OpenMed/multicare-articles huggingface dataset:
Watery Diarrhea Is Not Always Clostridioides difficile: A Case Report of Aeromonas hydrophila Gastroenteritis
Authors: Sahrudh Dharanendra, Aaron S Gillet, Bashir Geer, Mary Ann Kirkconnell Hall, Patricia R Hwang
Journal: Cureus (2024)
Keywords: acute watery diarrhea, aeromonas hydrophila, aeromonas infection, clostridioides difficile -associated diarrhea, gastroenteritis
MeSH terms: Case Reports

Aeromonas species can cause acute gastroenteritis but are much less commonly observed in the hospital setting than other bacteria. Most cases of Aeromonas hydrophila gastroenteritis reported in the literature have occurred in pediatric, elderly, and/or immunocompromised patients. We present a case of subacute watery diarrhea due to A. hydrophila infection in an otherwise healthy 48-year-old female patient with prior abdominal surgeries and recent hospitalization for a catheter-associated urinary tract infection (CAUTI) for which she received antibiotics. The patient presented with 10 days of increasingly frequent non-bloody, watery, foul-smelling diarrhea as well as decreased oral intake, cramping bilateral upper abdominal pain, chills, and malaise. Initial diagnoses considered included Clostridioides difficile in the setting of CAUTI and antibiotic use, small intestinal bacterial overgrowth, dumping syndrome related to bariatric surgery, and malabsorption. A computed tomography scan of her abdomen/pelvis, admission labs, and flexible sigmoidoscopy showed no relevant findings. Stool cultures eventually returned positive for A. hydrophila. The case is an uncommon presentation of Aeromonas infection that could be easily missed while other diagnoses are pursued. Early treatment of Aeromonas infection can be crucial in preventing advanced forms of disease such as septicemia and necrotizing fasciitis.
Testicular choriocarcinoma with pelvic and pulmonary metastases: a case report
Authors: Xin Bai, Xiao H Liu, Hai W Liang, Yi S Li, Biao F Shan, Jian M Tang
Journal: Front Oncol (2024)
Keywords: genital examination, lung metastases, pelvic metastases, retroperitoneal mass, testicular choriocarcinoma
MeSH terms: Case Reports

Testicular tumors represent a common form of solid tumor in young men, with choriocarcinoma of the testis being a rare, non-granulomatous germ cell tumor. It accounts for less than 0.3% of all testicular germ cell tumors. Pelvic and pulmonary metastases originating from testicular choriocarcinoma are exceptionally uncommon in men. This study describes a case of a 27-year-old male diagnosed with testicular choriocarcinoma, presenting initially with nausea, vomiting, and abdominal pain. Furthermore, this review encompasses cases of testiclar choriocarcinoma in individuals aged 30 years and below, both in China and internationally, over the past 20 years.
Bacteraemia and obstructive pyelonephritis caused by Bifidobacterium breve in an elderly woman: a case report and literature review
Authors: Mitsuru Nishio, Hiroshi Morioka, Shun Takai, Yukari Osada, Yoshie Seki, Takato Osugi, Airi Oba, Yuki Miyaki
Journal: Access Microbiol (2023)
Keywords: bifidobacterium, bifidobacterium breve, pyelonephritis, urinary tract infection
MeSH terms: Case Reports

Bifidobacterium spp. are non-spore-forming Gram-positive anaerobes that are indigenous to the human gastrointestinal tract and vagina. They are believed to be non-pathogenic organisms for humans and thus are widely used as probiotics. An 83-year-old woman taking cephalexin for 4 days was diagnosed with obstructive pyelonephritis. Y-branched Gram-positive rods were found in both anaerobic and aerobic blood culture bottles, and in an anaerobic urine culture. Bifidobacterium breve was finally identified. Ceftriaxone and metronidazole were administered to the patient, and she was discharged after intermittent catheterization for dysuria. Urinary tract infection caused by Bifidobacterium spp. is believed to be rare, but it can develop in patients with underlying urological conditions. Recognition of the characteristic morphology and conducting anaerobic urine culture may help in identifying more cases of Bifidobacterium urinary tract infections.
Posterior Sinuplasty: A New Strategy for Managing Hydrocolpos in Cloaca-Case Series
Authors: Amr AbdelHamid AbouZeid, Ahmed Saad Abdelmoniem, Mohamed Abdelrahman Fathy, Mohamed Ahmed Negm, Shaimaa Abdelsattar Mohammad
Journal: European J Pediatr Surg Rep (2024)
Keywords: mullerian anomalies, anorectal malformations, congenital, urogenital sinus, vaginal septum
MeSH terms: Case Reports

