OpenMed/multicare-articles huggingface dataset:
Acute appendicitis revealing a giant mesenteric pseudocyst: case report
Authors: Salsabil Mohamed Sabounji, Mbaye Fall, Doudou Gueye, Cheikh Seye, Gabriel Ngom
Journal: Pan Afr Med J (2022)
Keywords: pseudo-mesenteric, case report, child, giant cyst, mesenteric cyst
MeSH terms: Appendicitis / complications, Appendicitis / diagnosis, Appendicitis / surgery, Appendix, Cysts / complications, Mesenteric Cyst / diagnosis, Mesenteric Cyst / surgery, Case Reports, Abdominal Pain / complications, Acute Disease, Appendectomy, Child, Humans, Male

Mesenteric pseuodycst is a very rare benign childhood tumor, accounting for less than 1 out of 250,000 hospital admissions. We here report a case of giant mesenteric pseudocyst incidentally detected in a 11-year-old boy with acute appendicitis. He complained of persistent abdominal pain for the past 48 hours. He had a history of intermittent pain for several months. Physical examination showed fever and abdominal pain. Ultrasonography showed large peritoneal fluid related to peritonitis probably of appendicular origin. The patient underwent exploratory laparotomy revealing giant abdominal mesenteric cyst and acute appendicitis. Open resection of the cyst and appendectomy were performed. The diagnosis of uncomplicated acute appendicitis associated with mesenteric pseudocyst was made. Preoperative diagnosis of pseudomesenteric cysts is a clinical challenge. Knowledge is essential and suspicion should be maintained in patients with nonspecific symptoms.
MuSK-Myasthenia Gravis Unmasked by Hydroxychloroquine
Authors: Shalini Bhaskar, Mohammed Fauzi Bin Abdul Rani
Journal: Case Rep Med (2022)
MeSH terms: Case Reports

Introduction:
Muscle-specific tyrosine kinase (MuSK) antibody positive myasthenia gravis (MuSK-MG) is a rare clinical disorder, and diagnosing it can be challenging. Most of the patients present with predominant facial, oculo-bulbar, and neck muscle weakness along with respiratory muscle involvement. Such a presentation can be mistaken for bulbar onset motor neuron disease or as one of the rare oculopharyngeal myopathies. Case Report. We present a young female patient, who reported to us with neck muscle weakness, ocular and bulbar muscle paralysis, and breathing difficulty. She had been healthy till she was prescribed hydroxychloroquine (HCQ) tablets (400 mg per day) for a malar rash. By the end of the second week after commencing the HCQ therapy, she developed the muscle weakness. Her symptoms began to regress after stopping HCQ and starting steroids, pyridostigmine, and, subsequently, azathioprine. She was negative for anticholinesterase receptor antibodies (AChR-Ab) but was positive for MuSK antibodies (MuSK-Ab).
Conclusion:
This report proves that MuSK-MG can also be unmasked by HCQ administration. Awareness of drug-induced/-unmasked MG is important, as failure to do so may result in a severe morbidity and a fatal outcome. The offending drug has to be promptly discontinued, and appropriate treatment should be instituted.
Kratom-Induced Cholestatic Liver Injury and Its Conservative Management
Authors: Christopher T Fernandes, Umair Iqbal, Sean P Tighe, Aijaz Ahmed
Journal: J Investig Med High Impact Case Rep (2019)
Keywords: drug-induced liver injury, herbal supplements, hyperbilirubinemia, kratom
MeSH terms: Chemical and Drug Induced Liver Injury, Chronic / pathology, Conservative Treatment, Hyperbilirubinemia / chemically induced, Mitragyna / chemistry, Plant Extracts / adverse effects, Case Reports, Analgesics, Opioid / adverse effects, Chemical and Drug Induced Liver Injury, Chronic / drug therapy, Cholagogues and Choleretics / therapeutic use, Dietary Supplements / adverse effects, Humans, Hyperbilirubinemia / drug therapy, Liver / pathology, Liver / physiopathology, Male, Middle Aged, Pain Management, United States, Ursodeoxycholic Acid / therapeutic use, Analgesics, Opioid, Cholagogues and Choleretics, Plant Extracts, Ursodeoxycholic Acid

