OpenMed/multicare-articles huggingface dataset:
Strychnine poisoning due to traditional Chinese medicine: a case series
Authors: Hok-Fung Tong, Candace Yim Chan, Sau-Wah Ng, Tony Wing-Lai Mak
Journal: F1000Res (2021)
Keywords: maqianzi, strychni semen, strychnine poisoning, herbal medicine poisoning
MeSH terms: COVID-19, Strychnine / adverse effects, Case Reports, Humans, Medicine, Chinese Traditional, Pandemics, SARS-CoV-2, Strychnine

Background: Strychnine poisoning is rare but possibly fatal. The most reported sources of strychnine poisoning include rodenticides and adulterated street heroin. Here we report a case series of an unusual cause of strychnine poisoning - Strychni semen, a herb known as "maqianzi" in traditional Chinese medicine (TCM). Methods: All cases of strychnine poisoning confirmed by the Hospital Authority Toxicology Reference Laboratory (HATRL, the highest-level clinical toxicology laboratory in Hong Kong) between May 2005 and May 2018 were reviewed. Results: Twelve cases of strychnine poisoning were recorded, and Strychni semen was the exclusive source. Ten (83%) patients presented with muscle spasms, and four (33%) developed typical conscious convulsions. The poisoning was severe in two (17%) patients, moderate in three (25%) and mild in eight (58%). No case fatality was recorded. Three (25%) patients were TCM practitioners and two (17%) were laymen who bought the herb themselves without a proper prescription. Conclusion: The practice of TCM is becoming popular in different parts of the world amid the COVID-19 pandemic. The spectrum of clinical features of strychnine poisoning secondary to Strychni semen are similar to those arising from different origins. Eliciting a history of TCM use, apart from exposure to rodenticides and drugs of abuse, may allow timely diagnosis in patients with compatible clinical features. Enhancement of TCM safety could minimize the hazard.
Milky Ascites: A Diagnostic Dilemma
Authors: Baha Aldeen Bani Fawwaz, Arooj Mian, Gurdeep Singh, Aimen Farooq, Abu Hurairah
Journal: Cureus (2023)
Keywords: abdominal paracentesis, ascites, chyloperitoneum, chylous ascites, cirrhosis, lymphatic abnormalities, milky ascites, peritoneal fluid
MeSH terms: Case Reports

Chylous ascites is a milky-appearing, triglyceride-rich fluid within the abdominal cavity. It is a rare finding that arises from the disruption of the lymphatic system and can be caused by a wide variety of pathologies. Here, we present a diagnostically challenging case of chylous ascites. In this article, we discuss the pathophysiology and various etiologies of chylous ascites, explore the diagnostic tools available, and highlight the management strategies implemented in this rare finding.
Successful mesh plug repair using a hybrid method for recurrent inguinal hernia after laparoscopic transabdominal preperitoneal approach: A case report
Authors: Rina Kikugawa, Shingo Tsujinaka, Sawako Tamaki, Tsutomu Takenami, Ryo Maemoto, Rintaro Fukuda, Nobuyuki Toyama, Toshiki Rikiyama
Journal: Int J Surg Case Rep (2019)
Keywords: hybrid method, mesh plug, recurrent inguinal hernia

Introduction:
The HerniaSurge Group and the European Hernia Society guidelines recommend an anterior approach to treat recurrent inguinal hernias after a failed posterior approach. The hybrid method combining explorative laparoscopy and anterior open approach can provide the benefits of both approaches.
Presentation of case:
A 79-year-old man presented with a recurrent inguinal hernia after primary repair for an indirect hernia using the laparoscopic transabdominal preperitoneal approach (TAPP) 5 years ago. The indirect hernia formed inferior to the lower edge of the previous mesh was diagnosed under laparoscopy. The hernia defect (2 cm) was fixed using a mesh plug via the anterior approach. Appropriate mesh overlap was confirmed using laparoscopy.
Discussion:
This minimally invasive method enabled us to choose the best treatment for recurrent hernia and prevent chronic pain due to possible nerve damage caused by extended dissection of the scar tissue. Furthermore, the final confirmation step using laparoscopy assures complete coverage of all defects within the myopectineal orifice.
Conclusion:
This hybrid method facilitates the choice of an optimal approach for the treatment of recurrent hernia and may reduce surgical complications and re-recurrence rate.
A Case of Traumatic Catheterisation leading to Rectal Perforation and Periprostatic Abscess
Authors: Orla Cullivan, Silviu David, Syed Jaffry
Journal: Case Rep Urol (2022)
MeSH terms: Case Reports

