OpenMed/multicare-articles huggingface dataset:
Dabigatran reversal with idarucizumab in a patient undergoing heart transplantation: first European report
Authors: António Tralhão, Carlos Aguiar, Jorge Ferreira, Maria José Rebocho, Emília Santos, Dinis Martins, José Pedro Neves
Journal: Thromb J (2017)
Keywords: dabigatran, heart transplantation, idarucizumab
MeSH terms: Case Reports

Background:
Dabigatran is a direct thrombin inhibitor with a favorable effectiveness and safety profile when compared to vitamin K antagonists, both in randomized trials and real world registries of atrial fibrillation patients. Yet, physicians' fear of high bleeding risk scenarios in daily clinical practice still precludes a more widespread use of oral anticoagulation. We hereby report a successful case of dabigatran reversal with the novel monoclonal antibody fragment idarucizumab in a patient undergoing heart transplantation.
Case presentation:
A 45-year old male patient on dabigatran for atrial fibrillation thromboprophylaxis was enlisted for heart transplantation due to end-stage ischemic heart failure. Upon donor availability and suitability and following the last intake of the drug 12 h previously, activated partial thromboplastin time was measured and found to be elevated. After general anesthesia and before extracorporeal circulation, idarucizumab was administered as two boluses of 2.5 g. Orthotopic heart transplantation ensued under full heparinization and cardiopulmonary bypass. Total chest tube output was 1125 mL after 3 days and 4 units of fresh frozen plasma and one platelet pool were administered in the operating room without further need for blood products. The post-operative period was uneventful.
Conclusions:
Idarucizumab was associated with an effective hemostasis in the setting of heart transplantation. Dabigatran may be considered as an alternative to vitamin K antagonists in heart transplant candidates with an indication for oral anticoagulation.
Masked Hypotension due to Elevated Venous Pressure in a Patient with Complex Adult Congenital Heart Disease
Authors: Wytch Rigger, Sean P Javaheri, Gyanendra K Sharma, Norris Stanley Nahman Jr, Mark Sheynshteyn, Neal L Weintraub
Journal: Case Rep Cardiol (2020)
MeSH terms: Case Reports

An adult with surgically corrected Tetralogy of Fallot presented with profoundly elevated central venous pressure (CVP) and acute renal dysfunction thought secondary to acute on chronic right heart failure. Treatment with dopamine promoted diuresis and a stabilization of renal function. Repeated attempts to wean the patient from dopamine were associated with hypotension and worsening renal failure. Invasive hemodynamic assessment unexpectedly demonstrated high cardiac output with low systemic vascular resistance (SVR). In retrospect, the markedly elevated CVP had concealed the impact of reduced SVR on blood pressure. After reversible causes of low SVR state were excluded, the patient was successfully managed with oral alpha-adrenergic agents. While typically negligible under physiologic conditions, elevated CVP can artificially increase mean arterial pressure. We have coined the term "masked hypotension" to describe this unique pathophysiological phenomenon.
Pembrolizumab-induced optic neuropathy - a case report
Authors: Eveline Daetwyler, Alfred Zippelius, Peter Meyer, Heinz Läubli
Journal: Front Immunol (2023)
Keywords: pd-1/l1, case report, immune checkpoint inhibitor (ici), immune-related adverse event(s), neuropathic, optic neuropathy
MeSH terms: Hodgkin Disease / drug therapy, Optic Nerve Diseases / chemically induced, Optic Nerve Diseases / diagnosis, Optic Nerve Diseases / therapy, Case Reports, Antibodies, Monoclonal, Humanized / adverse effects, Humans, Mycophenolic Acid, pembrolizumab, Mycophenolic Acid, Antibodies, Monoclonal, Humanized

