OpenMed/multicare-articles huggingface dataset:
Caudal Neuraxial Blocks for Pain Relief From Pelvic Neuropathy Caused by Extensive Diffuse Large B-cell Lymphoma
Authors: Amanda Myles, Ammar Toubasi, Elizabeth Soladoye, Narayana Gowda, Joan Morny
Journal: Cureus (2024)
Keywords: cancer pain management, cancer-related neuropathic pain, caudal nerve block, central neuraxial block, neuraxial block, opioid refractory, opioid-refractory pain, refractory cancer pain, sciatic nerve block
MeSH terms: Case Reports

Central neuraxial blocks can be a vital therapeutic tool for neuropathic pain, but they are infrequently implemented for pain management in cancer patients. Upon a literature review, further data on the role or efficacy of central nerve blocks for neuropathic cancer pain would be beneficial. Additionally, evidence-based guidelines and practices are lacking regarding additional interventions for neuropathic pain relief, a common manifestation of cancer burden. Here, we report the case of a 29-year-old male patient who presented in the ED with intractable neuropathic pain from extensive diffuse large B-cell lymphoma. The patient demonstrated left lower extremity pain, fevers, chills, and tenderness with erythema over the site of his port-a-catheter on his chest. The patient was also hypotensive, despite IV fluid resuscitation. Recent imaging showed a hypermetabolic soft tissue mass in the left upper quadrant of the abdomen. There was also extensive cancer spread in the peripheral pelvis, presacral region, and within multiple sacral foramina, with a secondary perineural spread of the tumor. The patient previously positively responded to a caudal nerve block at an outpatient pain clinic. The patient was admitted to the ICU for three days, and following the resolution of sepsis, the patient received caudal and sciatic nerve blocks on admission day 8. Upon further imaging showing metastasis to the brain, the patient was discharged to inpatient hospice on hospitalization day 10 following a palliative conversation with the patient and family.
Metabolic pseudoprogression in a patient with metastatic KIT exon 11 GIST after 1 month of first-line imatinib: a case report
Authors: Elisa Tassinari, Nicole Conci, Giacomo Battisti, Francesco Porta, Valerio Di Scioscio, Maria Giulia Pirini, Dario de Biase, Maria Concetta Nigro, Miriam Iezza, Fausto Castagnetti, Luigi Lovato, Stefano Fanti, Maria Abbondanza Pantaleo, Margherita Nannini
Journal: Front Oncol (2023)
Keywords: fdg-pet, gist, functional imaging, gastrointestinal stromal tumors, imatinib
MeSH terms: Case Reports

Background:
Positron emission tomography (PET) with 18-fluorodeoxyglucose (18FDG) has proven to be highly sensitive in the early assessment of tumor response in gastrointestinal stromal tumors (GIST), especially in cases where there is doubt or when the early prediction of the response could be clinically useful for patient management. As widely known, kinase mutations have an undoubtful predictive value for sensitivity to imatinib, and the inclusion of KIT and PDGFRa mutational analysis in the diagnostic workup of all GIST is now considered standard practice.
Case presentation:
Herein, we described in detail a case of an exon 11 KIT mutated-metastatic GIST patient, who presented an unexpected metabolic progression at the early 18FDG-PET evaluation after 1 month of first-line imatinib, unconfirmed at the liver biopsy performed near after, which has conversely shown a complete pathological response.
Conclusions:
This report aims to highlight the existence of this metabolic pseudoprogression in GIST at the beginning of imatinib therapy in order to avoid early treatment discontinuation. Therefore, an early metabolic progression during a molecular targeted therapy always deserves to be evaluated in the context of the disease molecular profiling, and in case of a discordant finding between functional imaging and molecular background, a short-term longitudinal control should be suggested.
L-2 hydroxyglutaric aciduria: report of a Mexican-Mayan patient with the mutation c.569C>T and response to vitamin supplements and levocarnitine
Authors: Roberto Leal-Ortega, Luis Enrique Parra-Medina, Lizbeth Josefina González-Herrera
Journal: Tremor Other Hyperkinet Mov (N Y) (2024)
Keywords: l-2 hydroxyglutaric aciduria, l-carnitine, l2hgdh, t2-hyperintensities, cerebellar ataxia, riboflavin, tremor
MeSH terms: Brain Diseases, Metabolic, Inborn, Carnitine, Tremor, Case Reports, Adolescent, Alcohol Oxidoreductases / genetics, Female, Humans, Mutation / genetics, Vitamins, Carnitine, Vitamins, L2HGDH protein, human, Alcohol Oxidoreductases, 2-Hydroxyglutaricaciduria

