OpenMed/multicare-articles huggingface dataset:
A case report of diagnosis of cat-scratch disease using metagenomic next-generation sequencing
Authors: Tao Zhou, Yaqiu Zheng, Huizi Zhang, Yongfang Liu
Journal: Front Cell Infect Microbiol (2024)
Keywords: bartonella henselae, cat-scratch disease (csd), diagnosis, hypo-immunity, metagenomic next-generation sequencing (mngs), treatment
MeSH terms: Bartonella henselae / genetics, Bartonella, Cat-Scratch Disease / diagnosis, Cat-Scratch Disease / drug therapy, Case Reports, Adolescent, Child, High-Throughput Nucleotide Sequencing, Humans, Lymph Nodes / pathology, Male, Middle Aged

Cat-scratch disease (CSD) is an anthropozoonotic infection caused by Bartonella henselae, and it is one of the most common causes of lymph node infections in children and adolescents. B. henselae, belonging to the genus Bartonella, is a common human pathogen of human beings. CSD commonly develops as a result of cat scratches and bites or when injured skin comes into contact with cat saliva. The manifestation of CSD clinically differs for each patient based on their immune system. Individuals who have healthy immune systems generally manifest minimal clinical symptoms and do not necessitate any form of treatment. However, patients who have hypo-immunity require prompt medical attention due to the potential manifestation of severe symptoms that affect multiple systems of the body. Long latency and atypical clinical manifestations are characteristics of CSD. Bartonella isolation and identification are challenging procedures that require specialized equipment. There is no gold standard method for CSD diagnosis, and misdiagnosis and missed diagnosis rates are typically high. We present the case of a middle-aged male patient who developed fever, chills, anal distension, dizziness, and muscle pain for 10 days. The patient had a documented history of cat bites 1 month prior to the onset of symptoms. Following admission, he underwent an examination to determine superficial lymphadenopathy and hypoimmunity. Additionally, he had a fever during the disease. As the patient refused a needle biopsy of lymph nodes, metagenomic next-generation sequencing (mNGS) was employed and B. henselae was detected in the peripheral blood. The patient was diagnosed with CSD and treated with a combination of azithromycin and doxycycline. The fever symptoms were alleviated, and the patient was ultimately discharged. As a result of this case, we suggest that mNGS be used as a crucial supplementary diagnostic tool for individuals with compromised immune systems who may have CSD, especially when conventional diagnostic methods are inconclusive.
Case Report: Combined perioperative extracorporeal membrane oxygenation for acute heart failure caused by mitral regurgitation
Authors: Brock Daughtry, John Richardson
Journal: Front Cardiovasc Med (2024)
Keywords: ecmo, impella, acute heart failure (ahf), mitral regurgitation, mitral valve
MeSH terms: Case Reports

Extracorporeal membrane oxygenation (ECMO) and extracorporeal life support (ECLS) devices are well-established adjunctive treatment measures for patients with heart failure. ECMO can serve as a bridge to transplant in a chronic setting or as a salvage therapy for patients who are unable to be weaned from bypass following cardiac surgery. However, the role of ECMO as a bridge to definitive therapy in a setting of acute heart failure is less established. Similarly, the treatment of patients using combined ECMO and ECLS devices has been, at times, shown to show some benefit; however, these benefits have not been widely studied. In this study, we present the case of a patient who was diagnosed with severe acute onset heart failure secondary to torrential mitral regurgitation following COVID-19 pneumonia. The patient was emergently placed on venoarterial (VA) ECMO with an indwelling centrifugal pump device in the left ventricle. This combination of ECMO and ECLS served as a bridge to open mitral valve replacement 6 days after presentation. Following successful mitral valve replacement, the patient had persistent right ventricular failure, and therefore, a decision was made to incorporate venovenous (VV) ECMO into the VA ECMO circuit. This technique resulted in a VV-VA or VPa-VA configuration, as oxygenated blood was being returned to the pulmonary artery as well as the descending aorta. VA ECMO was discontinued after 4 days of therapy, and the patient was extubated 3 days later. VV ECMO was weaned over the following week, and the patient was decannulated after a total 23 days of ECMO. The patient was then transitioned to inpatient rehabilitation and ultimately discharged home after 18 days. At the 6-month follow-up, the patient was doing well, and objective cardiopulmonary testing revealed normal function. This case is an excellent demonstration of how advanced ECMO and ECLS devices can be used in unique ways through multiple configurations to rescue and optimize patients in the perioperative period.
Congenital absence of the gallbladder in a child: a case report
Authors: Xiao Wei, Liying You, Chun Liu, Xu Xu
Journal: Front Pediatr (2024)
Keywords: case report, congenital absence of the gallbladder, fatty liver, hepatic ultrasound, liver function abnormalities
MeSH terms: Case Reports

