OpenMed/multicare-articles huggingface dataset:
Antibody-mediated rejection of the heart in the setting of autoimmune demyelinating polyneuropathy: a case report and review of the literature
Authors: Kathryn J Lindley, Ashwin K Ravichandran, Joel Schilling, Susan M Joseph
Journal: Case Rep Cardiol (2012)

Background. Antibody-mediated rejection (AMR) is caused by the production of donor-specific antibodies (DSA) which lead to allograft injury in part via complement activation. The inflammatory demyelinating polyneuropathies (IDP) are inflammatory disorders of the nervous system, involving both cellular and humoral immune mechanisms directed against myelin. Case Report. A 58-year-old man five years after heart transplant presented with progressive dyspnea, imbalance, dysphagia, and weakness. Nerve conduction studies and electromyogram were consistent with IDP. Plasmapheresis and high-dose steroids resulted in improvement in neurologic symptoms. Within two weeks, he was readmitted with anasarca and acute renal failure, requiring intravenous furosemide and inotropic support. Echocardiogram and right heart catheterization revealed reduced cardiac function and elevated filling pressures. DSA was positive against HLA DR53, and endomyocardial biopsy revealed grade 1R chronic inflammation, with strong capillary endothelial immunostaining for C4d. Plasmapheresis and intravenous immunoglobulin (IVIG) were initiated. His anasarca and renal failure subsequently resolved, echocardiogram showed improved function off inotropes, and anti-DR53 MFI was reduced by 57%. Conclusions. This is an example of a single immune-mediated process causing concurrent IDP and AMR. The improvement in cardiac function and neurologic symptoms with plasmapheresis, IVIG, and high-dose steroids argues for a unifying antibody-mediated mechanism.
Glomus tumor of the leg: a case report
Authors: Mohamed Ali Sbai, Sofien Benzarti, Wafa Gharbi, Wadia Khoffi, Riadh Maalla
Journal: Pan Afr Med J (2018)
Keywords: glomus tumorlower limb, leg
MeSH terms: Glomus Tumor / diagnosis, Soft Tissue Neoplasms / diagnosis, Case Reports, Aged, Biopsy, Glomus Tumor / pathology, Glomus Tumor / surgery, Humans, Leg / pathology, Male, Pain / etiology, Soft Tissue Neoplasms / pathology, Soft Tissue Neoplasms / surgery

Glomus tumors are uncommon benign tumors developing from the neuro-myo-arterial glomus body. They are typically located in the fingers. The extra-digital involvement is unusual and makes diagnosis difficult. Only few cases have been reported in literature. We report an exceptional case of a glomus tumor of the lower leg in a 65-year-old male. The diagnosis was clinically suspected and confirmed by a biopsy. Surgical excision gave immediate pain relief. The aim of this report is to make the surgical community more aware of this entity based on the analysis of our own experience and a review of the literature.
Augmenting melodic intonation therapy with non-invasive brain stimulation to treat impaired left-hemisphere function: two case studies
Authors: Shahd Al-Janabi, Lyndsey A Nickels, Paul F Sowman, Hana Burianová, Dawn L Merrett, William F Thompson
Journal: Front Psychol (2014)
Keywords: aphasia, fmri, rtms, rehabilitation, stroke

The purpose of this study was to investigate whether or not the right hemisphere can be engaged using Melodic Intonation Therapy (MIT) and excitatory repetitive transcranial magnetic stimulation (rTMS) to improve language function in people with aphasia. The two participants in this study (GOE and AMC) have chronic non-fluent aphasia. A functional Magnetic Resonance Imaging (fMRI) task was used to localize the right Broca's homolog area in the inferior frontal gyrus for rTMS coil placement. The treatment protocol included an rTMS phase, which consisted of 3 treatment sessions that used an excitatory stimulation method known as intermittent theta burst stimulation, and a sham-rTMS phase, which consisted of 3 treatment sessions that used a sham coil. Each treatment session was followed by 40 min of MIT. A linguistic battery was administered after each session. Our findings show that one participant, GOE, improved in verbal fluency and the repetition of phrases when treated with MIT in combination with TMS. However, AMC showed no evidence of behavioral benefit from this brief treatment trial. Post-treatment neural activity changes were observed for both participants in the left Broca's area and right Broca's homolog. These case studies indicate that a combination of MIT and rTMS applied to the right Broca's homolog has the potential to improve speech and language outcomes for at least some people with post-stroke aphasia.
Fatal Progressive Meningoencephalitis Diagnosed in Two Members of a Family With X-Linked Agammaglobulinemia
Authors: Yasushi Kasahara, Masaru Imamura, Chansu Shin, Hiroshi Shimizu, Jirou Utsumi, Ryosuke Hosokai, Haruko Iwabuchi, Takayuki Takachi, Akiyoshi Kakita, Hirokazu Kanegane, Akihiko Saitoh, Chihaya Imai
Journal: Front Pediatr (2020)
Keywords: bruton tyrosine kinase, x-linked agammaglobulinemia, autoimmunity, neurodegeneration, progressive meningoencephalitis
MeSH terms: Case Reports

