OpenMed/multicare-articles huggingface dataset:
CMV Ileitis: To Treat or Not to Treat? Implications of Initiating Biologic Therapy for Concurrent Crohn's Disease
Authors: Kendra T Stilwell, Jason Estes, Maria T Kurtz, James M Francis, David T Lynch, Anish A Patel
Journal: Case Rep Gastrointest Med (2019)
MeSH terms: Case Reports

Cytomegalovirus (CMV) enteritis is traditionally thought to be a self-limited infection in immunocompetent individuals. Consequently, current guidelines recommend against treating nonimmunocompromised patients with antiviral therapy. Conversely, recent data suggests that spontaneous resolution occurs less frequently than previously believed; furthermore, mortality rate in immunocompetent individuals is similar to that of the immunosuppressed. We present a case of a 43-year-old male who was simultaneously diagnosed with CMV ileitis and Crohn's Disease. When discovered concomitantly, there is no guidance in the current medical literature regarding the benefit of antiviral treatment of the CMV infection prior to initiating biologic therapy versus the risks of withholding treatment, as is currently recommended for nonimmunosuppressed individuals.
Successful treatment of chronic osteomyelitis of the radius
Authors: Barry J O'Neill, Kieran M Hirpara, T Kenneth Kaar
Journal: ISRN Pediatr (2011)
MeSH terms: Case Reports

Chronic osteomyelitis is uncommon in the United Kingdom and Ireland. Current migration trends with an influx of people from less affluent nations may result in more cases of chronic osteomyelitis being seen in community and hospital practice. We report on a case of chronic osteomyelitis of the radius and document current treatment recommendations.
A case of overlapping choriocapillaritis syndromes: multimodal imaging appraisal
Authors: Tatiana Kuznetcova, Bruno Jeannin, Carl P Herbort
Journal: J Ophthalmic Vis Res (2012)
Keywords: choriocapillaritis, fundus autofluorescence, multifocal choroiditis indocyanine green angiography, multiple evanescent white dot syndrome, optical coherence tomography
MeSH terms: Case Reports

Purpose:
To present a patient with overlapping choriocapillaritis syndromes who first presented as a typical case of multiple evanescent white dot syndrome (MEWDS) and later with characteristic findings compatible with multifocal choroiditis (MFC).
Case report:
A 40-year-old myopic woman presented with a paracentral scotoma OS. Fundus examination revealed pale discolored areas around the optic disc corresponding to faintly hyperfluorescent areas on fluorescein angiography (FA). On indocyanine green angiography (ICGA) there was extensive peripapillary hypofluorescence and confluent hypofluorescent dots superiorly. According to the clinical picture, a diagnosis of MEWDS was made. In 4 weeks, the visual field reverted to normal together with almost complete regression of hypofluorescence on ICGA. However, 4 months later fundus examination revealed some scars, a finding not typical for MEWDS. Besides, she developed another scotoma 12 months later accompanied by photopsia and the fundus illustrated more numerous scars than one year earlier. ICGA showed hypofluorescent areas corresponding to the scotoma delineated by visual field testing. The pattern of this recurrence clearly corresponded to MFC.
Conclusion:
This case illustrates an overlap between two entities, MEWDS and MFC in two sequential episodes. FA and fundus autofluorescence accounted for the lesions and optical coherence tomography showed damage to the photoreceptor outer segments, but only ICGA correlated well with functional evolution.
P-chloroaniline poisoning causing methemoglobinemia: a case report and review of the literature
Authors: Anna Sarah Messmer, Christian Hans Nickel, Dirk Bareiss
Journal: Case Rep Emerg Med (2015)

Background. Methemoglobin (MetHb) most commonly results from exposure to an oxidizing chemical but may also arise from genetic, dietary, or even idiopathic etiologies. P-chloroaniline (PCA) was one of the first substances described in the context of acquired methemoglobinemia. Case Report. We report the case of a cyanotic chemistry worker who presented to our emergency department (ED) after working with PCA. His peripheral oxygen saturation (SpO2) measured by pulse oximetry was at 81% and remained on that level despite oxygen administration (100% oxygenation via nonrebreather mask). His MetHb level was measured at 42.8% in arterial blood gas analysis. After treatment with intravenous methylene blue cyanosis resolved and the patient was discharged after 36 hours of observation. Conclusion. Acquired methemoglobinemia is a treatable condition, which may cause significant morbidity and mortality. The knowledge about the most common causes, fast diagnostic, and proper treatment is crucial.
Handheld ECG Tracking of in-hOspital Atrial Fibrillation (HECTO-AF): A Randomized Controlled Trial
Authors: Marco Mancinetti, Sara Schukraft, Yannick Faucherre, Stéphane Cook, Diego Arroyo, Serban Puricel
Journal: Front Cardiovasc Med (2021)
Keywords: ecg handheld device, atrial fibrillation, prevention, screening, stroke
MeSH terms: Case Reports

