OpenMed/multicare-articles huggingface dataset:
Acquired Hemophilia A Diagnosed Based on Gross Hematuria: A Case Report and Literature Review
Authors: Kenichi Hata, Junichiro Kato, Yusuke Takahashi, Shun Saito, Keigo Sakanaka, Takahiro Kimura
Journal: Case Rep Urol (2024)
Keywords: acquired hemophilia, acquired hemophilia a, case report and literature review, gross hematuria, hematuria
MeSH terms: Case Reports

Acquired hemophilia A (AHA) is an acquired bleeding disorder caused by neutralizing antibodies (inhibitors) against Coagulation Factor VIII (FVIII:C), causing sudden hemorrhagic symptoms (i.e., subcutaneous bleeding, intramuscular bleeding, and hematuria). Herein, this study is aimed at presenting a case of AHA diagnosed based on hematuria and reviewing patients who were diagnosed with AHA due to hematuria. A 67-year-old woman was referred to Atsugi City Hospital with painless gross hematuria that began 4 weeks before presentation. Contrast-enhanced computed tomography (eCT) revealed an approximately 2 cm mass in the right renal pelvis, and the patient's activated partial thromboplastin time (APTT) was elevated (61.4 s). The day after the endoscopic biopsy, the patient was in shock due to a large retroperitoneal hematoma. Although her condition stabilized after intravenous radioembolization, she underwent emergency surgeries several times because of rebleeding within the next 3 weeks. At that time, APTT was more prolonged at 106.4 s, and the FVIII:C level was 2%. Mixing tests showed an upwardly convex curve after 2-h incubation, indicating the presence of an inhibitor. Factor VIII inhibitor titer was ≥5.1 Bethesda unit (BU)/mL. A combined product of Plasma-Derived Factors VIIa and X (pd-FVIIa/FX), as second-line hemostatic therapy, as well as cyclophosphamide (CYP), were administered after Recombinant Activated Factor VIIa (rFVIIa) had been ineffective. Following this, the Factor VIII inhibitor titer was undetectable, FVIII:C levels were restored, and APTT decreased to within the normal range. Gross hematuria was significantly alleviated. However, the patient died of cytomegalovirus and fungal infections due to prolonged immunosuppressive therapy. Although AHA diagnosed based on hematuria may have a better prognosis than others, there have been occasional cases with severe outcomes. APTT, detected upon initial hematological testing in patients with hematuria, may be a potential indicator of an existing AHA.
Tricuspid isthmus ablation with pulsed-field power by linear catheter: a case report
Authors: Xinzhong Li, Long Huang, Jianyong Li, Senlin Huang, Yuegang Wang
Journal: Eur Heart J Case Rep (2023)
Keywords: atrial flutter, case report, linear catheter, pulsed-field power, tricuspid isthmus
MeSH terms: Case Reports

Background:
Pulsed-field ablation using annular or petal-shaped catheters had been proven to be effective for achieving electrical isolation of pulmonary veins in patients with atrial fibrillation. However, the utilization of linear pulse-field power for treating atrial flutter has yet to been documented.
Case summary:
In this report, we present a case involving the successful treatment of tricuspid isthmus-dependent atrial flutter treated with a linear pulsed-field catheter. The patient, a 71-year-old male, presents with an electrocardiogram indicating atrial flutter. Subsequent electrophysiological examination reveals typical atrial flutter that is dependent on the cavo-tricuspid isthmus (CTI). This condition is successfully terminated through the application of linear pulsed-field ablation.
Discussion:
This case represents a pioneering instance of CTI-dependent atrial flutter ablation utilizing linear pulse-field power. The innovative approach not only effectively treats the patient but also serves as a valuable reference for future applications of linear treatment with pulsed-field ablation.
Case Report: Guanfacine and methylphenidate improved chronic lower back pain in autosomal dominant polycystic kidney disease with comorbid attention deficit hyperactivity disorder and autism spectrum disorder
Authors: Satoshi Kasahara, Shoichiro Kanda, Miwako Takahashi, Mao Fujioka, Taito Morita, Ko Matsudaira, Naoko Sato, Motoshi Hattori, Toshimitsu Momose, Shin-Ichi Niwa, Kanji Uchida
Journal: Front Pediatr (2023)
Keywords: attention deficit hyperactivity disorder, autism spectrum disorder, autosomal dominant polycystic kidney disease, cerebral blood flow, cystic fibrosis transmembrane conductance regulator, guanfacine, lower back pain, methylphenidate
MeSH terms: Case Reports

