OpenMed/multicare-articles huggingface dataset:
Valproic Acid-induced myoclonus in a demented patient: a case report
Authors: Tina M Gardner, Rehan Aziz, Sunanda Muralee, Rajesh R Tampi
Journal: Case Rep Med (2009)
MeSH terms: Case Reports

Valproic acid and its derivatives are now commonly used to treat various psychiatric disorders in the elderly. Data indicates that the elderly patients are more susceptible to developing neuropsychiatric complications when treated with these medications. In this report, we describe the case of a 66-year-old woman with early-onset, Alzheimer's type dementia, who developed myoclonus when treated with a valproic acid preparation for behavioral disturbances associated with the dementia.
Licorice consumption as a cause of posterior reversible encephalopathy syndrome: a case report
Authors: Eduard J van Beers, Jan Stam, Walter M van den Bergh
Journal: Crit Care (2011)
MeSH terms: Glycyrrhiza / adverse effects, Posterior Leukoencephalopathy Syndrome / chemically induced, Posterior Leukoencephalopathy Syndrome / diagnosis, Case Reports, Female, Humans, Middle Aged

Introduction:
A 49-year-old woman was admitted to our hospital because of thunderclap headache and blurred vision. At the time of presentation, her blood pressure was 219/100 mmHg, her arterial pH was 7.64 and her potassium level was 2.7 mM/l.
Methods:
The combination of sequential computed tomography (CT) and the triad of hypertension, hypokalemia and metabolic alkalosis in this patient suggested the diagnosis. Supplementary anamnesis and long-term follow-up confirmed it.
Results:
Brain computed tomography imaging showed minor bleeding in the left Sylvian fissure and bilateral occipital edema, suggestive of posterior reversible encephalopathy syndrome (PRES). Repeated brain CT after 10 days showed a complete resolution of radiological signs. The patient informed us that she had quit smoking 2 weeks ago and had started consuming large amounts of licorice instead of smoking. After she abandoned licorice consumption, her blood pressure normalized. Her latest blood pressure reading was 106/60 mmHg without the use of any antihypertensive drugs.
Conclusions:
To the best of our knowledge, this is the first case report describing licorice consumption as a cause of PRES. Glycyrrhizic acid, a component of licorice, inhibits 11β-hydroxysteroid dehydrogenase and subsequently causes mineralocorticoid excess. Mineralocorticoid excess in turn causes high blood pressure and ultimately gives rise to malignant hypertension. Physicians should remember that licorice use is a very easy-to-treat cause of hypertension, hypertensive encephalopathy and PRES.
Rare but Not Infrequent: Infective Endocarditis Caused by Abiotrophia defectiva
Authors: Sonia Chowdhury, Matthew L German
Journal: Case Rep Infect Dis (2018)
MeSH terms: Case Reports

Endocarditis (IE) is defined by an infection of a native or prosthetic heart valve, the mural endocardium, or an indwelling cardiac device. Although viridan-group streptococci (VGS) and Staphylococci species have collectively been considered as the most common cause of endocarditis, uncommon pathogens may also lead to the disease with significant morbidity and mortality. Abiotrophia defectiva, a nutritionally variant streptococci (NVS), is a virulent bacterium that preferentially affects endovascular structure and is implicated in many culture-negative endocarditis with dreadful complications such as heart failure, septic embolization, and valve destruction. Here, we report a case of a 60-year-old male patient, with a past medical history significant for hypertrophic obstructive cardiomyopathy, who was incidentally found to have mitral valve vegetative mass with an uncommon agent, A. defectiva. The patient was successfully treated with antimicrobial therapy. The objective of this article is to describe the possibility of uncommon cause of common diseases and raises awareness of infective endocarditis caused by A. defectiva among clinicians and microbiologists. Early and proper identification of this pathogen is important to achieve a better outcome.
Case Report: Calpainopathy Presenting After Bone Marrow Transplantation, With Studies of Donor Genetic Content in Various Tissue Types
Authors: Kristina Martens, Jamie Leckie, Daniel Fok, Robyn A Wells, Sameer Chhibber, Gerald Pfeffer
Journal: Front Neurol (2021)
Keywords: lgmd2a, bone marrow transplantation, calpain 3, digital droplet pcr, dystrophin, late onset, myopathy, transdifferentiation
MeSH terms: Case Reports

