OpenMed/multicare-articles huggingface dataset:
Deeply jaundiced: Not so surgical after all
Authors: Wesley P du Plessis, Sa'ad Lahri, Keethal Somers, Tamsin Lovelock
Journal: S Afr J Infect Dis (2023)
Keywords: south africa, jaundice, leptospirosis, severe leptospirosis, travel
MeSH terms: Case Reports

Leptospirosis is an under-recognised disease in sub-Saharan Africa and the diagnosis requires a high index of suspicion. This case report highlights the protean manifestations of leptospirosis. Leptospirosis should be considered in any patient presenting with fever and jaundice, especially when there has been a history of occupational or recreational exposure to water, soil or rodents.
Contribution:
This case report describes a typical case of leptospirosis, which often presents as a diagnostic dilemma.
A Rare Variant of Zinner Syndrome Involving Ectopic Ureteral Implantation into the Seminal Vesicle Causing Recurrent Epididymitis
Authors: Michael Zaliznyak, Aaron Baer, Joshua Trierweiler, Thomas Landon, Zachary Hamilton
Journal: Case Rep Urol (2024)
MeSH terms: Case Reports

Zinner syndrome is a rare congenital anomaly characterized by a triad of renal dysgenesis/agenesis, cysts in the ipsilateral seminal vesicle, and ejaculatory duct obstruction. Though often diagnosed in infancy, the diagnoses can be incidentally found in adults who present with nonspecific genitourinary symptoms including dysuria, ejaculatory dysfunction, or genital pain. We present an unusual case of a 29-year-old male patient who presented to the emergency department with recurrent testicular pain and hematospermia and was found to have an atrophic right kidney with an ectopic ureter implanting into a cystic seminal vesicle. These findings were consistent with a rare subvariant of Zinner syndrome only previously described four times in the literature. We performed a robotic-assisted laparoscopic ectopic nephroureterectomy with sparing of his seminal vesicle. To our knowledge, this is the first report to describe the safe and effective use of robotic surgery in this setting to remove affected anatomy while preserving the patient's seminal vesicle.
Unusual cutaneous adverse reaction to an erectile dysfunction drug: A case report
Authors: Ivânia Soares, Inês P Amaral, Madalena P Correia, Paulo Filipe
Journal: Urol Case Rep (2023)
Keywords: agep, cutaneous adverse reaction, tadalafil
MeSH terms: Case Reports

We presents an unique and significant case of Acute Generalized Exanthematous Pustulosis (AGEP) associated with the use of tadalafil, a phosphodiesterase type 5 inhibitor for erectile dysfunction. AGEP, typically linked to antibiotics and antiepileptics, had not been previously reported with tadaladil in the MEDLINE database. The case involved a 40-year-old male who developed an erythematous rash, fever and sterile pustules after starting tadalafil. A skin biopsy confirmed AGEP. Discontinuation of the drug and treatment with prednsiolone cleared the dermatosis. This case emphasizes the need for awareness among healthcare providers regarding this potential adverse reaction, considering the growing use of tadalafil.
Lisdexamfetamine-Induced Psychosis in a Patient With a Neurodevelopmental Disorder
Authors: Raghu Gandhi, Aimee Murray
Journal: Cureus (2024)
Keywords: adhd, autism spectrum disorder, neurodevelopmental disorders, psychosis, stimulants
MeSH terms: Case Reports

Individuals diagnosed with autism spectrum disorder (ASD) often experience a higher occurrence of comorbid attention deficit hyperactivity disorder (ADHD). Stimulant medications are frequently prescribed to manage ADHD. In rare instances, the use of stimulant medications has been linked to the development of psychotic symptoms. This is a case of a 13-year-old male diagnosed with ASD and comorbid ADHD, anxiety, and depression, who presented with an abrupt onset of psychosis, which manifested about a week after the initiation of lisdexamfetamine. The psychotic symptoms subsided upon discontinuation of lisdexamfetamine; however, there was a re-emergence of severe ADHD symptoms that proved resistant to non-stimulant medications. The patient experienced significant improvement without any recurrence of psychosis after being prescribed extended-release methylphenidate. Notably, there are no established clinical guidelines to assist in selecting one stimulant over another in the treatment of ADHD comorbid with ASD. The authors recommend considering the methylphenidate class of stimulants as a first-line treatment for ADHD in individuals with ASD, citing better tolerability compared to amphetamines.
Case report: Alternative approach for management of refractory volume overload in heart failure: usefulness of venous leg compression
Authors: Carlos Collado Macián, David Pujol Pocull, Fernando Dominguez, Juan Carlos López-Azor, Pablo Garcia-Pavia, Julio Nuñez, Marta Cobo Marcos
Journal: Front Cardiovasc Med (2023)
Keywords: edema, heart failure, heart failure and transplantation diuretic resistance, lower limb compression bandaging, venous leg compression
MeSH terms: Case Reports

