OpenMed/multicare-articles huggingface dataset:
COVID-19 Dysautonomia
Authors: Brent P Goodman, Julie A Khoury, Janis E Blair, Marie F Grill
Journal: Front Neurol (2021)
Keywords: covid-19, pots, autonomic neuropathy, dysautonomia, orthostatic hypotension, postural tachycardia syndrome

Objective: To report a case series of dysautonomia associated with COVID-19 infection. Methods: This is a retrospective review of patients evaluated in the autonomic clinic at our institution with suspected signs and symptoms of dysautonomia who underwent formal evaluation, including autonomic testing. Results: Six patients were identified with signs and symptoms suggestive of dysautonomia who underwent autonomic testing. All patients had symptoms typical of COVID-19 infection, though none were hospitalized for these or other symptoms. All patients reported symptoms of postural lightheadedness and near-syncope, fatigue, and activity intolerance. Five patients reported the onset of autonomic symptoms concomitant with other COVID-19 symptoms, with the other patient reporting symptom onset 6 weeks following initial COVID-19 symptoms. Autonomic testing demonstrated an excessive postural tachycardia in 4 patients, a hypertensive response with head-up tilt in 3 patients, orthostatic hypotension in 1 patient, and sudomotor impairment in 1 of the patients with excessive postural tachycardia. Conclusions: We present clinical features and results of autonomic testing in 6 patients with a history COVID-19 infection. While all patients reported typical features of orthostatic intolerance, fatigue, and activity intolerance, the results of autonomic testing were heterogenous, with orthostatic hypotension in 1 patient, excessive postural tachycardia typical of postural tachycardia syndrome in 4 patients, and postural hypertension in 3 patients.
Combination surgical excision and fractional carbon dioxide laser for treatment of rhinophyma
Authors: Ramtin Kassir, Johonna Gilbreath, Ali Sajjadian
Journal: World J Plast Surg (2012)
Keywords: fractional co2 laser, rhinophyma, surgical excision, treatment
MeSH terms: Case Reports

Rhinophyma is a severe late complication of rosacea, which is characterized by progressive hyperplasia of sebaceous glands and connective tissue involving the lower two-thirds of the nose. It can be an emotionally devastating disorder, and serve as a medium for occult cancers and other health problems. Many surgical treatments have been advocated, as well as dermabrasion and laser therapy. In light of the problems faced with these individual therapy modalities, we advocate a combination therapy of surgical debulking and fractionated Carbon dioxide laser therapy. By excising the tissue first, we not only decreased the amount of time needed for the procedure, we were also able to preserve a histopathologic specimen that can be examined for occult cancers. After debulking, the fractionated carbon dioxide laser is then used to blend. By using fractionated carbon dioxide, we avoided the complications associated with non-fractionated carbon dioxide lasers, such as delayed healing times, hypopigmentation, hyperpigmentation, scarring, and persistent redness. We report our experience in two patients with rhinophyma who underwent a combination of surgical excision and fractional Co2 laser therapy for treatment. Pre- and postoperative protocols and treatment parameters are discussed. Both patients had excellent cosmetic and functional results and were followed for at least one year.
Macular Rash, Thrombocytopenia, and Hyperbilirubinemia in a Preterm Infant
Authors: Nurin Chatur, Marina Castro, Kin Fan Young Tai
Journal: Case Rep Pediatr (2019)
MeSH terms: Case Reports

Neonatal hyperthyroidism is usually caused by the passage of maternal thyroid receptor antibodies. This relatively rare condition has various manifestations including cholestasis, prematurity, and cardiomegaly. We present a case of a preterm infant with neonatal Graves' disease who presented with cholestasis, cardiomegaly, and a macularpapular rash that was thought to be suspicious for congenital infection. This case has been reported to illustrate lessons learnt for early identification of a neonate with Graves' disease in order to expedite treatment.
Bilateral synovial chondromatosis in the knee joint with both intra and extra-articular diseases
Authors: Rida-Allah Bassir, Farid Ismael, Ahmed Elbardouni, Mustapha Mahfoud, Mohamed Saleh Berrada, Moradh Elyaacoubi
Journal: Pan Afr Med J (2014)
Keywords: synovial chondromatosis, bilateral, knee, literature
MeSH terms: Chondromatosis, Synovial / complications, Chondromatosis, Synovial / diagnostic imaging, Knee Joint, Case Reports, Adult, Chondromatosis, Synovial / pathology, Humans, Male, Radiography

