OpenMed/multicare-articles huggingface dataset:
Severe Adverse Toxic Effects of Low-Dose Methotrexate Treatment on an Ectopic Pregnancy Patient With Methylenetetrahydrofolate Reductase Mutations: A Case Report
Authors: Huan Yu, Wenhui Wang, Haiyan Liang, Kun Wang, Bin Ling
Journal: Front Med (Lausanne) (2021)
Keywords: ectopic pregnancy, methotrexate, methylenetetrahydrofolate reductase (mthfr) gene, myelosuppression, treatment
MeSH terms: Case Reports

Background: Low-dose methylenetetrahydrofolate (LD-MTX) has been widely used for the treatment of the ectopic pregnancy (EP) for many decades, and related severe adverse toxic effects are rare. Current studies have shown that the polymorphisms of methylenetetrahydrofolate reductase (MTHFR) gene can decrease the MTX clearance, leading to the metabolite accumulation. However, there is a lack of literature report on an MTHFR gene polymorphism associated with adverse toxic effects resulting from the use of LD-MTX in an EP. Case Presentation: We report a rare case of a 38-year-old female who developed persistent fever, grade IV myelosuppression, skin lesions, mucositis, and liver injury after single dose of LDMTX to treat EP. The personalized genetic testing showed that MTHFR TT (677C>T) and MTHFR AA (1298A>C) were detected. Gradually, the symptoms improved after calcium leucovorin (CF) rescue, continuous renal replacement therapy (CRRT), promoting blood system regeneration, and multiple supportive treatments. Conclusion: This is the first report on the serious adverse toxic effects of LD-MTX on an EP patient with MTHFR mutations. We aim to alert obstetricians and gynecologists to this rare condition. The unexpected life-threatening toxicity with LD-MTX should be highly considered and recognized early. In particular, some easily overlooked gastrointestinal, skin, and mucosal symptoms occur earlier than severe myelosuppression. When toxic effects are suspected, detecting the polymorphisms of an MTHFR gene and monitoring MTX concentration in blood could assist us to formulate individualized and active treatments.
Case Report: Sapien 3 Transcatheter Heart Valve Embolization: Cause, Management, and Redo
Authors: Mi Chen, Barbara E Stähli, Jonathan M Michel, Miriam Brinkert, Felix C Tanner, Albert Markus Kasel
Journal: Front Cardiovasc Med (2021)
Keywords: sapien 3, tavi – transcatheter aortic valve implantation, aortic stenosis, embolization, transcatheter heart valve (thv)
MeSH terms: Case Reports

The transcatheter heart valve (THV) embolization is a rare but challenging complication in transcatheter aortic valve implantation (TAVI). We report the case of an 81-year-old man with Sapien 3 embolization caused by interrupted rapid pacing. In this setting, we describe the embolized THV management and the technique of the second Sapien 3 implantation.
Secondary Amyloidosis Presenting as Ischemic Proctitis
Authors: Saad Hashmi, Assad Munis, Ryan T Hoff, Hymie Kavin, Eli D Ehrenpreis
Journal: Case Rep Gastrointest Med (2021)
MeSH terms: Case Reports

A 49-year-old man presented with abdominal pain and rectal bleeding for two days associated with a 50-pound unintentional weight loss. History was notable for hypertension, chronic kidney disease, obesity, gout, and acute cholecystitis status post cholecystectomy. Computed tomography (CT) of the abdomen and pelvis showed rectal wall thickening. Colonoscopy showed proctitis with superficial ulcerations. In the setting of renal insufficiency, malabsorption, and low-voltage QRS complexes on electrocardiogram (ECG), amyloidosis was considered in the differential diagnosis. Rectal and renal biopsies with subsequent retrospective staining of gallbladder tissue confirmed amyloid deposition. Gastrointestinal involvement of amyloidosis is relatively uncommon. Particularly, amyloid deposition in the gallbladder and rectum is very rare. The development of AA amyloidosis in our patient may have been related to gout, obesity, and the presence of a heterozygous complex variant for the MEFV (familial Mediterranean fever) gene. Awareness of this atypical presentation of amyloidosis is important, as additional staining of biopsy samples is necessary, and diagnosis allows for directed treatment.
Polymyxin B-Induced Skin Hyperpigmentation
Authors: Xueke Wen, Chunliu Luo, Weitao Lyu
Journal: Case Rep Med (2020)
MeSH terms: Case Reports

