OpenMed/multicare-articles huggingface dataset:
Stercoral Colitis in a Patient With Pediatric-Onset Systemic Lupus Erythematosus: Case Analysis and Review of the Literature
Authors: Chun-Chun Gau, Li-Lun Lin, Chao-Yi Wu, Jing-Long Huang
Journal: Front Pediatr (2021)
Keywords: case report, neuropsychiatric sle (npsle), pediatric-onset systemic lupus erythematosus, stercoral colitis, stercoral perforation
MeSH terms: Case Reports

Systemic lupus erythematosus (SLE) is an autoantibody-related disease that affects multiple organs. Stercoral colitis (SC) is a rare type of inflammatory colitis with a high mortality rate. Here, we report the first case of pediatric-onset lupus in a case complicated by stercoral colitis. We also conducted a literature review of patients with SC under 30 years old to provide useful clues for rapid diagnosis at a young age. A 28-year-old female with a history of lupus and neuropsychiatric SLE was admitted with severe abdominal pain. She was found to have stercoral colitis during surgery. Two years later, the patient underwent Hartman's operation due to ischemia of the colon. In addition, 10 patients younger than 30 years old with a diagnosis of SC were analyzed based on clinical presentation, physical examination, laboratory exam, imaging and treatment. All cases had a favorable outcome without mortality. Stercoral colitis is a rare but lethal complication, emphasizing the importance of a multidisciplinary approach. Differential diagnosis should include stercoral colitis for patients with SLE developing unexplained sharp abdominal pain.
Atraumatic Splenic Rupture in Legionella pneumophila Pneumonia
Authors: Elliott Worku, Dominic Adam Worku
Journal: Case Rep Infect Dis (2023)
MeSH terms: Case Reports

A previously fit 46-year-old male handyman presented to a rural hospital with a cough, fever, and epigastric pain without peritonism. The patient was admitted medically with symptoms and radiological appearances consistent with atypical community-acquired pneumonia. During the first 48 hours of admission, he suffered a significant haemodynamic deterioration and was transferred to the intensive care unit (ICU) for vasoactive support. Following stabilisation, urgent abdominal CT imaging demonstrated splenic rupture with haematoma in the absence of historical trauma. Emergency splenectomy was performed; the histopathological examination was unremarkable. Investigations for the presenting complaint confirmed Legionella pneumophila serotype 1 pneumonia by urinary antigen testing. The patient was extubated on postoperative day 2 and stepped down from ICU to complete a 14-day course of azithromycin. Atraumatic splenic rupture is a rarely described clinical entity. The process can be subdivided into pathological and nonpathological (spontaneous) cases. Pathological atraumatic splenic rupture may occur in the context of wide-ranging aetiologies, including bacterial pneumonia; however, the association with Legionella pneumophila serotype 1 is exceptional, with this representing the eighth case in the medical literature.
Clinical utility of chromosomal microarray analysis in the diagnosis and management of monosomy 7 mosaicism
Authors: Alka Chaubey Nee Dwivedi, Michael J Lyons, Kat Kwiatkowski, Frank O Bartel, Michael J Friez, Kenton R Holden, Eric T Fung, Barbara R DuPont
Journal: Mol Cytogenet (2014)
Keywords: microarray, monosomy 7, mosaicism, myelodysplasia
MeSH terms: Case Reports

