OpenMed/multicare-articles huggingface dataset:
Obstructive Jaundice as Initial Presentation of Multiple Myeloma: Case Presentation and Literature Review
Authors: Yasir Khan, Iyad Mansour, Eric Ong, Manish Shrestha
Journal: Case Rep Med (2015)

Multiple myeloma is a malignant plasma-cell disorder that primarily involves the bone marrow, but extramedullary involvement is becoming increasingly common (Bladé et al., 2012) both at initial presentation and follow-up. Most common initial presentations for multiple myeloma include generalized fatigue, renal insufficiency, bone pain, and recurrent bacterial infections. We present a case of a healthy 55-year-old man that presented to the emergency department with a three-week history of anorexia and jaundice without any past medical history. Patient's initial labs were significant for hyperbilirubinemia and elevated liver function enzymes (AST, ALT, ALP, and GGT). Additional laboratory workup was significant for mild hypercalcemia and increased protein gap. MRI and ERCP suggested primary sclerosing cholangitis but were not diagnostic. Liver biopsy illustrated plasma-cell infiltration and bone marrow biopsy diagnosed multiple myeloma with extramedullary disease. Patient was started on dexamethasone, bortezomib, and cyclophosphamide, but, despite this aggressive regimen, the patient continued to decline. We take this opportunity to present this atypical presentation of a common hematological malignancy and review the associated literature.
Sudden onset of artery dissection in a 32-year-old woman with vascular Ehlers-Danlos syndrome due to psychological stress of her mother's death: a case series
Authors: Yuichiro Shimoyama, Osamu Umegaki, Tomoyuki Agui, Noriko Kadono, Toshiaki Minami
Journal: JA Clin Rep (2017)
Keywords: psychological care, stent graft repair, vascular ehlers-danlos syndrome, vascular complication

Background:
Patients with vascular Ehlers-Danlos syndrome (EDS) are susceptible to significant vascular complications, such as aortic and visceral arterial ruptures, aneurysms, and dissection. We describe a case of repeated bleeding in a 57-year-old woman and a case of sudden onset of artery dissection in her daughter, both of whom were previously diagnosed with vascular EDS and managed at our institution.
Case presentation:
A 57-year-old woman was admitted to our emergency department due to sudden onset of left low back pain. Her past history included vascular EDS. An urgent abdominal computed tomography (CT) scan revealed a left-sided retroperitoneal hematoma and left external iliac artery dissection. Stent graft repair was performed. Five hours postoperatively, cardiac arrest occurred and resuscitation attempts failed. The 32-year-old daughter with genetically diagnosed vascular EDS was notified of the death of her mother during the customary end-of-life conference. Six hours after her mother's death, she was admitted to our emergency department due to sudden onset of left low back pain. On examination, she was not in hypovolemic shock, and weak pulses were palpable in the bilateral dorsalis pedis. An urgent abdominal CT scan revealed a right-sided retroperitoneal hematoma around the right external iliac artery and left external iliac artery dissection. She was admitted to the intensive care unit and underwent conservative therapy consisting of bed rest and antihypertensive therapy with nicardipine. She developed no further vascular complications requiring surgical intervention and was discharged on the 21st hospital day.
Conclusions:
Vascular rupture can be fatal in patients with vascular EDS. This report underscores the importance of strategic management of vascular complications to prevent rupture, and the importance of psychological care for the bereaved family given the hereditary nature of vascular EDS.
Diagnostic and therapeutic challenges of EBV-positive mucocutaneous ulcer: a case report and systematic review of the literature
Authors: Toni K Roberts, Xueyan Chen, Jay Justin Liao
Journal: Exp Hematol Oncol (2016)
Keywords: b-cell neoplasm, epstein–barr virus, epstein–barr virus-positive mucocutaeneous ulcer disease, immunosenescence, lymphoproliferative disorder, radiation therapy, rituximab
MeSH terms: Case Reports