Polymyxin B-induced skin hyperpigmentation is a rare adverse drug reaction (ADR). In this report, we present the case of a patient who underwent an abscess resection with right epididymitis, in which a multidrug-resistant Klebsiella pneumoniae infection (KPI) is formed. The patient was treated with polymyxin B and subsequently developed skin hyperpigmentation and desquamation. The desquamation improved and the pigmentation gradually returned to normal after sixty days after the withdrawal of polymyxin B.
Evaluation of tuberculosis infection in COVID-19 patients: a case of tuberculosis and COVID-19 co-infection
Authors: Hamid Reza Niazkar, Behdad Zibaee, Seyed Behzad Razavi, Kasra Ghanaeian, Vahid Talebzadeh, Negin Haji Vosugh
Journal: Egypt J Intern Med (2022)
MeSH terms: Case Reports

The COVID-19 pandemic affected millions of people worldwide, becoming a challenge of every nation. Since the COVID-19 can present wide spectrum of clinical signs and symptoms, patients with symptoms similar to that of COVID-19 may be misdiagnosed during the context of COVID-19 pandemic. In this regard, various co-infections may affect the outcome of COVID-19 patients if it lefts undiagnosed, especially during the administration of immunosuppressive drugs. Similar to COVID-19, TB affect the lungs and respiratory airways primarily. These two diseases have resembling symptoms, including dry cough, fever, and dyspnea. Due to the importance of early COVID-19 diagnosis, many other respiratory infectious diseases such as tuberculosis (TB) may be missed. Herein, a case of COVID-19 and tuberculosis co-infection is presented.
Early onset bilateral juvenile myasthenia gravis masquerading as simple congenital ptosis
Authors: Md Shahid Alam, Pratheeba Devi Nivean
Journal: GMS Ophthalmol Cases (2017)
Keywords: childhood myasthenia, congenital ptosis, juvenile myasthenia, masquerade, ocular myasthenic syndrome
MeSH terms: Case Reports

Myasthenia gravis is an autoimmune disorder affecting the neuromuscular junction. Ocular myasthenia gravis presents as ptosis with extraocular motility restriction and is prone to be misdiagnosed as third nerve palsy or congenital or aponeurotic ptosis. Juvenile ocular myasthenia gravis in very young children is difficult to diagnose and can be easily labeled as a case of congenital ptosis, the more so when the condition is bilateral. We present a case of a two-year-old child who presented with bilateral ptosis and was diagnosed as a case of simple congenital ptosis elsewhere with the advice to undergo tarsofrontalis sling surgery. The child was diagnosed with juvenile myasthenia gravis on thorough history, examination, and systemic evaluation and was started on anti-myasthenic treatment.
Early onset recall pneumonitis during targeted therapy with sunitinib
Authors: Takeshi Yuasa, Shinichi Kitsukawa, Gen Sukegawa, Shinya Yamamoto, Keita Kudo, Kazunari Miyazawa, Takuyo Kozuka, Sohei Harada, Junji Yonese
Journal: BMC Cancer (2013)
MeSH terms: Antineoplastic Agents / adverse effects, Carcinoma, Renal Cell / secondary, Carcinoma, Renal Cell / therapy, Indoles / adverse effects, Kidney Neoplasms / pathology, Protein Kinase Inhibitors / adverse effects, Pyrroles / adverse effects, Radiation Pneumonitis / chemically induced, Spinal Neoplasms / secondary, Spinal Neoplasms / therapy, Thoracic Vertebrae / drug effects, Thoracic Vertebrae / radiation effects, Case Reports, Research Support, Non-U.S. Gov't, Aged, Carcinoma, Renal Cell / drug therapy, Carcinoma, Renal Cell / radiotherapy, Glucocorticoids / administration & dosage, Humans, Male, Molecular Targeted Therapy, Prednisolone / administration & dosage, Pulse Therapy, Drug, Radiation Dosage, Radiation Pneumonitis / diagnostic imaging, Radiation Pneumonitis / drug therapy, Spinal Neoplasms / drug therapy, Spinal Neoplasms / radiotherapy, Sunitinib, Time Factors, Tomography, X-Ray Computed, Treatment Outcome, Antineoplastic Agents, Glucocorticoids, Indoles, Protein Kinase Inhibitors, Pyrroles, Prednisolone, Sunitinib

