OpenMed/multicare-articles huggingface dataset:
A descriptive case of persistent Acanthamoeba keratitis: raising awareness of this complex ocular disease
Authors: Lisa Connelly, Deepa Anijeet, Claire L Alexander
Journal: Access Microbiol (2019)
Keywords: acanthamoeba keratitis, clinical case, molecular testing
MeSH terms: Case Reports

Background:
Acanthamoeba species are ubiquitous free-living organisms found in the environment. They can cause a sight-threatening disease of the cornea termed Acanthamoeba keratitis (AK), often associated with contact-lens wearers. This case review describes a persistent presentation of AK and raises awareness of the challenges faced when diagnosing and managing the disease. It highlights the importance of an accurate and rapid diagnosis to assist patient management and to maximize the potential for a better outcome.
Case presentation:
A 73-year-old female was admitted to hospital due to vision impairment of her left eye. Following a clinical examination, the diagnosis of herpes simplex keratitis (HSK) was reported and treated with antivirals. However, deterioration of her keratitis continued after initial treatment, which prompted an investigation into the possibility of AK. Molecular testing of sequential corneal tissue was performed using a real-time PCR assay alongside further clinical examinations. Acanthamoeba species DNA was isolated from seven out of eight corneal tissues over a 12 month period. Following prolonged drug treatment and two corneal transplants, the individual's symptoms ceased and further molecular testing of corneal tissue was negative.
Conclusions:

Acanthamoeba keratitis can be easily misdiagnosed due to the similarities in the clinical presentation to other, much more common ocular pathogens. This case highlights the importance of considering AK in the first-line diagnosis, and raises awareness that an early, accurate and rapid diagnosis is crucial to improve patient outcome.
Case report: Obturator hernia: Diagnosis and surgical treatment
Authors: Han Li, Xuefeng Cao, Lingqun Kong
Journal: Front Surg (2023)
Keywords: case report, diagnose, obturator hernia, old woman, treatment
MeSH terms: Case Reports

Background:
Obturator hernia (OH) is a rare external abdominal hernia, accounting for only 0.07%-1% of all hernia cases. Because the female pelvis is wider and there is less preperitoneal adipose tissue, the obturator canal is larger, which can lead to herniation of abdominal contents when abdominal pressure increases in elderly women with thin body. The clinical symptoms of patients with obturator hernia included abdominal pain, nausea, vomiting, etc., and the mass in the inguinal region could not be touched. The positive Howship-Romberg sign is a specific sign of OH. CT is the first choice for the diagnosis of obturator hernia. Since intestinal incarceration in OH patients is prone to lead to intestinal necrosis, emergency surgical treatment is often required. However, due to the lack of specificity of its clinical manifestations, the misdiagnosis rate is high, which often leads to the delay of diagnosis and treatment.
Methods:
We report the case of an 86-year-old woman with a thin body and a history of multiple deliveries. The patient presented with abdominal pain, bloating, and constipation for 5 days. Physical examination revealed a positive Howship-Romberg sign on the right side, and CT examination suggested intestinal obstruction. Therefore, an urgent exploratory laparotomy was performed.
Results:
After opening the abdominal cavity we found that the wall of the ileum was embedded in the right obturator, and the proximal bowel was significantly dilated. We restored the embedded bowel wall to its original position, resected the necrotic bowel and performed an end-to-end anastomosis of the small intestine. The right hernia orifice was sutured, and OH was diagnosed during the operation.
Conclusion:
This article summarizes the diagnosis and treatment of OH by sharing this case, so as to provide a more detailed plan for early diagnosis and treatment of OH.
Post-Traumatic Epilepsy after Sports-Related Concussion: A Case Report
Authors: Justin E Hellwinkel, Forrest L Anderson, David P Trofa, Michael P Deitrich, Jalen D Dansby, James M Noble, Thomas S Bottiglieri
Journal: Neurotrauma Rep (2020)
Keywords: brain injury, concussion, post-traumatic epilepsy, sports-related concussion