Chronic enteroviral meningoencephalitis is a well-known complication in patients with X-linked agammaglobulinemia (XLA). However, progressive neurodegenerative disorders or chronic neuroinflammatory diseases with no causative microorganisms have been recognized as rare central nervous system (CNS) complications in XLA. We herein report a family in which two of three members with XLA had developed progressive meningoencephalitis with an unknown etiology. A 15-month-old male infant presented with left-sided ptosis. Initially, the family denied any family history of inherited diseases, but later disclosed a family history of agammaglobulinemia previously diagnosed in two family members. In the early 1980s, one of the elder brothers of the index patient's mother who had been treated with intramuscular immunoglobulin [or later intravenous immunoglobulin (IVIG)] for agammaglobulinemia deceased at 10 years of age after showing progressive neurological deterioration during the last several years of his life. The index patient was diagnosed with XLA caused by Bruton tyrosine kinase deficiency (654delG; Val219Leufs*9), and chronic meningoencephalitis with an unknown infectious etiology. Magnetic resonance imaging of the brain demonstrated inflammatory changes in the basal ganglia, hypothalamus, midbrain, and pons, with multiple nodular lesions with ring enhancement, which showed impressive amelioration after the initiation of IVIG replacement therapy. Pleocytosis, which was characterized by an increase in CD4-positive and CD8-positive T cells expressing an activation marker and an elevation in inflammatory cytokines in the cerebrospinal fluid, was identified. No microorganism was identified as a cause of CNS complications. He thereafter developed brain infarction at 19 months of age and fatal status epilepticus at 5 years of age, despite regular IVIG with high trough levels and regular intraventricular immunoglobulin administration. The etiology of this rare CNS complication in XLA is currently unknown. Previous studies have suggested a possible association of IVIG, which was clearly denied in our index case because of the demonstration of his neurological disorder at presentation. In the future, extensive and unbiased molecular methods to detect causative microorganisms, as well as to investigate the possible role of autoimmunity are needed to clarify the etiology of CNS complications.
Osteomyelitis of the Mandible after Dental Implants in an Immunocompetent Patient
Authors: Matthieu Balanger, Margaux Hinet, Christian Vacher, Norbert Bellaiche, Jean-Luc Charrier, Sarah Millot
Journal: Case Rep Dent (2017)
MeSH terms: Case Reports

Dental implants are now broadly used to replace missing teeth, and the presence of infectious complications is rising. Dental implant therapy as a local risk factor for the onset of osteomyelitis and its management have not been widely explored. Here, we report an unusual case of mandibular suppurative osteomyelitis caused by Streptococcus intermedius in a healthy and immunocompetent patient secondary to mandibular implants. We describe how surgery combined with systemic application of antibiotics allowed conservation of the dental implants in the mandibular bone, discuss the probable source of contamination, and present the follow-up of the osteomyelitis.
Perfusion Imaging in Autoimmune Encephalitis
Authors: Deepak Vallabhaneni, Muhammad Atif Naveed, Rajiv Mangla, Awss Zidan, Rashi I Mehta
Journal: Case Rep Radiol (2018)