We present a simple surgical technique aiming to improve urine outflow through the common urogenital sinus in cloaca and facilitate drainage of existing hydrocolpos. The study included three cases of cloaca with associated hydrocolpos that were operated during the period 2022 through 2023. The patient is placed in the prone position for a standard posterior sagittal anorectoplasty. The distal rectal fistula is severed flush with the vagina/sinus leaving an open defect in the posterior wall of the vagina/sinus. The defect is then widened distally via a vertical incision (∼1 cm) through the posterior wall of the common urogenital sinus toward but not reaching the perineum. This vertical defect is then closed horizontally displacing the posterior vaginal wall downwards toward the perineum (posterior sinuplasty). The postoperative recovery was uneventful in the three cases. Adequate drainage of hydrocolpos was confirmed by imaging at follow-up, as well as improvement of upper urinary tract dilatation. In selected cases of cloaca, posterior sinuplasty is a simple procedure that can be applied during anorectoplasty to provide effective drainage of associated hydrocolpos.
Zieve's Syndrome: An Underdiagnosed Cause of Non-immune Hemolytic Anemia
Authors: Rui Ribeiro, Marli Ferreira, Rui Coelho, Cláudia Pereira
Journal: Cureus (2024)
Keywords: acute alcoholic hepatitis, alcohol liver disease, hemolytic anemia, jaundice, zieve’s syndrome
MeSH terms: Case Reports

Zieve's syndrome is an underdiagnosed condition characterized by the triad of jaundice, hemolytic anemia, and hyperlipidemia in the setting of chronic alcohol use. It may be accompanied by acute alcoholic hepatitis. The distinction between the coexistence of acute alcoholic hepatitis with Zieve's syndrome and Zieve's syndrome in isolation is crucial, given the different treatments and prognoses in these situations. A 35-year-old woman presented with complaints of abdominal discomfort, nausea, and vomiting in the previous week. She was a heavy drinker with resultant cirrhosis, splenomegaly, and esophageal varices. An ancillary test showed hemolytic anemia, moderately elevated transaminases, hyperbilirubinemia, and coagulopathy. A negative direct Coombs test established the anemia as non-immune, supporting the diagnosis of Zieve's syndrome despite the absence of hyperlipidemia. Maddrey's discriminant function score was 92 points, so she was treated with supportive measures, as well as corticosteroids in the setting of acute alcoholic hepatitis. The patient showed a favorable clinical and analytical evolution and was discharged home one month following admission with her hemoglobin levels stabilized. Previous literature focused on the distinction between Zieve's syndrome and acute alcoholic hepatitis but they may coexist.
Creutzfeldt-Jakob disease presenting as psychiatric disorder: case presentation and systematic review
Authors: Brendan Huang, Neeva Shafiian, Paul Joseph Masi, Marc L Gordon, Ana M Franceschi, Luca Giliberto
Journal: Front Neurol (2024)
Keywords: creutzfeldt-jakob disease, depression, mania, psychosis, systematic review
MeSH terms: Review

Creutzfeldt-Jakob disease (CJD) is a spongiform encephalopathy caused by misfolded human prion proteins (PrP)s. Due to variability in presentation, the diagnosis may be missed in lieu of various psychiatric disorders. Our study reports on a prototypical case and psychiatric mimic for CJD, and the workup used to establish the correct diagnosis. A 54-year-old male with a past medical history of traumatic brain injury and major depressive disorder presented with chest pain. During the hospital stay, he was found to be increasingly aggressive, and behaved out of character. Further review of clinical history revealed that the patient was diagnosed with cognitive impairment and depression one year prior. The patient was agitated, poorly redirectable, and had unstable gait on neurological examination. Magnetic resonance imaging (MRI) of the brain demonstrated restricted diffusion (DWI) along the parietooccipital and temporal regions (L > R) and in the subcortical structures, including the basal ganglia and thalami, with accompanying subtle fluid attenuation inversion recovery (FLAIR) hyperintense signal abnormality in these regions, deemed as artifactual at the time. Repeat MRI brain two months later demonstrated progression of the DWI signal with ADC correlate and FLAIR findings. Cerebrospinal fluid 14-3-3 and RT-QuIC samples were positive. Upon passing a few months later, brain autopsy and Western Blot confirmed the CJD diagnosis. Literature review was conducted on PubMed to identify CJD cases initially diagnosed as psychiatric disorder. Search terms included "CJD" or "Creutzfeldt-Jakob disease" with three common psychiatric diagnoses, "Depression," "Psychosis," and "Mania." Positive EEG, MRI, PET, and CSF (including protein 14-3-3 and tau) findings for CJD were found in 66.7, 81.1, 50, and 72.7% of cases, respectively. Overall, CJD can present as a psychiatric mimic. In suspicious cases, EEG, imaging, and CSF studies should be promptly utilized to arrive at the correct diagnosis. Repeated MRI imaging is often required to help in the diagnostic process. Brain biopsy should be considered in selected cases.
Radiotherapy-induced vitiligo in a patient with breast cancer, a case report
Authors: Francisco E Villanueva, Natalia S Jara, Valentina Darlic
Journal: Ecancermedicalscience (2024)
Keywords: koebner phenomenon, breast cancer, melanocyte, radiotherapy, vitiligo

