OpenMed/multicare-articles huggingface dataset:
Proximal Humerus Fracture/Dislocation: Look for the Greater Tuberosity
Authors: Delaram Mostowfi Zadeh, Karim Abdelghafour, Angelos Assiotis
Journal: Cureus (2023)
Keywords: computerized tomography scan, greater tuberosity, missed fracture, pre-contoured locking plate, shoulder fracture dislocation
MeSH terms: Case Reports

The shoulder is the commonest major joint involved in dislocations. These are often associated with fractures of the surgical neck and/or of the greater tuberosity of the proximal humerus. A good functional recovery is associated with a successful union of the tuberosity fragment, as this carries the insertion of the superior and posterior rotator cuff tendons. A 29-year-old male patient presented to our Emergency Department (ED) after a fall off his motorbike, resulting in a left shoulder fracture dislocation and an axillary nerve injury. His shoulder was reduced under sedation in the ED, with post-reduction radiographs demonstrating a seemingly satisfactory fracture position. Later on, a computerized tomography (CT) scan was arranged which actually confirmed significant displacement of his greater tuberosity, which was not picked up on initial post-reduction radiographs. As a result of identifying the displacement, surgical fixation with a locking plate and suture construct was undertaken. This case demonstrates the ease with which greater tuberosity fractures can mistakenly be presumed as reduced on post-reduction films, whilst in fact they can be significantly displaced. This risk is especially great when only one radiographic view is obtained. The sign of the 'disappearing tuberosity' on a plain radiograph should prompt the clinician to seek further imaging by way of CT, to uncover the true position of the greater tuberosity.
Localized asymptomatic cerebellar abscess after penetrating brain injury by wooden foreign object with adequate antibiotics administration: A case report
Authors: Quri Meihaerani Savitri, Corinne Prawira Putri, Kevin Jonathan Gunawan, Dini Lukita Hapsari, Iwan Sidharta, Pandu Wicaksono
Journal: Int J Surg Case Rep (2020)
Keywords: cerebellar abscess, occupational accident, penetrating brain injury, wooden foreign body
MeSH terms: Case Reports

Introduction:
Brain abscess is a compilation of pus enclosed in capsule as a result of focal infection in brain parenchyma. It is one of several complications found in patients who suffered penetrating brain injury.
Case presentation:
Thirty-four-year-old man suffered a penetrating brain injury after a 50 cm piece of wood penetrated through his facial skull and ended its tip in his cerebellum, the wood priorly ejected from a moulding machine. As a consequence, he had to undergo a craniotomy procedure to remove the foreign body object and its debris. Following the surgery, adequate antibiotics were administered. Postoperative enhanced head CT revealed a cystic mass formation in the left hemisphere of cerebellum, measured 20 × 28 mm with blood density lesions and a visible ring enhancement. These features suggested a cerebellar abscess. The follow-up enhanced head CT later demonstrated that the size, shape, and location of the abscess were relatively consistent with the previous head CT.
Discussion:
Penetrating brain injury (PBI) is the most life-threatening head trauma. Although the prevalence number was low compared to other head traumas, its morbidity and mortality number were higher. Brain abscess formation is one of the many PBI complications. Due to direct inoculation of foreign body and its debris, PBI commonly leads an infection process. However, the infection process is supposed to be overcome by administering broad-spectrum antibiotics prophylactically. This case presented an inevitable brain abscess despite of the adequate antibiotics administration.
Conclusion:
Despite adequate antibiotics has been administered, cerebellar abscess after penetrating brain injury is still found challenging to manage. Therefore, holistic-multidisciplinary approaches are needed.
Case Report: Extracorporeal Membrane Oxgenation for Rapidly Progressive Interstitial Lung Disease Associated With Clinically Amyopathic Dermatomyositis in a Post-partum Woman
Authors: Qiao Gu, MengYuan Diao, Wei Hu, Man Huang, Ying Zhu
Journal: Front Med (Lausanne) (2021)
Keywords: amyopathic dermatomyositis, case report, extracorporeal membrane oxygenation (ecmo), interstitial lung disease (ild), lung transplantation, posterior reversible encephalopathy syndrome (pres)
MeSH terms: Case Reports