A 79-year-old gentleman presented to the Emergency Department (ED) with catheter-related issues on a background of a long-term catheter for previous urinary retention, Hartmann's procedure for colorectal cancer, and brachytherapy for prostate cancer. A 3-way silicone catheter was placed by ED staff and bladder irrigation commenced. The urine draining following catheterisation was found to be dark and thick, and irrigation fluid was noted to be draining per rectum. CT imaging was performed and demonstrated the catheter tip extending through the posterior wall of the urethra and into the rectum. The patient was admitted under the urology team, and urinary diversion was achieved with a suprapubic catheter. Subsequent imaging demonstrated a periprostatic abscess, which was initially managed with antimicrobial therapy, followed by attempted image-guided drainage. Repeat imaging following a 6-week course of antibiotics failed to show an improvement in the collection. During his inpatient stay, he contracted COVID-19 and passed away suddenly. This case demonstrates the potential catastrophic consequences associated with urethral catheterisation.
Scapular Angiomatoid Fibrous Histiocytoma with EWSR1-CREB1 Fusion in an Adult Patient
Authors: Hiroshi Kobayashi, Naohiro Makise, Aya Shinozaki-Ushiku, Yuki Ishibashi, Masachika Ikegami, Shinji Kohsaka, Tetsuo Ushiku, Katsutoshi Oda, Kiyoshi Miyagawa, Hiroyuki Aburatani, Hiroyuki Mano, Sakae Tanaka
Journal: Case Rep Orthop (2021)
MeSH terms: Case Reports

Background:
Angiomatoid fibrous histiocytoma (AFH) is a rare intermediate malignant tumor that arises mainly in soft tissues, especially in the superficial extremities of patients younger than 30 years. There have been a few reports of AFH arising from sites other than soft tissue, including bone, and unusual site and age make it difficult to diagnose this rare tumor. Case Presentation. Here, we present a case of a 54-year-old man who was examined for chest pain, and computed tomography (CT) incidentally detected a bone tumor at the scapula with destruction of cortical bone and invasion into soft tissue. Magnetic resonance imaging revealed multiple cystic components with fluid-fluid levels. FDG-PET showed uptake at the axillary lymph node. The CT-guided needle biopsy revealed spindle cell sarcoma on histopathology. After neoadjuvant chemotherapy, a scapulectomy was performed. The final postresection histopathological diagnosis was the same as the preoperative diagnosis, and no obvious chemotherapeutic effect was observed. Next-generation sequencing of RNA isolated from paraffin-embedded tumor tissue revealed that these lesions harbored the EWSR1-CREB1 fusion gene, and the tumor was diagnosed as AFH. C-reactive protein level, which was elevated preoperatively, decreased after the operation, and there was no recurrence or metastasis 5 years after the treatment.
Conclusion:
The diagnosis of AFH is difficult when the tumor has an atypical presentation. Comprehensive genomic analysis, especially RNA sequencing, is efficient in diagnosing this rare tumor. Moreover, magnetic resonance imaging findings identical to AFH in soft tissue, the presence of paraneoplastic symptoms such as elevated inflammatory markers, and lymph node swelling were clues towards suspecting this tumor.
Case Report: Use of Anakinra in Multisystem Inflammatory Syndrome During COVID-19 Pandemic
Authors: Sara Della Paolera, Erica Valencic, Elisa Piscianz, Valentina Moressa, Alberto Tommasini, Raffaella Sagredini, Valentina Kiren, Manola Comar, Andrea Taddio
Journal: Front Pediatr (2021)
Keywords: covid-19, il-1, kawasaki, misc-c, pims-ts, sars-cov-2, anakinra
MeSH terms: Case Reports