Background:
Congenital absence of the gallbladder (CAGB) is an exceedingly rare embryological anomaly of the biliary system, with a complex etiology involving the failure of gallbladder formation during embryogenesis. Clinical manifestations are diverse; most patients are asymptomatic, while some present with symptoms such as biliary colic. The complexity of its clinical presentation and radiological features renders diagnosis challenging.
Case presentation:
Fetal ultrasound at 22 weeks of gestation revealed an absent gallbladder. At 9 years and 11 months of age, the child exhibited significant weight gain and abnormalities. Abdominal ultrasound and magnetic resonance images demonstrated fatty liver and gallbladder agenesis. Liver function tests indicated mild abnormalities, with aspartate aminotransferase at 67 IU/L and alanine aminotransferase at 44 IU/L. Following 6 months of hepatoprotective and lipid-lowering therapy, a satisfactory treatment response was achieved, with normalization of liver function and improvement in fatty liver.
Conclusions:
CAGB may be associated with other congenital abnormalities, although isolated cases are uncommon. Clinically, it may manifest as nonspecific biliary, gastrointestinal, or urinary symptoms, mimicking various digestive disorders and leading to misdiagnosis. Genetic sequencing and in-depth embryological research may elucidate the etiology and enhance diagnostic accuracy.
Herpetic Keratitis Following Treatment of Acute Antibody-Mediated Rejection in a Renal Transplantation Recipient
Authors: Geeta Behera, Sandip Sarkar, Jagadeeshwari Jayaseelan, Sreejith Parameswaran
Journal: Cureus (2024)
Keywords: acute graft rejection, antiviral therapy, herpetic keratitis, immunosuppression, post kidney transplant
MeSH terms: Case Reports

We report an incident case of herpetic keratitis in a renal transplant recipient treated for acute renal allograft rejection. A lady in her forties, a renal transplant recipient on treatment for allograft rejection, was referred with mild ocular symptoms in the right eye for two days. On evaluation, she had mild conjunctival hyperemia and extensive herpetic epithelial keratitis involving the limbal and central corneas. The patient healed without sequelae from the antivirals and lubricants. Viral keratitis in immunosuppressed patients should be suspected, even in patients with mild symptoms, as early initiation of treatment can prevent rapid stromal involvement and scarring.
Case report: Tremor in the placebo condition of a blinded clinical trial of intermittent theta-burst stimulation for cocaine use disorder
Authors: Vaughn R Steele, Alexander Rotenberg, Noah S Philip, Mark Hallett, Elliot A Stein, Betty Jo Salmeron
Journal: Front Psychiatry (2024)
Keywords: cocaine use disorder, itbs, low-intensity rtms, placebo effect, sham rtms
MeSH terms: Case Reports

We report a case of a new-onset, persistent tremor that developed during a clinical trial (NCT02927236) of intermittent theta burst stimulation [iTBS, a form of repetitive magnetic transcranial magnetic stimulation (rTMS)] for cocaine use disorder. Although the participant exhibited an exceptionally strong clinical response, subsequent unblinding revealed that they received sham iTBS. This case highlights the potential for strong functional neurological placebo responses in rTMS trials, and functional disorders might be a marker of a placebo response. Additionally, we note the possibility that the weak e-fields produced by some sham rTMS systems may induce clinically relevant effects.
A Rare Case of Hypokalemic Periodic Paralysis With Acute Urinary Retention: Diagnosis and Management
Authors: S Sara, Dhigvijay Tv, Gokulesh Dg, Balaji Elumalai, Mohamed Javid
Journal: Cureus (2024)
Keywords: channelopathy, flaccid paralysis, hypokalemia, hypokalemic periodic paralysis, urinary retention
MeSH terms: Case Reports