Sports-related concussions (SRCs) are a public health concern across the United States, and they lead to neurological sequelae that can last long after the event itself. Concussive convulsions at the time of injury are common and rarely require additional workup or treatment. Post-traumatic epilepsy (PTE), however, is a rare phenomenon that can develop after traumatic brain injury and must be managed with adequate medical therapy. Herein we present the case of a 15-year-old football player who developed PTE after an SRC. This condition must be identified through proper education of sports clinicians and those involved in care and management of athletes.
Multimodal Anesthesia via Opioid-Free Analgesia and Erector Spinae Plane Block
Authors: Juan Carlos Luis-Navarro, Carmen Fornés-Rumbao, Ana Bella DeLaCalle-Gil, Mauricio Forero
Journal: Case Rep Anesthesiol (2020)
MeSH terms: Case Reports

Multimodal anesthesia, which combines general and epidural anesthesia, is used in surgical cases in which a large or painful incision is anticipated. However, both epidural blocks and opioid-based analgesia have limitations in application. Here, we present a case of supra-infraumbilical laparotomy in a patient whose history of neurostimulator use and marked scoliosis discouraged the placement of an epidural catheter and whose prior adverse response to opioids prohibited their use. The intraoperative and postoperative management of this patient consisted of a combination of analgesia without opioids and erector spinae plane block. Adequate analgesia was achieved, and intraoperative or postoperative opioids were not required. This case illustrates the importance of mastering alternative and multimodal analgesia techniques that can be used in place of classical analgesia techniques when classical analgesia techniques are not appropriate.
Case Report: Bladder adenocarcinoma: primary or urachal?
Authors: J Eduardo Tejeda-Mariaca, Marco Ordoñez-Alcantara, Aldo Bello-Sedano, Victor Perez-Cornejo, J Antonio Grandez-Urbina
Journal: F1000Res (2019)
Keywords: adenocarcinoma, surgical pathology, urinary bladder neoplasms
MeSH terms: Adenocarcinoma / diagnosis, Urachus / pathology, Urinary Bladder Neoplasms / diagnosis, Case Reports, Adenocarcinoma / pathology, Adult, Cystectomy, Female, Humans, Urinary Bladder Neoplasms / pathology

Background: Bladder adenocarcinoma (AC) is a scarce histological variant and there are few studies on its proper management. No previous case reports present the management of a urachal tumor and the incidental finding of bladder adenocarcinoma. Clinical case: We present the case of a young woman with nonspecific symptoms, who presented with a prior history of dysuria, bladder tenesmus, suprapubic pain and urinary urgency for one year, which had been treated as recurrent urinary tract infection. A partial cystectomy plus extended lymphadenectomy was scheduled. We found a bladder tumor with characteristics of a urachal tumor and the pathological report indicated a primary bladder AC. The patient had a complete recovery at one year of follow-up. Conclusions: A patient can present with a tumor with urachal characteristics; however, the pathology report can show primary AC. The decision to perform partial cystectomy was an appropriate option for the location of this tumor, with optimal surgical results. Still, a long-term follow-up is necessary. More specific management guidelines are required for the treatment of AC.
Paecilomyces lilacinus vaginitis in an immuno-competent patient
Authors: Jeanne Carey, Ron D'Amico, Deanna A Sutton, Michael G Rinaldi
Journal: Emerg Infect Dis (2003)
MeSH terms: Communicable Diseases, Emerging / microbiology, Immunocompetence, Mycoses / physiopathology, Paecilomyces / isolation & purification, Vaginitis / microbiology, Case Reports, Review, Adult, Antifungal Agents / therapeutic use, Female, Humans, Itraconazole / therapeutic use, Paecilomyces / pathogenicity, Treatment Outcome, Vaginitis / drug therapy, Vaginitis / physiopathology, Antifungal Agents, Itraconazole

Paecilomyces lilacinus, an environmental mold found in soil and vegetation, rarely causes human infection. We report the first case of P. lilacinus isolated from a vaginal culture in a patient with vaginitis.
Bone and Joint Infections due to Haemophilus parainfluenzae: Case Report and Review of the Literature
Authors: Conar R O'Neil, Evan Wilson, Bayan Missaghi
Journal: Can J Infect Dis Med Microbiol (2016)

Haemophilus parainfluenzae is a normal inhabitant of the human respiratory tract. However it is an increasingly recognized pathogen in invasive infections, particularly in the immunocompromised host and where there is disruption of the normal skin or mucosal barriers. We present a case of a 56-year-old female with a history of asplenia who developed H. parainfluenzae septic arthritis of the hip following an intra-articular steroid injection. We also summarize previously reported cases of bone and joint infections caused by H. parainfluenzae.
Fracture of the Tibial Baseplate 16 Years after Miller-Galante II Total Knee Arthroplasty
Authors: Kazuaki Mineta, Masahiko Okada, Soshi Matsumoto, Daisuke Hamada, Tomohiro Goto, Koichi Sairyo
Journal: Case Rep Orthop (2017)
MeSH terms: Case Reports

