OpenMed/multicare-articles huggingface dataset:
Case Report: A Case of Valproic Acid-Induced Hyperammonemic Encephalopathy Associated With the Initiation of Lithium: A Re-duplicable Finding
Authors: Anna Levy, Etienne Very, François Montastruc, Philippe Birmes, Adeline Jullien, Louis Richaud
Journal: Front Psychiatry (2022)
Keywords: encephalopathy, hyperammonemia, interaction, lithium, pharmacokinetic interaction, valproate sodium
MeSH terms: Case Reports

Introduction:
Hyperammonemic encephalopathy (HAE) is a serious adverse effect of valproate semisodium, which is facilitated by the potential for drug interaction. However, despite frequent co-prescription of valproate semisodium and lithium, the role of this combination in the occurrence of HAE has not been defined in the literature. This case report concerns the occurrence of HAE concomitant with the initiation of lithium in a 29-year-old patient who had been placed on valproate semisodium for a schizoaffective disorder.
Case report:
Due to a relapse while on a combined antipsychotic and mood-stabilizing therapy (paliperidone palmitate and valproate semisodium), a cross-taper from valproate semisodium to lithium was proposed. The initiation of lithium was accompanied by an acute confusional syndrome, an elevated serum valproate level and hyperammonemia suggestive of drug-induced HAE. The discontinuation of lithium and reduction of valproate semisodium led to neurological improvement, until a recrudescence of psychiatric symptoms justified a rechallenge of the combination within the framework of a new cross-taper. As soon as Lithium was re-initiated, an increase in the serum valproate level and hyperammonemia were again noted.
Discussion:
The mechanisms of valproate-related HAE involve various metabolic pathways. In this case, exploration of the iatrogenic hypothesis focused on the imputability of concomitant cannabis use and co-prescriptions of benzodiazepines, antipsychotics, and in all likelihood, mood stabilizers.
Conclusion:
Therefore, this case study suggests that Lithium plays a role in serum valproate level elevation, and supports the hypothesis of an association between an elevated serum valproate level, hyperammonemia and reversible encephalopathy. A more in-depth pharmacokinetic exploration would provide a better understanding of the mechanisms of these interactions and support for the benefit-risk balance associated with this frequent co-prescription.
Campylobacter jejuni-Associated Hemophagocytic Lymphohistiocytosis and Guillain-Barre Syndrome: A Case Report
Authors: Fang-E Shi, Mei-Fang Chen, Yong-Jie Li, Gui-Ying Dong, Ji-Hong Zhu
Journal: Front Med (Lausanne) (2022)
Keywords: campylobacter jejuni, guillain-barre syndrome, facial paralysis, hemophagocytic lymphohistiocytosis, ophthalmoplegia, peripheral nerve injury
MeSH terms: Case Reports

Campylobacter jejuni (C. jejuni), a Gram-negative bacterium, belongs to microaerobic bacteria. We reported a 21-year-old male patient diagnosed with hemophagocytic lymphohistiocytosis (HLH) due to C. jejuni infection, who presented with multiple clinical manifestations of peripheral nerve injury, such as ophthalmoplegia, facial paralysis, and urinary retention during the treatment. Electromyography showed neurogenic injury and the final diagnosis was Guillain-Barre Syndrome (GBS). After treatment of dexamethasone combined with immunoglobulin, the patient was discharged from the hospital with partial recovery of neurological symptoms.
Gordonia sputi-associated bloodstream infection in a renal transplant patient with chronic indwelling central venous catheter: a case report and literature review
Authors: Calvin Ka-Fung Lo, Conor Broderick, Aleksandra Stefanovic, William Connors, Melanie Murray
Journal: Access Microbiol (2023)
Keywords: 16s rrna, actinomycetes, gordonia, central line-associated bloodstream infection
MeSH terms: Case Reports