There have been dramatic improvements in our ability to more accurately diagnose the underlying genetic causes of developmental delay/intellectual disability; however, there is less known about the treatment trajectory and whether or not patient management and outcomes have changed due to the information gained from genetic testing. Here we report a case study of a 20-month-old male first referred to the genetics clinic in 2008 for interhemispheric cysts, agenesis of the corpus callosum, left cortical dysplasia, and developmental delay of unknown etiology. The diagnostic work-up for this patient included chromosomal microarray which detected >20% mosaicism for monosomy 7, which raised concern for a possible myelodysplastic syndrome. The clone was not detected in stimulated peripheral blood cultures and his karyotype was reported as a normal male. Because of this microarray finding, he was referred to pediatric hematology/oncology where he was confirmed to have a pre-symptomatic diagnosis of myelodysplastic syndrome and was treated with chemotherapy and a bone-marrow transplant. This case illustrates the clinical utility of microarray testing and the importance of long-term follow-up to assess patient outcomes.
Gliosarcoma case report and review of the literature
Authors: Awadia Salman Awadalla, Ahmed Mohammed Al Essa, Hassan Hasan Al Ahmadi, Abdulrazaq Al Ojan, Yahya Muazen, Ahmed Alsayyah, Hind Alsaif, Noor Said Alsafwani
Journal: Pan Afr Med J (2020)
Keywords: gliosarcoma, biphasic histology, brain tumor, parieto-occipital mass
MeSH terms: Brain Neoplasms / diagnosis, Gliosarcoma / diagnosis, Case Reports, Review, Adult, Antineoplastic Agents / therapeutic use, Brain Neoplasms / pathology, Brain Neoplasms / therapy, Craniotomy, Diagnosis, Differential, Fatal Outcome, Gliosarcoma / pathology, Gliosarcoma / therapy, Humans, Magnetic Resonance Imaging, Male, Positron Emission Tomography Computed Tomography, Radiotherapy, Adjuvant, Treatment Failure, Antineoplastic Agents

Gliosarcoma is an unusual subtype of glioblastoma multiforme. Its characteristic features are biphasic configuration, constituting a definite, separate glial and sarcomatous differentiation, on histological evaluation. Herein, we present a rare case of Gliosarcoma that had presented only once in our center in last 13 years. A 60 years old, diabetic, hypertensive male patient came to e emergency department with disturbed level of consciousness and right sided hemiplegia which was progressive over four days. On examination he was, conscious, unoriented in time, person or place, his mouth deviated to left and vitally stable. After initial evaluation, CT scan and MRI were advised. These showed a complex left parieto-occipital heterogeneous mass lesion with cystic and solid components, measuring approximately 5.2x4cm. The mass lesion was seen displacing the occipital horn anteriorly and inferiorly with probable extension into the lateral ventricular cavity. There was no associated midline shift or definite herniation. The lesion was diagnosed as highly suggestive of brain tumor with a differential diagnosis of glioblastoma multiforme or ependymoma. Blood picture revealed a rapidly increasing level of anemia. Surgical intervention comprising left parieto-occipital craniotomy and near total resection of the tumor was carried out. On histopathological and immunohistochemical evaluation the diagnosis of GS was established. A plan of a combination of adjuvant chemotherapy and radiation was formulated that was however, declined by the family. On regular follow up, the patients clinical state rapidly deteriorated with persistence of seizures and requirement of repeated blood transfusions. The patient finally passed away after eighth months.
Giant Muscle Invasive Dermatofibroma Clinically Mimicking a Malignant Tumor
Authors: Hideyuki Kinoshita, Takeshi Ishii, Hiroto Kamoda, Toshinori Tsukanishi, Sumihisa Orita, Kazuhide Inage, Seiji Ohtori, Tsukasa Yonemoto
Journal: Case Rep Dermatol Med (2019)
MeSH terms: Case Reports

