OpenMed/multicare-articles huggingface dataset:
Acute Myocardial Infarction of the Left Main Coronary Artery Presenting with Cardiogenic Shock and Pulmonary Edema during Noncardiac Surgery
Authors: Sakae Takenaka, Takao Konishi, Tomoya Sato, Atsushi Tada, Takuya Koizumi, Yoshifumi Mizuguchi, Takahide Kadosaka, Ko Motoi, Yuta Kobayashi, Hirokazu Komoriyama, Yoshiya Kato, Miwa Sarashina, Kazunori Omote, Shingo Tsujinaga, Takuma Sato, Rui Kamada, Kiwamu Kamiya, Hiroyuki Iwano, Toshiyuki Nagai, Tatsuya Orimo, Hirofumi Kamachi, Akinobu Taketomi, Toshihisa Anzai
Journal: Case Rep Cardiol (2021)
MeSH terms: Case Reports

Acute myocardial infarction (AMI) caused by severe stenosis of left main coronary artery (LMCA) presenting with cardiogenic shock and pulmonary edema during noncardiac surgery is uncommon, but a catastrophic event. A 77-year-old male with cholangiocarcinoma underwent hepatectomy. During the surgery, he presented with cardiogenic shock, which did not respond to infusion administration or vasopressor. A transesophageal echocardiogram revealed anterior, septal, and lateral severe hypokinesia and impaired left ventricular function. Emergent coronary angiogram showed severe stenosis of LMCA. The patient underwent primary percutaneous coronary intervention (PCI) under the support of intra-aortic balloon pump, followed by extracorporeal membrane oxygenation. The chest roentgenogram showed pulmonary edema. Two days after PCI, he successfully underwent hepatectomy and bile duct resection. Early identification of the cause of hemodynamic instability during noncardiac surgery and invasive strategy are important for minimizing the myocardial injury and improving clinical outcomes in AMI of LMCA.
Embolisation of posttraumatic superior mesenteric artery pseudoaneurysm in a patient with short bowel syndrome preceding bowel transplantation
Authors: Vinko Vidjak, Karlo Novacic, Marko Slavica
Journal: Case Rep Radiol (2011)
MeSH terms: Case Reports

Penetrating abdominal trauma often causes bowel injuries which may lead to "short bowel syndrome" which is a potential indication for bowel transplantation. Posttraumatic pseudoaneurysms of abdominal arteries are often a result of penetrating abdominal trauma. We report a successful embolisation of posttraumatic superior mesenteric artery (SMA) branch pseudoaneurysm using microcoil, in a patient with short bowel syndrome who was successfully transplanted three months after embolisation.
A Case of Pulmonary Cement Embolism Managed through Symptomatic Treatment
Authors: Alex R Waler, Kyle J Sanchez, Amay A Parikh, Okorie N Okorie
Journal: Case Rep Crit Care (2020)
MeSH terms: Case Reports

Objective:
This case describes symptomatic pulmonary cement embolism as a rare postvertebroplasty complication and highlights its critical yet ill-defined management.
Background:
Pulmonary cement embolism (PCE) is a feared complication of vertebroplasty in the treatment of vertebral fractures. While the majority of PCEs are asymptomatic, symptomatic PCEs often present with chest pain, tachycardia, signs of severe respiratory distress, and death. Computer tomography angiogram (CTA) allows visualization of cement within the pulmonary vasculature. Despite the well-established risk of PCE, clinical management is unclear with limited research on treatment options. Reported treatments include anticoagulation, embolectomy, CPR, and supportive care and observation. Report. We report the case of a 75-year-old woman who experienced shortness of breath, tachypnea, tachycardia, hypertension, and hypoxemia five days following a corrective surgery for a compression fracture of L3 with pedicle screw fixation, fusion of L2 through L4, and L2 vertebral body cement augmentation with polymethyl methacrylate.
Results:
Breath sounds were diminished bilaterally with respiratory alkalosis and hypoxemia evident on arterial blood gas. CTA revealed intravasated cement throughout the right lung, including the pulmonary artery and upper and middle lobar arteries. The proposed mechanism is embolization of cement particles from the lumbar veins, which also showed intravasation. Due to the inorganic nature of the occluding material, the use of a thrombolytic agent was ruled against. Treatment included bronchodilators, 3 L of oxygen via nasal cannula, and prophylactic antibiotics, pulmonary toilet, and incentive spirometry. Symptomatic management was continued until she was discharged from the hospital in a stable condition.
Conclusions:
Postvertebroplasty pulmonary cement embolisms can be managed conservatively, without the use of anticoagulant or thrombolytic agents. This case illustrates a variation of care for this rare presentation and adds to the sparse literature on the management of PCEs.
A rare case of granuloma faciale presenting with ulceration: A case report
Authors: Farhan Mahmood, Iris Yh Teo, Steven J Glassman
Journal: SAGE Open Med Case Rep (2022)
Keywords: granuloma faciale, monoclonal gammopathy, monoclonal gammopathy of undetermined significance, ulcer
MeSH terms: Case Reports