Drug-induced liver injury (DILI) is a common cause of hepatotoxicity associated with prescription-based and over-the-counter exposure to medications and herbal supplements. Use of unapproved and inadequately tested herbal supplements can cause DILI. Therefore, thorough history-taking on exposure to herbal supplements must be an integral part of clinical evaluation of DILI. Kratom is an herbal supplement or remedy that has been known for its analgesic effects and has also been used for self-treatment of opiate withdrawals. A 52-year-old man was seen for evaluation of yellow discoloration of the eyes and skin. He reported taking kratom for right shoulder strain for at least a couple of months. On workup, his total bilirubin was noted to be 23.2 mg/dL, which peaked at 28.9 mg/dL. He was noted to have mild elevation of aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase. Extensive laboratory tests were ordered and known causes of chronic liver disease ruled out. Magnetic resonance imaging of the abdomen was unremarkable without stigmata of portal hypertension or signs of chronic liver disease. He demonstrated no evidence of coagulopathy or hepatic encephalopathy during his illness. He underwent liver biopsy, which demonstrated histologic evidence of acute cholestatic hepatitis highly suspicious of DILI. He was advised to avoid kratom or other herbal supplements in future and prescribed ursodeoxycholic acid with significant improvement in his liver chemistries. Kratom is associated with significant liver enzymes derangements leading to DILI. Kratom is not approved for use in the United States and should be avoided.
Surgical Correction of Kyphosis in Patients With Camptocormia Associated With Parkinson's Disease: A Case Report and Review of the Literature
Authors: Guo-Long Mei, Hui-Ting Wei, Yue-Rong Ma, Dun Wan
Journal: Front Surg (2022)
Keywords: parkinson, camptocormia, revision surgery, surgical correction of kyphosis, treatment decision
MeSH terms: Case Reports

Background:
Camptocormia is a postural deformity that is characterized by a markedly flexed lumbar spine, with symptoms that worsen with walking and standing. Here, we report a case of camptocormia associated with Parkinson's disease.
Case description:
A 70-year-old man with a 7-year history of Parkinson's disease presented with a fall injury that caused lower back pain for 3 months and was aggravated for 2 months. He had been diagnosed with a compression fracture after the fall and had undergone percutaneous kyphoplasty at a local hospital. MRI showed non-union of the L1 vertebra and compression fracture of L2. The patient underwent posterior osteotomy, canal decompression, and internal fixation of the T10-L3 intervertebral plate with bone graft fusion. Postoperative examination showed that the lumbar lordosis was corrected and sensation was restored in both lower extremities. However, after 1 month, the fixation was loosened and a correction surgery was performed at our hospital. At the most recent follow-up at 1.5 years, the patient was found to be in good general health and did not complain of lower back discomfort. He was also actively exercising according to the rehabilitation regimen and had resumed social life.
Conclusion:
This is a rare case of camptocormia in a Parkinson's patient that highlights the need for careful evaluation of whether internal spinal fixation surgery is beneficial in such patients.
Metacognitive Therapy for Comorbid Anxiety Disorders: A Case Study
Authors: Sverre U Johnson, Asle Hoffart
Journal: Front Psychol (2016)
Keywords: anxiety, comorbidity, metacognition, metacognitive therapy, transdiagnostic

We aimed to systematically evaluate a generic model of metacognitive therapy (MCT) with a highly comorbid anxiety disorder patient, that had been treated with diagnosis-specific cognitive-behavioral therapy (CBT) without significant effect. Traditionally, CBT has progressed within a disorder-specific approach, however, it has been suggested that this could be less optimal with highly comorbid patients. To address comorbidity, transdiagnostic treatment models have been emerging. This case study used an AB-design with repeated assessments during each therapy session and a 1-year follow-up assessment to evaluate the effectiveness of MCT. Following 8 sessions of MCT, significant decrease in anxiety and depression symptoms, as well as loss of diagnostic status was observed. Outcomes were preserved at 12 months follow up. The generic model of MCT seems promising as an approach to highly comorbid mixed anxiety depression patients. Further testing using more powered methodologies are needed.
Natural Remission of Major Periprosthetic Osteolysis following Total Hip Arthroplasty with Metal-on-Metal Bearings
Authors: Tatsuya Tamaki, Kazuhiro Oinuma
Journal: Case Rep Orthop (2017)
MeSH terms: Case Reports