We present a patient who had two allogeneic bone marrow transplantations for acute lymphocytic leukemia. She developed slowly progressive limb-girdle weakness in the context of other symptoms of graft-vs.-host disease (GVHD). Her myopathy symptoms had been initially attributed to GVHD, but when she progressed despite immunotherapy, genetic testing was requested. Initial testing was performed on a blood sample, identifying a variant of unknown significance in DMD. Subsequent testing of DNA from the patient's muscle tissue identified two pathogenic variants in CAPN3, with absence of the DMD variant (this latter variant presumed to have been received from the donor). Allele-specific digital droplet qPCR permitted the quantification of the donor variant in various tissues from the patient (whole skin, isolated fibroblasts, whole blood, saliva, buccal cells, urine sediment, and two muscle biopsies taken at a 2 year interval). This report emphasizes that genetic disease should still be considered in the context of presumably acquired disease, and also demonstrates the extent of transdifferentiation of donor cells into other tissues.
Extensive skin necrosis after periprosthetic knee infection: a case that highlights the possibility of complications induced by low-molecular-weight heparin
Authors: Hélder Fonte, André Carvalho, João Rosa, Cláudia Pereira, Alexandre Pereira, Ricardo Sousa, Further Members Of The Porto Bone And Joint Infection Unit
Journal: J Bone Jt Infect (2021)
MeSH terms: Case Reports

We describe a case of a patient with atrial fibrillation, anticoagulated with dabigatran, that developed severe knee skin necrosis in the setting of an acute periprosthetic knee infection, after initiating low-molecular-weight heparin. A wide range of etiology hypotheses was discussed within a multidisciplinary team. The complex approach consisted of treating the underlying infection, multiple types of soft-tissue management, and stopping enoxaparin.
Immune Checkpoint Inhibitor Induced Pericarditis and Encephalitis in a Patient Treated With Ipilimumab and Nivolumab for Metastatic Melanoma: A Case Report and Review of the Literature
Authors: Jorja Braden, Jenny H Lee
Journal: Front Oncol (2021)
Keywords: delayed immune reaction, encephalitis, immune-related adverse effects, immunotherapy, melanoma, pericarditis
MeSH terms: Case Reports

Immune checkpoint inhibitors (ICIs) have dramatically improved outcomes in melanoma. Common ICI toxicities have become familiar to clinicians; however, rare delayed toxicities remain challenging given the paucity of data with such presentations. We present the unique case of a 61-year-old with metastatic melanoma with two rare, delayed ICI-induced toxicities. After resection of a large symptomatic parietal metastases, this patient received two doses of combination ipilimumab and nivolumab. Five weeks following his second dose, he developed ICI-induced pericarditis with associated pericardial effusion and early signs of tamponade. Corticosteroids were not administered due to a concurrent cerebral abscess. Administration of colchicine, ibuprofen, judicious monitoring, and cessation of immunotherapy led to the complete resolution of the effusion over several weeks. Seven months following his last dose of immunotherapy, the patient developed ICI-associated grade four autoimmune encephalitis, presenting as status epilepticus. High-dose steroid initiation led to rapid clinical improvement. The patient remains in near-complete response on imaging with no recurrence of pericardial effusion and partial resolution of neurological symptoms. ICI-induced pericardial disease and encephalitis carry substantial mortality rates and prompt diagnosis and management is critical. Clinicians must therefore remain vigilant for these rare toxicities regardless of duration of drug exposure or time since cessation of therapy.
A Rare Presentation of Congenital Chilaiditi Syndrome: Symptomatic Hepatobowel Entrapment
Authors: Waqar Akram, Lavi Singh, Sanket Shah, Shaheer Hussain, Vishrut Shah, Aaiz Hussain, Hasnan M Ijaz, Mustafa Rahim
Journal: Cureus (2023)
Keywords: chilaiditi, chilaiditi sign, ct (computed tomography) imaging, hepatobowel entrapment, pneumoperitoneum
MeSH terms: Case Reports