We report a rare case of tibial baseplate fracture of Miller-Galante II (MG II) prosthesis. We examine the factors that may cause such late fracture and review the literature on radiographic analysis and retrieval studies. A 76-year-old woman, who had undergone bilateral MG II total knee arthroplasty due to rheumatoid arthritis 16 years earlier, presented to our department with a 3-month history of left knee pain. Plain radiographs revealed severe distortion of the medial tibial component. During revision knee arthroplasty, we observed severe metallosis in the knee joint, polyethylene insert deformation, and posteromedial coronal baseplate fracture. After removal of the fractured tray, a bone deficit due to osteolysis was noted. The revision prosthesis (LCCK, Zimmer-Biomet) was implanted uneventfully. Four months after revision surgery, the patient was ambulating and had no complications. The implants on the right side had survived without complications for 17 years. We speculate that the primary causative factor of the fatigue fracture of the base plate due to loss of bony support most likely secondary to osteolysis was varus malalignment at primary implantation. This case highlights the importance of paying close attention to the correct alignment of each component at primary implantation.
Mycobacterium bovis BCG osteoarticular infection complicating immune therapy for bladder cancer: a case report
Authors: Rebecca Stern, Clay Roscoe, Elizabeth A Misch
Journal: J Bone Jt Infect (2021)
MeSH terms: Case Reports

Osteoarticular infection with Mycobacterium bovis (M. bovis) is a rare complication of bladder cancer treatment with intravesical Bacillus Calmette-Guèrin (BCG). We describe a case of disseminated Mycobacterium bovis BCG infection masquerading as a chronic prosthetic joint infection in a patient with several risk factors for progressive mycobacterial infection.
Pilocytic Astrocytoma-Derived Cells in Peripheral Blood: A Case Report
Authors: Giorgio Volpentesta, Giuseppe Donato, Elisabetta Ferraro, Chiara Mignogna, Riccardo Radaelli, Umberto Sabatini, Domenico La Torre, Natalia Malara
Journal: Front Oncol (2021)
Keywords: blood brain barrier, brain tumors, circulating glial cells, diagnostic liquid biopsy, pilocytic astrocytoma
MeSH terms: Case Reports

Imaging limitations, invasive tissue biopsies and poor information over the course of treatment to evaluate 'real-time' tumor dynamics justify the emerging use of liquid biopsies in the field of brain tumors. Circulating tumor cells (CTCs) from high-grade astrocytomas might reach the circulation by crossing the blood-brain barrier. Here, for the first time, CTCs cytology in a case of pylocitic astrocytoma is described. An obstructive hydrocephalous due to a lateral mesencephalic tectum mass occluding the Silvio Aqueduct was diagnosed in a young, 18 years old, male. Considering the location of the tumor and the rapid deterioration of the neurological status, it has been decided to urgency treat the patient with ventriculoperitoneal shunting. Magnetic resonance imaging showed a nodular shaped lesion localized within the left lateral mesencephalic tectum. Stereotactic biopsy was not approachable due significant risk of neurological consequences. The diagnosis was performed by blood sampling, a non-invasive procedure for the patient, in order to provide tumor information. Cytopathological features on detected circulating atypical GFAP positive cells led to pilocytic diagnosis confirmed by the patient's 68 months outcome.
Case Report: A Variety of Immune-Related Adverse Events Triggered by Immune Checkpoint Inhibitors in a Subject With Malignant Melanoma: Destructive Thyroiditis, Aseptic Meningitis and Isolated ACTH Deficiency
Authors: Yukino Katakura, Tomohiko Kimura, Takashi Kusano, Fuminori Tatsumi, Yuichiro Iwamoto, Junpei Sanada, Yoshiro Fushimi, Masashi Shimoda, Kenji Kohara, Shuhei Nakanishi, Kohei Kaku, Tomoatsu Mune, Hideaki Kaneto
Journal: Front Endocrinol (Lausanne) (2021)
Keywords: aseptic meningitis, destructive thyroiditis, immune checkpoint inhibitor, immune-related adverse event, isolated acth deficiency
MeSH terms: Adrenocorticotropic Hormone / deficiency, Endocrine System Diseases / chemically induced, Genetic Diseases, Inborn / chemically induced, Hypoglycemia / chemically induced, Immune Checkpoint Inhibitors / adverse effects, Meningitis, Aseptic / chemically induced, Thyroiditis / chemically induced, Case Reports, Antineoplastic Agents, Immunological / administration & dosage, Antineoplastic Agents, Immunological / adverse effects, Antineoplastic Combined Chemotherapy Protocols, Atrophy / chemically induced, Endocrine System Diseases / diagnosis, Genetic Diseases, Inborn / diagnosis, Humans, Hypoglycemia / diagnosis, Immune Checkpoint Inhibitors / administration & dosage, Ipilimumab / administration & dosage, Ipilimumab / adverse effects, Japan, Male, Melanoma / drug therapy, Meningitis, Aseptic / diagnosis, Middle Aged, Nivolumab / administration & dosage, Nivolumab / adverse effects, Skin Neoplasms / drug therapy, Thyroid Gland / drug effects, Thyroid Gland / pathology, Thyroiditis / diagnosis, Thyroiditis / pathology, Antineoplastic Agents, Immunological, Immune Checkpoint Inhibitors, Ipilimumab, Nivolumab, Adrenocorticotropic Hormone, ACTH Deficiency, Isolated, Melanoma, Cutaneous Malignant

