OpenMed/multicare-articles huggingface dataset:
Contribution of Ultra Deep Sequencing in the Clinical Diagnosis of a New Fungal Pathogen Species: Basidiobolus meristosporus
Authors: Emilie Sitterlé, Christophe Rodriguez, Roman Mounier, Julien Calderaro, Françoise Foulet, Michel Develoux, Jean-Michel Pawlotsky, Françoise Botterel
Journal: Front Microbiol (2017)
Keywords: basidiobolus meristosporus, its amplicons, ultra-deep sequencing, fungal infection, gastro-intestinal basidiobolomycosis
MeSH terms: Case Reports

Some cases of fungal infection remained undiagnosed, especially when the pathogens are uncommon, require specific conditions for in vitro growth, or when several microbial species are present in the specimen. Ultra-Deep Sequencing (UDS) could be considered as a precise tool in the identification of involved pathogens in order to upgrade patient treatment. In this study, we report the implementation of UDS technology in medical laboratory during the follow-up of an atypical fungal infection case. Thanks to UDS technology, we document the first case of gastro-intestinal basidiobolomycosis (GIB) due to Basidiobolus meristosporus. The diagnosis was suspected after histopathological examination but conventional microbiological methods failed to supply proof. The final diagnosis was made by means of an original approach based on UDS. DNA was extracted from the embedded colon biopsy obtained after hemicolectomy, and a fragment encompassing the internal transcribed spacer (ITS) rDNA region was PCR-amplified. An Amplicon library was then prepared using Genome Sequencer Junior Titanium Kits (Roche/454 Life Sciences) and the library was pyrosequenced on a GS Junior (Roche/454 Life Sciences). Using this method, 2,247 sequences with more than 100 bases were generated and used for UDS analysis. B. meristosporus represented 80% of the sequences, with an average homology of 98.8%. A phylogenetic tree with Basidiobolus reference sequences confirmed the presence of B. meristosporus (bootstrap value of 99%). Conclusion : UDS-based diagnostic approaches are ready to integrate conventional diagnostic testing to improve documentation of infectious disease and the therapeutic management of patients.
Urticarial vasculitis induced by OTC diet pills: a case report
Authors: Iván Chérrez Ojeda, Enrique Loayza, Leonardo Greiding, Juan Carlos Calderón, Annia Cherrez, Farid Adum
Journal: World Allergy Organ J (2015)
Keywords: otc diet pills, urticarial vasculitis, weight loss
MeSH terms: Case Reports

Background:
Urticarial Vasculitis (UV) is in most of the cases idiopathic; however it has been associated with several conditions and drugs. Over the counter (OTC) diet pills are widely available, even on-line, but they are rarely regulated by pharmaceutical control.
Case presentation:
We present the case of a 35-year-old female patient suffering of pruriginous and painful wheals more than 1 cm in diameter, with a burning sensation. The eruption lasted more than 24 hours and was accompanied by angioedema, headache and myalgia. No remarkable medical history was found, except for previous intake of OTC diet pills. UV diagnosis was confirmed by the skin biopsy of a lesion.
Conclusion:
OTC diet pills are widely available worldwide, and due to its widespread use, allergologists and dermatologist should be able to recognize symptoms and lesions of cutaneous vasculitis, which may be under reported.
Advanced metastatic pancreatic neuroendocrine tumor treated successfully with peptide receptor radionuclide therapy: a case report
Authors: Amit Kumar, Shweta Tanwar, Sudhish Gupta, Rajesh Chetiwal, Rohit Kumar
Journal: Explor Target Antitumor Ther (2022)
Keywords: neoplasm metastasis, neuroendocrine tumors, pancreas, peptide receptor radionuclide therapy
MeSH terms: Case Reports

Neuroendocrine tumor (NET) is a rare tumor that has been observed in different sites such as lungs and throughout the gastrointestinal tract. Clinical features are usually non-specific and vary considerably depending upon the location of the tumor. Symptoms are similar to those of common conditions such as peptic ulcer disease, gastritis, irritable bowel syndrome, asthma, etc. Thus, an initial diagnosis of a NET usually occurs at an advanced stage. This report describes a case of pancreatic NET (PNET, grade 2) with liver metastasis in a 37-year-old male which was found to be inoperable due to extensive direct involvement of the proximal jejunal branches and superior mesenteric vein. Peptide receptor radionuclide therapy (PRRT) with lutetium-177 dotatate (177Lu-DOTATATE) was administered due to the inoperability of primary PNET. Complete resolution of symptoms occurred with three cycles of PRRT.
Choroidal metastasis as a presenting feature in a metastatic lung carcinoma
Authors: Mukesh Jain, Deepika C Parameswarappa
Journal: GMS Ophthalmol Cases (2022)
Keywords: choroidal metastasis, lung carcinoma, multi-modal imaging
MeSH terms: Case Reports