Introduction:
Although rare, human infections caused by Gordonia spp. have been reported, especially within the immunocompromised population and those with long-term indwelling devices. We report a case of Gordonia spp. bacteraemia in a renal transplant patient and present a literature review on microbiological identification methods of this organism.
Case presentation:
A 62-year-old female renal transplant recipient admitted to hospital with a 2-month history of dry cough and fevers occurring weekly when receiving electrolyte replacement infusions via a Groshong line. Over 2 weeks, blood cultures repeatedly isolated a Gram-positive bacillus solely in aerobic bottles, and this was initially reported as Rhodococcus spp. by the local microbiology laboratory. Chest computed tomography (CT) showed multiple ground-glass lung opacities suggestive of septic pulmonary emboli. As central line-associated bloodstream infection was suspected, empirical antibiotics were initiated and the Groshong line was removed. The Gram-positive bacillus was later confirmed by the reference laboratory as Gordonia sputi via 16S rRNA sequencing. Vancomycin and ciprofloxacin for a duration of 6 weeks were completed as targeted antimicrobial therapy. After treatment, the patient remained symptom-free with marked improvement on repeat CT chest imaging.
Conclusion:
This case illustrates the challenges surrounding identification of Gordonia spp. and other aerobic actinomycetes. 16S rRNA gene sequencing may be a preferred identification method, especially when initial workup of a weakly acid-fast organism fails to make an identification or shows discrepant results using traditional diagnostic modalities.
Spontaneous Rupture of Rhabdomyosarcoma of the Testis With Unilateral Ptosis: A Case Report and Literature Review
Authors: Ronghua Wu, Xing Liu, Yajun Song, Shanhong Yi, Wei Chen, Wanlei Fu, Jingzhen Zhu
Journal: Front Pediatr (2022)
Keywords: case report, rhabdomyosarcoma, spontaneous rupture, testis, unilateral ptosis

Spontaneous rupture of testicular rhabdomyosarcoma is very rare. We report a case of spontaneous testicular rupture that was pathologically confirmed as rhabdomyosarcoma with unilateral blepharoptosis. The patient, a 19-year-old male, and his father had weakness of the left eyelid muscle. The patient was suspected to have a right inguinal hernia by a family doctor but was not treated further. 2 days later, there was skin itching in the right inguinal area, accompanied by redness, swelling and discomfort of the right scrotum, and the patient went to the local hospital again. Ultrasound examination showed that a contusion of the right testis may have been complicated with orchitis. Oral levofloxacin was ineffective. In addition, the swelling of scrotal increased significantly. He came to the emergency room of our hospital and also was treated with levofloxacin, but the pain was still not relieved. CT and ultrasound examination could not identify the cause of the disease. Exploration of the right scrotum was performed under general anesthesia and confirmed that the right testis had spontaneously ruptured. The pathological diagnosis was rhabdomyosarcoma of the right testis. Testicular rhabdomyosarcoma is clinically rare, and spontaneous rupture is even rarer. The pathogenesis of the disease needs to be further studied, and the diagnosis should be made on a case-by-case basis. Overall, the prognosis of testicular rhabdomyosarcoma is poor. As seen in this case, further study is required to determine whether there is some association between testicular rhabdomyosarcoma and ptosis. Unfortunately, the patient's family rejected a genetic examination because of financial difficulty. We only report a single case of this rare phenomenon here.
Ectopic Premolar Tooth in the Sigmoid Notch
Authors: K Törenek, H M Akgül, I S Bayrakdar
Journal: Case Rep Dent (2016)

Impaction of a mandibular premolar is relatively uncommon. Ectopic placement is more unusual and there has been no discussion in the literature of an ectopic mandibular premolar in the coronoid process. In this case report, we present an impacted ectopic mandibular permanent premolar in the sigmoid notch (incisura mandibulae) region. Etiology of the tooth and treatment options are discussed and illustrated by Cone Beam Computed Tomography (CBCT) images.
Obstructive jaundice as an initial manifestation of non-hodgkin lymphoma: treatment dilemma and high mortality
Authors: Dhara Chaudhari, Sarah Khan, Atif Saleem, Tamarro Taylor, Chakradhar Reddy, Thomas Borthwick, Mark Young
Journal: Case Rep Med (2013)

Introduction. Non Hodgkin lymphoma (NHL) presenting with obstructive jaundice is a rare occurrence. Because of rarity of combination, it is seldom considered in differential diagnosis of patients presenting with obstructive jaundice. It is considered treatable due to the chemosensitive nature of the disease and the recent advances in chemotherapy. Case Series. We present a case series of 2 patients with NHL presenting with obstructive jaundice as an initial manifestation. Both patients presented with obstructive jaundice and were diagnosed by CT guided liver biopsy. One patient died of sepsis and multiorgan failure before initiating chemotherapy and the second patient did not choose to undergo chemotherapy. Conclusion. Biliary obstruction is a sign of poor prognosis. The diagnosis of NHL needs to be considered in patients presenting with biliary obstruction. It can be associated with high mortality and poses treatment dilemma.
BRCA2 mutation in advanced lung squamous cell carcinoma treated with Olaparib and a PD-1 inhibitor: a case report
Authors: Zhujun Chen, Kang Wang, Lintao Zhao, Liang Gong
Journal: Front Oncol (2023)
Keywords: brca2 mutation, olaparib, pd-1 inhibitor, case report, lung squamous cell carcinoma
MeSH terms: Case Reports

