OpenMed/multicare-articles huggingface dataset:
Case report on renal failure reversal in lambda chain multiple myeloma with bortezomib and dexamethasone
Authors: Bhanu K Patibandla, Akshita Narra, Ahmad A Alwassia, Anthony Bartley, Gurprataap S Sandhu, James Rooney, Robert M Black
Journal: Case Rep Nephrol (2014)

Renal failure (RF) reversal in multiple myeloma (MM) is associated with an improved prognosis. Light chain myeloma, serum creatinine (SCr) > 4 mg/dL, extensive proteinuria, early infections, and certain renal biopsy findings are associated with lower rates of RF reversal. Our patient is a 67-year-old female with multiple poor prognostic factors for RF reversal who demonstrated a rapid renal response with bortezomib and dexamethasone (BD) regimen. She presented initially with altered mental status. On exam, she appeared lethargic and dehydrated and had generalized tenderness. She had been taking ibuprofen as needed for pain for a few weeks. Labs showed a white cell count-18,900/μL with no bandemia, hemoglobin 10.8 gm/dL, potassium-6.7 mEq/L, bicarbonate-15 mEq/L, blood urea nitrogen-62 mg/dL, SCr-5.6 mg/dL (baseline: 1.10), and corrected calcium-11.8 mg/dL. A rapid flu test was positive. Imaging studies were unremarkable. Her EKG showed sinus tachycardia and her urinalysis was unremarkable. The unexplained RF in an elderly individual in conjunction with hypercalcemia and anemia prompted a MM work-up; eventually, lambda variant MM was diagnosed. An immediate (4 days) renal response defined as 50% reduction in SCr was noticed after initiation of the BD regimen.
Atherosclerotic Components in Thrombi Retrieved by Thrombectomy for Internal Carotid Artery Occlusion Due to Large Artery Atherosclerosis: A Case Report
Authors: Futoshi Eto, Junpei Koge, Kanta Tanaka, Takeshi Yoshimoto, Masayuki Shiozawa, Kinta Hatakeyama, Kazunori Toyoda, Masatoshi Koga
Journal: Front Neurol (2021)
Keywords: acute ischemic stroke, cholesterol clefts, histopathology, large artery atherosclerosis, mechanical thrombectomy, thrombus
MeSH terms: Case Reports

Introduction: The correlation between the composition of thrombi retrieved by mechanical thrombectomy (MT) and stroke etiology is inconclusive. We describe a case with atherosclerotic components in thrombi retrieved by MT for acute internal carotid artery (ICA) occlusion. Case Presentation: A 69-year-old man with acute onset of global aphasia and right hemiplegia was transferred to our institute. His baseline National Institutes of Health Stroke Scale score was 24. Magnetic resonance imaging demonstrated acute ischemic stroke in the left parietal lobe. Magnetic resonance angiography revealed occlusion of the left ICA. MT was attempted for acute left ICA occlusion. The initial angiography showed occlusion of the proximal ICA, while intraprocedural angiography revealed a large thrombus that extended from the cervical ICA to the intracranial ICA. Successful reperfusion was achieved by five passes using stent retrievers and an aspiration catheter. A large volume of red thrombus was retrieved by each pass. The final angiogram showed successful reperfusion with modified Thrombolysis in Cerebral Ischemia grade 2b and severe stenosis in the proximal ICA. Neck magnetic resonance imaging showed severe left ICA stenosis with a vulnerable plaque. Hence, his stroke etiology was determined as large artery atherosclerosis. Histopathological examination of the retrieved thrombi revealed atheromatous components, including cholesterol clefts, foam cells, and a necrotic core. Conclusions: Atherosclerotic components in retrieved thrombi might provide useful clues for diagnosing stroke pathogenesis. Further studies are warranted to clarify the utility of assessing atheromatous components in retrieved thrombi in diagnosing stroke etiology.
Influenza A H3N2-Associated Meningoencephalitis in an Older Adult With Viral RNA in Cerebrospinal Fluid: Case Report
Authors: Yu-Chao Dou, Yu-Qing Li
Journal: Front Neurol (2022)
Keywords: adult, cerebrospinal fluid, influenza a h3n2, influenza associated encephalitis, metagenomic next-generation sequencing
MeSH terms: Case Reports