Synovial chondromatosis is a rare disease of unknown etiology. It usually occurs unilaterally in the large joints like the knee, but may occur in the shoulder, elbow, hip, ankle and temporomandibular joints. The disease is usually intracapsular, but can also be extracapsular on rare occasions. The diagnosis of synovial chondromatosis is given after an anamnesis, physical examination and radiographic examination. However, the diagnosis is obtained after histological examination of the synovial tissue. We report an unusual presentation of bilateral synovial chondromatosis in the knee joint, with both intra and extracapsular localization. never described in the literature. Although synovial chondromatosis is described as a benign disease, it can be very destructive and debilitating. These lesions can mimic a malignant tumor and present a diagnostic problem.
A coronary artery aneurysm revealing a Behçet's disease: a case report
Authors: Sameh Ben Farhat, Mehdi Slim
Journal: Pan Afr Med J (2020)
Keywords: behçet’s disease, acute coronary syndrome, coronary aneurysm
MeSH terms: Acute Coronary Syndrome / etiology, Behcet Syndrome / diagnosis, Coronary Aneurysm / etiology, Case Reports, Acute Coronary Syndrome / diagnostic imaging, Adult, Behcet Syndrome / complications, Coronary Aneurysm / diagnostic imaging, Coronary Angiography, Humans, Male

Behçet's disease (BD) is a multisystemic chronic vasculitis characterized by its clinical polymorphism. It concerns mainly young men and generally appears between the third and the fourth decades. Cardiac involvement in Behçet's disease is rare but represents a major prognostic factor. We report the case of a young man admitted in our department for the management of an acute coronary syndrome revealing a Behçet's disease. Coronary angiography had shown a giant thrombosed aneurysm of the left coronary artery. Surgical treatment was successfully performed and the patient had a left anterior descending coronary artery bypass using the left internal mammary artery graft.
Case Report: Toxigenic Corynebacterium ulcerans Diphtheria-Like Infection in a Horse in the United Kingdom
Authors: Flavia Zendri, Cajsa Marie Isgren, Matthew Sinovich, Peter Richards-Rios, Katie L Hopkins, Katherine Russell, Natalie Groves, David Litt, Norman K Fry, Dorina Timofte
Journal: Front Vet Sci (2021)
Keywords: st543, wgs, emerging zoonosis, horse, respiratory diphtheria-like illness, toxigenic corynebacterium ulcerans
MeSH terms: Case Reports

Corynebacterium ulcerans (C. ulcerans) may cause diphtheria in humans and can be carried by a wide range of animal species including dairy cows and, more recently, dogs and cats that have been increasingly involved in zoonotic trasmission. We isolated and characterized, by WGS, a toxigenic C. ulcerans strain from a diseased horse in the United Kingdom showing clinical signs of respiratory diphtheria comparable to those seen in people. Our results indicate a role for horses as reservoirs for zoonotic C. ulcerans.
De Novo PTEN Mutation in a Young Boy with Cutaneous Vasculitis
Authors: Angela Mauro, Ebun Omoyinmi, Neil James Sebire, Angela Barnicoat, Paul Brogan
Journal: Case Rep Pediatr (2017)
MeSH terms: Case Reports

Phosphatase and tensin homolog (PTEN) is the protein encoded by the PTEN gene (10q23.3). PTEN mutations are related to a variety of rare diseases referred to collectively as PTEN hamartoma tumor syndromes (PHTS), which include Cowden Syndrome, Bannayan-Riley-Ruvalcaba syndrome, Proteus Syndrome, and Proteus-like syndrome. These diseases are associated with an increased risk of malignancy and for this reason an accurate and early diagnosis is essential in order to institute cancer surveillance. PTEN is a regulator of growth and homeostasis in immune system cells, although there are limited data describing immune dysregulation caused by PTEN mutations. We describe a case of PHTS syndrome caused by a de novo mutation in PTEN detected using a targeted next generation sequencing (NGS) gene panel which was instigated for workup of cutaneous vasculitis. We highlight the diagnostic utility of this approach and that mutations in PTEN may be associated with immune-dysregulatory features such as vasculitis in young children.
Diplopia due to a neurovascular compression
Authors: Dana Margareta Cornelia Dăscălescu, Vasile Potop, Valeria Coviltir, Maria Cristina Corbu, Cristina Dijmărescu
Journal: Rom J Ophthalmol (2022)
Keywords: horizontal diplopia, neurovascular compression, sixth nerve palsy
MeSH terms: Abducens Nerve Diseases / complications, Diplopia / diagnosis, Diplopia / etiology, Case Reports, Adult, Female, Humans, Intraocular Pressure, Tonometry, Ocular, Visual Acuity