Background:
Epstein-Barr virus-positive mucocutaneous ulcer (EBVMCU) is a recently recognized B cell lymphoproliferative disorder that is driven by latent EBV infection and causes discrete ulcerations in the oropharynx, gastrointestinal tract, and skin. Local attenuation of immunosurveillance associated with iatrogenic immunosuppressant use, primary immunodeficiency, or age-associated immunosenescence has been implicated as a predisposing factor. This disorder is likely under reported, as it was only first defined in 2010 and shares histological features with other B-cell proliferative neoplasms. The first case series that described EBVMCU suggested that EBVMCU is generally self-limited and is likely to resolve without treatment. Since that publication, additional cases have been reported that describe a more heterogeneous clinical course, often requiring aggressive therapy. We now systematically review all published cases of EBVMCU and detail a case of aggressive and progressive EBVMCU, including diagnostic and management challenges, as well as successful treatment with radiation therapy.
Case presentation:
A forty-nine year old woman presented with painful and debilitating multifocal oral EBVMCU that initially responded to four weekly doses of rituximab. Her disease relapsed within 3 months and continued to progress and cause significant morbidity. She was successfully treated with local external beam radiation therapy of 30 Gy in 15 fractions, with duration of response of at least 6 months.
Conclusions:
We suggest that although many patients with EBVMCU experience a self-limited course, for others EBVMCU can be a debilitating, persistent disorder that requires aggressive therapy to prevent disease progression. CD20- and CD30-directed antibody therapy, local radiation therapy, local surgical excision, systemic chemotherapy, and a combination of these therapies have all been successfully used to treat EBVMCU with high rates of durable clinical remission. As EBVMCU is not currently included in the 2008 WHO classification of lymphoproliferative disorders and no evidence-based guidelines or expert opinions have been proposed to guide therapy, this case report and systematic review provides a foundation on which to guide therapeutic decisions.
An unusual presentation of vertigo: is head titubation the key to diagnosis?
Authors: O Judd, M Medcalf
Journal: Int J Otolaryngol (2009)
MeSH terms: Case Reports

Objective. Discuss complex interplay of pathophysiological effects of cerebellar space occupying lesions on the vestibular pathway. Discuss challenges of diagnosis and referral along with differential and final diagnosis of unusual presentation. Case Report. We describe the case of a patient with vertiginous symptoms complicated by neurological features, namely, head titubation and tremor. The patient also had signs of oscillopsia and possible impairment of the vestibulo-ocular reflex. The resulting symptom and sign complex made for a difficult diagnosis, as the interplay of the pathophysiology of these signs, were unusual. Conclusion. The discussion has revealed that the cerebellar lesions themselves may have simultaneously caused head tremor and an inability for the vestibulo-ocular reflex to compensate, resulting in vertigo. However, whether the vertigo was a result of an oscillopsia, nystagmus, or central cause, the referral route should initially be via a general physician to rule out such a life threatening cause as a tumour.
Familial Adenomatous Polyposis Manifesting as Lactococcus Endocarditis: A Case Report and Review of the Association of Lactococcus with Underlying Gastrointestinal Disease
Authors: Taylor C Bazemore, Stacey A Maskarinec, Kahli Zietlow, Edward F Hendershot, John R Perfect
Journal: Case Rep Infect Dis (2016)

A 45-year-old male with a prosthetic aortic valve presented to the hospital with several months of generalized malaise. On admission, he was noted to have anemia of unclear etiology and subsequently became febrile with multiple blood cultures growing Lactococcus garvieae. Inpatient workup was concerning for infectious endocarditis (IE) secondary to Lactococcus. The patient was discharged home with appropriate antimicrobial therapy; however, he was readmitted for persistent, symptomatic anemia and underwent colonoscopy, which revealed innumerable colonic polyps consistent with Familial Adenomatous Polyposis (FAP) that was later confirmed with genetic testing. Surveillance computed tomography (CT) imaging of the aortic repair later demonstrated valve dehiscence with surrounding fluid collection; he underwent redo surgery and was found to have destruction of the aortic annulus and a large pseudoaneurysm. Histopathology of the valve prosthesis confirmed IE. It is suspected that the patient developed Lactococcus IE from enteric translocation. Review of the literature provides several reports of Lactococcus infections in association with underlying gastrointestinal disease, including colorectal cancer. Given this association, we raise the question of whether the diagnosis of Lactococcus IE should evoke suspicion and encourage evaluation for gastrointestinal pathology, as occurs with Streptococcus bovis.
The 'dark bronchus' sign: HRCT diagnosis of Pneumocystis carinii pneumonia
Authors: Poonam Yadav, Ashu Seith, Rita Sood
Journal: Ann Thorac Med (2007)
Keywords: high resolution computerized tomography, pneumocystis carinii, pneumonia
MeSH terms: Case Reports

