OpenMed/multicare-articles huggingface dataset:
Itch and skin rash from chocolate during fluoxetine and sertraline treatment: case report
Authors: Jonas Cederberg, Stefan Knight, Svante Svenson, Håkan Melhus
Journal: BMC Psychiatry (2004)
MeSH terms: Cacao / adverse effects, Depressive Disorder / drug therapy, Exanthema / etiology, Fluoxetine / adverse effects, Pruritus / etiology, Selective Serotonin Reuptake Inhibitors / adverse effects, Sertraline / adverse effects, Case Reports, Exanthema / chemically induced, Exanthema / physiopathology, Fluoxetine / therapeutic use, Humans, Male, Middle Aged, Pruritus / chemically induced, Pruritus / physiopathology, Selective Serotonin Reuptake Inhibitors / therapeutic use, Serotonin / physiology, Sertraline / therapeutic use, Serotonin Uptake Inhibitors, Fluoxetine, Serotonin, Sertraline

Background:
The skin contains a system for producing serotonin as well as serotonin receptors. Serotonin can also cause pruritus when injected into the skin. SSRI-drugs increase serotonin concentrations and are known to have pruritus and other dermal side effects.
Case presentation:
A 46-year-old man consulted his doctor due to symptoms of depression. He did not suffer from any allergy but drinking red wine caused vasomotor rhinitis. Antidepressive treatment with fluoxetine 20 mg daily was initiated which was successful. After three weeks of treatment an itching rash appeared. An adverse drug reaction (ADR) induced by fluoxetine was suspected and fluoxetine treatment was discontinued. The symptoms disappeared with clemastine and betametasone treatment. Since the depressive symptoms returned sertraline medication was initiated. After approximately two weeks of sertraline treatment he noted an intense itching sensation in his scalp after eating a piece of chocolate cake. The itch spread to the arms, abdomen and legs and the patient treated himself with clemastine and the itch disappeared. He now realised that he had eaten a chocolate cake before this episode and remembered that before the first episode he had had a chocolate mousse dessert. He had never had any reaction from eating chocolate before and therefore reported this observation to his doctor.
Conclusions:
This case report suggests that there may be individuals that are very sensitive to increases in serotonin concentrations. Dermal side reactions to SSRI-drugs in these patients may be due to high activity in the serotonergic system at the dermal and epidermo-dermal junctional area rather than a hypersensitivity to the drug molecule itself.
Successful excision of a retrorectal cyst through trans-sacral approach: A case report
Authors: Tlal Matouq Alsofyani, Mohammed Yousef Aldossary, Faisal Fahd AlQahtani, Khalid Sabr, Ameera Balhareth
Journal: Int J Surg Case Rep (2020)
Keywords: posterior trans-sacral resection, retrorectal cyst, tailgut cyst
MeSH terms: Case Reports

Introduction:
Retrorectal cysts are rare congenital cystic lesions usually diagnosed in middle-aged women. They are generally asymptomatic; however, local pressure may result in complications. Pain or discomfort in the pelvic, sacral, lower back or perianal area are the most common symptoms. The diagnosis is difficult, and multidisciplinary management is required. An epidermoid cyst is the most common type. Surgical resection is the main treatment, and 3 operative approaches are commonly used: abdominal, trans-sacral, and combined abdominosacral. The selection of the approach depends on the nature and location of the lesion. Here, we present a case that demonstrates the trans-sacral approach to a retrorectal cyst is a feasible option in terms of safety and minimal invasiveness for selected patients with this rare type of retrorectal cystic lesion.
Presentation of case:
A 38-year-old woman with no comorbidities incidentally showed a retrorectal cyst on magnetic resonance imaging performed during pregnancy. The patient underwent surgical resection under general anesthesia, trans-sacral incision was performed, the posterior rectum exposed, and the cyst removed. No complications were seen in the postoperative period.
Discussion:
Posterior trans-sacral resection (Kraske) is preferred for patients with posterior retrorectal cyst because it provides adequate exposure.
Conclusion:
Posterior trans-sacral resection allows proximal extension for elimination of the infection and in cases of adherence of the cyst to surrounding structures or in malignancy, which require en bloc resection.
Case Report: An unusual case of small bowel volvulus due to appendicitis associated with pneumatosis intestinalis: Review of the literature
Authors: Alia Zouaghi, Dhafer Hadded, Mesbahi Meryam, Yazid Benzarti, Mona Cherif, Haithem Zaafouri, Khalil Ben Massoud, Chiraz Chamekhi, Anis Ben Maamer
Journal: F1000Res (2021)
Keywords: pneumatosis cystoid intestinalis, acute abdomen, case report, small bowel volvulus
MeSH terms: Pneumatosis Cystoides Intestinalis / complications, Pneumatosis Cystoides Intestinalis / surgery, Review, Case Reports, Humans, Ileum, Middle Aged, Tomography, X-Ray Computed / adverse effects