Background:
Immune checkpoint inhibitor (ICI) treatment has become important for treating various cancer types, including Hodgkin's lymphoma. However, ICI can overstimulate the immune system, leading to a broad range of immunological side effects, known as immune-related adverse events (irAEs). Here, we report a case of optic neuropathy caused by pembrolizumab.
Case presentation:
A patient with Hodgkin's lymphoma received pembrolizumab every three weeks. Twelve days after the sixth cycle of pembrolizumab, the patient was admitted to the emergency department with blurred vision, visual field impairment and altered color perception affecting the right eye. The diagnosis of immune-related optic neuropathy was established. Pembrolizumab was stopped permanently and high-dose steroid treatment was immediately started. This emergency treatment led to a satisfactory binocular vision and an improvement of visual acuity testing results. After another 7 months, the left eye was affected with the same symptoms. At this time, only an extended immunosuppressive therapy consisting of high-dose steroid treatment, plasmapheresis, immunoglobulin treatment, retrobulbar injection of steroids and mycophenolate mofetil, successfully reduced the symptoms.
Conclusions:
This case highlights the need for prompt recognition and treatment of rare irAEs, such as optic neuropathy. Urgent treatment with initial high-dose steroid treatment is required to avoid persistent loss of visual acuity. Options for further treatment are mainly based on small case series and case reports. In our case, a retrobulbar injection of steroids in combination with mycophenolate mofetil showed significant success in treating steroid-refractory optic neuropathy.
Effect of intravitreal methotrexate and rituximab on interleukin-10 levels in aqueous humor of treated eyes with vitreoretinal lymphoma
Authors: Harish Raja, Melissa R Snyder, Patrick B Johnston, Brian P O'Neill, Juline N Caraballo, Joseph G Balsanek, Brian E Peters, Paul A Decker, Jose S Pulido
Journal: PLoS One (2013)
MeSH terms: Antibodies, Monoclonal, Murine-Derived / pharmacology, Aqueous Humor / drug effects, Aqueous Humor / metabolism, Interleukin-10 / metabolism, Lymphoma / metabolism, Methotrexate / pharmacology, Vitreous Body, Case Reports, Research Support, Non-U.S. Gov't, Aged, Aged, 80 and over, Child, Diagnosis, Differential, Eye Neoplasms / diagnosis, Eye Neoplasms / metabolism, Female, Humans, Lymphoma / diagnosis, Male, Middle Aged, Rituximab, Uveitis / diagnosis, Uveitis / metabolism, Antibodies, Monoclonal, Murine-Derived, Interleukin-10, Rituximab, Methotrexate

Intraocular cytokines are promising diagnostic biomarkers of vitreoretinal lymphoma. Here, we evaluate the utility of IL-10, IL-6 and IL-10/IL-6 for discriminating lymphoma from uveitis and report the effects of intraocular methotrexate and rituximab on aqueous cytokine levels in eyes with lymphoma. This is a retrospective case series including 10 patients with lymphoma and 7 patients with uveitis. Non-parametric Mann-Whitney analysis was performed to determine statistical significance of difference in interleukin levels between lymphoma and uveitis. Compared to eyes with uveitis, eyes with lymphoma had higher levels of IL-10 (U = 7.0; two-tailed p = 0.004) and IL-10/IL-6 (U = 6.0; two-tailed p = 0.003), whereas IL-6 levels were more elevated, although insignificant, in those patients with uveitis than in lymphoma (U = 15.0; two-tailed p = ns). Using a receiver operating characteristic analysis to identify threshold values diagnostic for lymphoma, optimal sensitivity and specificity improved to 80.0% and 100%, respectively, for IL-10>7.025 pg/ml and 90.0% and 100.0%, respectively, for IL-10/IL-6>0.02718. In patients in whom serial interleukin levels were available, regular intravitreal treatment with methotrexate and rituximab was associated with reduction in IL-10 levels over time. In conclusion, optimal IL-10 and IL-10/IL-6 threshold values are associated with a diagnostic sensitivity ≥80% and specificity of 100%. Therefore, these cytokines may serve as a useful adjunct in the diagnosis of lymphoma. While negative IL-10 and IL-10/IL-6 values do not exclude a diagnosis of lymphoma, elevated levels do appear to be consistent with lymphoma clinically. Moreover, elevated levels of IL-10 in the setting of a clinically quiet eye may point to impending disease recurrence. Lastly, once lymphoma is diagnosed, IL-10 levels can be monitored over time to assess disease activity and therapeutic response.
Infective endocarditis following COVID-19 pneumonia: about two cases
Authors: Amal El Ouarradi, Aziza Kantri, Khalid Agrad, Ilham Bensahi, Fatimazzahra Merzouk, Zineb Guennoun, Said Makani, Yousra Jebbari, Chafik Elkettani, Mohamed Sabry
Journal: Pan Afr Med J (2021)
Keywords: covid-19, infective endocarditis, sars-cov-2, case report, heart failure
MeSH terms: COVID-19, Endocarditis, Case Reports, COVID-19 Testing, Humans, Pandemics, SARS-CoV-2