We report the importance of the 'dark bronchus' sign in the diagnosis of uniform, diffuse ground glass opacification on high resolution computerized tomography (HRCT). This sign is useful to identify diffuse ground glass opacity on HRCT in cases of Pneumocystis carinii pneumonia who may present with a normal or equivocal chest radiograph in the early course of disease.
Twin gestation in a septate bicornuate uterus
Authors: Henry Osazuwa, David Ejenobo
Journal: Case Rep Obstet Gynecol (2012)

Bicornuate and septate uteri are among the commonest Mullerian anomalies. They are sporadic and fairly distinguished, but hybrid deformities can occur. This combination creates aetiological and clinical difficulties. The alternative theory of concurrent fusion and septal resorption of the Mullerian duct is seen as the basis of the altered foetal embryology, while the favourable outlook of a bicornuate uterus may be offset by the suboptimal implantation across the avascular septum. Obstetric care is based on empirical interventions deduced from case series, with varied and inconsistent outcomes. We present a 32-year-old primipara with a dizygotic twin gestation in separate compartments of a septate bicornuate uterus. She had an elective bilateral caesarean delivery at term with an accidental septal resection for morbidly adherent placenta. Although a summation of obstetric risks is a possibility, an excellent outcome was observed.
Spontaneous Adrenal Hemorrhage with Mild Hypoadrenalism in a Patient Anticoagulated with Apixaban for Antiphospholipid Syndrome: A Case Report and Literature Review
Authors: Jia Wei Tan, Anant Shukla, Jiun-Ruey Hu, Sachin K Majumdar
Journal: Case Rep Endocrinol (2022)
MeSH terms: Case Reports

Background:
Adrenal hemorrhage (AH) is a serious endocrine complication of antiphospholipid syndrome (APLS). Case Presentation. We report a 45-year-old man who presented with several deep venous thromboses and was initially treated with apixaban, who later developed bilateral AH. Laboratory findings were consistent with cortisol deficiency yet preserved aldosterone physiology. He was diagnosed with APLS and treated with warfarin. After 8 months of follow-up, he remained on cortisol replacement with no evidence of recovery. We reviewed PubMed/MEDLINE indexed articles from 1950 to 2022 for cases of AH in APLS patients on anticoagulation. Six cases of patients on direct oral anticoagulants (DOACs) were reported. Discussion. The unique vasculature of the adrenal glands creates a "functional vascular dam" in the zona reticularis, which is susceptible to thrombosis in situ and hemorrhage. DOACs may further increase the risk of AH.
Conclusion:
Depending on the degree of adrenal involvement in AH, patients can present with partial or complete primary adrenal insufficiency. More data are needed to characterize adrenal function after AH, and the safety of DOAC versus warfarin in patients with APLS warrants further studies.
Warkany syndrome: a rare case report
Authors: Amit Agrawal, Rashmi Agrawal
Journal: Case Rep Pediatr (2011)
MeSH terms: Case Reports

Warkany syndrome 2 or Trisomy 8 mosaicism (T8M) is a well-described, but very rare, chromosomal abnormality. The phenotype is extremely variable ranging from normal individual to severe malformation syndrome and because of this variability, this condition often goes undiagnosed. We report trisomy 8 mosaicism (T8M) in a 3-year-old boy evaluated for facial dysmorphism and delayed development.
Ruptured intraventricular tuberculous brain abscess mimicking cystic neoplasm: a case report
Authors: Zakariae Benyaich, Farouk Hajhoui, Mehdi Laghmari, Houssine Ghannane, Said Ait Benali
Journal: Pan Afr Med J (2021)
Keywords: tuberculosis, brain abscess, case report, cerebral ventricles, intracranial hypertension
MeSH terms: Brain Abscess / diagnosis, Brain Neoplasms / diagnosis, Tuberculoma, Intracranial / diagnosis, Case Reports, Brain / diagnostic imaging, Brain / pathology, Brain Abscess / surgery, Diagnosis, Differential, Humans, Hydrocephalus / etiology, Magnetic Resonance Imaging, Male, Middle Aged, Tuberculoma, Intracranial / surgery

