OpenMed/multicare-articles huggingface dataset:
Challenging case of deficient mismatch repair right-sided locally advanced adenocarcinoma of the ascending colon with duodenal involvement: A case report including step-by-step video of operation
Authors: Alexander A J Grüter, Malaika S Vlug, Ide T Spaanderman, Adriaan D Bins, Tineke E Buffart, Jurriaan B Tuynman
Journal: Int J Surg Case Rep (2024)
Keywords: case report, deficient mismatch repair, locally advanced cancer, neoadjuvant therapy, right hemicolectomy, right-sided colon cancer
MeSH terms: Case Reports

Introduction and importance:
Irresectable colon cancer presents a complex clinical challenge. Neoadjuvant immunotherapy has shown potential in improving resectability. Additionally, advancements in surgical techniques, including complete mesocolic excision (CME) with central vascular ligation (CVL), have contributed to better outcomes for right-sided colon cancer. This case report aims to demonstrate the successful laparoscopic resection of initial appearing irresectable colon cancer with suspected duodenal involvement.
Case presentation:
A 70-year-old female presented with an irresectable mismatch repair deficient (dMMR) adenocarcinoma of the ascending colon with suspected duodenal ingrowth. Neoadjuvant treatment with pembrolizumab and ataluren resulted in a significant response, allowing for surgical resection. A laparoscopic right hemicolectomy with CME, including CVL, intracorporeal anastomosis and extraction through a Pfannenstiel incision, was performed. Additionally, the serosal layer of the duodenum was shaved after observing the absence of intraluminal invasion. Postoperatively, transient gastroparesis occurred, but overall outcomes were favourable.
Clinical discussion:
This case emphasizes the potential of immunotherapy in improving resectability for irresectable dMMR colon cancer with suspected involvement of surrounding organs. The combination of neoadjuvant therapy and advanced surgical techniques, such as CME with CVL, shows promise in achieving favourable clinical outcomes. However, further studies are needed to validate the effectiveness and safety of this combined approach in a larger cohort of patients.
Conclusion:
The successful laparoscopic resection of initially irresectable dMMR colon cancer with duodenal involvement, following neoadjuvant immunotherapy, demonstrated promising outcomes. This case advocates for further exploration of neoadjuvant treatments' efficacy, coupled with advanced surgical techniques, in managing locally advanced right-sided colon cancer.
Cytomegalovirus colitis in immunocompetent hosts: A case report and literature review
Authors: Mohammadreza Salehi, Nahid Shafiee, Maryam Moradi
Journal: Clin Case Rep (2024)
Keywords: cmv, cmv colitis, cytomegalovirus, immunocompetent, rectal bleeding
MeSH terms: Case Reports

Key clinical message:
Rectal bleeding can manifest cytomegalovirus (CMV) colitis even in immunocompetent patients, which can be cured with ganciclovir treatment.
Abstract:
Cytomegalovirus (CMV) is an opportunistic virus widely affecting immunocompromised patients. Different manifestations varied from asymptomatic in immunocompetent individuals to end organ involvement, such as colitis in those with immunodeficiency. Despite the rarity of CMV colitis in immunocompetent hosts, we should consider it when the other conditions have been excluded. In this article, we have described a case of CMV colitis in an immunocompetent host and have performed a literature review on this entity. An immunocompetent 70-year-old female was admitted to the hospital with recurrent rectal bleeding. After various evaluations including laboratory analysis, stool examination, and colonoscopy, we have detected superficial lesions. Pathology and polymerase chain reaction reports favored CMV involvement. Her condition continues to improve after intravenous ganciclovir infusion. Rectal bleeding can manifest CMV colitis even in immunocompetent patients, which can be cured with ganciclovir treatment.
Case report: Infective endocarditis after transcatheter aortic valve implantation surgically treated with sutureless prosthesis and ascending aorta replacement
Authors: Francesco Cabrucci, Beatrice Bacchi, Riccardo Codecasa, Pierluigi Stefàno
Journal: Front Cardiovasc Med (2023)
Keywords: tavi, endocarditis, hostile aortic root, porcelain aorta, sutureless prosthesis
MeSH terms: Case Reports

