OpenMed/multicare-articles huggingface dataset:
Case report: Cytokine hemoadsorption in a case of hemophagocytic lymphohistiocytosis secondary to extranodal NK/T-cell lymphoma
Authors: Juan Carlos Ruiz-Rodríguez, Luis Chiscano-Camón, Adolf Ruiz-Sanmartin, Clara Palmada, Ivan Bajaña, Gloria Iacoboni, Camilo Bonilla, Alejandra García-Roche, Erika Paola Plata-Menchaca, Carolina Maldonado, Marcos Pérez-Carrasco, Mónica Martinez-Gallo, Clara Franco-Jarava, Manuel Hernández-González, Ricard Ferrer
Journal: Front Med (Lausanne) (2022)
Keywords: cytokine hemoadsorption, cytokine storm, hemophagocytic lymphohistiocytosis, multiorgan dysfunction, shock
MeSH terms: Case Reports

We discuss a single case of Hemophagocytic lymphohistiocytosis (HLH) due to NK-type non-Hodgkin lymphoma and Epstein-Barr virus reactivation with multiorgan dysfunction and distributive shock in which we performed cytokine hemoadsorption with Cytosorb ®. A full microbiological panel was carried out, including screening for imported disease, standard serologies and cultures for bacterial and fungal infection. A liver biopsy and bone marrow aspirate were performed, confirming the diagnosis. The patients fulfilled the HLH-2004 diagnostic criteria, and according to the 2018 Consensus Statements by the HLH Steering Committee of the Histiocyte Society, dexamethasone and etoposide were started. There was an associated hypercytokinemia and, due to refractory distributive shock, rescue therapy with cytokine hemoadsorption was performed during 24 h (within day 2 and 3 from ICU admission). After starting this procedure, rapid hemodynamic control was achieved with a significant reduction in vasopressor support requirements. This case report highlights that cytokine hemoadsorption can be an effective since rapid decrease in IL-10 levels and a significant hemodynamic improvement was achieved.
Case Report: Durvalumab-Associated Encephalitis in Extensive-Stage Small Cell Lung Carcinoma
Authors: Yosuke Shionoya, Akito Hattori, Taro Hanada, Michihiro Fujino
Journal: Front Oncol (2021)
Keywords: durvalumab, encephalitis, extensive stage, immunotherapy, small cell lung carcinoma
MeSH terms: Case Reports

In recent years, the clinical importance of immunotherapy has been demonstrated in the treatment of extensive-stage small-cell lung cancer (ES-SCLC). However, immune checkpoint inhibitors (ICIs) have been shown to cause immune-related adverse events (irAEs), including autoimmune encephalitis. Here, we describe th treatment of a patient with ES-SCLC who developed immune-related encephalitis. A 68-year-old Japanese woman with ES-SCLC treated with carboplatin plus etoposide plus durvalumab 20 days earlier was admitted to our hospital with a high fever and anorexia. Her symptoms gradually worsened over time, and she had a headache daily and showed reduced levels of consciousness. An electroencephalogram showed diffuse slow waves, and there was a slight increase in cell counts and an increase in protein levels in the cerebrospinal fluid. The patient was diagnosed with durvalumab-associated encephalitis. Her symptoms improved immediately after steroid pulse therapy. Following steroid pulse therapy, oral prednisolone (1 mg/kg) was administered, and then, the dose was gradually reduced. Subsequently, treatment with carboplatin plus etoposide without durvalumab was restarted. In conclusion, this study shows the efficacy of steroid therapy in the treatment of durvalumab-induced encephalitis in ES-SCLC.
A novel variation of SERPINC1 caused deep venous thrombosis in a Chinese family: A case report
Authors: Yu Peng, Tun Wang, Yu Zheng, Aojie Lian, Di Zhang, Zhimin Xiong, Zhengmao Hu, Kun Xia, Chang Shu
Journal: Medicine (Baltimore) (2019)
MeSH terms: Antithrombin III / genetics, Asian People / genetics, Venous Thrombosis / diagnostic imaging, Venous Thrombosis / genetics, Case Reports, Adult, Child, Computed Tomography Angiography / methods, Exome Sequencing / methods, Humans, Male, Middle Aged, Pulmonary Embolism / diagnostic imaging, Thrombophilia / complications, Ultrasonography, Doppler, Color / methods, Venous Thrombosis / etiology, Young Adult, SERPINC1 protein, human, Antithrombin III, Antithrombin deficiency type 2