Background:
Management of patients with refractory congestion, is one of the most important challenges in the field of heart failure (HF). Diuretic therapy remains the most widely used therapy to achieve euvolemia. However, some patients experience fluid overload despite the use of high-dose diuretics and new strategies to overcome diuretic resistance are needed.
Case summary:
We report an 85 years-old male patient admitted for decompensated HF with persistent tissue fluid overload (peripheral edema) for more than two weeks despite high dose of intravenous furosemide with the combination of other diuretics. At this point, we performed leg venous compression using elastic bandages for three days. After 72 h, edema disappeared, and additional weight loss was achieved (1 kg/day). No side effects were observed and the patient was discharged home euvolemic.
Conclusion:
Venous leg compression may be an alternative therapy in patients with persistent tissue fluid overload resistant to diuretics.
Dystonic Tremor as an Atypical Presentation of Cervical Radiculopathy
Authors: Eric Chun-Pu Chu, Lucina Ng
Journal: Cureus (2024)
Keywords: brachialgia, cervical radiculopathy, chiropractic, chiropractor, dystonia, tremor
MeSH terms: Case Reports

Cervical radiculopathy often presents with neck pain, sensory disturbances, or motor weakness. This case report describes an atypical presentation of cervical radiculopathy manifesting as dystonic tremor and brachialgia, which has been documented only once previously. A 46-year-old, right-handed, male delivery worker presented with severe neck pain that gradually evolved into a dystonic tremor and sharp aching pain across his right shoulder. Despite medical intervention, his symptoms persisted, leading him to seek chiropractic care. Physical examination and diagnostic tests revealed degenerative osteophytes, causing bilateral foraminal impingement and narrowing. As orthopedic interventions only provide temporary relief, the patient opted for conservative chiropractic management, which led to a remarkable reduction in pain and complete resolution of the dystonic tremor and brachialgia. This case demonstrates that cervical disc prolapse may manifest with dystonic tremor due to excruciating radiculopathy. Additionally, it emphasizes the potential benefits of chiropractic care in managing such atypical presentations and underscores the need for further research on the mechanisms and management of such cases.
The Tunnelled Atrial Catheter: A Promising Solution for Vascular Capital Depletion in Dialysis despite Associated Thrombi
Authors: Meriam Hajji, Salah Saied, Ikram Mami, Yassine Khadhar, Tasnim Ben Ayed, Imen Gorsane, Fethi Ben Hamida, Jalel Ziadi, Mohamed Karim Zouaghi, Ezzeddine Abderrahim
Journal: Case Rep Nephrol (2024)
MeSH terms: Case Reports

Introduction:
Longer survival in dialysis led to a higher incidence of vascular access complications and failure. With the limited access to kidney transplantation programs and peritoneal dialysis, exhaustion of vascular access for hemodialysis is an increasingly common situation. Among the available options, atrial tunneled dialysis catheter (ATDC) has been reported as an effective vascular access in this population. Methodology. We report the experiences of two nephrology centers in Tunis with ATDC as an ultimate vascular access for dialysis. Case Reports. Two patients with exhausted vasculature underwent ATDC insertion in 2020 and 2022, respectively, as a vascular access of last resort. Both patients underwent CRBI, which resolved with favorable outcomes. One case was complicated by post-operative thrombosis and was successfully treated with thrombolysis. Both patients are currently on dialysis via their ATDC with a catheter patency of 29 months.
Conclusion:
ATDC is a life-saving and safe vascular access in cases of depleted vasculature. Little more than 50 cases have been reported in the literature during the last 30 years. As the frequency of vasculature exhaustion is expected to increase, preservation of veinous access in patients at risk of chronic kidney disease have never been more crucial.
Omeprazole Induced Rapid Drug Reaction with Eosinophilia, Systemic Symptoms, and Cross-Reactivity in Delayed-Type Hypersensitivity Associated with Proton-Pump Inhibitors: A Case Report and Literature Review
Authors: Kanokkarn Pinyopornpanish, Kanokporn Pinyopornpanish, Kanokwan Pinyopornpanish, Juthipong Benjanuwattra, Putthapon Teepapan, Apinya Chungcharoenpanich, Wannada Laisuan
Journal: Case Reports Immunol (2024)
MeSH terms: Case Reports

