three of the patients experienced significant symptom remission, while one experienced marginal improvement. Treatments ranged from 7 to 18 sessions. Specifically, the first patient reported substantial relief with a score reduction from 33 to 13; the second patient observed minimal change; the third patient's score decreased dramatically from 10 to 2 after eight sessions; the last patient had a score reduction from 21 to 12 after five sessions, but did not continue treatment for a second assessment.
Conclusion:
Acupuncture is a promising therapeutic approach for LIPN. However, larger and more thorough studies are needed to determine its full potential.
Acute cerebral microbleeds detected on high resolution head CT presenting with transient neurologic events
Authors: Abdullah Tawakul, Arturo R Toro, José Rafael Romero
Journal: Cereb Circ Cogn Behav (2024)
Keywords: anticoagulation, cerebral microbleed, cerebral small vessel disease, neurological markers
MeSH terms: Case Reports

Introduction:
Cerebral microbleeds (CMBs) are deposits of hemosiderin-laden macrophages that can be visualized on T2-weighted MRI sequences as small, ovoid areas of signal void. These markers represent hemorrhagic cerebral small vessel disease and are usually subclinical and asymptomatic. In these cases, we present two patients who presented with symptomatic, acute CMBs.
Case description:
Case 1 involves a 70-year-old male with history of diabetes, hypertension, hyperlipidemia, and obstructive sleep apnea. Five days prior to presentation, this patient reported a transient period of left upper extremity weakness. CT was performed and demonstrated a lesion on CT imaging consistent with an acute CMB in the R centrum semiovale.Case 2 describes an 82-year-old female with history of hypertension, remote large ischemic stroke, and post-stroke epilepsy. Patient described an episode of prolonged left sided shaking consistent with prior seizures despite her consistently taking anti-epileptic drugs. On CT, a small hyperdensity was seen in the R thalamus/internal capsule region consistent with acute CMB.
Discussion:
These two examples demonstrate acute CMBs causing patients to demonstrate symptoms mirroring those of a TIA and experience breakthrough seizures. A TIA would normally be an indication for antiplatelet therapy. Though prior reasoning warns against anticoagulation in patients with CMBs, recent works including the SPS3 (Shoamanesh et al., 2017) and WAKE-UP (Schlemm et al., 2022) trials both showed that the presence of CMB did not significantly affect outcomes after initiating antiplatelet therapy. One should adopt a more personalized approach when deciding the therapeutic intervention of choice in patients with prior CMB.
Case report: Unveiling genetic and phenotypic variability in Nonketotic hyperglycinemia: an atypical early onset case associated with a novel GLRX5 variant
Authors: Victor Marin, Louis Lebreton, Claire Guibet, Samir Mesli, Isabelle Redonnet-Vernhet, Mathurin Dexant, Delphine Lamireau, Sandrine Roche, Margaux Gaschignard, Jean Delmas, Henri Margot, Claire Bar
Journal: Front Genet (2024)
Keywords: glrx5, nkh, nonketotic hyperglycinemia, clinical genetics, glycine cleavage system, metabolic disorders
MeSH terms: Case Reports

Nonketotic hyperglycinemia (NKH) is a rare, autosomal recessive metabolic disorder usually associated with mutations in genes AMT, GLDC or GCSH involved in the glycine cleavage complex. Other genes have been linked with less severe NKH, associated with deficiency of lipoate cofactor such as GLRX5, LIAS, BOLA3. We identified a new case of GLRX5-mediated NKH who presented at 2-month with severe developmental delay and seizures. The initial suspicion was raised by the MRI and then confirmed by glycine measurements in cerebrospinal fluid and blood. Genetic analysis revealed a previously undescribed homozygous variant in the GLRX5 gene [NM_016417.3:c.367G>C; p. (Asp123His)]. Despite medication and supportive care, he died at the age of 4 months after a sudden neurological deterioration. It was decided to limit therapeutic interventions due to the severity of the prognosis. The case was more severe than the previous GLRX5-mediated NKH described, regarding the early age at onset and the severity. Moreover, the genetic variant was located at a potentially crucial site for glutathione binding in the GLRX5 protein. This report, thereby, expands our understanding of NKH's genetic underpinnings and phenotypic variability, highlighting the crucial role of GLRX5 and other related genes in variant NKH.
Functional and structural analysis of a novel splice site HMBS variant in a Chinese AIP patient
Authors: Xiaoqing Wang, Huifen Zhang, Huanhuan Huang, Wenli Wang, Yuping Wen, Zhuojin Dai, Shuling Huang, Jingyi Zhou, Yuqing Zhou
Journal: Front Genet (2023)
Keywords: hmbs, acute intermittent porphyria, molecular mechanism of the mutation, non-sense-mediated mrna decay, novel splice mutation, pathogenicity of the mutation

