OpenMed/multicare-articles huggingface dataset:
COVID-19-associated leukocytoclastic vasculitis leading to gangrene and amputation
Authors: Khalid Omar Alattar, Farah Noaman Subhi, Ayesha Humaid Saif Alshamsi, Nadereh Eisa, Niaz Ahmed Shaikh, Jehangir Afzal Mobushar, Asma Al Qasmi
Journal: IDCases (2021)
Keywords: amputation, covid-19, gangrene, pneumonia, vasculitis
MeSH terms: Case Reports

A 41-year-old male with type 2 diabetes mellitus (T2DM) presented with complaints of recent onset limb weakness, diffuse body rash and fever. Computerized Tomography (CT) scan of the brain did not reveal a stroke but laboratory investigations of the patient portrayed multi-systemic involvement. Naso-pharyngeal swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was taken which resulted as positive. Soon after, a biopsy of the skin lesions revealed histo-pathological features of leukocytoclastic vasculitis. The patient was further investigated for connective tissue disease and vasculitis only to yield a negative result for all relevant antibodies, with the exception of the anti-phospholipid antibody which was positive. The patient suffered through a complex and prolonged hospital stay that required the input of multiple sub-speciality teams. Although initially presenting with a normal chest X-ray the patient went on to have severe bilateral pneumonia and a progression of initial skin rash leading to severe necrosis of the left foot with dry gangrene of the left big toe. Due to these issues, coronavirus-disease-2019 (COVID-19) aimed therapy was started along with multiple skin debridements, antibiotics and eventual amputation of the patient's affected large toe. The following case-study details all the before-mentioned events with discussion of the possible reasons behind the patient's presentation and eventual outcome.
Extraosseous osteosarcoma of the esophagus: a case report
Authors: Rodney E Wegner, Kevin M McGrath, James D Luketich, David M Friedland
Journal: Sarcoma (2010)
MeSH terms: Case Reports

Extraosseous osteosarcoma (EOO) is a malignant mesenchymal neoplasm that is located in the soft tissues without direct attachment to the skeletal system and that produces osteoid, bone, or chondroid material. EOO is an extremely rare disease, accounting for only 1% of soft tissue sarcomas, and typically presents in either an extremity or the retroperitoneum. This paper presents the case of a 45-year-old Caucasian male with extraosseous osteosarcoma of the esophagus.
MRI of Wallerian Degeneration in the Brainstem: A Pictorial Essay
Authors: Nico Hustings, Marc Lemmerling
Journal: J Belg Soc Radiol (2021)
Keywords: mri, wallerian degeneration, cerebral injury, corticospinal tract, peduncular atrophy, prognosis
MeSH terms: Case Reports

Wallerian degeneration of the cerebral peduncle is a common MRI finding after cerebral injury. The degree of peduncular atrophy reflects the extent of damage in the corticospinal tract. The acute phase of Wallerian degeneration is visible with Diffusion-Weighted-Imaging. New investigation with Diffusion-Tensor-Imaging quantifies Wallerian degeneration in the subacute ischemic phase and is a good predictor for later functional recovery after stroke.
Refractory and progressively worsening nasal obstruction: case report of nasal osteoblastoma and literature review
Authors: Caishan Fang, Ruizhi Wang, Min Zhou, Tengyu Chen, Qinxiu Zhang, Yan Ruan, Chunqiao Li
Journal: Front Oncol (2023)
Keywords: fibrous dysplasia of bone, nasal obstruction, osteoblastic fibroma, osteoblastoma, osteoid osteoma
MeSH terms: Case Reports