Background:
Omeprazole, a proton pump inhibitor (PPI), is a widely used and generally safe agent for treating acid-related gastrointestinal conditions. However, drug reaction with eosinophilia and systemic symptoms (DRESSs) syndrome has been reported.
Objectives:
To report a case of omeprazole-induced rapid DRESS syndrome and to review the literature.
Methods:
Descriptive analysis of one new case and a case series from literature review.
Results:
We report a case of 82-year-old woman presenting with rapid-onset of DRESS syndrome. The condition was initially suspected to be caused by antibiotic, but the definite diagnosis was eventually omeprazole-induced DRESS syndrome as suggested by the enzyme-linked immune absorbent spot (ELISpot) assay along with the clinical picture. Previous literatures regarding cases of PPI-induced DRESS syndrome were pooled for descriptive analysis. Among 21 PPI cases pooled, esomeprazole was the most commonly implicated PPI (52.4%), followed by pantoprazole (19.1%), and omeprazole along with lansoprazole (both 14.3%). The issue of cross-reactivities amongst PPIs remains uncertain. Nonetheless, in situations in which a PPIs are deemed necessary, a prudent approach could be considering a switch to an alternative agent with distinct chemical structure.
Conclusion:
PPI is commonly used safely as an agent for acid-related gastrointestinal conditions. However, PPI-induced rapid DRESS syndrome can occur, particularly with prior exposure history. ELISpot is an in vitro test, useful in identifying the culprit agent in patients with delayed-type hypersensitivity reaction.
Case Report: Mycoplasma pneumoniae-associated acute pancreatitis
Authors: Hong Sun, Wei-Qun Wang, Long Lin, Zheng-Yang Shao, Lu Zhan, Lan-Fang Tang
Journal: Front Pediatr (2024)
Keywords: mycoplasma pneumoniae, acute pancreatitis, children, cytokine, extrapulmonary complications
MeSH terms: Case Reports

Mycoplasma pneumoniae is the primary pathogen causing community-acquired pneumonia in children, accounting for approximately 10%-40% of cases. It can lead to various extrapulmonary complications, including acute pancreatitis, which has been reported in approximately 30 cases to date. Here, we report a 4-year-old girl who presented with fever, cough, and elevated levels of M. pneumoniae IgM antibodies, followed by the onset of abdominal pain, elevated lipase, and elevated blood and urine amylase. Abdominal CT implied diffuse inflammation of the pancreas. Serum inflammatory cytokines, such as interleukin (IL)-2, IL-6, IL-17A, tumor necrosis factor, and interferon-gamma, were elevated. After excluding other causes, it was determined that M. pneumoniae infection was the cause of her acute pancreatitis. She was treated with macrolides and glucocorticoids and ultimately made a full recovery. Therefore, acute pancreatitis should be included in the differential diagnosis for patients with M. pneumoniae infection who present with abdominal pain. Inflammatory cytokines may play a role in mediating pancreatic damage.
Spinal cord stimulation in severe pharmacoresistant restless legs syndrome-two case reports
Authors: Sandra Hackethal, Paolo Maino, Eva Koetsier, Mauro Manconi
Journal: Front Neurol (2023)
Keywords: augmentation, case report, epidural spinal cord stimulation, periodic limb movements during sleep, restless legs syndrome
MeSH terms: Case Reports

