OpenMed/multicare-articles huggingface dataset:
Dabigatran Added to Dual Antiplatelet Therapy to Treat a Left Ventricular Thrombus in an 87 Year Old Patient With Myocardial Infarction and Very High Bleeding Risk
Authors: Maria Noflatscher, Nicolas Moes, Eva-Maria Gassner, Peter Marschang
Journal: Front Pharmacol (2018)
Keywords: anticoagulation therapy, high bleeding risk, left ventricular thrombus, myocardial infarction, rectal neoplasms, triple therapy
MeSH terms: Case Reports

Background: A left ventricular (LV) thrombus is detected in approximately 5-10% of patients after myocardial infarction (MI). If left untreated, these LV thrombi carry a significant risk of complications including embolic stroke. According to current guidelines, anticoagulation with vitamin K antagonists (VKA) is recommended to treat a LV thrombus. Case presentation: An 87 year old patient was referred to our department with non ST-elevation MI. Five months before, he had been diagnosed with a subacute ST elevation MI, which had been treated conservatively. Recently, a rectal neoplasia had been diagnosed, but not operated yet. The patient underwent coronary angiography with implantation of two drug eluting stents (Cre8) requiring dual antiplatelet therapy. During ventriculography an apical LV thrombus of 16 mm diameter was detected. Due to the high bleeding risk in this patient, VKA therapy with potentially fluctuating international normalized ratio (INR) values was considered unsuitable. Therefore, dabigatran at a dose of 110 mg bid was chosen as anticoagulation therapy. After 4 weeks, cardiac computed tomography was performed, which failed to detect the LV thrombus described previously. Notably, triple therapy with dabigatran, clopidogrel, and aspirin was well tolerated without evidence for bleeding. The surgical resection of the rectal neoplasm was performed 2 months later without bleeding complications. Discussion: Anticoagulation is effective in patients with MI and a LV thrombus in reducing the risk of embolization and in dissolving the thrombus. Our case is complex due to the required triple therapy, very old age and significant bleeding risk of our patient due to the rectal neoplasia. Although only few reports are available for the use of non VKA oral anticoagulants (NOAC) in this indication, we chose dabigatran at a dose of 110 mg bid added to dual antiplatelet therapy for our patient. Besides the advantage of a predictable pharmacokinetic profile of NOAC in contrast to VKA, the effect of dabigatran can rapidly be reversed by idaruzicumab in the case of severe bleeding. Conclusion remarks: Physicians should carefully weigh the risk of thromboembolic events versus the risk of bleeding when combining antiplatelet with anticoagulation therapy.
A case report of hairy cell leukemia presenting concomitantly with sweet syndrome
Authors: Mohammad Alkayem, Waina Cheng
Journal: Case Rep Med (2014)

Hairy cell leukemia and Sweet syndrome are both uncommon hematological diagnoses. We present a patient who was admitted with fevers, pancytopenia, pneumonia, and rash. Diagnostic bone marrow biopsy demonstrates Hairy cell Leukemia and skin biopsy demonstrates neutrophils infiltration consistent with Sweet syndrome. The patient was treated with purine analogs with resolution of the cytopenias, infection, and rash.
A case series investigation of association between co-morbid psychiatric disorder and the improvement in body mass index among patients with anorexia nervosa and eating disorder not otherwise specified of the anorexia nervosa type
Authors: Robin Goh
Journal: J Eat Disord (2015)
Keywords: anorexia nervosa, body mass index, depression, generalized anxiety disorder, personality

Background:
Anorexia nervosa and eating disorder not otherwise specified* (not fulfilling Anorexia Nervosa DSM IV criteria) are increasing in Singapore. Patients with eating disorders may also present with other psychiatric disorders such as depression and anxiety. The paper aims to investigate the association of co-morbid psychiatric disorders with the improvement of body mass index (BMI) in these patients.
Methods:
A retrospective cohort analysis of 182 patients with anorexia and eating disorder not otherwise specified at a tertiary hospital was done. The clinical course of co-morbid psychiatric disorders was correlated with the improvement of body mass index.
Results:
109 patients were included in the analysis and the mean BMI on resolution of co-morbid psychiatric disorders was BMI 16.9. There is a significant association between the BMI groups and the resolution of co-morbid psychiatric disorders, χ2 = 10.2, p = .03. Patients in BMI group 5 (BMI 16.6 - 18.5) were noted to be significantly less likely to resolve their psychiatric co-morbidity compared to the other 4 groups. (OR = 0.323).
Conclusion:
Patients with anorexia nervosa and eating disorders not otherwise specified were at increased risk of having co-morbid psychiatric disorders and the clinical course of co-morbid psychiatric disorders appeared to correlate with improved BMI. Specifically patients with BMI < 16.5 with co-morbid psychiatric disorders were more likely to recover from their co-morbid psychiatric disorder with nutritional rehabilitation than patients with a higher BMI.
Multimodal imaging of acquired vitelliform lesion diagnosed at pseudohypopyon stage
Authors: Nuno Moreira Gonçalves, Angela M Carneiro, Elisete Brandão, Fernando M Falcão-Reis
Journal: Case Rep Ophthalmol Med (2013)