Autosomal dominant polycystic kidney disease (ADPKD) is an inherited renal disease characterized by the bilateral development of multiple cysts in the kidneys. Pain management is a clinically important issue, especially because approximately 60% of patients with ADPKD experience chronic pain related to hemorrhage from renal cysts, which significantly reduces their daily life. The cystic fibrosis transmembrane conductance regulator, the molecule responsible for cyst formation in ADPKD, is also the cause of cystic fibrosis. Since attention deficit hyperactivity disorder (ADHD) is known to occur frequently in conjunction with cystic fibrosis, ADPKD may be associated with ADHD. However, to our knowledge, no study has investigated 1) ADHD or autism spectrum disorder (ASD) as comorbidities with ADPKD, 2) the effects of ADHD medications on chronic pain in ADPKD, or 3) cerebral blood flow corresponding to guanfacine (GF) or methylphenidate (MP) treatment for chronic pain. We report the case of a 15-year-old girl with ADPKD, who had chronic back pain associated with ADPKD and had to withdraw from high school because the pain interfered with her daily life. Although she took antihypertensive medications to prevent bleeding, they did not provide adequate blood pressure control. The patient was referred to a child psychiatrist and diagnosed with ASD; however, the pain did not improve. Subsequently, she was referred to our pain center. The diagnosis of ADHD was confirmed and treatment with ADHD medications was initiated. Monotherapy with MP, atomoxetine, and GF resulted in hypertension and hypotension as side effects; however, a combination of MP 18 mg and GF 4 mg provided pain relief and moderate blood pressure control, and the patient was able to go on to college. During the course of treatment, there was an improvement in the distribution of cerebral blood flow in the prefrontal and insular cortices. Confirmation of an ADHD diagnosis comorbid with ASD enabled the use of ADHD medications. The combination of MP and GF improved chronic back pain and high blood pressure due to ADPKD and cerebral blood flow. Screening for ADHD is important in the treatment of ADPKD.
Case report: Precise NGS and combined bevacizumab promote durable response in ALK-positive lung adenocarcinoma with multiple-line ALK-TKI resistance
Authors: Jin Xiong, Lei Xia
Journal: Front Oncol (2024)
Keywords: case report, combination therapy, long-term survival, multiple-line alk-tki, pleural effusion ngs
MeSH terms: Case Reports

Liquid biopsies including pleural fluid or plasma are commonly applied for patients with advanced non-small cell lung cancer (NSCLC) and pleural effusion (PE) to guide the treatment. ALK-TKIs are the first options for patients with ALK-positive mutations and combining ALK-TKIs with angiogenic agents may improve survival. We report here one case with ALK-positive lung adenocarcinoma in which the patient achieved a prolonged progression-free survival (PFS) of 97 months after undergoing precise pleural effusion NGS and receiving combined bevacizumab treatment following multiple-line ALK-TKI resistance.
Case Report: Brain tumor's pitfalls: two cases of high-grade brain tumors mimicking autoimmune encephalitis with positive onconeuronal antibodies
Authors: Stefano Consoli, Fedele Dono, Giacomo Evangelista, Clarissa Corniello, Marco Onofrj, Astrid Thomas, Stefano L Sensi
Journal: Front Oncol (2023)
Keywords: autoimmune encephalitis, diagnosis, epilepsy, glioblastoma, neuroimaging
MeSH terms: Case Reports

