OpenMed/multicare-articles huggingface dataset:
Utility of Iodine-131 hybrid SPECT-CT fusion imaging before high-dose radioiodine therapy in papillary thyroid carcinoma
Authors: Anish Bhattacharya, Sunil Hejjaji Venkataramarao, Chandra Sekhar Bal, Bhagwant Rai Mittal
Journal: Indian J Nucl Med (2010)
Keywords: carcinoma, spect-ct, hybrid imaging, iodine-131, thyroid
MeSH terms: Case Reports

The management protocol for differentiated thyroid cancer includes whole body iodine-131 imaging, to detect residual thyroid tissue and distant metastasis, after thyroidectomy. However, the diagnostic dose of radioiodine may fail to detect the non-functioning or poorly functioning metastasis. We present a case where hybrid single photon-emission computed tomographic and computed tomographic (SPECT-CT) fusion imaging, using a diagnostic dose of iodine-131, was able to detect both functioning as well as non-functioning pulmonary metastases, prior to high-dose radioiodine therapy.
Kocuria kristinae infection associated with short bowel syndrome: A case report
Authors: Yosuke Namba, Seiji Fujisaki, Toshikatsu Fukuda
Journal: Int J Surg Case Rep (2020)
Keywords: central venous access port, kocuria kristinae, short bowel syndrome
MeSH terms: Case Reports

Introduction:
Only a few cases of K. kristinae infection have been reported in the literature. Patients with short bowel syndrome have an increased risk of opportunistic infections due to decreased bowel immunity and the long-term central venous catheter placement. We report a rare case of K. kristinae infection associated with SBS requiring long-term central venous access port placement.
Presentation of case:
A 70-year-old woman presented with fever of approximately 39 °C to our hospital for examination. She has undergone total hysterectomy and radiation therapy for cervical cancer 36 years ago. Five years ago, she developed multiple small bowel perforations, and a jejunostomy was constructed at the oral end of the perforation and approximately 110 cm from the ligament of Treitz because of the difficulty in dissecting the adhesion. She developed short bowel syndrome, and the central venous port was constructed four years ago due to poor enteral nutrition. K. kristinae was detected in the central venous catheter tip and in two blood cultures. We administered intravenous vancomycin. After seven days of antibiotic treatment, both fever and inflammatory reaction improved, and the blood culture was negative. After 16 days of antibiotic treatment, we performed central venous port construction on the side opposite to the previous site.
Conclusion:
Patients with short bowel syndrome have an increased risk of K. kristinae infections due to decreased bowel immunity and the long-term central venous port, and therefore, these patients should be followed up carefully.
Case report: Concurrent intravestibular schwannoma mimicking Ménière's disease and cochlear hydrops detected via delayed three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging
Authors: Koji Nishimura, Toshihisa Murofushi, Nobuhiro Hakuba
Journal: Front Neurol (2022)
Keywords: ménière's disease, delayed 3d-flair mr imaging, endolymphatic hydrops (eh), intralabyrinthine schwannomas (ilss), intravestibular schwannoma, vestibular evoked myogenic potential (vemp), video head impulse test (vhit)
MeSH terms: Case Reports

Objective:
To present a case of intralabyrinthine schwannoma (ILS) presenting as Ménière's disease diagnosed via 4-h delayed gadolinium-enhanced three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging (3D-FLAIR MRI) and treated successfully using the translabyrinthine approach.
Patient:
A patient who was diagnosed with intravestibular ILS.
Interventions:
The patient underwent comprehensive preoperative neurological examinations and MRI. The tumor was resected using the translabyrinthine approach and was pathologically confirmed as schwannoma based on the surgical specimen.
Main outcome measures:
Preoperative audiogram and vestibular test findings and MRI images.
Results:
Preoperatively, pure-tone audiogram showed progressive sensorineural hearing loss only on the affected side. The video head impulse test and vestibular evoked myogenic potential test showed vestibular dysfunction on the affected ear. Immediate gadolinium-enhanced T1-weighted MRI revealed an enhanced region in the vestibule. Meanwhile, magnetic resonance cisternography showed a filling defect. Delayed 3D-FLAIR MRI revealed a signal void in the scala media of the cochlea indicative of cochlear hydrops, and a strong signal in the perilymph at the basal cochlea suggestive of impaired blood-labyrinthine barrier.
Conclusion:
Delayed 3D-FLAIR MRI is useful in diagnosing concurrent ILSs and endolymphatic hydrops.
Autoimmune rhabdomyolysis and a multiorgan display of PD-1 inhibitor induced immune related adverse events during treatment of metastatic melanoma
Authors: Hoda Z Pourhassan, David Tryon, Brett Schaeffer, Hamid Mirshahidi, John Wong
Journal: Exp Hematol Oncol (2019)
Keywords: immune mediated adverse events, immunotherapy, melanoma, myopathy, nivolumab, pd-1, rhabdomyolysis
MeSH terms: Case Reports