Background: Atrial fibrillation (AF) is frequent and causes substantial morbidity through AF-related strokes. Given the increasing prevalence of AF, screening methods are of interest given the potential to initiate timely appropriate anticoagulation. Aims: The HECTO-AF trial aims to determine the efficacy of AF screening with a single-lead electrocardiogram (ECG) handheld device in naïve in-hospital patients. Methods: The HECTO-AF is a single-center, open label, randomized controlled trial. Patients admitted to the general internal medicine ward of the University and Hospital Fribourg without previous diagnosis of AF were invited to participate in a screening program with a 1:1 allocation to either the screening group with intermittent single-lead handheld ECG recordings vs. a control group undergoing detection of AF as per routine clinical practice. The primary outcome was the prevalence of newly diagnosed AF during the hospital stay. Enrolment was terminated for poor patient recruitment and apparent futility before a sufficient sample for powered efficacy comparisons was enrolled. Results: A total of 804 patients were included of whom 381 were allocated to the intervention and 423 to the control group. Mean age was 65 ± 16 and 464 (58%) were male. Median CHA2DS2-VASc score was 3 (13% heart failure, 57% hypertension, 19% diabetes mellitus, 14% prior stroke/transient ischemic attack, and 29% arterial disease) and all CHA2DS2-VASc risk factors were equally distributed between groups. The incidence of newly detected AF was 1.4% over a median of 6 hospitalized days. Seven patients (1.8%) were diagnosed with AF in the intervention group vs. 3 (0.7%) in the control group (p = 0.20). Conclusion: There was a trend toward a higher AF detection over a median of 6 hospitalized days in the intervention group, but a definitive conclusion cannot be drawn due to the early termination of the present study. Systematic screening for AF in the hospital setting is resource-consuming, and of uncertain clinical benefit. The interpretation of single-lead handheld ECG is challenging and may result in inaccurate AF diagnosis. Clinical Trial Registration: ClinicalTrials.gov, identifier [NCT03197090].
[68Ga] Ga-Pentixafor diffuse bilateral Adrenal & Breast uptake in a patient with High-grade Glioma: A note of caution on normal variants
Authors: Hessamoddin Roustaei, Emran Askari, Somayeh Barashki, Kazem Anvari, Ramin Sadeghi, Kamran Aryana
Journal: Asia Ocean J Nucl Med Biol (2023)
Keywords: adrenal, breast, cxcr4, high-grade glioma, pet/ct
MeSH terms: Case Reports

[68Ga] Ga-labeled C-X-C motif receptor4 as a novel radio-ligand using PET/CT has been investigated for tracing various kinds of solid and hematopoietic malignancies in recent years. High-grade Glioma (WHO classification 2016 grade III and IV) shows elevated levels of CXCR4 ligand expression in the affected tumoral cells. Healthy and non-affected organ cells express low-level CXCR4 ligands density. We performed [68Ga] Ga-Pentixafor (Pars-Cixafor™) PET/CT in a patient with high-grade Glioma (anaplastic oligodendroglioma WHO grade III) with no other documented medical condition and history. In addition to the Pentixafor-avid tumor remnant in the PET/CT images, we observed mild symmetrical bilateral uptake in the fibro glandular tissue of the breasts and moderate CXCR4(Pentixafor) avidity in both adrenal glands without any discernable pathology and abnormal density changes in the CT component of the study. Attention should be paid to the interpreting [68Ga] Ga-Pentixafor PET/CT examination and its normal uptakes and variants.
Osteosarcoma of mandible initially resembling lesion of dental periapex: a case report
Authors: Rosilene C Soares, Andréa F Soares, Lélia B Souza, Aldo L V dos Santos, Leão P Pinto
Journal: Braz J Otorhinolaryngol (2005)
MeSH terms: Mandibular Neoplasms / diagnosis, Osteosarcoma / diagnosis, Case Reports, Review, Adult, Diagnosis, Differential, Fatal Outcome, Female, Humans, Mandibular Neoplasms / surgery, Neoplasm Recurrence, Local, Osteosarcoma / surgery, Periapical Diseases / diagnosis