Background: Acute intermittent porphyria (AIP) is a rare metabolic disorder that results from mutations in the gene encoding hydroxymethylbilane synthase (HMBS), an enzyme involved in heme biosynthesis. AIP follows an autosomal dominant inheritance pattern, but most carriers are asymptomatic. The clinical manifestations of AIP include acute attacks of abdominal pain and neuropsychiatric disturbances. The pathogenicity of novel HMBS variants identified in Chinese patients has not been well established. Objective: The article aims to identify the pathogenic mutation in an AIP patient and prove its pathogenicity through in vitro experiments. Methods: A 22-year-old female diagnosed with AIP participated in the study. Variant screening of her HMBS gene was carried out through Sanger sequencing. To ascertain the consequences of the newly discovered variant, we conducted in vitro experimentation targeting HMBS gene expression and enzymatic function. Additionally, protein structure analysis was performed. Cycloheximide treatment and UPF1-specific siRNA knockdown were employed to assess the impact of the mutation on the mechanism of non-sense-mediated mRNA decay (NMD). Results: A novel splice site variant in the HMBS gene (c.648_651+1delCCAGG) was detected in the patient, which caused aberrant mRNA splicing. In vitro experiments demonstrated that this variant significantly decreased the expression of HMBS. Further investigation confirmed that this decrease was due to NMD. Additionally, structural analysis indicated that this variant would destabilize the HMBS protein and impair its catalytic activity. To gain a comprehensive understanding of HMBS mutations in the context of AIP, we conducted a literature search on PubMed using the keywords 'HMBS' and 'Acute intermittent porphyria' from 2013 to 2023. This search yielded 19 clinical case reports written in English, which collectively described 220 HMBS gene mutations worldwide. Conclusion: The study identified and proved the pathogenicity of a novel splice site HMBS variant for the first time. Our results elucidated the pathological mechanism by which this mutation causes AIP through reducing HMBS expression and activity. These findings provide theoretical guidance for the diagnosis, treatment and genetic counseling of AIP patients.
Laparoscopic anatomical partial splenectomy for extremely rare isolated splenic lymphangioma in an adult: a case report and literature review
Authors: Ruizi Shi, Pei Yang, Yangjie Guo, Yiping Tang, Hua Luo, Chuan Qin, Ting Jiang, Yu Huang, Ziqing Gao, Xintao Zeng, Jianjun Wang
Journal: Front Oncol (2024)
Keywords: anatomical resection, case report, laparoscopic surgery, splenic benign tumor, splenic lymphangioma
MeSH terms: Case Reports

Background:
Benign tumors of the spleen are rare compared to those of other parenchymal organs, accounting for less than 0.007% of all tumors, and are often found incidentally. Splenolymphangiomas are much rarer, commonly occur in children, and tend to have multiple foci. Splenic lymphangiomas are rare in adults, and fewer than 20 adult patients with isolated splenic lymphangiomas have been reported. In this article, we report the case of a middle-aged female patient with isolated splenic lymphangioma who underwent laparoscopic anatomical hypophysectomy of the lower pole of the spleen. We also summarize the existing literature on splenic lymphangioma diagnosis and available treatment options.
Case presentation:
A 58-year-old middle-aged woman was found to have a mass approximately 60 mm in diameter at the lower pole of the spleen during a health checkup that was not accompanied by other symptoms or examination abnormalities. After completing a preoperative examination with no contraindications to surgery, the patient underwent laparoscopic anatomical splenectomy of the lower extremity of the spleen. The patient recovered well without complications and was discharged from the hospital on the 7th postoperative day. Histopathological and immunohistochemical results confirmed the diagnosis of splenic lymphangioma. Prompt surgical intervention is safe and necessary when splenic lymphangiomas are large or associated with a risk of bleeding.
Conclusion:
Splenic lymphangiomas are rare and require early surgical intervention in patients with large tumor diameters or those at risk of rupture and bleeding. After rigorous preoperative evaluation and preparation, laparoscopic anatomical partial splenectomy is safe and feasible for surgeons with experience in laparoscopic surgery.
Comprehensive Rehabilitation of a Patient With Right Hemiplegia: A Case Report
Authors: Maithili S Deshmukh, Pallavi Harjpal, Vaishnavi M Thakre, Aditi Dandekar, Sanjivani S Bangde
Journal: Cureus (2024)
Keywords: hemiplegia, middle cerebral artery, physiotherapy, rehabilitation, stroke
MeSH terms: Case Reports