Vitiligo is a disease characterised by the autoimmune destruction of melanocytes, manifesting as depigmentation of the skin. We present the case of a female patient with a history of breast cancer who developed vitiligo in the area of the treatment field 12 months after the end of radiotherapy. It has been reported in the literature that vitiligo can occur in patients with a history of vitiligo after radiotherapy, attributable to the Koebner phenomenon, where some treatments can induce new vitiligo lesions in the patient.
Elevation of D-dimer in eosinophilic gastrointestinal diseases in the absence of venous thrombosis: A case series and literature review
Authors: Yang Song, Boyu Yang, Wanlei Ren, Doudou Hu
Journal: Open Med (Wars) (2024)
Keywords: d-dimer, case series, eosinophilic gastroenteritis, literature review, venous thrombosis
MeSH terms: Case Reports

Introduction:
Eosinophilic gastrointestinal diseases (EGIDs) are rare and heterogeneous diseases characterized by excessive eosinophilic infiltration of the digestive system. D-dimer levels and its possible association with disease course were not reported.
Case series:
We reported a series of three EGID cases presenting with high levels of D-dimer. No evidence for potential venous thromboembolism was found through computed tomography pulmonary angiogram and vascular ultrasounds. Moreover, D-dimer levels decreased after short-time systemic prednisolone administration, accompanied by remission of clinical symptoms and decrease of peripheral eosinophil counts and IgE levels.
Conclusion:
Elevation of D-dimer in EGID may not represent thrombotic events but is possibly associated with disease severity. More population-based studies are needed to delineate the potential relationship among D-dimer, thrombosis, and inflammation in EGID.
Case Report: Role of numerical simulations in the management of acute aortic syndromes
Authors: Antonio Rizza, Vincenzo Castiglione, Katia Capellini, Cataldo Palmieri, Emanuele Gasparotti, Sergio Berti, Simona Celi
Journal: Front Cardiovasc Med (2024)
Keywords: acute aortic syndrome, aortic endograft, computational fluid dynamics, numerical simulations, penetrating aortic ulcer
MeSH terms: Case Reports

Penetrating aortic ulcer (PAU) represents a subset of acute aortic syndromes characterized by high rupture risk and management challenges, particularly in elderly patients with significant comorbidities. This case report showcases a 75-year-old patient with a history of coronary artery bypass graft (CABG) and with multiple PAUs involving the aortic arch, deemed unfit for conventional open surgery. A branched aortic endograft with a pre-cannulated side component for the left subclavian artery (LSA) was employed to preserve the patency of the previous CABG. Two computational fluid dynamics (CFD) simulations and a morphological analysis were performed on the pre- and post-intervention aortic configurations to evaluate changes in flow rate and pressure drop at LSA level and differences in the lumen size. The results revealed a decrease in the flow rate equal to 2.38% after the intervention and an increase in pressure drop of 4.48 mmHg, while the maximum differences in LSA cross-sectional areas and diameters were 1.49 cm2 and 0.64 cm, respectively. Minimal alteration in LSA blood flow due to the chosen intervention approach confirmed the effectiveness of the selected unibody design endograft with LSA preservation, ensuring myocardial perfusion. Therefore, CFD simulations demonstrate to be a powerful tool to evaluate the hemodynamic consequences of interventions by accurately estimating the main fluid dynamic parameters.
A Huge Hemangioma of the Urinary Bladder: A Case Report and Literature Review
Authors: Muhannad Wael, Wael Abuarafeh, Mohammad N Ghneimat, Murad Al Hammouri, Mutaz W Abuarafeh, Ahmad M Nabali
Journal: Cureus (2024)
Keywords: bladder cancer, cavernous hemangioma, hemangioma, partial cystectomy, urinary bladder
MeSH terms: Case Reports