Nasal osteoblastoma (OB) is a rare and locally aggressive osteogenic tumor that has rarely been reported, and there is a lack of effective evidence data for its diagnosis and treatment. In this study, we report a 31-year-old female patient who presented with nasal congestion and associated progressive painless swelling of the left maxillofacial region. A preoperative computed tomography (CT) examination of the paranasal sinuses was performed, and based on the imaging presentation, the surgeon was unable to differentiate between OB, osteoid osteoma (OO), fibrous dysplasia of bone (FDB) and osteoblastic fibroma (OF). After excluding contraindications to surgery, the patient underwent nasal endoscopic excision of the left nasal mass, which was found to be gravel-like and difficult to remove cleanly during the operation. The mass was brittle and bled easily, resulting in inadequate exposure of the operative field, prolonged operation time, and substantial intraoperative blood loss. This indicates that definite preoperative diagnosis (biopsy of deeper parts of the mass is recommended) and appropriate preoperative preparations (e.g., preoperative angiography and embolization, adequate blood preparation) are very important. The intraoperative frozen and postoperative pathological results clearly identified the tumor as OB. No local recurrence of the tumor was observed at the 11-month postoperative follow-up.
Frequency, symptoms and outcome of intestinal metastases of bronchopulmonary cancer. Case report and review of the literature
Authors: Andreas Hillenbrand, Joern Sträter, Doris Henne-Bruns
Journal: Int Semin Surg Oncol (2005)

Background:
We report a new case of small bowel metastases from primary lung cancer. Such metastases are not exceptional, but their clinical manifestations are rare.
Case presentation:
The case involved a 56-year-old man with a squamous cell carcinoma of the lung (stage IV) that had been treated with chemotherapy. He presented fourteen months after diagnosis with an acute abdominal pain. Abdominal CT-scan demonstrated a perforated jejunum and he underwent emergency surgery. Postoperative pathologic analysis confirmed the diagnosis of metastatic pulmonary carcinoma. The patient was discharged after ten days, but died 8 weeks after surgery at home on tumor progression.
Conclusion:
We were able to find 58 documented similar cases in the literature. Most cases presented with bowel perforation or obstruction. Squamous cell carcinoma was the most common histological cell type followed by large cell carcinoma. Other metastases are often present, and the prognosis is mostly fatal at short term.
Subcapsular haematoma following laparoscopic cholecystectomy
Authors: Brian M Moloney, Niamh Hennessy, Eoin O Malley, Felix Orefuwa, Peter A McCarthy, Chris G Collins
Journal: BJR Case Rep (2016)
MeSH terms: Case Reports

Laparoscopic cholecystectomy (LC) is now considered the gold standard treatment for symptomatic gallbladder disease. Over the last two decades, a reduction in postoperative morbidity, mortality and hospital stay have seen a complete shift from open surgery to a laparoscopic approach. Intrahepatic subcapsular haematoma (ISH) is a rare and potentially life-threatening complication of LC. A 34-year-old female underwent LC for uncomplicated cholelithiasis. No complications were observed intra-operatively. 2 h postoperatively, the patient developed severe abdominal pain and tachycardia. Ultrasonography demonstrated an echogenic collection adjacent to the gallbladder fossa. Laparoscopy showed an ISH involving the right and left lobes of the liver, and no evidence of any intra-abdominal haemorrhage. Subsequent urgent triphasic CT identified a large ISH and a hypervascular lesion on the right lobe of the liver. This lesion demonstrated delayed enhancement with contrast filling suggestive of a hepatic haemangioma. This case report demonstrates the impact of imaging on postoperative management and the importance of postoperative patient monitoring in patients who have undergone laparoscopic surgery. Imaging explorations have a decisive role in the detection and characterization of haematomas.
A Rare Cause of Chronic Hip Pain From PEComa: An Aggressive Mesenchymal Sarcoma
Authors: Samender Randhawa, Jessica Pinsker, Madhurya Amirapu, Metlapalli Venkata Sravanthi, Prashanth Ashok Kumar, Komal Akhtar
Journal: J Investig Med High Impact Case Rep (2022)
Keywords: pecoma, tfe3, epithelioid, hip pain, mesenchymal, metastatic, sarcoma, sirolimus, tumor
MeSH terms: Perivascular Epithelioid Cell Neoplasms / complications, Perivascular Epithelioid Cell Neoplasms / diagnosis, Perivascular Epithelioid Cell Neoplasms / genetics, Sarcoma, Case Reports, Basic Helix-Loop-Helix Leucine Zipper Transcription Factors / genetics, Humans, Male, Pain, Basic Helix-Loop-Helix Leucine Zipper Transcription Factors