Dermatofibromas are common benign fibrohistiocytic lesions, usually appearing as slow growing firm dermal nodules with a predilection for the extremities (mostly the lower legs). They are found mostly in middle-aged women and are usually smaller than 2 cm in diameter. Giant dermatofibromas exceeding 5 cm in diameter are rare. In recent years, reports have suggested a relationship between the primary size of dermatofibromas and rates of local recurrence and metastases after surgery. This relationship is however debated. The present report describes the case of a giant muscle invasive tumor in a 51-year-old female patient who presented with a large ulcerated mass in the right upper arm. The tumor appeared clinically malignant, measuring approximately 12 cm × 6 cm in size, with ulceration and invasion of surrounding muscle. Wide resection of the tumor was performed with myocutaneous flap-plasty. Histopathological examination showed evidence of a dermatofibroma. No recurrence, metastases, or other complications were noted at 5 years after surgery. The present case demonstrates that although dermatofibromas are essentially benign, they may present with atypical features including large size, ulceration, and muscle invasion, clinically mimicking malignant tumors.
Post Partum Death in a Patient Diagnosed With COVID-19
Authors: Atanas Sivevski, Dafina Karadzova, Natasha Davceva, Irena Aleksioska-Papestiev, Romir Kadriu, Ivan Velickovic, Ivana Markovic, Nada Pejcic, Curtis L Baysinger
Journal: Front Glob Womens Health (2020)
Keywords: corona virus disease (covid-19), infectious disease, maternal mortality, respiratory failure, vertical transmission
MeSH terms: Case Reports

Background: There are few case reports describing maternal mortality and intensive care of the pregnant patient with COVID-19 infection. Case: A 27-year-old patient at 34 weeks of gestation was admitted for the evaluation of cough, fever, tachypnea, and oligohydramnios. The day of admission she underwent cesarean delivery for a non-reassuring fetal heart rate tracing. Over the next 6 days her clinical condition deteriorated, she developed multi organ system failure, and died despite aggressive supportive care. Conclusion: Although mortality related to COVID-19 in pregnancy has been rarely reported to date, we describe a case of progressive clinical deterioration postpartum despite aggressive supportive care. Management strategies specific for pregnant women have not been developed. In timing delivery, the obstetrician must consider the possibility that the inflammatory response associated with CD may increase the risk for multiorgan system failure in parturients with COVID-19 while recognizing that risks to the fetus may be higher in patients with COVID-19 than in other critically ill parturients. Vertical transmission of infection to the neonate did not occur in our case and has not been demonstrated in other pregnancies with COVID-19 disease.
From contact coverage to effective coverage of community care for patients with severe mental disorders: A real-world investigation from Italy
Authors: Giovanni Corrao, Matteo Monzio Compagnoni, Angelo Barbato, Barbara D'Avanzo, Teresa Di Fiandra, Lucia Ferrara, Andrea Gaddini, Alessio Saponaro, Salvatore Scondotto, Valeria D Tozzi, Flavia Carle, Simona Carbone, Daniel H Chisholm, Antonio Lora
Journal: Front Psychiatry (2022)
Keywords: effective coverage, health service research, healthcare utilization database, mental healthcare, quality of healthcare

Objectives:
To measure the gap between contact and effective coverage of mental healthcare (MHC).
Materials and methods:
45,761 newly referred cases of depression, schizophrenia, bipolar disorder, and personality disorder from four Italian regions were included. A variant of the self-controlled case series method was adopted to estimate the incidence rate ratio (IRR) for the relationship between exposure (i.e., use of different types of MHC such as pharmacotherapy, generic contact with the outpatient services, psychosocial intervention, and psychotherapy) and relapse (emergency hospital admissions for mental illness).
Results:
11,500 relapses occurred. Relapse risk was reduced during periods covered by (i) psychotherapy for patients with depression (IRR 0.67; 95% CI: 0.49 to 0.91) and bipolar disorder (0.64; 0.29 to 0.99); (ii) psychosocial interventions for those with depression (0.74; 0.56 to 0.98), schizophrenia (0.83; 0.68 to 0.99), and bipolar disorder (0.55; 0.36 to 0.84), (iii) pharmacotherapy for patients with schizophrenia (0.58; 0.49 to 0.69), and bipolar disorder (0.59; 0.44 to 0.78). Coverage with generic care, in absence of psychosocial/psychotherapeutic interventions, did not affect risk of relapse.
Conclusion:
This study ascertained the gap between contact and effective coverage of MHC and showed that administrative data can usefully contribute to assess the effectiveness of a mental health system.
Guillain-Barré Syndrome Secondary to West Nile Virus in New York City
Authors: Rafail Beshai, Daniel Bibawy, Joseph Bibawy
Journal: Case Rep Infect Dis (2020)
MeSH terms: Case Reports

