OpenMed/multicare-articles huggingface dataset:
Spinal infection caused by Aspergillus flavus in a diabetic: a case report and literature review
Authors: Hongtao Li, Hongyu Pan, Yang Lei, Haozhong Wang, Sen Li, Changming Xiao
Journal: Front Med (Lausanne) (2024)
Keywords: aspergillus flavus, diabetes, fungi, spinal infection, terbinafine hydrochloride, voriconazole
MeSH terms: Case Reports

Spinal infections, notably those induced by Aspergillus flavus (A. flavus), represent a complex and uncommon clinical challenge. In individuals with diabetes mellitus, the risk is exacerbated due to a compromised immune response and a heightened vulnerability to non-standard pathogens. This case report chronicles the intricate diagnostic and treatment journey of a 59-year-old diabetic patient grappling with a spinal infection attributed to A. flavus. The diagnosis was delayed due to non-specific symptoms and unclear radiological signs. The administration of voriconazole, a targeted antifungal treatment, resulted in a significant clinical and radiological improvement, underscoring its effectiveness in treating such unusual fungal spinal infections; meanwhile, we found that terbinafine hydrochloride also has a similar effect in treating fungal spinal infections. This case underscores the importance of considering fungal causes in spinal infections among diabetic patients and highlights prompt diagnosis and individualized targeted antifungal therapy.
Percutaneous Intervention of LVAD Outflow Graft Obstruction and Thrombosis
Authors: Andrew Takla, Fahad Eid, Mostafa Elbanna, Mohamed Magdi Eid, Akshay Joshi, Abdallah Bitar, Ryan Lydon, Scott Feitell
Journal: Methodist Debakey Cardiovasc J (2024)
Keywords: lvad, graft stenting, left ventricular assist device outflow graft thrombosis, pump exchange
MeSH terms: Heart Failure / diagnosis, Heart Failure / etiology, Heart Failure / therapy, Heart-Assist Devices, Thrombosis / diagnostic imaging, Thrombosis / etiology, Thrombosis / therapy, Case Reports, Humans

Left ventricular assist devices serve as a salvage therapy for patients with advanced heart failure. Complications such as thrombosis and obstruction can lead to acute device malfunction, posing significant clinical risks. A multidisciplinary approach is crucial for management. Few cases in the literature have demonstrated the safety and efficacy of percutaneous intervention, which holds significant value due to its less invasive nature and minimal risk of morbidity, especially in high-risk surgical patients.
Case Report: Persistent residual shunt after a first percutaneous PFO closure followed by minimally invasive surgical failure: third time is a charm
Authors: Eustaquio M Onorato, Francesco Alamanni, Giovanni Monizzi, Angelo Mastrangelo, Antonio Luca Bartorelli
Journal: Front Cardiovasc Med (2024)
Keywords: atrial septal aneurysm, minimally invasive cardiac surgery, multifenestrated atrial septum aneurysm, patent foramen ovale, residual shunt, transcatheter closure
MeSH terms: Case Reports

Background:
Even though the optimal management of a moderate or large residual shunt following patent foramen ovale (PFO) closure is open to question, recent data confirmed that it is associated with an increased risk of stroke recurrence.
Case summary:
A 48-year-old woman, a migraineur with visual aura, was diagnosed with a PFO associated with a huge multifenestrated atrial septal aneurysm (mfASA) and a moderate right-to-left shunt, detectable only after a Valsalva maneuver on contrast-transthoracic echocardiography. Brain magnetic resonance imaging showed a 1-mm silent white matter lesion in the right frontal lobe. Although the indication was not supported by guidelines, a transcatheter PFO closure was performed at another center with implantation of a large, equally sized, double-disc device (Figulla UNI 33/33 mm). At 6-month follow-up, a 2D/3D transesophageal echocardiography (TEE) color Doppler showed incorrect orientation of the device, which was not parallel to the interatrial septum, with two discs failing to capture the aortic muscular rim and partially protruding in the right atrium; furthermore, a 4 mm × 7 mm ASA fenestration was documented with a residual bidirectional shunt. Thereafter, the same team performed a minimally invasive cardiac surgery under femoro-femoral cardiopulmonary bypass; however, the procedure proved ineffective and was complicated by postoperative pericarditis with pericardial effusion, requiring further rehospitalization 1 month later due to persistent pericarditis, bilateral pleuritis, phrenic nerve palsy, and atrial flutter, which was treated with amiodarone. The patient asked for a second opinion, and our multidisciplinary heart team decided to offer a percutaneous redo intervention. An uneventful implantation of a regular PFO occluder (Figulla Flex II 16/18 mm) across the septal defect was performed successfully. Twelve-month follow-up with 2D TTE color Doppler and contrast transcranial Doppler showed correct position and good interaction between the two devices, with no residual shunt.
Discussion:
In addition to the incorrect indication for PFO closure and the failure of minimally invasive surgery, the procedural mishap in this case could have been due to the inappropriate implantation of the first large device within the tunnel. It would have been better to deploy the same large device in the most central fenestration, covering the PFO and a greater part of the remaining mfASA at the same time.
Revisiting the Era of Intestinal Tuberculosis: A Case Presenting As Small Bowel Obstruction With Classical Imaging and Histopathological Appearances
Authors: Kajal Hatgoankar, Anand Hatgaonkar, Pratibha Dawande
Journal: Cureus (2024)
Keywords: computed tomography, extrapulmonary tuberculosis (eptb), intestinal stricture, intestinal tuberculosis, small-bowel obstruction
MeSH terms: Case Reports