Background:
Programmed death-1 (PD-1) inhibitors are among the immunotherapies that have revolutionized our approach to treating several cancers. These novel agents act by blocking PD-1 receptor/PD-1 ligand interactions that would otherwise allow tumor cells to evade host immune destruction by inhibiting response of cytotoxic T-lymphocytes. They are overall well tolerated, though they have been associated with a constellation of immune mediated adverse events (irAEs).
Case presentation:
We present a case of rare nivolumab mediated adverse events in a patient with nodular recurrence of melanoma. The patient presented with rhabdomyolysis and shortly thereafter developed a constellation of immune-mediated organ derangements. This case further demonstrates the utility and effectiveness of steroid therapy in the setting of irAEs despite our patient's eventual poor clinical outcome. While PD-1 inhibitors have revolutionized the treatment of several cancers, they require vigilance by the clinician for early detection and treatment of uncommon but potentially fatal irAEs.
Conclusions:
PD-1 inhibitors are now widely used in a multitude of cancer types including melanoma, advanced non-small cell lung cancer, metastatic renal cell carcinoma, and Hodgkin lymphoma amongst others. While these agents are often well tolerated, they are associated with a unique profile of immune-related toxicities that can cause significant morbidity and mortality. Education of both patients and healthcare providers is essential for diagnosis and treatment of these adverse events early in their course. This case highlights the uncommon but potentially serious PD-1-associated toxicity of myopathy and rhabdomyolysis along with other organ involvement and is directly applicable to use of these agents in patients with advanced cancers.
Long Term Survival and Continued Complete Response of Vemurafenib in a Metastatic Melanoma Patient with BRAF V600K Mutation
Authors: K Sahadudheen, Md Rafiqul Islam, M Iddawela
Journal: Case Rep Oncol Med (2016)

Introduction. BRAF kinase inhibitors such as Vemurafenib have shown improvement in overall survival, progression-free survival, and response rates in patients with metastatic melanoma with BRAF V600K mutation. However, there were no cases of complete remission reported in patients with V600K mutation before. Case Presentation. A 53-year-old man with metastatic melanoma and dialysis dependent end stage renal failure was treated safely with Vemurafenib for a BRAF V600K mutation positive melanoma and the case was reported elsewhere. After a long follow-up of the same patient treated with Vemurafenib, a complete radiological response was observed and the renal functions remained stable throughout the treatment. Main toxicities reported were grade 1 photosensitivity and skin cancers. Vemurafenib was discontinued but patient remains disease free 12 months after stopping treatment and the clinical review is ongoing. Conclusion. This is the first reported case of complete radiological response to a BRAF inhibitor in metastatic melanoma with BRAF V600K mutation and remains disease free even after discontinuation of treatment. This also shows clinical safety of Vemurafenib in end stage renal failure and highlights the need for closer look at the subgroup of patients with BRAF V600K mutation and its tumour biology.
In Utero Diagnoses of Strikingly Similar Presentations of Complete Atrioventricular Septal Defects in a Pair of Dizygotic Twins Concordant for Trisomy 21
Authors: Diamond Ling, Jonathan G Dayan
Journal: Case Rep Pediatr (2018)
MeSH terms: Case Reports

Trisomy 21, or Down syndrome (DS), is a genetic disorder affecting approximately 1 in 500-750 live births. The prevalence of DS has increased over the past two decades, correlating with a rise in the proportion of pregnancies complicated by advanced maternal age. There is also a correlation between advanced maternal age and dizygotic twinning rates. There is an increased risk of at least one twin being affected in dizygotic pregnancies compared to singletons. However, despite this greater relative risk, reports of concordance of DS in both dizygotic twins are very rare. Congenital heart disease (CHD) occurs in roughly 40% of individuals with DS, but there can be considerable phenotypic variation. The most common, atrioventricular septal defect accounts for only 40% of CHD seen in DS. There is also a higher incidence of CHD in twins, but also with a low incidence of concordance. There have been only five reported cases of concordant DS in dizygotic twins with confirmed chromosomal analyses; none of which describe concordant congenital heart disease. Here, we describe an unusual case of dizygotic twins of differing genders concordant for both Down syndrome and congenital heart disease of a strikingly similar presentation.
Uterine Carcinosarcoma: A Case Report and Literature Review
Authors: Ali Kord, Behnam Rabiee, Ismail Elbaz Younes, Karen L Xie
Journal: Case Rep Obstet Gynecol (2020)
MeSH terms: Case Reports