Recently, immune checkpoint inhibitors have been drawing much attention as cancer immunotherapy, but it has been shown that various immune-related adverse events (irAEs) are induced by immune checkpoint inhibitors in various organs, which has become one of the serious issues at present. A 58-year-old Japanese male with malignant melanoma was treated with nivolumab and/or ipilimumab. During the period of treatment, he suffered from various irAEs. Firstly, about 1 month after starting nivolumab monotherapy, destructive thyroiditis was induced, and so we started replacement therapy with levothyroxine. Secondly, about 1 month after starting nivolumab and ipilimumab combination therapy, aseptic meningitis was induced. We stopped both drugs and started steroid therapy with prednisolone. Finally, about 9 months after restarting nivolumab, isolated adrenocorticotropic hormone (ACTH) deficiency was induced, and so we started replacement therapy with hydrocortisone. Taken together, we should bear in mind the possibility of a variety of irAEs when we use immune checkpoint inhibitors.
Fulminant Clostridium difficile enteritis after proctocolectomy and ileal pouch-anal anastamosis
Authors: Elena Boland, Jon S Thompson
Journal: Gastroenterol Res Pract (2008)
MeSH terms: Case Reports

Clostridium difficile (C. difficile) infection of the small bowel is very rare. The disease course is more severe than that of C. difficile colitis, and the mortality is high. We present a case of C. difficile enteritis in a patient with ileal pouch-anal anastamosis (IPAA), and review previous case reports in order to better characterize this unusual condition.
Field investigation and response to a vaccine-derived poliovirus pre-tOPV switch in Southwest Nigeria, October 2015
Authors: Akinola Fatiregun, Ekundare Famiyesin, Samuel Bawa, Ninilola Ogunbodede
Journal: Pan Afr Med J (2020)
Keywords: acute flaccid paralysis, oral polio vaccine, vaccine-derived polio virus
MeSH terms: Central Nervous System Viral Diseases / diagnosis, Myelitis / diagnosis, Neuromuscular Diseases / diagnosis, Poliomyelitis / prevention & control, Poliovirus / isolation & purification, Poliovirus Vaccine, Oral / administration & dosage, Case Reports, Central Nervous System Viral Diseases / virology, Child, Preschool, Disease Outbreaks, Female, Humans, Infant, Male, Mass Vaccination / methods, Myelitis / virology, Neuromuscular Diseases / virology, Nigeria, Public Health, Vaccination / statistics & numerical data, Poliovirus Vaccine, Oral, acute flaccid myelitis