Background:
Sunitinib interacts with radiation therapy, leading to synergism of the toxicities of these treatments. Radiation recall pneumonitis is a rare but serious complication of targeted therapy with tyrosine kinase inhibitors.
Case presentation:
The case of a patient with metastatic renal cell cancer (RCC) who developed recall pneumonitis on the first cycle of systemic sunitinib treatment is reported here. A 65-year-old man with RCC and bone metastasis underwent radiation therapy on his thoracic vertebrae (Th5-8) with a total dose of 24 Gy. Sunitinib (37.5 mg) was started 14 days after completing the radiation therapy. On the 14th day of sunitinib treatment, the patient developed progressive fever with worsening of dyspnea and general weakness. Treatment with pulse administration of prednisolone 1,000 mg for 3 days was initiated. Thereafter, the symptoms and the radiological findings regarding the interstitial filtration gradually improved over 7 days.
Conclusion:
To our knowledge, this is the first report of early onset recall pneumonitis during sunitinib therapy. At present, how sunitinib interacts with radiation therapy remains unclear. The possibility that tyrosine kinase inhibitor therapy, including with sunitinib, after radiation therapy may lead to adverse effects should be kept in mind.
Histopathological Variability and Concomitant Lesions in Pterygium in a Large Case Series
Authors: Sabrina Bergeron, Hiroaki Ito, Yves E Dossous, Miguel N Burnier Jr
Journal: J Ophthalmol (2021)

Pterygium is a common lesion consisting of fleshy conjunctival growth extending towards the cornea. There is no documented risk of malignant transformation; however, concomitant disease is not rare, and its link to sunlight exposure indicates a risk of other malignancies. The purpose of our study is to describe histopathological features of resected pterygiums and to recognize patients at risk of other conjunctival diseases. One hundred and forty-nine formalin-fixed and paraffin-embedded pterygium samples were subjected to histopathological analysis. Histological H&E sections were obtained and digitalized using a Zeiss Axio Scan.Z1 slide scanner. Thirteen predefined morphological features were used to record histopathological changes in the epithelium and substantia propria. Neovascularization was observed in 54% of the samples. Sun damage, comprising solar elastosis and stromal plaque, was present in 81% of the samples. Variation in epithelial thickness was the most common change, with acanthosis and atrophy being observed in 62% and 26% of the samples, respectively. In our series, 21% (31/149) of pterygiums showed mild to moderate dysplasia, a finding that may be associated to ocular surface squamous neoplasia (OSSN). Moreover, 32% (47/149) of the cases showed melanocytic hyperplasia, which could represent primary acquired melanosis (PAM). There is a positive correlation between dysplasia and chronic inflammation (p=0.012) and an inverse correlation with epithelial atrophy (p=0.001) and neovascularization (p=0.05). Similarly, a positive correlation is observed between goblet cell hyperplasia and melanocytic hyperplasia (p=0.02). Our findings show that pterygiums harbour histological features that may be suggestive of OSSN or PAM in 53% of our patients. Whilst being on the benign side of the spectrum, these two entities are known for their potential progression to malignancy. A recommendation is made for all surgically excised pterygiums to be sent for histopathological diagnosis, and clear guidelines for reporting of these lesions should be established. Associated histopathological findings suggestive of other concomitant diseases should be identified to insure adequate follow-up of these patients.
Elbow arthroscopy: review of the literature and case reports
Authors: Prakash Khanchandani
Journal: Case Rep Orthop (2012)

Elbow arthroscopy, though described first in 1930s, gained popularity only in the last 3 decades. There has been a steady expansion in the clinical applications of elbow arthroscopy owing to the significant improvements in instrumentation and arthroscopic skills. The procedure which was mainly used for diagnostic purpose, loose body removals, and synovial biopsy has now become an important tool for managing elbow arthritis, stiff elbow, and trauma. However, this procedure has a higher incidence of neurological complications and hence case selection and surgeon's expertise are of utmost importance.
Case Report: Cutaneous Squamous Cell Carcinoma Arising From the Ulcer of the Lesions of Dupuytren's Disease on the Palm
Authors: Qingmiao Sun, Bin Fu, Sheng Li, Hong Fang, Jianjun Qiao
Journal: Front Oncol (2021)
Keywords: dupuytren’s disease, palm, skin cancer, squamous cell carcinoma, surgical excision
MeSH terms: Case Reports