We report a case of a 65-year-old female who presented to us with diminution of vision in the right eye. She was only able to perceive light in the right eye, and the left eye had a vision of 20/20, N6. Anterior segment examination in both eyes was unremarkable except for senile cataract in the left eye. Posterior segment examination revealed features of choroidal metastasis in both eyes and exudative retinal detachment in the right eye. Multimodal imaging helped in the further confirmation of metastatic lesions. Right-eye fundus autofluorescence showed hyperautofluorescent lesions, ultrasound B-scan showed an elevated mass lesion in the choroid with moderate to high internal echogenicity, and optical coherence tomography showed a lumpy-bumpy appearance of the retinal pigment epithelium as well as an elevated choroidal mass lesion beneath it. On detailed systemic evaluation, the primary site of cancer was found to be the lungs. The patient was referred to a pulmonologist and an oncologist for chemotherapy and further management.
Cutaneous larva migrans: a case report
Authors: Sergio Vano-Galvan, Manuel Gil-Mosquera, Mayte Truchuelo, Pedro Jaén
Journal: Cases J (2009)

Background:
Cutaneous larva migrans may be diagnosed by the typical clinical presentation, consisting on a pruritic serpiginous lesion that advances in a patient with a history of sunbathing, walking barefoot on the beach, or similar activity in a tropical location.
Case presentation:
We describe the case of a Mediterranean 32-year-old man, recently returned from a trip to a Brazilian beach, which presented with a 2-week history of pruritic cutaneous lesions that had not resolved after treatment with oral antihistamines and topical fluocinolone ointment. Physical examination showed a serpiginous, erythematous and slightly elevated lesion of 2-mm wide and 7-cm long located on the posterior aspect of his left knee. Patient affirmed that the lesion advanced progressively. Laboratory analyses only revealed an elevated absolute eosinophil count. Albendazole 400 mg/d 3 days was administered to the patient with complete resolution of symptoms within 1 week.
Conclusion:
Cutaneous larva migrans is common among travelers returning from tropical countries. We review epidemiology, clinical, diagnosis and therapeutic options of cutaneous larva migrans.
Coronary Atherosclerosis and Aortic Valve Disease as Long-Term Sequelae of Radiation Therapy in Childhood
Authors: Majken van den Handel Vestergaard, Ann Bovin, Erik Lerkevang Grove
Journal: Case Rep Cardiol (2021)
MeSH terms: Case Reports

Coronary atherosclerosis and valvular heart disease are rare, but potentially severe sequelae following mediastinal radiation therapy. We present a case of premature ischemic heart disease and severe aortic stenosis in a 40-year-old woman following radiation therapy in childhood. We stress the awareness of prior mediastinal radiation therapy as an important risk factor for premature coronary atherosclerosis and valvular heart disease, particularly in younger patients without classical risk factors for coronary artery disease.
Severe obstructive colitis treated with repeated colonoscopic decompression
Authors: Junya Arai, Nobumi Suzuki, Yoku Hayakawa, Hiroyuki Matzuzaki, Yuichiro Yokoyama, Tomonori Aoki, Rei Ishibashi, Nariaki Odawara, Sozaburo Ihara, Yosuke Tsuji, Soichiro Ishihara, Mitsuhiro Fujishiro
Journal: DEN Open (2023)
Keywords: black colon, bowel irrigation solution, colonoscopic decompression, diverticulosis, obstructive colitis
MeSH terms: Case Reports

