OpenMed/multicare-articles huggingface dataset:
Amnestic syndrome in the course of seronegative limbic encephalitis complicated by drug-resistant epilepsy: a case report
Authors: Kacper Łoś, Joanna Kulikowska, Monika Chorąży, Alina Kułakowska, Napoleon Waszkiewicz, Beata Galińska-Skok
Journal: Front Immunol (2024)
Keywords: amnestic syndrome, autoimmunology, epilepsy, psychotic symptoms, seronegative limbic encephalitis
MeSH terms: Amnesia / etiology, Drug Resistant Epilepsy / diagnosis, Drug Resistant Epilepsy / etiology, Limbic Encephalitis / complications, Limbic Encephalitis / diagnosis, Limbic Encephalitis / immunology, Case Reports, Adult, Anticonvulsants / therapeutic use, Female, Humans, Magnetic Resonance Imaging, Anticonvulsants

We present the case of a 35-year-old female patient admitted to the hospital with symptoms of rapidly increasing disturbances of consciousness and fever for 48 hours. A lumbar puncture, bacteriological and virological examinations, and initial imaging studies did not show abnormalities. Brain magnetic resonance imaging (MRI), repeated several times, showed hyperintense confluent lesions in both temporal lobes and atrophy of both hippocampi. General examination, cerebrospinal fluid culture, the panel of antineuronal antibodies, and tumor markers remained negative on subsequent repeats. Despite several laboratory and imaging studies, the etiology of the disease could not be established, infections were excluded, and no autoantibodies were found. A diagnosis of probable limbic encephalitis, amnestic syndrome resulting from organic brain damage, and drug-resistant epilepsy was made. The patient, with limbic encephalitis complicated by drug-resistant status epilepticus, was treated with cycles of immunoglobulin and subsequent plasmapheresis. She was then transferred to the Department of Psychiatry for diagnosis and treatment of intermittent psychotic disorders. During hospitalization, the patient was observed to have multiple epileptic seizures with temporal and frontal morphology, amnestic syndrome with confabulations, and periodic psychotic disorders with the occurrence of visual hallucinations. Antiepileptic treatment was escalated by including cenobamate in increasing doses. To control the mental disorders, duloxetine, tiapride, and cognitive function exercises were introduced. There was a slight improvement in memory, a cessation of confabulations, and an emergence of the patient's criticism of the symptoms presented. The psychotic symptoms subsided, and the number of epileptic seizures decreased. The described case portrays a unique co-occurrence of disease symptoms that are difficult to treat. It shows the therapeutic difficulties that can occur in patients with suspected autoimmune encephalitis. Furthermore, it shows the need for multispecialty care of a patient with psychotic symptoms in the course of epilepsy accompanied by amnestic syndrome.
Case Report: A rare infection of multidrug-resistant Aeromonas caviae in a pediatric case with acute lymphoblastic leukemia and review of the literature
Authors: Yiling Dai, Ju Gao, Mingyan Jiang
Journal: Front Pediatr (2024)
Keywords: aeromonas caviae, bloodstream infection, drug sensitivity test, pediatric acute lymphoblastic leukemia, treatment
MeSH terms: Case Reports

Aeromonas caviae infection of the bloodstream and intestine is a rare and severe opportunistic infection in immunocompromised people. In Southwest China, we first reported a case of bloodstream and intestinal infection with multidrug-resistant (MDR) Aeromonas caviae in a 4-year-old child with T-cell acute lymphoblastic leukemia. Blood and stool cultures were used to identify the infection. The selection of antibiotics was based on clinical expertise and medication sensitivity tests. We used linezolid, levofloxacin, and polymyxin B to treat the patient aggressively. Aeromonas caviae infection is uncommon in juvenile acute lymphoblastic leukemia. Doctors should be aware of the likelihood of opportunistic infection during the post-chemotherapy bone marrow suppression period. We further conducted a review of the literature and performed a detailed analysis of Aeromonas infection in pediatric leukemia. It is becoming increasingly apparent that antibiotic is abused domestically and abroad, resulting in the sharp increase of MDR bacteria. In general, most of the Aeromonas isolates are susceptible to third- or fourth-generation cephalosporins, aminoglycosides, quinolones, and carbapenem, but drug-resistant strains are being reported increasingly. We summarized the drug resistance rate of Aeromonas caviae and Aeromonas hydrophila in China in the last 10 years. Early recognition and effective treatment will improve prognosis and reduce mortality.
Intussuscepted Polypoid Meckel's Diverticulum Presenting With Gastrointestinal Bleeding in a Young Adult
Authors: Christos Konstantakis, Petros Mantzios, Christos Sotiropoulos, Stathis Anesidis, Konstantinos C Thomopoulos
Journal: Cureus (2024)
Keywords: gastrointestinal bleeding, intussusception, inversion, meckel’s diverticulum, small bowel capsule endoscopy
MeSH terms: Case Reports