Perivascular epithelioid cell tumors (PEComas) are related to the tuberous sclerosis complex (TSC) and are commonly benign. When malignant, they can be aggressive with local invasion and metastatic spread. Conventional PEComas do not have TFE3 gene rearrangement and are associated with TSC with a preference for an occurrence at a younger age. We report a case of a young male who had progressive chronic hip pain and was found to have a TFE3-associated PEComa in his pelvic region.
Congenital Cataracts and Microphakia with Retinal Dysplasia and Optic Nerve Hypoplasia in a Calf
Authors: Christopher L Siepker, Jennifer L Zimmer, Kathleen M Bedard, Kelsey A Hart, Sarah L Czerwinski, K Paige Carmichael
Journal: Case Rep Vet Med (2021)
MeSH terms: Case Reports

Case Description. A two-month-old, female, Aberdeen-Angus calf was presented for congenital cataracts and blindness in both eyes (OU). The dam had a reported history of visual defects (not specified) and had produced other affected calves (per owner history). Ophthalmic examination revealed mature bilateral cataracts, attenuation of the iridic granules, persistent pupillary membranes, and dyscoric pupils. Additionally, the calf had a poor body condition, prognathism, dome-shaped head, excessive nasal drainage, limb contracture, and fever. Histopathology of both eyes revealed lenticular degeneration (congenital cataracts), retinal dysplasia, and optic nerve hypoplasia. BVDV IHC detected antigen within only the left eye (OS), consisting of intrahistiocytic and endothelial immunoreactivity within the ciliary body, iris, and choroid. No BVDV immunoreactivity could be detected in the right eye (OD). This case highlights the unique ocular changes present in in utero BVDV infection of cattle with a different immunohistochemical staining profile than previously described.
Protoplasmic astrocytoma with multifocal involvement: case report and radiological findings
Authors: A Abdullah, P Entezami, L Halpin, J Feldmeier, R E Mrak, D Gaudin
Journal: BJR Case Rep (2015)
MeSH terms: Case Reports

Protoplasmic astrocytomas are a poorly characterized and extremely rare subtype of astrocytoma. We describe the CT, MR and 18F-fludeoxyglucose positron emission tomography (FDG-PET) findings of a multifocal protoplasmic astrocytoma in a 29-year-old male with neurological deficits. He was initially diagnosed with neurosarcoidosis based on imaging. MRI demonstrated intraparenchymal lesions involving the right temporal lobe and cerebellum. These appeared as extremely hyperintense signals on T 2 weighted imaging and as homogeneous enhancements with a small non-enhancing cystic component on contrast-enhanced MR. Diffuse post-contrast enhancement of the craniospinal meninges was also noted. Post-radiation therapy PET-CT demonstrated a highly FDG-avid tumour in the right temporal lobe and left cerebellum. To our knowledge, a multifocal form of protoplasmic astrocytoma in an adult patient has not been previously described.
Development of Merkel Cell Carcinoma in a Patient Receiving Rituximab
Authors: Bana Antonios, Ujjwal Karki, Kais Antonios, Bipin Ghimire, Mohammad Muhsin Chisti
Journal: Case Rep Oncol Med (2022)
MeSH terms: Case Reports

Merkel cell carcinoma (MCC) is a rare, rapidly growing, and aggressive dermatological neoplasm. It is commonly reported in Caucasian ethnicities, and almost 50% of the patients have a concomitant malignancy and are on immunosuppressive chemotherapy. Here, we present a 79-year-old woman with a history of relapsed Stage II, grade III follicular lymphoma, receiving maintenance rituximab infusions. She presented with a raised erythematous papule on her left cheek. An excisional biopsy of the lesion confirmed a diagnosis of Merkel cell carcinoma. After which, she underwent a wider excision with 1-2 cm margins. PET scan did not reveal any FDG-avid uptake lesions that would be concerning for metastatic disease. However, she underwent a sentinel lymph node biopsy which was also negative. Thus, the diagnosis was finalized as Stage I (T1 N0 M0) MCC. There are only two reported cases in literature about the significant progression of Merkel cell carcinoma in patients who coincidentally were receiving rituximab as a part of treatment for another disease. This raises questions for future investigation and research on whether there is a direct association between rituximab use specifically and the rapid growth of MCC.
Treatment of cardiac nocardiosis in a post-renal transplant patient of systemic nocardiosis
Authors: Muddassar Mahboob, Sana Hassan, Ashraf Ali Attia, Ebadur Rahman, Muhammad Shoaib Khan, Syed Rizwan Bokhari
Journal: J Cardiovasc Thorac Res (2019)
Keywords: cardiac nocardiosis, nocardia, opportunistic infections
MeSH terms: Case Reports