Pneumatosis cystoid intestinalis is a rare disease reported in the literature affecting 0.03% of the population. It has a variety of causes and its manifestation may change widely. It usually presents as a marginal finding resulting from various gastrointestinal pathologies. In the acute complicated form of pneumatosis intestinalis, management is challenging for physicians and surgeons. We present a case of a 60-year-old patient who was admitted to our surgical department with a symptomatology suggestive of small bowel occlusion. Computed tomography demonstrated ileal volvulus associated with parietal signs suffering and pneumoperitoneum. An emergent exploratory laparoscopy followed by conversion was performed demonstrating segmental ileal pneumatosis intestinalis secondary to a small bowel volvulus due to an inflammatory appendix wrapping around the distal ileum. Further, detorsion, retrograde draining, and appendectomy were performed because there were no signs of necrosis and the appendix was pathological. The postoperative course was uneventful. This case is exceedingly rare in the literature, because it was featured by the ileal volvulus due to appendicitis.This case report emphasizes the importance of surgical procedures in the management of symptomatic pneumatosis intestinalis associated to an acute abdomen.
A young male with shortness of breath
Authors: Fahmi Yousef Khan, Ahmed Al Ani, Mustafa S Allaithy, Issam A Al-Bozom
Journal: Ann Thorac Med (2008)
Keywords: extragonadal seminoma, mediastinal seminoma
MeSH terms: Case Reports

We report a case of primary mediastinal seminoma, which presented initially with shortness of breath and a swelling in upper part of anterior chest wall. The diagnosis of primary mediastinal seminoma was established on the basis of histologic findings and was confirmed by immunohistochemical analysis. Abdominal, pelvis and cerebral CT scan, testicular ultrasound and TC-99 MDP bone scintigraphy were negative. Chemotherapy was initiated with B.E.P. protocol (Bleomycin, Etoposide, Cisplatinum); the patient received four cycles of chemotherapy. After 8 months, the patient was seen in the clinic; he was well.
Diagnostic and therapeutic dilemma in Stevens-Johnson syndrome-like acute graft-versus-host disease after liver transplantation: A case report
Authors: Yi-Teng Hung, Yau-Ren Chang, Hsuan-Ning Wang, Wei-Chen Lee, Chen-Fang Lee, Chun-Bing Chen
Journal: Front Immunol (2022)
Keywords: stevens-johnson syndrome, anti-tnf-α, graft-versus-host disease, immunomodulant, liver transplantation, target therapy
MeSH terms: Graft vs Host Disease / diagnosis, Graft vs Host Disease / drug therapy, Graft vs Host Disease / etiology, Liver Transplantation / adverse effects, Pancytopenia, Sepsis / complications, Stevens-Johnson Syndrome / diagnosis, Stevens-Johnson Syndrome / etiology, Stevens-Johnson Syndrome / therapy, Case Reports, Adrenal Cortex Hormones / therapeutic use, Humans, Immunosuppressive Agents / adverse effects, Male, Middle Aged, Tacrolimus, Tumor Necrosis Factor Inhibitors, Tumor Necrosis Factor-alpha / therapeutic use, Adrenal Cortex Hormones, Immunosuppressive Agents, Tumor Necrosis Factor Inhibitors, Tumor Necrosis Factor-alpha, Tacrolimus