Coronavirus disease 2019 (COVID-19) has emerged as a pandemic and public health crisis across the world. The severity of this situation is escalating in certain populations, particularly when the COVID-19 diagnosis may delay the recognition of more dramatic illnesses such as infective endocarditis, which is a dreaded complication in patients with cardiac disease. We report the case of two patients who presented with infective endocarditis initially mistaken for COVID-19 pneumonia, which was responsible for a delay in diagnosis. We discuss the diagnostic difficulties as well as the management of this complication in the COVID-19 era. As a physician, one must remain alert to this dreaded complication, especially in patients with a cardiac history, in order to prevent it, detect it early, and manage it in time.
Partial and Transient Clinical Response to Omalizumab in IL-21-Induced Low STAT3-Phosphorylation on Hyper-IgE Syndrome
Authors: Cesar Daniel Alonso-Bello, María Del Carmen Jiménez-Martínez, María Eugenia Vargas-Camaño, Sagrario Hierro-Orozco, Mario Alberto Ynga-Durand, Laura Berrón-Ruiz, Julio César Alcántara-Montiel, Leopoldo Santos-Argumedo, Diana Andrea Herrera-Sánchez, Fernando Lozano-Patiño, María Isabel Castrejón-Vázquez
Journal: Case Reports Immunol (2019)
MeSH terms: Case Reports

Hyper-IgE syndrome (HIES) is a rare primary immunodeficiency characterized by elevated levels of immunoglobulin E (IgE), eczematous dermatitis, cold abscesses, and recurrent infections of the lung and skin caused by Staphylococcus aureus. The dominant form is characterized by nonimmunologic features including skeletal, connective tissue, and pulmonary abnormalities in addition to recurrent infections and eczema. Omalizumab is a humanized recombinant monoclonal antibody against IgE. Several studies reported clinical improvement with omalizumab in patients with severe atopic eczema with high serum IgE level. We present the case of a 37-year-old male with HIES and cutaneous manifestations, treated with humanized recombinant monoclonal antibodies efalizumab and omalizumab. After therapy for 4 years, we observed diminished eczema and serum IgE levels.
Transrectal drainage of a diverticular abscess using a pigtail catheter without radiological guidance: a case report
Authors: Bobby Vm Dasari, John Lawson, Jack Lee
Journal: J Med Case Rep (2011)

Introduction:
Percutaneous or endocavitory drainage of a diverticular abscess under radiological guidance often enables one to perform a one-staged resection and anastomosis (without stoma formation) instead of a two-staged procedure. It reduces the significant postoperative morbidity and mortality associated with the conventional emergency surgical management. However, radiological guidance is not always available due to limited resources during out-of-hours.
Case presentation:
A 78-year-old Caucasian woman underwent transrectal drainage of a diverticular abscess performed with a pigtail catheter without radiological guidance. Technical details of the procedure are described and alternative options discussed.
Conclusion:
In carefully selected patients, per-rectal drainage using a pigtail catheter can be performed without radiological guidance and the procedure offers a simple and effective way of controlling sepsis.
Neurocysticercosis presenting as a locked-in lateral ventricle: A case report and evidence-based review
Authors: Moustafa A Mansour, Mohamed Tahir, Zarina Ahmadi
Journal: IDCases (2023)
Keywords: cns infections, case report, hydrocephalus, locked-in ventricle, neurocysticercosis, parasitic infestation
MeSH terms: Case Reports