Background:
L-2-hydroxyglutaric aciduria (L2HGA) is a rare inherited autosomal recessive neurometabolic disorder caused by pathogenic variants in the L2HGDH gene which encodes mitochondrial 2-hydroxyglutarate dehydrogenase. Here, we report a case of L2HGA in a Mexican-Mayan patient with a homozygous mutation at L2HGDH gene and clinical response to vitamin supplements and levocarnitine.
Case report:
A 17-year-old, right-handed female patient with long-term history of seizures, developmental delay and ataxia was referred to a movement disorders specialist for the evaluation of tremor. Her brain MRI showed typical findings of L2HGA. The diagnosis was corroborated with elevated levels of 2-hydroxyglutaric acid in urine and genetic test which revealed a homozygous genetic known variant c.569C>T in exon 5 of L2HGDH gene. She was treated with levocarnitine and vitamin supplements, showing improvement in tremor and gait.
Discussion:
To our knowledge this is the first report of a Mexican patient with L2HGA. This case adds information about a rare condition in a different ethnic group and supports the findings of other authors which encountered symptomatic improvement with the use of flavin adenine dinucleotide (and its precursor riboflavin), and levocarnitine.
Highlights:
We report the first case of Mexican-Mayan patient with L2HGA showing a missense homozygous mutation in L2HGDH gene, and improvement of symptoms with vitamin supplements and levocarnitine.
Niraparib for the treatment of metastatic ccRCC in a patient with CDK12 and RAD51C mutations: a case report
Authors: Xiaolong Yue, Chenkang Yang, Dandan Cao, Yue Li
Journal: Front Pharmacol (2024)
Keywords: cdk12, parpi, rad51c, ccrcc, niraparib
MeSH terms: Case Reports

Background:
Niraparib, a poly ADP-ribose polymerase inhibitors (PARPi), has been widely applied in the intervention of epithelial ovarian, fallopian tube, or primary peritoneal cancer. Nevertheless, as of the present moment, there are limited instances demonstrating favorable outcomes stemming from niraparib therapy in patients with clear cell renal cell carcinoma (ccRCC).
Case presentation:
Here, we report a case of a 50-year-old patient with ccRCC who subsequently developed distant metastasis. The patient received monotherapy with pazopanib and combination therapy with axitinib and tislelizumab, demonstrating limited efficacy. Liquid biopsy revealed missense mutations in the CDK12 and RAD51C of the homologous recombination repair (HRR) pathway, suggesting potential sensitivity to PARPi. Following niraparib treatment, the patient's condition improved, with no significant side effects.
Conclusion:
In summary, patients with ccRCC harboring HRR pathway gene mutation may potentially benefit from niraparib. This will present more options for ccRCC patients with limited response to conventional treatments.
Ustekinumab trough levels in children with Crohn's disease refractory to anti-tumor necrosis factor agents: a prospective case series of off-label use
Authors: Marleen Bouhuys, Paola Mian, Patrick F van Rheenen
Journal: Front Pharmacol (2023)
Keywords: crohn’s disease, inflammatory bowel disease, pediatrics, therapeutic drug monitoring, ustekinumab

Background: Ustekinumab is used off-label in pediatric Crohn's disease refractory to anti-tumor necrosis factor. Data on optimal dosing, target trough levels, and potential benefit of therapeutic drug monitoring in children treated with ustekinumab are limited. Materials and Methods: We describe a series of six adolescents who consented to be treated with ustekinumab. We measured their trough levels, C-reactive protein, and fecal calprotectin before every administration. Results: Standard adult dosing was effective to achieve biochemical remission (fecal calprotectin < 250 mg/kg) in one patient and clinical remission (resolution of symptoms) in another. The other four patients failed to respond on standard dosing and underwent intravenous re-induction and interval shortening to increase ustekinumab trough levels. This resulted in biochemical remission in one patient and clinical remission in another, suggesting an exposure-response relationship. The remaining two patients had no therapeutic benefit, and ustekinumab was discontinued. Conclusion: In this report, we show that ustekinumab can induce remission in pediatric patients with anti-tumor necrosis factor refractory Crohn's disease. It is worth escalating the dose before abandoning the drug as ineffective. Prospective studies in children are needed to determine long-term efficacy of ustekinumab, usefulness of therapeutic drug monitoring strategies, and, if applicable, optimal target trough levels.
Adenocarcinoma of the Lung Masquerading As Invasive Pulmonary Aspergillosis in an Elderly Lady: A Diagnostic Challenge
Authors: Ramyashree N Reddy, Nandakishore Baikunje, Giridhar Belur, Nandu Nair
Journal: Cureus (2024)
Keywords: aspergillosis, bronchogenic adenocarcinoma, elderly population, lung cancer, occult disease
MeSH terms: Case Reports