Influenza-associated encephalopathy (IAE) is most frequently observed in young children, but less reported in adults. Diagnosis of IAE is difficult, as clinical presentations vary significantly and the influenza virus is rarely detected in cerebrospinal fluid (CSF). Herein, we described the case of an older adult presenting with acute meningoencephalitis due to an influenza A (H3N2) infection and the influenza A (H3N2) RNA is detected in cerebrospinal fluid. To the best of our knowledge, this is infrequently reported in the literature. We emphasize that, in adults presenting with acute viral encephalitis, clinicians should consider an influenza infection as part of the differential diagnosis and that metagenomic next-generation sequencing of CSF for IAE may help establish an accurate diagnosis. It must be emphasized that the administration of steroids in a timely manner following the onset of symptoms may yield a better outcome in patients.
Oral Perampanel for the Treatment of Super-Refractory Status Epilepticus
Authors: Abdallah Rahbani, Grace Adwane, Najo Jomaa
Journal: Case Rep Neurol Med (2019)
MeSH terms: Case Reports

A 72-year-old man presented with a super-refractory partial status epilepticus following evacuation of a right subdural hematoma. He failed to respond to treatment with high doses of intravenous valproic acid, Levetiracetam, Lacosamide, Thiopental, and Midazolam. He was given 4 mg of Perampanel orally via nasogastric tube and the dose was rapidly increased to 8 mg after 12 hours with cessation of clinical and electrical seizures. Other antiepileptic drugs were tapered progressively with an excellent clinical outcome.
Successful Immunotherapy for Pancreatic Cancer in a Patient With TSC2 and SMAD4 Mutations: A Case Report
Authors: Yanghui Ye, Song Zheng
Journal: Front Immunol (2021)
Keywords: smad4, tsc2, chemotherapy, immunotherapy, next generation sequencing (ngs), pancreatic cancer
MeSH terms: Antibodies, Monoclonal, Humanized / therapeutic use, Antineoplastic Combined Chemotherapy Protocols / pharmacology, Carcinoma, Pancreatic Ductal / drug therapy, Oxonic Acid / therapeutic use, Pancreatic Neoplasms / drug therapy, Tegafur / therapeutic use, Case Reports, Research Support, Non-U.S. Gov't, Antibodies, Monoclonal, Humanized / pharmacology, Antineoplastic Combined Chemotherapy Protocols / therapeutic use, Carcinoma, Pancreatic Ductal / diagnosis, Carcinoma, Pancreatic Ductal / genetics, Carcinoma, Pancreatic Ductal / immunology, DNA Mutational Analysis, Drug Combinations, Drug Resistance, Neoplasm, Fluorouracil / pharmacology, Fluorouracil / therapeutic use, High-Throughput Nucleotide Sequencing, Humans, Irinotecan / pharmacology, Irinotecan / therapeutic use, Leucovorin / pharmacology, Leucovorin / therapeutic use, Male, Middle Aged, Mutation, Neoplasm Staging, Oxaliplatin / pharmacology, Oxaliplatin / therapeutic use, Oxonic Acid / pharmacology, Pancreatic Neoplasms / diagnosis, Pancreatic Neoplasms / genetics, Pancreatic Neoplasms / immunology, Prognosis, Programmed Cell Death 1 Receptor / antagonists & inhibitors, Response Evaluation Criteria in Solid Tumors, Smad4 Protein / genetics, Tegafur / pharmacology, Tuberous Sclerosis Complex 2 Protein / genetics, Antibodies, Monoclonal, Humanized, Drug Combinations, PDCD1 protein, human, Programmed Cell Death 1 Receptor, SMAD4 protein, human, Smad4 Protein, TSC2 protein, human, Tuberous Sclerosis Complex 2 Protein, folfirinox, Oxaliplatin, S 1 (combination), Tegafur, Oxonic Acid, Irinotecan, sintilimab, Leucovorin, Fluorouracil

Background:
Pancreatic cancer has a poor prognosis, and it is traditionally treated with chemotherapy. Fortunately, immunotherapy has rapidly changed the landscape of solid tumor treatment, and improving the survival of cancer patients. However, pancreatic cancer is non-immunogenic, and single agent immunotherapies are unfavorable to its prognosis.
Case presentation:
Here, we report a case of stage IV pancreatic cancer in a patient with TSC2 and SMAD4 mutations treated with immunotherapy when the disease progressed after multi-line chemotherapy. Next generation sequencing (NGS) confirmed the presence of TSC2 and SMAD4 mutations and microsatellite stability (MSS). When the disease progressed after chemotherapy, a combination strategy was devised consisting of chemotherapy (S-1) and sintilimab. The patient had a partial response to therapy with this regimen, the lesions were significantly reduced and nearly disappeared. In metastatic pancreatic cancer, responses of this magnitude are rarely seen.
Conclusions:
This outcome reveals that this combination can be effective in treating metastatic pancreatic cancer, especially in pancreatic cancer patients with SMAD4 and TSC2 mutations. This may help increase the use of this therapy in large-scale clinical research.
Parachute Mitral Valve in an Adult
Authors: Priscilla Wessly, William A Zoghbi
Journal: Methodist Debakey Cardiovasc J (2023)
Keywords: congenital heart disease, mitral stenosis, parachute mitral valve
MeSH terms: Diabetes Mellitus, Type 2, Heart Septal Defects, Ventricular, Case Reports, Adult, Echocardiography, Female, Humans, Middle Aged, Mitral Valve / diagnostic imaging, Mitral Valve / surgery

