OpenMed/multicare-articles huggingface dataset:
A case of septicaemic anthrax in an intravenous drug user
Authors: Arfon G M T Powell, Joseph E M Crozier, Heather Hodgson, David J Galloway
Journal: BMC Infect Dis (2011)
MeSH terms: Anthrax / etiology, Bacteremia / etiology, Drug Contamination, Heroin / adverse effects, Substance Abuse, Intravenous / complications, Case Reports, Adult, Anthrax / microbiology, Bacillus anthracis / isolation & purification, Bacillus anthracis / physiology, Bacteremia / microbiology, Drug Users, Heroin / administration & dosage, Humans, Male, Heroin

Background:
In 2000, Ringertz et al described the first case of systemic anthrax caused by injecting heroin contaminated with anthrax. In 2008, there were 574 drug related deaths in Scotland, of which 336 were associated with heroin and or morphine. We report a rare case of septicaemic anthrax caused by injecting heroin contaminated with anthrax in Scotland.
Case presentation:
A 32 year old intravenous drug user (IVDU), presented with a 12 hour history of increasing purulent discharge from a chronic sinus in his left groin. He had a tachycardia, pyrexia, leukocytosis and an elevated C-reactive protein (CRP). He was treated with Vancomycin, Clindamycin, Ciprofloxacin, Gentamicin and Metronidazole. Blood cultures grew Bacillus anthracis within 24 hours of presentation. He had a computed tomography (CT) scan and magnetic resonance imagining (MRI) of his abdomen, pelvis and thighs performed. These showed inflammatory change relating to the iliopsoas and an area of necrosis in the adductor magnus.He underwent an exploration of his left thigh. This revealed chronically indurated subcutaneous tissues with no evidence of a collection or necrotic muscle. Treatment with Vancomycin, Ciprofloxacin and Clindamycin continued for 14 days. Negative Pressure Wound Therapy (NPWT) device was applied utilising the Venturi™ wound sealing kit. Following 4 weeks of treatment, the wound dimensions had reduced by 77%.
Conclusions:
Although systemic anthrax infection is rare, it should be considered when faced with severe cutaneous infection in IVDU patients. This case shows that patients with significant bacteraemia may present with no signs of haemodynamic compromise. Prompt recognition and treatment with high dose IV antimicrobial therapy increases the likelihood of survival. The use of simple wound therapy adjuncts such as NPWT can give excellent wound healing results.
Eosinophilic Granulomatosis With Polyangiitis Presenting With Oral Granuloma as the Initial Symptom: A Case Report
Authors: Lirong Lin, Rongjie Yu, Luquan Zheng, Shuyu Gong, Jurong Yang
Journal: Front Med (Lausanne) (2022)
Keywords: anca-associated vasculitis (aav), antineutrophil cytoplasmic antibody, case report, eosinophilic granulomatosis with polyangiitis, myeloperoxidase
MeSH terms: Case Reports

Antineutrophil cytoplasmic antibody associated vasculitis includes granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis (EGPA), and microscopic polyangiitis. While EGPA has no specific symptoms, it usually presents as necrotizing vasculitis, eosinophil infiltration of the tissues and organs, and extravascular granuloma formation. Here, we report a patient who had a rare initial presentation of oral granuloma and had been previously misdiagnosed several times at other hospitals. He was finally diagnosed with EGPA and recovered after methylprednisolone and cyclophosphamide treatment. The disease EGPA can present with a rare initial presentation of oral granuloma, methylprednisolone, and cyclophosphamide can be a suitable choice of treatment.
Delta-8-THC association with psychosis: A case report with literature review
Authors: Chelsea R Miller, Bradley G Burk, Rachel E Fargason, Badari Birur
Journal: Front Psychiatry (2023)
Keywords: cannabis sativa, case report, delta-8-thc, delta-8-tetrahydrocannabinol, delta-9-tetrahydrocannabinol, psychosis
MeSH terms: Case Reports