Rationale:
Deep vein thrombosis (DVT) is the formation of a blood clot formed in the deep veins of the lower limbs. Known genetic factors of DVT include deficiencies of antithrombin (AT), protein C, protein S, factor V Leiden mutation, and prothrombin G20210A mutation. Here, a 5-generation Chinese family with inherited DVT was recruited for genetic analysis.
Patient concerns:
The patient came to see a doctor because of leg swelling. A color Doppler ultrasound examination showed extensive thrombosis within the deep veins of her left leg. Computed tomography angiography showed a pulmonary embolism in her right lower pulmonary artery.
Diagnoses:
Type II AT deficiency lead to inherited DVT.
Interventions:
Whole-exome sequencing and cosegregation analysis were carried for the DVT family.
Outcomes:
An unreported heterozygous missense variation, c.281T>C, was identified within the SERPINC1 gene. This missense variation of SERPINC1 leads to type II AT deficiency.
Lessons:
This result further enriched the variation spectrum of the SERPINC1 gene.
Case Report: Dynamic Changes in Hemodynamics During the Formation and Progression of Intracranial Aneurysms
Authors: Xiaodong Zhai, Yadong Wang, Gang Fang, Peng Hu, Hongqi Zhang, Chengcheng Zhu
Journal: Front Cardiovasc Med (2022)
Keywords: computational fluid dynamics, dynamic changes, hemodynamic analysis, intracranial aneurysms, natural history
MeSH terms: Case Reports

Despite the devastating consequences of aneurysmal subarachnoid hemorrhage (SAH), the mechanisms underlying the formation, progression, and rupture of intracranial aneurysms (IAs) are complex and not yet fully clear. In a real-world situation, continuously observing the process of aneurysm development in humans appears unrealistic, which also present challenges for the understanding of the underlying mechanism. We reported the relatively complete course of IA development in two real patients. On this basis, computational fluid dynamics simulation (CFD) was performed to evaluate the changes in hemodynamics and analyze the mechanism underlying the formation, progression, and rupture of IAs. Our results suggested that the formation and progression of IAs can be a dynamic process, with constantly changing hemodynamic characteristics. CFD analysis based on medical imaging provides the opportunity to study the hemodynamic conditions over time. From these two rare cases, we found that concentrated high-velocity inflow jets, flows with vortex structures, extremely high WSS, and a very steep WSSG were correlated with the formation of IAs. Complex multi-vortex flows are possibly related to IAs prior to growth, and the rupture of IAs is possibly related to low WSS, extreme instability and complexity of flow patterns. Our findings provide unique insight into the theoretical hemodynamic mechanism underlying the formation and progression of IAs. Given the small sample size the findings of this study have to be considered preliminary and exploratory.
A Case of Dysgraphia after Cerebellar Infarction Where Functional NIRS Guided the Task Aimed at Activating the Hypoperfused Region
Authors: Mutsumi Fujii, Kazumi Tanigo, Hirokazu Yamamoto, Keijyu Kikugawa, Masayuki Shirakawa, Miki Ohgushi, Takaaki Chin
Journal: Case Rep Neurol Med (2021)
MeSH terms: Case Reports