The natural course of adverse events following the use of metal-on-metal (MoM) bearings in total hip arthroplasty (THA) is not well known. In this article, we report the case of a patient with asymptomatic major acetabular osteolysis following MoM THA that diminished gradually without any surgical intervention. A 58-year-old male underwent one-stage bilateral MoM THA for bilateral osteoarthritis. Four years after THA, major acetabular osteolysis developed in his right hip without any local or systemic symptoms. The patient underwent a careful radiographic and clinical observation without any surgical intervention because he did not want to undergo revision surgery. The lesion gradually diminished after 7 years, and most of the osteolytic area was replaced by newly formed bone at 10 years. He continues to be followed with no evidence of cup loosening or migration. Our observation suggests that a periprosthetic osteolytic change related to the use of MoM bearings has the potential for natural remission.
Metastasis from tongue squamous cell carcinoma to the kidney
Authors: Hanan S Elsarraj, Sidrah Khawar, Ameer Hamza
Journal: Autops Case Rep (2021)
Keywords: kidney, neoplasm metastasis, oropharynx, tongue
MeSH terms: Case Reports

Metastasis to the kidney from other primary sites is extremely rare. Previous studies reported the lung as the most common primary site. Distant metastasis from the tongue to the kidney is exceedingly rare. Herein, we describe a case of metastatic squamous cell carcinoma to the kidney in a 71-year-old male with a detailed discussion of differentiating it from potential mimickers. The patient underwent a total glossectomy and bilateral cervical lymph node dissection. A diagnosis of well-differentiated squamous cell carcinoma of the tongue was rendered and the tumor was staged pT3 pN3b. Within two years of initial presentation, the patient developed widely metastatic disease, including pulmonary nodules, renal masses, left adrenal mass, and pancreatic mass. Accurate diagnosis of a secondary involvement of the kidney by a metastatic tumor requires the appropriate correlation of clinical and imaging findings as well as morphologic and immunohistochemical clues.
Hybrid palliation of interrupted aortic arch in a high-risk neonate
Authors: Mohsen Karimi, Ahmed Farouk, Alex Golden, Robert Gilkeson
Journal: Ann Pediatr Cardiol (2010)
Keywords: acyanotic congenital heart disease, hybrid procedure, interrupted aortic arch
MeSH terms: Case Reports

We report a case of a high-risk neonate with interrupted aortic arch (IAA) and ventricular septal defect who underwent a successful hybrid palliative procedure using a ductal stent and bilateral branch pulmonary artery banding. This case represents not only a successful use of hybrid approach in high-risk neonates with IAA, but also introduces an alternative and safe access for ductal stent insertion through the right ventricular infundibulum.
Refractory Central Neurogenic Hyperventilation: A Novel Approach Utilizing Mechanical Dead Space
Authors: Alexander J Sweidan, Matthew M Bower, Jeffrey Paullus, Michelle Sterpi, Sara Stern-Nezer, Cyrus Dastur, Wengui Yu, Leonid I Groysman
Journal: Front Neurol (2019)
Keywords: central neurogenic hyperventilation, critical care, lymphoma, mechanical ventilation, neuro-oncology, neurocritical care
MeSH terms: Case Reports

This report describes the successful management of a case of central neurogenic hyperventilation (CNH) refractory to high dose sedation by increasing the mechanical dead space. A 46-year-old male presented with a history of multiple neurological symptoms. Following an extensive evaluation, he was diagnosed with primary diffuse CNS lymphoma and started on high dose steroids. After initial symptomatic improvement, the patient developed increasing respiratory distress and tachypnea. He was intubated and transferred to the neurointensive care unit (neuro ICU). While in the ICU the patient remained ventilator dependent with significant tachypnea and respiratory alkalosis resistant to fentanyl and propofol. This prompted an attempt to normalize the PaCO2 via an increase of the mechanical dead space. This approach successfully increased PaCO2 and bridged the patient until ongoing therapy for the underlying disease resolved the pervasive breathing pattern typical of CNH. Further investigation is warranted to evaluate this strategy, which upon review of the literature appears underused.
Subtle Radiological Features of Splenic Avulsion following Abdominal Trauma
Authors: S A Rehim, H Dagash, P P Godbole, A Raghavan, G V Murthi
Journal: Case Rep Med (2010)
MeSH terms: Case Reports