Central nervous system (CNS) tuberculosis is a potentially life-threatening condition that may manifest in different forms and simulate other pathologies. It rarely involves the ventricles and the occurrence of primary intraventricular tuberculous brain abscess (TBA) has exceptionally been reported. As far as we know, ruptured intraventricular TBA has not been described before. An immunocompetent 56-years-old man was admitted for sub-acute intracranial hypertension with behaviour disorders. Cranial magnetic resonance imaging (MRI) showed a cystic lesion of the third ventricle containing fluid-fluid level with biventricular hydrocephalus and debris in the occipital horns. A ruptured cystic neoplasm was first considered. The patient underwent surgery via a right transcortical transventricular approach, combining both microscope and endoscope. The puncture of the lesion brought pus and the Ziehl-Neelson (ZN) staining demonstrated acid-fast bacilli. Intraventricular tuberculous abscess is an extremely rare condition that can take an unusual radiological appearance. This observation highlights the consideration of tuberculosis within the list of differential diagnosis of intraventricular cystic lesions in immunocompetent hosts.
Intravenous immunoglobulin is safe and effective in controlling pre-existing paraneoplastic neuromuscular diseases in cancer patients treated with immune checkpoint inhibitors: two case reports and literature review
Authors: Ge Xiong, Richard Benjamin Young, Helen Chow, Emanual Maverakis, Ricardo A Maselli, David Paul Richman, Tianhong Li
Journal: Front Oncol (2023)
Keywords: immune checkpoint inhibitor, intravenous immune globulin (ivig), paraneoplastic neurologic disease, pre-existing, safety and effectiveness
MeSH terms: Case Reports

Immune checkpoint inhibitors cause rare but potentially fatal neuromuscular complications, leading to a concern to use these agents in cancer patients with pre-existing autoimmune or inflammatory neuromuscular diseases. We report two such patients with paraneoplastic dermatomyositis and "seronegative" paraneoplastic demyelinating neuropathy, respectively, who have been successfully treated with immune checkpoint inhibitor monotherapy as well as maintenance intravenous immunoglobulin. While controlling the paraneoplastic or autoimmune neuromuscular diseases, the use of intravenous immunoglobulin did not compromise the anti-cancer effect of immune checkpoint inhibitor.
Successful use of pazopanib for treatment of refractory metastatic hemangiopericytoma
Authors: Su Jin Lee, Seung Tae Kim, Se Hoon Park, Yoon La Choi, Jae Berm Park, Sung-Joo Kim, Jeeyun Lee
Journal: Clin Sarcoma Res (2014)
Keywords: anti-angiogenic agent, hemangiopericytoma, pazopanib
MeSH terms: Case Reports

Hemangiopericytoma is a rare disease entity of soft-tissue sarcoma (STS) that can be cured with surgical resection. In cases of inoperable recurrence or metastasis, palliative chemotherapy is indicated, though there is currently no approved chemotherapy regimen. Therefore new treatment regimens are needed. We describe three cases of metastatic hemangiopericytoma. In the first case, five lines of chemotherapeutic agents were used unsuccessfully in a patient with a 12-year history of metastatic hemangiopericytoma. After one cycle of pazopanib therapy, however, chest radiography showed a decrease in tumor volume of more than 30%. A marked decrease in FDG uptake on PET CT was also noted, and the patient is now on her 5(th) month of pazopanib therapy. The second case is a patient with a brain hemangiopericytoma with multiple liver, lung, and bone metastases. Pazopanib induced radiologic stabilization of metastatic disease over the course of 8 months. The third case is a patient with a retroperitoneal hemangiopericytoma with pleural and peri-renal metastases. For more than 8 months, he has exhibited stable disease with pazopanib treatment. Pazopanib may be useful for treatment of metastatic hemangiopericytoma, though further studies are needed to confirm the efficacy of this medication and to investigate its molecular mechanism of action.
Bone-patellar tendon-bone allograft reconstruction for peri-patellar tendon sarcomas: case series
Authors: Jungo Imanishi, Damien Grinsell, Peter F M Choong
Journal: Springerplus (2015)
Keywords: allograft, knee extension mechanism, patellar tendon, reconstruction, soft tissue sarcoma

Introduction:
Reconstruction after wide resection for a sarcoma involving the knee extensor mechanism is challenging even if the tumor is small.
Case description:
We report on four consecutive peri-patellar tendon sarcomas treated similarly at a single institution. Histological diagnoses were synovial sarcoma (two cases), clear cell sarcoma and extraskeletal Ewing's sarcoma (one case each). Follow-up periods after surgery were 18-67 months. All cases underwent pre-operative radiotherapy and subsequent surgery. After preoperative radiotherapy and wide resection including the patellar tendon, bone-patellar tendon-bone allograft was fixed to the residual patella and tibial tuberosity with screws and a cable wire. Soft tissue and skin defect over allograft was covered by free antero-lateral thigh flap. Post-operatively, the operated knee was splinted straight for at least 6 weeks, and then range-of-motion exercise was gradually introduced. Except for one case with a proximal tibial stress fracture 5 months post-operatively, no complication was observed. Both bone-bone junctions between allograft and residual bones were united within 1 year after surgery. At the latest clinical follow-up, all the patients had satisfactory functions with Musculoskeletal Tumor Society score of 28-30 out of 30 points and virtually full range of motion.
Discussion and evaluation:
This case series is the first to report bone-patellar tendon-bone allograft for reconstruction after tumor resection with joint preservation and with satisfactory clinical outcomes.
Conclusions:
Bone-patellar tendon-bone allograft reconstruction with vascularized flap reconstruction is a viable option for peri-patella tendon sarcomas.
Reducing Children's Media Viewing
Authors: Erin Clyne, Leonard A Jason
Journal: Case Rep Psychiatry (2011)
MeSH terms: Case Reports