The displacement and trapping of the colon between the liver and the right hemidiaphragm are known as the Chilaiditi sign or syndrome. The Chilaiditi sign presents in an asymptomatic patient, while Chilaiditi syndrome presents with symptoms such as abdominal pain, distension, and constipation, in addition to complications such as perforation, volvulus, and bowel obstruction. It is often misdiagnosed as pneumoperitoneum or free air under the diaphragm and liver, often seen on the abdomen and chest radiography. It more commonly presents in males than in females. Here, we present the case of a 37-year-old female who reported abdominal pain and persistent constipation. An abdominal CT scan showed entrapment of a bowel segment, which is referred to as the Chilaiditi sign. The patient's presentation with hepatobowel entrapment and persistent gastrointestinal symptoms was diagnosed as Chilaiditi syndrome. This presentation entails a conservative management approach. The aim of this report is to educate about the rare occurrence of Chilaiditi sign and Chilaiditi syndrome as a differential diagnosis to often misdiagnosed critical conditions such as pneumoperitoneum and intestinal perforation. Correctly identifying these patients will reduce overtreatment and help improve outcomes.
Extraoral Osseous Choristoma in the Head and Neck Region: Case Report and Literature Review
Authors: Philipp Arens, Andrea Ullrich, Heidi Olze, Florian Cornelius Uecker
Journal: Case Rep Otolaryngol (2019)
MeSH terms: Case Reports

An osseous choristoma is a benign tumor consisting of regular bone tissue in an irregular localization. Choristomas in the head and neck region are rare. Most frequently, they are found in the region of the tongue or oral mucosa. There are also very few reports on osseous choristomas in the submandibular region. We present the case of a woman with a large, caudal osseous choristoma within the lateral cervical triangle. Literature review is given about all of the reported cases in the region of the neck. The pathogenesis is yet unexplained. Our case supports the theory that the development of an osseous choristoma is a reaction to a former trauma. Cervical osseous choristomas are seldom, but they represent an important differential diagnosis when dealing with a cervical tumor.
Selective head cooling for the treatment of neurologic complications of acute liver failure in a newborn with disseminated herpes infection
Authors: Gregory Hansen, Michele Grimason, James W Collins, Mark S Wainwright
Journal: Springerplus (2013)
Keywords: acute liver failure, eeg, hypothermia, neonate, transcranial doppler

Background:
Neurologic complications of pediatric acute liver failure (ALF) are a major determinant of outcome. Management of these complications, including increased intracranial pressure (ICP) is largely supportive. Although hypothermia is an effective treatment for perinatal asphyxia and is used to reduce ICP following traumatic brain injury, it has not been evaluated for neurologic complications of ALF in the newborn.
Methods:
Case report.
Results:
We present a case of neonatal herpes simplex virus (HSV)-associated ALF with profound neurologic impairment and increased ICP. The patient was treated with selective head cooling, and monitored with transcranial doppler (TCD) studies of cerebral blood flow velocity, and electroencephalograms (EEG). The duration of head cooling was influenced by absent diastolic flow on TCDs, which subsequently improved during hypothermia. Continuous EEGs captured subclinical seizures, which improved with antiepileptic medications. Her death was attributed to a massive pulmonary hemorrhage and a hypoxemic cardiac arrest secondary to significant coagulopathy.
Conclusion:
This case demonstrates that selective head cooling may attenuate increased ICP in neonatal encephalopathy, and that TCDs may guide management in the absence of invasive monitoring.
Type B idiopathic bone defect of mandible: an etiopathogenic dilemma
Authors: Aakarsh V Jhamb, Parul A Jhamb, Aparna Dave, Vishwa Prakash Shetty
Journal: Case Rep Dent (2012)
MeSH terms: Case Reports

Etiopathogenesis of the pathologic lesions forms the basis for formulation of appropriate intervention and further prevention. There is still a vast unknown field that has to be explored to know the causative reason behind certain benign & malignant lesions. Idiopathic bone defects are nonodontogenic pseudocystic cavities that are seen in the long bones & jaw bones. Radiographic interpretation is at times inadequate in diagnosis of odontogenic & nonodontogenic radiolucent lesions involving jaw bones. Histopathology has different criteria to segregate this lesion. In this paper, we discuss a case of type B histopathological variant of idiopathic bone defect that may suggest an alternative pathogenesis from type A variant.
Utilization of the safe surgical dislocation approach of the hip to retrieve a bullet from the femoral head
Authors: Ruth Delaney, Maurice Albright, Gleeson Rebello
Journal: Case Rep Orthop (2011)
MeSH terms: Case Reports