Splenic trauma in children following blunt abdominal injury is usually treated by nonoperative management (NOM). Splenectomy following abdominal trauma is rare in children. NOM is successful as in the majority of instances the injury to the spleen is contained within its capsule or a localised haematoma. Rarely, the spleen may suffer from an avulsion injury that causes severe uncontrollable bleeding and necessitates an emergency laparotomy and splenectomy. We report two cases of children requiring splenectomy following severe blunt abdominal injury. In both instances emergency laparotomy was undertaken for uncontrollable bleeding despite resuscitation. The operating team was unaware of the precise source of bleeding preoperatively. Retrospective review of the computed tomography (CT) scans revealed subtle radiological features that indicate splenic avulsion. We wish to highlight these radiological features of splenic avulsion as they can help to focus management decisions regarding the need/timing for a laparotomy following blunt abdominal trauma in children.
Video-assisted thoracoscopic implantation of a diaphragmatic pacemaker in a child with tetraplegia: indications, technique, and results
Authors: Darcy Ribeiro Filho Pinto, Miguel Lia Tedde, Alexandre José Gonçalves Avino, Suzan Lúcia Brancher Brandão, Iuri Zanatta, Rafael Hahn
Journal: J Bras Pneumol (2015)
Keywords: pacemaker, artificial, quadriplegia, respiration, artificial, spinal cord injuries
MeSH terms: Diaphragm, Electric Stimulation Therapy / instrumentation, Pacemaker, Artificial, Phrenic Nerve, Quadriplegia / complications, Respiration, Artificial / instrumentation, Thoracic Surgery, Video-Assisted, Case Reports, Anesthesia / methods, Child, Electric Stimulation Therapy / methods, Electrodes, Implanted, Humans, Male, Prosthesis Implantation / methods, Respiration, Artificial / methods, Spinal Cord Injuries / complications

We report the case of a child with tetraplegia after cervical trauma, who subsequently underwent diaphragmatic pacemaker implantation. We reviewed the major indications for diaphragmatic pacing and the types of devices employed. We highlight the unequivocal benefit of diaphragmatic pacing in the social and educational reintegration of individuals with tetraplegia.
Granulomatous polyangiitis involving the fourth ventricle: Report of a rare case and a literature review
Authors: Dan Yuan, Qing Ji, Jin-Hua Xia, Jin-Jing Wang, Na Liang
Journal: Open Life Sci (2023)
Keywords: wegener’s granulomatosis, fourth ventricle, granulomatous polyangiitis, necrotizing granulomatous vasculitis, treatment
MeSH terms: Case Reports

Granulomatous polyangiitis (GPA) is a rare systemic autoimmune vasculitis disease that is highly correlated with anti-neutrophil cytoplasmic antibodies (ANCAs). It was formerly called as "Wegener's granulomatosis." The clinical manifestations are diverse, mainly involving the upper respiratory tract, lungs, and kidneys, and this disease can involve the brain parenchyma as an isolated solid mass. Only one case has been reported thus far. To provide further information on this rare case, we report a case of GPA involving the fourth ventricle and review the relevant literature. A 32-year-old Chinese female developed fever, cough, and shortness of breath for 20 days. An 80 mm × 80 mm skin ulcer was seen on the right lower limb. CT showed multiple large patches of increased density in both lungs. The patient's serological ANCA was positive. Later, the patient developed dizziness and headache. Magnetic resonance imaging of the head showed a mass of approximately 21 mm × 24 mm in the fourth ventricle. The patient had a craniotomy for mass resection, and macroscopically, the mass was gray-red and measured 25 mm × 20 mm × 20 mm, was soft, had local hemorrhage and necrosis, and had no capsule. The main microscopic features included necrotizing granulomatous vasculitis, the patient's immunohistochemistry was positive for CD68 and negative for glial fibrillary acidic protein, and the acid-fast staining and hexaamine silver staining were negative. Combined with the clinical history, serology, and imaging, the pathological diagnosis was GPA in the fourth ventricle. The patient was switched to rituximab combined with steroid therapy because she did not tolerate cyclophosphamide. After 5 months of follow-up, the patient's lung lesions and skin ulcers had completely improved, but the brain lesions had further progressed. When a patient has multiple system diseases, abnormal clinical manifestations, and positive serological ANCAs, a diagnosis of GPA should be carefully considered, and biopsies of easy-to-access sites should be performed. If the patient's histopathological manifestations include vasculitis, granuloma, and necrosis, a diagnosis of GPA is more likely. If a patient subsequently develops an intraventricular mass, the clinicians should consider a diagnosis of GPA, which can rarely involve the cerebral ventricle to avoid an unnecessary biopsy or surgical treatment of intracranial lesions. When a patient is intolerant to the traditional treatment drug cyclophosphamide and needs to be switched to rituximab, the treatment effect of intracerebral lesions is not ideal; therefore, the treatment of lesions involving GPA in the ventricle is worthy of further exploration.
Apocrine carcinoma in the parotid gland and in the submandibular region
Authors: Jairo S Francisco, Silvia E N Alfaro, Daniela C C M Oliveira, Sebastião Tonon, Eliane P Dias
Journal: Braz J Otorhinolaryngol (2005)
MeSH terms: Apocrine Glands, Carcinoma / pathology, Mouth Neoplasms / pathology, Sweat Gland Neoplasms / pathology, Case Reports, Female, Humans, Middle Aged, Parotid Neoplasms / pathology

