OpenMed/multicare-articles huggingface dataset:
Pituitary metastasis of hepatocellular carcinoma as the initial presentations: a case report and review of the literature
Authors: Qiang He, Feng Deng, Bowen Cai, Chao You, Songping Zheng
Journal: Front Oncol (2023)
Keywords: case report, headache, hepatocellular carcinoma, literature review, pituitary metastasizes
MeSH terms: Case Reports

Background:
Extrahepatic metastasis of hepatocellular carcinoma (HCC) is common. However, pituitary metastasis of HCC is extremely rare. Our case may be helpful to extend the understanding of the disease.
Case presentation:
A 65-year-old man presented to the outpatient department for unexplained headache and ptosis for 1 month. Brain imaging showed a slight enhancement tumor in the pituitary fossa, and the endocrinological assessment showed normal results. We considered the tumor as a non-functioning pituitary adenoma before surgery. Then, the tumor was resected by an endonasal endoscopic transsphenoidal approach. The histopathological examination results revealed the pituitary metastasis of HCC. Additional abdominal imaging revealed tumors were located in the left and right liver lobes with portal vein invasion and bilateral ilium metastases. After multidisciplinary cooperation, the patient chose chemotherapy.
Conclusion:
We report a case of HCC metastasis to the pituitary gland that initially presented with neurological symptoms. We should consider the possibility of pituitary metastasis in HCC patients.
Rare Presentation of Disseminated Gout Nodulosis and Chronic Inflammatory Arthritis
Authors: Faria Sami, Shahzad Ahmed Sami, Shilpa Arora
Journal: Case Rep Rheumatol (2023)
MeSH terms: Case Reports

Background:
Gout is an inflammatory arthritis caused by monosodium urate (MSU) deposition. Acute gout is a dramatic painful swelling of the joint; however, MSU can deposit in other tissues as well, including skin, gastrointestinal tract, and bones over time. Disseminated tophi in the skin are a rare presentation of gout known as gout nodulosis. We present a case of gout nodulosis with subcutaneous diffuse miliary nodules in nonarticular areas with concurrent findings suggestive of chronic inflammatory arthritis. Case Presentation. A 39-year-old patient presented with intermittent painful swelling in multiple joints with prolonged morning stiffness. On exam, synovitis was present in multiple proximal interphalangeal joints, wrists, elbows, and knees. Chronic raised pearly nodular rash and swellings on extensor aspects of arms, legs, and anterior abdomen were noticeable. He had negative rheumatoid factor and anti-CCP antibody, C-reactive protein of 0.23 mg/dL, erythrocyte sedimentation rate of 37 mm/hr, and uric acid of 10.6 mg/dL. Hand X-rays revealed severe periarticular osteopenia and joint space narrowing in several joints. Musculoskeletal ultrasound showed a double contour sign at multiple joints and a tophaceous deposit over the olecranon fossa. The biopsy of the nodular rash was consistent with tophi. He was diagnosed with chronic tophaceous gout with skin nodulosis and possible overlap of seronegative rheumatoid arthritis given his X-ray findings.
Conclusion:
This case discusses one of the rare presentations of gout with disseminated gouty tophi in the skin to raise clinical awareness. The clinical dilemma of the overlap of gout and rheumatoid arthritis posing a diagnostic challenge for clinicians is also highlighted.
Case Report: Identification of Multiple TERT and FGFR2 Gene Fusions in a Pineal Region Glioblastoma Case
Authors: Xing Guo, Teng Chen, Shiming Chen, Chao Song, Dezhi Shan, Shujun Xu, Shuo Xu
Journal: Front Oncol (2021)
Keywords: fgfr2, tert, amplification, gene fusion, glioblastoma, somatic variation
MeSH terms: Case Reports

As an oncogenic somatic variant, telomerase reverse transcriptase promoter (TERTp) mutations are frequently observed in adult glioblastoma (GBM). Alternatively, we report the first case of glioblastoma with TERT amplification accompanied by multiple TERT and FGFR2 gene fusions instead of TERTp mutation. A 55-year-old woman presented with dizziness, headache, and diplopia for three weeks. Magnetic resonance imaging (MRI) demonstrated a heterogeneously enhancing lobulated mass centered in the pineal region. Partial tumor resection and ventriculoperitoneal shunt were achieved, and the residual tumor was then treated with standard radiation. The tumor was diagnosed as GBM, IDH-wild type, WHO grade IV, and the Ki67 proliferation index was high (30-40%). Intriguingly, TERT amplification without TERTp mutation was identified via next generation sequencing (NGS). Further analysis revealed multiple TERT (TERT-NUBPL, MARCH6-TERT, and CJD4-TERT) and FGFR2 (CXCL17-FGFR2, SIPA1L3-FGFR2, FGFR2-SIPA1L3, and FGFR2-CEACAM1) gene fusions. After the surgery, the patient's condition deteriorated rapidly due to the malignant nature of the tumor and she died with an overall survival of 3 months. Our report provides the molecular clue for a novel telomerase activation and maintenance mechanism in GBM.
Slippery Stents: A Case Report and Review of the Literature Describing Patients with May-Thurner Syndrome That Experienced Stent Migration
Authors: Ramy Mando, Priscilla Sigua-Arce, Lisa Spencer, Alexandra Halalau
Journal: Case Rep Vasc Med (2019)
MeSH terms: Case Reports