Hypokalemic periodic paralysis (hypoPP) is a rare channelopathy caused by mutations in skeletal muscle ion channels that usually occurs in young individuals and adolescents. The etiology can be attributed to various factors, such as idiopathic or secondary causes. It is characterized by episodes of sudden flaccid muscle weakness. Timely detection may mitigate the risk of severe complications. Secondary causes of hypoPP, such as hyperthyroidism, should be ruled out, as this could lead to thyrotoxic periodic paralysis. We report the case of a 19-year-old boy who presented to the ED with severe weakness in both the upper and lower extremities. The weakness rapidly progressed to his trunk and was accompanied by acute urinary retention. The physical examination was significant for bilateral upper and lower extremity weakness. Subsequent laboratory investigations revealed markedly low serum potassium levels. The patient's symptoms resolved after the replacement of potassium, and he was discharged without neurological deficits. Although rarely accompanied by acute urinary retention, hypoPP must be differentiated from other causes of weakness and paralysis so that the proper treatment can be initiated quickly. The rarity of hypoPP, a condition seldom encountered in clinical practice, and the added rarity of its coexistence with acute urinary retention further underscore the uniqueness of this case report.
Case report: Macrophage activation syndrome in a patient with Kabuki syndrome
Authors: Jingyuan Zhang, Yuanbo Kang, Zenan Xia, Yuming Chong, Xiao Long, Min Shen
Journal: Front Immunol (2024)
Keywords: kmt2d, kabuki syndrome, t cells, immunodeficiency, macrophage activation syndrome
MeSH terms: Abnormalities, Multiple / genetics, Face / abnormalities, Hematologic Diseases / diagnosis, Hematologic Diseases / etiology, Macrophage Activation Syndrome / diagnosis, Macrophage Activation Syndrome / etiology, Vestibular Diseases / diagnosis, Vestibular Diseases / etiology, Vestibular Diseases / genetics, Case Reports, DNA-Binding Proteins / genetics, Histone-Lysine N-Methyltransferase / genetics, Humans, Male, Neoplasm Proteins / genetics, Phenotype, Young Adult, KMT2D protein, human, Neoplasm Proteins, Histone-Lysine N-Methyltransferase, DNA-Binding Proteins, Kabuki syndrome

Macrophage activation syndrome (MAS), is a severe and fatal complication of various pediatric inflammatory disorders. Kabuki syndrome (KS), mainly caused by lysine methyltransferase 2D (KMT2D; OMIM 602113) variants, is a rare congenital disorder with multi-organ deficiencies. To date, there have been no reported cases of MAS in patients with KS. This report describes a case of a 22-year-old male with Kabuki syndrome (KS) who developed MAS. This unique case not only deepens the understanding of the involvement of KMT2D in immune regulation and disease, but expands the phenotype of the adult patient to better understand the natural history, disease burden, and management of patients with KS complicated with autoimmune disorders.
Non-steroidal anti-inflammatory drug induced intestinal stricturing: diaphragm disease
Authors: Nathan Johnson, Maseera Solkar, Rishabh Sehgal, Kallingal Riyad
Journal: J Surg Case Rep (2024)
Keywords: nsaids, diaphragm disease, inflammatory bowel disease, stricture
MeSH terms: Case Reports

Diaphragm disease (DD) is a rare small bowel enteropathy associated with non-steroidal anti-inflammatory drug use. Since the first description there have only been approximately 100 cases of DD reported in the literature. Stricturing webs or 'diaphragms' form in the bowel, causing non-specific abdominal symptoms that can ultimately lead to bleeding and obstruction. Diagnosis is notoriously challenging as there is no single gold standard investigation. We present two cases of DD both of which were ultimately diagnosed by surgical resection. We also propose a novel flow algorithm that can be utilized for working up patients with suspected DD.
Case report: Exceptional and durable response to Radium-223 and suspension of androgen deprivation therapy in a metastatic castration-resistant prostate cancer patient
Authors: Francesca Zacchi, Joan Carles, Macarena Gonzalez, Xavier Maldonado, Raquel Perez-Lopez, Maria Eugenia Semidey, Joaquin Mateo
Journal: Front Oncol (2024)
Keywords: radium-223, bone metastases, bone response, metastatic castration-resistant prostate cancer, prognosis
MeSH terms: Case Reports

Despite the development of new therapies in the last few years, metastatic prostate cancer (PCa) is still a lethal disease. Radium-223 (Ra-223) is approved for patients with advanced castration-resistant prostate cancer (CRPC) with bone metastases and no visceral disease. However, patients' outcomes are heterogenous, and there is lack of validated predictive biomarkers of response, while biomarkers for early identification of patients who benefit from treatment are limited. This case report describes a remarkable and durable response to Ra-223 in a CRPC patient with bone metastases who had rapidly progressed to many previous therapies; this response is now lasting for 5 years even after having stopped backbone androgen deprivation therapy (ADT). Here, we present the clinical course of this exceptional response, as well as comprehensive genomic and histopathology analyses on sequential biopsies acquired before and after therapy. Additionally, we review current knowledge on predictive and response biomarkers to Ra-223 in metastatic prostate cancer.
Optimal response to tislelizumab plus chemotherapy in metastatic triple-negative breast cancer: a case report and literature review
Authors: Yuxin Ma, Xinhong Shi, Kun Zhao, Shuyi Hu, Yue Shi, Yingying Jiang, Yiling Liu, Lin Lu, Yuting Chang, Fei Zhou, Yingying Dai, Zipeng Wu, Shiyi Li, Zhiying Qian, Xia Xu, Chenchen Li, Bo Shen, Guoren Zhou, Cheng Chen, Xiaohua Wang, Jifeng Feng
Journal: Front Oncol (2024)
Keywords: case report, eribulin mesylate, immune checkpoint inhibitors (icis), metastatic triple negative breast cancer (mtnbc), tislelizumab
MeSH terms: Case Reports