Osteosarcoma is a malignant mesenchymal tumor whose cancerous cells produce osteoid matrix. It is the most common primary malignant bone tumor, accounting for approximately 20% of the sarcomas, but only 5% of the osteosarcomas occur in the jaws. They present various clinical and histological aspects, as well as variable disease progression and outcome. This article shows a case report of a 20-year-old woman who presented swelling near the mandibular left premolar. After clinical diagnosis of lesion of the dental periapex, the patient initially underwent endodontic treatment of the tooth involved. Thereafter, in a period of eleven days, a significant increase of the lesion could be observed, resulting in visible facial asymmetry. The occlusal radiographic view showed an area of bone destruction and abnormal bone formation in the region. The external cortical portion showed clear radiopacity resembling sunrays, suggesting the diagnosis of osteosarcoma. The treatment comprised partial mandibulectomy and reconstruction of the area, using bone of the rib and skin graft from the buttock for the oral mucosa involved. Eight months after surgery, there was local recurrence of the lesion and the patient died approximately one year after relapse.
Diagnostic Value and Clinical Application of mNGS for Post-Liver Transplantation Infection: A Cross-Sectional Study With Case Reports
Authors: Dong Zhao, Liping Guo, Dongli Lian, Yuchen Gu, Xu Yan, Hongxing Hu, Jing Yuan
Journal: Front Microbiol (2022)
Keywords: bronchoalveolar lavage fluid, liver transplantation, metagenomic next-generation sequencing, pathogen detection, whole blood

Liver transplantation is widely acknowledged as the only effective treatment for end-stage liver disease, and infection is reportedly an important cause of postoperative death. Clinical use of metagenomic next-generation sequencing (mNGS) to diagnose postoperative infection and successfully guide drug therapy remains rare. This study included patients with infectious complications after liver transplantation from July 2019 to December 2020 and was divided into three groups: pneumonia, unknown fever, and others (including hepatic failure, kidney failure, cirrhosis after LT, and other postoperative complications that predispose to infection). The mNGS sequencing was used to detect microorganisms, and the results were compared with traditional culture. We found that mNGS yielded improved sensitivity over culture (85.19 vs. 22.22%; p<0.0001) but lower specificity (35.71 vs. 89.28%; p<0.0001). Among the 48 kinds of pathogens detected, the Torque teno virus 22 (15/122) was the most common, followed by Primate erythroparvovirus 1 (13/122). The top four bacteria included Klebsiella pneumoniae (n = 8), Enterococcus faecium (n = 5), Stenotrophomonas maltophilia (n = 4), and Escherichia coli (n = 4). Aspergillus fumigatus was the most common fungus. The bronchoalveolar lavage fluid (BALF) exhibited the highest proportion of positive findings among sample types, with viral, fungal, and bacterial mixed infection being the most common (n = 6, 19.35%). Besides, using mNGS for early diagnosis of infection after liver transplantation may effectively prolong patient survival. This is the first study to explore the application value of mNGS and its comparison with traditional culture in pneumonia and other infections in post-liver transplantation patients. The simultaneous application of these two methods suggested that the Torque teno virus 22, Klebsiella pneumoniae, and the Aspergillus fumigatus are the most common pathogens of viruses, bacteria, and fungi after LT, suggesting that these pathogens may be associated with postoperative pathogen infection and patient prognosis. The mNGS technique showed distinct advantages in detecting mixed, viral, and parasitic infections in this patient population. Further studies are warranted to systematically elucidate the dynamic evolution and molecular characteristics of infection after liver transplantation.
Localized Bilateral Superior and Inferior Orbital Neurofibroma in the Absence of Neurofibromatosis
Authors: Daniela Rojas-Correa, Álvaro Bengoa-González, Enrique Mencía-Gutiérrez, Aurelio Hernández-Laín, Elena Salvador, Agustín Martín-Clavijo, Justino Jiménez-Almonacid, María-Dolores Lago-Llinás
Journal: Case Rep Ophthalmol Med (2021)
MeSH terms: Case Reports