A 36-year-old female patient presented to our clinic with a two months history of diplopia and dizziness. The symptoms appeared gradually and increased in frequency and intensity. She had no significant medical history and she did not take any medication. A full ophthalmological consult was performed, which revealed restricted ocular motility in the left eye (LE), in left gaze. Otherwise, the examination showed no pathological findings: best corrected visual acuity (BCVA) both eyes (OU) 1 (Snellen chart), normal slit lamp examination and pupillary reflexes, normal intraocular pressure (IOP) and fundus aspect. Diplopia tests revealed a horizontal diplopia, exacerbated in left gaze. Sixth nerve palsy suspicion was raised and the patient was directed to the neurology department. Following magnetic resonance imaging, with angiographic sequence, a complex intracerebral vascular malformation that interacted with the cranial nerves and determined horizontal diplopia, was found. For a correct diagnosis, we needed a good collaboration between various medical specialties, especially ophthalmology and neurology, because patients with diplopia often present for the first time at the ophthalmologist. Abbreviations: BCVA = best corrected visual acuity, IOP = intraocular pressure, LE = left eye, RE = right eye.
Case Report: Selexipag in pediatric pulmonary hypertension: Initiation, transition, and titration
Authors: Jenna M Faircloth, Neelam D Bhatt, Corey A Chartan, Ryan D Coleman, Natalie Villafranco, Fadel E Ruiz, Raysa Morales-Demori, Elise Whalen, Erin Ely, Rozmeen Fombin, Nidhy P Varghese
Journal: Front Pediatr (2023)
Keywords: initiation, pediatric pulmonary hypertension, prostacyclin, selexipag, transition, treprostinil
MeSH terms: Case Reports

Selexipag, a selective prostacyclin receptor agonist, is approved for treating pulmonary arterial hypertension in WHO Group 1 adult patients. Compared to parenteral prostacyclin formulations, selexipag offers a significant improvement in patient's and caregiver's quality of life because of its oral formulation, frequency of administration, and mechanism of action. Although experience in the pediatric population is limited to case reports in older adolescent patients and selexipag is not approved for use in the pediatric pulmonary hypertension population, many pediatric centers are expanding the use of this therapy to this population. We report our institution's experience in the use of selexipag to treat pulmonary hypertension in children under 10 years of age, between 10 and 30 kg. Seven patients were initiated on selexipag therapy including de novo initiation and transition from intravenous treprostinil to oral selexipag. All patients were on stable background therapy with phosphodiesterase-5 inhibitor and endothelin receptor antagonist therapies at baseline. All patients reached their planned goal selexipag dose during admission without the need for changes to the titration schedule and without hemodynamic deterioration. In our experience, oral selexipag is safe and well-tolerated in young pediatric patients with pulmonary hypertension. Based on our favorable experience, we developed an institution-specific selexipag process algorithm for continued successful use in the pediatric population.
Hailey-Hailey disease: the role of azathioprine an immunomodulator
Authors: Malumani Malan, Wu Xuejingzi, Jiang Si, Song Ji Quan
Journal: Pan Afr Med J (2019)
Keywords: familial benign chronic pemphigus, hailey-hailey disease, azathioprine, benign chronic familial pemphigus, benign chronic pemphigus, familial benign pemphigus
MeSH terms: Azathioprine / therapeutic use, Immunologic Factors / therapeutic use, Pemphigus, Benign Familial / drug therapy, Case Reports, Humans, Male, Middle Aged, Pemphigus, Benign Familial / physiopathology, Treatment Outcome, Immunologic Factors, Azathioprine

Hailey-Hailey disease (HHD) is a rare autosomal dominant hereditary blistering and erosions disorder affecting the intertriginous regions of the body. There is still no treatment protocol for this disease thus clinicians are highly advised to draw up individualized treatment plan. In this case report, we discuss a case of HHD in a 58-year-old Chinese man who was successfully treated with azathioprine in Hubei province.
Primary adenocarcinoma of ileostomy: case report with review of the literature
Authors: Shailesh Mohandas, Stephen Lake
Journal: Case Rep Med (2010)
MeSH terms: Case Reports