Granuloma faciale is an uncommon inflammatory dermatosis characterized by persistent dermal plaques, typically on the face, that mimic granulomatous disorders like sarcoidosis. Ulceration of granuloma faciale has very rarely been reported, and the plaques are usually asymptomatic and of cosmetic impact. We present a case of an 83-year-old male with recurrent granuloma faciale with spontaneous ulceration and monoclonal gammopathy of undetermined significance. Intralesional triamcinolone, 10 mg/mL monthly for 5 months, with pimecrolimus cream twice daily resolved the ulceration and the lesion continues to flatten and lighten. Ulceration is rare and atypical in granuloma faciale lesions which can be treated.
From Neck Pain to Sarcoidosis: The Interesting Association
Authors: Fadi Kharouf, Mohammad Yassin, Issa Al-Kharouf, Issam Hindi, Rottem Kuint
Journal: Case Rep Rheumatol (2021)
MeSH terms: Case Reports

We report the case of a 31-year-old male patient, presenting to the emergency department (ED) with a 6-week history of left-sided lateral neck pain, along with a minor localized swelling. A few weeks after the beginning of his complaints, he contracted a mild coronavirus disease 2019 (COVID-19). Upon examination, his aches were defined as carotidynia; thus, proper radiologic evaluation was carried out. While ultrasound (US) and magnetic resonance imaging (MRI) scans showed evident signs of left common carotid (LCC) vasculitis, computed tomography angiography (CTA) and positron emission tomography-CT (PET-CT) scans revealed no vascular findings. Unexpected hypermetabolic hilar and mediastinal lymphadenopathy was found on PET-CT, necessitating lymph node biopsy. Pathology results displayed noncaseating granulomas. Besides, angiotensin-converting enzyme (ACE) levels in blood were high. Sarcoidosis, with concurrent LCC vasculitis, was diagnosed, and corticosteroid therapy was started. Shortly thereafter, remarkable recovery ensued.
Neonatal episodic hypoglycemia: a finding of valproic acid withdrawal
Authors: Dilek Çoban, Selim Kurtoğlu, Mustafa Ali Akın, Mustafa Akçakuş, Tamer Güneş
Journal: J Clin Res Pediatr Endocrinol (2010)
Keywords: hypoglycemia, newborn, valproic acid, withdrawal
MeSH terms: Anticonvulsants / adverse effects, Hypoglycemia / chemically induced, Infant, Newborn, Diseases / chemically induced, Prenatal Exposure Delayed Effects / chemically induced, Valproic Acid / adverse effects, Case Reports, Anticonvulsants / therapeutic use, Epilepsy / drug therapy, Female, Glucose / administration & dosage, Glucose / therapeutic use, Humans, Hypoglycemia / drug therapy, Infant, Newborn, Infant, Newborn, Diseases / drug therapy, Infusions, Intravenous, Male, Pregnancy, Pregnancy Complications / drug therapy, Prenatal Exposure Delayed Effects / drug therapy, Treatment Outcome, Valproic Acid / therapeutic use, Young Adult, Anticonvulsants, Valproic Acid, Glucose