Infective endocarditis on transcatheter aortic valve implantation (TAVI) represents an increasingly frequent challenge for cardiac surgeons. Patients undergoing TAVI usually have high mortality risk scores and unsuitable anatomy for the traditional surgical approach. Therefore, surgical planning is crucial, albeit sometimes intraoperative findings can be unexpected and arduous. We describe a case of infective endocarditis on TAVI in a patient with a porcelain aorta and "hostile" aortic root surgically treated with Perceval sutureless prosthesis and ascending aorta replacement.
Xerophthalmia secondary to bowel malabsorption after Roux-en-Y gastric bypass
Authors: José Arturo Oyervides-Alvarado, Schenny Murra-Anton, Ethel Guinto-Arcos, Laura Alejandra González-Dibildox, Nallely Ramos-Betancourt
Journal: GMS Ophthalmol Cases (2024)
Keywords: bitot’s spots, lynch syndrome, bowel malabsortion, case report, vitamin a deficiency, xerophthalmia
MeSH terms: Case Reports

Introduction:
Vitamin A is a fat-soluble vitamin, obtained through diet. Vitamin A deficiency is the leading cause of preventable blindness in children in developing countries due to impaired intake (Phanachet et al. 2018). Nevertheless, it is uncommon in the developed world where malabsorption takes a prominent role.
Case description:
A fifty-one-year-old female presented complaining of foreign body sensation, pain, tearing, fluctuating visual acuity, nyctalopia, diarrhea, polyphagia and weight loss. She had history of Roux-en-Y gastro-jejunal bypass, Lynch syndrome and right hemicolectomy with ileo-colonic anastomosis, she also referred to an additional unspecified bowel resection. In the ophthalmologic examination, best corrected visual acuity was 20/30, intraocular pressure was 11 mmHg in both eyes. Anterior segment biomicroscopy revealed a dry and thickened conjunctiva with wrinkles, multiple grey-white small, round, confluent, foamy lesions in the interpalpebral conjunctiva of both eyes, compatible with Bitot's spots, and superficial punctate keratitis.
Discussion:
The rise of bariatric surgery, inflammatory bowel disease and end stage liver disease has led to an increase in cases of malabsorption syndrome and nutrient deficiencies in the developed world. Retinoids are essential for corneal and conjunctival epithelial cells differentiation and its deficiency is associated with a wide spectrum of ocular surface manifestations known as xerophthalmia. In this case, a gastric bypass and another unspecified bowel resection should raise the suspicion of malabsorption and nutrient deficiencies. In our patient, the diagnosis was made early and appropriate treatment was implemented before irreversible damage arose, however, vitamin A deficiency can be easily overlooked.
Conclusion:
In patients with xerophthalmia, interrogation should include previous history of gastrointestinal surgery, especially since bariatric surgery has become a popular technique. This is, to our knowledge, the first case report of xerophthalmia in a patient with Lynch syndrome.
Case report: Effectiveness of low-dose methotrexate monotherapy in post-essential thrombocythemia myelofibrosis
Authors: Sebastian Francis, Tom King, Martin P Zeidler
Journal: Front Med (Lausanne) (2024)
Keywords: case report, methotrexate, myelofibrosis, psoriasis, quality of life
MeSH terms: Case Reports

JAK/STAT pathway signalling is associated with both chronic inflammatory conditions such as psoriasis and haematological malignancies such as the myeloproliferative neoplasms (MPNs). Here we describe a 73yo female patient with a history of chronic plaque psoriasis, post-essential thrombocythemia myelofibrosis (MF) and a quality of life substantially impacted by both conditions. We report that 15 mg oral Methotrexate (MTX) weekly as a monotherapy is well tolerated, provides a substantial clinical improvement for both conditions and significantly improves quality of life. We suggest that the recently identified mechanism of action of MTX as a JAK inhibitor is likely to explain this efficacy and suggest that repurposing MTX for MPNs may represent a clinical- and cost-effective therapeutic option.
Adult-onset multifocal kaposiform hemangioendothelioma in the bone marrow, lung, liver, and brain: a case report
Authors: Alexa Bello, Mir B Alikhan, Aparna Subramaniam, Zenab I Yusuf, Bruce Brockstein, Vinod Ravi
Journal: Front Oncol (2024)
Keywords: adult, bone marrow, case report, kaposiform hemangioendothelioma, myelofibrosis
MeSH terms: Case Reports