Background:
Linguistic impairment following cerebellar lesions is characterized by a marked cerebellocerebral diaschisis with decreased perfusion in the left cerebral hemisphere.
Case:
We report on a 60-year-old right-handed French chef who presented with linguistic deficits following a right cerebellar infarction. Neurolinguistic examinations in the acute phase showed impaired graphomotor planning, especially for kanji (Japanese morphograms). Despite the absence of any structural damage to the supratentorial brain regions, a quantitative 123I-IMP SPECT study revealed a relative hypoperfusion, mainly around the left posterior middle temporal gyrus, considered to be a crossed cerebellar-cerebral diaschisis. We performed functional near-infrared spectroscopy (fNIRS) and observed that a picture card task could increase blood perfusion in the affected area. This task was as follows: once he saw a picture card depicting a dish, the patient had to list the ingredients that make up the dish. For example, he had to name vegetables, meat, and spices upon seeing a "curry" picture card. We added this task to his daily speech-hearing therapy regimen. In the chronic phase, we confirmed symptom amelioration in linguistic performance-paralleled reduction in the level of hypoperfusion on SPECT study. Discussion. This case is the first report of an fNIRS approach used to evaluate evidence-based prospective speech-hearing tasks by observing blood flow to the hypoperfused area of the cerebral cortex surface.
Case Report: Cryptococcal meningitis in Hodgkin's Lymphoma patient receiving brentuximab-vedotin therapy
Authors: Tatiana Cunha Pereira, Rita Rb-Silva, Rita Félix Soares, Nelson Domingues, José Mariz
Journal: F1000Res (2020)
Keywords: brentuximab-vedotin, c neoformans, hodgkin lymphoma, meningitis
MeSH terms: Brentuximab Vedotin / therapeutic use, Hodgkin Disease / complications, Hodgkin Disease / drug therapy, Meningitis, Cryptococcal / drug therapy, Case Reports, Amphotericin B / therapeutic use, Antifungal Agents / therapeutic use, Cryptococcus neoformans, Dexamethasone / therapeutic use, Flucytosine / therapeutic use, Humans, Male, Middle Aged, Opportunistic Infections / drug therapy, Opportunistic Infections / microbiology, Antifungal Agents, Dexamethasone, Brentuximab Vedotin, Amphotericin B, Flucytosine

Cryptococcus neoformans infections occur mostly in immunodeficient individuals, being the most common opportunistic fungal central nervous system (CNS) infection in HIV seropositive patients. Moreover, other conditions affecting host immunity, such as hematologic malignancies, organ transplantation and immunosuppressive drugs are implicated as risk factors. The authors present a case of a 48-year-old male with Hodgkin Lymphoma for 26 years and submitted to several lines of treatment, diagnosed with cryptococcal meningitis while on therapy with brentuximab. The patient presented with positive cerebral spinal fluid (CSF) cryptococcal antigen plus positive blood cultures. He was put under induction antifungal treatment with liposomal amphotericin B and flucytosine, as well as corticosteroid therapy with dexamethasone with headache improvement and a favorable clinical evolution. There are no reported cases of cryptococcal meningoencephalitis under CD30-directed monoclonal antibody. Furthermore, this case illustrates the risk of Cryptococcus neoformans infection in immunocompromising conditions other than HIV, underlining the need of considering this differential diagnosis when physicians face an opportunistic neuroinfection.
Acute Pancreatitis and Disseminated Intravascular Coagulopathy in COVID-19 Infection: A Case Report
Authors: Mohammad Abu-Abaa, Ghassan Al-Qaysi, Ali Abdulsahib, Talar Acob
Journal: Cureus (2023)
Keywords: bleeding, covid 19, disseminated intravascular coagulation (dic), elevated lipase, severe pancreatitis
MeSH terms: Case Reports