Background: Clinically amyopathic dermatomyositis (CADM) presented with rapid progressive interstitial lung disease (RP-ILD) is rare. Here, we present a case of a post-partum female with CADM complicated by severe RP-ILD managed with venovenous extracorporeal membrane oxygenation (V-V ECMO). Case Summary: A 36-year-old woman was referred to a local hospital with cough and fever. She had a history of facial erythema and cough since an induction of labor for a stillborn fetus 2 months ago. Her status developed into RP-ILD with mediastinal emphysema and subcutaneous emphysema after admission, and V-V ECMO was initiated. After several failed attempts to wean the patient from ECMO, a decision was made to place the patient on the lung transplant waitlist. She underwent a double lung transplant on ECMO day 31 and received tacrolimus as an immunosuppressive regimen. The patient presented with positive anti-MDA5 and anti-Ro-52 antibodies and a high ferritin level, all of which indicated the presence of clinically amyopathic dermatomyositis (CADM). The patient was weaned from ECMO at 3 days after transplantation, but the patient's state of consciousness deteriorated, and head CT was considered for posterior reversible encephalopathy syndrome (PRES). After the temporary cessation of calcineurin inhibitors and a dosage reduction, the patient's state of consciousness returned to normal. Because of another disturbance of consciousness, the patient declined further treatment and was discharged 14 days after transplantation. Conclusion: Early recognition of CADM can effectively improve patients' prognosis. ECMO should be considered as a supportive therapy in patients in acute respiratory failure secondary to RP-ILD.
Synchronous primary cancers of the thyroid and breast: A case report and review of the literature
Authors: Li Liu, Jing Shi, Fengfeng Mao, Jinli Wei, Deyuan Fu, Jiaxin Zhang
Journal: Oncol Lett (2015)
Keywords: breast cancer, diagnose, mechanism, synchronous neoplasms, thyroid cancer

The current report presents the case of a 41-year-old female exhibiting synchronous primary cancers of the thyroid and breast. Pathological examination of a tissue sample following biopsy identified papillary carcinoma of the thyroid and invasive ductal carcinoma of the breast to provide a definitive diagnosis of synchronous primary tumors. The patient underwent a modified radical mastectomy and total thyroidectomy. Following regular adjuvant chemotherapy with cyclophosphamide (800 mg), doxorubicin (100 mg) and paclitaxel (120 mg), once every three weeks for 3.5 months, oral levothyroxine and endocrinotherapy was recommended. Two years after the initial diagnosis, the patient was healthy with no disease recurrence. To the best of our knowledge, no association has been identified between the etiology and diagnoses of the two synchronous primary tumors. Thus, the aim of the current report was to improve the understanding of synchronous primary tumors of the thyroid and breast by presenting a review of the associated literature regarding breast and thyroid cancer. The mechanisms of synchronous neoplasms have only recently been elucidated, however, misdiagnosis is common. Clinicians are, therefore, advised to carefully examine patients with thyroid or breast cancer to avoid an incorrect or misdiagnosis. Furthermore, the present report aims to provide a reference for the cancer database, since the majority of analyses of rare diseases are derived from case reports. To improve the understanding of synchronous primary cancers of the thyroid and breast, an analysis of recent studies regarding the underlying mechanisms of synchronous primary cancers was also undertaken.
Extreme Phenotypes With Identical Mutations: Two Patients With Same Non-sense NHEJ1 Homozygous Mutation
Authors: Maria J Recio, Nerea Dominguez-Pinilla, Melina Soledad Perrig, Carmen Rodriguez Vigil-Iturrate, Nerea Salmón-Rodriguez, Cristina Martinez Faci, María J Castro-Panete, Javier Blas-Espada, Marta López-Nevado, Raquel Ruiz-Garcia, Rebeca Chaparro-García, Luis M Allende, Luis Ignacio Gonzalez-Granado
Journal: Front Immunol (2019)
Keywords: dna repair, nhej1 mutation, xlf/cernunnos, lymphomagenesis, radiosensitive scid (rs-scid), severe combined immunodeficiency
MeSH terms: DNA Repair Enzymes / deficiency, DNA Repair Enzymes / genetics, DNA-Binding Proteins / deficiency, DNA-Binding Proteins / genetics, Phenotype, Rare Diseases / genetics, Severe Combined Immunodeficiency / genetics, Case Reports, Research Support, Non-U.S. Gov't, Antibodies / blood, B-Lymphocytes, Child, Codon, Nonsense, DNA Breaks, Double-Stranded, DNA End-Joining Repair / genetics, Fibroblasts / radiation effects, Follow-Up Studies, Hematopoietic Stem Cell Transplantation, Homozygote, Humans, Infant, Intellectual Disability / diagnosis, Lymphopenia / diagnosis, Microcephaly / diagnosis, Pedigree, Radiation Tolerance, Rare Diseases / diagnosis, Rare Diseases / pathology, Rare Diseases / therapy, Severe Combined Immunodeficiency / diagnosis, Severe Combined Immunodeficiency / pathology, Severe Combined Immunodeficiency / therapy, T-Lymphocytes, Treatment Outcome, Antibodies, Codon, Nonsense, DNA-Binding Proteins, NHEJ1 protein, human, DNA Repair Enzymes

