OpenMed/multicare-articles huggingface dataset:
Solitary Fibrous Tumor of the Central Nervous System: A Report of Two Cases with Emphasis on Diagnostic Pitfalls
Authors: Absalom Mwazha, Nondabula Moyeni, Zuzile Zikalala, Gamalenkosi Bonginkosi Nhlonzi
Journal: Case Rep Pathol (2024)
MeSH terms: Case Reports

Solitary fibrous tumor (SFT) is a rare primary central nervous system neoplasm that usually presents as a dural-based mass. Awareness of the entity is limited by the rarity of the tumor which renders it prone to misdiagnosis. We present two cases of SFT located in the right parafalx and intraventricular region. The cases were classified as WHO grade 1 and grade 2, respectively. The present study discusses the radiological, histomorphological, and immunohistochemical features of SFT, with emphasis on potential diagnostic pitfalls that may lead to erroneous diagnosis.
Case report: Secondary failure to tolvaptan in a patient with SCLC and paraneoplastic SIADH
Authors: Sheryl Menzi, Silvia Daniela Jaramillo, Stephan Pfister, Hubert Schefer, Andreas Werner Jehle
Journal: Front Endocrinol (Lausanne) (2024)
Keywords: adh, sclc, siadh, antidiuretic hormone, copeptin, hyponatremia, lung cancer, tolvaptan
MeSH terms: Antidiuretic Hormone Receptor Antagonists / therapeutic use, Inappropriate ADH Syndrome / complications, Inappropriate ADH Syndrome / drug therapy, Lung Neoplasms / complications, Lung Neoplasms / drug therapy, Small Cell Lung Carcinoma / complications, Small Cell Lung Carcinoma / drug therapy, Tolvaptan / therapeutic use, Case Reports, Aged, Humans, Hyponatremia / drug therapy, Hyponatremia / etiology, Male, Middle Aged, Treatment Failure, Tolvaptan, Antidiuretic Hormone Receptor Antagonists

The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is frequent in lung cancer patients. Here, we report a case with persistent hyponatremia, which suggested malignant SIADH and facilitated an early diagnosis of small cell lung cancer (SCLC). A combined radio-chemotherapy led to a partial remission and resolution of SIADH. An early relapse was indicated by reoccurring severe hyponatremia and increased copeptin levels, which were used as surrogate markers for the antidiuretic hormone (ADH). As palliative immunochemotherapy, together with fluid restriction and solute substitution, were unable to control hyponatremia, treatment with the ADH V2-receptor antagonist tolvaptan was initiated. Over time, the dose of tolvaptan needed to be increased, paralleled by a well-documented exponential increase of copeptin levels. In summary and conclusion, this is a rare case of a secondary failure to tolvaptan with unique documentary evidence of increasing copeptin levels. This observation supports the hypothesis that exceedingly high ADH levels may lead to competitive displacement of tolvaptan from the V2 receptor.
Case report: Widely split P' waves in a patient with focal atrial tachycardia
Authors: Hao Jiang, Zhongbao Ruan, Yin Ren, Xiangwei Ding
Journal: Front Cardiovasc Med (2024)
Keywords: p' waves, electrocardiography, electrophysiology, focal atrial tachycardia, left atrial appendage
MeSH terms: Case Reports

Background:
Widely split P waves in sinus rhythm have been reported previously. However, widely split P' waves in focal atrial tachycardia (AT) on a surface electrocardiogram (ECG) have rarely been reported. The electrophysiological mechanism is relatively difficult to clarify, requiring a electrophysiological study.
Case summary:
A 67-year-old patient, who had undergone two radiofrequency ablations for atrial fibrillation, presented with recurrent palpitation. During the palpitation episode, the 12-lead ECG showed AT with a 3:1 atrioventricular conduction rate. P' waves were markedly prolonged in duration and widely split in morphology. An electrophysiological study showed that the tachycardia arose from the left atrial appendage (LAA) and was conducted through two distinct pathways. The impulse of one pathway was transmitted solely via the superior part of the atrium, including the Bachmann bundle. The second pathway was conducted via the coronary sinus and transmitted the impulse from the LAA to the ventricle. After the site showed that the earliest activation was ablated, repeated intravenous infusion of isoprenaline and programmed atrial stimulation did not induce tachycardia.
Conclusion:
Widely split P' waves in AT indicate intra- and interatrial conduction blocks, which can be easily overlooked due to the presence of low-voltage areas. Therefore, an electrophysiological study is crucial for identifying the origin of the tachycardia and elucidating the mechanistic details.
Rare metastasis in a patient with BRAF-mutated rectal cancer: choroidal metastasis - case report and literature review
Authors: Hacer Demir, Mustafa Muhterem Ekim, Esra Özgül, Sena Ece Davarci, Meltem Baykara
Journal: GMS Ophthalmol Cases (2024)
Keywords: braf mutation, choroid metastasis, rectal cancer
MeSH terms: Case Reports