Obstructive colitis is an acute condition caused by colorectal strictures and requires a combination of therapeutic strategies, including surgery, endoscopic interventions, and medications. Here, we describe the case of a 69-year-old man who developed severe obstructive colitis owing to diverticular stenosis of the sigmoid colon. We immediately performed endoscopic decompression to avoid perforation. The mucosa of the dilated colon appeared black, suggesting severe ischemia. We considered surgical total colectomy owing to the extensive colitis. However, considering the invasiveness of the emergent surgery, we adopted a conservative approach as enhanced computed tomography demonstrated colonic dilation with maintained blood flow in the deeper layer of the colonic wall and no signs of colonic necrosis, such as peritoneal irritation sign or elevation of deviation enzymes, were observed. Moreover, the patient preferred a conservative approach, and surgeons in our team agreed with this conservative approach. While relapses of colonic dilation occurred several times, antibiotic treatment and repeated endoscopic decompression successfully suppressed the dilation and systemic inflammation. The colonic mucosa healed gradually, and we performed a colostomy without resecting a large portion of the colorectum. In conclusion, severe obstructive colitis with maintained blood flow can be treated with endoscopic decompression instead of emergent resection for a wide portion of the colorectum. Moreover, endoscopic images of improved colitic mucosa obtained through repeated colorectal procedures are rare and noteworthy.
Ruptured ectopic pregnancy in caesarean section scar: a case report
Authors: Kamal Singh, Anjali Soni, Shelly Rana
Journal: Case Rep Obstet Gynecol (2012)

Pregnancy implantation within previous caesarean scar is one of the rarest locations for an ectopic pregnancy. Incidence of caesarean section is increasing worldwide and with more liberal use of transvaginal sonography, more cases of caesarean scar pregnancy are being diagnosed in early pregnancy thus allowing preservation of uterus and fertility. However, a delay in either diagnosis or treatment can lead to uterine rupture, hysterectomy, and significant maternal morbidity. We are reporting a rare case of first trimester caesarean scar pregnancy with viable fetus in the process of rupture, where uterine repair could be done, thus preserving the future fertility.
Central Pulmonary Embolism Detected on a Chest X-Ray: A Case Report
Authors: Thomas Saliba, Denis Tack
Journal: J Belg Soc Radiol (2023)
Keywords: fleischner’s sign, westermark sign, chest x-ray, knuckle sign, pulmonary embolism
MeSH terms: Case Reports

Patients presenting to the emergency room with respiratory symptoms often receive a chest X-ray as part of the initial workup to exclude common pathologies. A 60-year-old patient presented to the emergency department with dyspnoea. An initial chest X-ray revealed the Fleischner's sign, the knuckle sign, and the Westermark sign, specific but not sensitive for central pulmonary embolism, prompting a follow-up angio CT to confirm the diagnosis. The patient was treated and discharged a few days later.
Teaching point:
Chest X-rays, done as part of an initial workup, can show signs of pathologies that are not yet clinically suspected, such as pulmonary embolism.
Mandibular Canines with Two Roots and Two Root Canals: Case Report and Literature Review
Authors: Hugo Plascencia, Álvaro Cruz, Gerardo Gascón, Beatriz Ramírez, Mariana Díaz
Journal: Case Rep Dent (2017)
MeSH terms: Case Reports

Usually, the mandibular canine only has one root and one root canal. However, there has been a noticeable increment in evidence showing variations in its morphology, such as the presence of two roots and two root canals. The aim of this article was to present a case of a mandibular canine with two roots and two root canals and to review the available literature on this anatomic variation. Root canal treatment of tooth #43 with such morphology was performed in a 47-year-old woman. Careful inspection of the preoperative radiograph indicated the presence of more than one canal. The 12-month follow-up showed normal periapical tissues, with no pain or tenderness. Literature review revealed that the overall prevalence of such root canal configuration is 5.7%, with a strong preference for female sex (87.5%). Although mandibular canines with two roots and two root canals are not common, clinicians should always anticipate the presence of possible variations. Therefore, timely diagnosis and meticulous exploration of such mandibular canines allow for planning of an individualized treatment protocol, tailored to their peculiar morphology, focused on avoiding excessive weakening or even perforation of the roots.
Acute severe autoimmune hepatitis with anti-rods and rings autoantibodies; literature first evidence
Authors: Roberto Assandri, Alessandro Montanelli
Journal: Gastroenterol Hepatol Bed Bench (2021)
Keywords: autoimmun hepatitis, autoimmun liver disease, rods and rings antibodies
MeSH terms: Case Reports