Uterine carcinosarcomas are rare and extremely aggressive undifferentiated carcinomas which include both carcinomatous and sarcomatous elements. A 52-year-old female presented with heavy irregular menstrual bleeding for several years and new right elbow pain and swelling. Ultrasound and computed tomography showed a large uterine mass with regional and distant metastatic lymphadenopathy and suspicious findings of osseous metastasis to the right elbow. A biopsy confirmed uterine carcinosarcoma, and the patient underwent chemotherapy and then surgical resection of the uterine mass with palliative radiotherapy of the right elbow. The postoperative imaging showed new metastasis, and the patient was scheduled to start on immunotherapy. Considering the highly invasive nature of uterine carcinosarcomas, timely detection of this cancer using characteristic imaging and pathology findings is of extreme importance to improve the patient's survival.
Apathetic Thyroid Storm with Cardiorespiratory Failure, Pulmonary Embolism, and Coagulopathy in a Young Male with Graves' Disease and Myopathy
Authors: Abuobeida Ali, Wail Mostafa, Cornelius Fernandez, Habib Ahmad, Nyi Htwe
Journal: Case Rep Endocrinol (2020)
MeSH terms: Case Reports

A 38-year-old gentleman presented with thyroid storm with multiorgan involvement in the form of heart failure (thyrotoxic cardiomyopathy), respiratory failure (respiratory muscle fatigue), hepatic dysfunction, fast atrial fibrillation, pulmonary embolism, and disseminated intravascular coagulation (DIC). His Graves' disease (GD) remained undiagnosed for nearly 8 months because apart from weight loss, he has not had any other symptoms of thyrotoxicosis. The presentation of thyroid storm was atypical (apathetic thyroid storm) with features of depression and extreme lethargy without any fever, anxiety, agitation, or seizure. There were no identifiable triggers for the thyroid storm. Apart from mechanical ventilation and continuous veno-venous renal replacement therapy in the intensive care unit, he received propylthiouracil (PTU), esmolol, and corticosteroids, which were later switched to carbimazole and propranolol with steroids being tapered down. He was diagnosed with thyrotoxic myopathy which, like GD, remained undiagnosed for long (fatigability). A high index of suspicion and a multidisciplinary care are essential for good outcome in these patients.
Radiation for MALT of the Submandibular Gland
Authors: Juskaran Chadha, Marita S Teng, Julie Teruya-Feldstein, Richard L Bakst
Journal: Case Rep Hematol (2017)
MeSH terms: Case Reports

We are reporting a case of a 27-year-old woman with a history of swelling in the left submandibular region. This swelling was associated with a mass, and this was pathologically confirmed to be an extranodal marginal zone lymphoma (MALT). The patient underwent surgical excision and postoperative adjuvant radiation therapy. The patient tolerated treatments well and remains free of disease. Here, we describe the case and management described in the current literature.
A rare case of invasive pulmonary aspergillosis presenting as organizing pneumonia due to Aspergillus niger in an immunocompetent host
Authors: Raphaël Schils, Antoine Altdorfer, Filip Moerman, Thierry Weber, Michèle De Waele, Johan Maertens, Benoit F Pirotte
Journal: Respir Med Case Rep (2021)
Keywords: aspergillus niger, invasive pulmonary aspergillosis, organizing pneumonia
MeSH terms: Case Reports

Invasive pulmonary aspergillosis associated with organizing pneumonia is increasingly described and mainly affects the immunocompromised individual. Most of Aspergillus invasive infections in both immunocompetent and immunocompromised patients are attributed to Aspergillus fumigatus. Herein we describe a clinical case of pulmonary Aspergillus niger infection presenting as an organizing pneumonia in an immunocompetent patient. A wedge resection and two successive cures of azoles (voriconazole 6 weeks then itraconazole 6 weeks) were necessary for the patient to be totally recovered. The association of OP and IPA is rare. The involvement of A. niger makes it even rarer, this is the reason why we decided to report on this case.
Case Report: Positive Outcome of a Suspected Drug-Associated (Immune Mediated) Reaction in a 4-Year-Old Male French Bulldog
Authors: Line-Alice Lecru, Daniel Combarros, Eloy Castilla-Castaño, Maxence Delverdier, Marie-Christine Cadiergues, Charline Pressanti
Journal: Front Vet Sci (2021)
Keywords: beta-lactams antibiotic, dog, drug reaction, skin, toxic epidermal necrolysis
MeSH terms: Case Reports