Cernunnos/XLF deficiency is a rare primary immunodeficiency classified within the DNA repair defects. Patients present with severe growth retardation, microcephaly, lymphopenia and increased cellular sensitivity to ionizing radiation. Here, we describe two unrelated cases with the same non-sense mutation in the NHEJ1 gene showing significant differences in clinical presentation and immunological profile but a similar DNA repair defect.
Novel Mutation in CACNA1A Associated with Activity-Induced Dystonia, Cervical Dystonia, and Mild Ataxia
Authors: Benjamin Stampfl, Dominic Fee
Journal: Case Rep Neurol Med (2021)
MeSH terms: Case Reports

CACNA1A encodes the pore-forming α1 subunit of the neuronal voltage-gated Cav2.1 (P/Q-type) channels, which are predominantly localized at the presynaptic terminals of the brain and cerebellar neurons and play an important role in controlling neurotransmitter release. Mutations in CACNA1A have been associated with several autosomal dominant neurologic disorders, including familial hemiplegic migraine type 1, episodic ataxia type 2 (EA2), and spinocerebellar ataxia type 6. A 37-year-old woman presented with a history of slowly progressive, activity-induced stiffness, and pain in her right leg since age 15 and cervical dystonia since age 20. She denied any right leg stiffness or pain at rest, but when she began to walk, her right foot turned in and her right leg stiffened up. She also had neck pain, stiffness, and spams. There was no family history of similar symptoms. On physical exam, her strength, tone, and reflexes were normal in all extremities at rest. There was mild head titubation and very mild past pointing on finger-to-nose testing. MRI of the brain and spinal cord was unremarkable. This patient's clinical picture was felt to be most consistent with paroxysmal kinesigenic dyskinesia, as she has attacks of dystonia that are triggered by voluntary movement, last from a few seconds to a minute, and are relieved with rest. She was trialed on carbidopa/levodopa without improvement. A dystonia panel showed two potentially pathologic mutations, one in CACNA1A and the other in PNKP, along with a variant of unknown significance in ATP7B. The mutation in CACNA1A is C2324 G < A. It is heterozygous, autosomal dominant, and computer modeling suggests pathogenicity. This mutation has not been reported previously and is likely the cause of her paroxysmal dystonia; dystonia is sometimes seen during episodes of ataxia in EA2, and CACNA1A knockout mice exhibit dystonia and cerebellar atrophy. After receiving her genetic diagnosis, the patient was trialed on acetazolamide without improvement in her dystonia symptoms. This is the second case report of a patient with cervical dystonia and cerebellar ataxia associated with a mutation in CACNA1A.
The Case for Improved Interprofessional Care: Fatal Analgesic Overdose Secondary to Acute Dental Pain during Pregnancy
Authors: Sarah K Y Lee, Rocio B Quinonez, Alice Chuang, Stephanie M Munz, Darya Dabiri
Journal: Case Rep Dent (2016)

Prenatal oral health extends beyond the oral cavity, impacting the general well-being of the pregnant patient and her fetus. This case report follows a 19-year-old pregnant female presenting with acute liver failure secondary to acetaminophen overdose for management of dental pain following extensive dental procedures. Through the course of her illness, the patient suffered adverse outcomes including fetal demise, acute kidney injury, spontaneous bacterial peritonitis, and septic shock before eventual death from multiple organ failure. In managing the pregnant patient, healthcare providers, including physicians and dentists, must recognize and optimize the interconnected relationships shared by the health disciplines. An interdisciplinary approach of collaborative and coordinated care, the timing, sequence, and treatment for the pregnant patient can be improved and thereby maximize overall quality of health. Continued efforts toward integrating oral health into general healthcare education through interprofessional education and practice are necessary to enhance the quality of care that will benefit all patients.
Delirious mania: can we get away with this concept? A case report and review of the literature
Authors: Rajshekhar Bipeta, Majeed A Khan
Journal: Case Rep Psychiatry (2012)

