OpenMed/multicare-articles huggingface dataset:
Metagenomic next-generation sequencing confirms the diagnosis of Legionella pneumonia with rhabdomyolysis and acute kidney injury in a limited resource area: a case report and review
Authors: Rao Du, Yinhe Feng, Yubin Wang, Jifeng Huang, Yuhan Tao, Hui Mao
Journal: Front Public Health (2023)
Keywords: legionella pneumonia, acute kidney injury, case report, metagenomic next-generation sequencing, rhabdomyolysis
MeSH terms: Acute Kidney Injury / diagnosis, Acute Kidney Injury / etiology, Legionella / genetics, Legionnaires' Disease / complications, Legionnaires' Disease / diagnosis, Legionnaires' Disease / microbiology, Pneumonia, Rhabdomyolysis / complications, Rhabdomyolysis / diagnosis, Case Reports, Research Support, Non-U.S. Gov't, High-Throughput Nucleotide Sequencing, Humans, Male, Middle Aged

Background:

Legionella pneumonia, rhabdomyolysis, and acute kidney injury are called the Legionella triad, which is rare and associated with a poor outcome and even death. Early diagnosis and timely treatment are essential for these patients.
Case presentation:
A 63-year-old man with cough, fever, and fatigue was initially misdiagnosed with common bacterial infection and given beta-lactam monotherapy but failed to respond to it. Conventional methods, including the first Legionella antibody test, sputum smear, and culture of sputum, blood, and bronchoalveolar lavage fluid (BALF) were negative. He was ultimately diagnosed with a severe infection of Legionella pneumophila by metagenomics next-generation sequencing (mNGS). This patient, who had multisystem involvement and manifested with the rare triad of Legionella pneumonia, rhabdomyolysis, and acute kidney injury, finally improved after combined treatment with moxifloxacin, continuous renal replacement therapy, and liver protection therapy.
Conclusion:
Our results showed the necessity of early diagnosis of pathogens in severe patients, especially in Legionnaires' disease, who manifested with the triad of Legionella pneumonia, rhabdomyolysis, and acute kidney injury. mNGS may be a useful tool for Legionnaires' disease in limited resource areas where urine antigen tests are not available.
Testicular arteriovenous malformation: gray-scale and color Doppler ultrasonography features
Authors: Fatih Gulsen, Ismail Mihmanli, Fatih Kantarci, Abdulkadir Eren, Suleyman Onder Ataus
Journal: Case Rep Med (2011)
MeSH terms: Case Reports

Intratesticular arteriovenous malformations (AVMs) are extremely rare benign incidental lesions of the testis. Ultrasonography (US) generally reveals a hypoechoic solid mass within the testicular parenchyma. We describe a patient with intratesticular AVM which was found incidentally during workup for infertility. The gray-scale and Doppler US appearance of an intratesticular AVM and the differential diagnosis have been presented. Based on the gray-scale, US appearance differentiation from malignant testicular tumors is difficult. Doppler US examination aids in the diagnosis by demonstrating the vascular nature of the tumor.
Dementia in Fragile X-associated Tremor/Ataxia Syndrome
Authors: Ricardo Nitrini, Márcia Rúbia R Gonçalves, Leonardo P Capelli, Egberto Reis Barbosa, Cláudia Sellitto Porto, Edson Amaro, Paulo Alberto Otto, Angela M Vianna-Morgante
Journal: Dement Neuropsychol (2010)
Keywords: ataxia, dementia, essencial tremor, fragile x, premutation, tremor
MeSH terms: Case Reports

Fragile X-associated tremor/ataxia syndrome (FXTAS) is a cause of movement disorders and cognitive decline which has probably been underdiagnosed, especially if its prevalence proves similar to those of progressive supranuclear palsy and amyotrophic lateral sclerosis. We report a case of a 74-year-old man who presented with action tremor, gait ataxia and forgetfulness. There was a family history of tremor and dementia, and one of the patient's grandsons was mentally deficient. Neuropsychological evaluation disclosed a frontal network syndrome. MRI showed hyperintensity of both middle cerebellar peduncles, a major diagnostic hallmark of FXTAS. Genetic testing revealed premutation of the FMR1 gene with an expanded (CGG)90 repeat. The diagnosis of FXTAS is important for genetic counseling because the daughters of the affected individuals are at high risk of having offspring with fragile X syndrome. Tremors and cognitive decline should raise the diagnostic hypothesis of FXTAS, which MRI may subsequently reinforce, while the detection of the FMR1 premutation can confirm the condition.
Persistent Diarrhoea after Percutaneous Endoscopic Gastrostomy (PEG) in Paediatric Patient: Lessons from a Complication
Authors: Sara Silvaroli, Filomena Valentina Paradiso, Valentina Giorgio, Lorenzo Nanni
Journal: Case Rep Pediatr (2022)
MeSH terms: Case Reports