A 59-year-old hypertensive woman presented with a year-long history of cough, expectoration, and progressive breathlessness, recently complicated by hemoptysis and significant weight loss. Initial investigations, including a chest x-ray and contrast-enhanced computed tomography (CECT) of the thorax, suggested an infective pathology. Despite negative bacterial, fungal, and tuberculosis cultures, elevated bronchoalveolar lavage (BAL) galactomannan and serum Aspergillus-specific IgG levels led to a diagnosis of invasive pulmonary aspergillosis (IPA), and antifungal treatment commenced. The patient's initial response was positive; however, symptoms recurred three months later. Further investigations revealed adenocarcinoma, confirmed by cytology from a thoracentesis. The patient, a non-smoker, began targeted therapy with tyrosine kinase inhibitors but declined further diagnostic evaluation. Despite the poor prognosis and palliative care options, the patient opted for discharge to home care. This case underscores the complexity of diagnosing lung pathologies and the importance of considering alternative diagnoses in persistent respiratory symptoms.
Fusion of the 2nd with the 3rd Cervical Vertebrae (C2-C3): A Case Series with Possible Clinical Significance
Authors: Eirini Demeneopoulou, Dorina Papa, Ilias Giotas, Angelos Nikolaou, George Tsakotos, Vasilios Karampelias, Theodore Mariolis-Sapsakos, Dimitrios Filippou, Maria Piagkou
Journal: Case Rep Orthop (2023)
MeSH terms: Case Reports

Purpose:
The current case series describes three cases of fusion between the 2nd cervical vertebra, the axis (C2), and the 3rd cervical vertebra (C3), creating a C2-C3 osseous complex and highlighting its morphological type of fusion (partial or complete) and morphometric details. The developmental background of this complex is emphasized, pointing out the possible clinical significance.
Materials and methods:
The osseous complexes were derived from disarticulated skeletons of body donors and were collected from the osseous collection of the Anatomy Department of the Medical School of the National and Kapodistrian University of Athens.
Results:
Three blocked vertebral complexes (2 partial and 1 complete C2-C3 osseous masses) were identified. In two cases, the vertebral bodies were partially fused and in one case were completely fused. In the 1st case, the C2-C3 complex had fused spinous processes and distinct transverse processes. Facets were completely fused on the left and partially fused on the right side. In the 2nd case, the C2-C3 complex had partially fused vertebral bodies and distinguishable spinous processes. In the 3rd case, the C2-C3 complex had completely fused vertebral bodies, facets, laminae, and transverse and spinous processes.
Conclusions:
Among the three (C2-C3) fused osseous complexes, the two were partially and the one was completely ossified. The fused vertebrae were characterized by osteophytic formations (at the dens and C3 area) and osteoporotic lesions. Taking into consideration the C2-C3 fusion, and possible coexisted variants, particular caution should be made in the upper cervical area, to interpret possible neurological manifestations and to reach a safe surgical plan.
Pontine myelinolysis with an uncommon manifestation of hallucination: a case report
Authors: Andreia Braga Mota Azzoni, Vitor Maia Arca, Eduardo Sousa de Melo
Journal: Dement Neuropsychol (2024)
Keywords: delirium, hallucinations, hyponatremia, myelinolysis, central pontine
MeSH terms: Case Reports