This case study evaluates the use of a Restrictive aide and the complementary use of parental mediation techniques to reduce media viewing among children. A family was provided a TV Token Timer, which involved a positive reward in exchange for participating in activities outside of watching television. Media viewing habits decreased from the baseline to the completion of the intervention at week 8 for both children. The parent reported high levels of Instructive mediation and positively evaluated the family's use of the TV Token Timer.
Combined Candida dubliniensis and Candida albicans Keratitis following a Chemical Injury
Authors: Justin Torosian, Thomas Mauger
Journal: Case Rep Ophthalmol Med (2019)
MeSH terms: Case Reports

Candida dubliniensis is an uncommon source of ocular infections and has only been reported in a single previous case of keratitis. This report documents the course of a combined Candida dubliniensis and Candida albicans keratitis following a chemical injury. Antifungal sensitivities of the two different Candida species are also demonstrated.
Extrapulmonary small cell carcinoma of the anal canal: a case report and review of the literature
Authors: Joshua M Eberhardt, Karen Brown, Shelly Lo, Suneel Nagda, Sherri Yong
Journal: Case Rep Med (2012)
MeSH terms: Case Reports

Purpose. Extrapulmonary small cell carcinoma affecting the anal canal is a rare and poorly understood entity which can, in its early stages, masquerade as benign anorectal disease such as hemorrhoids. Methods. We report a case of this rare malignancy which initially presented with hematochezia and anal pain. We also review the literature with regard to previously described cases and management strategies including the role of surgery. Results. Despite aggressive multidisciplinary treatment consisting of chemotherapy and radiation, the disease progressed rapidly with dissemination occurring only three months after completion of treatment. Because of the aggressive nature of this tumor, the treatment options for this almost universally fatal malignancy are often palliative in nature. Conclusion. Chemoradiotherapy is likely the most reasonable approach to extrapulmonary small cell carcinoma of the anal canal given its aggressiveness.
Viable abdominal pregnancy: a case report in Yaoundé (Cameroon)
Authors: Florent Ymele Fouelifack, Jovanny Tsuala Fouogue, Jeanne Hortence Fouedjio, Zacharie Sando
Journal: Pan Afr Med J (2014)
Keywords: abdominal pregnancy, cameroon, ectopic pregnancy, viable
MeSH terms: Pregnancy, Abdominal / physiopathology, Case Reports, Adult, Delayed Diagnosis, Fatal Outcome, Female, Gestational Age, Humans, Infant, Newborn, Infant, Premature, Infant, Premature, Diseases, Laparotomy, Male, Pelvic Inflammatory Disease, Pregnancy, Pregnancy, Abdominal / diagnostic imaging, Pregnancy, Abdominal / surgery, Pregnancy, Tubal, Reproductive History, Respiratory Distress Syndrome, Newborn, Risk Factors, Salpingectomy, Ultrasonography, Prenatal

We herein report a case of abdominal pregnancy managed in Yaounde (Cameroon). The 33 year old G5P2022 woman was referred to our setting for management of an abdominal pregnancy of 34 weeks diagnosed during the first routine obstetrical ultrasonography done two days earlier. This ultrasonography revealed a live foetus within intestinal loops with a severe oligoamnios. After two days of lung maturation, laparotomy was carried out and the live male baby weighed 2 600 grammes. The placenta was left on its implantation sites: omentun, uterine fundus and intestinal loops. The mother did well post-operatively and the resorption of the placenta took 11 months. The newborn presented compression deformities and died three days later of respiratory distress. This case illustrates that intra-abdominal fetuses can reach viability. Though rare, abdominal pregnancy remains a threat to mothers. Practitioners should therefore know the traps in its management.