OpenMed/multicare-articles huggingface dataset:
Case report: Disseminated mucormycosis misdiagnosed as malignancy developed from allergic bronchopulmonary mycosis caused by Rhizopus microsporus following SARS-CoV-2 infection in a woman
Authors: Chengying Kong, Laibin Zong, Shunxian Ji, Yangxiang Liu, Miaomiao Li
Journal: Front Med (Lausanne) (2024)
Keywords: rhizopus spp, sars-cov-2, allergic bronchopulmonary mycosis (abpm), case report, mucormycosis, pulmonary mucormycosis
MeSH terms: Case Reports

Mucormycosis has become more prevalent during the COVID-19 pandemic and is associated with a high mortality rate. However, concurrent host allergic reactions, invasive pulmonary mucormycosis, and disseminated mucormycosis are rarely reported. Herein, we describe a case of disseminated mucormycosis initially misdiagnosed as a malignancy that developed from allergic bronchopulmonary mycosis caused by Rhizopus microsporus in a woman with post-SARS-CoV-2 infection. The previously healthy patient presented with a sizeable mass in the right middle lobe and multiple lesions across the lungs, brain, spleen, kidneys, pancreas, and subcutaneous tissue 6 months after SARS-CoV-2 infection, mimicking an extensive metastatic malignancy. Eosinophilia, elevated total plasma immunoglobulin E, and significant eosinophilic lung tissue infiltration were observed. Rhizopus microsporus was isolated from subcutaneous tissue, and hyphae were detected in the lung tissue. Sequential amphotericin B liposomes followed by isavuconazole antifungal therapy combined with systemic corticosteroids improved symptoms, significantly reduced the sizes of pulmonary lesions, and reduced eosinophil count. However, it failed to halt the overall progression of the disease, and the patient died. The absence of asthma-like symptoms and delayed recognition of invasive fungal infection signs contributed to poorer outcomes, highlighting the need for a thorough post-COVID-19 follow-up.
A patient with MELAS syndrome combined with autoimmune abnormalities: a case report
Authors: Mingmin Zhao, Chun Zuo, Hongyu Hao, Xing Xing, Lei Zhao, Na Li
Journal: Front Neurol (2023)
Keywords: melas, antimetabolic glutamate receptor 5 encephalitis, antinuclear antibodies (ana), autoimmune abnormalities, mitochondrial encephalomyopathy
MeSH terms: Case Reports

Background:
Mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS) is a group of maternally inherited disorders caused by mutations or deletions in mitochondrial genes with mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes as the main clinical manifestations.
Case presentation:
We reported a 20-year-old female patient with MELAS syndrome combined with autoimmune abnormalities. She suffered from an intermittent headache in the right temporal region with no obvious cause, and then, after strenuous exercise in dance class, the headache became aggravated, accompanied by unresponsiveness, blurred vision, and diplopia. Her blood lactate levels were elevated, her antinuclear antibodies were positive, and the antimetabolic glutamate receptors 5 in her serum were positive. Brain DWI showed a hypertensive signal in the right temporo-parietal-occipital cortex and subcortical area. Brain MRS showed decreased NAA peak and increased Lac peak. Muscle biopsy showed myogenic damage, and the modified Gomori trichrome (MGT) staining showed ragged red fibers (RRF). A genetic study revealed a mitochondrial DNA A3243G mutation.
Conclusion:
Mitochondrial encephalomyopathy is a rare clinical condition; however, the association with autoimmune diseases is not yet clear and still needs further research and analysis.
Topical imiquimod adverse event: Beyond the local skin reaction-A case report
Authors: Florence Lagacé-Thomassin, Ariana Nateghi, Elio Kechichian, Mylène Veilleux
Journal: SAGE Open Med Case Rep (2024)
Keywords: case report, stevens–johnson syndrome, adverse reactions, basal cell carcinoma, cutaneous skin reactions, imiquimod, severe cutaneous adverse reactions, toxic epidermal necrolysis
MeSH terms: Case Reports