Retained intra-articular missiles from low-velocity handguns can lead to mechanical arthritis, synovitis, and lead toxicity. Various surgical approaches have been described to extract such foreign bodies from the hip joint. We present the case of a 17-year-old male in which the surgical dislocation approach was utilized to retrieve a bullet from the femoral head with a good short-term outcome. This case represents a rare application of the surgical hip dislocation approach for an unusual trauma.
Prolapsing left atrial mass causing severe pulmonary hypertension in a new cardiac service in a rural hospital in Cameroon: a case report
Authors: Clovis Nkoke, Christelle Makoge
Journal: Pan Afr Med J (2022)
Keywords: left atrial mass, case report, myxoma, pulmonary hypertension, rural
MeSH terms: Heart Neoplasms / complications, Heart Neoplasms / diagnosis, Heart Neoplasms / surgery, Hypertension, Pulmonary / diagnosis, Hypertension, Pulmonary / etiology, Myxoma / complications, Myxoma / diagnosis, Myxoma / surgery, Case Reports, Cameroon, Heart Atria / diagnostic imaging, Hospitals, Rural, Humans, Male, Middle Aged

We report a case of a left atrial mass in a 62-year-old patient with no relevant past history. He presented with dyspnea of 1 year duration. Clinical examination revealed a blood pressure of 130/82mmHg, a heart rate of 80 beats per minute. The heart sounds S1 and S2 were normal with no added sounds. Electrocardiogram showed a normal sinus rhythm at 78 beats per minute with premature ventricular contractions. Two dimensional echocardiography revealed a large mobile mass attached to the interatrial septum occupying the most of the left atrium and prolapsing into the left ventricle during diastole. There was dilatation of the right atrium and right ventricle with elevated pulmonary artery systolic pressure (85mmHg). The mean transmitral pressure gradient was 5.5mmHg. The mass was compatible with a myxoma. The patient was sent for surgical resection of the mass but this could not be performed due to financial constraints.
Venous small bowel infarction: intraoperative laser Doppler flowmetry discriminates critical blood supply and spares bowel length
Authors: S A Käser, P M Glauser, C A Maurer
Journal: Case Rep Med (2012)

Introduction. In mesenteric infarction due to arterial occlusion, laser Doppler flowmetry and spectrometry are known reliable noninvasive methods for measuring microvascular blood flow and oxygen utilisation. Case Presentation. As an innovation we used these methods in a patient with acute extensive mesenteric infarction due to venous occlusion, occurring after radical right hemicolectomy. Aiming to avoid short bowel syndrome, we spared additional 110 cm of small bowel, instead of leaving only 80 centimetres of clinically viable small bowel in situ. The pathological examination showed only 5 mm of vital mucosa to be left distal to the dissection margin. No further interventions were necessary. Conclusion. Laser doppler flowmetry and spectrometry are potentially powerful methods to assist the surgeon's decision-making in critical venous mesenteric perfusion, thus having an important impact on clinical outcome.
Case Report: Effects of Anti-SARS-CoV-2 Convalescent Antibodies Obtained With Double Filtration Plasmapheresis
Authors: Diego Curtò, Federica Tomatis, Sara Gastoldi, Miriam Galbusera, Marina Noris, Federico Raimondi, Ferdinando Luca Lorini, Anna Falanga, Marina Marchetti, Giuseppe Remuzzi, Piero Ruggenenti
Journal: Front Immunol (2021)
Keywords: covid-19, case report, coagulation biomarkers, convalescent antibodies, double filtration plasmapheresis, hypercoagulability, immunosuppression, rituximab
MeSH terms: Antibodies, Neutralizing / therapeutic use, Antibodies, Viral / therapeutic use, COVID-19 / therapy, Immunization, Passive / methods, Immunocompromised Host, Immunoglobulin G / therapeutic use, Plasmapheresis / methods, SARS-CoV-2 / genetics, Case Reports, Research Support, Non-U.S. Gov't, Antineoplastic Agents, Immunological / adverse effects, Antiviral Agents / therapeutic use, COVID-19 / immunology, COVID-19 / virology, COVID-19 Serotherapy, Female, Humans, Immunity / drug effects, Lymphoma, Large B-Cell, Diffuse / drug therapy, Middle Aged, RNA, Viral / genetics, Rituximab / adverse effects, Treatment Outcome, Antibodies, Neutralizing, Antibodies, Viral, Antineoplastic Agents, Immunological, Antiviral Agents, Immunoglobulin G, RNA, Viral, Rituximab