Cavernous hemangioma of the bladder is a benign and very rare vascular tumor. It can be isolated or part of a syndrome. Neither clinical symptoms nor imaging modalities lead to a definitive diagnosis as there are no specific findings on imaging studies or specific symptoms. Painless gross hematuria is the most common chief complaint and presentation and should never be underestimated. Here, we report a case of a large hemangioma of the urinary bladder in a young man who presented with recurrent recent episodes of painless gross hematuria and, surprisingly, with a previous episode of painless hematuria 15 years ago, which was treated successfully with partial cystectomy. We discuss the clinical features, evaluation, diagnosis, biopsy, management, the challenges encountered in treatment, and assert the value of tissue diagnosis and follow-up pattern and period. Due to the rarity of the tumor and lack of trials and evidence-based guidelines for management, treatment modalities vary and the risk for recurrence is questionable and not known.
Case report: Artificial thymic organoids facilitate clinical decisions for a patient with a TP63 variant and severe persistent T cell lymphopenia
Authors: Alevtina Gall, Marita Bosticardo, Stacey Ma, Karin Chen, Kayla Amini, Francesca Pala, Ottavia M Delmonte, Tara Wenger, Michael Bamshad, John Sleasman, Matthew Blessing, Nicolai S C van Oers, Luigi D Notarangelo, M Teresa de la Morena
Journal: Front Immunol (2024)
Keywords: t cell lymphopenia, tp63, ankyloblepharon-ectodermal defects-cleft lip/palate (aec), artificial thymic organoids, cultured thymus tissue implantation (ctti), ectrodactyly-ectodermal dysplasia clefting (eec)
MeSH terms: Lymphopenia / genetics, Lymphopenia / immunology, Organoids, Thymus Gland / immunology, Transcription Factors / genetics, Tumor Suppressor Proteins / genetics, Case Reports, Cell Differentiation, Female, Humans, Infant, Newborn, Mutation, T-Lymphocytes / immunology, Transcription Factors, TP63 protein, human, Tumor Suppressor Proteins, T-Lymphocytopenia

Pathogenic variants in the transcription factor TP63 are associated with clinically overlapping syndromes including ectrodactyly-ectodermal dysplasia clefting (EEC) and ankyloblepharon-ectodermal defects-cleft lip/palate (AEC). T cell lymphopenia has rarely been described in individuals with TP63 variants and the cause of the T cell defect is unclear. Here, we present a case of a female infant born with TP63-related syndrome and profound T cell lymphopenia, first uncovered through newborn screening. Flow cytometry analysis revealed low CD4+ naïve T cells and nearly absent CD8+ T cells with intact B and NK cell compartments. A de novo heterozygous pathogenic variant c.1040 G>A (C347Y) in exon 8 of TP63 was identified. An artificial thymic organoid system, to assess the intrinsic ability of the patient's hematopoietic cells to develop into T cells, was performed twice using separate peripheral blood samples. Ex vivo T cell differentiation was evident with the artificial organoid system, suggesting that a thymic stromal cell defect may be the cause of the T cell lymphopenia. Consistent with this, interrogation of publicly available data indicated that TP63 expression in the human thymus is restricted to thymic epithelial cells. Based on these data, congenital athymia was suspected and the patient received an allogenic cultured thymus tissue implant (CTTI). This is the first report of suspected congenital athymia and attempted treatment with CTTI associated with TP63 variant. At 9 months post-implant, peripheral lymphocyte analysis revealed measurable T cell receptor excision circles and presence of CD4+ recent thymic emigrants suggestive of early thymopoiesis. She will continue regular monitoring to ensure restoration of T cell immunity.
Case report: Sepsis secondary to infected protracted parotid sialocele after maxillofacial oncologic surgery in a dog
Authors: Stephanie Goldschmidt, Jamie Anderson, Janny Evenhuis, Eric Stoopler, Thomas P Sollecito
Journal: Front Vet Sci (2024)
Keywords: stensen’s duct, oncologic surgery, oral surgery, parotid duct, parotid gland, sepsis, sialocele
MeSH terms: Case Reports