Imiquimod is a well-known topical treatment for its efficacy against various skin conditions. While generally well-tolerated, adverse reactions like local skin irritation are common. However, severe systemic effects such as Stevens-Johnson syndrome (SJS) are rare, but possible. We present the case of an 82-year-old male who developed SJS following topical Imiquimod therapy for basal cell carcinoma. Despite minimal systemic absorption, serious reactions can occur, warranting caution. Prompt recognition and discontinuation of treatment are crucial for managing such rare but severe adverse events. This case underscores the importance of informed consent and vigilant monitoring for adverse reactions associated with Imiquimod therapy.
Duodenitis associated with ulcerative colitis and pouchitis after total colectomy successfully treated with upadacitinib: A case report
Authors: Kentaro Kojima, Jun Takada, Kiichi Otani, Naoya Masuda, Yukari Tezuka, Sachiyo Onishi, Masaya Kubota, Takashi Ibuka, Masahito Shimizu
Journal: DEN Open (2024)
Keywords: colectomy, duodenitis, pouchitis, ulcerative colitis, upadacitinib
MeSH terms: Case Reports

A 27-year-old man had ulcerative colitis (UC) 1 year prior and underwent a colectomy and two-stage ileal pouch-anal anastomosis for medically refractory UC 6 months ago. He visited our department with epigastric pain and discomfort, increased stool frequency, and bloody diarrhea. Esophagogastroduodenoscopy revealed continuous diffuse friable mucosa, erosions, and edema in the duodenum, and pouchoscopy revealed multiple ulcers and purulent mucus adhesions. Based on endoscopic and pathological findings, the patient was diagnosed with duodenitis associated with UC and pouchitis, for which he received oral prednisolone (40 mg/day) and ciprofloxacin. The frequency of stools and occurrence of bloody diarrhea reduced, and epigastric pain and discomfort improved after 2 weeks. However, when prednisolone was discontinued, the symptoms worsened, albumin level decreased, and C-reactive protein level increased. Following this, we administered a 20 mg prednisolone sodium phosphate enema once daily, and the patient's symptoms improved. However, the symptoms relapsed when the enema was discontinued. Assuming that the patient had steroid-dependent duodenitis associated with UC and pouchitis, we initiated upadacitinib. His symptoms improved within a few days, and biomarkers returned to normal after 1 month. Nine months after initiating the upadacitinib treatment, endoscopic remission was achieved in the mucosa of the duodenum and pouch. The patient has been in clinical remission for 1 year without any adverse events.
Combined Use of Guanfacine and N-Acetylcysteine for the Treatment of Cognitive Deficits After Traumatic Brain Injury
Authors: Siddharth Khasnavis, Timothy Belliveau, Amy Arnsten, Arman Fesharaki-Zadeh
Journal: Neurotrauma Rep (2024)
Keywords: n-acetylcysteine, cognitive symptoms, guanfacine, traumatic brain injury

Traumatic Brain Injury (TBI) is a significant contributor to disability across the world. TBIs vary in severity, and most cases are designated mild TBI (mTBI), involving only brief loss of consciousness and no intracranial findings on imaging. Despite this categorization, many persons continue to report persistent cognitive changes in the months to years after injury, with particular impairment in the cognitive and executive functions of the pre-frontal cortex. For these persons, there are no currently approved medications, and treatment is limited to symptom management and cognitive or behavioral therapy. The current case studies explored the use of the alpha-2A adrenoreceptor agonist, guanfacine, combined with the antioxidant, N-acetylcysteine (NAC), in the treatment of post-TBI cognitive symptoms, based on guanfacine's ability to strengthen pre-frontal cortical function, and the open-label use of NAC in treating TBI. Two persons from our TBI clinic were treated with this combined regimen, with neuropsychological testing performed pre- and post-treatment. Guanfacine + NAC improved attention, processing speed, memory, and executive functioning with minimal side effects in both persons. These results encourage future placebo-controlled trials to more firmly establish the efficacy of guanfacine and NAC for the treatment of cognitive deficits caused by TBI.
Primary ovarian hydatid cyst mimicking cyst adenoma: a rare case report
Authors: Ensiyeh Bahadoran, Fatemeh Samieerad, Simindokht Molaverdikhani, Saeideh Gholamzadeh Khoei
Journal: GMS Hyg Infect Control (2024)
Keywords: echinococcosis, hydatid cyst, ovary, primary
MeSH terms: Case Reports