Purpose:
Colorectal cancers are common and have high mortality, and metastasis is common in follow up. Choroidal metastasis is encountered rarely in rectum cancers, and there is no previous case reported from Turkey. We present our patient who developed choroidal metastasis in his cancer follow-up.
Case report:
A 74-year-old male patient had undergone operation due to the diagnosis of rectum cancer two years ago, and lung (L) metastasis developed in the 4th month after the adjuvant therapy, but he refused to receive treatment and remained out of follow-up. The patient presented with complaints of decreased vision and light flashes in his eye 21 months after the diagnosis.
Management and outcome:
Ocular examination revealed a choroidal mass and radiologically choroidal and multiple brain metastases were detected. In our case, whole-brain radiotherapy was administered in the treatment since there were also multiple brain metastases. However, as the ECOG (Eastern Cooperative Oncology Group) performance status of the patient was 3-4 after radiotherapy, systemic treatment was not considered appropriate, and the best supportive care was given. The patient died 2 months after the diagnosis of choroidal metastasis.
Conclusion:
Currently, there are few suggestions in case reports regarding appropriate treatment approaches for the treatment of rectal cancerchoroidal metastases. Multidisciplinary approaches may be effective for local and systemic treatment. Our case highlights a pathological entity with poor prognosis, which is rarely encountered during the course of rectal adenocarcinomas, and it is the first case of choroidal metastasis reported from our country. However, we believe that it will be important to draw attention to the fact that it is the first reported case of choroid metastasis in a rectal cancer patient with a BRAF V600 E mutation, and patients with BRAF V600 E mutation may develop metastasis to atypical areas due to their aggressive biology.
Case Report: Upper limb superficial venous thrombosis associated with oral contraceptives mimicking soft tissue mass
Authors: Jun Hyeong Song, Kyoung-Chul Chun, Gwan Hee Han, Seung-Woo Yang, Sang-Hee Yoon, Jin-Sung Yuk, Jaeki Ahn, Sang Hyun Nam, Jongwoo Kim, Myounghwan Kim
Journal: Front Cardiovasc Med (2023)
Keywords: forearm mass, forearm pain, oral contraceptives, upper extremity, venous forearm mass, venous thrombosis
MeSH terms: Case Reports

Background:
Venous thrombosis associated with the use of oral contraceptives (OCs) occurs mostly in the deep veins of the lower extremity. A lesion of the upper extremity is rare, and the majority of thrombotic events that occur in the superficial vein of the upper extremity are caused by intravenous catheters. We present a rare case of superficial venous thrombus on the upper extremity in a woman with a history of long-term OC use.
Case presentation:
A 35-year-old woman, with an 8-year history of OC use, presented with a 2-year history of painfully palpable masses on her left forearm. The lesion mimicking soft tissue mass was confirmed to be superficial venous thrombi through ultrasound and magnetic resonance imaging. Conservative treatment including non-steroidal anti-inflammatory drugs, vasoprotective agents, and aspirin was prescribed. Through consultation with the Department of Obstetrics and Gynecology, it was confirmed that the current OCs could be discontinued, and the pain was almost relieved after conservative treatment.
Conclusions:
If thrombotic events occur in the superficial vein of the upper extremity without intravenous catheters, detailed medical history taking and the possibility of OCs should be considered.
Refractory human cytomegalovirus infection without evidence of genetic resistance in the UL-54 and UL-97 genes in a pediatric hematopoietic stem cell transplant recipient: a case report
Authors: Alejandra Pando-Caciano, Ketty Adid Escudero-Ramirez, Jackeline Carol Torres-Rodríguez, Holger Maita-Malpartida
Journal: Front Med (Lausanne) (2024)
Keywords: hsct, antiviral resistance, case report, cidofovir, cytomegalovirus infection, foscarnet, ganciclovir
MeSH terms: Case Reports