Background:
Acute graft-versus-host disease (aGVHD) is a severe and fatal complication after orthotopic liver transplantation (OLT). Clinical manifestations of severe aGVHD can resemble drug-induced Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN), and there are also various medications, such as antibiotics and immunosuppressants, used after transplantation, causing a diagnostic dilemma. Furthermore, there have been no standardized diagnostic and therapeutic strategies for OLT-aGVHD due to its rarity.
Case summary:
A 52-year-old man presented with generalized maculopapular eruptions, fever, and pancytopenia 1 month after OLT and 4 days after taking sulfamethoxazole/trimethoprim. After assessment of the scoring criteria for drug causality of drug allergy, histopathological findings of skin biopsy, lymphocyte activation test of the potential offending drug, and microchimerism study, the diagnosis was in favor of aGVHD mimicking SJS/TEN. Considering severe sepsis, the anti-tumor necrosis factor alpha (TNF-α) agent, etanercept, was used to replace tacrolimus and corticosteroid. Skin lesions resolved gradually after anti-TNF-α biologics rescue; tacrolimus and corticosteroid therapy were re-administrated after controlling sepsis. Pancytopenia recovered and the patient was discharged in a stable condition.
Conclusion:
We demonstrated a diagnostic strategy for OLT-aGVHD. Targeting therapy with anti-TNF-α blockade and a temporary withdrawal of traditional immunosuppressants may be among effective and safe therapeutic options of OLT-aGVHD for those with severe sepsis.
COVID-19 and fortuitous discovery of chronic lymphocytic leukemia: biological findings and therapeutic challenges
Authors: Boubaker Charra, Ayman Ellouadghiri, Abdellah Magramane, Touda Kebbou, Kenza Damaan, Abdeljabbar Maghfour, Kamal Seddiki, Hanane Ezzouine
Journal: Pan Afr Med J (2020)
Keywords: cll, covid-19, sars-cov-2, diagnosis, therapy
MeSH terms: Betacoronavirus, Coronavirus Infections / diagnosis, Leukemia, Lymphocytic, Chronic, B-Cell / diagnosis, Pneumonia, Viral / diagnosis, Case Reports, Aged, COVID-19, Coronavirus Infections / blood, Coronavirus Infections / complications, Fatal Outcome, Humans, Incidental Findings, Male, Pandemics, Pneumonia, Viral / blood, Pneumonia, Viral / complications, SARS-CoV-2, Symptom Assessment

With the major spread of SARS-COV-2 around the world, its association with various pathologies has been reported. However, hemopathy has rarely been revealed during a coronavirus infection. The authors of this article aim to emphasize the diagnostic and therapeutic challenges faced while treating COVID/hemopathy patients.
Synchronous Presence of Nasopharyngeal Carcinoma and Marginal Zone (MALT-Type) B-Cell Lymphoma in the Pharynx
Authors: Triantafyllia Koletsa, Georgios Petrakis, Georgia Karayannopoulou, Dimitrios Pappas, Konstantinos Markou, Georgios Karkavelas, Ioannis Kostopoulos
Journal: Patholog Res Int (2011)
MeSH terms: Case Reports