Percutaneous endoscopic gastrostomy (PEG) is increasingly used in paediatric population. We report a case of a 4-year-old boy who, two weeks after PEG placement, presented persistent diarrhoea interpreted as intolerance to enteral feeding. His CT scan confirmed the correct placement of gastrostomy, but during gastroscopy, gastrostomy could not be found in the stomach, and the following colonoscopy revealed migration of gastrostomy to the transverse colon. The patient required removal of the misplaced PEG and conservative management of the fistula with surgical replacement of gastrostomy. We faced an unusual presentation of PEG placement complication due to colon interposition during blind gastric puncture. In children with anatomical deformities, previous surgery, or low weight or malnutrition (<10 kg), we suggest laparoscopic-assisted gastrostomy to avoid the risk of a major complication.
Acute Ascending Flaccid Paralysis Secondary to Multiple Trigger Factor Induced Hyperkalemia
Authors: K H D Thilini Hemachandra, M B Kavinda Chandimal Dayasiri, Thamara Kannangara
Journal: Case Rep Neurol Med (2018)
MeSH terms: Case Reports

Background:
Acute flaccid paralysis is an uncommon, but potentially life threatening, sequel of severe hyperkalemia. Reported primary aetiologies include renal failure, Addison's disease, potassium sparing diuretics, potassium supplements, and dietary excess. Coconut water, when consumed in excess, has been reported to cause severe hyperkalemia. We report the case of acute ascending flaccid paralysis secondary to hyperkalemia induced by multiple trigger factors-king coconut water, renal failure, diabetes, metabolic acidosis, and potassium sparing diuretics.
Case presentation:
A 78-year-old man presented with acute ascending type flaccid paralysis over five-hour duration and subsequently developed preterminal cardiac arrhythmias secondary to severe hyperkalemia (serum potassium: 7.02 mEq/L). He was on Losartan and Spironolactone for ischemic heart disease. Dietary history revealed excessive intake of king coconut water (Cocos nucifera) over past one week. Electrocardiogram returned to normal rhythm and serum potassium was 6.1 mEq/L within 2 hours of institution of emergency management for life threatening hyperkalemia. Neurological symptoms completely recovered within twenty-four hours without the need for dialysis. Electromyogram three days after the initial presentation revealed normal findings.
Conclusions:
The report describes a rare case of secondary hyperkalemic flaccid paralysis induced by multiple trigger factors. It is important that patients with risk factors for hyperkalemia are educated regarding avoiding excess dietary potassium. Regular follow-up of these patients is mandatory with review of medication related side effects and serum electrolytes.
Symptomatic pneumocephalus associated with lumbar dural tear and reverse trendelenburg positioning: a case report and review of the literature
Authors: Stephen M Pirris, Eric W Nottmeier
Journal: Case Rep Neurol Med (2013)

Symptomatic pneumocephalus is a rare complication of degenerative lumbar spine surgery. This is a case report of a patient who developed transient diplopia associated with pneumocephalus following lumbar spine surgery complicated by a dural tear. The diplopia improved as the pneumocephalus resolved. Factors involved in the development of pneumocephalus include an unintended durotomy and intraoperative reverse Trendelenburg positioning that was utilized to decrease the risk of postoperative vision loss. When encountering cerebrospinal fluid (CSF) leakage intraoperatively, spine surgeons should level the operating table until closure of the dural defect to prevent potential complications associated with pneumocephalus. If postoperative patients complain of severe headaches or display a focal cranial neurologic deficit, then a computed tomography (CT) scan of the brain should be ordered and evaluated. Consulting neurologists should be aware of the circumstances surrounding this rare complication.
Impact of overdose prevention sites during a public health emergency in Victoria, Canada
Authors: Bernadette Pauly, Bruce Wallace, Flora Pagan, Jack Phillips, Mark Wilson, Heather Hobbs, Joann Connolly
Journal: PLoS One (2020)
MeSH terms: Drug Overdose / prevention & control, Emergencies / epidemiology, Illicit Drugs / poisoning, Substance Abuse, Intravenous / prevention & control, Research Support, Non-U.S. Gov't, Adult, British Columbia, Female, Humans, Male, Needle-Exchange Programs / methods, Organizational Case Studies / methods, Public Health / methods, Illicit Drugs