Cytomegalovirus (CMV) infection is a common complication in patients undergoing hematopoietic stem cell transplantation (HSCT). Management of refractory CMV infections, especially in developing countries, can be challenging due to the limited availability of second and third-line antiviral drugs or alternative treatments. Here, we present a case of an 8 years-old patient diagnosed with acute myeloid leukemia. Eight months post-diagnosis, the patient underwent TCR-αβ+/CD19+-depleted haploidentical HSCT. Both the donor and recipient tested positive for anti-CMV IgG and negative for IgM antibodies. Before transplantation, the patient received CMV prophylaxis in the form of intravenous ganciclovir. Post-transplantation, the patient exhibited oscillating CMV viral loads and was diagnosed with a refractory infection. Treatment with ganciclovir, foscarnet, and cidofovir was unsuccessful. Sequencing of UL-54 and UL-97 genes was performed to rule out potential resistance to first-line treatment. Ten months after the HSCT, the child died from hypovolemic shock due to gastrointestinal bleeding. This is the first case reported in Peru and Latin America of a refractory CMV infection in a pediatric HSCT recipient without evidence of clinical symptoms and CMV genetic resistance. This case demonstrates the need for alternative treatments to manage refractory CMV infections, especially in haploidentical HSCT cases where drug resistance is frequent (~15%). Furthermore, this case highlights the importance of using highly sensitive genetic tools to detect mutations associated with virus resistance in a broader range of the viral genome.
A rare presentation of acute-onset chronic inflammatory demyelinating polyneuropathy with the detection of anti-GM3 and anti-sulfatides antibodies: a case report
Authors: Ruohan Sun, Yao Meng, Lingyu Li, Wei-Hong Chen, Jing Xu, Peiyuan Lv, Yanhong Dong
Journal: Front Immunol (2024)
Keywords: guillain-barré syndrome, antibody, chronic inflammatory demyelinating polyneuropathy, demyelinating disease, diagnose
MeSH terms: Autoantibodies / blood, Autoantibodies / immunology, G(M3) Ganglioside / analogs & derivatives, G(M3) Ganglioside / immunology, Polyradiculoneuropathy, Chronic Inflammatory Demyelinating / blood, Polyradiculoneuropathy, Chronic Inflammatory Demyelinating / diagnosis, Polyradiculoneuropathy, Chronic Inflammatory Demyelinating / immunology, Case Reports, Diagnosis, Differential, Female, Humans, Immunoglobulins, Intravenous / therapeutic use, Middle Aged, Sulfoglycosphingolipids / immunology, Autoantibodies, G(M3) Ganglioside, Sulfoglycosphingolipids, Immunoglobulins, Intravenous

Objectives:
Chronic inflammatory demyelinating polyneuropathy (CIDP) is an acquired immune-mediated neuropathy defined by clinical progression for more than 2 months. 16-20% of CIDP patients may present with rapidly progressive weakness that resembles GBS, known as acute-onset CIDP (A-CIDP). However, it is challenging to distinguish from GBS-TRF because of their similar clinical symptom and features. In this case review, we report a patient with A-CIDP with the detection of anti-GM3 and anti-sulfatides antibodies, which rarely have been in A-CIDP and may account for her progressive and recurrent symptoms.
Methods:
We analyzed existing medical literature and described a clinical case of A-CIDP with antibodies positive.
Results:
We reported a 56-year-old female presented with bilateral lower extremity weakness and distal numbness. She experienced similar symptoms four times and responded well to the IVIg therapy. Lumbar puncture demonstrated albumin-cytologic dissociation and EDX examination revealed multiple peripheral nerve damage. After ruling out other demyelination diseases, a diagnosis of A-CIDP was made.
Discussion:
The antiganglioside and anti-sulfatide antibodies are involved in CIDP pathogenesis and can help to distinguish A-CIDP and other variants. To prevent secondary damage, it is important to monitor relapse and remission symptoms along the treatment line. A rare case of A-CIDP is discussed concerning the detection of anti-GM3 and anti-sulfatides antibodies, thus making a retrospective comparison of antibodies in some literature to understand A-CIDP better.
Late Presentation of β-Thalassemia Major Patient With Left Hemiparesis: A Case Report
Authors: Ashwaq Hussain, Ajay Singh, Sanjiya Arora, Varnika Gupta, Priya R Mallimala
Journal: Cureus (2024)
Keywords: beta-thalassemia, blood transfusion, cerebral atrophy, hemiparesis, iron overload
MeSH terms: Case Reports