Background:
Glioblastoma (GBM) is the most common primary brain tumor in adulthood. Initial diagnosis is generally based on clinical and MRI findings, which may be misinterpreted as other neurological pictures, including autoimmune encephalitis (AE). AE is a heterogeneous group of neuroinflammatory diseases due to the presence of auto-antibodies targeting antigens on neuronal synaptic or cell surface. In the present report, we describe two peculiar cases of GBM initially misdiagnosed as AE, focusing on the diagnostic pitfalls and the treatment strategies.
Methods:
We report the case of two patients with high-grade brain tumors, initially misdiagnosed and treated for AE. Clinical, laboratory, and neuroradiological data are discussed in terms of differential diagnosis between AE and GBM.
Results:
The presence of atypical brain MRI findings and the unresponsiveness to immunosuppressive treatment are major red flags in the differential diagnosis between AE and GBM. In these cases, a brain biopsy is necessary to confirm the diagnosis.
Conclusions:
Atypical brain tumor presentation causes a diagnostic and therapeutic delay. A positive onconeural autoantibodies result should always be interpreted cautiously, considering the possibility of a false-positive test. A brain biopsy is mandatory for a definite diagnosis.
QL1604 combined with bevacizumab as an innovative first-line treatment for HCC patient with extensive metastasis who showed remarkable effect: a case report
Authors: Yanzhi Wan, Keqin Tan, Hong Zhu
Journal: Front Pharmacol (2024)
Keywords: ql1604, bevacizumab, hepatocellular carcinoma, intraspinal metastasis, paralysis
MeSH terms: Case Reports

Hepatocellular carcinoma (HCC) is a common and highly malignant tumor with poor outcomes, especially when it metastasizes. In this report, we present the case of a 64-year-old male patient diagnosed with recurrence and multiple metastases of HCC 7 years after surgery. As the tumor invaded the spinal canal and pressed on the spinal cord, the patient experienced paralysis in the lower limbs. After undergoing surgical resection for spinal decompression, the patient chose an innovative regimen: QL1604 200 mg every 3 weeks plus bevacizumab 675 mg every 3 weeks as first-line treatment. From July 2022 to February 2024, the patient has regularly received the treatment. During the treatment, the paralysis symptoms of the patient gradually improved, and the motor function of the lower limbs completely returned to normal. When re-evaluated his spinal cord injury, the Frankel grade of the patient was downgraded from C to E. The tumor shrank to reach a state of PR and lasted for one and a half years. QL1604 combined with bevacizumab demonstrated excellent efficacy and minimal side effects in this patient. This new combined therapy holds potential as a first-line treatment strategy.
Oral lesions in patients with severe COVID-19 in the National Institute of Respiratory Diseases in Mexico: Case series
Authors: Carlos Alberto Carrasco Rueda, Ilan Vinitzky Brener
Journal: J Dent Res Dent Clin Dent Prospects (2023)
Keywords: covid-19, oral lesions, sars-cov-2, severe
MeSH terms: Case Reports

Oral manifestations in patients with COVID-19 have already been reported in the literature. Determining whether the oral manifestations in these cases are directly related to SARS-CoV-2 infection or not has been challenging for both clinicians and researchers, although at present it has not been possible to prove. There are several possible causes for the development of the oral lesions in patients with COVID-19, among them are, opportunistic infections, drug reactions, iatrogenic and those directly related to viral infection. The present work describes the main characteristics of 10 severe COVID-19 hospitalized patients with oral manifestations. By analyzing the characteristics of the reported patients, and what is published in the literature, we conclude that for this series of cases the manifestations are not directly related to SARS-CoV-2, however, it is a possibility that should be considered for all patients.
The Use of Amantadine in Treating Extrapyramidal Symptoms in Organophosphates Poisoning in a Child
Authors: Wesam Althaqafi, Reham Ibrahim Alanazi, Wadha Khalid Almeshari
Journal: Case Rep Pediatr (2023)
MeSH terms: Case Reports