Purpose. To present a case study of a monocular acquired vitelliform lesion, studied with multimodal fundus imaging (spectral-domain-optical coherence tomography, fundus autofluorescence, and fluorescein angiography) with a followup of three years. Case Report. An asymptomatic macular lesion was detected on a 64-year-old man. Fundus exam revealed a macular lesion with an apparent horizontal level associated with multiple round small whitish lesions, suggestive of cuticular drusen. He was studied with autofluorescence of the fundus (FAF), fluorescein angiography (FA), spectral domain-optical coherence tomography (SD-OCT), and electrooculogram. The findings were compatible with the diagnosis of acquired vitelliform lesion, associated with cuticular drusen. After one year, the visual acuity decreased to 20/50, without identifiable alterations of the FAF, FA, or SD-OCT. Three years later, fundoscopy and imaging showed an evolution to a state similar to vitelli disruptive phase of Best disease with an improvement of visual acuity to 20/25. We report the results of FAF, FA, and SD-OCT at this stage. Conclusion. Acquired vitelliform lesions associated with cuticular drusen can present as a pseudohypopyon lesion, and the evolution to the atrophic phase can be associated with an improvement of visual acuity.
Transient neuronal injury followed by intravascular injection during an ultrasound guided stellate ganglion block
Authors: Hariharan Shankar, Swetha Simhan
Journal: Anesth Pain Med (2013)
Keywords: complications, stellate ganglion, ultrasonography
MeSH terms: Case Reports

Ultrasound guidance for pain interventions is becoming increasing recognized as a useful imaging tool. One of the common interventions where it is gaining wider acceptance is during the performance of a stellate ganglion block. The following is a unique report where intravascular and neuronal injury occurred during the performance of an ultrasound guided stellate ganglion block followed by dysphagia. 41 year old male, with a diagnosis of complex regional pain syndrome, was referred to our clinic for further management. He underwent a diagnostic ultrasound guided stellate ganglion block after having tried conservative therapies. The stellate ganglion block provided him with complete pain relief for over five weeks. During a subsequent therapeutic stellate ganglion block, performed by an experienced pain medicine fellow with more than 50 ultrasound guided proceduresclinician, the patient developed a transient injury to the brachial plexus upon needle entry. Subsequent redirection and injection of an ml of injectate resulted in an intravascular injection producing tinnitus. After the tinnitus decreased, he underwent another stellate block using an out of plane approach without any further complications. Two days later, he reported chest and throat discomfort which resolved over the next few days possibly due to a retropharyngeal hematoma. He declined further interventions and was subsequently managed with 3 tablets of oxycodone a day. This report highlights the importance of vigilance and meticulous planning during the performance of ultrasound guided pain interventions.
Vestibule-Middle Ear Dehiscence Tested With Perilymph-Specific Protein Cochlin-Tomoprotein (CTP) Detection Test
Authors: Takeshi Fujita, Takaaki Kobayashi, Kazuya Saito, Toru Seo, Tetsuo Ikezono, Katsumi Doi
Journal: Front Neurol (2019)
Keywords: ctp, cochlin-tomoprotein, conductive hearing loss, fissula ante fenestram, otic capsule dehiscence, perilymph, perilymphatic fistula
MeSH terms: Case Reports

An 8-year-old boy was referred to the ENT department for further evaluation of right-sided conductive hearing loss. A small cyst anterior to the oval window and fixation of the stapes footplate were observed during an exploratory tympanotomy. The concentration of a perilymph-specific protein, cochlin-tomoprotein (CTP), in the middle ear lavage fluid was measured with an ELISA-based CTP detection kit. The level of CTP in the middle ear lavage fluid before fenestration of the cyst was 0.26 ng/ml (negative), and its level after fenestration was 2.98 ng/ml (positive), confirming the presence of perilymph in the cyst. A small bone dehiscence, considered to be the fissula ante fenestram, was observed anterior to the stapes footplate after removal of the cyst. The CTP detection test results allowed us to confirm that the small bone dehiscence was connected to the inner ear.
Evidence already exists for motor system reorganization in CRPS
Authors: Shabbir Hussain I Merchant
Journal: Can J Pain (2018)
Keywords: complex regional pain syndrome, corticospinal tracts, graded motor imagery, motor system, transcranial magnetic stimulation