Background:
Cannabis (Δ9-THC) is the most commonly consumed illicit drug. The Agricultural Improvement Act of 2018 removed hemp, a strain of Cannabis sativa, as a controlled substance. This law allowed the plant to be processed into its components, which contain <0.3% Δ9-THC. As a result, delta-8-tetrahydrocannabinol (Δ8-THC), a federally unregulated substance, grew in popularity in 2020. Δ8-THC is readily available in most gas stations or head shops and may be considered harmless by patients. However, an increasing number of patients admitted for psychiatric hospitalization report use, with limited literature on the effects.
Case presentations:
This case report describes three individual cases of patients who required admission to a university psychiatric hospital after the regular use solely of Δ8-THC. All three patients developed psychotic and paranoid symptoms concurrently with the use of Δ8-THC, with a severity exceeding their previous historical presentations. The presenting psychotic symptoms were also atypical for all three patients. New-onset violence and visual hallucinations were noted in two of the patients, one patient with no previous psychiatric history and one patient while on a therapeutic dose of his antipsychotic. In the third case, a new onset of bizarre, fixed delusions of puppies dissolving in the bathtub developed.
Conclusion:
This report adds to the limited body of evidence on Δ8-THC documenting a temporal association between Δ8-THC use and the development of psychotic symptoms. A strong body of research already correlates the continued use of Δ9-THC with psychosis, and Δ8-THC acts at the same CB1 and CB2 receptors as Δ9-THC. Therefore, it is hypothesized that Δ8-THC may have similar adverse psychiatric effects as Δ9-THC. These conclusions are not without speculation, due to the need for self or collateral-reporting of Δ8-THC use as urine drug screening cannot distinguish Δ8-THC from Δ9-THC, and the patients' symptoms could be explained by medication non-adherence and primary psychotic disorders. However, physicians should be encouraged to gather a specific history of Δ8-THC use and treat patients with Δ8-THC-related intoxication and symptoms.
Squamous cell carcinoma of kidney and its prognosis: a case report and review of the literature
Authors: Tapan Kumar Sahoo, Saroj Kumar Das, Chandraprava Mishra, Ipsita Dhal, Rohani Nayak, Iftekhar Ali, Debashis Panda, Saroj Kumar Das Majumdar, Dillip Kumar Parida
Journal: Case Rep Urol (2015)

Primary squamous cell carcinoma of the renal parenchyma is an extremely rare entity. The diagnosis of squamous cell carcinoma of the renal pelvis is usually unsuspected due to the rarity and inconclusive clinical and radiological features. Most of the patients are diagnosed at an advanced stage and are with poor outcome. Radical nephrectomy is the mainstay of the treatment. We reported a case of squamous cell carcinoma of the kidney in a 50-year-old female who presented with the right sided abdomen pain. The patient was treated with radical nephrectomy.
An unexpected death after low anterior resection due to disseminated intravascular coagulation: A case report
Authors: Jurij Ales Kosir, Mensur Salihovic, Primoz Sever, Jasna Klen
Journal: Int J Surg Case Rep (2020)
Keywords: case report, disseminated intravascular coagulation, postoperative death, rectal carcinoma
MeSH terms: Case Reports

Introduction:
Disseminated intravascular coagulation (DIC) is a blood clotting disorder that is characterized by intravascular thrombi formation and exhaustion of platelets and coagulation factors resulting in diffuse hemorrhage and multiple organ dysfunction.
Presentation of case:
We present a case report of a previously healthy middle-aged patient who was treated by low anterior resection for rectal carcinoma and suddenly went into unexpected circulatory shock on the 7th postoperative day. Despite our resuscitation efforts, he succumbed to the disease. The postmortem examination showed findings consistent with DIC.
Discussion:
The cause for DIC in this patient may be multifactorial. Sepsis, tumor-related factors and hereditary predisposition may have played a role. The role of blood components in treatment is not fully understood as they may worsen the inflammatory response.
Conclusion:
DIC can be the presenting sign of unrecognized sepsis and it can occur in all surgical patients. Even with prompt treatment, the disease can have a fatal course.
Opioid Overdose and Serotonin Syndrome due to Gastric Bezoar in a Woman with Autism and Pica Behaviour
Authors: Iolanda Palimaru, Michaël Guetta, Cora Cravero, Clémence Fron, David Cohen, Marianna Giannitelli
Journal: Case Rep Psychiatry (2021)
MeSH terms: Case Reports

We are presenting the case of a 38-year-old woman with nonverbal autism and intellectual disability, hospitalized in a neurobehavioural unit because of a pica behaviour for 3 years. During the hospitalization, the patient presented an episode of pain, agitation, restlessness, rhabdomyolysis, coma, tachycardia, hyperthermia, shivering, and diarrhoea. The main hypothesis raised was tramadol overdose because of the immediate antidote response to the injection of naloxone 0,4 mg/mL. Even if we did not exceed the recommended prescription dosage of tramadol, the presence of gastric bezoar slowed the absorption of the drug, and the consequence was an opioid overdose and serotonin syndrome.
A Case Report of Cardiac Amyloidosis Highlighting the Importance of Strain Analysis
Authors: Andres Cordova Sanchez, Ryan Murphy, Suman Rao, Fidel Martinez, Stephanie Bryant, Debanik Chaudhuri
Journal: Case Rep Cardiol (2021)
MeSH terms: Case Reports