Two-dimensional transthoracic echocardiography images for a 49-year-old female with a history of ventricular septal defect status post repair, type 2 diabetes mellitus, and hyperlipidemia whose evaluation of her lower extremity edema showed parachute mitral valve.
Myoma expulsion after embolization: case report and literature review
Authors: Maria Clara Amorim Silva, Rafael Everton Assunção Ribeiro da Costa, Wilson de Oliveira Sousa Júnior, Ariane Pereira Carvalho, Sabas Carlos Vieira
Journal: Pan Afr Med J (2022)
Keywords: myoma, case report, postoperative complications, uterine artery embolization
MeSH terms: Embolization, Therapeutic / methods, Leiomyoma / therapy, Myoma / therapy, Uterine Artery Embolization / methods, Uterine Neoplasms / therapy, Review, Case Reports, Adult, Female, Humans, Uterus

Uterine artery embolization (UAE) is a very efficient treatment modality for myoma. A rare complication of this procedure is vaginal expulsion of the uterine myoma (expelled myoma) which may occur in 3 to 5% of cases during a period of 3 to 48 months. We report a case of myoma expulsion after embolization, discussing diagnosis and treatment. A literature review was also conducted. A 40-year-old patient sought medical care on 5/2/2021 with intermittent pelvic pain and hypermenorrhagia. Vaginal ultrasound revealed an enlarged uterus (253 cm3) with myomas. The largest intramural myoma measured 7 cm. Uterine artery embolization was performed on 11/11/2021, without any complications. On 12/7/2021, during clinical examination an expelled myoma was observed entirely inside the vaginal canal. A vaginal myomectomy was performed, without any complications. At 15 months after the initial follow-up, the patient is doing well.
Acute retinal vein occlusion and cystic fibrosis
Authors: Matthew R Starr, Suzanne M Norby, John P Scott, Sophie J Bakri
Journal: Int J Retina Vitreous (2018)
Keywords: branch retinal vein occlusion, cystic fibrosis, fibrinogen, homocysteine
MeSH terms: Case Reports

Background:
The ocular manifestations of cystic fibrosis typically present with surface irritation or nyctalopia due to Vitamin A deficiency, however, there have been two previous reports of patients with cystic fibrosis that developed retinal vein occlusions. These reports hypothesized that either elevated fibrinogen levels due to chronic infections or elevated homocysteine levels have predisposed patients with cystic fibrosis to develop retinal vein occlusions.
Case presentation:
We present a case of a 35-year-old male with cystic fibrosis complicated by chronic sinusitis with no history of organ transplantation or chronic pulmonary infections who presented with an acute branch retinal vein occlusion in his left eye with associated macular edema. Evaluation revealed an elevated fibrinogen level, while the rest of his workup was relatively unremarkable including a normal homocysteine level. His vision remained 20/20 throughout his care and he did not require treatment of his macular edema.
Conclusions:
Patients with cystic fibrosis are at an increased risk of developing retinal vein occlusions likely due to a variety of systemic thrombogenic factors rather than a single risk factor which had been reported previously. Elevated fibrinogen levels in these patients may not be due to chronic infections, but inherent to the cystic fibrosis.
First case of bioterrorism-related inhalational anthrax in the United States, Palm Beach County, Florida, 2001
Authors: Marc S Traeger, Steven T Wiersma, Nancy E Rosenstein, Jean M Malecki, Colin W Shepard, Pratima L Raghunathan, Segaran P Pillai, Tanja Popovic, Conrad P Quinn, Richard F Meyer, Sharif R Zaki, Savita Kumar, Sherrie M Bruce, James J Sejvar, Peter M Dull, Bruce C Tierney, Joshua D Jones, Bradley A Perkins, Florida Investigation Team
Journal: Emerg Infect Dis (2002)
MeSH terms: Anthrax / diagnosis, Anthrax / transmission, Bioterrorism / statistics & numerical data, Population Surveillance, Case Reports, Anthrax / drug therapy, Anthrax / epidemiology, Antibiotic Prophylaxis, Bacillus anthracis / isolation & purification, Environmental Monitoring, Epidemiological Monitoring, Fatal Outcome, Female, Florida / epidemiology, Humans, Inhalation Exposure, Male, Middle Aged, Nasopharynx / microbiology, Risk Factors, Workplace