Thalassemia is a hereditary autosomal recessive disorder that is distinguished by a diminished rate of hemoglobin (Hb) synthesis arising from an anomaly in the synthesis of α or β globin chains. Classical symptoms of β-thalassemia are frequently observed in patients who present late for blood transfusion (BT), which is typical among South Asian countries in light of their limited resources. This case report is an uncommon instance of a typical occurrence that has been infrequently reported in the South Asian region. The reporting of this case will assist healthcare workers in managing cases appropriately. We present a 12-year-old female child diagnosed with β-thalassemia major with a late presentation than usual accompanied by an unusual finding of left hemiparesis at a young age of five years. The patient had been lost to follow-up, presented with easy fatiguability, poor weight gain, and growth restriction, all of which are classic symptoms of β-thalassemia. The patient was treated with a BT and continued to be monitored for transfusion and iron overload management.
Optimizing outcomes when treating functional neurological disorder in acute care settings: case reports depicting the value of diagnostic precision and timely and appropriate psychological interventions using an interdisciplinary framework
Authors: Melissa J Greenfield, Aaron D Fobian, Rachel E Fargason, Badari Birur
Journal: Front Psychiatry (2024)
Keywords: acute care, functional neurological symptom, intervention, medical utilization, psychiatry, psychology, stigma
MeSH terms: Case Reports

Introduction:
Unexplained physical signs and symptoms represent a significant portion of patient presentations in acute care settings. Even in cases where a patient presents with a known medical condition, functional or somatic symptoms may complicate the diagnostic and treatment processes and prognostic outcome. One umbrella category for neurologically related somatic symptoms, functional neurological disorder (FND), presents as involuntary neurological symptoms incompatible with another medical condition. Symptoms may include weakness and/or paralysis, movement disorders, non-epileptic seizures, speech or visual impairment, swallowing difficulty, sensory disturbances, or cognitive symptoms (1). While FND presents as neuropsychiatric, providers commonly report feeling hesitant to diagnose these disorders. Inexperience or lack of appropriate education on relevant research regarding evidence-based practices or standard of practice (SOP) may result in over- or underperforming diagnostic workups and consultations, utilizing inappropriate medications, and failing to offer evidence-based psychological interventions. Being mindful of these challenges when treating patients presenting with functional symptoms in acute care settings can help to support and protect the patients and care team and appropriately control healthcare costs.
Methods:
The University of Alabama at Birmingham Medical Center identified cases representing categories of quality and safety problems that arise in treating FND in acute care settings. Patients signed a consent form to participate in the case report. The case information for each was presented without identifying information.
Discussion:
The cases highlight potential challenges when caring for patients presenting with FND in acute care settings. The challenges covered include over- or underutilization of diagnostic workups and consultation, over- or underutilization of psychopharmacological medications, and over- or undertreating a medical condition when a functional symptom is present. In each case, these lapses and errors caused the patient distress, additional treatments, care delays, and delayed symptom remission. Additionally, these challenges have direct and indirect fiscal costs, which can be mitigated with the appropriate education and training, resources, and protocols. Hospitals can benefit from system-wide SOP to improve the identification and management of FND to prevent harm to patients. An SOP commonly presents to specific specialties and ensures the appropriate diagnostic workup, consultations, and timely evidence-based interventions.
Toxic anterior segment syndrome following trabeculectomy with mitomycin C
Authors: Helen Ginger-Eke, Chimdia Ogbonnaya, Annamalai Odayappan, Jude Shiweobi
Journal: GMS Ophthalmol Cases (2023)
Keywords: tass, complications, mitomycin c, trabeculectomy
MeSH terms: Case Reports

Objective:
Toxic anterior segment (TASS) is a rare acute sterile anterior segment inflammation that typically develops within 12 to 24 hours after an anterior segment surgery. The purpose of this case report is to alert surgeons to the possibility of this complication following any anterior segment surgery, including trabeculectomy, and to highlight the possible etiologies and measures to prevent it.
Patient and method:
A 58-year-old male glaucoma patient was initially managed medically for primary open angle glaucoma with antiglaucoma medications. There was rapidly progressive glaucomatous optic nerve damage in his left eye within the following year, despite the use of antiglaucoma medications, hence the need for trabeculectomy.
Result:
The post-operative condition of the patient's eye was stormy with diffuse limbus-to-limbus corneal edema and profound Descemet's membrane folds, among other features of TASS, with associated deteriorating visual acuity.
Conclusion:
Although there is no documented report of TASS following trabeculectomy with mitomycin C, surgeons should be alerted to this possibility. Preventive measures include extreme care to avoid errors while preparing and administering diluted solutions, especially medications that are administered into the intracameral space.
Antiphospholipid syndrome presenting as extensive skin ulcers on unilateral lower extremity: a case report
Authors: Yanan Yang, Yaoyao Zhou, Lingyi Zhang, Mengru Pang
Journal: Front Surg (2024)
Keywords: antiphospholipid syndrome, immunity, lower extremity, surgery, ulcers
MeSH terms: Case Reports

Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by recurrent arterial and venous thrombosis, habitual fetal miscarriages, often accompanied by mild to moderate thrombocytopenia, and persistent moderate-to-high titer positivity for antiphospholipid antibodies (aPLs). However, patients with antiphospholipid antibodies may also present with several nonthrombotic clinical manifestations, such as thrombocytopenia, cardiac valve disease, nephropathy, skin ulcers, or cognitive dysfunction, which are collectively referred to as nonstandard manifestations of APS. Of these, for APS with predominantly cutaneous ulcers, previous reports have focused on APS with combined cutaneous vasculitis, and its medical treatment, rather than cutaneous ulcers with predominantly fatty inflammatory lesions, and the associated surgical treatment. Here, we admitted a relatively rare case of primary APS with extensive skin ulceration of the right lower extremity, without cutaneous vasculitis, in the presence of extensive and severe inflammatory lipoatrophy, carrying anti-β2-glycoprotein I and lupus anticoagulant, which is reported as follows, with a view to raising awareness of this disease.
Missile embolism from pulmonary vein to left ventricle: report of a case
Authors: Mohammadrafie Khorgami, Fattaneh Khalaj, Maziar Gholampour, Hassan Tatari
Journal: Front Cardiovasc Med (2024)
Keywords: foreign body, gunshot, left ventricle, missile embolization, pulmonary vein (pv)
MeSH terms: Case Reports

Missile embolization is rare in penetrating trauma, occurring in 0.3% of cases. Bullet embolism into the left ventricle is less frequent, with few instances described in the literature. This paper describes an instance of left ventricular bullet embolism from the pulmonary venous system following gunshot chest trauma. A 7-year-old boy sustained a gunshot wound to his chest during an assault accident. Despite thoracic pain, he remained conscious and exhibited vital signs. A CXR and CT scan revealed a bullet in the left mediastinum. A left thoracotomy was performed to remove blood and clots from the pericardium. The patient was sent to a tertiary referral hospital for further investigation. The patient underwent elective surgery to remove the foreign body from inside the heart. The procedure involved a partial thymectomy and pericardial opening, and the patient was released from medical care after 14 days. After 6 months, there were no signs or symptoms of cardiothoracic infection or evidence of mitral valve regurgitation in echocardiography.
Atypical Presentation and Diagnosis of Multiple Myeloma: A Case Report
Authors: Iris Kong, Luke W Riddell, Jacquelyn M Kohler, Michael C Nguyen, Michelle N Carraro
Journal: Cureus (2024)
Keywords: blunt trauma, expansile mass, imaging, multiple myeloma, vertebral artery dissection
MeSH terms: Case Reports

Chronic neck pain is a common, seemingly benign condition that typically does not warrant an urgent workup, in contrast to acute onset neck pain. Vertebral artery dissection (VAD) is a relatively rare presentation of acute onset neck pain and often presents in the context of blunt trauma. Due to the risk of subsequent clot formation and stroke, patients who present with symptoms suggestive of VAD must be promptly screened, most often first with computed tomography angiography (CTA) followed by magnetic resonance imaging (MRI) or magnetic resonance angiography (MRA) for further evaluation. We present a case of a 69-year-old male with a history of chronic neck pain who was seen in the emergency department due to acute, severe neck pain with initial CTA imaging that suggested left VAD. However, follow-up MRI of his cervical spine identified that what seemed to be a left VAD was instead multiple myeloma. This case demonstrates the utility of using multiple imaging modalities, including CT, CTA, MRI, and MRA, in diagnosing an atypical presentation of multiple myeloma and the consequences of physician implicit biases that are often involved when treating patients with chronic pain.
Systemic pain relief after omalizumab injection in patient with hypermobile Ehlers-Danlos syndrome: A case report
Authors: Sarahrose Jonik, Andrew Joseph Rothka, Neyha Cherin
Journal: Clin Case Rep (2024)
Keywords: chronic pain, hypermobile ehlers–danlos syndrome, omalizumab, physical medicine and rehabilitation, quality of life
MeSH terms: Case Reports

Omalizumab may be a beneficial adjunct treatment option for hEDS patients require to improve pain control, ability to perform ADLs and functionality and social engagement, and most importantly, quality of life.