The treatment of epilepsy during pregnancy is a worldwide problem. Drugs need to be used to control seizures in the mothers. In utero, exposure to valproic acid (VPA) and phenytoin (PH) may cause congenital malformations and also withdrawal symptoms such as irritability, jitteriness and symptoms of hypoglycemia. We present here a newborn with episodic hypoglycemia due to in utero exposure to VPA and PH. The mother was diagnosed as having complex partial epilepsy and was treated with PH (200 mg/day) and VPA (600 mg/day). The offspring developed jitteriness on the second day of life. The infant was hypoglycemic (32 mg/dl). These findings were accepted as withdrawal symptoms, since serum levels of VPA and PH were 37.8 μg/ml (50-100 μg/ml) and 6.37 μg/dl (10-20 μg/ml), respectively. Measurement of blood glucose is important and should be carefully monitored in infants exposed to antiepileptics in utero.
Hemophilia A Complicated by Ulcerative Colitis
Authors: Maxim Olivier, Mario Madruga, S J Carlan, Li Ge
Journal: Case Rep Gastrointest Med (2018)
MeSH terms: Case Reports

Background:
Hemophilia A is an X-linked recessive disorder characterized by defective synthesis of Factor VIII protein. Depending on the level of FVIII activity, patients may present with easy bruising, inadequate clotting of traumatic or mild injury, or in severe hemophilia, spontaneous hemorrhage. Ulcerative colitis (UC) is an inflammatory bowel disease (IBD) that is reported to have a decreased frequency of occurrence in subjects with coagulation disorders.
Case:
A 26-year-old white male with Hemophilia A was admitted for one month of rectal bleeding. The bleeding continued despite Factor VIII replacement and colonoscopy and biopsy were performed confirming the presence of active UC.
Conclusion:
Ulcerative colitis with underlying F VIII deficiency can result in serious, prolonged, and possibly fatal bleeding if left unrecognized and untreated. Treatment of both conditions concurrently utilizing tertiary facilities and consultations appears to be the safest strategy for management.
Management of coccydynia in the absence of X-ray evidence: Case report
Authors: Samantha Dayawansa, David Garrett Jr, Marcus Wong, Jason H Huang
Journal: Int J Surg Case Rep (2019)
Keywords: coccydynia, coccygectomy, coccygodynia, coccyx, spine

Background and importance:
Coccydynia is a rare pain syndrome due to trauma to the coccyx that is diagnosed through history, physical, and sitting/standing lateral plain film radiographs. Coccydynia is typically managed conservatively with specialized cushions, NSAIDS, and physical therapy. In cases refractory to nonsurgical management, coccygectomy has a high success rate for pain reduction.
Clinical presentation:
Our patient had coccygeal pain for three years and endorsed a mobile fragment that was not highlighted on plain film radiographs. After evaluation with MRI and CT, a coccygeal source of their pain was highlighted and partial coccygectomy was performed.
Conclusion:
Post-operatively, patient endorsed major improvement in her pain at follow up. In a case of suspected coccydynia where initial imaging is inconclusive but clinical suspicion is very high, higher level imaging such as MRI or CT can reveal radiographic findings of coccydynia. MRI and CT can play a role in the diagnosis and treatment of coccydynia in the absence of x-ray evidence.
Keratitis due to Chaetomium sp
Authors: Jayaraman Kaliamurthy, Catti Munuswamy Kalavathy, Christadoss Arul Nelson Jesudasan, Philip A Thomas
Journal: Case Rep Ophthalmol Med (2011)
MeSH terms: Case Reports