Primary adenocarcinoma is a rare and late complication following proctocolectomy and ileostomy for ulcerative colitis, familial adenomatous polyposis, Crohn's disease and multifocal colorectal cancer. We report a case of adenocarcinoma of the ileostomy occurring 48 years after proctocolectomy for ulcerative colitis. A review of the literature suggests that there are 39 cases reported in literature and this case reports the longest interval between formation of ileostomy and diagnosis of ileostomy adenocarcinoma. This case also reports lymph node metastasis to the adjacent mesenteric lymph node. The incidence of lymphnode metastasis is 15 percent as per literature. Onces diagnosis is confirmed by biopsy enblock excision with or without stomal relocation is the main stay of treatment. Patient education and regular surveillance of patients with long-standing ileostomy is recommended for early detection of this unusual cancer.
Acute Sheehan's Syndrome Presenting with Hyponatremia Followed by a Spontaneous Pregnancy
Authors: Maria M Pineyro, Leonardo Diaz, Macarena Guzzetti, Mariana Risso, Jimena Pereda
Journal: Case Rep Endocrinol (2022)
MeSH terms: Case Reports

Background:
Acute Sheehan's syndrome is rare, as well as hyponatremia as its initial manifestation. In addition, spontaneous pregnancy in patients after Sheehan's syndrome is unusual. To our knowledge, no cases of spontaneous pregnancy after acute Sheehan's syndrome have been reported. We describe a case of Sheehan's syndrome that presented with acute hyponatremia and a spontaneous pregnancy.
Case:
A 34-year-old female developed blood loss during delivery, which required a blood transfusion. On day seven postpartum, she presented with headaches, lethargy, and difficulty in breastfeeding. The workup showed hyponatremia (118 mEq/l), secondary hypothyroidism, and low prolactin levels. Magnetic resonance imaging showed pituitary necrosis. She was treated with NaCl, hydrocortisone (cortisol results were not available), and levothyroxine. Laboratory tests six weeks after discharge showed low IGF-1 and 8 AM cortisol and normal FT4, LH, FSH, and PRL levels. She was able to partially breastfeed until 4 months postpartum. Regular menstrual cycles started three months later. She became spontaneously pregnant one year later.
Conclusion:
Acute Sheehan's syndrome should be considered in the evaluation of postpartum patients with suggestive symptoms. Physicians should be aware that hyponatremia could be an initial manifestation of Sheehan's syndrome, which requires a high index of suspicion for diagnosis. Spontaneous pregnancy can occur after acute Sheehan's syndrome.
Confusion and Hallucination: A Case Report of an Unusual Presentation of COVID-19
Authors: Rawabi Aljumaiah, Wael Alturaiki, Bandar Alosaimi
Journal: Case Rep Psychiatry (2021)
MeSH terms: Case Reports

Besides respiratory symptoms, COVID-19 disease has a wide range of clinical, subclinical, and atypical presentations reported previously. Here, we report the case report of a middle-aged man, with no previous known medical illness, who presented with a 5-day-history of anxiety, fever, confusion, and hallucinations. Patient's SARS-CoV-2 polymerase chain reaction test was positive, and he underwent daily vital signs and respiratory, cardiovascular, and abdominal examinations. Chest radiography, electrocardiogram, microbial culture, biochemistry, and toxicology tests were also investigated. In this report, a case of COVID-19 is described with an unusual presentation of confusion and hallucinations in the absence of severe upper respiratory or constitutional symptoms. The earlier recognition of atypical manifestation, the safer the practice, with optimal timely diagnosis, and less anticipated outbreaks in healthcare facilities. Further studies are needed to establish the underlying pathophysiological mechanisms involved.
Haemorrhage in pre-existing adrenal masses. A case series
Authors: Alexander M Nixon, Anna Botou, Chrysanthi Aggeli, Evaggelos Falidas, Theodosia Choreftaki, Georgios N Zografos
Journal: Int J Surg Case Rep (2020)
Keywords: adrenal haemorrhage, adrenal incidentaloma, endocrine surgery, pheochromocytoma