In general, nocardia infects immunosuppressed patients, however, sometimes it can also infect immunocompetent individuals. Nocardia infection can disseminate to any organ system of the body but the pulmonary system is the most commonly involved system. In some rare cases, the heart can also be involved and the resulting cardiac mycetoma can be treated successfully with antimicrobials without the need of surgery, unlike fungal cardiac mycetomas wherein surgery may be required in addition to antimicrobial therapy. We present an interesting case of post-renal transplant cardiac nocardiosis, which was treated successfully with a course of antibiotics.
Case Report of Diffuse Large B Cell Lymphoma of Uterine Cervix Treated at a Semiurban Cancer Centre in North India
Authors: Vibhor Sharma, Tapas Dora, Mehul Patel, Sankalp Sancheti, Epari Sridhar
Journal: Case Rep Hematol (2016)

Lymphoma of the uterine cervix is very rare. We report a case of diffuse large B cell lymphoma (DLBCL) involving the uterine cervix treated at a newly commissioned semiurban cancer centre in north India in 2015. Data for this study was obtained from the hospital electronic medical records and the patient's case file. We also reviewed published case reports of uterine and cervical lymphoma involving forty-one patients. We treated a case of stage IV DLBCL cervix with six cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) and intrathecal methotrexate followed by consolidation with radiotherapy. The patient showed complete response to chemotherapy. We conclude that, in advanced stage lymphoma involving uterus and cervix, combination of chemotherapy and radiotherapy is effective in short term.
Heterozygous Deletion of the SHOX Gene Enhancer in two Females With Clinical Heterogeneity Associating With Skewed XCI and Escaping XCI
Authors: Yixi Sun, Yuqin Luo, Yeqing Qian, Min Chen, Liya Wang, Hongge Li, Yu Zou, Minyue Dong
Journal: Front Genet (2019)
Keywords: humara assay, leri-weill dyschondrosteosis, shox gene enhancer, clinical heterogeneity, escaping x-chromosome inactivation (xci), skewed x-chromosome inactivation (xci)
MeSH terms: Case Reports

Skewed X-chromosome inactivation (XCI) plays an important role in the phenotypic heterogeneity of X-linked disorders. However, the role of skewed XCI in XCI-escaping gene SHOX regulation is unclear. Here, we focused on a heterozygous deletion of SHOX gene enhancer with clinical heterogeneity. Using SNP array, we detected that the female proband with Leri-Weill dyschondrosteosis (LWD) carried an 857 kb deletion on Xp22.3 (encompassing SHOX enhancer) and a 5,707 kb large-fragment deletion on Xq25q26. XCI analysis revealed that the X-chromosome with the Xq25q26 large-fragment deletion was completely inactivated, which forced the complete activation of the other X-chromosome carrying SHOX enhancer deletion. While the Xp22.3 deletion locates on the escaping XCI region, under the combined action of skewed XCI and escaping XCI, transcription of SHOX gene was mainly from the activated X-chromosome with SHOX enhancer defect, involving in the formation of LWD phenotype. Interestingly, this SHOX enhancer deletion was inherited from her healthy mother, who also demonstrated completely skewed XCI. However, the X-chromosome with SHOX enhancer deletion was inactivated, and the normal X-chromosome was activated. Combing with escaping XCI, her phenotype was almost normal. In summary, this study was a rare report of SHOX gene enhancer deletion in a family with clinical heterogeneity due to skewed inactivation of different X-chromosomes, which can help in the genetic counseling and prenatal diagnosis of disorders in females with SHOX defect.
Magnetic resonance cholangiopancreatography with secretin stimulation in the diagnosis of intraductal papillary mucinous neoplasm: a paradigmatic case report
Authors: Elsa Iannicelli, Francesco Carbonetti, Marco Di Pietropaolo, Giulia Francesca Federici, Gabriele Capurso, Vincenzo David
Journal: Case Rep Radiol (2014)