Dupuytren's disease is a benign fibromatosis that mainly involves the fascia of the palm and digits. The relationship between Dupuytren's disease and the evolution of cutaneous squamous cell carcinoma is still unclear. Here we report the case of a 52-year-old female with squamous cell carcinoma arising from the ulcer of the lesions of Dupuytren's disease on the left palm. To our knowledge, this is the first reported case in the English literature of squamous cell carcinoma on the palm of someone with Dupuytren's disease.
[Middle ear squamous papilloma: report of a case and literature review]
Authors: Samir Cahali, Flávia B da Silva, Márcia C Machado, Danielle A da Silva, Olga M R Reforeme, Michel B Cahali
Journal: Braz J Otorhinolaryngol (2005)
MeSH terms: Ear Neoplasms / pathology, Papilloma / pathology, Case Reports, English Abstract, Aged, Biopsy, Ear Neoplasms / virology, Hearing Loss / diagnosis, Humans, Male, Nasopharyngeal Neoplasms / pathology, Papilloma / virology, Papilloma, Inverted / pathology, Papillomavirus Infections / complications

Squamous papillomas are benign neoplasms. The occurrence of middle ear squamous papilloma is rare. It is usually associated with nasosinusal pathology. The authors report a case of middle ear squamous papilloma and discuss its diagnostic aspects.
Perioperative management of polycythemia vera with advanced gastric cancer: A case report
Authors: Tetsuya Mochizuki, Kazuaki Tanabe, Ryusuke Saito, Hiroshi Ota, Yuji Yamamoto, Yoshihiro Saeki, Hideki Ohdan
Journal: Int J Surg Case Rep (2019)
Keywords: gastrectomy, gastric cancer, polycythemia vera

Introduction:
Polycythemia vera (PV) is a chronic myeloproliferative disorder with generally good prognosis. However, thrombotic and cardiovascular complications are among the leading causes of death in patients with PV and sufficiently effective management strategies are yet to be established. We report a case involving operation for gastric cancer in a patient being treated for PV.
Presentation of case:
A 73-year-old man was diagnosed as PV on the basis of abnormal laboratory data eight years previously. Three months ago, he was referred to our department for anorexia and melena. The preoperative diagnosis was advanced gastric cancer, Stage IIB. To avoid perioperative thrombotic and hemorrhagic events, low-dose aspirin administration was continued with an additional dose of hydroxyurea. Emergent control was necessary because of the severity of gastric cancer symptoms, including pyloric stenosis and anemia. Distal gastrectomy with D2 lymph node resection was performed. The postoperative course was satisfactory, and the patient is currently doing well without any signs of recurrence or hematological complications.
Discussion:
We described the successful management of a patient being treated for PV who underwent gastrectomy. As mentioned earlier, thrombotic complications and hemorrhage during the perioperative period are the major risk factors in patients with PV. In this case, control of white blood cell and platelet counts during the perioperative period led to good results.
Conclusions:
Perioperative management for PV is important for complication-free surgery. Careful follow up should be performed for gastric cancer and PV recurrence.
Case report: Prenatal diagnosis of fetal intracranial hemorrhage due to compound mutations in the JAM3 gene
Authors: Min Xu, Pengzhen Jin, Yingzhi Huang, Yeqing Qian, Miaochun Lin, Juan Zuo, Jin Zhu, Zhaohui Li, Minyue Dong
Journal: Front Genet (2022)
Keywords: jam3, genetic counseling, intracranial hemorrhage, prenatal diagnosis, whole-exome sequencing
MeSH terms: Case Reports

Intracranial hemorrhage is a common complication in preterm infants but occasionally occurs in fetuses. Disruptions of the genes, such as the COL4A1 and COL4A2 genes, are common genetic causes identified in fetal intracranial hemorrhage; however, the disruptions of the JAM3 gene are rarely reported. In the current investigation, fetal intracranial hemorrhage and dilated lateral ventricles were observed in three consecutive siblings in a pedigree. The pregnancies were terminated, and whole-exome sequencing, followed by Sanger sequencing, was performed on the affected fetuses. Pre-implantation genetic testing for monogenic diseases was performed to avoid the recurrence. The compound heterozygous variants of c.712 + 2T > A and c.813C > G p.Tyr271* in the JAM3 gene (NM_032801.4) were identified in the proband and its affected brother, which were predicted to be pathogenic. The variant of c.813C > G p.Tyr271* but not c.712 + 2T > A was identified in the fourth fetus, implying a good prognosis. Our findings expanded the spectrum of the pathogenic mutations in the JAM3 gene and revealed an important application of fetal whole-exome sequencing in idiopathic fetal intracranial hemorrhage.
Case Report: Extracorporeal Membrane Oxygenation Followed by Intra-Aortic Balloon Counterpulsation Successfully Treated Cardiac Arrest Caused by Anomalous Origin of a Left Coronary Artery From the Right Coronary Sinus
Authors: Xiaolan Xu, Peng Xu, Xiaoyan Wu, Hua Lin, Yinhua Chen, Xiaohua Hu, Jiangquan Yu, Ruiqiang Zheng
Journal: Front Med (Lausanne) (2022)
Keywords: aoca, ecmo, iabp, cardiac arrest, case report
MeSH terms: Case Reports