A 22-year-old female patient with a recent hospitalization for gastrointestinal bleeding presented with recurrent hematochezia and a positive shock index. Previous investigations, including endoscopy and wireless small bowel capsule, were non-diagnostic. CT angiography revealed extravasation in the ileum. Initial tests like technetium-99m scintigraphy and ileocolonoscopy were negative. Repeat wireless small bowel capsule identified a partially ulcerated polypoid mass in the distal ileum. At surgical exploration, an intussuscepted Meckel's diverticulum was identified and resected. A histopathologic examination confirmed the diagnosis. Meckel's diverticulum is a rare cause of gastrointestinal bleeding in adults. Preoperative diagnosis can be challenging. Reports of a polypoid morphology are very scarce in indexed literature and mostly derive from investigation with device-assisted enteroscopy. We report this extremely rare finding at capsule endoscopy to raise clinician awareness and to discuss diagnostic difficulties associated with similar cases, such as the negative scintigraphy result and the optimal timing of repeat capsule endoscopy.
Operationalizing ambiguity in sustainability science: embracing the elephant in the room
Authors: Anita Lazurko, L Jamila Haider, Tilman Hertz, Simon West, Daniel D P McCarthy
Journal: Sustain Sci (2024)
Keywords: ambiguity, boundaries, co-production, complexity, transdisciplinarity

Ambiguity is often recognized as an intrinsic aspect of addressing complex sustainability challenges. Nevertheless, in the practice of transdisciplinary sustainability research, ambiguity is often an 'elephant in the room' to be either side-stepped or reduced rather than explicitly mobilized in pursuit of solutions. These responses threaten the salience and legitimacy of sustainability science by masking the pluralism of real-world sustainability challenges and how research renders certain frames visible and invisible. Critical systems thinking (CST) emerged from the efforts of operational researchers to address theoretical and practical aspects of ambiguity. By adapting key concepts, frameworks, and lessons from CST literature and case studies, this paper aims to establish (1) an expansive conceptualization of ambiguity and (2) recommendations for operationalizing ambiguity as a valuable means of addressing sustainability challenges. We conceptualize ambiguity as an emergent feature of the simultaneous and interacting boundary processes associated with being, knowing, and intervening in complex systems, and propose Reflexive Boundary Critique (RBC) as a novel framework to help navigate these boundary processes. Our characterization of ambiguity acknowledges the boundary of a researcher's subjective orientation and its influence on how ambiguity is exposed and mediated in research (being), characterizes knowledge as produced through the process of making boundary judgments, generating a partial, contextual, and provisional frame (knowing), and situates a researcher as part of the complexity they seek to understand, rendering any boundary process as a form of intervention that reinforces or marginalizes certain frames and, in turn, influences action (intervening). Our recommendations for sustainability scientists to operationalize ambiguity include (1) nurturing the reflexive capacities of transdisciplinary researchers to navigate persistent ambiguity (e.g., using our proposed framework of RBC), and (2) grappling with the potential for and consequences of theoretical incommensurability and discordant pluralism. Our findings can help sustainability scientists give shape to and embrace ambiguity as a fundamental part of rigorous sustainability science.
Case report: Thyroid metastasis from hepatocellular carcinoma: a rare case with diffuse solid occupancy and unusual imaging findings
Authors: Tinghua Feng, Menghua Xue, Miaoyu Sang, Rongrong Cui, Xiaofang Liu, Liping Liu
Journal: Front Oncol (2024)
Keywords: case report, diffuse thyroid lesion, echography, hepatocellular carcinoma, thyroid metastasis
MeSH terms: Case Reports