Endovascular stent placement is an effective treatment for relieving chronic venous obstruction in patients with May-Thurner Syndrome (MTS) with or without the presence of thrombotic lesions. Stent migration is a rare but potentially life-threatening complication of endovascular stenting. Herein, we describe a case of stent migration from the left common iliac vein into the right heart, requiring open-heart surgery. We also completed a literature review of MTS patients with stent migration in hopes of raising awareness of this rare and life-threatening complication.
Arterial thrombosis in patients with human immunodeficiency virus: two-case reports and review of the literature
Authors: C Konin, J B Anzouan-Kacou, A Essam N'loo
Journal: Case Rep Vasc Med (2011)
MeSH terms: Case Reports

Thrombosis during HIV infection was commonly vein thrombosis. Arterial thrombosis is also more and more described. We report two cases detected in the Abidjan Cardiology Institute. Case Reports. Case 1: an HIV infected female presented with sudden loss of consciousness and right hemiplegia. She had been taking HAART regimen for five years. Neck vessels ultrasonography revealed thrombosis on left ICA. Anticoagulant treatment leads to reduction of symptoms and left ICA partial recanalization. Case 2: male HIV infected taking HAART therapy was admitted for an acute pain of left lower limb; examination showed a decrease of heat, sensitivity, and mobility of this limb with popliteal and tibial pulses abolished. Arterial ultrasonography and CT angiography showed occlusion on the lower third of superficial femoral artery and homolateral popliteal artery suggesting a thrombosis of this artery. He underwent a femorotibial bypass surgery and anticoagulant treatment. The outcome was good with reappearance of local heat of the limb and tibial pulses. Probable etiology is early carotid atherosclerosis associated with protein S deficiency in the first case and antiphospholipid syndrome in the second case. Conclusion. Arterial thrombosis might occur in HIV infection. Several etiological factors could be involved in the pathogeny of these arterial thromboses.
Primary infectious aortic aneurysm: a case series and review of the literature
Authors: Fernanda Beatriz Araújo de Albuquerque, Matheus Oliveira Feijó, Jacob Hindrik Antunes Smit, Ricardo Bernardo da Silva, Adenauer Marinho de Oliveira Góes
Journal: J Vasc Bras (2022)
Keywords: abdominal aortic aneurysm, aortic aneurysm, infectious aneurysm, ruptured aortic aneurysm

Infectious aneurysms, formerly known as mycotic aneurysms, are rare, most often involve the aorta in young patients, and have a greater tendency to rupture than aneurysms of other etiologies. The most characteristic shape is saccular and the most common etiologic agents are Staphylococcus sp. and Salmonella sp. There is scant and imprecise information in the literature about correct nomenclature, diagnosis, and treatment. The authors present three cases in which diagnostic and therapeutic procedures were documented. In addition to reporting this case series, the authors also present a review of the subject, outlining pertinent diagnostic and therapeutic strategies.
Persistent Mixed Donor Chimerism following Double Umbilical Cord Transplantation in a Patient with T-Cell Prolymphocytic Leukemia
Authors: Ronak H Mistry, Elizabeth O Hexner, James K Mangan
Journal: Case Rep Hematol (2019)
MeSH terms: Case Reports