Complex regional pain syndrome (CRPS) is a disabling condition that is usually preceded by trauma or surgical procedure. Involvement of the motor system is a well-known phenomenon in CRPS, though the pathophysiologic mechanisms of motor system affliction in CRPS are poorly understood. Graded motor imagery (GMI) has been proposed to be one of the therapeutic interventions to help improve pain and other disabling symptoms associated with CRPS, though the benefits noted are modest and inconsistent. The neurophysiological mechanisms implicated in motor imagery are intended to target the aberrant prefrontal and sensorimotor integration areas, which may potentially help restore the aberrant cortical plasticity in CRPS. Detailed well-controlled experiments using insights from the existing body of literature on motor system reorganization in CRPS are required to better understand this complicated disorder. Attempts to gain pathophysiologic insights about complicated disorders like CRPS based on case reports with poorly performed and uncontrolled interventions are misguided.
Case report: Experience of a rare case of rebound of the Kasabach-Merritt phenomenon during sirolimus treatment in kaposiform hemangioendothelioma
Authors: Liang Wang, Jing Li, Changhua Wu, Dan Song, Zhuang Liu, Yanli Niu, Jie Zhou, Lei Guo
Journal: Front Pediatr (2022)
Keywords: kasabach-merritt phenomenon, ablation, embolization, kaposiform hemangioendothelioma, prognosis, vincristine
MeSH terms: Case Reports

Kaposiform hemangioendothelioma (KHE) is a rare vascular neoplasm associated with the Kasabach-Merritt phenomenon (KMP), which is a consumptive coagulopathy with associated potentially life-threatening thrombocytopenia. There are no standardized treatment protocols for the management of KHE with KMP. Moreover, there are limited reports regarding the treatment of cases of rebound. Herein, we describe a rare case of rebound of KHE/KMP, during systemic sirolimus treatment, successfully treated with embolization and vincristine infusion combined with microwave ablation.
Isolated Middle-Third Clavicle Fracture Causing Horner's Syndrome: A Case Report and Literature Review
Authors: Chia-Yu Lin, Hao-Wei Chang, Yu-Hsuan Chang, I-Hao Lin, Hung-Yu Huang, Cheng-Hsien Chang, Hsien-Te Chen, Yi-Wen Chen, Tsung-Li Lin, Chin-Jung Hsu
Journal: Front Surg (2021)
Keywords: horner's syndrome, clavicle fracture, emergency, oculosympathetic pathway, trauma
MeSH terms: Case Reports

The pathophysiology of Horner's syndrome arises due to compression or destruction of the oculosympathetic nerve pathway. Traumatic Horner's syndrome may indicate lethal neurovascular injury, such as brain stem lesion, cervical spine injury, or carotid artery dissection. The middle-third is the most common type of clavicle fracture. However, the association of the isolated middle-third clavicle fracture and Horner's syndrome is rare. We report the case of a 47 year-old woman who presented to our emergency department with acute trauma. Severe tenderness and limited mobility were observed in her left shoulder. On radiographic examination, a middle-third clavicle fracture was diagnosed. Ptosis and myosis were also noticed on further examination, and she was subsequently diagnosed with Horner's syndrome. A survey of the brain, cervical spine, carotid artery, and lung revealed no pathological findings. Surgery for the clavicle fracture was performed 2 days after the accident. The patient recovered from Horner's syndrome gradually over the 2 months following the surgery, and the syndrome completely resolved by the third month. To the best of our knowledge, this is the first report of traumatic Horner's syndrome caused by an isolated middle-third clavicle fracture. The improved outcome may be attributed to the surgical intervention for middle-third clavicle fracture, which may help release ganglion or neuronal compression.
Presence of Middle Cerebellar Peduncle Sign in FMR1 Premutation Carriers Without Tremor and Ataxia
Authors: Jessica L Famula, Forrest McKenzie, Yingratana A McLennan, James Grigsby, Flora Tassone, David Hessl, Susan M Rivera, Veronica Martinez-Cerdeno, Randi J Hagerman
Journal: Front Neurol (2018)
Keywords: fmr1 premutation, fxtas, mcp sign, mri, movement disorder
MeSH terms: Case Reports