Human neurocysticercosis is one of the most prevalent parasitic infestations of the central nervous system. It is considered the most frequent underlying etiology of acquired epilepsy in endemic areas in Central and South America, East Europe, Africa, and Asia, with over 50 million people affected globally. Ventricular involvement is a severe form of neurocysticercosis commonly manifests as arachnoiditis, raised intracranial pressure, or hydrocephalus, secondary to CSF flow obstruction of the ventricular system by cysts of Taenia solium, hence requiring prompt, aggressive intervention to alleviate the increased intracranial pressure to prevent imminent lethal complications. Ventricular neurocysticercosis can involve any brain ventricle but with a paramount preference for the fourth ventricle, causing non-communicating hydrocephalus and symmetric ventriculomegaly. However, in this clinical report, we present an uncommon case of trapped (locked-in) lateral ventricle caused by an isolated cysticercus trapped at the ipsilateral foramen of Monro, which is an atypical location for neurocysticercosis, adding more challenges to diagnosis and during the process of surgical extraction. We additionally provide a comprehensive, evidence-based review of the clinical course and management options relevant to the entity of ventricular neurocysticercosis, besides recent relevant clinical updates.
A Case of Pharyngeal Stenosis Caused by Behçet's Disease Treated With Transoral Videolaryngoscopic Surgery
Authors: Yu Suekata, Kiyohito Hosokawa, Takahiro Kawasaki, Daisuke Nakatsubo, Masashi Tanida, Makoto Ogawa, Hidenori Inohara
Journal: Cureus (2023)
Keywords: behçet’s disease, dysphagia, pharyngeal stenosis, tracheotomy, transoral surgery
MeSH terms: Case Reports

Behçet's disease is a refractory inflammatory disease characterized by recurrent oral aphthous ulcers. Ulcers are commonly seen in the oral cavity and the pharyngeal region. In patients with recurrent pharyngeal ulcers, pharyngeal stenosis may occur and leads to dysphagia. Herein, we report a case of pharyngeal stenosis caused by recurrent ulcers due to incomplete Behçet's disease. Prednisolone, colchicine, and infliximab were administered and resolved the pharyngeal ulcers, however, dysphagia persisted. To improve the swallowing function, a pharyngeal dilation surgery and transoral videolaryngoscopic surgery were performed, which resulted in an enlarged pharyngeal cavity. Oral intake of water was initiated the day after surgery, and after six days, the patient was able to take a normal diet. The pharyngeal stenosis had not recurred for one year after the surgery, and a normal diet continued without any dietary restrictions. Therefore, in a case of a severe oropharyngeal lesion, periodic follow-up and surgical interventions by an otolaryngologist are necessary.
Infiltrating Cardiac Synovial Sarcoma Presenting as Acute Cerebrovascular Accident
Authors: Kelechukwu U Okoro, Matthew D Roby, David C Sane, Robert E Budin
Journal: Case Rep Med (2017)
MeSH terms: Case Reports