Context. One of the characteristic findings of intraductal papillary mucinous neoplasms (IPMN) is the presence of a direct communication between the lesion and the ductal pancreatic system and when magnetic resonance cholangiopancreatography (MRCP) shows uncertain findings, it is useful to perform a MRCP after secretin stimulation (MRCP-S) which provides a better visualization of the ductal system. Case Report. We present a case of 51-year-old man in whom, during a CT follow-up for a renal tumour, was found a cystic lesion of the pancreas. To better evaluate the lesion and its suspected communication with the pancreatic system, MR with gadolinium and MRCP and MRCP-S were performed. With the MRCP and MRI it was not possible to identify a clear communication between the cystic lesion and the ductal system. MRCP-S showed an increase in signal intensity of the lesion and its communication with the ductal system, allowing us to classify the cystic lesion as a main duct in intraductal papillary mucinous neoplasm. The patient underwent a surgical duodenal pancreatectomy. The histological result of the specimen confirmed the diagnosis of adenocarcinoma IPMN. Conclusion. In this case MRCP-S has allowed a clearer identification of the cystic lesion allowing a correct diagnosis and treatment.
ST Segment Elevation and Depressions in Supraventricular Tachycardia without Coronary Artery Disease
Authors: Fuad Habash, Arwa Albashaireh, Mohammed Eid Madmani, Hakan Paydak
Journal: Case Rep Cardiol (2018)
MeSH terms: Case Reports

ST segment changes are well documented in literature during supraventricular tachycardias. We present a case of a 21-year-old male who presents with chest pain, shortness of breath, and dizziness with an ECG showing atrioventricular reentrant tachycardia and diffuse ST segment depressions. Patient spontaneously converted to sinus rhythm, but he was still complaining of crushing chest pain. ECG taken after conversion showed sinus rhythm at a rate of 65 and showed obvious persistence of ST depressions in majority of leads. Emergent left heart catheterization showed normal coronaries. Such ST depression is suggestive of global ischemia in small intracardiac vessels that cannot be evaluated by left heart catheterization.
Avelumab inducing hypothyroidism and hypoadrenalism: A case report and review of literature
Authors: Kashif Aziz, Amir Shahbaz, Muhammad Umair, Isaac Sachmechi
Journal: EXCLI J (2018)
Keywords: immune check point inhibitors, pd-l1, avelumab, endocrinopathies, hypoadrenalism, hypothyroidism
MeSH terms: Case Reports

Avelumab is an anti-PD-L1 (programmed death-ligand 1) immune checkpoint inhibitor (ICIs) and the monoclonal antibody that constitutes a major development in the immunotherapy of cancer. In 2017, The European Medicine Agency (EMA) approved it as an orphan drug for treatment of gastric cancer. Avelumab has recently been approved in the United States, Europe and Japan for treatment of metastatic Merkel cell carcinoma (MCC). Avelumab inhibits the interaction of Programmed cell death protein 1 (PD-1) on immune cells with PD-L1 on tumor cells, thus banishing immunosuppressive signals and leading to enhanced immune cell activation. Here we are revealing a case of the patient with metastatic gastric cancer receiving avelumab with the development of undesirable endocrinopathies during the course of treatment. We suggested that patients receiving avelumab immunotherapy should be monitored for signs and symptoms of thyroiditis, hypothyroidism and adrenal insufficiency, which may require immediate attention and supportive treatment by immunosuppression and respective hormone replacement.
Hemoperitoneum Secondary to Spontaneous Rupture of a Retroperitoneal Varix
Authors: Derrick D Eichele
Journal: Case Reports Hepatol (2017)
MeSH terms: Case Reports

Hemoperitoneum due to a ruptured retroperitoneal varix is an exceedingly rare condition and a poor prognostic sign with catastrophic and life-threatening complication of portal hypertension. We present a unique case of a 56-year-old female with cirrhosis secondary to primary sclerosing cholangitis who presented with acute abdominal pain and hypovolemic shock prior to a cardiac arrest following a ruptured retroperitoneal varix without prior esophageal varices and a newly identified intrahepatic cholangiocarcinoma. The clinical presentation with abdominal pain and hemorrhagic shock is consistently reported in the relevant literature. Early recognition affords appropriate management and urgent surgical intervention leading to survival.