Background. Delirious mania (DM) as a clinical entity is well described, yet is often unrecognized in clinical practice. While most often misdiagnosed as acute psychotic episodes of organic delirium, these patients meet the criteria for mania with attendant delirium and pose therapeutic challenges. In addition to the case presentation, this paper also discusses the available literature on DM. Case Presentation. A 29-year-old man with DM was treated with a combination of electroconvulsive therapy (ECT), divalproex 2000 mg/day, loxapine 100 mg/day, and lorazepam 4 mg/day. He demonstrated clinically significant improvement by day 10, which persisted through the twelve-month follow-up period. Conclusions. DM is a severe psychiatric syndrome which should be accurately diagnosed. Patients with DM should be treated aggressively, especially with ECT. Lack of recognition of DM can lead to serious morbidity or fatal outcomes. Though the concept of DM is well established, recent psychiatric literature does not make a mention of this life threatening yet treatable condition. We propose that there is a dire need to keep this concept alive.
Pleomorphic spindle cell sarcoma (PSCS) (formerly known as malignant fibrous histiocytoma, MFH) of the spleen, mimics an atypical haemangioma on 99mTc-RBC, CT and Ultrasound: staging with 18F-FDG PET/CT
Authors: William Makis, Karim Samji, Ryan W Hung, Jean Deschenes
Journal: BJR Case Rep (2017)
MeSH terms: Case Reports

A 63-year-old male was found to have a 7.5-cm splenic mass that had imaging appearances of an atypical haemangioma on CT, ultrasound and a 99mTc-RBC scan, and he was followed conservatively with serial ultrasounds. Sixteen months later, however, the splenic lesion grew and he developed numerous new liver masses which were biopsy confirmed to be a pleomorphic spindle cell sarcoma (PSCS), formerly known as malignant fibrous histiocytoma (MFH). A staging 18F-FDG PET/CT was performed and showed innumerable, mostly necrotic hepatic and splenic masses. The patient passed away a few days after the PET/CT, before a treatment program could be implemented. The use of 18F-FDG PET/CT in the staging of splenic PSCS has not been previously described. We present the 99mTc-RBC and 18F-FDG PET/CT image characteristics of a patient with splenic PSCS.
Micromonas micros Infection of a Prosthetic Hip Joint: A Case Report and Review of the Literature
Authors: Abhimanyu Aggarwal, Durane Walker
Journal: Case Rep Infect Dis (2021)
MeSH terms: Case Reports

Micromonas micros is an oral anaerobic Gram-positive coccus and is a commensal of the mouth, and it is rarely isolated in prosthetic joint infections (PJIs) and even less frequently related to a preceding dental procedure with eventual hematogenous seeding of the prosthetic joint. Here, we present a case of a 56-year-old male with a prosthetic hip joint who developed Micromonas micros prosthetic hip joint infection with symptoms starting a few days after a dental procedure and not having received periprocedural antibiotic prophylaxis. He recovered well with surgical intervention and antimicrobial therapy. We conducted a literature review of prosthetic hip joint infections caused by Micromonas micros as well as briefly discuss current guidelines on antibiotic prophylaxis in patients with prosthetic joints undergoing dental procedures and some knowledge gaps.
Bipolar Disorder after COVID-19 Infection: A Case Report from an Ethiopian Perspective
Authors: Elias Tesfaye, Selamawit Alemayehu, Elias Gebru
Journal: Case Rep Psychiatry (2022)
MeSH terms: Case Reports

Introduction:
COVID-19 has been a sudden public health crisis since January 2020, spreading from the city of Wuhan, China, to the whole country within a month and posing serious threats to lives. The pandemic has a profound effect on all aspects of society, including mental health and physical health. The actual effect of the virus on the brain and possible psychiatric manifestations is still an area of study and further investigation. There are also several case reports showing manic like symptoms after COVID-19 infection. We describe the case of a 55-year-old patient who presented with behavioral and mood symptoms after a COVID-19 infection. Case Presentation. The patient presented with behavioral disturbance after a diagnosis of COVID-19. He exhibited symptoms including irritability, verbal and physical aggressiveness, increased goal-directed activity, elated and expansive mood, increased energy, grandiosity and inflated self-esteem, and decreased need for sleep. Findings on psychiatric evaluation encompassing detailed history and mental state examination suggested bipolar disorder due to COVID-19 infections. For this, he was put on sodium valproate 1000 mg per day and later, and he was discharged after 21 days with improvement.
Conclusions:
This case highlights the importance of paying attention to psychiatric symptoms in patients with COVID-19 and the early intervention and involvement of psychiatrists especially in critically ill patients. In the present scenario, we urge physicians to pay attention to those cases and be open-minded for such a possible new diagnosis. We also recommend performing antibody tests for CSF and RNA tests for patients with mental abnormalities following COVID-19. Further studies can be performed to identify the relationship between COVID-19 and bipolar disorders.
An Unusual Case of Syringohydromyelia Presenting with Neurogenic Bladder
Authors: Antonella Geljic, Slaven Abdovic, Fran Stampalija, Lana Loncar, Batos A Tripalo, Martin Cuk
Journal: European J Pediatr Surg Rep (2019)
Keywords: neurogenic bladder, syringohydromyelia, vesicourethral reflux
MeSH terms: Case Reports