Primary cardiac sarcoma is a rare malignant myocardial neoplasm that does not exhibit gender predominance or age predilection. The classification of these tumors includes several subtypes, of which synovial sarcoma is a rare manifestation. When present, these tumors portend a poor prognosis with high morbidity and mortality that is attributable to their inherent infiltrative capacity, especially in the absence of treatment. The general consensus for treatment is surgical excision and neoadjuvant chemotherapy and radiotherapy. In this report, a case of synovial sarcoma involving the left ventricular outflow tract and aortic valve is presented.
Palmaris Brevis Syndrome: A Treatable Pseudodystonia
Authors: Mark S LeDoux, Jianfeng Xiao
Journal: Tremor Other Hyperkinet Mov (N Y) (2021)
Keywords: botulinum toxin, dystonia, palmaris brevis, spasm, ulnar nerve
MeSH terms: Botulinum Toxins, Type A / therapeutic use, Dystonic Disorders / diagnosis, Dystonic Disorders / drug therapy, Case Reports, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Review, Hand, Humans, Muscle, Skeletal, Ulnar Nerve, Botulinum Toxins, Type A

Background:
Palmaris brevis syndrome, a pseudodystonia characterized by abnormal involuntary contractions of the palmaris brevis muscle which resides in the hypothenar eminence, is believed to be due to compressive irritation of motor fibers which arise from the superficial branch of the ulnar nerve.
Case report:
Herein, we review the origins, differential diagnosis and pathophysiology of the palmaris brevis syndrome, and effective treatment of a patient with workplace modifications and injections of botulinum toxin type A.
Discussion:
Prompt diagnosis of the palmaris brevis syndrome facilitates effective treatment and resolution.
Highlights:
Like the task-specific hand dystonias seen in writers and musicians, palmaris brevis syndrome, a pseudodystonia, may be caused and aggravated by extreme repetitive use. Here, we report a case of palmaris brevis syndrome apparently triggered by high-volume use of a pipette and computer mouse and review relevant clinical facets from previously published cases. Treatment must include workplace modifications and may include injections of botulinum toxin.
An Uncommon Presentation of Adrenal Cyst with Subclinical Cushing's Syndrome: A Diagnosis Dilemma
Authors: A Tahri, W Abdellaoui, S Benyakhlef, K Boujtat, I Mahroug, I Kamaoui, A Barki, F Kettani, S Rouf, H Latrech
Journal: Case Rep Endocrinol (2021)
MeSH terms: Case Reports

Adrenal cysts are a rare entity that is usually nonfunctional and asymptomatic. Their association with adrenal neoplasms was rarely described in the literature. We report a unique case of a 40 -year-old woman who was referred for evaluation of a left adrenal incidentaloma with subclinical Cushing's syndrome. The tumor was suspicious for malignancy regarding computed tomography scan (CT scan) features. Therefore, a laparoscopic left partial adrenalectomy was performed. Pathology examination showed multilocular spaces lined by endothelial cells which are compatible with endothelial adrenal cyst, associated to an adrenocortical adenoma. We further discuss the management of adrenal cyst with review of the literature.
The Clinical Role of CT-Based Morphologic Description in Severely Calcified Coronary Arteries Ectasia Encountering Acute Coronary Syndrome
Authors: Yen-Yu Liu, Jui-Peng Tsai, Chung-Lieh Hung, Jiun-Yi Li, Jen-Yuan Kuo
Journal: Case Rep Cardiol (2012)
MeSH terms: Case Reports

Diffuse coronary arteries ectasia combined with calcification is seldom reported. Acute coronary syndrome, a potentially life-threatening disease, accompanied with coronary ectasia and diffuse calcification, made percutaneous coronary intervention difficult and risky owing to increasing complications rate. Dual-source computed tomography and three-dimensional volume rendering images help cardiovascular surgeon easier to localize the ideal site and facilitate the procedure.
Image-Guided Embolization Coil Placement for Identification of an Endophytic, Isoechoic Renal Mass During Robotic Partial Nephrectomy
Authors: James Jeffery Reeves, Andrew Forauer, John D Seigne, Elias S Hyams
Journal: J Endourol Case Rep (2015)
MeSH terms: Case Reports