Stroke is a common cause of death and neurological impairment. The largest artery in the brain is the middle cerebral artery. When this artery suffers a stroke from an abrupt interruption or cessation of blood flow, tissue dies, and severe, potentially irreversible brain damage occurs. Comprehensive assessments of stroke patients are required for proper care management, evaluation of interventions, and assessment of outcomes. With the development of new, efficient stroke treatments, it is of the utmost significance for nurses to take advantage of the chance to document stroke impairments and disabilities to track recovery and make plans for re-entry into society. We describe the case of a 50-year-old man with right hemiplegia. The brain CT made visible the left front parietotemporal region and the left insular cortex of the acute left-sided middle cerebral artery infarct. The patient received immediate medical attention. After the early stabilization of acute symptoms, physiotherapy treatment was started. The physiotherapy intervention given in this case enabled the patient to have a speedy and effective recovery. It helped improve his motor impairments and quality of life. Post-rehabilitation, the patient became independent in daily activities like brushing, bathing, eating, etc.
Ultrasound-Assisted Management for Tracheal Intubation in the Patient with Tracheal Diverticulum
Authors: Tingting Wan, Ya Gao, Changyi Wu
Journal: Case Rep Anesthesiol (2023)
MeSH terms: Case Reports

Tracheal diverticulum (TD) is a rare disease. Due to the worldwide pandemic of COVID-19, the increase of routine preoperative chest CT examination has led to a higher detection rate of TD. Although TD is very rare, it is one of the reasons for difficult intubation and difficult ventilation. Improper treatment can cause severe airway emergencies such as diverticulum tearing, tracheal rupture, and subcutaneous or mediastinal emphysema. Unfortunately, there are few studies on TD, especially in perioperative airway and anesthesia management. This paper reports a case of TD found by preoperative chest CT examination who required tracheal intubation under general anesthesia. For the first time, ultrasound was used to confirm the position of tracheal tube and TD, and good results were achieved. This attempt provides a new idea and method for airway management in patients with TD.
Indwelling central venous catheter infection with Chryseobacterium shandongense - successful eradication in a 5-year-old with cystic fibrosis
Authors: Anthony Rowan, Tiarnan Fallon Verbruggen, Nuala H O'Connell, Patrick J Stapleton, Colum P Dunne, Barry Linnane, Daryl Butler
Journal: Access Microbiol (2023)
Keywords: chryseobacterium shandongense, cystic fibrosis, port-a-cath infection
MeSH terms: Case Reports

Introduction:

Chryseobacterium shandongense is a Gram-negative Flavobacterium bacillus with intrinsic multidrug-resistant properties.
Case presentation:
Herein, we present the first case report of human C. shandongense infection, relating to an implantable portal and catheter (port-a-cath) central line in a 5-year-old female with cystic fibrosis. The infection was identified using a Bruker MALDI-TOF Biotyper with BDAL (v12) of blood, which was cultured due to pyrexia and rigour following port-a-cath access. This report details the effective eradication of C. shandongense infection from the port-a-cath device using initial empirical gentamicin followed by targeted ciprofloxacin locks and systemic antibiotics.
Conclusion:
We demonstrated successful eradication of C. shandongense from a port-a-cath device, including the minimum inhibitory concentrations (MICs) required in this case. The result was eradication of central access infection, preventing progression to bacteraemia/septicaemia and preserving central access in a child with cystic fibrosis and established respiratory disease.
Case report: Allogeneic feline umbilical cord-derived mesenchymal stem cell transplantation for feline oral squamous cell carcinoma
Authors: Mi-Kyung Park, Kun-Ho Song
Journal: Front Vet Sci (2024)
Keywords: anti-inflammatory effect, feline, mesenchymal stem cell, oral squamous cell carcinoma, umbilical cord
MeSH terms: Case Reports