We report the case of a 4-year-old boy who first presented with acute pyelonephritis at the age of 6 months. Diagnostic workup revealed high-grade bilateral vesicourethral reflux (VUR). At the age of 18 months, a bulking agent was used to treat bilateral VUR. Since the VUR persisted, an open bilateral Lich-Gregoir procedure was done at the age of 3 years. Immediately after surgery, he developed acute urinary retention with hydronephrosis that resolved with the placement of dwelling urinary catheter. After removal of the catheter urinary retention relapsed so placement of suprapubic urinary catheter was indicated since he did not have sensory loss. He was started with tamsulosin (α - 1-blocker) and prophylactic antibiotics. Urodynamics were performed and suggested bladder outlet obstruction. On the basis of previous urethroscopy and the absence of neurological sequelae, the differential diagnosis of Hinman syndrome was made. After removal of the suprapubic catheter, clean intermittent catheterization was started and α-blocker continued. However, magnetic resonance imaging of the brain and the spinal cord revealed syringohydromyelia extending from thoracic spine (Th5) to conus medullaris with 6 to 7 mm in diameter. Electromyoneurogram was normal. After a follow-up of 3 years, the hydronephrosis has resolved. The patient is on clean intermittent catherization and has no urinary tract infections.
Giant merkel cell carcinoma masquerading as a benign cyst on the buttock of an african american man
Authors: Marissa J Perman, Janelle M King, Laurel L Leithauser, Hugh M Gloster
Journal: Case Rep Oncol Med (2011)
MeSH terms: Case Reports

We report a case of a 60-year-old African American man who presented with a 4-year history of a previously asymptomatic, recently enlarging nodule on his left buttock, which was initially presumed to be an epidermoid cyst. Physical examination revealed a large, fixed, subcutaneous tumor, and a biopsy revealed merkel cell carcinoma. Immunohistochemical staining was positive for pankeratin, CAM 5.2, synaptophysin, and CD56 and negative for CK7, CK20, TTF-1, chromogranin, CD3, CD20, CD57, MART1, and HMB 45. The patient underwent wide local excision of the lesion with removal of the fascia overlying the gluteus and full body positron emission tomography (PET) and was found to have Stage IIb disease. He subsequently received adjuvant radiotherapy limited to the tumor bed at a dose of 60 gray.
Horner Syndrome Secondary to Thyroid Surgery
Authors: Meliha Demiral, Ciğdem Binay, Enver Simsek, Hüseyin Ilhan
Journal: Case Rep Endocrinol (2017)
MeSH terms: Case Reports

Horner syndrome (HS), caused by an interruption in the oculosympathetic pathway, is characterised by myosis, ipsilateral blepharoptosis, enophthalmos, facial anhydrosis, and vascular dilation of the lateral part of the face. HS is a rare complication of thyroidectomy. A 15-year-old female patient presented with solitary solid and large nodule in the right thyroid lobe. Ultrasound-guided fine-needle aspiration was performed and the cytological examination results were undefined. The patient underwent a total thyroidectomy. On postoperative day 2, she developed right-sided myosis and upper eyelid ptosis. HS was diagnosed. Interestingly, the patient exhibited an incomplete clinical syndrome with the absence of vasomotor symptoms. We herein report a case of HS in a 15-year-old female patient after total thyroidectomy. The possible causes of HS were ischaemia-induced nerve damage and stretching of the cervical sympathetic chain by the retractor during thyroidectomy. Clinicians should be aware of the possibility of this rare but important surgical complication.
Multiple stafne bone defects: a rare entity
Authors: Luciana Barreto Vieira Aguiar, Frederico Sampaio Neves, Luana Costa Bastos, Iêda Crusoé-Rebello, Glaucia Maria Bovi Ambrosano, Paulo Sérgio Flores Campos
Journal: ISRN Dent (2011)
MeSH terms: Case Reports

Stafne bone defects (SBDs) are generally located in the lingual cortex, close to the mandibular angle. We report the occurrence of multiple SBDs in an asymptomatic patient, a 60-year-old man, referred to a radiology clinic to undergo examination for the purpose of implant planning. The case of multiple SBD presented here, probably the first reported in the literature, reinforces the hypothesis that some cases of SBD may be the result of a focal failure during the ossification of the mandible.