West Nile virus (WNV) is an arthropod-borne flavivirus belonging taxonomically to the Japanese encephalitis subgroup. Usually, it is transmitted by Culex pipiens mosquitoes. Consequently, an increase in WNV-positive mosquitoes presents a rise of the number of patients, as it has been seen in NYC. We present a 65-year-old patient with WNV infection who presented with Guillain-Barré syndrome (GBS). She had a rapidly progressing ascending paralysis, a common feature in GBS patients but an uncommon presentation in WNV. Realizing WNV as an emerging pathogen along with its uncommon presentation of GBS can be potentially lifesaving if caught at an early stage.
Intestinal Diffuse Large B-Cell Lymphoma in a Patient with Systemic Lupus Erythematosus
Authors: Masaya Iwamuro, Takahide Takahashi, Yoko Ota, Takehiro Tanaka, Noboru Asada, Shuya Yano, Mayu Uka, Rei Nakamura, Yuki Baba, Seiji Kawano, Yoshiro Kawahara, Hiroyuki Okada
Journal: Case Rep Gastrointest Med (2020)
MeSH terms: Case Reports

A 44-year-old Japanese woman with systemic lupus erythematosus (SLE) presented to our hospital with abdominal pain. Radiological and endoscopic examinations led to the diagnosis of diffuse large B-cell lymphoma of the jejunum, which was subsequently resected. Patients with SLE reportedly have an increased risk of non-Hodgkin lymphoma, as demonstrated by our patient. Hence, lymphoma should be considered in the differential diagnosis of neoplastic lesions emerging in SLE patients. In addition, flow cytometry using endoscopically biopsied fragments is useful for the immediate diagnosis of lymphoma, leading to timely and accurate preoperative staging.
Hirayama Disease: A Rare Disease with Unusual Features
Authors: S Anuradha, Vanlalmalsawmdawngliana Fanai
Journal: Case Rep Neurol Med (2016)
MeSH terms: Case Reports

Hirayama disease, also known as monomelic amyotrophy (MMA), is a rare cervical myelopathy that manifests itself as a self-limited, asymmetrical, slowly progressive atrophic weakness of the forearms and hands predominantly in young males. The forward displacement of the posterior dura of the lower cervical dural canal during neck flexion has been postulated to lead to lower cervical cord atrophy with asymmetric flattening. We report a case of Hirayama disease in a 25-year-old Indian man presenting with gradually progressive asymmetrical weakness and wasting of both hands and forearms along with unusual features of autonomic dysfunction and upper motor neuron lesion.
Colonic metastasis from infiltrating ductal breast carcinoma in a male patient: A case report
Authors: Ashley Jones, Madison R Kocher, Ashlee Justice, Fernando Navarro
Journal: Int J Surg Case Rep (2019)
Keywords: breast carcinoma, case report, colonic metastases, ductal carcinoma, male breast carcinoma, metastatic breast carcinoma