Kaposiform hemangioendothelioma (KHE), a rare form of vascular neoplasm, is typically seen in children. In this paper, we report a unique case of KHE replacing bone marrow tissue mimicking myeloproliferative neoplasm with additional involvement in the lung, liver, and brain in a 60-year-old Caucasian woman. The patient was initially seen in the hematology department for the chief complaint of epigastric pain and anemia. Abdominal magnetic resonance imaging (MRI) revealed mild splenomegaly with iron deposition secondary to extramedullary hematopoiesis. Additional workup was inconclusive. Subsequent bone marrow and lung biopsies eventually revealed bone marrow with extensive grade 3 fibrosis and multiple foci of low-grade vasoformative neoplasm in the lung suggestive of KHE. Although rare, KHE can present as an aggressive disease with indolent behavior in adults and can be distinguished from other vascular malignancies based on histopathology and imaging findings.
Unveiling the Hidden Patterns: Multimodality Cardiac Imaging in Takotsubo Cardiomyopathy Diagnosis
Authors: Moath Said Alfawara, Mahmoud Al Rifai, Malek Nayfeh, Mohammed A R Chamsi-Pasha, Mouaz H Al-Mallah
Journal: Methodist Debakey Cardiovasc J (2023)
Keywords: takotsubo cardiomyopathy, cardiac computed tomography, cardiac echocardiography, cardiac magnetic resonance imaging, cardiac positron emission tomography
MeSH terms: Takotsubo Cardiomyopathy / diagnostic imaging, Case Reports, Aged, Echocardiography, Electrocardiography, Female, Heart, Humans, Treatment Outcome

Takotsubo cardiomyopathy, also known as stress cardiomyopathy, is a reversible form of cardiomyopathy characterized by reduced ejection fraction with regional wall motion abnormalities, elevated cardiac enzyme levels, and signs of ischemia on electrocardiogram despite the absence of obstructive epicardial coronary artery disease. It is often preceded by intense emotional or physical illness stressors. This case describes a 65-year-old female patient who likely developed takotsubo cardiomyopathy precipitated by the stress of diverticulitis.
A case of disseminated sporotrichosis
Authors: Ashleigh A S Lamont, Kurai Tsoka, Sadhna Kooverjee, Michelle Venter
Journal: S Afr J Infect Dis (2024)
Keywords: sporothrix schenckii, cutaneous sporotrichosis, disseminated sporotrichosis, human immunodeficiency virus, osteo-articular sporotrichosis

Sporothrix schenckii is a thermally dimorphic fungus found in soil and in plant matter. Cutaneous sporotrichosis is the most common manifestation and disseminated sporotrichosis is the rarest. Delayed diagnoses are not uncommon. We report a case of disseminated sporotrichosis involving the skin, bones and joints, with subsequent joint destruction, tissue loss and permanent disability.
Contribution:
This case report highlights the debilitating potential of sporotrichosis and its often elusive nature regarding diagnosis.
Case report: Variability in clinical manifestations within a family with incontinentia pigmenti
Authors: Tatiana Belysheva, Tatiana Nasedkina, Irina Kletskaya, Dana Volchek, Irina Barinova, Vera Semenova, Aida Gadzhigoroeva, Ekaterina Zelenova, Timur Valiev, Elena Sharapova, Anna Michenko, Anastasiia Allenova, Darya Ponomareva
Journal: Front Med (Lausanne) (2024)
Keywords: ikbkg/nemo deletion, x-chromosome inactivation, dental abnormalities, family case report, hair, incontinentia pigmenti, squamous cell carcinoma
MeSH terms: Case Reports

Diagnosing skin diseases in children can be a complex interdisciplinary problem. Incontinentia pigmenti (IP), also known as Bloch-Sulzberger syndrome, is a rare hereditary genodermatosis related to a mutation in the IKBKG gene. We present a family case of IP described from the perspective of various specialists, including dermatologists, oncologists, geneticists, dentists, and trichologists. The peculiarity of this case is the development of squamous cell carcinoma (SCC) on the shin of a 10-year-old female patient with IP. The patient had a positive family history: her mother and two sisters also displayed clinical manifestations of IP with involvement of skin, teeth and hair. The presence of exons 4-10 deletion in the IKBKG gene in all affected females was confirmed by detailed genetic evaluation using long-range PCR, and also high degree of X-chromosome inactivation skewing was demonstrated. The family underwent a comprehensive examination and was followed up for 2 years with successful symptomatic treatment of dermatologic manifestations. Recommendations were also made regarding dental and hair problems. By the end of the follow-up period, patients had stabilized, with the exception of a 36-year-old mother who developed generalized morphea. The study demonstrates the varying expressiveness of clinical symptoms among family members and emphasizes the importance of timely diagnosis for effective management of patients with IP.
A suspected case of "itai-itai disease" in a cadmium-polluted area in Akita prefecture, Japan
Authors: Toru Sasaki, Hyogo Horiguchi, Takehisa Matsukawa, Momoko Kobayashi, Yuki Omori, Etsuko Oguma, Atsushi Komatsuda
Journal: Environ Health Prev Med (2024)
Keywords: akita prefecture, cadmium, itai-itai disease
MeSH terms: Cadmium, Case Reports, Aged, Cadmium Poisoning / epidemiology, Cadmium Poisoning / etiology, Environmental Pollutants, Farmers, Female, Humans, Japan / epidemiology, Cadmium, Environmental Pollutants