Metastatic triple-negative breast cancer (mTNBC) has the worst prognosis among breast cancer subtypes. Immune checkpoint inhibitors (ICIs) plus chemotherapy have promising survival benefits. Herein, we report a 51-year-old woman whose metastatic lesions were diagnosed as triple-negative subtype and who received tislelizumab plus eribulin treatment and achieved excellent efficacy. To our knowledge, this study is the first attempt to present tislelizumab in combination with eribulin for mTNBC treatment. New treatments resulting in prolonged survival and durable clinical responses would benefit mTNBC patients. Then, we summarize the possible influencing factors of the interaction between tislelizumab and eribulin.
Persistent Paradoxical Reaction to Midazolam despite General Anesthesia with Dexmedetomidine
Authors: Sarah Park, Mariam Ibrahim, Augusto Torres
Journal: Case Rep Anesthesiol (2024)
MeSH terms: Case Reports

Midazolam is a widely used benzodiazepine due to its rapid onset of action and relatively safe side effect profile. It is used for sedation, anxiolysis, and induction of general anesthesia. However, in <1% of instances, it may cause a paradoxical excitement: agitation, restlessness, myoclonus, stiffening of the limbs, and aggression. We report a case report in which preoperative administration of midazolam caused onset of the aforementioned symptoms that were not attenuated by general anesthesia with dexmedetomidine. This case report aims to create awareness about the rare adverse reactions of midazolam and prepare clinicians to manage these situations.
Case Report: The woman with the big heart-an imaging-guided attempt of surgical reduction
Authors: Katharina Huenges, Patrick Langguth, Christina Grothusen, Grischa Hoffmann, Julia Kapahnke, Assad Haneya, Jörg Strotmann, Jochen Cremer
Journal: Front Cardiovasc Med (2024)
Keywords: atrial, cardiac surgery, imaging, mitral, mitral valve
MeSH terms: Case Reports

In a female patient with acute cardiac decompensation, an auxiliary finding of a giant left atrium emerged. The surgical therapy of the atrial reduction, in addition to a mitral valve replacement and a coronary artery bypass grafting, is hereby presented.
Central Nervous System (CNS) T-Cell Lymphoma as the Presenting Manifestation of Late-Onset Combined Immunodeficiency
Authors: Anthony Jeffrey, Luke A Coyle, Dishan Samaranayake, Therese Boyle, James Drummond, Suran L Fernando
Journal: Case Rep Hematol (2023)
MeSH terms: Case Reports

Late-onset combined immunodeficiency (LOCID), considered now a subset of common variable immunodeficiency (CVID) disorders, is characterized by a predominantly T-cell immune defect. LOCID has a distinct phenotype from CVID with a greater risk of lymphoproliferative complications. As compared to the CVID cohort, LOCID patients also have increased rates of splenomegaly and granulomatous disease. We report a case of central nervous system (CNS) T-cell lymphoma in a 67-year-old male as the presenting manifestation of LOCID. The patient achieved a complete response to therapy after 4 cycles of MATRix (methotrexate, cytarabine, and thiotepa) and 2 cycles of ICE (etoposide, carboplatin, and ifosfamide) chemotherapy followed by CNS-directed autologous stem cell transplantation. Intravenous immunoglobulin replacement was commenced to address the underlying immunodeficiency. Pulmonary lesions consistent with a diagnosis of granulomatous and lymphocytic interstitial lung disease (GLILD) were identified as a second noninfectious complication of LOCID. The pulmonary lesions resolved after chemotherapy and immunoglobulin replacement. The patient remains well with no evidence of disease recurrence now more than 18 months after completion of therapy. This is the first reported case of T-cell lymphoma in an adult patient with LOCID. Further study is needed to elucidate the mechanisms of transformation of B- or T-cells to lymphoproliferation in primary immunodeficiency patients as well as research to inform evidence-based therapeutic strategies for this challenging cohort of patients.
Anterolateral Thigh Flap Reconstruction of Full Thickness Lateral Abdominal Wall Defect from Desmoid Tumour
Authors: Melissa Yeo
Journal: Case Rep Surg (2024)
MeSH terms: Case Reports