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and can be a plausible trigger for both disseminated intravascular coagulopathy (DIC) and acute pancreatitis. We present an 85-year-old male patient who presented with altered mental status and tested positive for COVID-19 infection. He was hypoxic with an incremental need for oxygen. He had clinical as well as imaging evidence of acute pancreatitis. Clinical evidence of bleeding was noted and lab findings were suggestive of DIC. Despite aggressive initial management, his clinical status continued to deteriorate and comfort care was sought eventually. This case highlights COVID-19 infection as a possible trigger for acute pancreatitis as well as DIC. It also highlights some of the differences in COVID-19-induced DIC, which fulfills the diagnostic criteria of DIC but has atypical findings.
A rare case of ectopic pregnancy in a caesarean section scar: a case report
Authors: Omer A Mahmoud, Mustafa Z Mahmoud
Journal: BJR Case Rep (2017)
MeSH terms: Case Reports

Intramural pregnancy with implantation in a previous caesarean section scar is probably the rarest location for an ectopic pregnancy. Little is known about its incidence and natural history. This rare condition may be accompanied by serious clinical events, such as rupture of the uterus and unrestrainable haemorrhage, which are sometimes treated with hysterectomy causing sterility. Most treatment choices are effectual, such as dilatation and curettage (D and C), excision of trophoblastic tissues using either laparotomy or laparoscopy, systemically administered methotrexate and, more recently, uterine artery embolization. Here, we report a case of an ectopic pregnancy that occurred in the scar of a previous caesarean section, which was diagnosed by transvaginal sonography.
Case report: incidental findings of COVID-19 infection on positron emission tomography/computed tomography for staging of a giant gastric gastrointestinal stromal tumor
Authors: Hamish Reed-Embleton, Khurram Shahzad Khan, Navin Mathias, Sajid Mahmud
Journal: Pan Afr Med J (2020)
Keywords: covid-19, fdg-pet, gist, gastrointestinal stromal tumor
MeSH terms: COVID-19 / diagnostic imaging, COVID-19 Testing / methods, Gastrointestinal Stromal Tumors / diagnostic imaging, Stomach Neoplasms / diagnostic imaging, Case Reports, Fluorodeoxyglucose F18, Gastrointestinal Stromal Tumors / pathology, Humans, Incidental Findings, Male, Middle Aged, Neoplasm Staging, Positron Emission Tomography Computed Tomography, Radiography, Stomach Neoplasms / pathology, Fluorodeoxyglucose F18

We report the incidental finding of COVID-19 in a 59-year-old male, with no significant cardiorespiratory past medical history who underwent a fluorodeoxyglucose positron emission tomography (FDG-PET) scan for investigation of a likely gastric gastrointestinal stromal tumor (GIST). There may be significant discrepancies between clinical symptoms and radiological severity with COVID-19 infection. FDG-PET scanning has the potential to complement traditional radiological imaging in COVID-19 in diagnosis of subclinical diagnosis or early stage disease, as well as monitoring disease progression.
Rich table but short life: Diffuse idiopathic skeletal hyperostosis in Danish astronomer Tycho Brahe (1546-1601) and its possible consequences
Authors: Sacha Kacki, Petr Velemínský, Niels Lynnerup, Sylva Kaupová, Alizé Lacoste Jeanson, Ctibor Povýšil, Martin Horák, Jan Kučera, Kaare Lund Rasmussen, Jaroslav Podliska, Zdeněk Dragoun, Jiří Smolík, Jens Vellev, Jaroslav Brůžek
Journal: PLoS One (2018)
MeSH terms: Hyperostosis, Diffuse Idiopathic Skeletal / diagnosis, Paleopathology, Case Reports, Research Support, Non-U.S. Gov't, Review, Astronomy, Bone and Bones / diagnostic imaging, Bone and Bones / pathology, Cause of Death, Decision Trees, Hair / pathology, Humans