An 8-year-old male intact mixed breed dog was treated for a 3.7×3×3.6 cm grade 1 multilobular osteochondrosarcoma (MLO) arising from the dorsal aspect of the right coronoid process with a coronoidectomy, a zygomectomy, and a caudal maxillectomy. Ten months later, the dog presented for a swelling near the right angular process, which was presumed to be a locoregional recurrence. Blood work and initial staging tests (abdominal ultrasound) had mild abnormalities of no clinical concern/significance. The dog was hospitalized with a plan for computed tomographic (CT) scan of skull and chest the following day. Overnight, the swelling rapidly increased, and the dog became laterally recumbent, febrile, and hypotensive. Laboratory evaluation revealed hypoglycemia, elevated lactate, and elevated band neutrophils with moderate toxicity, most consistent with sepsis. The dog was stabilized with fluid resuscitation, intravenous (IV) antibiotics, IV dextrose, and pressor support. Once stabilized, a contrast CT scan was performed, which revealed evidence of an infected parotid gland sialocele. To our knowledge, this is the first veterinary case that describes sepsis secondary to an infected protracted parotid sialocele.
Penile Fracture Secondary to Gunshot Injury: A Multidisciplinary Approach and Exceptional Surgical Management in an Uncommon Case
Authors: Javier Meza-Hernandez, Christian Sánchez-Treviño, Marco Antonio Ascencio-Martínez, Alejandra Nuñez-Venzor
Journal: Cureus (2024)
Keywords: gunshot wound, multidisciplinary approach, penile fracture, surgical management, uncommon case
MeSH terms: Case Reports

Penile fractures happen when the tunica albuginea is forcefully torn during intense sexual activity or vigorous masturbation. Gunshot-induced cases are extremely rare. Diagnosis, often requiring surgical exploration, poses challenges due to the condition's rarity and severity. We report a complex case of a patient with multiple gunshot wounds, highlighting the need for a multidisciplinary approach for abdominal and genitourinary regions. A 24-year-old male presented to the emergency department with multiple gunshot wounds to the anterior thoracic and abdominal walls, inguinal region, penis, and lower extremities. Despite multiple gunshot wounds, the patient maintained hemodynamic stability during physical examination. No imaging study was performed since surgical management was decided due to the presence of hematemesis. During exploratory laparotomy, a 2 cm stomach lesion was found and repaired by the general surgery team. Urology then addressed genital trauma, identifying and fixing a 1 cm tunica albuginea defect in each corpora cavernosa, achieving bilateral penile fracture repair. The patient was discharged after eight days of hospitalization, with adequate oral intake and urinating. Fifty-two days later, he persists with mild erectile dysfunction (International Index of Erectile Function-5 score: 17 points). This unique case involving a gunshot-induced penile fracture alongside abdominal and several other injuries was successfully managed through a multidisciplinary approach. As these lesions are rare, prompt treatment with standardized surgical procedures for civilian cases is crucial for optimal outcomes.
Applying enhanced recovery after surgery protocols in a patient with a giant spleen: a case report
Authors: Dan Fang, Biling Gan, Mei Li, Dailan Xiong
Journal: Front Oncol (2024)
Keywords: case report, enhanced recovery after surgery, nursing, primary myelofibrosis, splenomegaly
MeSH terms: Case Reports

Although splenomegaly is a common finding in several diseases, massive splenomegaly is rare. Patients with massive splenomegaly often present with a complex clinical picture. This case report describes a 72-year-old female with a complex medical history. Fifteen years ago, she was diagnosed with primary myelofibrosis, which subsequently led to progressive abdominal enlargement and bloating over the past 5 years. Recently, she developed edema in her limbs, accompanied by dizziness, shortness of breath, and fatigue. A massive splenomegaly was discovered during her hospitalization. Additionally, the patient has a history of Crohn's disease, gout, renal insufficiency, and hypertension. Laboratory results reveal severe anemia and thrombocytopenia. Abdominal CT scans confirm the enlarged spleen and show ascites. She was treated by a multidisciplinary team comprising several departments. Even after a period of comprehensive treatment, the symptoms of massive splenomegaly did not significantly improve. Thus, the patient underwent an open surgical excision of the giant spleen. The weight of the giant spleen was 5.0 kg. During the perioperative period, Enhanced Recovery After Surgery (ERAS) protocols were applied to facilitate recovery. Her recovery was uneventful, and she was able to resume her regular daily routine shortly after the procedure. This report presented a complex and rare case of massive splenomegaly, and underscored that a proper medical and nursing care is the key to better recovery.