Aim. To describe keratitis due to Chaetomium sp. occurring in a 65-year-old woman who presented with a corneal ulcer with hypopyon of the right eye with a history of trauma by vegetable matter. Method. Multiple scrapings were obtained from the ulcer. A lactophenol cotton blue wet mount and a Gram-stained smear of the scrapings were made. Scrapings were also inoculated onto various culture media. Results. Direct microscopy of corneal scrapings revealed moderate numbers of septate fungal hyphae. Greenish-yellow-coloured fungal colonies with aerial mycelium were observed in culture of the corneal scrapes. On the basis of colony characteristics and conidial structure, the fungal isolate was identified as Chaetomium sp. The patient was treated with topical natamycin (5%) hourly and cyclopentolate 1% drops 3 times a day. After 4 weeks of therapy, the hypopyon had disappeared, the epithelial defect had healed, and the stromal infiltration had almost completely resolved; the visual acuity of the eye improved from hand movements to (1/2)/60. Conclusion. Fungi of the genus Chaetomium, which are rare causes of human disease (systemic mycosis, endocarditis, subcutaneous lesions), may also cause ocular lesions.
Late Sac Rupture due to a Type IV Endoleak after Previous Endovascular Aortic Aneurysm Repair: A Case Report
Authors: Konstantinos Filis, Constantinos Zarmakoupis, Georgios Karantzikos, Frangiska Sigala, Gerasimos Bazigos, George Galyfos
Journal: Front Surg (2017)
Keywords: endovascular aortic aneurysm repair, microleakage, open repair, rupture, type iv endoleak
MeSH terms: Case Reports

Type IV endoleaks have been identified as endoleaks of low flow, and rupture risk has been estimated to be minimal in literature. Therefore, conservative treatment has been recommended in most cases. We are presenting a rare case of late rupture due to type IV endoleak that was treated with open repair applying a novel surgical technique.
Case Report: Acute Pancreatitis Associated With Tacrolimus in Kidney Transplantation and a Review of the Literature
Authors: Yixuan Ding, Chang Qu, Huan He, Feng Cao, Tongwen Ou, Fei Li
Journal: Front Med (Lausanne) (2022)
Keywords: abdominal pain, acute pancreatitis, drug-induced pancreatitis, kidney transplantation, tacrolimus
MeSH terms: Case Reports

Background:
Drug-induced pancreatitis is a rare cause of acute pancreatitis. Tacrolimus has been used as an immunosuppressant agent in patients after organ transplantation. However, only a few case reports of tacrolimus-induced acute pancreatitis in kidney transplantation have been reported. The purpose of this case report is to alert clinicians that tacrolimus-induced acute pancreatitis may occur during tacrolimus therapy in kidney transplant patients.
Case presentation:
We present the case of a 38-year-old woman who underwent kidney transplantation and received immunosuppressive therapy with tacrolimus; on day 20 post-transplantation, she presented with acute abdominal pain in the middle and left areas of the abdomen accompanied by diarrhea, nausea, and vomiting. We excluded gallstone disease, alcohol, hypertriglyceridemia, and other possible causes, and speculated that tacrolimus was the probable cause of pancreatitis because of the extremely high blood concentration of tacrolimus. After tacrolimus was changed to cyclosporine, her symptoms were gradually improved, and she was discharged home without relapse.
Conclusion:
Tacrolimus is a rare cause of pancreatitis after kidney transplantation. It is important to note that tacrolimus-induced acute pancreatitis may occur during tacrolimus therapy in kidney transplantation patients.
Case Report: Severe form of hemolytic-uremic syndrome with multiple organ failure in a child: a case report
Authors: Dino Mijatovic, Ana Blagaic, Zeljko Zupan
Journal: F1000Res (2014)