The exhumation of Danish astronomer Tycho Brahe (1546-1601) was performed in 2010 to verify speculative views on the cause of his death. Previous analyses of skeletal and hair remains recovered from his grave refuted the presumption that he died from poisoning. These studies also outlined the possibility that he actually died from an acute illness, echoing the rather vague and inaccurate testimony of some historical records. We performed a detailed paleopathological analysis of Tycho Brahe's skeletal remains, along with a reconstruction of his diet based on carbon and nitrogen stable isotopes analysis and an estimate of his physical status (relative body fat) based on medullar and cortical dimensions of the femoral shaft. The astronomer's remains exhibit bone changes indicative of diffuse idiopathic skeletal hyperostosis (DISH). The study further allows us to classify him as obese (100% reliability according to our decision tree designed from Danish males), and points out his rich diet (high input of animal protein and/or marine resources) and high social status. Comorbidities of DISH and obesity are reviewed, and their influence on health status is discussed. We further consider some conditions associated with metabolic syndrome as possible causes of Tycho Brahe's final symptoms (urinary retention, renal failure and coma), including diabetes, alcoholic ketoacidosis and benign prostatic hypertrophy. Although a definite and specific diagnosis cannot be established, our study points to today's civilization diseases often associated with DISH and metabolic syndrome as the possible cause of death of Tycho Brahe.
Case Report: Repeated Low-Dose Rituximab Treatment Is Effective in Relapsing Neuro Behçet's Disease
Authors: Chao Zhao, Chuan Li, Feng-Ju Duan, Qi Yan, Zhuo Zhang, Ying Du, Wei Zhang
Journal: Front Neurol (2021)
Keywords: low dose, neuro behçet disease, remission, rituximab, treatment
MeSH terms: Case Reports

Neuro Behçet's disease (NBD) is a rare but most aggressive manifestation of Behçet's disease (BD) with a poor prognosis, and some patients even present a relapsing and treatment-resistant progressive course. In some relapsing NBD cases, traditional corticosteroids and immunosuppressive drugs show limited efficacy, while benefits of biological agents, such as anti-B-lymphocyte CD20 biological agent rituximab (RTX), gradually represent potential therapeutic advantages with clinical rapid remission and long-time maintenance. However, up to now, the optimal dosage of RTX in NBD is still elucidated. Here, we report two patients with relapsing NBD, despite continuous high dose steroids and sufficient azathioprine treatment, still presenting severe and relapsing meningoencephalitis or brainstem involvement. Repeated low-dose RTX (100 mg × 3/1 week apart, 100 mg repeated every 6 months) is then attempted with rapid recovery and sustained remission. The approach in our cases may expand therapeutic options and provide helpful references for relapsing NBD treatment.
Treatment of an Intractable Forefoot Ulcer Using Realignment Osteotomy in a Patient with Rheumatoid Arthritis
Authors: Makoto Imai, Naoki Kondo, Rei Kumazaki, Naoto Endo
Journal: Case Rep Orthop (2020)
MeSH terms: Case Reports

Forefoot deformities are common among patients with rheumatoid arthritis (RA). Herein, we describe a case of intractable ulceration on the dorsomedial aspect of the right 5th digit, secondary to forefoot deformity, in a 76-year-old woman with a 35-year history of RA. The ulcer was due to a persistent subcutaneous infection. Although the infection was controllable with antibiotics, there was concern of relapse because of the abnormal pressure on the skin due to an overlap of the 4th and 5th digits. We proceeded with surgical correction of the forefoot alignment, including shortening oblique osteotomy of metatarsals 2 through 5, rather than amputation of the 5th digit. Following surgery, targeted antibiotic treatment was provided. The postoperative course was unremarkable, and the patient recovered weight-bearing function without recurrence of pain or ulceration. Forefoot realignment is a feasible option that should be considered for treating intractable foot pain and ulceration secondary to long-lasting RA.
Case report: Uridine triacetate in the management of delayed onset 5-fluorouracil toxicity: A case report and review of literature
Authors: Aasems Jacob, Janeesh Sekkath Veedu, Insija Selene, Rishi Raj, Lakshmi Kannan, Reema Patel
Journal: Front Pharmacol (2022)
Keywords: 5-fluorouracil, capecitabine, chemotherapy, dihydropyridine deaminase deficiency, toxicity, uridine triacetate, vistogard
MeSH terms: Case Reports