On October 4, 2001, we confirmed the first bioterrorism-related anthrax case identified in the United States in a resident of Palm Beach County, Florida. Epidemiologic investigation indicated that exposure occurred at the workplace through intentionally contaminated mail. One additional case of inhalational anthrax was identified from the index patient's workplace. Among 1,076 nasal cultures performed to assess exposure, Bacillus anthracis was isolated from a co-worker later confirmed as being infected, as well as from an asymptomatic mail-handler in the same workplace. Environmental cultures for B. anthracis showed contamination at the workplace and six county postal facilities. Environmental and nasal swab cultures were useful epidemiologic tools that helped direct the investigation towards the infection source and transmission vehicle. We identified 1,114 persons at risk and offered antimicrobial prophylaxis.
An Atypical Rash in Disseminated Herpes Zoster: A Case Report
Authors: Tomás Costa, Tiago Gomes, Cândida Fernandes
Journal: Cureus (2023)
Keywords: disseminated rash, herpes zoster virus, maculopapular exanthema, papulovesicular rash, varicella zoster virus infection
MeSH terms: Case Reports

Disseminated cutaneous herpes zoster (DCHZ) is an atypical presentation of herpes zoster (HZ) that mainly affects immunosuppressed patients. Given the potential risk for visceral fatal involvement, prompt recognition of this condition is crucial. In this case report, we present the case of a 90-year-old male with chronic lymphocytic leukemia under chlorambucil treatment who presented to the emergency department with multiple, converging, crusted papules on his face. He was misdiagnosed with a drug eruption and hospitalized after switching the antibiotic therapy. After one week, the lesions spread in a cephalocaudal pattern, affecting both the trunk and limbs, following which the Dermatology team was consulted. We performed an HZV smear test and initiated acyclovir. Unfortunately, the test was positive, and DCHZ was confirmed. The patient died one week later due to pneumonitis which evolved into a severe acute respiratory distress syndrome.
Two Cases of Oculofaciocardiodental (OFCD) Syndrome due to X-Linked BCOR Mutations Presenting with Infantile Hemangiomas: Phenotypic Overlap with PHACE Syndrome
Authors: T M Morgan, J M Colazo, L Duncan, R Hamid, K M Joos
Journal: Case Rep Genet (2019)
MeSH terms: Case Reports

Background:
Oculofaciocardiodental (OFCD) syndrome is due to mutations in BCOR (BCL-6 corepressor). OFCD has phenotypic overlaps with PHACE syndrome (Posterior fossa anomalies, Hemangioma, Arterial anomalies, Cardiac defects, Eye anomalies). Infantile hemangiomas are a key diagnostic criterion for PHACE, but not for OFCD. A previous study reported two cases of infantile hemangiomas in OFCD, but the authors could not exclude chance association.
Case presentation:
We describe two novel cases of female patients (one initially diagnosed with PHACE syndrome), both of whom had infantile hemangiomas. Ophthalmological findings were consistent with oculofaciocardiodental (OFCD) syndrome. Upon genetic testing, these two females were determined to have X-linked BCOR mutations confirming OFCD syndrome diagnoses.
Conclusion:
These case reports add support to the hypothesis that infantile hemangiomas may be a feature of OFCD. BCOR may potentially be within a pathway of genes involved in PHACE syndrome and/or in infantile hemangioma formation.
Nevus of ota with rare palatal involvement: a case report with emphasis on differential diagnosis
Authors: Gaurav Sharma, Archna Nagpal
Journal: Case Rep Dent (2011)
MeSH terms: Case Reports