During COVID-19 outbreak, a large number of children with severe inflammatory disease has been reported. This condition, named Pediatric Multi-inflammatory Syndrome temporally associated with COVID-19 (PIMS-TS) or Multisystem Inflammatory Syndrome associated with Coronavirus Disease 2019 (MIS-C), shares some clinical features with Kawasaki disease and is frequently complicated by myocarditis or shock. It has been suggested that MIS-C belongs to the group of cytokine storm syndromes triggered by SARS-CoV-2 infection. So far, intravenous immunoglobulin (IVIG) and systemic glucocorticoids are the most common therapeutic approaches reported in this group of patients. However, the use of anakinra in patients with severe forms of COVID-19 is showing promising results. Here we reported two patients with multisystem inflammatory syndrome complicated with shock. Both the patients presented a poor response to IVIG and systemic glucocorticoids and received anakinra. Treatment with IL-1 receptor antagonist showed a rapid improvement of clinical conditions and biochemical analysis in both patients and demonstrated a good safety profile. Thus, we look forward for future controlled clinical trials with the aim to demonstrate the effectiveness of anakinra in patients with MIS-C and established precise criteria for its use.
Diagnosis of an inguinal hernia after a blunt inguinal trauma with an intestinal perforation
Authors: Farès Moustafa, Julien Avouac, Marie-Aude Vaz, Jeannot Schmidt
Journal: Case Rep Emerg Med (2014)

Introduction. Inguinal hernias are very common in men. A clinical exam can do the diagnosis easily. But bowel perforation inside an inguinal hernia caused by a directly blunt trauma is rare and can have important consequences. Up to now, there have been a few case reports that described blunt injury to the inguinal area causing traumatic perforation of the bowel in the inguinal hernia. Case Report. We present a case of a 45-year-old Eastern European man with a small perforation of ileal bowels and a peritonitis after direct blunt trauma to the inguinal hernia region, with no inguinal hernia known by the patient, and show how the diagnosis can be difficult. Conclusion. This case shows that external forces, that may seem too trivial to cause intraperitoneal injury, can cause significant injury when applied to a patient with a hernia and shows how a careful examination, with the help of an abdominal CT scan, is important even if the patient do not seem to have an inguinal hernia.
Case Report: Mevalonic Aciduria Complicated by Acute Myeloid Leukemia After Hematopoietic Stem Cell Transplantation
Authors: Hyery Kim, Beom Hee Lee, Hyo-Sang Do, Gu-Hwan Kim, Sunghan Kang, Kyung-Nam Koh, Ho Joon Im
Journal: Front Immunol (2021)
Keywords: acute myeloid leukemia, hematopoietic stem cell transplantation, inflammation, mavalonic kinase deficiency, mevalonic aciduria
MeSH terms: Leukemia, Myeloid, Acute / complications, Mevalonate Kinase Deficiency / complications, Mevalonate Kinase Deficiency / diagnosis, Case Reports, Research Support, Non-U.S. Gov't, Biomarkers, Biopsy, Bone Marrow / pathology, Exome Sequencing, Fatal Outcome, Female, Hematopoietic Stem Cell Transplantation, Humans, In Situ Hybridization, Fluorescence, Infant, Leukemia, Myeloid, Acute / diagnosis, Leukemia, Myeloid, Acute / therapy, Mevalonate Kinase Deficiency / therapy, Mutation, Phosphotransferases (Alcohol Group Acceptor) / genetics, Sequence Analysis, DNA, Symptom Assessment, Transplantation, Haploidentical, Biomarkers, Phosphotransferases (Alcohol Group Acceptor), mevalonate kinase

Mevalonic aciduria (MA) is the most severe clinical subtype of mevalonate kinase deficiency (MKD) caused by an inherited defect in the mevalonate pathway. The treatment of MKD focuses on the suppression of recurrent hyperinflammatory attacks using anti-inflammatory drugs. Recently, allogeneic hematopoietic stem cell transplantation (HCT) was shown to successfully ameliorate autoinflammatory attacks in patients with MKD. Here, we report a case of an infant who showed severe recurrent systemic inflammation and was diagnosed with MA. Although she responded to steroids, her symptoms relapsed after the dose was tapered, and organ deterioration occurred. Therefore, at the age of 11 months, HCT from a matched, unrelated donor was performed for curative treatment. However, at 50 days after transplantation, acute myeloid leukemia was diagnosed, which was chemo-refractory. A second HCT from her haploidentical father was performed to treat the acute myeloid leukemia, but the patient died of sepsis on day 4 after transplantation. This is the first report of malignancy following HCT for MA. Our findings suggest that normalizing the mevalonate pathway after HCT in patients with MKD impacts patients differently depending on the clinical spectrum and severity of disease.
Acute radiation syndrome in a non-destructive testing worker: a case report
Authors: Ji-Sung Ahn, Jai-Dong Moon, Wonyang Kang, Hyeong-Min Lim, Seunghyeon Cho, Dae-Young Lim, Won-Ju Park
Journal: Ann Occup Environ Med (2018)
Keywords: acute radiation syndrome, non-destructive testing, pancytopenia, radiation
MeSH terms: Case Reports