5-fluorouracil (5FU) and capecitabine are fluoropyrimidine anti-neoplastic drugs commonly used in the treatment of different types of cancer. Hereditary dihydropyrimdine deaminase (DPD), thymidylate synthase mutations and drug overdose may lead to life-threatening toxicities. Uridine triacetate (UTA) is an emergency treatment for overdoses and early onset, severe or life-threatening toxicities from fluoropyrimidines. It is approved for use in adults and children within 96 h of last fluoropyrimidine administration. We present the case of a 64-year-old male treated with 5-FU and oxaliplatin as adjuvant systemic therapy for stage IIIA rectal cancer who developed delayed central nervous system toxicity 18 days after initiating chemotherapy. He had rapidly worsening encephalopathy and ataxia. Laboratory workups, MRI brain and EEG were negative. He was started on UTA with concerns of 5-FU toxicity due to the life-threatening nature of his condition even beyond the recommended 96-h time cut-off. He had rapid improvement in clinical status and resolution of encephalopathy. DPD deficiency testing later resulted as heterozygous for IVS14+1G>A allele indicating enzyme deficiency. This report demonstrates the importance of identifying delayed side effects with fluoropyrimidine therapy and potential treatment for reversing these effects. We also did an extensive literature review and obtained reports from the uridine triacetate clinical trials on patients receiving UTA after the 96-h cut-off. Based on our experience and previous published reports, a patient developing life-threatening delayed 5-FU toxicity should also be considered for UTA on a case-by-case basis.
Bilateral Facial Paralysis and Deafness in a Child Treated for Acute Lymphoblastic Leukemia
Authors: Rafael V Lucena, Yuri C F Fernandes, Débora B Pazinatto, Rebecca C K Maunsell
Journal: Case Rep Otolaryngol (2019)
MeSH terms: Case Reports

Involvement of the ear and temporal bone in acute leukemias are uncommon. We report a case of atypical mastoiditis with bilateral facial paralysis in a child diagnosed with Acute Lymphoblastic Leukemia (ALL). A 20-month-old male child was diagnosed with ALL and developed otorrhea unresponsive to antimicrobial treatment during the first week of chemotherapy followed by hearing loss, loss of balance, and bilateral facial paralysis. A CT scan of the mastoids showed cortical erosion of the temporal bone and presence of soft tissue contents filling the mastoid cells and external auditory canal bilaterally. Mastoidectomy was performed to collect material for analysis. Histopathologic examination of the material revealed an active chronic inflammatory process, with a moderate amount of plasma cells. Chemotherapy was reintroduced 3 weeks after the surgical procedure, and progressive improvement of otorrhea and imbalance was noted. Grade III House-Brackmann peripheral facial paralysis persisted on 6-month follow-up, and the patient is in rehabilitation program.
Myopericarditis in a Young Adult Secondary to COVID-19 Vaccination
Authors: Corbin G Walters, Dev D Jaiswal, Tom X Hu, Steve S Kim
Journal: Methodist Debakey Cardiovasc J (2021)
Keywords: covid-19, sars-cov-2, echocardiography, myocarditis, pericarditis, vaccination
MeSH terms: COVID-19 Vaccines / adverse effects, COVID-19 / prevention & control, Myocarditis / diagnosis, Myocarditis / drug therapy, Myocarditis / etiology, Case Reports, Adult, Humans, Male, SARS-CoV-2, Vaccination, COVID-19 Vaccines

We present the case of a healthy 29-year-old male with no significant medical history who presented with electrocardiogram findings consistent with pericarditis and elevated troponin levels, commonly seen in myocarditis, after receiving his second Pfizer-BioNTec vaccination for SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). The patient had significant clinical improvement shortly after receiving aspirin and colchicine and was discharged home with these medications. His laboratory findings returned to baseline less than 2 weeks after his illness. While this case highlights the importance of diagnosis, intervention selection, and treatment of myopericarditis amid ongoing global vaccination campaigns, it should be emphasized that the benefits of vaccination considerably outweigh the risks.