Cardiac involvement in light-chain (AL) amyloidosis has a high mortality. Once cardiac symptoms are present, it is important to make a diagnosis as there is an inverse relationship between mortality and time of diagnosis. Echocardiography is usually one of the first tests performed. But strain analysis, which can provide important clues, is not routinely performed. This is a case of AL amyloidosis presenting with heart failure in which echocardiographic strain analysis was vital for its diagnosis.
Chronic eosinophilic pneumonia after trastuzumab and radiation therapy for breast cancer: A case report
Authors: Fan Jin, Shao-Ting Wang
Journal: Medicine (Baltimore) (2019)
MeSH terms: Antineoplastic Agents, Immunological / adverse effects, Breast Neoplasms / drug therapy, Pulmonary Eosinophilia / chemically induced, Radiotherapy / adverse effects, Trastuzumab / adverse effects, Case Reports, Administration, Oral, Antineoplastic Agents, Immunological / therapeutic use, Breast Neoplasms / complications, Breast Neoplasms / radiotherapy, Chronic Disease, Female, Glucocorticoids / administration & dosage, Glucocorticoids / therapeutic use, Humans, Middle Aged, Prednisone / administration & dosage, Prednisone / therapeutic use, Pulmonary Eosinophilia / diagnostic imaging, Pulmonary Eosinophilia / drug therapy, Pulmonary Eosinophilia / pathology, Tomography, X-Ray Computed / methods, Trastuzumab / therapeutic use, Treatment Outcome, Antineoplastic Agents, Immunological, Glucocorticoids, Trastuzumab, Prednisone

Rationale:
Chronic eosinophilic pneumonia (CEP) is rare and an idiopathic disorder. The disease has been associated with drugs, infection, or irradiation, and its relationship with asthma remains unclear.
Patient concerns:
We reported a case of a 49-year-old female patient after trastuzumab and radiation therapy for breast cancer. Two months after radiation treatment, the patient complained of productive cough, progressive breathlessness, occasional wheezing, and left pectoralgia.
Diagnoses:
Computed tomography (CT) scan revealed infiltrates in lungs. Without evidence of infection, marked increased eosinophils in a transbronchial biopsy performed from the left upper lobe confirmed the diagnosis of CEP after trastuzumab and radiation therapy.
Interventions:
The patient was started with oral prednisone at 0.5 mg/kg/day.
Outcomes:
A CT scan of the chest obtained 2 weeks after steroid treatment showed diminishment of the lesions, and at the 6-month follow-up, the patient had no complaints of discomfort with no relapse of pulmonary lesions.
Lessons:
Physicians should consider CEP as a diagnosis in patients who have had previous exposure to trastuzumab and radiation therapy, especially with a history of asthma. Timely diagnosis and treatment may benefit these patients.
Complete Surgical Enucleation of a Giant Chylous Mesenteric Cyst
Authors: Maria Isaia, Maria Erodotou, Georgios Nakos, Nikolaos Nikolaou
Journal: Case Rep Surg (2020)
MeSH terms: Case Reports

Mesenteric cysts are rare benign abdominal tumors, and they can appear anywhere in the mesentery of the gastrointestinal tract, from the duodenum to the rectum. They are generally asymptomatic and may present as an incidental finding. The diagnosis is confirmed by the laparotomy findings and the results of the histopathological examination. Complete surgical (open or laparoscopic) enucleation of the cyst is the treatment of choice. We present a case of a female patient who presented with abdominal pain and a giant palpable abdominal mass. The patient underwent a surgical exploration which showed a giant mesenteric cyst. A complete surgical enucleation of the cyst was successfully performed without the need of bowel resection. The histopathological examination of the cyst was compatible with the diagnosis of chylous mesenteric cyst.
Periodontal probing of an impacted tooth recovered through a surgical-orthodontic approach: a case report
Authors: Maria Teresa Dinoi, Mariano Lacarbonara, Salvatore Dimartino, Annalisa Monaco, Giuseppe Marzo
Journal: J Med Case Rep (2014)