Background:
Itai-itai disease is the most severe case of chronic cadmium (Cd) toxicity, which was endemic in Cd-polluted areas in the Jinzu River basin in Toyama prefecture, Japan. Akita prefecture also has Cd-polluted areas, but there have been no cases of "itai-itai disease".
Case presentation:
An elderly female farmer with Cd nephropathy residing in a Cd-polluted area in the northern part of the Akita prefecture was identified through hospital-based screening at Akita Rosai Hospital in Odate city. She had chronic renal failure with a high Cd exposure level and advanced renal tubular dysfunction. The shortening of height, bone deformities and fractures, abnormal bone metabolism suggesting osteomalacia, and renal anemia were also noted. Therefore, "itai-itai disease", similar to cases in the Jinzu River basin, was suspected.
Conclusion:
This is the first case of "itai-itai disease" in a Cd-polluted area in Akita prefecture.
Case report: Confusing lung signs - is the source of the disease in the lungs or intestines?
Authors: Xiying Zhao, Jiahao Mo, Beiping Zhang, Haiyan Zhang
Journal: Front Med (Lausanne) (2023)
Keywords: crohn’s disease, abnormal lung manifestations, case report, granulomatous inflammation, lung
MeSH terms: Case Reports

At the time of the spread of the COVID-19 epidemic, blurred lung signs suggested by imaging examination are particularly common. Novel coronavirus infection is mainly caused by respiratory symptoms. In the early stage of imaging examination, multiple small patchy shadows or ground glass shadows and invasive shadows of both lungs are dominant. While the pulmonary involvement in Crohn's disease (CD) is rare and not widely reported. For CD patients, the pulmonary manifestations do not belong to its routine symptoms. The lung involvement of CD patients is difficult to attract clinicians' attention. If CD patients have vague lung manifestations but have no response to routine treatment, they should consider the respiratory diseases related to CD. We describe a rare case of granulomatous inflammation associated with Crohn's disease. The patient do not respond to conventional treatment. The final treatment plan was CD immunomodulatory therapy (oral corticosteroids and azathioprine). After treatment, a review of the lung CT showed focal fibrosis and significant improvement in the lung lesions. It suggests that CD related respiratory diseases should be considered when CD patients have abnormal lung manifestations that do not respond to conventional treatment.
Adrenocortical carcinoma: selective internal radiation therapy and liver metastases
Authors: Leo Baxendale-Smith, Karim El-Shakankery, James Gordon-Smith, Lucy Wall
Journal: Endocr Oncol (2024)
Keywords: sirt, adrenal, adrenocortical carcinoma, liver metastasis, selective internal radiation therapy
MeSH terms: Case Reports

Selective internal radiation therapy (SIRT) is a novel intervention for both primary and metastatic malignant liver lesions. Adrenocortical carcinoma (ACC) is rare with limited treatment options; evidence for SIRT in ACC liver metastases consists of case reports only. Selective internal radiation therapy (SIRT) was employed to treat recurrent liver metastases in a 49-year-old gentleman with ACC, who previously underwent a left-sided hepatectomy. The patient opted for SIRT after reviewing the literature regarding mitotane chemotherapy and its toxicities. Selective internal radiation therapy (SIRT) provided several months of progression-free survival (PFS), with no toxicity and an excellent radiological response. The patient re-presented 12 years after the initial diagnosis with skeletal metastases and sadly died in September 2022. Substantial unmet need exists for effective treatments in ACC, with 75% of patients presenting with incurable disease. Developing widespread disease, SIRT offered 2 years' PFS in our patient; this was well tolerated with minimal residual liver impairment. Its use in ACC liver-limited disease warrants investigation.
Significance statement:
Adrenocortical carcinoma (ACC) is a rare and aggressive tumour with limited treatments. Once metastatic disease develops, existing standard-of-care treatments offer a dismal overall survival, alongside marked toxicities. Selective internal radiation therapy (SIRT) may represent a new intervention in the treatment paradigm for liver-limited, metastatic ACC. Here, we present the case of a patient treated with multiple rounds of SIRT for relapsed, liver-limited ACC, prolonging survival by several years. Recurrent SIRT led to maintained liver function and no toxicities. Little evidence outlines its use in ACC but further study is certainly warranted to ascertain the value of SIRT, considering the limited treatment landscape that currently exists.
A case of babesiosis in a returning traveller
Authors: James W Mac Donald, John A Frean, John M Ratabane, Bhavani Moodley, Karissa Mannaru, Guillaume E Holz
Journal: S Afr J Infect Dis (2024)
Keywords: babesia microti, plasmodium falciparum, south africa, babesiosis, malaria
MeSH terms: Case Reports