Encephalitis is characterized by inflammation of brain tissue and has various infectious and noninfectious causes. CSF analysis and MRI usually reveal inflammatory changes although sometimes brain imaging may be normal. Autoimmune encephalitis is caused by antibodies against neuronal synaptic receptors, surface proteins, or intracellular proteins. In this case report, we present a 65-year-old female who presented with a fall and altered mental status. Workup for infectious etiologies was negative and MRI of the brain displayed focal restricted diffusion with corresponding T2-FLAIR hyperintensity involving gray matter structures, making the diagnosis unclear. CT perfusion of the brain demonstrated increased cerebral blood volume and cerebral blood flow in the left parietooccipital gray matter, with corresponding normal mean transit time. Following treatment failure with acyclovir, antibiotics, and steroids, the patient was found to be positive for GAD65 antibodies and diagnosed with autoimmune encephalitis. Symptoms markedly improved with plasmapheresis. Autoimmune encephalitis rarely causes restricted diffusion and this is the first case report to describe corresponding hyperperfusion on CT perfusion study.
Antenatal sonographic diagnosis of pharyngeal teratoma: our experience of a rare case with review of the literature
Authors: M Varras, Ch Akrivis, Ch Plis, G Tsoukalos
Journal: Obstet Gynecol Int (2009)
MeSH terms: Case Reports

Background. Teratomas are the most common tumors. They are usually localized in the sacrococcygeal area, while the pharyngeal localization is very rare. The number of cases of stomatopharyngeal teratomas detected prenatally via sonography is very small. Case Report. We present the case of a 24-year-old primipara at 18 weeks' gestation, that at the routine ultrasound scan, the fetus was found with an echogenic mass, filling the stomatopharyngeal cavity and protruding from the mouth. Other abnormalities were not found. Termination of pregnancy was achieved using misoprostol. A female stillborn fetus with a weight of 250 g and length of 25.5 cm was delivered. The postmortem and pathologic examination confirmed the diagnosis. Conclusion. Pharyngeal teratomas can be diagnosed with the use of ultrasounds in utero facilitating parents' counseling in early time.
Aggressive Digital Papillary Adenocarcinoma of the Hand Presenting as a Felon
Authors: Justin R Bryant, Preston Gardner, Matthew Yousif, John C Pui, Raymond T Hajjar, E Aron Haass
Journal: Case Rep Orthop (2017)
MeSH terms: Case Reports

Aggressive digital papillary adenocarcinoma is a rare eccrine sweat gland malignancy that is frequently misdiagnosed at initial presentation. Histologically, this tumor is similar in appearance to many adenocarcinomas and as such may be diagnosed as a metastatic lesion. We present the case of a patient with digital papillary adenocarcinoma, which was initially diagnosed as a felon. No consensus has been published regarding the treatment of this disease. A review of the diagnosis, pathology, treatment, and adjunctive treatments of aggressive digital papillary adenocarcinoma are also included.
Orbital Tumors Excision without Bony Marginotomy under Local and General Anesthesia
Authors: Robert A Goldberg, Daniel B Rootman, Nariman Nassiri, David B Samimi, Joseph M Shadpour
Journal: J Ophthalmol (2014)

To present our experience of removing middle to deep orbital tumors using a combination of minimally invasive soft tissue approaches, sometimes under local anesthesia. Methods. In this retrospective case series, 30 patients (13 males and 17 females) underwent tumor removal through eyelid crease (17 eyes), conjunctival (nine eyes), lateral canthal (two eyes), and transcaruncular (two eyes) approaches. All tumors were located in the posterior half of the orbit. Six cases were removed under monitored anesthesia care with local block, and 24 were under general anesthesia. Results. The median (range) age and follow-up duration were 48.5 (31-87) years old and 24.5 (4-375) weeks, respectively. Visual acuity and ocular motility showed improvement or no significant change in all but one patient at the latest followup. Confirmed pathologies revealed cavernous hemangioma (15 cases), pleomorphic adenoma (5 cases), solitary fibrous tumor (4 cases), neurofibroma (2 cases), schwannoma (2 cases), and orbital varix (1 case). None of the patients experienced recurrence. Conclusions. Creating a bony marginotomy increases intraoperative exposure of the deep orbit but adds substantial time and morbidity. Benign orbital tumors can often be removed safely through small soft-tissue incisions, without bone removal and under local anesthesia.
Case Report: Multifocal non-invasive follicular thyroid neoplasm with papillary-like nuclear features presenting in a female child
Authors: Asmaa Gaber Abdou, Hayam Aiad, Nancy Asaad
Journal: F1000Res (2020)
Keywords: niftp, children, multifocality
MeSH terms: Adenocarcinoma, Follicular / diagnosis, Thyroid Neoplasms / diagnosis, Case Reports, Child, Female, Humans, Male, Neoplasm Recurrence, Local