The primary objective of this study was to examine the impacts associated with implementation of overdose preventions sites (OPSs) in Victoria, Canada during a declared provincial public health overdose emergency. A rapid case study design was employed with three OPSs constituting the cases. Data were collected through semi-structured interviews with 15 staff, including experiential staff, and 12 service users. Theoretically, we were informed by the Consolidated Framework for Implementation Research. This framework, combined with a case study design, is well suited for generating insight into the impacts of an intervention. Zero deaths were identified as a key impact and indicator of success. The implementation of OPSs increased opportunities for early intervention in the event of an overdose, reducing trauma for staff and service users, and facilitated organizational transitions from provision of safer supplies to safer spaces. Providing a safer space meant drug use no longer needed to be concealed, with the effect of mitigating drug related stigma and facilitating a shift from shame and blame to increasing trust and development of relationships with increased opportunities to provide connections to other services. These impacts were achieved with few new resources highlighting the commitment of agencies and harm reduction workers, particularly those with lived experience, in achieving beneficial impacts. Although mitigating harms of overdose, OPSs do not address the root problem of an unsafe drug supply. OPSs are important life-saving interventions, but more is needed to address the current contamination of the illicit drug supply including provision of a safer supply.
Laparoscopic Release for Median Arcuate Ligament Compression Syndrome Associated with a Celiac-Mesenteric Trunk
Authors: Shamir O Cawich, Dave Harnanan, Lemuel Pran
Journal: Case Rep Vasc Med (2022)
MeSH terms: Case Reports

The median arcuate ligament compression syndrome is a rare entity that occurs in 2 per 100,000 unselected individuals. We present a case where the median arcuate ligament compression syndrome was associated with an equally uncommon anatomic variation-a celiac-mesenteric trunk, which occurs in 0.42-2.7% of unselected individuals. We could find no prior report of a celiac-mesenteric trunk being associated with the median arcuate ligament compression syndrome. This report also adds to the literature to show that a laparoscopic approach to median arcuate ligament release is feasible.
Pathological fracture due to primary bone lymphoma in a patient with a history of prostate cancer: A case report and review of literature
Authors: Pooja Bhakta, Zachary E Hunzeker, Juan D Garcia, Ayman Youssef, Bradley J Grant, Rasha Alfattal, Dylan Weaver, Peeyush Bhargava, Ariel Rischall, Tejo Musunuru, Palawinnage V Muthukumarana, Jayati Mallick, Kirill A Lyapichev
Journal: Front Oncol (2023)
Keywords: chop, diaphyseal fracture, diffuse large b cell lymphoma (dlbcl), femur, pathological fracture, primary bone lymphoma, rituximab
MeSH terms: Case Reports

Primary bone lymphoma (PBL) is a rare extranodal presentation within lymphomas and primary bone malignancies. Pathologic fracture (PF) is a common complication of metastatic bone disease but is, rarely, the presentation of a primary bone tumor. We report a case of an 83-year-old man with a history of untreated prostate cancer, presenting with atraumatic fracture of his left femur after months of intermittent pains and weight loss. Radiographic workup revealed a lytic lesion suspicious for PF secondary to metastatic prostate cancer; however, initial core biopsy results were inconclusive for malignancy. A complete blood count with differential and complete metabolic panel was within normal limits. During surgical fixation and nailing of the femur, a reaming biopsy was performed as a repeat measure and revealed diffuse large B-cell lymphoma. Staging with positron emission tomography and computed tomography found no evidence of lymphatic or visceral involvement and chemotherapy was promptly initiated. This case highlights the diagnostic workup challenges for PF secondary to PBL, especially in the setting of concurrent malignancy. Because of the non-specific presentation of a lytic lesion on imaging associated with atraumatic fracture, we highlight PBL as an important diagnostic consideration.
Unusual presentation of hereditary neuropathy with liability to pressure palsies
Authors: Muhammad U Farooq, Jayne H W Martin, Michael T Andary
Journal: J Brachial Plex Peripher Nerve Inj (2008)
MeSH terms: Case Reports