Background:
Thyroid metastasis represents a rare occurrence, with commonly observed primary tumors originating from renal cell carcinoma, malignant neoplasms of the gastrointestinal tract, lungs, and breast. However, the metastasis of hepatocellular carcinoma to the thyroid gland remains infrequent. Previous investigations have consistently demonstrated an unfavorable prognosis for patients with malignancies that have metastasized to the thyroid. In this context, we present a noteworthy case of thyroid metastasis from hepatocellular carcinoma (HCC), characterized by a distinct ultrasonographic manifestation of diffuse thyroid lesion, deviating from the previously documented imaging presentations of thyroid metastases in HCC.
Case presentation:
A 62-year-old Chinese female patient was diagnosed with hepatocellular liver cancer in 2019, following which she underwent a radical hepatic resection. Pathological examination revealed HCC located in the right lobe (stage T3bN0M0 IIIB). No additional interventions were administered subsequent to the surgery. After a span of 15 months, the patient presented with dyspnea. Ultrasonographic findings showed diffuse solid infiltration within the thyroid gland, along with tumor thrombi in both internal jugular veins. Computed tomography (CT) scans demonstrated malignant thyroid lesions infiltrating the retropharyngeal space, prevertebral space, and esophageal wall. The subsequent pathology report from the puncture biopsy confirmed the malignant nature of the tumor, and immunohistochemical analysis definitively established its hepatic origin.
Conclusions:
Patients with a history of HCC should be subjected to long-term monitoring and habitual thyroid ultrasonography. Newly detected thyroid nodules in such patients should be immediately regarded suspect for potential metastatic disease. Even when a nodule doesn't exhibit malignant characteristics on ultrasound, FNAB should be administered promptly to elucidate the pathological condition. Larger, swiftly multiplying thyroid masses should warrant an immediate CNB. The identification of thyroid metastases, particularly when coupled with peripheral tissue invasion, typically signifies a bleak prognosis.
Case report: Paraneoplastic lower motor neuronopathy associated with a malignant liver tumor
Authors: Chaowei Xu, Hanfan Wu, Jian Chen
Journal: Front Neurol (2024)
Keywords: diagnosis, malignant tumor of the liver, motor neuron disorders, paraneoplastic lower motor neuronopathies, treatment
MeSH terms: Case Reports

Paraneoplastic lower motor neuronopathies (LMNs) have rarely been reported with malignant liver tumors. A 71-year-old man developed chronic progressive upper limb and cranial nerve paralysis. Electromyography examination suggests chronic progressive neuronal damage involving the right C4-T1 nerve root innervated muscle and the right sternocleidomastoid muscle. Magnetic resonance imaging suggested the presence of a malignant liver tumor. His serum was positive for anti-Yo antibodies. Hepatic artery chemoembolization was performed, followed by treatment with pembrolizumab and lenvatinib. The patient's condition improved, and paraneoplastic LMNs were diagnosed. Paraneoplastic causes should be considered in the differential diagnosis of chronic progressive LMNs. A combination of surgical treatment and immunotherapy may result in a favorable outcome.
Apical Hypertrophic Cardiomyopathy With a Sub-aortic Membrane: A Case Report
Authors: Akbar Hussain, Adnan Bhopalwala, Huzefa Bhopalwala, Nakeya Dewaswala, Aelia Akbar
Journal: Cureus (2024)
Keywords: apical hypertrophy cardiomyopathy, heart surgery, hypertrophic obstructive cardiomyopathy (hocm), hypertrophy cardiomyopathy, subaortic stenosis
MeSH terms: Case Reports

Hypertrophic obstructive cardiomyopathy (HOCM) and subaortic membrane (SAS) are distinct cardiac conditions, but their coexistence presents complex diagnostic challenges. We report the case of a 52-year-old male with HOCM and a concurrent subaortic membrane, highlighting the intricacies of diagnosis and management. The patient's presentation included symptoms of dyspnea and chest tightness, and diagnostic evaluations revealed a unique combination of dynamic left ventricular outflow tract (LVOT) obstruction from HOCM and fixed obstruction from the subaortic membrane. This case emphasizes the importance of a comprehensive diagnostic workup to guide appropriate treatment decisions when managing multiple cardiac abnormalities.
Local subcutaneous lidocaine injection for the treatment of complex regional pain syndrome: a case report and literature review
Authors: Yaping Su, Zhenyu Li, Qian Wang, Hui Tang
Journal: Front Neurol (2023)
Keywords: analgesic therapy, case report, complex regional pain syndrome, lidocaine, local subcutaneous injection
MeSH terms: Case Reports