Background:
Hydatid cysts (HC) are zoonotic diseases that are mainly caused by Echinococcus granulosus. Ovarian HC is a rare condition with different and unspecified presentations. Here we report a rare case of primary ovarian HC.
Case presentation:
A 47-year-old woman with chronic abdominal pain and left hemipelvic fullness was referred to the Obstetrics Clinic of the Kowsar Hospital of Qazvin. Abdominopelvic sonography revealed a cystic mass, which primarily suggested a cyst adenoma. The tumor marker levels were within normal limits. After surgical resection, histopathological examination showed a cystic mass with dimensions of 10×6×3 cm, smooth external and internal aspects, wall thickness of 0.3 cm, and multiple pieces of irregular gray membranous tissue. The patient was treated with albendazole 3 months after surgery, and a 6-month follow-up sonogram revealed no signs of recurrence.
Discussion:
HC has non-specific presentations. Radiologists, pathologists, and surgeons should consider HC as a differential diagnosis for any cystic mass in the pelvic cavity, especially in endemic areas. Surgical resection and albendazole administration are the chosen treatments.
Subacute-onset cataract in a 29-year-old man with mitochondrial encephalomyopathy: A case report
Authors: Lu Chen, Yueyang Zhong, Jingjie Xu, Qiuli Fu, Ke Yao
Journal: Clin Case Rep (2024)
Keywords: case report, cataract, mitochondrial encephalomyopathy, ocular manifestation
MeSH terms: Case Reports

This case report aims to emphasize that subacute occurrence of nuclear cataract might be one of the underestimated manifestations of mitochondrial encephalomyopathy, thus periodical ophthalmologic examinations are recommended.
Chemical abscess post vein of Galen aneurysmal malformation embolisation with ethylene vinyl alcohol copolymer
Authors: Uday Bhanu Kovilapu, Rahul Dudhal, Saurabh Maheshwari, Peeyush Dhagat, Umesh K Mishra
Journal: SA J Radiol (2024)
Keywords: vgam, brain abscess, chemical abscess, endovascular embolisation, ethylene vinyl alcohol copolymer (onyx), onyx granuloma, vein of galen, vein of galen malformation
MeSH terms: Case Reports

Vein of Galen aneurysmal malformation (VGAM) is a rare congenital malformation characterised by arteriovenous fistulas between primitive choroidal arteries and the median prosencephalic vein, the embryonic precursor to the vein of Galen. Endovascular techniques have changed the management of these patients with improved prognosis. An eight-month-old with VGAM managed by endovascular embolisation using ethylene vinyl alcohol copolymer (EVOH) developed a chemical abscess - a rare complication. It was managed conservatively and showed promising clinical outcome.
Contribution:
Chemical abscesses following EVOH embolisation are scarce - with imaging differentials, which include brain abscess and onyx granuloma. Knowledge and successful identification of this entity are essential as its management as prognoses differ. Chemical abscess is managed conservatively and has a good prognosis.
Tri-axial rubidium and helium optically pumped magnetometers for on-scalp magnetoencephalography recording of interictal epileptiform discharges: a case study
Authors: Odile Feys, Pierre Corvilain, Etienne Labyt, Mahdi Mahmoudzadeh, Laura Routier, Claudine Sculier, Niall Holmes, Matthew Brookes, Serge Goldman, Rudy Romain, Sergey Mitryukovskiy, Agustin Palacios-Laloy, Denis Schwartz, Nacim Betrouni, Philippe Derambure, Fabrice Wallois, Vincent Wens, Xavier De Tiège
Journal: Front Neurosci (2023)
Keywords: focal epilepsy, magnetoencephalography, on-scalp magnetoencephalography, optically pumped magnetometers, refractory epilepsy
MeSH terms: Case Reports

Cryogenic magnetoencephalography (MEG) enhances the presurgical assessment of refractory focal epilepsy (RFE). Optically pumped magnetometers (OPMs) are cryogen-free sensors that enable on-scalp MEG recordings. Here, we investigate the application of tri-axial OPMs [87Rb (Rb-OPM) and 4He gas (He-OPM)] for the detection of interictal epileptiform discharges (IEDs). IEDs were recorded simultaneously with 4 tri-axial Rb- and 4 tri-axial He-OPMs in a child with RFE. IEDs were identified visually, isolated from magnetic background noise using independent component analysis (ICA) and were studied following their optimal magnetic field orientation thanks to virtual sensors. Most IEDs (>1,000) were detectable by both He- and Rb-OPM recordings. IEDs were isolated by ICA and the resulting magnetic field oriented mostly tangential to the scalp in Rb-OPMs and radial in He-OPMs. Likely due to differences in sensor locations, the IED amplitude was higher with Rb-OPMs. This case study shows comparable ability of Rb-OPMs and He-OPMs to detect IEDs and the substantial benefits of triaxial OPMs to detect IEDs from different sensor locations. Tri-axial OPMs allow to maximize spatial brain sampling for IEDs detection with a limited number of sensors.
A retrospective case series on bisphosphonate related osteonecrosis of the jaw in 20 cats
Authors: Suzanna L Hatunen, Jamie G Anderson, Cynthia M Bell, Hugo C Campos, Matthew D Finkelman, Bonnie H Shope
Journal: Front Vet Sci (2024)
Keywords: bronj, mronj, alendronate, bisphosphonate, feline, hypercalcemia, jaw, osteonecrosis