Autoimmune hepatitis (AIH) was defined as a progressive, chronic inflammatory autoimmune liver disease (ALD). The diagnosis of AIH requires the presence of characteristic clinical and laboratory features, and the exclusion of other clinical conditions that cause chronic hepatitis and cirrhosis. AIH can have an acute onset that mimics an acute viral or toxic hepatitis or an acute severe (fulminant, ASF) presentation that satisfies criteria for acute liver. Guidelines from the European Association for the Study of Liver Diseases define ALF with absence of pre-existing liver disease, acute onset of ≤ 26 weeks, coagulopathy (international normalised ratio (INR) ≥ 1.5), and presence of hepatic encephalopathy (HE). In recent years, autoantibodies (Aab) targeting subcellular structures described as the rods and rings (R&R) pattern in HEp-2 ANA have been presented as a unique and particular case of Aab generation. These R&R structures are composed of inosine monophosphate dehydrogenase type 2 (IMPDH2), and their formation can be induced in vitro by several small-molecule inhibitors. Aab targeting these relatively unknown structures has been observed in Hepatitis C virus (HCV) patients who have undergone treatment with pegylated interferona/ ribavirin (IFN/RBV) therapy. We presented and characterized a case patient with R&R and SMA Aab in AIH (ASF, fatal, without liver transplantation). To the best of our knowledge, this is the first evidence described in the Literature. Our early experience showed the R&R circulating Aab in one patient with Primary Biliary Cholangitis. This work now demonstrates that R&R Aab can also be present in AIH case.
Frontotemporal dementia and amyotrophic lateral sclerosis: revisiting one of the first case reports with neuropathology examination
Authors: Ricardo Nitrini
Journal: Dement Neuropsychol (2014)
Keywords: amyotrophic lateral sclerosis, dementia, frontotemporal dementia, motor neuron disease, neuropathology
MeSH terms: Case Reports

The occurrence of dementia in amyotrophic lateral sclerosis (ALS) was only widely recognized in the late 20th century. Hitherto, it was believed that dementia was a rare event due to the fortuitous association with other diseases. In 1924, Kostantin Nikolaevich Tretiakoff and Moacyr de Freitas Amorim reported a case of dementia with features of frontotemporal dementia (FTD) that preceded the motor signs of ALS. Neuropathological examination confirmed ALS and found no signs of other dementia-causing diseases. The authors hypothesized that dementia was part of ALS and recommended the search for signs of involvement of motor neurons in cases of dementia with an ill-defined clinical picture, a practice currently accepted in the investigation of cases of FTD. This was one of the first descriptions of dementia preceding the motor impairments of ALS and was published in Portuguese and French in Memórias do Hospício de Juquery.
A Case of Lenvatinib-Induced Focal Segmental Glomerulosclerosis (FSGS) in Metastatic Medullary Thyroid Cancer
Authors: Kathryn Fleming, James McGuinness, David Kipgen, Hilary Glen, Pavlina Spiliopoulou
Journal: Case Rep Oncol Med (2018)
MeSH terms: Case Reports

We describe a case of lenvatinib (E7080) associated focal segmental glomerulosclerosis (FSGS) encountered during the treatment of metastatic medullary thyroid cancer. Proteinuria is a relatively common side effect of VEGF-targeted treatments and can occasionally result in treatment discontinuation. Here, we describe a patient who developed secondary FSGS necessitating discontinuation of treatment at first but who was subsequently rechallenged with anti-VEGF-targeted treatment without recurrence of proteinuria. Lenvatinib was a novel experimental agent at the time the treatment took place; however, its recent licensing for the treatment of thyroid malignancies in the UK makes reporting of these adverse effects all the more important now.
Case report: Acute vestibular syndrome and cerebellitis in anti-Yo paraneoplastic syndrome
Authors: Bassil Kherallah, Elias Samaha, Sarah E Bach, Cindy Guede, Jorge C Kattah
Journal: Front Neurol (2022)
Keywords: pca-1, acute vestibular syndrome (avs), anti-yo, cerebellitis, paraneoplastic syndrome
MeSH terms: Case Reports