Restless legs syndrome is a prevalent, sleep-related sensorimotor disorder with relevant impact on the patients' quality of life. For patients suffering from severe, pharmacoresistant restless legs syndrome, few therapeutic options remain to alleviate symptoms. In this case series, two patients with severe, pharmacoresistant restless legs syndrome were treated with epidural spinal cord stimulation and repeatedly assessed with polysomnography, including sleep structure and periodic limb movements as objective biomarkers not subject to placebo effects, during a 6-month follow-up period. One of the patients experienced excellent short- and long-term efficacy on subjective symptom severity (International RLS Study group rating scale 1 vs. 34 points at 3 months) and objective sleep parameters such as sleep architecture and periodic limb movements during sleep, while the second patient only reported short-term benefits from spinal cord stimulation. Ultimately, both patients opted for removal of the device for inefficacy. Based on the complex pathophysiology of restless legs syndrome and presumed mechanism of action of spinal cord stimulation in chronic pain disorders, we provide a detailed hypothesis on the possible modulating effect of spinal cord stimulation on the key symptoms of restless legs syndrome. Apart from describing a new therapeutic option for pharmacoresistant restless legs syndrome, our findings might also provide further insights into the pathophysiology of the syndrome.
Case report: Echocardiographic and computed tomographic features of congenital bronchoesophageal artery hypertrophy and fistula in a dog
Authors: Yewon Ji, Jinsu Kang, Suyoung Heo, Kichang Lee, Hakyoung Yoon
Journal: Front Vet Sci (2024)
Keywords: aberrant bronchoesophageal artery, aortopulmonary shunt, canine, cardiovascular anomaly, esophageal varices
MeSH terms: Case Reports

Introduction:
Studies on aberrant bronchoesophageal arteries are limited. Herein, we report a case of a multi-origin systemic-to-pulmonary shunt with suspected bronchoesophageal artery hypertrophy and fistula in a dog.
Case report:
A 4-year-old castrated male beagle weighing 11 kg underwent routine medical screening. Physical examination revealed a right-sided continuous murmur of grades 1-2. Thoracic radiography revealed a mild cardiomegaly. Echocardiography revealed a continuous turbulent shunt flow distal to the right pulmonary artery (RPA) branch from the right parasternal short axis pulmonary artery view. Computed tomography demonstrated systemic-to-pulmonary shunts originating from the descending aorta at the level of T7-8, the right 5th and 6th dorsal intercostal arteries, and the right brachiocephalic trunk, which formed anomalous networks around the trachea and esophagus that anastomosed into a large tortuous vessel at the level of T6-7 and entered the RPA. Surgical ligation of multiple shunting vessels was performed. Postoperative echocardiography and computed tomography showed decreased left ventricular volume overload and markedly decreased size of the varices. Additionally, most of the shunting vessels were without residual shunt flow.
Conclusion:
The present study provides information regarding imaging features and the successful surgical management of multiple systemic-to-pulmonary shunts originating from the descending aorta, right brachiocephalic trunk, and intercostal arteries and terminating at the RPA. Multimodal imaging features after surgical ligation have also been described.
A rare morphology of the cardiac fibroma in a child: a case report
Authors: Yunfei Tian, Jiayi Lin, Xiaohui Yang, Debin Zeng, Yuan Hu, Jingnan Chen, Zhongshi Wu, Xicheng Deng
Journal: Front Cardiovasc Med (2024)
Keywords: cardiac fibroma, cardiac mass, echocardiography, pediatric, surgery
MeSH terms: Case Reports

Here we report a rare morphology of a cardiac fibroma in a child. A 2-year and 8-month-old toddler came for "chronic constipation" and was found to have a heart murmur on cardiac auscultation. Further transthoracic echocardiography suggested "a strong echogenic mass in the left ventricular wall, with some part of "a string of beads" in shape extending into left ventricle outflow tract", which was atypical for either a tumor, thrombus or vegetation. The child underwent resection of the mass and mitral valvuloplasty. Pathological examination confirmed the mass as a cardiac fibroma.
Case report of scrub typhus complicated by hypokalemia and multiple organ dysfunction syndrome
Authors: Li Chen, Yi Deng, Peiying Huang, Sisi Lei, Shuling Liu, Weitao Lin, Zhishang Li, Jing Zeng, Miaochun Huang, Qiuping Huang, Qihua Wu, Haobo Zhang, Bojun Chen
Journal: Sao Paulo Med J (2024)
MeSH terms: Hypokalemia, Scrub Typhus, Shock, Septic, Case Reports, Electrolytes, Female, Humans, Middle Aged, Multiple Organ Failure, Electrolytes