The incidence of tuberculosis (TB) worldwide is still significantly high, with India contributing a high global TB burden. This case study features a 49-year-old male who had complaints of pain and abdominal distention for one and a half months. An erect abdominal radiograph showed features suggesting small bowel obstruction. Contrast-enhanced computed tomography (CT) of the abdomen was done. It showed multiple strictures involving the distal jejunum and ileum, causing small bowel obstruction. There was mesenteric and retroperitoneal lymphadenopathy with central necrosis and ascites. The patient was operated on for a small bowel obstruction. The resected intestine showed four strictures, tiny nodules on the serosal surface, and many enlarged lymph nodes. Representative tissue from these areas showed the typical picture of multiple caseating granulomas and fibrosis. Ziehl-Neelsen (ZN) staining highlighted the acid-fast bacilli (AFB). The suspicion index for intestinal tuberculosis (ITB) should be kept high while evaluating patients with intestinal obstruction presenting in endemic areas and high-risk populations, such as HIV-infected, undernourished, immunocompromised, and those with diabetes, smoking, and alcohol addiction.
Case Report: Supercharged end-to-side anterior interosseous to ulnar motor nerve transfer for ulnar nerve neuropathy after cross pinning of pediatric supracondylar humerus fracture
Authors: Jian-Jiun Chen, Chen-Yuan Yang
Journal: Front Pediatr (2024)
Keywords: case report, pediatric, supercharged end-to-side nerve transfer, supracondylar distal humerus fracture, ulnar neuropathy
MeSH terms: Case Reports

Ulnar nerve neuropathy following pediatric supracondylar humerus fracture fixation with cross pinning poses challenges in management. Despite various treatment strategies, including conservative approaches and early intervention, achieving complete neural recovery remains elusive in some cases. This paper presents a novel approach utilizing supercharged end-to-side anterior interosseous nerve transfer for a 13-year-old patient who experienced persistent ulnar neuropathy after K-wire removal. The patient underwent neurolysis of the ulnar nerve followed by nerve transfer, resulting in significant improvement in function and strength. This case highlights the potential efficacy of combining neurolysis and supercharge techniques in pediatric ulnar neuropathy cases refractory to conservative treatment, offering a promising avenue for enhancing patient outcomes.
MSH6 germline mutations leading to Lynch syndrome-associated cholangiocarcinoma: a case report
Authors: Zheng Zhang, Subo Ma, Shixing Li, Zhengfu Chen, Runda Song, Zhanpeng Wang
Journal: Front Oncol (2024)
Keywords: lynch syndrome, msh6 gene, cholangiocarcinoma, immunohistochemistry, mismatch repair genes
MeSH terms: Case Reports