Introduction:
This retrospective study highlights the salient aspects of a series of feline patients affected with bisphosphonate related osteonecrosis of the jaw. Though more commonly published in human literature, this presentation is rare in cats. The authors hope that this study will assist in making this a more globally known entity with subsequent improved prognosis.
Methods:
Data was retrospectively obtained from the medical records between 2015 and 2021 of 20 cats with Medication Related Osteonecrosis of the Jaw. Data included patient information, clinical history, presenting complaint, systemic diseases, details referable to hypercalcemia and treatment thereof, bisphosphonate specifics (dose and duration), clinical presentation of the lesion, diagnostic testing including radiographic and histopathologic descriptions, treatment, and outcome.
Results:
Pertinent results include that all 20 cats who developed Medication Related Osteonecrosis of the Jaw had been treated for idiopathic hypercalcemia with the bisphosphonate medication alendronate. Eighty-five percent of the cases had prior dental extractions at the site of MRONJ lesion. Ninety-five percent of the affected cats required a surgical procedure to control the disease. Thirty-five percent of cases required at least one revision surgery after the initial procedure was performed. Diagnosis of MRONJ was made by a correlation of diagnostic findings and patient history. No single diagnostic, or combination was pathognomonic for lesion diagnosis. As well, there were no statistically significant associations between patient variables assessed and the overall patient outcome.
Discussion:
The case series reveals that cats with feline idiopathic hypercalcemia treated with alendronate may be at a risk for development of MRONJ, a serious oral condition with significant morbidity. Prior dental extraction sites in patients concurrently treated with bisphosphonate medications were often associated with MRONJ lesions. Therefore, any needed dental surgery should be performed prior to the use of bisphosphonates where possible. The authors have also included a relevant comparative literature review.
Acute Peritoneal Dialysis in a Patient with Severe Uremic Syndrome and Multiple Hemodialysis Access Failure
Authors: Made Dyah Vismita Indramila Duarsa, Gede Wira Mahadita, Yenny Kandarini
Journal: Case Rep Nephrol (2024)
MeSH terms: Case Reports

A 67-year-old woman was diagnosed with chronic kidney disease stage V, severe uremia syndrome, hyperkalemia, metabolic acidosis, suspected pulmonary oedema, and multiple hemodialysis access failure. The patient is in a condition that requires emergency hemodialysis, but the patient does not have any access to undergo hemodialysis. The patient then underwent acute peritoneal dialysis and received an adequate response. The patient continued continuous ambulatory peritoneal dialysis and responded well.
A wolf in sheep's clothing-aortic stenosis and cardiac amyloidosis: "RAISE"ing awareness in clinical practice
Authors: H Sabbour, K Al-Humood, Z Al Taha, I Romany, H Haddadin, D Mohty
Journal: Front Cardiovasc Med (2024)
Keywords: raise score, aortic stenosis, cardiac amyloidosis, diagnosis, heart failure, low-flow/low-gradient, transthyretin

Aesop's fable of the wolf in sheep's clothing encourages us to look beneath the exterior appearance of a situation and evaluate the truth that lies beneath. This concept should be applied when managing older patients with severe aortic stenosis. This population of patients is increasingly being identified as having concomitant cardiac amyloidosis, which is an underrecognized cause of common cardiac conditions. The presence of cardiac amyloidosis negatively affects the outcome of patients with aortic stenosis, these patients undergo transcatheter aortic valve replacement (TAVR) with increasing frequency and have a significantly higher overall mortality rate than patients with aortic stenosis alone. Although left ventricular wall hypertrophy is expected in patients with aortic stenosis, it should not be assumed that this is caused only by aortic stenosis. A suspicion of cardiac amyloidosis should be raised in patients in whom the degree of hypertrophy is disproportionate to the degree of aortic stenosis severity. The remodeling, age, injury, systemic, and electrical (RAISE) score was developed to predict the presence of cardiac amyloidosis in patients with severe aortic stenosis. This article highlights the value of increased clinical suspicion, demonstrates the use of the multiparameter RAISE score in daily clinical practice, and illustrates the scoring system with case studies. In elderly patients being considered for TAVR, systematic testing for cardiac amyloidosis should be considered as part of the preoperative workup.
Case Report: Response of cutaneous lupus lesions in SLE to interferon receptor blockade parallels reduction of interferon score in blood
Authors: Claudia Günther, Christine Wolf, Louisa Fennen, Sarah Rösing, Stefan Beissert, Martin Aringer, Min Ae Lee-Kirsch
Journal: Front Immunol (2023)
Keywords: clasi, ifn score, anifrolumab, cutaneous lupus, interferon
MeSH terms: Interferon Type I, Lupus Erythematosus, Cutaneous / diagnosis, Lupus Erythematosus, Cutaneous / drug therapy, Lupus Erythematosus, Systemic / diagnosis, Lupus Erythematosus, Systemic / drug therapy, Case Reports, Research Support, Non-U.S. Gov't, Antibodies, Monoclonal / therapeutic use, Humans, Receptors, Interferon, Receptors, Interferon, Interferon Type I, Antibodies, Monoclonal