Non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was introduced as a separate entity by the World Health Organization in 2017 with strict inclusion and exclusion criteria. Most NIFTP cases have been reported in adults and few cases have been diagnosed in children. Here, we present a classic case of NIFTP affecting a 10-year old female child. We also review previous reports of NIFTP in children regarding size, focality, nodal metastasis, recurrence, type of operation and follow-up data. The present report adds a new case of NIFTP in the paediatric age group characterized by multifocality, absence of nodal invasion and indolent course until last follow-up, recommending less aggressive management.
Brain abscess formation as a CSF shunt complication: a case report
Authors: Aimun Ab Jamjoom, Abrar R Waliuddin, Abdulhakim B Jamjoom
Journal: Cases J (2009)

The formation of a brain abscess as a result of a cerebrospinal fluid shunt complication is extremely rare in the literature with only 7 cases reported in the last 20 years. We report a patient that developed a brain abscess adjacent to a functioning ventricular catheter in the presence of shunt infection by another pathogen. Clinicians should consider this complication in any shunted patient with clinical features of infection and suggestive changes on imaging however subtle. Expedited standard management for the abscess and the CSF shunt infection, if present, should be employed. Removal of all non-functioning catheters should be encouraged.
Ectopic follicular variant of papillary thyroid carcinoma in anterior mediastinum with a normal thyroid gland. A case report
Authors: Farida Karim, Hina Inam, Usama Khalid Choudry, Saulat Hasnain Fatimi
Journal: Int J Surg Case Rep (2018)
Keywords: ectopic papillary thyroid carcinoma, mediastinal tumor, normal thyroid gland

Introduction:
Ectopic thyroid is rare, especially in the anterior mediastinum. Furthermore, true malignant transformation in ectopic location with normal orthotopic gland is exceptionally unusual. The authors have tried to put forward a challenging case of a malignant mediastinal mass managed successfully via a multidisciplinary approach.
Presentation of case:
We report the case of a 55 year old female with ectopic follicular variant of papillary thyroid cancer in the anterior mediastinum with no disease in the thyroid gland. Subsequently, complete excision of the mediastinal mass and total thyroidectomy was done followed by radio-iodine ablation with radiotherapy. Patient showed good uneventful recovery and remains tumor free till date.
Conclusion:
The aim of this report is to bring forward malignant ectopic thyroid carcinoma as a differential for malignant mediastinal masses. It is emphasized that the diagnosis is made essentially through physical and pathological examination and, in most cases, only after surgery. A Multidisciplinary approach is recommended in such cases.
Mucormycosis in a renal transplant recipient: case report and comprehensive review of literature
Authors: Tamim Hamdi, Vanji Karthikeyan, George J Alangaden
Journal: Int J Nephrol (2014)
MeSH terms: Review

Mucormycosis is a rare but devastating infection. We present a case of fatal disseminated mucormycosis infection in a renal transplant patient. Uncontrolled diabetes mellitus and immunosuppression are the major predisposing factors to infection with Mucorales. Mucorales are angioinvasive and can infect any organ system. Lungs are the predominant site of infection in solid organ transplant recipients. Prompt diagnosis is challenging and influences outcome. Treatment involves a combination of surgical and medical therapies. Amphotericin B remains the cornerstone in the medical management of mucormycosis, although other agents have been used. Newer agents are promising.
Carmi Syndrome in a Preterm Neonate: A Multidisciplinary Approach and Ethical Challenge
Authors: Timothy D Hicks, Himanshu Singh, Michel Mikhael, Anita R Shah
Journal: Case Rep Pediatr (2018)
MeSH terms: Case Reports

Epidermolysis bullosa (EB) is characterized by blistering of the skin and mucosal erosions caused by hemidesmosomal abnormalities. EB is divided into 3 major subgroups depending on the particular location of tissue separation: EB simplex, dystrophic EB, and junctional EB. Junctional EB (JEB) can further be broken down into Herlitz, non-Herlitz, and JEB with pyloric atresia (Carmi syndrome) depending on genetic and histologic testing. When extensive, management of a patient with EB can be challenging due to not only cutaneous but also extracutaneous manifestations as well. Families and health care teams are often faced with difficult decisions in their infant's best interest. We report a case of a preterm neonate with Carmi syndrome and unique findings on immunofluorescence studies. The patient's course was complicated by multisystem involvement and ultimately death. A multidisciplinary approach was crucial in the light of diagnostic, therapeutic, and ethical challenges.
Amoxicillin/Clavulanic Acid-Induced Agranulocytosis: A Case Report and Review of the Literature
Authors: Aristides Armas Villalba, Marya Haq, Cunxian Zhang, Jinen Thakkar
Journal: Case Rep Hematol (2019)
MeSH terms: Case Reports