Background:
In Korea, there were repeated radiation exposure accidents among non-destructive testing workers. Most of the cases involved local injury, such as radiation burns or hematopoietic cancer. Herein, we report a case of acute radiation syndrome caused by short periods of high exposure to ionizing radiation.
Case presentation:
In January 2017, Korea Information System on Occupational Exposure (KISOE) found that a 31-year-old man who had worked in a non-destructive testing company had been overexposed to radiation. The patient complained of symptoms of anorexia, general weakness, prostration, and mild dizziness for several days. He was anemic. The venous injection areas had bruises and bleeding tendency. Blood and bone marrow testing showed pancytopenia and the patient was diagnosed with acute radiation syndrome (white blood cells: 1400/cubic mm, hemoglobin: 7.1 g/dL, platelets: 14000/cubic mm). He was immediately prohibited from working and blood transfusion was commenced. The patient's radiation exposure dose was over 1.4 Gy (95% confidence limits: 1.1-1.6) in lymphocyte depletion kinetics. It was revealed that the patient had been performing non-destructive tests without radiation shielding when working in high places of the large pipe surface.
Conclusions:
Exposure prevention is clearly possible in radiation-exposed workers. Strict legal amendments to safety procedures are essential to prevent repeated radiation exposure accidents.
Contrast-Induced Encephalopathy following Cerebral Angiography in a Hemodialysis Patient
Authors: Marija Bender, Gojko Bogdan, Dorijan Radančević, Nataša Pejanović-Škobić
Journal: Case Rep Neurol Med (2020)
MeSH terms: Case Reports

Contrast-induced encephalopathy (CIE) is a rare complication of contrast media use during angiographic procedures. With the growing use of endovascular interventions, this complication is likely to become more common. We present a case of a 46-year-old woman with hypertension, hypothyroidism, and chronic renal failure. She developed CIE following cerebral angiography for diagnosis of intracranial aneurysm. We had a high index of suspicion for CIE, excluded the most common differential such as stroke, and immediately started hemodialysis with a short course of corticosteroids. The disease runs a benign course, and neurological symptoms resolved completely after five days. We emphasize the need for increased awareness of CIE to make a valid diagnosis and to start supportive therapy as soon as possible.
Effectiveness and safety of Belimumab combined with standard therapy in severe active lupus nephritis requiring kidney replacement therapy: A case report and literature review
Authors: Chengning Zhang, Ming Zeng, Yifei Ge, Kang Liu, Changying Xing, Huijuan Mao
Journal: Front Immunol (2022)
Keywords: acute kidney injury, belimumab, case report, kidney replacement therapy, severe active lupus nephritis
MeSH terms: Lupus Erythematosus, Systemic / drug therapy, Lupus Nephritis / chemically induced, Lupus Nephritis / drug therapy, Case Reports, Review, Research Support, Non-U.S. Gov't, Antibodies, Monoclonal, Humanized / adverse effects, Humans, Immunosuppressive Agents / adverse effects, Antibodies, Monoclonal, Humanized, Immunosuppressive Agents, belimumab

Lupus Nephritis (LN) is the most common manifestation of severe organ damage for systemic lupus erythematosus (SLE) patients. Severe active LN could result in acute kidney injury (AKI), which could even require Kidney Replacement Therapy (KRT). Therefore, there needs to be a more proactive and safe induction therapy to quickly and effectively control renal immune inflammation, maintain kidney function or reverse kidney damage. While multiple clinical studies have proven the efficacy and safety of Belimumab in treating SLE and LN, these studies have not included cases of severe LN requiring KRT. We observed the effectiveness and safety of Belimumab in treating four severe active LN patients undergoing KRT. With Belimumab administered at a dosage of 10mg/kg, all four patients were able to discontinue KRT with no adverse events (AEs) to date ultimately. These cases provided an excellent basis for the application of Belimumab combined with standard therapy to LN patients with a medium to severe kidney injury.