Localized or isolated neurofibromas are peripheral nerve sheath tumors. They are rare in the orbit and occur without a systemic neurofibromatosis. There are few cases of bilateral tumors reported but none affecting both supraorbital and infraorbital nerves. We report a 45-year-old female who presented an extraconal mass in the right orbit as an incidental finding in a head computer tomography, without ocular symptoms. Magnetic resonance image showed a well-defined oval mass in the right supraorbital and infraorbital nerves, of similar characteristics, as well as smaller masses in the left supraorbital and infraorbital nerves. A progressive increase in size of the left supraorbital and infraorbital tumor motivated their surgical excision. The histological result was compatible with a neurofibroma. These uncommon orbital tumors are slow growing and affect the sensory nerves of the trigeminal nerve. Neurofibromas usually present progressive symptoms due to the orbital mass, proptosis, or visual changes although not in this case. Surgical removal is the only definitive treatment.
Contralateral Anterior Interhemispheric-Transcallosal-Transrostral Approach for the Resection of a Subcallosal Cavernous Malformation: A Case Report and an Operative Video
Authors: Aderaldo Costa Alves Jr, Marco Antônio Zanini, Pedro Tadao Hamamoto Filho, Feres Eduardo Aparecido Chaddad-Neto
Journal: Front Surg (2022)
Keywords: interhemispheric approach, brain surgery, cerebral cavernous malformation (ccm), lateral decubitus position, microsurgery
MeSH terms: Case Reports

This case report demonstrates the surgical resection of a cerebral cavernous malformation located in the subcallosal region. The authors present a detailed operative video explaining the steps to successfully remove the lesion through a contralateral interhemispheric-transcallosal-transrostral approach with the patient in lateral decubitus. The surgical procedure was uneventful, and the patient had no postoperative deficits and no residual lesions in a three-month follow-up.
A Case Report of Mania and Psychosis Five Months after Traumatic Brain Injury Successfully Treated Using Olanzapine
Authors: Giordano F Cittolin-Santos, Jesse C Fredeen, Robert O Cotes
Journal: Case Rep Psychiatry (2017)
MeSH terms: Case Reports

Background:
There are few published pharmacologic trials for the treatment of acute mania following traumatic brain injury (TBI). To our knowledge, we present the first case report of an individual being treated and stabilized with olanzapine monotherapy for this condition.
Case presentation:
We describe the case of a 53-year-old African American male admitted to an inpatient psychiatric hospital with one month of behavioral changes including irritability, decreased need for sleep, hyperverbal speech, hypergraphia, and paranoia five months after TBI. Using Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria, he was diagnosed with bipolar disorder due to traumatic brain injury, with manic features. He was serially evaluated with clinical rating scales to measure symptom severity. The Young Mania Rating Scale (YMRS) score upon admission was 31, and the Clinician-Rated Dimensions of Psychosis Symptom Severity (CRDPSS) score was initially 9. After eight days of milieu treatment and gradual titration of olanzapine to 15 mg nightly, his symptoms completely abated, with YMRS and CRDPSS scores at zero on the day of discharge.
Conclusion:
Olanzapine was effective and well tolerated for the treatment of mania following TBI.
Temporomandibular joint disorder in systemic sclerosis: a case report
Authors: Raja Chebbi, Hanen Ben Khalifa, Monia Dhidah
Journal: Pan Afr Med J (2016)
Keywords: systemic sclerosis, condylar resorption, pain, temporomandibular joint
MeSH terms: Magnetic Resonance Imaging / methods, Scleroderma, Systemic / complications, Temporomandibular Joint Disorders / etiology, Case Reports, Female, Humans, Middle Aged, Mouth / diagnostic imaging, Pain / etiology, Range of Motion, Articular, Temporomandibular Joint Disorders / diagnostic imaging

Systemic sclerosis have several effects on the orofacial region such as widening of the periodontal ligament space, xerostomia and bone resorption of the mandible. We report a case of systemic sclerosis with temporomandibular joint involvement in a 45-year-old female patient accompanied by severe limited mouth opening and pain in the right and left preauricular regions and tenderness in masseter muscles with a morning stiffness of jaws.Magnetic resonance imaging showed a resorption of mandibular condylar process, with disk and joint abnormalities.
Cocaine-Induced Raynaud's Phenomenon: A Case Report
Authors: Heong Jin C Ahn, Albert Tine Iii, Arsh N Patel, Samantha A Le, Fulton Defour
Journal: Cureus (2023)
Keywords: cocaine use, drug induced vasculitis, raynaud disease, raynaud’s phenomenon, secondary raynaud's
MeSH terms: Case Reports