Context:
Scrub typhus, caused by Orientia tsutsugamushi, has a wide range of clinical manifestations, including meningoencephalitis, acute renal failure, pneumonitis, myocarditis, and septic shock. However, there are no documented cases of scrub typhus with hypokalemia. In this report, we present a case of scrub typhus with hypokalemia and multiple organ failure syndrome, highlighting the importance of electrolyte imbalance in patients with scrub typhus.
Case report:
A 59-year-old woman presented to the emergency department with abdominal pain that had been present for 1 day. On admission, the physical examination and laboratory test results indicated that the patient had renal, liver, and circulatory failure, and hypokalemia. She developed meningitis and disseminated intravascular coagulation during hospitalization. She recovered with appropriate management, and was discharged on day 17.
Conclusion:
This report highlights the potential for atypical presentations of scrub typhus, including a previously undocumented association with hypokalemia. Although the contribution of hypokalemia to the patient's clinical course remains uncertain, this case underscores the importance of considering electrolyte imbalance in the management of patients with scrub typhus. Further research is warranted to better understand the relationship between scrub typhus and electrolyte imbalance.
Case Report: Case report: An unusual presentation of granulomatosis with polyangiitis
Authors: Ichrak Bannour, Maroi Ben Brahim, Sondes Arfa, Soumaya Ben Amor, Asma Ben Mabrouk, Olfa Berrich, Sonia Hammemi
Journal: F1000Res (2023)
Keywords: case report, granulomatosis with polyangiitis, necrotizing granulomatosis hepatitis, skin lesions
MeSH terms: Granulomatosis with Polyangiitis / complications, Granulomatosis with Polyangiitis / diagnosis, Lung Diseases, Case Reports, Antibodies, Antineutrophil Cytoplasmic, Cyclophosphamide, Humans, Inflammation, Male, Middle Aged, Nose, Cyclophosphamide, Antibodies, Antineutrophil Cytoplasmic

Aim: We are reporting a case of an unusual presentation of granulomatosis with polyangiitis (GPA) with liver involvement. Case presentation: A 45-year-old male patient presented with erythematous plaques on the face and bilateral nasal obstruction. On physical examination, the patient had a ring-shaped squamous plaque on the face. The laboratory findings revealed an accelerated erythrocyte sedimentation rate at 100 mm/h, an elevated C-reactive protein at 66 mg/L, hyper gamma globulinemia 16 g/L and an elevated alkaline phosphatase (twice the upper normal limit). The craniofacial and thoracoabdominal computed tomography (CT) -scans showed ethmoid and maxillary sinusitis, low facial bone density, multiple mediastinal and hilar lymphadenopathy, diffuse small pulmonary nodules, and hepatomegaly. A cutaneous lesion biopsy, the nasal mucosa, and the liver showed a chronic inflammatory granulomatosis process with necrosis. Serum anti-neutrophil cytoplasmic antibody (ANCA) against PR3 was positive. The clinical, biological, radiological, and histological findings substantiated the diagnosis of GPA. The patient received systemic steroids combined with cyclophosphamide pulses on days 1, 14 and 28 and then he was lost to follow-up. Two-years later, he presented with a cardiac failure and skin ulcer in the right lower limb. A nasal endoscopic exam showed nasal septum cartilage perforation with resorption of the middle and inferior nasal concha. Two weeks later, he developed a diffuse alveolar hemorrhage and was therefore transferred to the intensive care unit but died of respiratory failure 3 days later. Conclusion: Clinicians should be aware of GPA atypical clinical manifestations.
Exposed Embolic Coils Observed in a 64-Year-Old Male With Head and Neck Cancer Following Transarterial Embolization for Carotid Blowout Syndrome
Authors: Jia-Zheng Huang, Wei-Chen Lu, Bo-Ching Lee
Journal: Case Rep Oncol Med (2024)
Keywords: carotid blowout syndrome, head and neck cancer, transarterial embolization
MeSH terms: Case Reports

Background: Delayed migration and exposure of embolic coils is a rare complication of endovascular therapy for carotid blowout syndrome. Methods: A 64-year-old man with recurrent tongue cancer noticed the presence of foreign body in the malignant wound on the right side of his neck. He had undergone transarterial embolization on his right vertebral artery, right common carotid artery (CCA), and internal carotid artery (ICA) for carotid blowout syndrome 1 month prior. On physical examination, exposed spring-like metallic coils were observed, covered in brownish granulation tissue, at the bottom of the malignant wound. Neck radiograph and computed tomography confirmed the extrusion and migration of the embolic coils. Results: In this case, the patient was managed by transection of the exposed coils at the wound surface with close monitoring. Conclusions: Computed tomography angiography is essential for assessing the condition of the remaining embolic coils. In cases with thrombosed parent arteries, a conservative approach, like the transection of exposed coils, can be employed as part of the management strategy.