T-cell prolymphocytic leukemia (T-PLL) is a rare and aggressive postthymic T-cell neoplasm with an associated survival time of 1 year when left untreated. Current standard of care for T-PLL is with alemtuzumab, followed by allogeneic or autologous stem cell transplant. Little is found in the literature about alternative donor transplantation in T-PLL. Here, we present the case of a patient treated with double umbilical cord blood transplantation, which resulted in initial complete remission. An unusual outcome of this case is that coengraftment of both cords was established. After 16 months, the patient had relapse of the disease, unfortunately, prompting treatment with alemtuzumab and pentostatin, which resulted in remission once again. Here, we report a unique phenomenon whereby single-cord dominance occurred after treatment with these agents, suggesting that anti-T-cell therapy after transplant may help achieve single-unit dominance. A second relapse of the disease occurred six months thereafter, ultimately resulting in the patient's death, highlighting the aggressive nature of this disease.
Insulin oedema in newly diagnosed type 1 diabetes mellitus
Authors: Veysel Nijat Baş, Semra Çetinkaya, Sebahat Yılmaz Ağladıoğlu, Havva Nur Peltek Kendirici, Hatice Bilgili, Nurdan Yıldırım, Zehra Aycan
Journal: J Clin Res Pediatr Endocrinol (2010)
Keywords: type 1 diabetes
MeSH terms: Diabetes Mellitus, Type 1 / drug therapy, Edema / chemically induced, Insulin / adverse effects, Case Reports, Adolescent, Child, Female, Humans, Lower Extremity / pathology, Insulin

Despite the essential role of insulin in the management of patients with insulin deficiency, insulin use can lead to adverse effects such as hypoglycaemia and weight gain. Rarely, crucial fluid retention can occur with insulin therapy, resulting in an oedematous condition. Peripheral or generalised oedema is an extremely rare complication of insulin therapy in the absence of heart, liver or renal involvement. It has been reported in newly diagnosed type 1 diabetes, in poorly controlled type 2 diabetes following the initiation of insulin therapy, and in underweight patients on large doses of insulin. The oedema occurs shortly after the initiation of intensive insulin therapy. We describe two adolescent girls with newly diagnosed type 1 diabetes, who presented with oedema of the lower extremities approximately one week after the initiation of insulin treatment; other causes of oedema were excluded. Spontaneous recovery was observed in both patients.
Case Report: Allergic Bronchopulmonary Aspergillosis Revealing Asthma
Authors: Houda Snen, Aicha Kallel, Hana Blibech, Sana Jemel, Nozha Ben Salah, Sonia Marouen, Nadia Mehiri, Slah Belhaj, Bechir Louzir, Kalthoum Kallel
Journal: Front Immunol (2021)
Keywords: aspergillus fumigatus, allergic bronchopulmonary aspergillosis, antifungal therapy, drug toxicity, uncontrolled asthma
MeSH terms: Aspergillosis, Allergic Bronchopulmonary / diagnosis, Aspergillus fumigatus / isolation & purification, Asthma / diagnosis, Lung / microbiology, Case Reports, Adrenal Cortex Hormones / therapeutic use, Aged, Anti-Asthmatic Agents / therapeutic use, Antifungal Agents / therapeutic use, Aspergillosis, Allergic Bronchopulmonary / drug therapy, Aspergillosis, Allergic Bronchopulmonary / microbiology, Aspergillosis, Allergic Bronchopulmonary / physiopathology, Asthma / drug therapy, Asthma / physiopathology, Female, Humans, Lung / drug effects, Lung / physiopathology, Reinfection, Treatment Outcome, Adrenal Cortex Hormones, Anti-Asthmatic Agents, Antifungal Agents

Allergic bronchopulmonary aspergillosis (ABPA) is an immunological pulmonary disorder caused by hypersensitivity to Aspergillus which colonizes the airways of patients with asthma and cystic fibrosis. Its diagnosis could be difficult in some cases due to atypical presentations especially when there is no medical history of asthma. Treatment of ABPA is frequently associated to side effects but cumulated drug toxicity due to different molecules is rarely reported. An accurate choice among the different available molecules and effective on ABPA is crucial. We report a case of ABPA in a woman without a known history of asthma. She presented an acute bronchitis with wheezing dyspnea leading to an acute respiratory failure. She was hospitalized in the intensive care unit. The bronchoscopy revealed a complete obstruction of the left primary bronchus by a sticky greenish material. The culture of this material isolated Aspergillus fumigatus and that of bronchial aspiration fluid isolated Pseudomonas aeruginosa. The diagnosis of ABPA was based on elevated eosinophil count, the presence of specific IgE and IgG against Aspergillus fumigatus and left segmental collapse on chest computed tomography. The patient received an inhaled treatment for her asthma and a high dose of oral corticosteroids for ABPA. Her symptoms improved but during the decrease of corticosteroids, the patient presented a relapse. She received itraconazole in addition to corticosteroids. Four months later, she presented a drug-induced hepatitis due to itraconazole which was immediately stopped. During the monitoring of her asthma which was partially controlled, the patient presented an aseptic osteonecrosis of both femoral heads that required surgery. Nine months after itraconazole discontinuation, she presented a second relapse of her ABPA. She received voriconazole for nine months associated with a low dose of systemic corticosteroid therapy with an improvement of her symptoms. After discontinuation of antifungal treatment, there was no relapse for one year follow-up.
A Giant Epidermal Cyst in the Gluteal Region: A Case Report
Authors: Rahul Rajendran, Sajika P Dighe
Journal: Cureus (2023)
Keywords: epidermal inclusion cyst, giant, gluteal region, mri- magnetic resonance imaging, ultrasonography (usg)
MeSH terms: Case Reports