Introduction:
The aim of this work was to assess the periodontal support of a central upper incisor recovered through a surgical-orthodontic approach compared to the spontaneously erupted contralateral incisor.
Case presentation:
This case study describes an 8-year-old Caucasian female with an impacted upper right central incisor. Surgical-orthodontic treatment was performed to reset the impacted dental element in the arch. Periodontal probing was performed of all sites (mesio-buccal, central-buccal, disto-buccal, mesio-palatal, central-palatal and disto-palatal) of the recovered impacted tooth and the contralateral tooth. The results were compared to determine whether the treated element showed signs of periodontal injury.
Conclusions:
Most of the probing results on both her right and left incisors gave values of approximately 3mm, which were not considered pathological. Both dental elements had adequate and physiological osseous attachments.
Case Report: A Case of Pituitary Adenoma Producing Growth Hormone and Thyroid-Stimulating Hormone Simultaneously
Authors: Junpei Sanada, Fuminori Tatsumi, Shinji Kamei, Yoshiro Fushimi, Masashi Shimoda, Kenji Kohara, Shuhei Nakanishi, Kohei Kaku, Tomoatsu Mune, Hideaki Kaneto
Journal: Front Endocrinol (Lausanne) (2021)
Keywords: growth hormone, immunostaining, insulin-like hormone, pituitary adenoma, thyroid-stimulating hormone
MeSH terms: Human Growth Hormone / metabolism, Pituitary Neoplasms / metabolism, Thyrotropin / metabolism, Case Reports, Adult, Female, Humans, Insulin-Like Growth Factor I / metabolism, Pituitary Neoplasms / surgery, Human Growth Hormone, Insulin-Like Growth Factor I, Thyrotropin

Background:
Pituitary adenoma producing growth hormone (GH) or thyroid-stimulating hormone (TSH) is characterized by various specific symptoms and/or findings. However, the frequency of pituitary adenoma producing both hormones is relatively low. In this report, we show a case of pituitary adenoma producing both GH and TSH simultaneously.
Case presentation:
A 27-year-old woman was diagnosed as acromegaly based on various symptoms and clinical findings. For further examination and treatment, she was hospitalized in our institution. It was likely that this subject had pituitary adenoma producing both GH and TSH. In brain magnetic resonance imaging, there was a giant tumor around pituitary fossa. After the diagnosis of GH- and TSH-producing pituitary adenoma, pituitary tumor resection and cyber knife therapy were performed. In addition, we started additional treatment with somatostatin analog and GH receptor antagonist. After then, GH and insulin-like growth factor (IGF-1) levels were suppressed. After the operation, since thyroid function was not sufficiently suppressed, we started anti-thyroid drug thiamazole. After then, thyroid function was normalized and we stopped thiamazole. In GH and TSH staining, many GH-positive and TSH-positive cells were observed. These findings further confirmed our diagnosis that the pituitary adenoma in this subject produced both GH and TSH simultaneously.
Conclusions:
We should bear in mind the possibility of pituitary adenoma producing both GH and TSH at the same time.
Delayed recovery due to exaggerated acid, base and electrolyte imbalance in prolonged laparoscopic repair of diaphragmatic hernia
Authors: Rakesh Garg, Jyotsna Punj, Ravindra Pandey, Vanlal Darlong
Journal: Saudi J Anaesth (2011)
Keywords: hypocalcemia, hypokalemia, laparoscopic surgery, metabolic acidosis, tissue handling
MeSH terms: Case Reports

The acid, base and electrolyte changes are usually observed in the perioperative settings. We report a case of prolonged laparoscopic repair of left-sided diaphragmatic hernia which involved a lot of tissue handling and fluid replacement leading to acid, base and electrolyte imbalance. A 42-year-old male underwent prolonged laparoscopic repair under general anesthesia. Intraoperatively, surgeon reported that contents of hernia includes bowel along with mesentery, spleen and lot of fatty tissue The blood loss was about 2 L which was replaced with 1 L of colloid and 7.5 L of lactated ringer. Near the end of surgery arterial blood gas analysis revealed metabolic acidosis, hyperkalemia, and hypocalcemia leading to delayed recovery. We conclude prolonged laparoscopic surgery involving lot of tissue handling including gut and fat should be monitored for acid, base, electrolyte imbalance and corrected timely to have uneventful rapid recovery.
Three-step surgical treatment of aortoesophageal fistula after thoracic endovascular aortic repair: A case report
Authors: Atsushi Kamigaichi, Yoichi Hamai, Manabu Emi, Yuta Ibuki, Shinya Takahashi, Keijiro Katayama, Tomokuni Furukawa, Morihito Okada
Journal: Int J Surg Case Rep (2019)
Keywords: aneurysm, esophagus, fistula, stent-graft, thoracic endovascular aortic repair