Desmoid tumours are benign but locally aggressive mesenchymal neoplasms that occur most commonly in the abdomen, with the potential to invade surrounding structures causing significant morbidity. Lateral abdominal wall defects are known to be more challenging and less frequently encountered compared to ventral abdominal wall defects. Asymmetric forces caused by contraction of remnant rectus and contralateral oblique muscles increase the risk of herniation postoperatively. We report a case of a challenging abdominal wall reconstruction after desmoid tumour resection in a 62-year-old male patient who presented to our hospital with a progressively enlarging left upper back lump of 6 months duration. A venous supercharged pedicled anterolateral thigh flap was combined with PROLENE® mesh for reconstruction, and the patient recovered well with good functional and aesthetic outcomes at 2-year follow-up. The pedicled anterolateral thigh flap with venous supercharging can be effectively used for the reconstruction of extensive lateral abdominal wall defects.
Pituitary Apoplexy After a Major Abdominal Surgery: A Case Report
Authors: Abdulaziz M Alshahrani, Ali Al Bshabshe, Mohammed B Al Shahrani
Journal: Cureus (2024)
Keywords: hepatic hydatid cyst resection, major abdominal surgery, pituitary adenoma, pituitary apoplexy, severe headache
MeSH terms: Case Reports

Pituitary apoplexy is a major complication of pituitary adenoma, and the diagnosis might be challenging if the patient presents with signs of meningeal irritation or electrolyte imbalance. It can be fatal if not diagnosed and treated appropriately. Apoplexy is the first clinical presentation in the majority of pituitary adenoma cases. The pathophysiology of pituitary apoplexy involves bleeding and/or ischemia of pituitary enlargement. In this case report, we present a case of pituitary apoplexy that developed after a major abdominal surgery. The patient presented with headache, hypertension, and visual loss. After confirming the diagnosis through a CT scan, the patient underwent a transsphenoidal surgical decompression.
Combined medical-interventional approaches for the management of complex fungal balls: a case series as a viable alternative in non-surgical patients
Authors: Elaine Dumoulin, Christina S Thornton, John H MacGregor, Alain Tremblay, Chrystal Chan, Paul R MacEachern, Margaret M Kelly, Ranjani Somayaji, Michael D Parkins, Christopher H Mody
Journal: Ther Adv Respir Dis (2024)
Keywords: aspergilloma, antifungals, bronchoscopy, fungal ball, mycetoma
MeSH terms: Antifungal Agents / administration & dosage, Bronchoscopy, Pulmonary Aspergillosis / drug therapy, Observational Study, Adult, Aged, Combined Modality Therapy, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Treatment Outcome, Antifungal Agents

Intracavitary pulmonary aspergilloma is a persistent and life-threatening infection that carries a mortality rate of up to 15%. It occurs when Aspergillus species gain entry to an existing lung cavity. In the absence of definitive treatment, patients may succumb to severe complications such as massive hemoptysis, cachexia, or secondary infections. Aspergillomas often show limited response to antifungal medications, mainly due to insufficient drug concentrations within the cavities. Surgery is frequently the preferred treatment option, but it poses significant risks, and many individuals are ineligible due to underlying health issues. We present the most extensive non-surgical fungal ball cohort to date, managed using an innovative multimodal strategy that combines antifungal therapy before and after bronchoscopic debulking. This was a cross-sectional observational study. For those who cannot undergo surgery, our medical center has pioneered a multimodal approach to aspergilloma resection. This approach combines bronchoscopic endoscopy with antifungal therapy and has been applied successfully to more than 18 patients that are presented in this series. The median age of the cohort was 58 years (range: 32-73), with an equal sex distribution. The mean percent predicted FEV1 was 65.3%. The mean follow-up duration was 3.6 years (range: 0.5-10 years). The cohort receiving antifungals systematically prior to debridement showed a reduction of the pre-existing cavity (40.38 mm versus 34.02 mm, p = 0.021). Across the 18 patients during the follow-up period, 94% remained recurrence-free (defined by symptoms and radiology). Our study fills a critical knowledge gap regarding the significance of initiating antifungal treatment before bronchoscopic debulking and presents a viable approach in these cases for which there is a current unmet therapeutic need.