Background. Organophosphates are chemicals that lead to the accumulation of acetylcholine, causing muscarinic symptoms such as salivation and nicotinic manifestations like muscle weakness and hypertension and rarely leading to basal ganglia impairment, manifesting as extrapyramidal symptoms. Literature reported that the use of amantadine, an amine that has both antiviral and dopaminergic activities, improves extrapyramidal manifestations. Most of the studies exploring the effect of amantadine were conducted on adults and there are extremely limited data in regards to this topic in Saudi Arabia. Thus, the purpose of this case study is to report the outcome of treating a child who developed extrapyramidal symptoms due to organophosphates poisoning with amantadine. Case Description. A 6-year-old boy was found by his family drowsy and drooling with an insecticide bottle beside him. He was brought to the ER and arrested on arrival, and he was eventually revived after 5 minutes of CPR. Then, he developed features of extrapyramidal involvement such as delirium, hyperactivity, akathisia, aphonia, and tremors. He was started on oral amantadine 50 mg once daily and then increased to twice daily for two weeks while admitted. During admission, his symptoms were assessed daily, and an improvement was noticed by his family and the medical team. Upon discharge, he was able to form sentences; tremors were almost resolved; and there was no rigidity or agitation. He was followed up postdischarge and showed significant improvement. He continued amantadine for almost 3 months until the full resolution of his symptoms. Discussion and Conclusion. This case illustrates the promising benefits of using amantadine in treating extrapyramidal manifestations following organophosphate ingestion.
Case report: Inspiration from a rare fatal heart perforation after percutaneous vertebroplasty
Authors: Ke Deng, Jia-Lin Yu, Ye-Jun Feng, Kui Huang, Guo-Feng Wu
Journal: Front Surg (2023)
Keywords: bone cement leakage, intracardiac cement embolism, osteoporosis, percutaneous vertebroplasty, vertebral compression fracture
MeSH terms: Case Reports

The principal benefit of employing percutaneous vertebroplasty (PVP) for managing osteoporotic vertebral compression fractures lies in its capacity to facilitate early mobilization in elderly patients, thereby effectively avoiding the potential catastrophic complications associated with prolonged bedridden states. However, bone cement leakage, as the most common complication of PVP, may have fatal consequences. Here, we report a case involving an 85-year-old male patient with L1 vertebral compression fracture who underwent PVP at our hospital and was discharged on the same day of the surgical intervention. Subsequently, the patient experienced symptoms of chest tightness and palpitations. Cardiac ultrasound examination revealed pericardial effusion, while pulmonary computed tomographic angiography (CTA) demonstrated a strip high-density shadow in the right ventricular area. Finally, it was determined that the perforation of the right ventricular wall was caused by bone cement embolism. Through this comprehensive case report, we aim to deepen the understanding of orthopedic doctors on the importance of preventing bone cement leakage.
Complete remission in a pretreated, microsatellite-stable, KRAS-mutated colon cancer patient after treatment with sintilimab and bevacizumab and platinum-based chemotherapy: a case report and literature review
Authors: Lijuan He, Haiyuan Li, Yunpeng Wang, Weidong Li, Lei Gao, Bo Xu, Jike Hu, Puyi He, Weigao Pu, Guodong Sun, Zhuanfang Wang, Qinying Han, Ben Liu, Hao Chen
Journal: Front Immunol (2024)
Keywords: kras mutation, mss, bevacizumab, colon cancer, immunotherapy, metastasis, recurrence, sintilimab
MeSH terms: Antibodies, Monoclonal, Humanized, Colonic Neoplasms / drug therapy, Colonic Neoplasms / genetics, Proto-Oncogene Proteins p21(ras) / genetics, Review, Case Reports, Research Support, Non-U.S. Gov't, Bevacizumab / therapeutic use, Humans, Male, Microsatellite Repeats, Pathologic Complete Response, Platinum, Tumor Microenvironment, sintilimab, Bevacizumab, Proto-Oncogene Proteins p21(ras), Platinum, KRAS protein, human, Antibodies, Monoclonal, Humanized

Metastatic colon cancer remains an incurable disease, and it is difficult for existing treatments to achieve the desired clinical outcome, especially for colon cancer patients who have received first-line treatment. Although immune checkpoint inhibitors (ICIs) have demonstrated durable clinical efficacy in a variety of solid tumors, their response requires an inflammatory tumor microenvironment. However, microsatellite-stable (MSS) colon cancer, which accounts for the majority of colorectal cancers, is a cold tumor that does not respond well to ICIs. Combination regimens open the door to the utility of ICIs in cold tumors. Although combination therapies have shown their advantage even for MSS colon cancer, it remains unclear whether combination therapies show their advantage in patients with pretreated metastatic colon cancer. We report a patient who has achieved complete remission and good tolerance with sintilimab plus bevacizumab and platinum-based chemotherapy after postoperative recurrence. The patient had KRAS mutation and MSS-type colon cancer, and his PD-1+CD8+ and CD3-CD19-CD14+CD16-HLA-DR were both positive. He has achieved a progression-free survival of 43 months and is still being followed up at our center. The above results suggest that this therapeutic regimen is a promising treatment modality for the management of pretreated, MSS-type and KRAS-mutated metastatic colorectal cancer although its application to the general public still needs to be validated in clinical trials.
Case report: Neglected subacute thyroiditis: a case following COVID-19 vaccination
Authors: Shuai Yang, Ting Guan, HuanYi Yang, YiRong Hu, Yan Zhao
Journal: Front Med (Lausanne) (2024)
Keywords: covid-19, sars-cov-2 vaccine, autoimmunity, fever, subacute thyroiditis
MeSH terms: Case Reports