Background:
Mutations in the human breast cancer susceptibility gene 2 (breast cancer 2, BRCA2) increase the risk of breast, ovarian and other cancers. Olaparib, an oral poly[adenosine diphosphate (ADP)-ribose] polymerase (PARP) inhibitor, is usually prescribed to treat BRCA mutated tumors, especially breast and ovarian cancers. Programmed cell death-1 (PD-1) inhibitors have revolutionized the treatment of lung cancer and many other cancers by destroying the interaction between receptors with ligands in the tumor-immune microenvironment and enabling T cells to recognize and attack cancer cells.
Case description:
In our study, we report a patient with advanced BRCA2 lung squamous cell carcinoma who received platinum-based chemotherapy combined with paclitaxel. Seven months later, the disease progressed. BRCA2 mutations were detected in peripheral blood by next-generation sequencing. After 2 months of treatment with Olaparib combined with Cindilimab, the patient was in partial remission and the progression-free survival (PFS) lasted for 6 months, but the patient developed immune renal damage.
Conclusions:
This study adds to the clinical data for the treatment of BRCA2 mutant non-small cell lung cancer by demonstrating that lung squamous cell carcinoma has a good response to PARP inhibitors. It also serves as a reminder that there may still be some negative effects from targeted superimposed immunotherapy.
Rare metastasis of gastric cancer to the axillary lymph node: A case report
Authors: Qingshun Zhu, Lei Li, Xuguang Jiao, Jinqiu Xiong, Shengyong Zhai, Guangxu Zhu, PeiPei Cheng, Jianjun Qu
Journal: Front Oncol (2022)
Keywords: axillary lymph node metastasis, gastric cancer, immunohistochemical staining, radical total gastrectomy, tumor markers
MeSH terms: Case Reports

Lymph node metastasis of gastric cancer is more common, metastatic lymph nodes are often around the stomach, and metastasis is carried out in a certain order, but gastric cancer metastasis to axillary lymph nodes is very rare. Due to the small number of patients with this kind of metastasis, its clinical features and treatment are not very clear. We initially thought that the enlarged axillary lymph nodes were inflammatory lesions. Axillary lymph node biopsy was later diagnosed as gastric cancer metastases to axillary lymph nodes. The patient refused further treatment and died 11 months after the second operation because of multiple systemic metastases. We believe that metastasis of gastric cancer to axillary lymph nodes is rare and the prognosis is poor. In clinical work, the possibility of metastatic lymph nodes should be considered in patients with a history of gastric cancer with enlarged axillary lymph nodes.
Educational Case: Hemolysis elevated liver enzymes and low platelets (HELLP syndrome)
Authors: Larry Nichols, Kelsey Bree Harper, Keisha R Callins
Journal: Acad Pathol (2022)
Keywords: female reproductive system, hellp syndrome, organ system pathology, pathology competencies, preeclampsia, pregnancy
MeSH terms: Case Reports

Recommended management of patients with preeclampsia starts with a comprehensive clinical maternal and fetal evaluation, including maternal complete blood count, platelets, creatinine, LDH, liver enzymes, and urine test for proteinuria, along with fetal ultrasonographic evaluation and fetal antepartum testing.7 Subsequent management depends on the results of this evaluation and on gestational age. Continued observation is recommended for a woman with a preterm fetus if she has gestational hypertension or preeclampsia without severe features, until delivery at 37 weeks of gestation in the absence of abnormal antepartum testing, preterm labor, premature rupture of membranes, or vaginal bleeding.7 There are numerous conditions precluding such expectant management including severe hypertension refractory to treatment, persistent headaches refractory to treatment, epigastric or right upper pain refractory to treatment, visual disturbances, motor deficit, altered sensorium, stroke, myocardial infarction, new or worsening renal dysfunction, pulmonary edema, suspected acute placental abruption, vaginal bleeding in the absence of placenta previa, eclampsia, or HELLP syndrome.7.
The first case of transcatheter device closure of perimembranous ventricular septal defect in Nigeria: a case report
Authors: Ogochukwu Jidechukwu Sokunbi, Bassey Olumide Udom, Naveen Kuzhippil Sreedhar, Michael Olutoyin Sanusi, Rajasekaran Premsekar
Journal: Pan Afr Med J (2023)
Keywords: nigeria, transcatheter closure, case report, interventional paediatric cardiology, ventricular septal defect
MeSH terms: Cardiac Catheterization / methods, Heart Septal Defects, Ventricular / surgery, Case Reports, Child, Preschool, Female, Hospitalization, Humans, Infant, Nigeria, Treatment Outcome, Weight Gain