A 14-year-old child was diagnosed with complex regional pain syndrome (CRPS) after bromhidrosis surgery. She experienced a stinging, knife-like, and intermittent attack pain, accompanied by numbness of both upper limbs and limited movements. Ultrasound-guided radiofrequency surgery on the peripheral nerve did not reduce pain. Then, gabapentin 300 mg three times a day and 2% lidocaine by local subcutaneous injection once a day for 3 days were administrated. After the local subcutaneous injection of lidocaine, the pain was significantly relieved, and the pain induced by skin touch at the scar disappeared. No pain recurred after the 1-month follow-up. An evidence-based literature review showed that local or systemic intravenous lidocaine was used to reduce adult CRPS symptoms but less has been reported in children. In our case, a local subcutaneous injection of 2% lidocaine in a child for CRPS treatment was reported to be effective in relieving complex local pain with favorable outcomes. Though further high-quality randomized controlled trials are needed to investigate the effects and safety of local subcutaneous lidocaine injection on pain relief in children with CRPS, it could still provide a relatively safe and effective adjuvant therapy for minor patients.
Rare tuberculosis in recipients of allogeneic hematopoietic stem cell transplantation successfully treated with contezolid-a typical case report and literature review
Authors: Junhong Li, Zhaoxian Yu, Yingyi Jiang, Suihua Lao, Dexian Li
Journal: Front Cell Infect Microbiol (2023)
Keywords: antibiotic therapy, contezolid, hematopoietic stem cell transplantation, myelosuppression, tuberculosis
MeSH terms: Hematopoietic Stem Cell Transplantation / adverse effects, Tuberculosis / diagnosis, Tuberculosis, Pulmonary / diagnosis, Review, Case Reports, Research Support, Non-U.S. Gov't, Anti-Bacterial Agents / therapeutic use, Humans, Linezolid / therapeutic use, Male, contezolid, Linezolid, Anti-Bacterial Agents

Background:
Tuberculosis (TB) is a rare but potentially devastating complication in hematopoietic stem cell transplantation (HSCT) recipients. Myelosuppression-related antibiotics should be used cautiously in patients with hematological malignancies, especially those undergoing bone marrow transplantation and receiving bone marrow suppression therapy. Although linezolid has become the recommended drug for severe TB, its hematological toxicity is still an obstacle to its clinical application. Contezolid is a new representative of oxazolidinones in clinical development, showing superior anti-infection efficacy, but there have been no reports on the treatment of post-HSCT TB.
Case presentation:
We reported a patient with acute lymphoblastic leukemia suffered from pulmonary TB infection after HSCT. During anti-TB treatment, the patient had a poor response to linezolid-containing regimen, and developed side effects such as gingival bleeding and thrombocytopenia, so the administration was switched to contezolid. After 15 days of continuous treatment, the patient's platelet increased to 58×109/L, and he was discharged in stable condition. During subsequent anti-TB treatment with contezolid for more than 7 months, the platelets remained stable, and no hematological adverse reactions and no symptoms of peripheral neuropathy were observed. Moreover, repeat imaging showed that the bilateral lung lesions were significantly reduced, indicating a good outcome for the patient.
Conclusion:
This was the first successful case of post-HSCT TB patients treated with contezolid-containing antibiotic management strategies, which exhibited remarkable efficacy and good safety in this deadly disease.
A case report of multicentric reticulohistiocytosis with atypical cutaneous presentation
Authors: Xiangru Chen, Lin An, Zhongmin Jiang, Yuxi Jia
Journal: Front Immunol (2024)
Keywords: differential diagnosis, gouty arthritis, immunohistochemistry, multicentric reticulohistiocytosis, nodular xanthomatosis
MeSH terms: Arthritis / etiology, Histiocytosis, Non-Langerhans-Cell / diagnosis, Histiocytosis, Non-Langerhans-Cell / drug therapy, Histiocytosis, Non-Langerhans-Cell / pathology, Skin Diseases / pathology, Case Reports, Aged, Humans, Immunohistochemistry, Male, Skin / pathology