Introduction:
A colonic metastasis from infiltrating breast ductal carcinoma is a rare phenomenon in the literature, especially in a male.
Presentation of case:
We present a rare case of a 55-year-old male with a past medical history of breast cancer who presented with signs and symptoms of appendicitis. A computed tomography (CT) scan revealed acute appendicitis in addition to a 2.3 cm cecal mass that correlated with a hypermetabolic region on positron emission testing (PET) the previous year. Analysis of a previously biopsied axillary lymph node demonstrated infiltrating ductal carcinoma. After an appendectomy and a right hemicolectomy were performed, pathologic analysis of the specimen revealed metastatic ductal carcinoma to the cecum.
Discussion:
Gastrointestinal metastases of breast carcinoma are rare with colonic metastases occurring in approximately 3% of these cases. At the time of diagnosis of these colonic metastases, the disease is often times multifocal in the gastrointestinal tract. Solitary gastrointestinal metastases are less common than both secondary primaries and benign processes. Biopsies obtained during colonoscopy are often non-diagnostic, mandating surgical excision and pathologic examination.
Conclusion:
Although colonic metastases from a primary breast ductal carcinoma are rare, a low level of suspicion must be maintained in a patient with such a history presenting with abdominal symptoms.
Deciding the Cause of Death in a Victim of a Road Traffic Accident Became Difficult Due to Interventions: A Case Report
Authors: Ashok Kumar Rastogi, Tarun Kumar, Amit Patil, Binay Kumar
Journal: Cureus (2023)
Keywords: arrhythmia, atrioventricular node, conduction system, septal contusion, subendocardial hemorrhage
MeSH terms: Case Reports

Though uncommon, puncture injury to the heart can occur during cardiac resuscitation and when inserting a lifesaving drug directly into the left ventricle of the heart. Utmost precaution must be taken to avoid damaging the conduction system of the heart, particularly the nodal part, as it can cause cardiogenic shock, arrhythmia, and sudden death. Our index case report describes a 55-year-old male who was fatally injured after being hit by a truck while riding his bike. The autopsy revealed multiple puncture injuries to the atrioventricular node area of the septum, observed on both sides of the interatrial septal wall surface. Histopathological examination also showed subendocardial hemorrhage around the atrioventricular nodal area. The nature of the injuries made identification of the cause of death difficult.
An Aggressive Case of Adrenocortical Carcinoma Complicated by Paraneoplastic Cushing's Syndrome
Authors: Mohamed Zakee Mohamed Jiffry, Breeana Hernandez, Meagan Josephs, Aimal Khan, Zaamar Malik
Journal: Cureus (2023)
Keywords: adrenal malignancy, adrenocortical carcinoma (acc), chemo radiotherapy (chemo-rt), ectopic cushing’s syndrome, paraneoplastic syndromes
MeSH terms: Case Reports

Adrenocortical carcinoma (ACC) is a rare endocrine malignancy with a poor prognosis. Surgical resection may be curative if localized disease is identified, although recurrence is common. Research shows that the use of adjuvant therapeutic regimens such as EDP-M (combination of mitotane, etoposide, doxorubicin, and cisplatin) in high-risk patients has survival benefits. A 75-year-old female was incidentally found to have a right adrenal heterogeneous internal enhancement measuring 5.0 x 3.7cm. The workup confirmed autonomous adrenal production of corticosteroids and she was referred to surgery for an adrenalectomy. A T2 ACC with positive margins and lympho-vascular invasion was resected, following which she was started on external beam radiation followed by four cycles of carboplatin and etoposide. Despite initial treatments, she was diagnosed with refractory metastatic disease at subsequent follow-ups. Pembrolizumab immunotherapy was started, but disease progression continued, and she was eventually transitioned to mitotane 1g twice daily. She continued to worsen and was eventually transitioned to hospice care. The management of ACC remains diagnostically challenging, especially because most patients do not present until an advanced stage of disease. Surgery is commonly employed with a curative intent, and opinions regarding adjuvant cytotoxic therapy and/or radiotherapy remain mixed.
Hepatitis B virus variants in an HIV-HBV co-infected patient at different periods of antiretroviral treatment with and without lamivudine
Authors: Eneida A Santos, Michel V F Sucupira, Juçara Arabe, Selma A Gomes
Journal: BMC Infect Dis (2004)
MeSH terms: Anti-HIV Agents / therapeutic use, HIV Infections / drug therapy, HIV-1, Hepatitis B virus / genetics, Hepatitis B, Chronic / virology, Lamivudine / therapeutic use, Case Reports, Research Support, Non-U.S. Gov't, Adult, Anti-HIV Agents / pharmacology, Cloning, Molecular, DNA, Viral / blood, DNA, Viral / chemistry, DNA-Directed DNA Polymerase / genetics, Drug Resistance, Viral / drug effects, Drug Resistance, Viral / genetics, Fatal Outcome, HIV Infections / complications, Hepatitis B Surface Antigens / genetics, Hepatitis B virus / classification, Hepatitis B virus / drug effects, Hepatitis B, Chronic / complications, Hepatitis B, Chronic / drug therapy, Humans, Lamivudine / pharmacology, Male, Mutation / drug effects, Phylogeny, Polymerase Chain Reaction, Anti-HIV Agents, DNA, Viral, Hepatitis B Surface Antigens, Lamivudine, DNA-Directed DNA Polymerase