Ventricular septal defect (VSD) is the most common congenital cardiac anomaly with a prevalence of 1.17 per 1000 live births. Haemodynamically significant VSDs require closure either surgical or transcatheter. We report a case of transcatheter device closure of a moderate-sized perimembranous ventricular septal defect (PmVSD), the first of its kind in Nigeria. The procedure was performed on a 23-month-old female weighing 10 kg who had presented with a history of frequent pneumonia and poor weight gain and signs of heart failure. The procedure was uncomplicated, and she was discharged 24 hours after the intervention. She had been followed-up two years post-procedure without complications and she had achieved appreciable weight gain. This non-surgical option was effective in this patient and provided the advantage of limited hospitalization, accelerated recovery, and intervention without the need for blood products. Such interventions should be scaled up in Nigeria and other sub-Saharan African countries.
Fulminant Necrotising Amoebic Colitis of Whole of Large Bowel: A Rare Complication of a Common Infectious Disease
Authors: Mohd Yasir Beg, Lovenish Bains, Ratnesh Mahajan, Pawan Lal, Sharmana Choudhury, N Pritesh Kumar, Eva Wilse C Momin, Veer Pal
Journal: Case Rep Infect Dis (2020)
MeSH terms: Case Reports

Background:
Fulminant necrotising amoebic colitis (FulNAC) is an uncommon and grave complication of a very common infectious disease widely prevalent in tropical countries. In most of the cases reported, only a segment of large bowel was gangrenous. The involvement of the whole of the large bowel, as in our case, is very rare and has very high mortality ranging from 55% to 100%. Case Summary. A 50-year-old gentleman presented with an acute abdomen with a history of crampy abdominal pain and passage of blood mixed with mucous and loose stools. After resuscitation and investigations, the patient was taken up for laparotomy and the findings showed that the caecum was sloughed off and the entire large bowel had multiple perforations. Subtotal colectomy with ileostomy was performed. Histopathological examination showed evidence of pancolitis with multiple colonies of amoebic trophozoites. Discussion. Entamoeba histolytica is a protozoon that affects the large intestine and liver in humans. There can be various presentations of amoebiasis: asymptomatic infection (90%), symptomatic noninvasive infection (6-8%), acute amoebic colitis (dysentery), or fulminant colitis with perforation. FulNAC is an uncommon complication, difficult to diagnose and treat, and associated with a high mortality rate, ranging from 55% to 100%.
Conclusion:
It is important to consider the possibility of fulminant necrotising amoebic colitis (FulNAC) as an uncommon and fatal complication of amoebiasis, especially in tropical countries, where amoebiasis is prevalent. Early diagnosis and antiamoebic treatment, along with urgent aggressive surgical resection of the involved segment and exteriorization of the proximal and distal bowel ends, are shown to reduce mortality.
Case Report: Rare Acute Abdomen: Focal Nodular Hyperplasia With Spontaneous Rupture
Authors: Ying Si, Bo Sun, Ting Zhao, Ke Xiao, Dong-Xia Zhao, Yong-Mao Huang
Journal: Front Oncol (2022)
Keywords: acute abdomen, focal nodular hyperplasia (fnh), liver, rupture, surgery
MeSH terms: Case Reports

Focal nodular hyperplasia (FNH) of the liver is a benign lesion characterized by hypertrophic nodules with central star-shaped fibrous scars. The etiology and pathogenesis of FNH are not completely understood. A 43-year-old man was hospitalized because of acute abdominal pain. Emergency computed tomography(CT) showed hepatic tumor rupture and bleeding. The patient's condition improved following arteriographic embolization to stop bleeding. Laparotomy confirmed spontaneous rupture and hemorrhage of focal hyperplasia and the patient remains asymptomatic after an uneventful recovery. FNH with spontaneous rupture and bleeding is extremely rare. Currently, there is no unified management standard for FNH and most previous studies recommend observation and follow-up. We recommend consideration of surgical treatment of cases with spontaneous rupture and bleeding.
Case Report: De Clerambault's Syndrome in Dementia With Lewy Bodies
Authors: Takashi Suehiro, Yuto Satake, Mamoru Hashimoto, Manabu Ikeda
Journal: Front Psychiatry (2021)
Keywords: de clerambault's syndrome, delusion, dementia, dementia with lewy bodies, erotomania
MeSH terms: Case Reports