The objectives of this paper are to report a case of apocrine carcinoma and the discussion of aspects related to its diagnosis, treatment, and prognosis. Carcinomas with apocrine differentiation not related to extramammary Paget's disease, ductal breast carcinoma, Moll's glands adenocarcinoma and ceruminous glands carcinoma are very uncommon tumors. We report a case of a 51-year-old black woman who developed apocrine carcinoma lesions in the head and neck region. Two lesions involved her left parotid gland (first tumor and local recurrence), and other involved her submandibular skin. The microscopic aspects were as follows: infiltrative glandular epithelial neoplasm with moderate cellular and nuclear pleomorphism; neoplasic cells with polygonal or circular shape, large nuclei and eosinophilic and granular cytoplasm. The apical decapitation secretion was viewed in a large number of intra-cystic tumor cells. Moreover, we found areas with comedo-necrosis or PAS positive staining (with or without diastase). Based on cutaneous apocrine carcinoma compatibility of the microscopic aspects, we concluded that the tumor in the submandibular skin was probably the primary neoplasm. The patient was treated by surgical excisions, and no evidence of recurrent or metastatic disease has been seen after a follow-up period of 12 months.
Pompe Disease Could Mimic Exam Findings of Amyloidosis: Two Rare Diagnoses Bona Fide
Authors: Jithma P Abeykoon, Narjust Duma, Jennifer A Tracy, Margherita Milone, Ronald Go
Journal: Case Rep Hematol (2018)
MeSH terms: Case Reports

A 70-year-old female presented with a three-year history of evolving macroglossia causing dysphagia and dysarthria, with proximal muscle weakness. Given the classic physical finding of macroglossia, the patient underwent extensive evaluation for amyloidosis which proved to be negative apart from a bone marrow biopsy which stained positive for transthyretin without amino acid sequence abnormality, thus giving wild-type transthyretin amyloidosis. Since the wild-type transthyretin amyloidosis could not entirely explain her clinical presentation and evaluation, further studies were conducted in a sequential manner, thus leading to a diagnosis of Pompe disease explaining her presenting signs and symptoms including her macroglossia. Through this fascinating case, we attempt to highlight the approach for the diagnoses of two rare diseases in a patient by emphasizing the importance of having a broad differential diagnosis when presented with findings which may have been thought as pathognomonic for certain diseases.
Lifetime autism spectrum features in a patient with a psychotic mixed episode who attempted suicide
Authors: Marly Simoncini, Mario Miniati, Federica Vanelli, Antonio Callari, Giulia Vannucchi, Mauro Mauri, Liliana Dell'Osso
Journal: Case Rep Psychiatry (2014)

We present a case report of a young man who attempted suicide during a mixed episode with psychotic symptoms. The patient's history revealed the lifetime presence of signs and features belonging to the autism spectrum realm that had been completely overlooked. We believe that this case is representative of an important and barely researched topic: what happens to children with nondiagnosed and nontreated subthreshold forms of autism when they grow old. The issue of early recognition of autism spectrum signs and symptoms is discussed, raising questions on the diagnostic boundaries between autism and childhood onset psychotic spectrums among patients who subsequently develop a full-blown psychotic disorder.
Acute Renal Failure Secondary to Inadvertent Propylene Glycol Overdose with Single-Day High-Dose Vitamin D (Stosstherapy)
Authors: David H Jelley, Deborah Zayneb Mohamad Ali, Michelle Condren
Journal: Case Rep Endocrinol (2019)
MeSH terms: Case Reports

Globally, there has been increasing attention paid to vitamin D deficiency and its treatment. Vitamin D stosstherapy with high-dose ergocalciferol in a single day is reemerging as a potential treatment option. We present an as yet unreported complication of acute renal injury due to propylene glycol toxicity in a 7-month infant treated with vitamin D stosstherapy. The product label for the vitamin D used for this patient states it is dissolved in propylene glycol (PG), but the amount is not listed on this or other US ergocalciferol liquid products that contain PG. Caution should be used when considering vitamin D stosstherapy with liquid ergocalciferol products available in the United States.