Human babesiosis data in Africa is scarce. The clinical presentation and parasite morphology mimics falciparum malaria infection. Diagnostic confirmation is informed by adequate history and communication with the laboratory to activate appropriate testing. This case report describes the course of a returning traveller with persisting symptoms that resolved on tailored antimicrobial therapy following prompt collaborative diagnosis.
Contribution:
Case highlighting overlapping characteristics of Babesia and malaria infection, necessitating close clinical and laboratory correlation to confirm diagnosis.
Case of Circulating Tumor Cells Discovered in Extensive Deep Venous Thrombosis in a Patient with Known Urothelial Carcinoma
Authors: Ekrem Yetiskul, Ali Kimyaghalam, Shahkar Khan, Yisroel Grabie, Taqi A Rizvi, Salman Khan
Journal: Case Rep Hematol (2024)
MeSH terms: Case Reports

Background:
Currently, minimal data are available to explore the composition of venous thromboembolism in patients with cancer. This case report discusses a presentation of venous thromboembolism in a patient with high-grade urothelial carcinoma and highlights the pathology findings in thrombi. Case Presentation. A 55-year-old female who was diagnosed with high-grade urothelial carcinoma with multiple metastases developed an extensive deep vein thrombosis in her left lower extremity. Endovascular revascularization was indicated due to left lower extremity pain and swelling not responsive to anticoagulation. A mechanical thrombectomy was performed, and samples were sent for pathology. Pathologic examination discovered minute fragments of metastatic carcinoma, admixed with laminated blood clots (thrombus). The morphology of metastatic carcinoma and the immunostain profile were compatible with metastatic carcinoma of bladder origin.
Conclusion:
Cancer is a well-known risk factor for developing VTEs, and it is estimated that approximately 4-20% of cancer patients will experience VTE at some stage, the rate being the highest in the initial period following diagnosis. Annually, 0.5% of cancer patients will experience thrombosis compared with a 0.1% incidence rate in the general population (Elyamany et al., 2014). Despite knowing the increased incidence of VTEs in cancer patients, there are few studies to date that analyze the composition of thrombi in patients with cancer.
Case Report: Acute abdomen and large mesenteric mass as another face of multisystem inflammatory syndrome in an adolescent child: measure twice, act once!
Authors: Mustafa Bakir, Umair Iqbal, Ayoolamide N Gazal, Daniel Robertson
Journal: Front Pediatr (2023)
Keywords: covid-19, kawasaki disease, kikuchi-fujimoto disease, mis-c, appendicitis, mesenteric lymphadenopathy
MeSH terms: Case Reports

Introduction:
During the Covid-19 era, acute abdomen and mesenteric lymphadenopathy were encountered as frequent mimic of appendicitis. This phenomenon can further complicate the diagnosis of acute abdominal conditions, not solely due to bacterial or viral intestinal infections but also attributable to post-infectious acute inflammatory states resulting in either undertreatment of inflammatory conditions or unnecessary surgery.
Case presentation:
In this case study, we present the case of an 11-year-old female who initially presented with fever and right lower quadrant abdominal pain, raising concerns of appendicitis. However, upon further investigation, it was revealed that she harbored a sizable mesenteric mass. Subsequent biopsy results unveiled a significant necrotic mesenteric lymphadenitis. Notably, this patient fulfilled the criteria for Multisystem Inflammatory Syndrome in Children (MIS-C), a condition that manifested following persistent postoperative fever. Remarkably, the patient exhibited a highly favorable response to the treatment administered. This clinical scenario presents an atypical manifestation of MIS-C, as the patient displayed a substantial mesenteric mass alongside symptoms mimicking appendicitis, within the context of an acute abdomen.
Conclusion:
Clinicians should consider MIS-C and other post-infectious inflammatory conditions in mind when diagnosing acute abdominal cases. The presented case underscores the importance of recognizing atypical presentations of MIS-C that can mimic appendicitis, sometimes necessitating surgical resection of a large lymph node. We propose diagnostic flow chart to aid in the differentiation of acute bacterial appendicitis from MIS-C.