Cutaneous lupus erythematosus (CLE), the main manifestation of systemic lupus erythematosus (SLE), is driven by type I interferons (IFNs) and often only partially responds to conventional therapies. Treatment of seven SLE patients with the monoclonal antibody anifrolumab induced fast and sustained remission of previously refractory CLE lesions, beginning within the first weeks of treatment. Decline in CLASI-A score was paralleled by a reduction in IFN score determined by mRNA expression of seven IFN-stimulated genes (ISGs) in blood. These data suggest that a subset of ISGs could be a valuable biomarker in CLE.
Gonadal dysfunction in a man with Noonan syndrome from the LZTR1 variant: case report and review of literature
Authors: Francesca Orsolini, Luisa Pignata, Fulvia Baldinotti, Silvia Romano, Massimo Tonacchera, Domenico Canale
Journal: Front Endocrinol (Lausanne) (2024)
Keywords: lztr1 variant, noonan syndrome, case report, fertility, gonadal function
MeSH terms: Noonan Syndrome / complications, Noonan Syndrome / genetics, Case Reports, Review, Research Support, Non-U.S. Gov't, Adult, Erectile Dysfunction / genetics, Humans, Infertility, Male / genetics, Male, Mutation, Oligospermia / genetics, Transcription Factors / genetics, LZTR1 protein, human, Transcription Factors

Noonan syndrome (NS) is a genetic disorder characterized by multiple congenital defects caused by mutations in the RAS/mitogen-activated protein kinase pathway. Male fertility has been reported to be impaired in NS, but only a few studies have focused on fertility status in NS patients and underlying mechanisms are still incompletely understood. We describe the case of a 35-year-old man who underwent an andrological evaluation due to erectile dysfunction and severe oligospermia. A syndromic facial appearance and reduced testis size were present on clinical examination. Hormonal evaluation showed normal total testosterone level, high FSH level, and low-normal AMH and inhibin B, compatible with primary Sertoli cell dysfunction. Genetic analysis demonstrated the pathogenetic heterozygous variant c.742G>A, p.(Gly248Arg) of the LZTR1 gene (NM_006767.3). This case report provides increased knowledge on primary gonadal dysfunction in men with NS and enriches the clinical spectrum of NS from a rare variant in the novel gene LZTR1.
Giant splenic artery aneurysm: case report
Authors: Aleksey Vasilyevich Shabunin, Vladimir Vladimirovich Bedin, Mikhail Mikhailovich Tavobilov, Аleksey Andreevich Karpov, Fariza Fayzulloevna Alieva
Journal: J Vasc Bras (2023)
Keywords: aneurysm management, aneurysm resection, distal pancreatic resection, giant splenic artery aneurysm, splenectomy, splenic artery intervention, vascular surgery
MeSH terms: Case Reports

True splenic artery aneurysms are exceedingly rare and the medical literature contains only a limited number of reports on this pathology. Presently, there remains a lack of consensus regarding the optimal management and treatment approaches for patients in this category. Over the course of the last century, significant changes have occurred in the realm of surgical options, transitioning from open and endovascular procedures to the more advanced laparoscopic and robotic interventions. The propensity for these aneurysms to rupture underscores the need for timely intervention. The risk of rupture is notably elevated in patients harboring giant splenic artery aneurysms. In this report, we present the case of a 55-year-old woman diagnosed with a giant splenic artery aneurysm measuring 12x12 cm in diameter. She presented with notable weakness, discomfort, and pain in the left subcostal area. In response to her complaints and after thorough evaluation, we opted for a surgical procedure encompassing distal pancreatic resection in conjunction with splenectomy and resection of the giant splenic artery aneurysm.