Background:
Intraoperative ultrasonography has proven to be a useful tool for tumor identification during robot-assisted laparoscopic partial nephrectomy (RALPN). However, its utility is limited in renal tumors that are completely endophytic and isoechoic in nature. We present a novel approach to intraoperative tumor identification using preoperative percutaneous intratumoral embolization coil placement that may be utilized in the management of such cases.
Case presentation:
A 42-year-old Caucasian male was referred with an incidentally discovered right renal mass that was posterior and completely endophytic. He desired a RALPN; however, preoperative renal ultrasound demonstrated an isoechoic lesion. Thus, the patient underwent preoperative image-guided placement of an embolization coil within the tumor. This facilitated identification of the tumor intraoperatively using intracorporeal ultrasound centered on the coil and enabled resection with negative margins.
Conclusion:
Utilizing a novel approach analogous to preoperative localization of other solid malignancies, such as breast cancer, we were able to effectively identify and resect an isoechoic renal mass during RALPN.
Kawasaki Disease Complicated With Macrophage Activation Syndrome: Case Reports and Literature Review
Authors: Ping Jin, Yong Luo, Xi Liu, Jinji Xu, Chunyi Liu
Journal: Front Pediatr (2019)
Keywords: kawasaki disease, children, complication, coronary artery, macrophage activation syndrome
MeSH terms: Case Reports

Macrophage activation syndrome (MAS) is a rare and severe complication of Kawasaki disease (KD). The clinical feature, early diagnosis and treatment options, and prognosis need to be further determined in patients with KD complicated with MAS. In this report, we retrospectively analyzed three KD patients complicated with MAS who were treated in pediatric intensive care units (PICU) and reviewed the relevant literatures. We find that being male, being age over 2 years old, incomplete KD, intravenous immunoglobulin (IVIG) non-responder, or persistent fever greater than 10 days are all highly associated with occurrence of MAS. Additional work-ups should be performed promptly in patient with above predisposing factors to rule out complication of MAS. Patients with KD complicated with MAS are at a higher risk of having coronary artery involvement or aneurysm formation, which can be reversed with timely treatment. Early identification and prompt treatment are key points for improving the prognosis of KD patients complicated with MAS.
Locked Central Fracture Dislocation of the Hip in a Child after Low-Energy Trauma
Authors: Alexandre H Nehme, Jack C Daoud, Hicham G Abdelnour, Jad N Bou Mounsef, Ramzi C Moucharafieh, Joseph W Wehbe
Journal: Case Rep Orthop (2017)
MeSH terms: Case Reports

We present the case of a 13-year-old boy who sustained a locked central fracture dislocation of the right acetabulum following a bicycle fall. Immediate external reduction maneuvers under general anesthesia were unsuccessful due to intrapelvic entrapment of the femoral head. Open reduction internal fixation was achieved 48 hours later. After an initial satisfactory postoperative course, the patient ended up developing severe hip osteoarthritis 16 months after the procedure. The rarity of this injury in children is discussed, with its possible implications on joint congruity and potential growth injury.
Chorea-Acanthocytosis in a Chinese Family With a Pseudo-Dominant Inheritance Mode
Authors: Fang Yi, Wenwen Li, Nina Xie, Yafang Zhou, Hongwei Xu, Qiying Sun, Lin Zhou
Journal: Front Neurol (2018)
Keywords: vps13a, case report, chorea-acanthocytosis, genetic variation, mutation
MeSH terms: Case Reports

Chorea-acanthocytosis (ChAc) is a rare neurodegenerative movement disorder with variable clinical features, including movement disorders, cognitive decline, myopathy, neuropathy, behavioral changes, seizures and acanthocytosis. The majority of ChAc patients display an autosomal recessive mode of inheritance. A pseudodominant way of transmission represents only a rare condition. Few studies have reported the clinical status of the obligate carriers of ChAc. Here, we describe a Chinese ChAc family with a novel mutation in the VPS13A gene, presenting a pseudo-dominant inheritance mode. Our report further expanded the knowledge of phenotypes of ChAc.