This report aims to present an elderly woman with persistent delirium after hospitalization for lethargy secondary to hyponatremia. The diagnosis of pontine myelinolysis was made and there were no characteristic neurological manifestations such as pupillary changes or spastic tetraparesis. Hallucinations and personality changes were the clues to the diagnosis and should be considered an atypical manifestation of pontine myelinolysis.
Subretinal Drusenoid Deposits in a Patient With HELLP (Hemolysis, Elevated Liver Enzymes, Low Platelet) Syndrome
Authors: Ceren Durmaz Engin, Omer Karti, Kutlay Kandemir
Journal: Cureus (2024)
Keywords: hellp syndrome, malignant hypertension, preeclampsia, subretinal deposit, subretinal drusenoid deposit
MeSH terms: Case Reports

Subretinal drusenoid deposits (SDD) are findings that can be observed in age-related macular degeneration as well as in ischemic ocular diseases. These deposits are believed to be of prognostic importance, as they have been shown to be associated with choroidal neovascularization. HELLP (hemolysis, elevated liver enzymes, low platelet) syndrome is a condition linked with severe preeclampsia, and it presents ocular findings such as hypertensive retinopathy, serous retinal detachment, and cortical visual impairment. This case report discusses the presence and course of SDD in a female patient who presented with hypertensive retinochoroidopathy secondary to HELLP syndrome.
The treatment process of a giant phyllodes tumor of the breast: a case report and review of the literature
Authors: Yujun Tong, Siyu Liu, Lijuan Zhao, Zhen Zhang, Haiyan Hu, Yu Jing, Tiantian Liang
Journal: Front Oncol (2024)
Keywords: diagnosis, giant phyllodes tumor, recurrence, surgery, treatment
MeSH terms: Case Reports

Giant phyllodes tumors are rare fibroepithelial tumors that are usually larger than 10 cm in diameter, have rapid tumor growth, and are easily recurrent. They are frequently accompanied by skin necrosis and infection, particularly in malignant phyllodes tumors. This case report presents a 50-year-old woman who presented to the hospital with a huge left breast mass that was ruptured and infected. The patient received anti-infective treatment and underwent mastectomy and skin grafting, which indicated a malignant phyllodes tumor. The tumor was completely excised after a local recurrence in the chest wall 6 months post-surgery. Unfortunately, one year later, the patient pass away due to multiple organ failure. Giant phyllodes tumor management presents challenges to the surgeon. This case is being presented to enhance understanding and treatment of phyllodes tumors, specifically giant malignant phyllodes tumors, with the aim of improving patients' quality of life.
Antineutrophil Cytoplasmic Antibody Vasculitis after Coronary Artery Bypass Grafting
Authors: Dwight D Harris, Sharif A Sabe, Afshin Ehsan
Journal: Case Rep Surg (2024)
MeSH terms: Case Reports

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis is a group of rare autoimmune disorders associated with the presence of ANCA autoantibodies. We present the first reported case of acute ANCA-associated vasculitis following coronary artery bypass grafting in a 74-year-old male presenting on postoperative day 13 with shortness of breath, orthopnea, and acute kidney injury. Renal biopsy ultimately showed focal necrotizing and crescentic glomerulonephritis, and the patient was successfully managed with corticosteroids and outpatient rituximab. This rare case highlights the importance of having an expanded differential for uncommon causes of cardiovascular disease and unexpected outcomes after coronary artery bypass grafting.
Clinicopathologic Correlation of Large Gastric Polyps in an Elderly Female: Case Report and Review of the Literature
Authors: Abdulaziz S Taleb, Babatope L Awosusi
Journal: Cureus (2024)
Keywords: endoscopy, fundic gland polyp, gastric, gastritis, helicobacter pylori
MeSH terms: Case Reports

Fundic gland polyps (FGPs) are benign epithelial polyps usually located in the gastric body and fundus. Here, we describe the case of an elderly woman who presented with symptomatic anemia, abdominal pain, and weight loss. There was also history of chronic use of proton pump inhibitors for the symptomatic treatment of dyspepsia. Reflux esophagitis, duodenal ulcers, and multiple gastric polyps suspicious of malignancy were found at endoscopy. A large pedunculated antral polyp measuring more than 10mm in the largest dimension and other smaller polyps in the body and fundus were removed completely by cold snare and sent for histopathologic evaluation. The polyps were eventually diagnosed as benign fundic gland polyps. Biopsies taken from the gastric mucosa also showed Helicobacter pylori-associated gastritis. Helicobacter pylori eradication therapy was commenced with the resultant resolution of symptoms. No surveillance is required for FGPs because they are not premalignant lesions. However, large FGPs require excision and thorough histopathologic evaluation to rule out atypia and malignancy. This index case further highlights a possible causal link between the chronic use of proton pump inhibitors and the development of fundic gland polyps.
Walls of resistance: Underground memories and political violence in Colombia
Authors: Patrick Naef
Journal: Hist Anthropol Chur (2023)
Keywords: colombia, political violence, memory, murals and street art, resistance