Background: Erotomania, also known as de Clerambault's syndrome, is characterized by the delusion that a person has fallen in love with the patient. It occasionally appears secondary to psychiatric disorders and organic brain diseases. However, there have been no reports on cases secondary to dementia with Lewy bodies (DLB). Case Presentation: The patient was an 83-year-old woman who lived alone. Mild cognitive impairment appeared at the age of 82 years. Soon after, she had the delusional conviction that her family doctor was in love with her. Her symptoms, such as gradually progressive cognitive impairment, cognitive fluctuations, and parkinsonism, indicated DLB. She was treated with a small dose of antipsychotic agents. Conclusions: This case report suggests the possibility of de Clerambault's syndrome during the early stages of DLB. Further investigations are required to clarify the mechanism and treatment of de Clerambault's syndrome in patients with DLB.
Aortic deceleration injury treated by endograft: a case report with 11-year followup
Authors: Zhi-Wei Hu, Wang-Zhong Gao, Yong-Quan Gu, Bing Chen, Guang-Chang Zhu, Wei-Tao Liang, Ya-Chan Ning
Journal: Case Rep Vasc Med (2012)

Aortic deceleration injury is a common and critical condition following automobile accident with high fatality. The survivors complicated with associated serious injuries are even rare and definitive treatment is required. A 37-year-old male patient had both aortic blunt injury and coronary artery injury after a frontal car collision. After failed coronary artery percutaneous transluminal angioplasty (PTA) and deteriorated aortic lesion, the ruptured aorta was subsequently successfully treated by us with a self-made individualized endograft. The endograft was well in position and the patient functioned well in 11-year followup. With the development of endograft and technique, the endovascular treatment may be an option for patients with complicated aortic blunt injury. Yet careful patient selection and the long-term followup are essential.
Uncommon abdominal "egg-shelled" lesions mimic hepatic echinococcosis: Two cases report
Authors: Yubo Liao, Guo Zhou, Chong Yang, Yu Zhang
Journal: Front Surg (2022)
Keywords: diagnosis, hepatic echinococcosis, surgery, treatment, “egg-shelled” lesions
MeSH terms: Case Reports

Background:
Primary abdominal "egg-shelled" lesions with positive anti-echinococcus IgG antibody were misdiagnosed as echinococcosis.
Case presentation:
Herein we report two cases with primary abdominal "egg-shelled" lesions were misdiagnosed as echinococcosis. Case 1: A 44-year-old woman presented to our department with a history of slight abdominal pain for 4 months. After admission, the laboratory tests indicated a positive anti-echinococcus IgG antibody status. The contrast-enhanced CT scan showed a 12 × 12 cm "me contrast-mass located in the hepatorenal area. The patient had the entire mass and the right adrenal gland resected. This patient recovered smoothly and was discharged uneventfully 20 days after the operation. The pathologic diagnoses was adrenal lymphangioma. Case 2: A 55-year-old woman was admitted with a history of an abdominal mass for over 10 years. After admission, her anti-echinococcus IgG antibody was positive. The contrast-enhanced CT scan revealed a heterogeneous, solid mass measuring 10 × 9 × 8 cm in the right hepatic lobe. A laparoscopic exploration was performed, and the surgery revealed that the mass arose from the retroperitoneal tissue rather than the liver. Finally, the pathologic diagnoses were paraganglioma with necrosis and cystic changes.
Conclusion:
Enhanced CT scan and contrast-enhanced ultrasound scans are important for distinguishing echinococcosis disease from the other "egg-shelled" lesions. Surgical resection is the main treatment method for this disease. Minimally invasive surgery is recommended but should be performed by experienced surgical teams. Immunohistochemical examination is important for the pathologic diagnosis.
An Unusual Presentation of Acute Weakness: Acute Inflammatory Demyelinating Polyneuropathy in a Patient with Psychiatric Illness
Authors: Eric Lombardi, Ryan Misek, Krishna Patel
Journal: Case Rep Emerg Med (2018)
MeSH terms: Case Reports

We report an unusual presentation of Guillain-Barré wherein a patient with an extensive history of psychiatric illness had a dream that his legs were crushed in an earthquake and awoke from the dream with paresthesias and rapid paralysis of bilateral lower extremities. This article discusses an atypical presentation of pathology and diagnostic evaluation for a form of Guillain-Barré called Acute Inflammatory Demyelinating Polyneuropathy (AIDP).