Epidermal cysts are the most commonly occurring cysts in the subcutaneous plane and are usually asymptomatic, small, and slow growing. When the size of an epidermal cyst is greater than 5 cm, it is considered a giant epidermal cyst. Common etiologies include sun-damaged skin and acne vulgaris, and they can appear anywhere in the body, but preferably over the face, neck, and trunk. Unusual sites include the breast, penis, spleen, bones, subungual region, palms, soles, and buttocks. In this report, we presented the case of a 31-year-old female having a large, painless, gradually progressing swelling for two years in the left gluteal region, which was insidious in onset and slow-growing. The patient eventually described a discomfort that made it impossible for her to sit for long hours or sleep in a supine position. Clinical examination revealed circumscribed mass over the left gluteal region from which diagnosis of giant lipoma was confirmed, but due to its large size and involvement of the whole left buttock, we considered it important to perform an ultrasound examination to reinforce our diagnosis, which revealed a large cystic mass in the left gluteal subcutaneous plane that was excised. As a definitive management, surgery was performed with excision of the swelling, which was extracted in toto and was identified as a cyst, and on histopathological examination, the cyst wall was lined by stratified squamous epithelium. Hence, this case report highlights a rare case of a giant epidermal cyst in the gluteal region.
Computer guided temporomandibular joint reconstruction of Kaban III hemifacial microsomia with anotia: A case report
Authors: Mamdouh Ahmed, Sherif Ali
Journal: Int J Surg Case Rep (2019)
Keywords: computer-assisted surgery, craniofacial microsomia, kaban iii, reconstructive surgery, temporomandibular joint

INTRODUCTION, Hemifacial microsomia is the second most common craniofacial congenital anomaly. It corresponds to a group of malformations ranging from minimal facial asymmetry to sever form affecting mandible, soft tissues, orbit, ear, and cranial nerves. PRESENTATION OF CASE, We present a case of 6 years old patient with Kaban class III hemifacial microsomia with anotia. Temporomandibular joint was reconstructed by costochondral graft using computer guided surgery (simulation and rapid prototyping). A computer guided soft tissue guide, mandibular, and maxillomandibular/zygomatic models were constructed using rapid prototyping technology. The customized computer guided soft tissue guide was used to localize the proper position of skin incision, the mandibular model was used for preoperative reconstruction plate bending, and the maxillomandibular/zygomatic model was used to estimate the rib graft length and position. Postoperative assessment showed proper positioning of the graft, with no complications or facial nerve affection. DISCUSSION, In this report, we introduce a new computer guided technique to estimate and identify the proper position of the temporomandibular joint graft based on patient CT. This technique eliminated the need of extended incisions with excessive dissection and provided a more accessible field for rib graft fixation, facilitating the surgical procedures. CONCLUSION, The use of computer guided surgery (simulation and rapid prototyping) for temporomandibular joint reconstruction in Kaban III hemifacial microsomia with anotia facilitates the surgical procedure, minimizes procedure time, increases precision, and reduces possible complications.
Gastric Dilation due to a Neuroleptic Agent in an Elderly Patient: A Case Report
Authors: V Parent, L Popitean, A Loctin, A Camus, P Manckoundia
Journal: Case Rep Med (2014)

Neuroleptics may cause side effects, some of which are little known. We describe here a case of gastric dilation related to treatment with a neuroleptic in an elderly man. To our knowledge, such a case has never been reported in the literature. A 76-year-old man, living in a nursing home, was hospitalized for general weakness and abdominal pain. He had dementia with behavioral disorders treated with cyamemazine, a sedative and anxiolytic neuroleptic. Given a clinical suspicion of intestinal occlusion, an abdominopelvic computerized tomography scan was performed before the patient was admitted to our hospital. This computerized tomography scan did not show intestinal occlusion and there was no mention of gastric dilation in the computerized tomography scan report. Thus, acute gastroenteritis was suspected. The usual medications were stopped and symptomatic treatment for gastroenteritis was started. Quickly, his clinical state and biological parameters returned to normal and his usual treatment, including cyamemazine, was started again. The next day, the digestive symptoms, except for obstipation, reappeared. The abdominal X-ray showed gastric dilation without intestinal occlusion. The neuroleptic was stopped again and symptoms vanished the next day. This report underlines all of the necessary precautions and surveillance around drug prescription, especially in elderly persons.
Syndrome of Inappropriate Secretion of Antidiuretic Hormone (SIADH) With Severe Hyponatremia As the Initial and Sole Presentation of COVID-19 Infection: A Case Report and Pathophysiologic Insights
Authors: Parinaz Ayat, Sultana Alam, Violeta Capric, James Chen, Samy I McFarlane
Journal: Cureus (2023)
Keywords: atypical presentation, covid-19, hyponatremia, sars-cov-2 infection, siadh
MeSH terms: Case Reports