In this article, I examine 'underground memories' to demonstrate how they serve as resources for resistance in the margins of Colombia. I focus on their relations with the urban fabric, looking at the ways the walls of Bogota and Medellin are used as canvases for spreading images and narratives about the conflict. I suggest that murals representing the violence serve as a repository for memories; they challenge hegemonic narratives and contribute to the recovery of public space. This analysis draws on three case studies. In the first one, I examine the impact of a mural in Bogota that denounced extrajudicial killings involving the Colombian army. The second case focuses on a community initiative aimed at collecting testimonies from residents in a marginalized district of Medellin. Finally, the last case study analyses the touristification of some of the many murals depicting the violence in Medellin. I argue that, to different degrees, all the memorial projects presented in this study challenge state narratives. Through representations of murdered teenagers, suspect military officers and even drug cartel bosses, they raise questions of social justice, impunity, illegality and the dramatic banalization of violence in the country. They broaden the narrative on the recent past, through histories and images that the Colombian state is still reluctant to unearth.
Crossroads of Neurodermatology: Trigeminal Trophic Syndrome
Authors: Dimitra Xenopoulou, Evelyn Greco
Journal: Cureus (2024)
Keywords: cutaneous paresthesia, neurodermatology, nonhealing ulcer, trigeminal neuralgia, trigeminal trophic syndrome
MeSH terms: Case Reports

A 98-year-old female, with a past medical history of trigeminal neuralgia (TN) and non-melanoma skin cancer, presented with a crescent-shaped ulcer on her right nasal ala that had been present for months. On exam, the patient was aware of her issue, readily admitted to manipulation of the area, and had a past medical history significant for TN. The patient's history and clinical presentation led to a diagnosis of trigeminal trophic syndrome (TTS). TTS is an extremely rare, ulcerative condition that can arise in patients suffering from TN. While TN itself is well-documented, treatment is often challenging and usually focused on achieving symptomatic relief; for this patient, she did not achieve adequate management of her neuropathic symptoms, and her condition progressed to TTS. Thus, given the patient's ongoing multi-modal TN treatment, she was encouraged not to pick or manipulate the area to the best of her ability to curb the extent of ulceration. Given that TTS is so infrequently seen, we are hopeful that, by identifying the specifics of the underlying neuronal aberrancies in the future, we may be able to better grasp TTS's pathophysiology, ulcer development, and potential future treatment options.
Unusual presentation of glioblastoma in the brainstem: a case report of a diffuse pontine glioblastoma multiforme and surgical management
Authors: Brandon Edelbach, Vadim Gospodarev, Miguel Lopez-Gonzalez, Jeremy Deisch, Maninder Kaur
Journal: Front Oncol (2024)
Keywords: stupp regimen, glioblastoma multiforme, infratentorial glioblastoma multiforme, molecular subtyping, pons, radiation therapy, temozolomide therapy
MeSH terms: Case Reports

Diffuse pontine glioblastoma multiforme is a rare subtype of glioblastoma associated with a poor prognosis. In this case report, we present a unique case of diffuse primary pontine glioblastoma multiforme in a patient without any supratentorial lesions. We review the symptoms, treatment options, and case management of patients with infratentorial glioblastoma multiforme and compare these with our patient. Our patient presented with symptoms including progressive diplopia, gait disturbance, and lower extremity weakness. Magnetic resonance imaging revealed a diffuse lesion involving the pons and biopsy revealed only mildly-atypical glial infiltrates. Consequentially, diagnosis was driven by genetic analysis. Due to the location of the tumor, surgery was not considered a viable option. Instead, the patient received radiation therapy along with concomitant and adjuvant temozolomide chemotherapy which has resulted in improvement of symptoms. This case highlights the challenges of managing diffuse primary pontine glioblastoma multiforme and the need for more effective treatment options for this rare subtype of glioblastoma. Despite aggressive treatment, the prognosis for patients with infratentorial glioblastoma multiforme remains poor, with a median survival time of less than a year. Further research is needed to improve our understanding of the biology and optimal management of this disease.