Synchronous malignancy of squamous cell carcinoma and malignant lymphoma in the head and neck region is extremely rare. Nasopharyngeal carcinoma is a nonlymphomatous, squamous cell carcinoma that occurs in the nasopharyngeal epithelium. Reported herein is a unique case of nasopharyngeal carcinoma occurring simultaneously with MALT-type lymphoma in an 83-year-old woman, who complained of deglutition dysfunction. Endoscopic examination of respective organs revealed a submucosal tumour on the posterior wall of pharynx. Biopsy of the hypopharynx was taken and sent for histological examination, which revealed two different neoplasms. Immunohistochemical and molecular analysis confirmed the diagnosis of nasopharyngeal carcinoma coexisting with a MALT-type lymphoma.
Tracheobronchomegaly (Mounier-Kuhn syndrome) and Bronchiectasis as rare manifestations of Homocystinuria
Authors: Aasir M Suliman, Mohamed A Alamin, Maha M Hamza
Journal: Respir Med Case Rep (2023)
Keywords: bronchiectasis, fibrillin degeneration, homocystinuria, mounier-kuhn syndrome, tracheobronchomegaly
MeSH terms: Case Reports

Homocystinuria (HCU) is a rare autosomal recessive inherited disorder usually diagnosed in childhood. It is characterized by a deficiency of the enzyme that converts homocysteine to cystathionine. The accumulation of homocysteine leads to abnormalities in the ocular, skeletal, cardiovascular, and central nervous systems. HCU shares several clinical features with Marfan syndrome; however, respiratory system involvement in HCU is uncommon and rarely reported. Bronchiectasis has been previously reported in a few cases of HCU, and it was attributed mainly to fibrillin deficiency. This case describes a young girl diagnosed with classical HCU since childhood who presented with a chronic productive cough and was initially misdiagnosed as bronchial Asthma. However, upon further evaluation, she was eventually diagnosed with tracheobronchomegaly (TBM), or Mounier-Kuhn Syndrome, and bronchiectasis based on the computed tomography (CT) scan of chest findings. To our knowledge, this is the first reported case of TBM and bronchiectasis in HCU. We believe that fibrillin degeneration may be the key to understanding this unusual association in HCU.
Extensive Aortic Thromboembolism in a Patient With Erdheim-Chester Disease: A Case Report
Authors: Jiangping He, Xin Fang, Xianfeng Zhang, Kuang Chen, Jiao Huang
Journal: Front Cardiovasc Med (2022)
Keywords: erdheim-chester disease, aortic thromboembolism, lipogranulomatosis, non-langerhans cell histiocytosis, splenic infarction
MeSH terms: Case Reports

Background:
Erdheim-Chester disease (ECD) is a rare disease that affects multiple systems and is characterized by non-Langerhans cell histiocytosis. Classic clinical signs include long bone infiltration, central nervous system involvement, diabetes insipidus, and sheathing of the entire aorta. However, thrombosis is not recognized as a typical cardiac manifestation of ECD. Here, we report the case of an ECD patient with extensive arterial thrombus formation and embolism in several sections of the aorta.
Case:
A 36-year-old woman was admitted due to recurrent fever and left finger cyanosis for 20 days. Laboratory tests revealed that her C-reactive protein and interleukin-6 levels were significantly elevated. Thoracic computed tomographic angiography (CTA) revealed thrombosis from the aortic arch to the left subclavian artery accompanied by severe stenosis of the left subclavian artery. Abdominal CTA revealed splenic infarction due to splenic artery embolism and thrombus formation in multiple abdominal arteries. She underwent emergent arterial thrombectomy. During hospitalization, she complained of polyuria. The desmopressin test and pituitary magnetic resonance imaging findings suggested diabetes insipidus. Furthermore, positron emission tomography-computed tomography and bone emission computed tomography showed long bone impairment, and pathological examination of the bone samples confirmed ECD. Steroids and tocilizumab were selected as the initial therapies; however, thrombosis continued to develop. After replacement of tocilizumab with interferon-α, her condition became stable.
Conclusion:
Although extremely rare, fatal thrombosis may be a significant cardiovascular manifestation of ECD.
Clinically important left superior polar artery giving rise to a left inferior suprarenal artery and an aberrant left inferior polar artery: a case report
Authors: Naveen Kumar, Ashwini Aithal Padur, Mohandas Rao Kappettu Gadahad, Swamy Ravindra Shanthakumar
Journal: J Vasc Bras (2023)
Keywords: inferior mesenteric vein, inferior suprarenal artery, polar artery, renal artery, ureter
MeSH terms: Case Reports