Hyponatremia is one of the common electrolyte imbalances among hospitalized patients with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) being a common etiology for hyponatremia. There are multiple pathophysiologic considerations in the differential diagnosis of the etiologic factor for SIADH, including infections such as pneumonia and meningitis, as well as coronavirus disease 2019 (COVID-19) infection. However, SIADH, as the sole initial presentation of the infection of COVID-19, is rarely reported. In this report, we present a case of SIADH as the initial and only presentation of a COVID-19 infection, highlighting the clinical course and treatment strategy while providing the putative pathophysiologic insights into this unusual and potentially serious complication of COVID-19 infection.
Symptomatic Pituitary Metastasis as Initial Manifestation of Renal Cell Carcinoma: Case Report and Review of Literature
Authors: Gunjan Y Gandhi, Russell Fung, Patrick E Natter, Raafat Makary, K C Balaji
Journal: Case Rep Endocrinol (2020)
MeSH terms: Case Reports

Metastasis to the pituitary gland is extremely rare (∼2% of sellar masses). Clinical, biochemical, and radiologic characteristics of pituitary metastasis are poorly defined and can be difficult to diagnose before surgery. We present an unusual case with pituitary metastasis as the first manifestation of renal cell carcinoma (RCC). A 70-year-old male presented with acute onset of weakness, dizziness, diplopia, and progressively worsening headache. The initial CT head revealed a heterogeneous sellar mass measuring 2.8 × 1.9 × 1.7 cm. A follow-up MRI showed the sellar mass invading the right cavernous sinus. The presumptive diagnosis was a pituitary macroadenoma. Physical examination revealed bilateral 6th cranial nerve palsy and episodes of intermittent binocular horizontal diplopia. Hormonal testing noted possible secondary adrenal insufficiency (AM serum cortisol: 3.3 mcg/dL, ACTH: 8 pg/mL), secondary hypothyroidism (TSH: <0.01 mIU/L, FT4: 0.7 ng/dL), secondary hypogonadism (testosterone: 47 ng/dL, LH: 1.3 mIU/mL, and FSH: 2.3 mIU/mL), and elevated serum prolactin (prolactin: 56.8 ng/ml, normal: 4.0-15.2 ng/ml). IGF-1 level was normal at 110 ng/mL (47-192 ng/mL). The patient was discharged on levothyroxine and hydrocortisone therapy with plans for close surveillance. However, his condition worsened over the next three months, and he was subsequently readmitted with nausea, vomiting, and hypernatremia secondary to diabetes insipidus. Repeat MRI pituitary showed an interval increase in the size of the sellar mass with suprasellar extension and a new mass effect on the optic chiasm. The sellar mass was urgently resected via a trans-sphenoidal approach. The tumor was negative for neuroendocrine markers and pituitary hormone panel, ruling out the diagnosis of pituitary adenoma and triggered workup for metastatic renal cell carcinoma, clear cell type. The diagnosis of renal cell carcinoma was confirmed by the diffuse and strong staining for renal cell carcinoma markers (Pax-8, RCC-1, and CD10). A follow-up CT scan noted large right renal mass measuring 11 × 10 × 11 cm. The patient underwent a cytoreductive robotic right radical nephrectomy for WHO/ISUP histologic grade II clear cell RCC, stage pT2b pNX pM1. He subsequently received fractionated stereotactic radiotherapy to the pituitary gland. He is presently stable with no radiological evidence of progression or new intracranial disease on subsequent imaging. Pituitary metastasis most commonly occurs from breast, lung, or gastrointestinal tumors but also rarely from renal cell carcinoma. Biochemical findings such as panhypopituitarism, acute clinical signs such as headache, visual symptoms, and diabetes insipidus and interval increase in sellar mass in a short time interval should raise suspicion for sellar metastasis.