Here we report five cases of male FMR1 premutation carriers who present without clinical symptoms of the fragile X-associated tremor/ataxia syndrome (FXTAS), but who on MRI demonstrate white matter hyperintensities in the middle cerebellar peduncles (MCP sign) and other brain regions, a rare finding. MCP sign is the major radiological feature of FXTAS; it is therefore remarkable to identify five cases in which this MRI finding is present in the absence of tremor and ataxia, the major clinical features of FXTAS. Subjects underwent a detailed neurological evaluation, neuropsychological testing, molecular testing, and MRI evaluation utilizing T2 imaging described here. Additional white matter disease was present in the corpus callosum in four of the five cases. However, all cases were asymptomatic for motor signs of FXTAS.
Case Report: Desmoid tumor response to magnetic resonance-guided high intensity focused ultrasound over 4 years
Authors: Sin Yuin Yeo, Grischa Bratke, Peter Knöll, Sebastian Gottfried Walter, David Maintz, Holger Grüll
Journal: Front Oncol (2023)
Keywords: hifu, mr-hifu, desmoid tumor, focused ultrasound, magnetic resonance-guided high intensity focused ultrasound, tumor control
MeSH terms: Case Reports

Desmoid tumors are a rare form of cancer, which show locally aggressive invasion of surrounding tissues and may occur anywhere in the body. Treatment options comprise conservative watch and wait strategies as tumors may show spontaneous regression as well as surgical resection, radiation therapy, nonsteroidal anti-inflammatory drugs (NSAID), chemotherapy, or local thermoablative approaches for progressive disease. The latter comprises cryotherapy, radiofrequency, microwave ablation, or thermal ablation with high intensity focused ultrasound (HIFU) as the only entirely non-invasive option. This report presents a case where a desmoid tumor at the left dorsal humerus was 2 times surgically resected and, after recurrence, thermally ablated with HIFU under magnetic resonance image-guidance (MR-HIFU). In our report, we analyze tumor volume and/or pain score during standard of care (2 years) and after HIFU treatment over a 4-year follow-up period. Results showed MR-HIFU treatment led to complete tumor remission and pain response.
Acute Diffuse Peritonitis Caused by Urinary Retention: A Rare Case of Gangrenous Cystitis
Authors: Konstantinos Kotoulas, Chrysostomos Georgellis, Engkin Kigitzi, Apostolos Liappis, Marios Spounos, Vasiliki Tsalkidou, Emmanouil Patris
Journal: Case Rep Urol (2018)
MeSH terms: Case Reports

Gangrenous cystitis is an umbrella term encompassing conditions from necrosis of the mucosa and submucosa to necrosis of the entire bladder wall that can result in acute peritonitis. Timely diagnosis is challenging as the symptoms are nonspecific and resemble other conditions such as cystitis. We report a case of gangrenous cystitis in a 63-year-old woman who was diagnosed with peritonitis preoperatively by a CT scan of the abdomen. Overdistension of the bladder due to chronic urinary retention was the primary cause. The patient underwent partial cystectomy, excising nonviable detrusor with preservation of the trigone and ureters, but conclusively succumbed. Etiopathology, symptoms, and treatment of this rare disease are also considered.
Epstein Barr Virus-positive large T-cell lymphoma presenting as acute appendicitis 17 years after cadaveric renal transplant: a case report
Authors: Shiva K Ratuapli, Shishir Murarka, Karen A Miller, James C Ferraro, Haider Zafar
Journal: J Med Case Rep (2011)

Introduction:
The majority of post-transplant lymphoproliferative disorders in renal transplant patients are of the B-cell phenotype, while the T-cell phenotype is rare. We report a case of Epstein Barr Virus-positive, T-cell lymphoma in a renal transplant patient, presenting unusually as acute appendicitis.
Case presentation:
A 45-year-old Hispanic male renal transplant patient presented with right-side abdominal pain 17 years after transplant. The laboratory studies were unremarkable. Laparoscopic exploration showed an inflamed appendix so a laparoscopic appendectomy was performed. Pathology of the appendix showed large cells positive for CD3, CD56 and Epstein Barr Virus-encoded RNA staining, and negative for CD20 and CD30. The tissue tested positive for T-cell receptor gene rearrangement by polymerase chain reaction analysis. Treatment management involved reduction of immunosuppression and initiation of chemotherapy with cisplatin, etoposide, gemcitabine, and solumedrol followed by cyclophosphamide, hydroxydaunorubicin, vincristine and prednisone). He recovered and the allo-grafted kidney is fully functional.
Conclusion:
We report a rare case of post-renal transplant large T-cell lymphoma, with an unusual presentation of acute appendicitis and Epstein Barr Virus-positivity, which responded well to chemotherapy.
Prurigo Nodularis after Radiotherapy: An Isoradiotopic Response?
Authors: Caspar Weel Krammer, Rami Mossad Ibrahim
Journal: Case Rep Dermatol Med (2018)
MeSH terms: Case Reports