The renal arteries arise from the lateral side of the abdominal aorta at the L2 vertebral level, just below the origin of the superior mesenteric artery. Multiple aberrant renal arteries can pose difficulties in renal transplantation, interventional radiological and urological procedures, renal artery embolization, angioplasty, or vascular reconstruction for congenital and acquired lesions. We present a case of a left kidney supplied by the left renal artery along with superior and inferior polar arteries, arising from the aorta and inferior mesenteric artery respectively. The inferior mesenteric artery was crossed by the left ureter and inferior mesenteric vein. The superior polar artery gave rise to an inferior suprarenal artery making the variation important for clinicians and surgeons.
Hyper-reactive malarial splenomegaly (HMS) in a patient with β thalassaemia syndrome
Authors: Yaw Ampem Amoako, George Bedu-Addo
Journal: Pan Afr Med J (2014)
Keywords: ghana, hyper-reactive malarial splenomegaly, massive splenomegaly, proguanil, béta thalassemia syndrome
MeSH terms: Antimalarials / therapeutic use, Malaria / complications, Splenomegaly / parasitology, beta-Thalassemia / physiopathology, Case Reports, Adolescent, Female, Humans, Malaria / drug therapy, Splenomegaly / drug therapy, Antimalarials

This report describes a case of hyper-reactive malarial splenomegaly in a patient with a thalassaemia syndrome. Increased haemoglobin A2 is valuable for the diagnosis of common forms of β-thalassemia, while haemoglobin F (HbF) helps in diagnosis of the rarer δβ- forms. Thalassemia is characterised by splenomegaly and is common in malaria endemic areas. Hyper-reactive malarial splenomegaly is also a common cause of massive splenomegaly in malaria endemic areas. Splenic enlargement regresses with prolonged antimalarial therapy.
Bilateral Vertebral Venous Sinus Thrombosis Causing Cervical Spinal Cord Compression in a Dog
Authors: Kathryn E Rhue, Amanda R Taylor, Robert C Cole, Randolph L Winter
Journal: Front Vet Sci (2017)
Keywords: mri, coagulation, tetraparesis, thrombus, warfarin
MeSH terms: Case Reports

A 10-year-old male neutered mixed breed dog was evaluated for cervical hyperesthesia and tetraparesis. Magnetic resonance imaging of the brain and cervical spinal cord identified an extradural compressive lesion over the body of C2 caused by marked dilation of the vertebral venous sinuses. Following intravenous contrast administration both vertebral sinuses had heterogeneous contrast enhancement consistent with incomplete thrombi formation. An abdominal ultrasound also showed a distal aortic thrombus. A definitive cause for the thrombi formation was not identified, but the patient had several predisposing factors which may have contributed. The patient was treated with a combination of warfarin, clopidogrel, and enoxaparin as well as analgesics. Within 48 h of initiation of warfarin therapy, the tetraparesis and hyperesthesia were markedly improved. Repeat abdominal ultrasound 3 weeks after discharge showed reduction in size of aortic thrombus. Neurologic function remained normal for 6 weeks following initiation of treatment. Seventy-four days following initial diagnosis the patient rapidly declined and passed away at home. Necropsy was declined. This is the first report of vertebral venous sinus enlargement leading to spinal cord compression and tetraparesis in a dog. Additionally, warfarin in combination with clopidogrel and enoxaparin appeared to be a safe and effective treatment for the suspected thrombi reported in this case. Vertebral sinus enlargement secondary to thrombi should be considered as a differential diagnosis in patients presenting with tetraparesis and cervical hyperesthesia.
Utility of [18F] Fluoro-Deoxyglucose Positron Emission Tomography/Computed Tomography for Staging and Therapy Response Evaluation in Pediatric Rhabdomyosarcoma: A Case Series and Literature Review
Authors: Ri Sa, Danyan Liu, Hongguang Zhao, Sen Hou, Qiuyu Lin, Feng Guan
Journal: Front Med (Lausanne) (2020)
Keywords: pet/ct, metabolic tumor volume (mtv), rhabdomyosarcoma, standardized uptake value (suv), total lesion glycolysis (tlg)