Background:
Anomalous origin of a coronary artery (AOCA) is defined as the failure of the coronary artery to originate from the normal coronary sinus. The anomalous origin of the left coronary artery arising from the right coronary sinus is rare, dangerous and at risk of malignant arrhythmia, sudden death, and high mortality.
Case presentation:
In this study, we present a 14-year-old adolescent male who went to a hospital with transient unconsciousness after exercise, who subsequently developed cardio arrest due to malignant arrhythmia. He was admitted to the intensive care unit, and who subsequently received successful veno-arterial extracorporeal membrane oxygenation (VA ECMO) assisted circulation followed by intra-aortic balloon counterpulsation (IABP). Echocardiography and cardiac CTA were also performed, further confirming that the abnormal left coronary artery originated from the right coronary sinus. The patient subsequently underwent heart surgery.
Conclusion:
The successful treatment of the patient in this report was attributed to the immediately VA ECMO, supplemented by IABP. Establishing clear diagnosis is a process of multidisciplinary joint diagnosis, which provides a reference for clinicians when encountering similar cases.
Colon Cancer Metastasis to the Right Testis: Case Report and Review of Literature
Authors: Mizuki Kasahara, Tomo Shimizu, Hiroshi Aoki, Mizuho Okawa, Fumito Yamabe, Hideyuki Kobayashi, Koichi Nagao, Koichi Nakajima, Yozo Mitsui
Journal: Case Rep Urol (2022)
MeSH terms: Case Reports

Introduction:
A metastatic testicular tumor is uncommon. We report here a case of testicular metastasis associated with recurrent colorectal cancer. Case Presentation. A 75-year-old male was presented with right scrotum pain one year after undergoing a right hemicolectomy combined with resection of the small intestine and omentum for ascending colon cancer (pT4N0M0). Magnetic resonance imaging of the pelvis showed a 7.3 × 5.4 × 4.5 cm mass consisting of a cystic solid tumor. A right inguinal orchiectomy was performed and right testicular pain improved after surgery. Pathology results showed that the tumor was a metastatic adenocarcinoma. The patient subsequently died two months later due to progression of the colon cancer.
Conclusion:
Although colorectal cancer metastasis to the testis is very uncommon, it should be kept in mind in clinical situations, especially for older males with a testicular mass or discomfort.
Extensive migration of injected free liquid silicone for breast augmentation with related major complications
Authors: J D Hilton, K Steinke
Journal: BJR Case Rep (2015)
MeSH terms: Case Reports

Free liquid silicone breast injections have been used for off-label breast augmentation since the 1960s. Shortly after the invention of this technique, multiple adverse effects became apparent and the technique became illegal in most countries. The procedure continues to be undertaken owing to its decreased cost compared with silicone prostheses. Complications from free silicone injections lead to complex management issues and health risks. This case demonstrates severe silicone migration, the extent of which has not previously been documented. In addition, the migration caused a serious life-threatening complication with subsequent complex management issues.
Suicidality and Self-Harming Behaviors in Patients with Prader-Willi Syndrome (PWS): Case Report and Literature Review
Authors: Val Bellman, Zargham Abbass, Ramsa Sohail, Syed Jafri
Journal: Case Rep Psychiatry (2021)
MeSH terms: Case Reports

Prader-Willi syndrome (PWS) is a rare neurodevelopmental disorder which is often associated with significant behavioral challenges and poor intellectual functioning. Research has shown that individuals with PWS are more likely to experience mental health problems, have higher relapse rates, and are at risk of self-harming behavior. Although PWS is associated with mild intellectual disability, which in itself confers a higher mortality rate, suicidality in this population is so far unreported in the literature. We present the case of an 18-year-old male patient who was admitted to our facility following exogenous insulin administration with suicidal intent. The main clinical characteristics, self-harming behaviors, and suicide risk factors of patients with PWS are discussed in this report. The article's objective is to redirect clinicians' attention to carefully screen and treat the underlying behavioral problems in PWS patients.