Toxic epidermal necrolysis (TEN) is a rare and severe life-threatening syndrome characterized by apoptosis of keratinocytes resulting in devitalization of the epidermis affecting more than 30% of skin surface. In humans and animals, this condition is mostly triggered by drugs. Identification of the putative agent and its withdrawal are crucial to successful management of a patient with TEN. In this case study, we report the clinical features, histopathological findings and management of a dog with TEN. A 4-year-old intact male French bulldog presented with acute onset of severe lethargy and cutaneous ulcerations on the footpads, scrotum, and hind limbs associated with marked pain. A Stevens-Johnson syndrome/TEN was suspected and drugs, especially beta-lactams, were withdrawn. Histopathology confirmed the diagnosis of epidermal necrosis. Advanced supportive therapy, pain management and skin care led to rapid remission. Early identification and removal of the suspected medication was crucial to improving TEN prognosis in this dog. Antibiotics (penicillin, ampicillin, cephalexin, and sulfonamides) are frequently involved in adverse cutaneous reactions in dogs. Ideal treatment remains elusive is humans and dogs and this disease has a poor prognosis. Supportive care combined with pain management and treatment of the cutaneous ulcerations is essential.
Hyperbaric Oxygen Therapy for Suburethral Vaginal Mucosal Necrosis after Interstitial Irradiation for Recurrent Cervical Cancer
Authors: Yoshihisa Arakaki, Yuko Shimoji, Tadaharu Nakasone, Yusuke Taira, Tomoko Nakamoto, Wataru Kudaka, Keiko Mekaru, Yoichi Aoki
Journal: Case Rep Obstet Gynecol (2021)
MeSH terms: Case Reports

Patients with gynecological malignancies can develop radiation injuries, such as cystitis, proctitis, and soft tissue necrosis which have approved indications for hyperbaric oxygen therapy (HBOT). A 76-year-old Japanese woman with vaginal recurrence of cervical cancer was treated with the high-dose rate interstitial brachytherapy. Twenty-one months after the irradiation, she developed radiation necrosis on the external urethral opening. Two cycles of HBOT were performed. HBOT consisted of delivering 100% oxygen for 60 minutes at 2.4 atmospheres absolute. Pressure exposure was performed once daily, 5 days a week for 6 weeks. Eventually, the necrotic mucosa was completely replaced by the normal mucosa. No adverse effects were observed. We successfully treated a case of late adverse events of radiation therapy with HBOT. It was noninvasive and appears to be a useful treatment option which should be considered standard treatment practice.
Case Report: Neoadjuvant and Adjuvant Crizotinib Targeted Therapy in Stage IIIA-N2 ALK-Positive Non-Small-Cell Lung Cancer
Authors: Xiao-Hong Xie, Ze-Jiang Zhan, Yin-Yin Qin, Ju-Hong Jiang, Wei-Qiang Yin, Rong-Hui Zheng, Shi-Yue Li, Cheng-Zhi Zhou
Journal: Front Oncol (2021)
Keywords: alk inhibitor, adjuvant, locally advanced non-small-cell lung cancer, neoadjuvant, targeted therapy
MeSH terms: Case Reports

The treatment of anaplastic lymphoma kinase (ALK)-positive locally advanced non-small-cell lung cancer (NSCLC) is challenging because there is no randomized controlled trial has been reported. The value of neoadjuvant and adjuvant targeted therapy remains unclear. Herein, we show that systemic treatment with ALK inhibitor crizotinib before surgery can provide the potential to cure the initially inoperable tumor. A 27-year-old man was diagnosed with a stage IIIAcT3N2M0 (7thUICC/AJCC) upper left lung adenocarcinoma harboring EML4-ALK fusion gene. Clinically, the patient had a large primary lesion adjacent to the pericardium and regional lymph node metastasis at the ipsilateral mediastinum. Poor tumor response was observed after 3 cycles of chemotherapy (gemcitabine plus cisplatin), and upon multidisciplinary discussion, the patient was started with 250 mg crizotinib twice daily. Successive clinical examinations showed a progressive reduction of the lesions. After 2 months of therapy, the patient was downstaged to cT2aN2M0, then video-assisted thoracic surgery was performed and the final histopathological stage was ypT2aN2M0. The treatment with crizotinib (250 mg, qd) was continued more than 30 months post surgery and stopped until intracranial oligometastasis. The patient's overall survival (OS) time is 68 months at last follow-up. This case presented here supports the use of neoadjuvant and adjuvant treatment with ALK inhibitors in ALK positive locally advanced NSCLC.
Musical Hallucinations in Chronic Pain: The Anterior Cingulate Cortex Regulates Internally Generated Percepts
Authors: Ashlyn Schmitgen, Jeremy Saal, Narayan Sankaran, Maansi Desai, Isabella Joseph, Philip Starr, Edward F Chang, Prasad Shirvalkar
Journal: Front Neurol (2021)
Keywords: anterior cingulate, chronic pain, deep brain stimulation, musical hallucination, perception