Amoxicillin/clavulanic acid is one of the widely prescribed antibiotics in the outpatient setting giving excellent antimicrobial coverage and relatively safe profile in terms of adverse reactions. Gastrointestinal and cutaneous reactions are among the commonly reported. Our goal is to describe a case of agranulocytosis induced by amoxicillin/clavulanic acid in a previously healthy patient and review prior reports with similar presentation.
Use of Direct Hemoperfusion with Polymyxin B-Immobilized Fiber for the Treatment of Septic Shock Complicated with Lemierre Syndrome Caused by Fusobacterium necrophorum
Authors: Yoshiyuki Kodama, Gaku Takahashi, Shigenori Kan, Takayuki Masuda, Yoriko Ishibe, Rise Akimaru, Maria Nonoguchi, Yoshihiro Inoue
Journal: Case Rep Crit Care (2019)
MeSH terms: Case Reports

We report a case of septic shock treated with PMX-DHP that was complicated with Lemierre syndrome caused by Fusobacterium necrophorum. The patient was a 31-year-old man who was initially diagnosed with influenza. He received treatment; however, because his symptoms gradually worsened, he was transported to our hospital 10 days following his diagnosis. His initial examination revealed symptoms of respiratory distress and an altered level of consciousness. Based on laboratory and imaging results, it became clear that he suffered from septic shock of unknown etiology, disseminated intravascular coagulation, and acute renal and respiratory failure. We initiated treatment with vasopressors, an antibacterial agent, immunoglobulins as well as an appropriate ventilator management; however, his unstable circulatory condition continued. As soon as PMX-DHP was initiated, 2 days following admission to the ICU, his circulatory instability normalized. F. necrophorum was ultimately detected after a culture examination, and contrast-enhanced computed tomography revealed a jugular vein thrombus, which led to the diagnosis of Lemierre syndrome. The patient's condition gradually improved, and he was discharged from the ICU after 19 days.
Successful myomectomy during pregnancy: a case report
Authors: Chisara Umezurike, Paul Feyi-Waboso
Journal: Reprod Health (2005)

Background:
The medical literature has reported an increase in myomectomy during caesarean section in the past decade. However, myomectomy performed during pregnancy remains a rarity. The management of uterine fibroids during pregnancy is usually expectant and surgical removal is generally delayed until after delivery. We present a case of a large, symptomatic uterine fibroid diagnosed during pregnancy which was successfully managed by antepartum myomectomy.
Case presentation:
A 30 year old woman presented with a one year history of abdominal swelling, amenorrhea and severe epigastric discomfort of 19 weeks duration. The abdomen was grossly distended and tense. A sonographic diagnosis of ovarian tumor in pregnancy was made. Laparotomy revealed a 32 cm degenerating subserosal uterine fibroid co-existing with an intrauterine pregnancy. Myomectomy was successfully performed. The subsequent antenatal period was uneventful with a spontaneous vaginal delivery of a female baby at 38 weeks.
Conclusion:
This report supports other studies and case series that have demonstrated the safety of myomectomy during pregnancy in selected circumstances.
Adrenocortical carcinoma with skeletal metastases in a postmenopausal woman
Authors: Shila Mitra, Suparna Ghosh Roy, Prabir Kumar Sur
Journal: Indian J Med Paediatr Oncol (2009)
Keywords: adrenocortical carcinoma, androgen secreting tumors, mitotane
MeSH terms: Case Reports

Adrenocortical cancer is a very rare tumor with a poor prognosis. About half of them are hormone-secreting tumors. In most cases, hormonal investigations reveal an excess secretion of steroids, mostly cortisol and androgens. A 54-year-old lady presented with history of pain in left shoulder and leg for 6 months and features of virilization. CT-guided fine-needle aspiration cytology of an abdominal mass revealed the presence of a carcinoma of the left adrenal cortex. A whole-body radionuclide bone scan revealed increased uptake in the left clavicle and left femur. The patient has received palliative radiotherapy for the skeletal lesions and 3 cycles of palliative chemotherapy at present.