Lynch syndrome, a hereditary cancer susceptibility syndrome, arises from pathogenic mutations in mismatch repair genes. This syndrome is strongly linked to colorectal and endometrial cancers, as well as an elevated risk for other cancers such as gastric, ovarian, renal pelvis/ureter, and prostate. Notably, Lynch syndrome is rarely associated with cholangiocarcinoma (CCA). In this case study, we present a unique instance of Lynch syndrome-related CCA resulting from a singular MSH6 mutation. Notably, our findings reveal discrepancies between immunohistochemistry (IHC) and microsatellite stability results compared to genetic testing outcomes. This discrepancy underscores the limitations of solely relying on IHC analysis and microsatellite stability testing for the detection of hereditary tumors, emphasizing the crucial role of genetic testing in such cases. This insight enhances our comprehension of the mechanisms involved in cancer development and underscores the significance of thorough analysis integrating immunohistochemistry and genetic testing for diagnosing Lynch syndrome-related cancers.
Case report: Recurrent cervical spinal stenosis masquerading as myalgic encephalomyelitis/chronic fatigue syndrome with orthostatic intolerance
Authors: Charles C Edwards 3rd, Charles C Edwards 2nd, Scott Heinlein, Peter C Rowe
Journal: Front Neurol (2023)
Keywords: case report, cervical stenosis, myalgic encephalomyelitis/chronic fatigue syndrome, orthostatic intolerance, postural tachycardia syndrome
MeSH terms: Case Reports

Introduction:
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex, chronic, multi-system disorder that is characterized by a substantial impairment in the activities that were well tolerated before the illness. In an earlier report, we had described three adult women who met criteria for ME/CFS and orthostatic intolerance, and had congenital or acquired cervical spinal stenosis. All three experienced substantial global improvements in their ME/CFS and orthostatic intolerance symptoms after recognition and surgical treatment of the cervical stenosis. After a several year period of improvement, one of the individuals in that series experienced a return of ME/CFS and orthostatic intolerance symptoms.
Main symptoms and clinical findings:
Radiologic investigation confirmed a recurrence of the ventral compression of the spinal cord due to a shift of the disc replacement implant at the involved cervical spinal level.
Therapeutic intervention:
Decompression of the spinal cord with removal of the implant and fusion at the original C5-C6 level was once again followed by a similar degree of improvement in function as had been observed after the first operation.
Conclusion:
This recapitulation of the outcomes after surgical management of cervical stenosis provides further evidence in support of the hypothesis that cervical spinal stenosis can exacerbate pre-existing or cause new orthostatic intolerance and ME/CFS. Especially for those with refractory symptoms and neurological signs, surgical interventions may offer relief for selected patients with this complex condition.
Spinal Segmental Myoclonus in Primary Progressive Multiple Sclerosis
Authors: Mariano Ruiz-Ortiz, Julián Benito-León
Journal: Tremor Other Hyperkinet Mov (N Y) (2024)
Keywords: movement disorders, multiple sclerosis, spinal myoclonus
MeSH terms: Movement Disorders, Multiple Sclerosis / complications, Multiple Sclerosis, Chronic Progressive / complications, Multiple Sclerosis, Chronic Progressive / drug therapy, Myoclonus / drug therapy, Myoclonus / etiology, Spinal Cord Diseases, Case Reports, Female, Humans, Middle Aged

Background:
A wide variety of associated movement disorders has been described in multiple sclerosis.
Phenomenology shown:
A 57-year-old woman with primary progressive multiple sclerosis developed spinal segmental myoclonus associated with focal myelitis.
Educational value:
Movement disorders in multiple sclerosis are phenomenologically diverse and have varied pathophysiological mechanisms, making it essential to identify them to initiate appropriate treatment.
Case report: Clinical experience of treating pembrolizumab-induced systemic capillary leak syndrome (SCLS) in one patient with metastatic gastroesophageal junction squamous cell carcinoma
Authors: Hua Ni, Xinjia Ding, Shikai Wu, Xuan Jin
Journal: Pathol Oncol Res (2023)
Keywords: scls, adverse effect, immune checkpoint inhibitor, pembrolizumab, systemic capillary leak syndrome
MeSH terms: Capillary Leak Syndrome / chemically induced, Capillary Leak Syndrome / diagnosis, Capillary Leak Syndrome / drug therapy, Carcinoma, Squamous Cell / complications, Case Reports, Adrenal Cortex Hormones / therapeutic use, Antibodies, Monoclonal, Humanized / adverse effects, Humans, pembrolizumab, Antibodies, Monoclonal, Humanized, Adrenal Cortex Hormones