Background:
Hereditary neuropathy with liability to pressure palsies (HNPP) is an autosomal-dominant painless peripheral neuropathy characterized by episodes of repeated focal pressure neuropathies at sites of entrapment/compression, with a considerable variability in the clinical course. Electrodiagnostic and genetic testing are important in the diagnostic evaluation of these patients.
Case presentation:
We report an unusual HNPP phenotype, five compression neuropathies in four nerves in a patient with bilateral hand numbness. A 42-year-old female, presented with acute bilateral paresthesias and weakness in her hands after starting yoga exercises requiring hyperextension of her hands at the wrists. Her presentation was complicated by: a) a remote history of acute onset foot drop and subsequent improvement, b) previous diagnoses of demyelinating peripheral neuropathy, possibly Charcot-Marie-Tooth disease, and c) exposure to leprosy. Electrodiagnostic testing showed 5 separate compression neuropathies in 4 nerves including: severe left and right ulnar neuropathies at the wrist, left and right median neuropathies at the wrist and left ulnar neuropathy at the elbow. There was a mild generalized, primarily demyelinating, peripheral polyneuropathy. Based on the clinical suspicion and electrodiagnostic findings, consistent with profound demyelination in areas of compression, genetic analysis was done which identified a deletion of the PMP-22 gene consistent with HNPP.
Conclusion:
HNPP can present with unusual phenotypes, such as 5 separate mononeuropathies, bilateral ulnar and median neuropathies at the wrists and ulnar neuropathy at the elbow with mild peripheral demyelinating polyneuropathy associated with the PMP-22 gene deletion.
Diffuse Alveolar Hemorrhage: A Rare Complication of Severe Hypertension
Authors: Mohamad Talal Basrak, Muhammad Firas Alhammad, Shahzad Anjum, Mohammad Altermanini, Yasir E Ahmed
Journal: Cureus (2023)
Keywords: diffuse alveolar hemorrhage, hemoptysis, severe hypertension, sob - shortness of breath, sudden-onset, uncontrolled hypertension
MeSH terms: Case Reports

Severe hypertension is a rare cause of diffuse alveolar hemorrhage. We reported a case of a 43-year-old woman who presented with shortness of breath, hemoptysis, and severe hypertension. The patient was diagnosed with diffuse alveolar hemorrhage due to severe hypertension which improved after controlling her blood pressure.
Morbidly obese woman unaware of pregnancy until full-term and complicated by intraamniotic sepsis with pseudomonas
Authors: H Muppala, J Rafi, I Arthur
Journal: Infect Dis Obstet Gynecol (2007)
MeSH terms: Chorioamnionitis / diagnosis, Obesity, Morbid / complications, Pregnancy Complications, Infectious / diagnosis, Pseudomonas Infections / complications, Case Reports, Adult, Cesarean Section, Chorioamnionitis / microbiology, Community-Acquired Infections / complications, Female, Humans, Infant, Newborn, Male, Pregnancy, Pregnancy Complications, Infectious / physiopathology, Pseudomonas Infections / diagnosis, Sepsis / diagnosis, Sepsis / microbiology

A 32-year-old Caucasian woman of body mass index (BMI) 46 presented with urinary symptoms to accident and emergency (A&E). Acute pyelonephritis was the diagnosis. Transabdominal scan revealed a live term fetus. Both the partners were unaware of the ongoing pregnancy until diagnosed. She underwent emergency cesarean under general anaesthesia (GA) for nonreassuring CTG, severe chorioamnionitis, and moderate preecclampsia. A live male baby weighing 4400 grams delivered in poor condition. Placental tissue on culture exhibited scanty growth of pseudomonas aeruginosa. Chorioamnionitis due to pseudomonas is rare, with high neonatal morbidity and mortality. It is mostly reported among preterm prelabor rupture of membranes (PPROM). Educating the community especially morbidly obese women if they put on excessive weight or with irregular periods should seek doctor's advice and exclude pregnancy. For the primary care provider, it is of great importance to exclude pregnancy in any reproductive woman presenting with abdominal complaints. This case also brings to clinicians notice that pseudomonas can be community-acquired and can affect term pregnancies with intact or prolonged rupture of membranes.
Peripheral Medulloepithelioma: A Rare Entity to Know
Authors: W Matrane, S Cherkaoui, M Regragui, N Bennani Guebessi, M Karkouri, S Salam, A Madani, A Quessar, N Khoubila
Journal: Case Rep Oncol Med (2020)
MeSH terms: Case Reports