Passive antibody therapy has been used to treat outbreaks of viral disease, including the ongoing pandemic of severe respiratory acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2) or COVID-19. However, the real benefits of the procedure are unclear. We infused a concentrated solution of neutralizing anti-SARS-CoV-2 antibodies obtained from a convalescent donor with a single session of double filtration plasmapheresis (DFPP) into a 56-year-old woman with long history of unremitting, severe COVID-19. She was unable to establish an adequate antiviral immune response because of previous chemotherapy, including the infusion of the anti-CD20 monoclonal antibody rituximab, administered to treat a diffuse large B-cell lymphoma. The disease promptly recovered despite evidence of no endogenous anti-SARS-CoV-2 antibody production. The observation that passive antibody therapy might prove particularly effective in immunodepressed COVID-19 patients requires evaluation in prospective randomized controlled trial.
Intimate Partner Violence and Child Custody Evaluation: A Model for Preliminary Clinical Intervention
Authors: Marialuisa Gennari, Giancarlo Tamanza, Sara Molgora
Journal: Front Psychol (2018)
Keywords: child custody evaluation, divorce, intimate partner violence, relational-intergenerational approach, separation, single case, therapeutic assessment

Intimate partner violence is defined by the World Health Organization as "any behavior within an intimate relationship that causes physical, psychological, or sexual harm to those in the relationship" and it refers to a specific relationship dynamic. In recent decades, an increasing number of studies have focused on this phenomenon, considering its exponential growth over time. Many studies have focused on risk factors for violence within the couple relationship. This paper specifically analyses the association between violence and separation or divorce. Although many interventions have been developed over the years, the effectiveness of extant interventions on violent behaviors is not yet empirically supported. Since clinical experience allows to affirm that both partners can be involved in treatment for intimate partner violence especially during mandated proceedings, the present study focuses on domestic violence in separated couples involved in a child custody evaluation process. In this case, literature supports the need for individualized assessment in order to promote the best intervention according to the specific conditions of each partner, whether the battered one or the perpetrator. However, little research has been done on child custody evaluation in the presence of violent couples. The aim of the present study is to present a model of couple clinical intervention with a separated violent couple in the context of a child custody evaluation. This model can be defined as relational-intergenerational and its main aim is to understand the exchange between familial generations and to search for factors that safeguard and care for family relations. Furthermore, according also to the therapeutic assessment approach, there is an intrinsic connection between assessment and "family transformative potential." This paper presents the specific working methodology underlying this model, through the description of a single clinical case. In particular, the proposed model provides a multi-dimensional assessment comprising three levels: individual, evaluating parents' history through representations, thoughts, and feelings; interpersonal, investigating the different relations; discussion and dialogue with the parental couple about findings.
Central Nervous System Involvement by Small Lymphocytic Lymphoma after a Myxoma-Related Embolic Event
Authors: Nicolas Gallastegui, Daniel P Cassidy, Deborah O Heros, Francisco Vega, Jonathan H Schatz
Journal: Case Rep Hematol (2019)
MeSH terms: Case Reports

Involvement of the central nervous system by chronic lymphocytic leukemia/small lymphocytic lymphoma is exceedingly rare, and currently no risk factors have been described. We report the case of a patient with concomitant chronic lymphocytic leukemia/small lymphocytic lymphoma and an embolic cerebrovascular accident related to a cardiac myxoma, who developed parenchymal central nervous system involvement of lymphoma on the ischemic bed. The patient was successfully treated with a high-dose fludarabine-based chemotherapy regimen, achieving a sustained remission. We propose that embolic breakage of the blood-brain barrier may be a major risk factor in producing central nervous system involvement. We also propose that a high-dose fludarabine-based chemotherapy regimen may be adequate to achieve a better CNS penetration and improved outcomes.
A Paraurethral Aggressive (Deep) Angiomyxoma
Authors: Daniel York, Smera Saikumar, Pavan Patel, Christian Edwards, Geossette Garcia, Hyder Naqvi
Journal: Case Rep Obstet Gynecol (2022)
MeSH terms: Case Reports

Background:
Aggressive angiomyxomas (AAs) are rare mesenchymal tumors that are histologically composed of myxoid stroma and vasculature. AAs are typically located in the pelvis and perineum and occur more frequently in females of reproductive age. Case Presentation. In this report, we outline a patient who had a paraurethral tumor with histopathology showing a circumscribed hypocellular lesion with myxoid stroma and abundant vasculature, consistent with the diagnosis of aggressive angiomyxoma. The mass was excised with resolution of symptoms and the patient was advised to continue close follow-up with her gynecologist and endocrinologist to monitor for recurrence.
Conclusion:
Due to its rarity, aggressive angiomyxomas are often misdiagnosed as cysts, hernias, lipomas, or cancerous lesions. Although benign, close follow-ups are crucial to monitor for recurrences or metastasis.