We illustrate a notable case of a middle-aged male who presents to a community hospital with left third- and fourth-digit discoloration and pain for the past four days. On presentation to the emergency department, a urine drug screen was ordered which showed synthetic cannabinoids, cocaine, and amphetamines. Initial therapy of nitroglycerin paste, oral oxycodone, intravenous Dilaudid®, and aspirin was started, which resulted in decreased subjective pain. The pathophysiology and mechanism of cocaine-induced Raynaud's phenomenon (RP) are discussed. Our purpose in putting forward this case is to acknowledge cocaine use as a cause of secondary RP and to emphasize the importance of early recognition to reduce the occurrence of digital necrosis.
Combination of Dabrafenib and Trametinib for the Treatment of Relapsed and Refractory Multiple Myeloma Harboring BRAF V600E Mutation
Authors: Rūta Čepulytė, Andrius Žučenka, Valdas Pečeliūnas
Journal: Case Rep Hematol (2020)
MeSH terms: Case Reports

Multiple myeloma (MM) is an incurable plasma cell neoplasia characterized by relapsed and/or refractory (R/R) disease course, which poses a major therapeutic challenge. New therapies, including BRAF V600E mutation targeting, may become a new treatment option for R/R MM. In combination with mitogen-activated protein kinase inhibitors (MEKi), BRAF inhibitors (BRAFi) could provide better tailored clinical management, although experience in this field is lacking. To this date, there is only one case describing R/R MM treatment with BRAFi vemurafenib and MEKi cobimetinib. This is the first case presenting a R/R MM patient treated with BRAFi dabrafenib and MEKi trametinib.
Terminal quadrifurcation of the aorta: A case report
Authors: Siviwe S Mpateni, Jacques Bence, Richard D Pitcher, Michelle Da Silva
Journal: SA J Radiol (2023)
Keywords: angiography, aorta, interventional radiology, trauma, vascular anatomy
MeSH terms: Case Reports

Congenital anatomical variations of the terminal aorta are rare. Given the increasing number of endovascular and laparoscopic procedures, such variations are likely to assume greater clinical significance. A 15-year-old male sustained a pelvic vascular injury following a stab to the left gluteus. Computed tomographic angiography and digital subtraction angiography demonstrated a left superior gluteal artery pseudoaneurysm and absence of the common iliac arteries consistent with congenital quadrifurcation of the terminal aorta. The patient was subsequently treated with endovascular coil embolisation with a good angiographic and clinical outcome.
Contribution:
Terminal aortic variants are rare and given the increasing number of interventional endovascular procedures performed in the aorta, an awareness of the potential anatomical configurations of the distal aortic branches is of increasing relevance. The authors describe the imaging findings of one such anatomical variant.
Placenta Previa Percreta: A Case Report of Successful Management via Conservative Surgery
Authors: Silvia Canonico, Maurizio Arduini, Giorgio Epicoco, Giuseppe Luzi, Saverio Arena, Graziano Clerici, Giuseppe Affronti
Journal: Case Rep Obstet Gynecol (2013)

Placenta percreta is one of the most serious complications of placenta previa and is frequently associated with severe obstetric hemorrhage usually necessitating hysterectomy. We present a case of placenta previa percreta diagnosed by ultrasound and magnetic resonance imaging techniques, in which we accomplished conservative management of postpartum hemorrhage. The management we propose includes the following steps: preventive catheterization of the descending aorta via transhumeral access; Stark cesarean delivery; uterotonics drugs; Affronti endouterine square hemostatic sutures; intrauterine application of Bakri balloon and partial filling with 100 mL of normal saline; B Lynch suture, hysterorrhaphy, and filling a Bakri balloon with up to 500 mL of normal saline; reversible radiological embolization; and/or surgical ligation of the uterine arteries. The bleeding stopped following placement of Affronti sutures combined with external (B-Lynch suture) and internal (Bakri balloon) uterine compression. Our experience indicates that this conservative method can be considered an option in the management of selected cases of pregnancy at high risk for intrapartum hemorrhage.