Systemic capillary leak syndrome (SCLS) is a rare and complex adverse effect of immune checkpoint inhibitors (ICIs). The diagnosis of drug-induced SCLS is based on diffuse infusions of exudative fluid into the interstitial areas and the exclusion of other causes. The best management of ICIs-induced SCLS is not settled, though proper supportive care and corticosteroids were commonly applied as the first-line treatment. In our patient with advanced gastroesophageal junction squamous cell carcinoma, although ICIs-induced SCLS was successfully controlled with corticosteroids, the patient soon experienced cancer progress and died of pulmonary infections. Based on our experience and the reported cases by other hospitals, different stages of SCLS might respond differently to the same treatment. Therefore, a grading of ICIs-induced SCLS might help to stratify the patient for different treatment strategies. Besides, corticosteroids-sensitive patients, though waived from deadly SCLS, might be at higher risk of cancer progress and subsequent infections due to the application of corticosteroids. Considering that the inflammatory factors should be closely involved in the development of ICIs-induced SCLS, targeted therapy against the driver inflammatory cytokine might offer treatment regimens that are more effective and safer.
Persistent Lactatemia in Mauriac Syndrome
Authors: Nada El Tobgy, Laura Hinz
Journal: Case Rep Endocrinol (2024)
MeSH terms: Case Reports

Mauriac syndrome is a rare disorder that occurs in patients with type 1 diabetes mellitus (T1DM) with glucose levels significantly above target, characterized by hepatomegaly, growth delay, and cushingoid features. Another distinguishing feature of Mauriac syndrome is persistent lactatemia during diabetic ketoacidosis (DKA) management. We present a case of an 18-year-old patient with T1DM who presented in DKA and then developed elevated lactate levels leading to a diagnosis of Mauriac syndrome. The cause of the persistent lactatemia is not well understood though it is likely related to glycogenic hepatopathy causing hepatomegaly, abnormalities in glucose metabolism, and subsequent inappropriate lactate production. Since the liver changes seen in Mauriac syndrome are reversible with optimal blood glucose control, these patients should be connected to intensive psychosocial and medical support to help them improve their blood glucose levels.
Leveraging the outcome of a frontal bone tumor facial reconstruction case by a multimodal approach
Authors: Marek Dobke, Frederic J Kolb, Douglas M Arm
Journal: Case Reports Plast Surg Hand Surg (2024)
Keywords: craniofacial reconstruction, craniofacial defect, microvascular tissue, oncological reconstruction, wound healing
MeSH terms: Case Reports

The importance of multimodality in the diagnosis and treatment of medical conditions cannot be overemphasized. Herewith a case of facial malignancy encompassing all stages of management and requiring multimodal approaches for diagnosis, oncological treatment, anatomical reconstruction, and ultimately aesthetics and "identity" is presented.
Case Report: Clinical manifestations and treatment of two Chinese patients with FINCA syndrome carrying a novel variant of NHLRC2
Authors: Yuemei Liu, Hongling Wang, Yu Tang, Lei Zhang, Yanyan Su, Yanqion Wang, Shasha Xu, Shiyue Mei, Chunyang Jia, Yuelin Shen, Xiaolei Tang
Journal: Front Pediatr (2024)
Keywords: nhlrc2, genetics, interstitial lung disease, lung fibrosis, neurodegeneration
MeSH terms: Case Reports

Fibrosis, neurodegeneration, and cerebral angiomatosis (FINCA) syndrome is an autosomal recessive genetic disorder caused by mutations in NHL-repeat-containing protein 2 (NHLRC2) gene. This case report describes two Chinese siblings with FINCA syndrome carrying a novel frameshift variant, c.1610dupT (p.L537Ffs*17), of NHLRC2 gene. They shared similar symptoms of interstitial lung disease (ILD) and neurodegeneration, with early onset during infancy, and shared similar chest CT findings of bilateral ground-glass opacities and consolidations. The elder brother died of infantile respiratory failure, while the younger brother showed improvement in respiratory symptoms, chest CT, and Krebs von den Lungen-6 levels after long-term systemic glucocorticoid therapy, indicating that anti-inflammatory treatment may be beneficial in the treatment of ILD caused by FINCA syndrome.
Successful avatrombopag combined with cyclosporine treatment for carboplatin/pegylated liposomal doxorubicin/bevacizumab-induced acquired amegakaryocytic thrombocytopenia in a patient with recurrent ovarian cancer: case report
Authors: Weikang Meng, Jinsheng Hua, Jiabing Wang
Journal: Front Oncol (2024)
Keywords: acquired amegakaryocytic thrombocytopenia, avatrombopag, carboplatin/pegylated liposomal doxorubicin/bevacizumab, cyclosporine, recurrent ovarian cancer
MeSH terms: Case Reports