Nevus of Ota, a dermal melanocytic nevus, is rare in the Indian subcontinent. It presents as a brown, blue, or gray patch on the face and is within the distribution of the ophthalmic and maxillary branches of the trigeminal nerve. The oral cavity is infrequently involved in nevus of Ota. Only 11 cases have been documented in the English literature. We report a rare case of intraoral nevus of Ota in a 22-year-old male patient. This paper focuses on the differential diagnosis of oral manifestations of nevus of Ota to assist in proper followup to avert malignant transformation.
Performance of the new clinical case definitions of pertussis in pertussis suspected infection and other diagnoses similar to pertussis
Authors: Mioljub Ristić, Biljana Radosavljević, Vesna D Stojanović, Milan Đilas, Vladimir Petrović
Journal: PLoS One (2018)
MeSH terms: Whooping Cough / diagnosis, Bordetella pertussis / isolation & purification, Child, Child, Preschool, Female, Humans, Infant, Infant, Newborn, Likelihood Functions, Male, Population Surveillance, Sensitivity and Specificity, Serbia / epidemiology, Whooping Cough / epidemiology

Background:
In an effort to improve the pertussis diagnosis, the Global Pertussis Initiative (GPI) proposed an algorithm of the signs/symptoms of pertussis for three age groups: 0-3 months, 4 months to 9 years, and ≥10 years of age.
Methods:
We evaluated the accuracy of the clinical case definitions for pertussis proposed by the GPI using laboratory-confirmed pertussis as a reference standard for four groups: clinically suspected pertussis without comorbidity; asthma exacerbation; allergic constitution, and other diagnoses (bronchitis, bronchiolitis, laryngitis, and tracheitis). We included only patients who fulfilled one or more criteria of clinical case definitions for the age groups (0-3 months, 4 months-9 years, and ≥10 years of age). The data for this prospective epidemiological study were collected between 1st January 2013-31st December 2016 at the outpatients and inpatients health care settings in the South Bačka District of Autonomous Province of Vojvodina, Serbia. We evaluated accuracy of the certain sign and symptom combinations of GPI case definitions based on their sensitivity, specificity, and likelihood ratios.
Results:
A total of 1043 participants were included, with 306 (29.3%) laboratory-confirmed pertussis cases. In patients aged 0-3 months, whoop and apnoea associated with laboratory confirmation of pertussis. In patients aged 4 months-9 years with a pertussis suspicion infection or with one of the other diagnoses, the highest accuracy was found for whoop combined with apnoea or post-tussive emesis. In patients aged 10 years and older, several different sign and symptom combinations were associated with an increased risk of pertussis among all enrolment diagnoses. There were fewer hospitalizations among the fully vaccinated children than in partly or unvaccinated children aged 4 months to 6 years (20.7% vs. 60.0%, p = 0.017).
Conclusions:
The numerous sign and symptom combinations in the observed case definitions were good predictors for laboratory-confirmed pertussis among all enrolment diagnoses, therefore suggesting the necessity for increased awareness of possibility for pertussis in patients with certain pertussis-like medical conditions.
Pyogenic Lumbar Facet Joint Infection with Foot Drop
Authors: Haruka Maehara, Toshihiro Sano, Yuki Yanagawa, Kyuichi Hashimoto, Nobuaki Tadokoro
Journal: Case Rep Orthop (2021)
MeSH terms: Case Reports

Pyogenic facet joint infection (PFJI) is a relatively rare spinal infection. Clinical suspicion of this condition is a key for diagnosis. We report a case of PFJI which required decompression surgery for severe neurological dysfunction. The patient was a 44-year-old woman who had a previous history of orthotic therapy for idiopathic scoliosis. The patient was admitted to our hospital with a history of two days of high fever and severe low back pain. There was no neurologic deficit, and blood tests revealed high levels of inflammatory markers. There was a slight amount of fluid that had collected at L4/5 facet joint in lumbar MRI. She was admitted for examination and treatment of fever of unknown origin and low back pain. Antibiotic treatment started the day after hospitalization since the first report of the blood culture taken upon admission tested positive to gram-positive cocci. As low back pain and fever persisted, an MRI was taken again on the fifth day of hospitalization. Repeated MRI showed fluid extension from the left facet joint to paravertebral muscles and epidural space. She was diagnosed with PFJI, and facet joint puncture was performed. At this time, it became clear that she had foot drop on the right, the contralateral side of the PFJI. She underwent irrigation, debridement, and partial laminectomy. Methicillin-sensitive Staphylococcus aureus (MSSA) was detected in blood cultures at the time of hospitalization, in the puncture fluid and tissue collected during surgery. The patient recovered completely from foot drop after the operation and a three-month course of antibiotics. As the imaging findings may be inadequate in the early stages of onset and PFJI potentially causes neurologic deficit such as foot drop, neurological findings need to be carefully observed even after hospitalization and one should reexamine the MRI if symptoms or clinical findings did not improve or were aggravated.