A 5-year-old neutered female Korean domestic shorthair cat diagnosed with oral squamous cell carcinoma (SCC) presented to the hospital with severe oral purulent discharge, anorexia, and lethargy. Owing to extensive lesions, surgical excision and radiation therapy were not feasible. Instead, prior to metronomic therapy with toceranib, the patient received an intravenous injection of feline umbilical cord-derived mesenchymal stem cells (fUC-MSCs) (1 × 106 cells/10 mL of saline) to reduce inflammation. No acute side effects (such as fever, increased respiratory rate, diarrhea, and vomiting) were observed following stem cell therapy. For 6 days, purulent discharge, bleeding, swelling, a bad odor, and crust exfoliation in the tumor area on the face were dramatically reduced. However, the patient exhibited difficulty in voluntarily receiving foods, and weight loss persisted. Starting from the 7th day, purulent discharge, bleeding, and odor at the SCC area worsened again. Toceranib, low-dose NSAIDs (meloxicam, every other day), antibiotics (cefazoline), and gabapentin were administered; however, they were not effective in reducing the pus, bleeding, foul odor, and crust exfoliation at the SCC area. Symptoms of pain, weakness, and weight loss progressed, leading to the choice of euthanasia with the owner's consent approximately 1 month later. This case report reveals that allogeneic fUC-MSCs have a slight short-term effect on purulent discharge, bleeding, odor, and crust exfoliation and may be additional therapy for feline oral SCC.
A Rare 46,X,t(Y;10)(q12;p14) Balanced Translocation in Non-Obstructive Azoospermic Patient with Elevated FSH and LH Levels
Authors: Kousar Jahan Syeeda Khursheed, Mohammed Rahman Kaleemullah, Annu Joseph, Mohammed Hasan Al Durazi, Moiz Bakhiet
Journal: Case Rep Genet (2023)
MeSH terms: Case Reports

Structural chromosomal aberrations like translocations have been shown to cause spermatogenic failure. We report a rare 46,X,t(Y;10)(q12;p14) balanced translocation in an otherwise healthy non-obstructive azoospermic male with high follicle-stimulating hormone (26.65 IU/L) and high luteinizing hormone (13.58 IU/L). The patient was referred to us after clinical, hormonal, and histopathological investigations to identify chromosomal abnormalities by karyotyping and fluorescence in situ hybridization (FISH). Analysis of the banding pattern by karyotyping followed by FISH confirmed reciprocal translocation and identified the breakpoints at Yq heterochromatin (Yq12) and 10p14. Further molecular tests including AZF microdeletion assay were done, and the results, which showed no mutations in the analyzed genes, were provided by the referring doctor. Thus, our study points to the importance of conventional cytogenetic techniques in the preliminary evaluation of a genetic abnormality in cases of infertility and would help the patient make an informed decision before pursuing assisted reproductive technology.
Rapid diagnostic work-up of Streptococcus dysgalactiae endophthalmitis by a novel culture processing system
Authors: Erin Su, Jessica Chang, Khay Ugaban, Rosemary C She
Journal: Access Microbiol (2023)
Keywords: streptococcus, rapid diagnostics, vitreous fluid
MeSH terms: Case Reports

The diagnosis of infective endophthalmitis is supported by microbiological work-up. Rapid work-up is critical to confirm clinical suspicion and appropriate antimicrobial therapy. We report the novel use of an automated liquid culture processing system (FAST system, Qvella, ON, Canada) in a vitreous fluid culture. A 59-year-old patient with post-operative endophthalmitis presented with acute right eye pain and blurred vision. Vitreous fluid collected for microbiology culture was of limited quantity and only inoculated to thioglycolate broth. The broth recovered beta-haemolytic, group G Streptococcus dysgalactiae susceptible to penicillin and vancomycin. Experimental application of the FAST system to purify the organism from broth culture yielded the same identification and susceptibility test results but 1 day sooner. Despite prompt treatment with appropriate antibiotics, including vancomycin and ceftazidime, disease progressed rapidly and required enucleation to achieve a stable therapeutic outcome. Use of automated processing of monomicrobial broth cultures has thus far focused on positive blood culture broths, but could potentially include other liquid-based cultures such as for sterile body fluids of critical nature.
Ivabradine and Milrinone-Bridge to Recovery in New HFrEF With Low-Output Heart Failure
Authors: Lekha Racharla, Lucas Gitzel, Max Joseph, Desire Guthier, Nael Hawwa
Journal: Case Rep Cardiol (2024)
Keywords: heart failure recovery, heart failure remission, inotrope, ivabradine, reverse remodeling
MeSH terms: Case Reports

In patients with newly diagnosed heart failure with reduced ejection fraction (HFrEF) who are on a downward clinical trajectory, options are mostly limited to left ventricular assist device and transplantation. However, in those with factors favorable for reverse remodeling, every effort should be made to promote native myocardial recovery. We present three patients with newly diagnosed severe HFrEF, NYHA Class 3-4 symptoms, and low cardiac output with and without organ malperfusion. Ivabradine and/or home milrinone were used during their tenuous hemodynamic period as a bridge to optimize guideline-directed medical therapy (GDMT), device therapy, and eventual reverse remodeling. Evidence of structural heart improvement continued far beyond 1 year.