The anterior cingulate cortex (ACC) has been extensively implicated in the functional brain network underlying chronic pain. Electrical stimulation of the ACC has been proposed as a therapy for refractory chronic pain, although, mechanisms of therapeutic action are still unclear. As stimulation of the ACC has been reported to produce many different behavioral and perceptual responses, this region likely plays a varied role in sensory and emotional integration as well as modulating internally generated perceptual states. In this case series, we report the emergence of subjective musical hallucinations (MH) after electrical stimulation of the ACC in two patients with refractory chronic pain. In an N-of-1 analysis from one patient, we identified neural activity (local field potentials) that distinguish MH from both the non-MH condition and during a task involving music listening. Music hallucinations were associated with reduced alpha band activity and increased gamma band activity in the ACC. Listening to similar music was associated with different changes in ACC alpha and gamma power, extending prior results that internally generated perceptual phenomena are supported by circuits in the ACC. We discuss these findings in the context of phantom perceptual phenomena and posit a framework whereby chronic pain may be interpreted as a persistent internally generated percept.
Acute Complete Foot Drop Caused by Intraneural Ganglion Cyst without a Prior Traumatic Event
Authors: Stavros Stamiris, Dimitrios Stamiris, Athanasios Sarridimitriou, Elissavet Anestiadou, Christos Karampalis, Vasileios Vrangalas
Journal: Case Rep Orthop (2020)
MeSH terms: Case Reports

Intraneural ganglion cysts are benign soft-tissue masses located in the epineurium of peripheral nerves. They originate from nearby joint connections via articular branches. Traumatic events seem to play a role in their pathogenesis as well. Clinical manifestations include pain over the area of the cyst, palpable tender mass, hypoesthesia, and muscle weakness depending on the affected nerve. Our case highlights an uncommon clinical manifestation of this entity with acute foot drop, as the primary symptom, without any previous traumatic event, enriching by this way the current diagnostic thinking process of clinical physicians. We report a case of a 42-year-old military officer who presented to our emergency department with acute foot drop that appeared during a march. Initially, the common peroneal palsy was misdiagnosed as L5-S1 disc herniation, but investigation with lumbar MRI scan led to rejection of our primary diagnosis. After performing EMG of the lower extremity and knee MRI, an intraneural ganglion cyst of the common peroneal nerve was diagnosed. Patient was treated with surgical decompression of the cyst, followed by ligation and complete resection of the articular branch, as well as disarticulation of the superior tibiofibular joint. At a twelve-month follow-up, the patient showed significant functional recovery. This is, to the best of our knowledge, the first case of intraneural ganglion cyst manifested with an acute complete foot drop without a clear prior traumatic event. We underline the need for a high index of suspicion when dealing with cases of acute peroneal palsy without any accompanying symptoms.
Laparoscopic adjustable gastric banding connecting tube causing small bowel obstruction and perforation
Authors: Mojtaba Hashemzadeh, Mahmoud Karamirad, Leila Zahedi-Shoolami
Journal: Case Rep Surg (2013)

Background. Laparoscopic adjustable gastric banding (LAGB) is an effective method of reducing excess weight in obese patients. We report a patient who developed a bowel obstruction caused by the connecting tube between the gastric band and the injection port. Case Presentation. The patient was a 42-year-old Caucasian female who had undergone LAGB 19 months earlier. She presented with dehydration, low-grade fever, tachycardia, and mild abdominal tenderness. Laparotomy revealed that the connecting tube was looped around the mesentery, and a loop of small bowel was incarcerated between the tube and the mesentery. The incarcerated small bowel loop was perforated in two places. Conclusion. Surgeons should be aware of the possibility of obstruction caused by the connecting tube in patients who have undergone LAGB.