Background: The role of [18F] fluoro-deoxyglucose [[18F] FDG] positron emission tomography (PET)/computed tomography (CT) in pediatric rhabdomyosarcoma (RMS) is not well-established. This manuscript explores the role of staging and therapy response evaluation of PET/CT in a series of patients with RMS. Methods: Thirteen consecutive patients with pathologically proven RMS underwent baseline PET/CT scan and a second PET/CT for evaluation of therapy response. Maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), highest standardized uptake peak value (SUVpeak), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were obtained from baseline PET/CT and were used as potential predictors for evaluation of metabolic treatment response. Results: On baseline PET/CT, most RMSs are located in the pelvic cavity, and upper arms ranked second. The primary lesions were large and showed invasion to the surrounding tissues. Lymph node metastases were seen in eight patients, and eight patients showed distant metastasis to the lung, liver, and bone. The median SUVmax, SUVmean, and SUVpeak of primary sites were 7.1, 4.0, and 5.9, respectively. The median MTV and TLG were 196.6 cm3 and 780.2, respectively. After therapy, six patients received complete metabolic response (CMR) and non-CMR occurred in seven patients on the second PET/CT. SUVmax, SUVpeak, MTV, and TLG in patients with CMR were significantly lower than those in patients with non-CMR. Conclusions: Primary sites and metastatic lesions of RMS demonstrate increased glycolytic activity, which may allow them to be imaged using [18F] FDG PET/CT. Metabolic parameters derived from the baseline PET/CT have potential value for predicting CMR to therapy in pediatric RMS.
Case report: Spontaneous coronary artery dissection in a man with Ehlers-Danlos syndrome
Authors: Qiao Li, Min Ma, Yong He
Journal: Front Cardiovasc Med (2022)
Keywords: ehlers–danlos syndrome, acute coronary syndrome, imaging, percutaneous coronary revascularization, spontaneous coronary artery dissection
MeSH terms: Case Reports

Background:
Spontaneous coronary artery dissection (SCAD), as a medical emergency, represents one of the non-atherosclerotic causes of an acute coronary syndrome (ACS). It often occurs in young and middle-aged females and is a rarity among male patients. Yet, it is easily misdiagnosed or missed even though it has one of the highest in-hospital mortality rates.
Case summary:
Here, we present a young male patient admitted to the emergency department of our hospital due to a complaint of acute chest pain. During his hospitalization, we utilized several tools, including imaging modalities, genetic analyses, and clinical strategies, to ensure a proper diagnosis and management of the patient. The results indicated that the patient suffered from SCAD, as well as vascular Ehlers-Danlos syndrome (vEDS). Unfortunately, the patient died of SCAD-related sudden cardiac death (SCD) on the ninth day before the DNA analysis results were obtained. Despite a global effort and huge progress in the clinical characterization of SCAD, as well as patients' assessments, its pathophysiology remains poorly understood, with a significant recurrence risk and no specific disease-modifying therapy.
Conclusion:
Vascular Ehlers-Danlos syndrome, as an inherited connective tissue disorder characterized by congenital connective tissue dysplasia, is a rare and particularly challenging monogenetic disease. It can cause life-threatening changes, including arterial dissections and ruptures, and lead to early death due to COL3A1 pathogenic variants. It is also a rare cause of SCAD. Currently, the gold standard for SCAD diagnosis is coronary angiography (CAG).