Carboplatin/pegylated liposomal doxorubicin/bevacizumab is an accepted standard anti-cancer treatment option for recurrent ovarian cancer. However, the occurrence of adverse events associated with this therapeutic regimen limits its continued clinical use. Among these adverse events, acquired amegakaryocytic thrombocytopenia is a rare but often potentially life-threatening adverse effect, and is intolerant to multiple treatment approaches. We report, for the first time, the successful treatment using avatrombopag combined with cyclosporine in one case of carboplatin/pegylated liposomal doxorubicin/bevacizumab-induced acquired amegakaryocytic thrombocytopenia, which was refractory or intolerant to glucocorticoids, intravenous immunoglobulin, recombinant human thrombopoietin, androgen, and even thrombopoietin receptor receptor agonist eltrombopag and herombopag. To date, this case manifests as normal platelet counts that are independent of transfusion. Our findings suggest that this combination is a potential and valuable alternative in acquired amegakaryocytic thrombocytopenia.
Case report: Excessive daytime sleepiness as a presenting manifestation of autoimmune glial fibrillary acidic protein astrocytopathy
Authors: Mingyang Tang, Shuo Huang, Weitong Guo, Junfang Zhou, Zhencan Huang, Wanru Li, Qingqing Sun, Zan Wang
Journal: Front Immunol (2023)
Keywords: autoimmune glial fibrillary acidic protein astrocytopathy, case report, glial fibrillary acidic protein, narcolepsy, sleep apnea-hypopnea syndrome
MeSH terms: Disorders of Excessive Somnolence / cerebrospinal fluid, Disorders of Excessive Somnolence / diagnosis, Disorders of Excessive Somnolence / etiology, Narcolepsy, Case Reports, Research Support, Non-U.S. Gov't, Glial Fibrillary Acidic Protein, Humans, Male, Middle Aged, Orexins, Sleepiness, Orexins, Glial Fibrillary Acidic Protein

Autoimmune glial fibrillary acidic protein astrocytopathy (GFAP-A) is a recently discovered autoimmune inflammatory disease of the central nervous system. It presents with a variety of clinical symptoms, including fever, seizures, psychiatric symptoms, limber weakness, and sensory symptoms. However, the symptoms of sleep disorders have not been sufficiently addressed. Here, we report a case of GFAP-A in which the patient complained of excessive daytime sleepiness and an excessive need for sleep. Our patient was a 58-year-old male who experienced excessive daytime sleepiness for 50 days following SARS-CoV-2 infection. He was diagnosed with coronavirus disease 2019 on June 1st. On the 7th of June, he experienced excessive daytime sleepiness, nausea, reduced food intake, lower limb weakness, and dysuria. Subsequently, his sleepiness significantly deteriorated on July 21st. Five months prior, the patient underwent laparoscopic partial right nephrectomy for clear-cell renal cell carcinoma. Brain MRI revealed abnormal hyperintense lesions in the pontine brain and around the mesencephalic aqueduct on T2 and T2-fluid attenuated inversion recovery (T2-FLAIR) sequences However, these lesions did not exhibit any pathological enhancement. Spinal cord MRI revealed lesions in the C6-C7 and T2-T3 segments on the T2 sequence. His Epworth Sleepiness Scale (ESS) score was 16 (reference range, <10), and 24-hour polysomnography supported the diagnosis of rapid-eye-movement sleep disorder and severe sleep apnea-hypopnea syndrome. Glial fibrillary acidic protein IgG antibodies were detected in the cerebrospinal fluid (1:32, cell-based assay) but not in the serum. The level of hypocretin in the cerebrospinal fluid was 29.92 pg/mL (reference range ≥110 pg/mL), suggesting narcolepsy type 1. After treatment with corticosteroids for approximately 1 month, the patient showed considerable clinical and radiological improvement, as well as an increase in hypocretin levels. Although repeated polysomnography and multiple sleep latency tests suggested narcolepsy, his ESS score decreased to 8. Our findings broaden the range of clinical manifestations associated with GFAP-A, thereby enhancing diagnostic and therapeutic strategies for this disease. Additionally, our results indicate a potential common autoimmune mechanism involving GFAP-A and orexin system dysregulation, warranting further investigation.