We report a case of overlooked Subacute Thyroiditis (SAT) potentially induced by the administration of a COVID-19 vaccine. This case prompted a thorough review of the existing literature to elucidate possible mechanisms by which immune responses to the COVID-19 vaccine might precipitate thyroid damage. The primary objective is to enhance the clinical understanding and awareness of SAT among healthcare professionals. Subacute thyroiditis is a prevalent form of self-limiting thyroid disorder characterized by fever, neck pain or tenderness, and palpitations subsequent to viral infection. The development of numerous SARS-CoV-2 vaccines during the COVID-19 pandemic was intended to mitigate the spread of the virus. Nevertheless, there have been documented instances of adverse reactions arising from SARS-CoV-2 vaccines, such as the infrequent occurrence of subacute thyroiditis. While the majority of medical practitioners can discern classic subacute thyroiditis, not all cases exhibit typical characteristics, and not all systematic treatments yield positive responses. In this study, we present a rare case of subacute thyroiditis linked to the administration of the SARS-CoV-2 vaccine. A previously healthy middle-aged female developed fever and sore throat 72 h post-inoculation with the inactivated SARS-CoV-2 vaccine. Initially attributing these symptoms to a common cold, she self-administered ibuprofen, which normalized her body temperature but failed to alleviate persistent sore throat. Suspecting a laryngopharyngeal disorder, she sought treatment from an otolaryngologist. However, the pain persisted, accompanied by intermittent fever over several days. After an endocrinology consultation, despite the absence of typical neck pain, her examination revealed abnormal thyroid function, normal thyroid antibodies, heterogeneous echogenicity on thyroid ultrasonography, and elevated levels of Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP). These findings led to a consideration of the diagnosis of SAT. Initially, she was treated with non-steroidal anti-inflammatory drugs (NSAIDs) for her fever, which proved effective, but her neck pain remained uncontrolled. This suggested a poor response to NSAIDs. Consequently, steroid therapy was initiated, after which her symptoms of fever and neck pain rapidly resolved.
Mycophenolate mofetil in giant cell arteritis
Authors: Anne Pankow, Sena Sinno, Thorsten Derlin, Marcus Hiss, Annette D Wagner
Journal: Front Med (Lausanne) (2023)
Keywords: mycophenolate mofetil, case series, giant cell arteritis, imaging, vasculitis

Introduction:
Giant cell arteritis (GCA) is a systemic granulomatous vasculitis affecting the large arteries. Abnormal lymphocyte function has been noted as a pathogenic factor in GCA. Mycophenolate mofetil (MMF) inhibits inosine monophosphate dehydrogenase and is therefore a highly lymphocyte-specific immunosuppressive therapy. We aimed to assess the efficacy of MMF for inducing remission in GCA.
Methods:
Seven patients (5 female, 2 male) with GCA under therapy with MMF and who were treated at the outpatient clinic for rare inflammatory systemic diseases at Hannover Medical School between 2010 and 2023 were retrospectively included in the study. All patients underwent duplex sonography, 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET), magnetic resonance imaging (MRI), and/or biopsy to confirm the diagnosis. The primary endpoints were the number of recurrences, CRP levels at 3-6 and 6-12 months, and the period of remission.
Results:
All patients in this case series showed inflammatory activity of the arterial vessels in at least one of the imaging modalities: duplex sonography (n = 5), 18F-FDG PET (n = 5), MRI (n = 6), and/or biopsy (n = 5). CRP levels of all patients decreased at the measurement time points 3-6 months, and 6-9 months after initiation of therapy with MMF compared with CRP levels before MMF therapy. All patients with GCA in this case series achieved disease remission.
Discussion:
The results of the present case series indicate that MMF is an effective therapy in controlling disease activity in GCA, which should be investigated in future randomized controlled trials.