Background:
Lamivudine inhibits replication of both human immunodeficiency virus (HIV) and hepatitis B virus (HBV) and is commonly used as part of antiretroviral therapy. The main limitation in the use of lamivudine is resistant mutation selection. Most of these mutations affect the YMDD motif of the HBV DNA polymerase. The resistance occurs through M550V or M550I aminoacid replacements. The M550V variation may be accompanied by L526M mutation, notably in HIV-HBV co-infected patients. The aim of this study was to investigate mutations associated with lamivudine resistance in a hemodialysis patient chronically co-infected with HIV-1 and HBV, who was submitted to several antiretroviral treatments.
Methods:
HBV isolates derived from three blood samples collected at different times of antiretroviral therapies with and without lamivudine, were titred and submitted to nucleotide sequencing.
Results:
HBV isolate derived from a sample collected in 1999 during an antiretroviral treatment with lamivudine showed the lamivudine resistant double mutation (L526M, M550V). However, no mutation associated with lamivudine resistance was observed in the HBV genome derived from the sample collected during a period of treatment without lamivudine (2001). After reinstitution of lamivudine (2002), the predominant HBV population exhibited a rare triple mutation (V519L, L526M, M550V), which has previously been associated with an in vitro reduction of virus antigenicity (escape mutant). HBV DNA was detected at high levels (108-109 copies/ml) in the three blood samples.
Conclusions:
Reintroduction of lamivudine as part of antiretroviral treatment in a patient who had developed lamivudine resistant HBV strains favored the predominance of an HBV isolate with reduced antigenicity. The absence of hepatitis acute exacerbation in this patient may be correlated to the absence of significant variations of the viral load, which was independent of the presence of mutations in the HBV DNA polymerase.
Renal Tubular Acidosis and Hypokalemic Paralysis as a First Presentation of Primary Sjögren's Syndrome
Authors: Arun Sedhain, Kiran Acharya, Alok Sharma, Amir Khan, Shital Adhikari
Journal: Case Rep Nephrol (2018)
MeSH terms: Case Reports

Sjögren's syndrome is an autoimmune disease with multisystem involvement and varying clinical presentation. We report the clinical course and outcome of a case who presented with repeated episodes of hypokalemia mimicking hypokalemic periodic paralysis and metabolic acidosis, which was later diagnosed as distal renal tubular acidosis secondary to primary Sjögren's syndrome. A 50-year-old lady, who was previously diagnosed as hypokalemic periodic paralysis, presented with generalized weakness and fatigue. She was found to have severe hypokalemia with normal anion-gap metabolic acidosis consistent with distal renal tubular acidosis. Subsequent evaluation revealed Sjögren's syndrome as the cause of her problems. Kidney biopsy done to evaluate significant proteinuria revealed nonproliferative morphology with patchy acute tubular injury and significant chronic interstitial nephritis. The patient responded well to potassium supplementation and oral prednisolone. Presentation of this case highlights the necessity of close vigilance while managing a case of repeated hypokalemia, which could be one of the rare clinical manifestations of Sjögren's syndrome.