According to the World Health Organization, medulloepithelioma belongs to the embryonal neoplasm entity. It is a very rare, highly malignant tumor typically affecting infants and young children. Usually, the tumor arises in the eye or in the central nervous system; a peripheral location has been rarely reported without an established treatment. The recognition and separation of this neoplasm from other differential tumors are mandatory for better understanding of its biology and determination of optimal treatment. This paper reports a case of an ectopic intrapelvic medulloepithelioma with liver metastasis in a 3-year-old girl.
Clonidine Overdose as an Unusual Cause of Heart Failure
Authors: Jagdeep Bhullar, Arti Patel, Jaagruthi Chitithoti, Frederick Venter, Theingi Win, Fowrooz Joolhar
Journal: J Investig Med High Impact Case Rep (2022)
Keywords: gdmt, hfref, nstemi, cardiology, clonidine overdose, heart failure, troponemia
MeSH terms: Attention Deficit Disorder with Hyperactivity / drug therapy, Heart Failure / chemically induced, Hypertension / chemically induced, Hypertension / drug therapy, Case Reports, Adult, Antihypertensive Agents / therapeutic use, Clonidine / therapeutic use, Disease Progression, Female, Humans, Antihypertensive Agents, Clonidine

Clonidine is used as an antihypertensive medication due to its effect on decreasing peripheral vascular resistance and therefore lowering blood pressure. Alpha antagonism in the medulla and the posterior hypothalamus causing a reduction in sympathetic activation allows for clonidine to be used as an effective off-label treatment for attention-deficit/hyperactivity disorder (ADHD). This is a case of a 28-year-old female with hypertension, ADHD, and depression who developed acute heart failure with significant troponemia after ingesting 30 pills of clonidine. We illustrate the possible rare diagnosis of systolic heart failure and coronary vasospasm secondary to clonidine overdose.
Ruptured renal arteriovenous malformation successfully treated by catheter embolization: a case report
Authors: Nobuhiro Takeuchi, Yusuke Nomura
Journal: BMC Res Notes (2014)
MeSH terms: Arteriovenous Malformations / therapy, Embolization, Therapeutic / methods, Kidney / blood supply, Case Reports, Aged, 80 and over, Aneurysm, Ruptured / diagnostic imaging, Aneurysm, Ruptured / etiology, Aneurysm, Ruptured / surgery, Arteriovenous Malformations / complications, Arteriovenous Malformations / diagnosis, Arteriovenous Malformations / diagnostic imaging, Combined Modality Therapy, Embolization, Therapeutic / instrumentation, Female, Hematuria / etiology, Hemostatics / therapeutic use, Humans, Hydronephrosis / etiology, Magnetic Resonance Imaging, Rupture, Spontaneous, Shock, Hemorrhagic / drug therapy, Shock, Hemorrhagic / etiology, Stents, Tomography, X-Ray Computed, Hemostatics

Background:
Renal arteriovenous fistula (RAVF) is a comparatively rare malformation. Here, we report a case of ruptured RAVF that was successfully treated by catheter embolization.
Case presentation:
An 89-year-old female was transferred to our institution with massive gross hematuria in March 2011. Plain abdominal computed tomography (CT) revealed dilated left renal pelvis with high-density contents. Hematoma was suspected. Subsequent plain abdominal magnetic resonance imaging revealed left hydronephrosis and blood retention in the dilated left renal pelvis. No renal or ureteral cancer was evident. Hematuria was conservatively treated using hemostatic agents but hematuria persisted. Repeated urinary cytology revealed no malignant cells. On day 9, the patient went into septic and/or hemorrhagic shock. Fluid and catecholamine infusion, blood transfusion, and antibacterial drugs were rapidly initiated, and the patient's general condition gradually improved. Contrast-enhanced abdominal CT revealed marked expansion of the hematoma in the renal pelvis and microaneurysms in the segmental arteries of the left kidney. Inflammation improved, and a left double-J stent was inserted. Selective renal angiography revealed RAVF with microaneurysms in the left segmental arteries; therefore, catheter embolization using metallic coils was performed, which resolved hematuria.
Conclusion:
We report a case of ruptured renal arteriovenous malformation, which was successfully treated by catheter embolization.