Introduction:
Hemolytic-uremic syndrome (HUS) is a leading cause of acute renal failure in infants and young children. It is traditionally defined as a triad of acute renal failure, hemolytic anemia and thrombocytopenia that occur within a week after prodromal hemorrhagic enterocolitis. Severe cases can also be presented by acute respiratory distress syndrome (ARDS), toxic megacolon with ileus, pancreatitis, central nervous system (CNS) disorders and multiple organ failure (MOF).
Case presentation:
A previously healthy 4-year old Caucasian girl developed acute renal failure, thrombocytopenia and hemolytic anemia following a short episode of abdominal pain and bloody diarrhea. By the end of the first week the diagnosis of the typical HUS was established. During the second week the disease progressed into MOF that included ileus, pancreatitis, hepatitis, coma and ARDS, accompanied by hemodynamic instability and extreme leukocytosis. Nonetheless, the girl made a complete recovery after one month of the disease. She was successfully treated in the intensive care unit and significant improvement was noticed after plasmapheresis and continuous veno-venous hemodialysis.
Conclusions:
Early start of plasmapheresis and meticulous supportive treatment in the intensive care unit, including renal placement therapy, may be the therapy of choice in severe cases of HUS presented by MOF. Monitoring of prognostic factors is important for early performance of appropriate diagnostic and therapeutical interventions.
Treatment of two canals in all mandibular incisor teeth in the same patient
Authors: Vandana B Kokane, Swapnil N Patil, Mohit K Gunwal, Rajesh Kubde, Swaraj Atre
Journal: Case Rep Dent (2014)

The main reason for unfavourable outcome in endodontic treatment of mandibular incisor is the inability to detect the presence of second canal. Pain even after extirpation of complete pulp tissue from root canal of vital teeth is the main indication of hidden canals. The present case report is also on pain because of another neglected canal in all mandibular incisors in the same patient.
A Rare Case of BCL2-Positive Multiple Myeloma Complicated with Follicular Lymphoma
Authors: Yutaka Tsutsumi, Shinich Ito, Mirei Kobayashi, Takanori Teshima
Journal: Case Rep Hematol (2022)
MeSH terms: Case Reports

A 68-year-old woman presented with follicular lymphoma complicated by IgG kappa-positive multiple myeloma. In this case, both follicular lymphoma and plasma cells were positive for BCL2 by immunostaining. T-cell association in the FL and MM was also analyzed in this case. Some CD3-positive T-cells were found around the plasma cells. These cells were mainly CD8-positive T-cells and not CD4-positive T-cells. These results suggest that CD4-positive T-cells were not associated with the proliferation of the plasma cells in this case. Although the FL that developed was initially positive for BCL2 protein, this does not indicate that plasma cells were derived from FL cells because of the eventual complication that occurred in this case. Furthermore, in this case, rituximab and bendamustine were effective for FL. They were not effective for MM, however, demonstrating that additional treatment options are necessary for the simultaneous treatment of BCL2-positive MM with FL.
Systemic lupus erythematosus and systemic autoimmune connective tissue disorders behind recurrent diastolic heart failure
Authors: Luis Miguel Blasco Mata, Olga Acha Salazar, Carmen Rosa González-Fernández, Francisco Novo Robledo, Enrique Pérez-Llantada Amunárriz
Journal: Clin Dev Immunol (2012)
MeSH terms: Autoimmune Diseases / complications, Connective Tissue Diseases / complications, Heart Failure, Diastolic / etiology, Lupus Erythematosus, Systemic / complications, Case Reports, Abortion, Habitual / etiology, Aged, Aged, 80 and over, Autoimmune Diseases / diagnosis, Autoimmune Diseases / epidemiology, Cardiovascular Agents / therapeutic use, Connective Tissue Diseases / diagnosis, Connective Tissue Diseases / epidemiology, Critical Care, Delayed Diagnosis, Female, Heart Failure, Diastolic / drug therapy, Humans, Lupus Erythematosus, Systemic / diagnosis, Lupus Erythematosus, Systemic / epidemiology, Male, Mass Screening, Middle Aged, Mitral Valve Insufficiency / etiology, Pregnancy, Prospective Studies, Recurrence, Spain / epidemiology, Cardiovascular Agents