Multicentric reticulohistiocytosis (MRH) is a rare systemic disorder characterized by histiocytic hyperplasia that mainly involves the skin, mucous membranes, and joints. The typical clinical features include papules, nodules, and arthritis. MRH lesions are relatively extensive but small and scattered. Joint inflammation is characterized by diffuse symmetric polyarthritis as the first symptom, which can be severe and disabling due to destructive joint changes. MRH is easily misdiagnosed in clinical practice. Here, we report the case of an elderly male patient who presented with polyarticular pain in the hip and interphalangeal joints as the first manifestation, followed by the development of large, isolated, bulging skin nodules, which are atypical MRH lesions. This is rare in all MRH case reports, and we made the correct diagnosis by combining skin histopathology, immunohistochemistry, and other clinical examinations. We performed surgical treatment on the local skin lesions of this patient. This case suggests that clinicians should actively correlate the condition and accurately diagnose MRH when encountering atypical skin changes or other diseases as the first symptom and explore the mechanisms of MRH and other clinical manifestations.
Postpartum hemorrhage with associated placenta previa in a kidney transplant recipient: A case report
Authors: Toshinao Suzuki, Takahiro Sugiura, Junko Okazaki, Hiroaki Kimura
Journal: Int J Surg Case Rep (2024)
Keywords: balloon occlusion, case report, kidney transplantation, placenta previa, postpartum hemorrhage, uterine artery embolization
MeSH terms: Case Reports

Introduction:
The efficacy and safety of uterine artery embolization (UAE) and prophylactic resuscitative endovascular balloon occlusion of the aorta (REBOA) against postpartum hemorrhage (PPH) in pregnant women after kidney transplantation have not been reported. Here, we describe a case of PPH associated with placenta previa in pregnancy following kidney transplantation, which was managed with UAE and prophylactic REBOA.
Case presentation:
A 35-year-old, gravida 2, para 1 woman with total placenta previa presented with vaginal bleeding (460 mL) at 33 weeks and 3 days of gestation. Previously, she underwent a living-donor kidney transplantation for IgA nephropathy, and the renal artery of the transplanted kidney was anastomosed with the right internal iliac artery. An emergency cesarean section with prophylactic REBOA was performed under general anesthesia. A balloon catheter was introduced via the left femoral artery and positioned above the aortic bifurcation (Aortic zone 3). Upon confirming fetal delivery, the balloon was immediately inflated, and the total aortic occlusion time was 20 min. However, following aortic balloon deflation, atonic bleeding continued despite Bakri balloon usage and uterotonic drug administration. Subsequently, UAE was performed for the refractory PPH, the left uterine artery was embolized using a gelatin sponge, and hemostasis was successfully achieved. The patient recovered uneventfully and was discharged on postoperative day 7.
Discussion and conclusion:
In pregnancies following kidney transplantation, prophylactic REBOA controls bleeding; however, it decreases blood flow to the transplanted kidney. Furthermore, uterine nutrient vasculature alterations are observed, necessitating a thorough understanding of the uterine artery supply pathways during UAE.
New-onset of pemphigus following COVID-19 infection: A case report
Authors: Elena Pastukhova, Feras M Ghazawi
Journal: SAGE Open Med Case Rep (2024)
Keywords: covid-19, sars-cov-2, autoimmune bullous disease, immunology, paraneoplastic pemphigus, pemphigus, pemphigus vulgaris
MeSH terms: Case Reports

COVID-19 has been implicated in various cutaneous autoimmune diseases. Pemphigus is a group of autoimmune blistering diseases that target the desmosomal complexes. Pemphigus triggered by COVID-19 has been seldom reported in the literature and remains both a diagnostic and therapeutic challenge. We report a case of COVID-19-induced pemphigus that responded well to prednisone and mycophenolate mofetil after 9 months from initial presentation. On histologic examination, both intercellular and basement membrane staining were noted. Indirect immunofluorescence staining was positive against the intercellular cement of the stratified epithelium from monkey esophagus. We hypothesize that COVID-19 stimulated the release of multiple pemphigus antigens, which resulted in the unusual histologic pattern reported in the present case. Although malignancy should be suspected when features of paraneoplastic pemphigus, such as basement membrane staining on direct immunofluorescence, are noted, it may also be a histologic pattern of pemphigus secondary to COVID-19 that clinicians may consider.