Prurigo nodularis is a rare and chronic skin disorder with multiple, pruritic, and firm nodules. The exact pathophysiology is still unknown. Skin disorders appearing at sites of radiation can be defined as isoradiotopic. A 35-year-old male had developed a skin lesion in the left submandibular area on a base of irradiated skin which was initially suspected as a skin malignancy. The patient had a history of undifferentiated nasopharyngeal cancer with lymph node involvement which was treated by radiochemotherapy thirteen years previously. Histological examination confirmed that it was a case of prurigo nodularis which subsequently evolved at distant sites. This presentation may suggest a case of an isoradiotopic response.
Optical Coherence Tomography Angiography of Punctate Inner Choroidopathy
Authors: Blake M Hampton, Christopher M Aderman, Harry W Flynn Jr, Jayanth Sridhar
Journal: Case Rep Ophthalmol Med (2017)
MeSH terms: Case Reports

Purpose:
To report a case of bilateral choroidal neovascularization (CNV) in punctate inner choroidopathy (PIC) visualized utilizing optical coherence tomography angiography (OCT-A).
Methods:
Case report.
Results:
A 29-year-old woman presented with new visual symptoms in both eyes. Fundoscopic exam revealed bilateral multifocal, small, well-defined lesions consistent with PIC. Optical coherence tomography demonstrated subretinal fluid and retinal pigment epithelium detachments (RPEDs) in both eyes. OCT-A revealed bilateral abnormal increased flow within the RPEDs consistent with CNV. Fluorescein angiography confirmed the presence of bilateral CNV.
Conclusion:
CNV secondary to PIC may be identified using noninvasive optical coherence tomography angiography.
A rare association between a dermoid cyst and arachnoid cyst of the cerebellopontine angle: a case report
Authors: Zoubeyr Abbou, Rania Djennati, Zeyad Khalil
Journal: Pan Afr Med J (2021)
Keywords: arachnoid cyst, case report, cerebellopontine angle, child, dermoid cyst
MeSH terms: Arachnoid Cysts / diagnosis, Arachnoid Cysts / surgery, Dermoid Cyst / diagnosis, Dermoid Cyst / surgery, Case Reports, Brain, Cerebellopontine Angle, Drainage, Female, Humans, Magnetic Resonance Imaging

Supratentorial arachnoid cysts are usually asymptomatic and may be discovered by chance at autopsy; however, infratentorial arachnoid cysts, which correspond to liquid forms enclosed by an arachnoid sheet but whose pathogenesis is unknown, might cause symptoms. They don't need to be treated if they're asymptomatic and were discovered by chance. A variety of neurological symptoms can be present depending on their localization. Intracranial dermoid cysts are uncommon tumours that develop from ectopic epithelial cells in the brain. They are benign, slow-growing, and rarely rupture. The association between the two diseases is extremely rare and when it is present may suggest the existence of a common factor. We present a unique case of a young girl who developed headache and ataxia as a result of an intracranial infratentorial dermoid cyst and an arachnoid cyst of the cerebellopontine angle. Complete removal of the dermoid cyst and drainage of the cyst leads to a full recovery. Dermoid and arachnoid cyst are two pathologies with a possible common embryogenic factor, early surgery can give a better outcome in the long term.
Acute Liver Rejection in a Multiple Myeloma Patient Treated with Lenalidomide
Authors: Iuliana Vaxman, John Eaton, Hee Eun Lee, Morie A Gertz
Journal: Case Rep Transplant (2020)
MeSH terms: Case Reports

Herein we present a patient that underwent a liver transplant due to primary biliary cholangitis (PBC) and after 9 years developed multiple myeloma. Following the cessation of mycophenolate mofetil and 2 weeks after lenalidomide treatment was started, the patient experienced acute cellular rejection. The patient recovered after treatment with corticosteroids, resumption of mycophenolate mofetil, and cessation of lenalidomide. Lenalidomide-associated allograft rejection has been reported in other organs. However, this is the first case report of liver rejection induced by lenalidomide.