Diastolic heart failure (DHF) remains unexplained in some patients with recurrent admissions after full investigation. A study was directed for screening SLE and systemic autoimmune connective tissue disorders in recurrent unexplained DHF patients admitted at a short-stay and intermediate care unit. It was found that systemic autoimmune conditions explained 11% from all of cases. Therapy also prevented new readmissions. Autoimmunity should be investigated in DHF.
Anorectal Malformation: Paediatric Problem Presenting in Adult
Authors: Rahulkumar N Chavan, Bhargav Chikkala, Cinjini Das, Somak Biswas, Diptendra Kumar Sarkar, Sushil Kumar Pandey
Journal: Case Rep Surg (2015)

This is a case report of 22-year-old girl admitted with abdominal distension, vomiting, and chronic constipation since birth. Abdomen was distended, and perineal examination revealed imperforate anus with vestibular fistula (ARM). So far worldwide very few cases have been reported about anorectal malformation presenting in adulthood, and thus extremely little data is available in the literature about an ideal management of anorectal malformation in adults. In our case in the treatment instead of conventional procedure of posterior sagittal anorectoplasty (PSARP) anal transposition was done and till two years after the definitive treatment during follow-up patient has been doing well with Kelly's score of six. Our experience suggests that anal transposition provides satisfactory outcome in adults presenting late with anorectal malformation.
Intrabiliary Hepatic Metastasis of Colorectal Carcinoma Mimicking Primary Cholangiocarcinoma: A Case Report and Review of the Literature
Authors: Yimin Dong, Hitendra Patel, Charmi Patel
Journal: Case Rep Pathol (2016)

Intrabiliary metastasis from colorectal carcinoma (CRC) growing within or invading bile ducts is not a very common pattern. However, accurate diagnosis of metastatic lesions is very important for selection of adjuvant therapy and prognosis. We report a case of 71-year-old male who developed painless jaundice due to hepatobiliary obstruction. MRI demonstrated 1.4 cm intraductal mass at hepatic hilum with severe intrahepatic ductal dilation, consistent with cholangiocarcinoma. ERCP (endoscopic retrograde cholangiopancreatography) showed intraductal segmental biliary stricture. Biopsy from the lesion showed adenocarcinoma favoring primary cholangiocarcinoma due to the papillary morphology and location of the mass. His past history was significant for rectosigmoid carcinoma (pT1N0) ten years ago and liver resection for metastatic CRC four years ago. He subsequently underwent central hepatectomy with resection of common bile duct. Grossly, there was a 1.2 cm intraductal mass at the bifurcation of bile ducts with multiple nodules in liver parenchyma. Microscopic examination revealed intraductal carcinoma with papillary architecture colonizing bile duct epithelium with resultant dilation and tortuosity. Occasional liver parenchymal nodules show classical metastatic pattern resembling CRC. Because of two distinct morphologic patterns and patient's past history, immunostains were performed. CK7 stained uninvolved bile duct epithelium with no staining in intrabiliary metastatic growth. CK20 and CDX2 were positive, thus confirming intrabiliary growth as metastatic growth from CRC. In summary, findings from our case indicate that intrabiliary growth of metastatic CRC can easily be overlooked with major duct involvement. Pathologic evaluation with use of immunohistochemical stains is very important to achieve correct diagnosis.
Intra-abdominal testicular seminoma in a woman with testicular feminization syndrome
Authors: Darshana D Rasalkar, Bhawan K Paunipagar, Alex Ng, Fernand M Lai, Shalini Jain Bagaria
Journal: Case Rep Radiol (2011)
MeSH terms: Case Reports

We report a case of intra-abdominal testicular tumor in a 36-year-old married lady presenting with chief complaints of primary amenorrhea. The patient was later diagnosed with testicular feminization syndrome, a form of male pseudohermaphroditism. This testicular tumor was histologically proven as seminoma. Due to rarity, imaging findings in patients with testicular feminization syndrome and intraabdominal testicular tumor have been poorly documented. So far, only one case report had described the combined role of CT and MR imaging in intraabdominal testicular sex-cord stromal tumor. To our knowledge, this case is first to document USG and MR imaging in addition to MR spectroscopy features in intraabdominal testicular seminoma.