Background:
We define acute vestibular syndrome (AVS) as a sudden onset vertigo, nausea, vomiting, and head motion intolerance, more frequently associated with an acute peripheral and unilateral vestibulopathy. About 10-20% of all cases with central vestibulopathy are secondary to stroke. We report three patients evaluated over the past decade with an acute AVS along with subtle downbeat nystagmus (DBN), followed by dysarthria and progressive truncal and limb ataxia, as well as increasing DBN intensity.
Methods:
All patients underwent neurologic examination, video-oculography, MRI, serum cancer markers, spinal fluid examination, paraneoplastic panel testing, and oncologic workup. With a consolidated diagnosis of cancer/paraneoplastic syndrome, we treated with plasma exchange (PLEX), high-dose steroids, surgery, and oncologic investigation. We additionally provided oncotherapy in one out of three patients.
Results:
All three patients had an acute AVS, downbeat nystagmus DBN, and inability to perform tandem gait. Two of three patients had a normal head impulse test (HIT). As acute vertigo, nausea, and vomiting subsided, a progressive cerebellar syndrome ensued characterized by persistent DBN, impaired horizontal and vertical pursuit, impaired VOR suppression, truncal and limb ataxia, and dysarthria. All patients had normal MRI brain studies excluding stroke. CSF studies demonstrated lymphocytic pleocytosis and elevated protein. One patient had confirmed ovarian cancer with high CA-125 serum levels; another had undifferentiated cancer of unknown primary with high CA-125 and one patient with esophageal cancer. All had a positive PCA-1 antibody titer, also known as anti-Yo antibody. In one patient with expeditious immunosuppression, the ataxia progression slowed for 18 months, whereas the other two patients with delayed initiation of treatment had more rapidly progressive ataxia.
Discussion:
Paraneoplastic encephalitis related to PCA-1 antibody (Anti-Yo) targets Purkinje cells and cells in the granular layer of the cerebellar cortex. Clinically, our patients had a central AVS characterized by DBN and followed with progressive ataxia and unremarkable neuroimaging studies. Rapid initiation of treatment may offer a greater chance to prevent further neurologic decline. Any patient with an AVS as well as DBN and normal MRI should have an expeditious workup to rule out metabolic, toxic, and infectious causes just prior to considering prompt treatment with high-dose steroids and plasma exchange (PLEX) to mitigate the risk of rapidly progressive and irreversible neurologic decline.
Acute Appendicitis Masquerading Distal Intestinal Obstruction Syndrome in Adult Cystic Fibrosis
Authors: Sushant M Nanavati, Hiren Patel, Gabriel Melki, Vinod Kumar, Edward Milman, Patrick Michael, Ariy Volfson
Journal: Case Rep Gastrointest Med (2018)
MeSH terms: Case Reports

Overshadowed by Sino-pulmonary infections, Cystic Fibrosis (CF) commonly affects gastrointestinal organs because of secretory and motility dysfunction. Infrequently, these changes result in Distal Intestinal Obstruction Syndrome (DIOS), an increasingly diagnosed gastrointestinal entity in adult Cystic Fibrosis patients. We present a case 22-year-old male who presented to our hospital with right lower quadrant abdominal pain with suspicion of acute appendicitis and was subsequently diagnosed as DIOS. Our case highlights the importance of DIOS as one of the differential diagnosis of right lower quadrant abdominal pain in a patient with a CF, especially for physicians working at community hospitals which may not have a Cystic Fibrosis care program available.
An Unusual Case of Perineural Infiltration and Orbital Invasion of Squamous Cell Carcinoma Associated with Actinic Keratosis
Authors: Edgard Farah, Marie Callet, Augustin Leclerc, Tryfon Rotsos, Chrysanthos Symeonidis, Pierre-Vincent Jacomet, Olivier Galatoire
Journal: Case Rep Ophthalmol Med (2020)
MeSH terms: Case Reports

Actinic keratosis is considered a precancerous lesion, constituting a precursor to squamous cell carcinoma (SCC) formation. Perineural invasion has been observed in patients with cutaneous carcinoma due to local subcutaneous tissue destruction and primarily involves the trigeminal nerve due to rich innervation provided by the supraorbital nerve in addition to the facial nerve. An unusual case of perineural infiltration and orbital invasion of squamous cell carcinoma associated with actinic keratosis is presented. A 70-year-old Caucasian woman presented with complete left eye ophthalmoplegia, total left upper-eyelid ptosis, and facial pain with paresthesia. Computed tomography revealed a process of the soft tissues in the left cheek infiltrating the infraorbital canal, pterygopalatine fossa, inferior orbital fissure, and left cavernous sinus with periosteal adherence. Magnetic resonance imaging revealed pathological extension via the left infraorbital canal with a considerable area of necrosis. Treatment of facial actinic keratosis may not prevent malignant transformation and can delay diagnosis and treatment of SCC. A deep biopsy appears to be essential for a correct diagnosis. Perineural spread of cutaneous SCC may be characterized by insidious progression in the cranial trigeminal nerve, abnormal ocular motility, diplopia, or external ophthalmoplegia.
Urethral diverticulum calculi in a male: a case report
Authors: Emil Gadimaliyev
Journal: Case Rep Urol (2013)

A 42-year-old male presented to the urology department, complaining of frequency and dysuria. A large number of calculi were revealed on IVU and USS. On endoscopic investigation, there were 3 stones (1.5 × 1 cm) found in the bladder and 5 more (1.5 × 0.8 cm) in the diverticulum of the posterior urethra. All of the stones were successfully broken down via a transurethral approach. This paper contains a detailed description of the case.