Introduction:
Aortoesophageal fistula (AEF) is a fatal complication results in sudden massive hematemesis. Although thoracic endovascular aortic repair (TEVAR) is an established method of treating aortic aneurysms or aortic dissection, the number of AEF after TEVAR is recently increasing due to the spread of TEVAR. However, the therapeutic strategy for AEF remains controversial.
Presentation of case:
We describe a 71-year-old man with Stanford B aortic dissection and aortic aneurysm rupture treated by TEVAR who developed AEF between the thoracic aorta and upper thoracic esophagus 20 months thereafter. We applied a three-step surgical procedure for this patient comprising resection of the esophagus as the infectious source, removal of an aortic aneurysm with stent-graft and replacement of the aorta, and final reconstruction of the esophagus. Thereafter, the patient resumed oral intake and has remained relapse-free for 24 months without adverse events.
Discussion:
Previous reports have described simultaneous resection of the esophagus and aortic stent-graft via a left thoracotomy followed by a two-step surgical reconstruction of the esophagus. We applied a three-step procedure consisting of resections of the esophagus and aortic stent-graft on separate occasions followed by esophageal reconstruction in this patient. The first procedure in the three-step approach is less stressful than that of the two-step approach.
Conclusion:
The three-step surgical approach to treating AEF after TEVAR resulted in a good outcome for this patient. Thus, this surgical strategy is a useful option for treating AEF after TEVAR.
Euglycemic Ketoacidosis in Spinal Muscular Atrophy
Authors: Dimitrios Stoimenis, Christina Spyridonidou, Sofia Theofanidou, Nikolaos Petridis, Nikos Papaioannou, Christina Iasonidou, Nikolaos Kapravelos
Journal: Case Rep Pediatr (2019)
MeSH terms: Case Reports

Euglycemic ketoacidosis is defined by the triad of high anion gap acidosis, increased plasma ketones, and the absence of hyperglycemia. Apart from diabetes mellitus, the disorder may occur in prolonged fasting, excessive alcohol consumption, pregnancy, and inborn errors of metabolism. Here, we highlight the diagnosis of euglycemic ketoacidosis in a pediatric nondiabetic patient with spinal muscular atrophy (SMA) type 1 (Werdnig-Hoffmann disease), who, subsequently to her postoperative admission to the intensive care unit following a spinal surgery, developed high anion gap metabolic acidosis. We discuss the pathophysiology of acid-base disorders in SMA, along with the glucose and fatty acids metabolism, the necessary knowledge for medical practitioners.
Pneumothorax and Pneumomediastinum Secondary to COVID-19 Disease Unrelated to Mechanical Ventilation
Authors: Lara Tucker, Sachin Patel, Catherine Vatsis, Antonia Poma, Ali Ammar, Wael Nasser, Satyanarayana Mukkera, Mai Vo, Rumi Khan, Steve Carlan
Journal: Case Rep Crit Care (2020)
MeSH terms: Case Reports

In the recent worldwide coronavirus 2019 pandemic, a notable rise in pneumomediastinum and pneumothorax complications has been witnessed in numerous mechanically ventilated patients infected with severe acute respiratory syndrome coronavirus 2. Most cases have reported these complications as barotrauma from mechanical ventilation with COVID-19 disease. We aim to report three polymerase chain reaction-confirmed COVID-19 patients who developed pneumomediastinum and pneumothorax unrelated to mechanical ventilation. We originally analyzed 800 patients with COVID-19 disease at Orlando Regional Medical Center from March 1, 2020, to July 31, 2020, of which 12 patients developed pneumomediastinum and pneumothorax in their hospital course. Interestingly, three patients developed pneumomediastinum on chest imaging prior to intubation. We present these three patients, one female and two males, ages of 42, 64, and 65, respectively, who were diagnosed with COVID-19 disease through nasopharyngeal sampling tests with acute respiratory distress syndrome. Spontaneous pneumomediastinum and pneumothorax are potential complications of COVID-19 disease in the lungs unrelated to mechanical ventilation. This is similar to previous outbreaks of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) diseases. Further investigation is needed to define the causality of pneumomediastinum in nonintubated COVID-19 patients to define the incidence of disease.