Introduction:
Adrenal haemorrhage in the context of a pre-existing adrenal mass is a rare, underestimated and potentially fatal surgical emergency. It is a rare cause of acute abdominal pain.
Presentation of cases:
Data from 13 patients with adrenal haemorrhage in a pre-existing adrenal mass were prospectively collected during a 9 year period from a single institution. All patients underwent CT imaging which formed the basis of diagnosis and a complete endocrinological evaluation. Seven out of 13 patients underwent an elective surgical procedure and 2 patients underwent emergency laparotomy. Five out of 13 patients were diagnosed with metastatic disease. One patient was diagnosed with pheochromocytoma.
Discussion:
The likelihood of an undiagnosed pheochromocytoma renders emergency surgery extremely precarious. Complete patient evaluation includes testing for hormonally active adrenal tumors and malignancy. Emergency surgery is reserved for cases where conservative management fails.
Conclusion:
Haemorrhage of an adrenal mass constitutes a diagnostic and therapeutic challenge. Most patients respond well to initial resuscitation efforts. When feasible, patients should undergo a complete hormonal and oncologic evaluation before surgical intervention is considered.
Anesthesia outside the Operating Room in a Patient with Mitochondrial Disease
Authors: Alejandra Fadrique-Fuentes, Beatriz Martínez-Rafael, Rodrigo Poves-Álvarez, Estefanía Gómez-Pesquera
Journal: Case Rep Anesthesiol (2020)
MeSH terms: Case Reports

Mitochondrial dysfunction comprehends a wide range of genetic disorders. These patients' precarious metabolic balance makes its management difficult. Furthermore, the same systems affected by mitochondrial disease can be altered by many of the frequently used anesthetic agents. Each patient has to be evaluated individually according to their comorbidities and anesthetic requirements.
Spontaneous Loculated Bilateral Hydropneumothoraces in a Patient with Recent COVID-19 Infection
Authors: Jacques Lowe, Bradley Kaptur, Ali Baltaji, Daniel Rosenblat, James Kumar, Vishesh Paul
Journal: Case Rep Med (2022)
MeSH terms: Case Reports

A 53-year-old male presented to the emergency room with chest pain, shortness of breath, and back pain. He had recently recovered from COVID-19 infection and returned home on room air. Chest imaging showed bilateral hydropneumothoraces that were not present on the imaging performed during his prior admission three weeks ago. The patient was treated with bilateral chest tube drainage and oxygen support and responded well to treatment. This case represents a unique occurrence of spontaneous loculated bilateral hydropneumothoraces in the context of recent clinical recovery from COVID-19 infection requiring inpatient treatment. This case highlights the importance of an awareness of a potential sequela of COVID-19 that may occur even after presumed clinical recovery.
Giant Vulvar Condylomata: Two Cases and a Review of the Literature
Authors: Funda Gungor Ugurlucan, Cenk Yasa, Omer Demir, Ozlem Dural, Ekrem Yavuz, Suleyman Engin Akhan
Journal: Case Rep Obstet Gynecol (2019)
MeSH terms: Case Reports

Introduction:
Giant vulvar condyloma is usually associated with the HPV subtypes 6 and 11 and is characterized by excessive growth of verrucous lesions on the genitals and/or perianal region. It may be observed in sexually inactive as well as sexually active women. Immunosuppression plays an important role in the development of the disease.
Patients and methods:
We report two cases of giant vulvar condyloma together with the review of the literature.
Results:
One case was a 21-year old sexually inactive woman with a history of Type 1 Diabetes. Second case was a 20-year-old sexually active woman with a rapidly progressing disease and cervical dysplasia. Both cases were operated; all the condylomatous structures were resected with preservation of the anatomy and clitoral innervation and blood flow. Skin and subcuticular dehiscence was the only complication encountered in the first case.
Conclusion:
Main treatment of giant vulvar condyloma is surgical resection with maintenance of the vulvar anatomy. Preservation of especially the clitoral innervation as much as possible is very important.
Infected thyroglossal duct cyst involving submandibular region: a case report
Authors: Rahul A Gandhi, Rahul Bhowate, Shirish Degweker, Arvind Bhake
Journal: Case Rep Dent (2011)
MeSH terms: Case Reports

Thyroglossal duct cyst presents most frequently in the midline of the neck, either at or just below the level of the hyoid bone. They generally manifest as painless neck swelling, and they move on protrusion of tongue and during swallowing. A case of thyroglossal cyst was reported in the left submandibular region in a 14-year-old girl, above the level of hyoid bone; ultrasound examination favored a cystic lesion which moved in a vertical fashion on swallowing whereas fine needle aspiration cytology report was suggestive of simple cystic lesion of thyroglossal cyst. No lymphoid or malignant cells were present. The cyst was excised completely by surgical procedure under general anesthesia. Histopathological analysis revealed thyroglossal cyst showing columnar and flattened epithelium of cyst with focal aggregate of chronic inflammatory cells supported by fibrocollagenous cyst wall. The clinical, ultrasound, and histopathological findings suggested that the lesion was an infected thyroglossal cyst. There was no evidence of recurrence 6 months after surgery.