A vaccine-derived poliovirus (VDPV) was isolated in an acute flaccid paralysis (AFP) case reported from Ile-Ife, in Osun state, Southwest Nigeria. We investigated the epidemiological characteristics of the polio event and described the immediate public health response that followed. We interviewed the primary caregiver of the case and conducted active case searches for additional AFP cases in the communities in Ife East Local Government Area (LGA) of Osun state. Stool samples of contacts and non-contacts were collected and sent for laboratory investigation. A public health response with mass supplementary immunization in the affected areas followed immediately in the ward the case was located in October 2015. Also, we reviewed the administrative record of the oral polio vaccine (OPV) coverage in the LGA in the previous four years. The VDPV case was a female, one-month-old child with adequate vaccination history for her age. However, the environment of the child was relatively filthy with inappropriate facilities. Laboratory reports from contact samples were negative for VDPV or any polio isolates. A missed AFP case was found from active case searches and a high proportion of under-five children was immunized with tOPV. The OPV3 administrative coverage in the LGA peaked in 2014 (103%) and dropped in 2015 (67%). Efforts directed toward improving environmental hygiene in households and improving OPV coverage in subsequent routine and supplementary immunization are suggested.
A Case of an Obstructive Intramural Haematoma during Percutaneous Coronary Intervention Successfully Treated with Intima Microfenestrations Utilising a Cutting Balloon Inflation Technique
Authors: Osama Alsanjari, Aung Myat, James Cockburn, Grigoris V Karamasis, David Hildick-Smith, Andreas S Kalogeropoulos
Journal: Case Rep Cardiol (2018)
MeSH terms: Case Reports

During percutaneous coronary interventions (PCI), good lesion preparation with adequate balloon predilatation is a fundamental step before stent deployment in order to achieve optimal stent expansion and favourable long-term outcomes post PCI. During PCI, inadvertent vessel tearing can occur, resulting in coronary dissections and formation of intramural haematomas. The latter might be associated with compression of the vessel lumen and significant compromise of the coronary blood flow leading to myocardial ischaemia and infarction. Herein, we present a case of intramural haematoma that occurred after PCI of the left anterior descending artery resulting in occlusion of the vessel and the subsequent use of a cutting balloon inflation technique to resolve the haematoma and restore the normal coronary blood flow.
A Sudden Onset of Severe Thrombocytopenia While Using Evolocumab
Authors: Ikuo Inoue, Yasuhiro Takenaka, Yoshitora Kin, Satoshi Yamazaki, Yuichi Ikegami, Daigo Saito, Akira Shimada
Journal: Case Rep Hematol (2020)
MeSH terms: Case Reports

A 72-year-old man with a 10-year history of coronary heart disease started evolocumab treatment once a month after developing excess myalgia due to therapy with a 3-hydroxy-methylglutaryl CoA reductase inhibitor. No side effects such as myalgia symptoms had been reported during the first 14 months of evolocumab treatment; however, he suddenly presented with acute severe thrombocytopenia following the 14th treatment. His platelet count continued to decrease to a nadir of 1,000/μL. His platelet-associated immunoglobulin G level had elevated to 790 ng/107 cells. He started receiving a combination of steroid therapy, high-dose immunoglobulin therapy, and platelet transfusions, but the first-line therapy was ineffective. He was subsequently treated with a thrombopoietin receptor agonist, and his platelet count recovered to 250,000/μL.
Obturator Nerve Schwannoma as a Mimic of Ovarian Malignancy
Authors: Tyler Gleason, Brian H Le, Kirthik Parthasarathy, Bernice Robinson-Bennett
Journal: Case Rep Obstet Gynecol (2017)
MeSH terms: Case Reports

The obturator nerve is an extremely rare location for schwannomas to originate, and such diagnosis is typically not considered among the imaging diagnostic possibilities for a cystic-solid pelvic mass. A 63-year-old female with a known pelvic mass presented with increasing pelvic pain. The mass, which had been followed by serial imaging over five years, was described showing mixed solid and cystic components, likely arising from the left ovary. Although the key diagnosis to be excluded was a primary ovarian malignancy, the patient chose to pursue active surveillance. Over the five years of close observation, the lesion increased slowly, while her CA-125 level showed no significant elevation. Increase in size of the mass and worsening pain and concern for a gynecologic malignancy on MRI led her to ultimately consent to a hysterectomy with bilateral salpingooophorectomy. During the surgery, the mass was noted to be contiguous with the left obturator nerve. Pathologic evaluation revealed a schwannoma (WHO grade I). The patient's postsurgical course was uneventful, without residual weakness in the left adductor muscles.