OpenMed/multicare-articles huggingface dataset:
Toxoplasmosis Presenting as Nonhealing Cutaneous Ulcer
Authors: M Adhikari, S Dhakal, S Bhattarai, U Rai
Journal: Case Rep Pathol (2020)
MeSH terms: Case Reports

Introduction:
Systemic manifestation of toxoplasmosis is commonly seen in immune-compromised individuals. Skin manifestations are seen commonly in conjunction with systemic features. Isolated cutaneous toxoplasmosis is extraordinarily rare in immunocompetent patients. Case Description. A 64-year-old female presented to the Dermatology Outpatient Department (OPD), with a nonhealing ulcer over dorsum of the left hand for one year. The patient did not have any systemic diseases. Serology tests were negative. An incisional biopsy of the lesion revealed dense inflammatory cell infiltrates comprising predominantly of plasma cells and lymphocytes, multinucleated giant cells, and focal abscess formation in the dermis. Periodic Acid Schiff (PAS) stain showed organisms in the dermis with morphological resemblance to tachyzoites of Toxoplasma gondii.
Conclusion:
Though rare, a possibility of primary cutaneous toxoplasmosis should always be considered and looked for, even in immunocompetent patients presenting with chronic nonhealing ulcers.
Case report: Spiller syndrome initially mimicking vestibular neuritis
Authors: Huiyuan Wang, Tianming Shi, Yafei Shang, Xinyi Chen, Jie Xu, Yu Geng
Journal: Front Neurol (2023)
Keywords: spiller syndrome, ischemic stroke (is), nucleus prepositus hypoglossal, nystagmus, vertigo, vestibular neuritis (vn)
MeSH terms: Case Reports

Spiller syndrome is a rare subtype of medial medullary infarction (MMI). Herein, we report on a patient with progressing stroke who presented with the initial features of acute peripheral vestibulopathy and MMI (Spiller syndrome), as confirmed by magnetic resonance imaging (MRI). A 42-year-old man experienced acute persistent vertigo with nausea, vomiting, and severe gait instability for 6 h before presenting to the emergency department. He exhibited spontaneous right-beating horizontal-torsional nystagmus that intensified on rightward gaze. The patient fell to the left side during the Romberg test. Cranial computed tomography (CT) performed immediately upon admission did not provide evidence for ischemia or hemorrhage of the brainstem and cerebellum; however, the symptoms underwent exacerbation 4 h after admission, manifesting as left-sided limb weakness and dysarthria, without dysphagia. Furthermore, bedside examination revealed difficulty in extending the tongue to the right, positive left Babinski's sign, and abnormal vibration and position sense in the paralyzed limb. Head impulse test recording revealed a normal gain in the vestibulo-ocular reflex, and numerous consistent covert corrective saccades were captured upon turning the head to the left side. Cranial MRI depicted an acute infarct confined to the right side of the medial medulla, which met the diagnostic criteria for Spiller syndrome. Our study underscores the importance of considering the possibility of a nucleus prepositus hypoglossi lesion even if the signs and symptoms support the diagnosis of peripheral lesions in patients with acute vestibular syndrome exhibiting vascular risk factors.
The need for guidelines in asplenic patients undergoing total joint arthroplasty: a case report
Authors: S R Shaarani, D Collins, J M O'Byrne
Journal: Case Rep Orthop (2012)
MeSH terms: Case Reports

There are currently no guidelines for splenectomy patient undergoing total joint arthroplasty. We present a case history of a 63-year-old man with a history of splenectomy that underwent a total knee arthroplasty with standard intravenous antibiotic prophylaxis. Two weeks postoperatively, he developed a prosthetic joint infection and followed the standard antimicrobial management with intravenous and oral antibiotics prior to having revision surgery. We propose that there are guidelines to properly manage these patients in the pre- and perioperative setting following an orthopaedic procedure.
Auditory Processing after Early Left Hemisphere Injury: A Case Report
Authors: Cristina Ferraz Borges Murphy, Georgios Stavrinos, Kling Chong, Tony Sirimanna, Doris-Eva Bamiou
Journal: Front Neurol (2017)
Keywords: acquired auditory processing disorder, auditory perception, early brain injury, language reorganization, left hemisphere lesion
MeSH terms: Case Reports

Few studies have addressed the long-term outcomes of early brain injury, especially after hemorrhagic stroke. This is the first study to report a case of acquired auditory processing disorder in a 10-year-old child who had a severe left hemorrhagic cerebral infarction at 13 months of age, compromising nearly all of the left temporal lobe. This case, therefore, is an excellent and rare opportunity to investigate the presence of neural plasticity of central auditory system in a developing brain followed severe brain damage. After assuring normal functioning of the peripheral auditory system, a series of behavioral auditory processing tests was applied in dichotic and monaural listening conditions and with verbal and non-verbal stimuli. For all verbal dichotic tasks (dichotic digits, competing words, and sentences tests), good performance on the left ear, especially for Dichotic digits test (100%), and zero performance on the right ear were observed. For monaural low-redundancy tests, the patient also exhibited good performance for auditory figure-ground and time-compressed sentences tests in the left ear. In the right ear, a very poor performance was observed, but slightly better than the same in Dichotic tasks. Impaired performance was also observed in the LiSN test in terms of spatial advantage and, for the Pitch Pattern Sequence test, the only non-verbal test applied, the patient had performance within the normal range in both ears. These results are interpreted taking into consideration the anatomical location of stroke lesion and also the influence of hemispheric specialization for language on auditory processing performance.
Case Report: Prolonged CSF PCR Positivity in a Neonate With GBS Meningitis
Authors: Nourah Alruqaie, Yara Falatah, Fawaz Alzahrani, Musaed Alharbi
Journal: Front Pediatr (2021)
Keywords: csf infection, group b streptococcus (gbs), meningitis, multiplex pcr, neonate
MeSH terms: Case Reports

Bacterial meningitis is one of the critical diseases that needs to be diagnosed and treated promptly. Recent diagnostics of high sensitivity and specificity rates, such as PCR, helped with such presentation, especially in cases with prior antibiotics that led to culture negativity. However, the time window of PCR positivity is not well-studied, with scattered reports of different periods of positivity. Here, we report a case of neonatal GBS meningitis with positive PCR for more than 80 days from starting antibiotics.
Recurrent paratesticular giant liposarcoma: A case report and literature review
Authors: Runmiao Hua, Liwei Zhao, Li Xu, Ji Sun, Jiaguo Huang, Qiyan Hua
Journal: Front Surg (2023)
Keywords: case report, diagnosis, paratesticular liposarcoma, prognosis, treatment
MeSH terms: Case Reports

Background:
Primary paratesticular liposarcoma is rarely diagnosed among urinary tumors. In this study, through the retrospective analysis of clinical data and literature review, a case of recurrent paratesticular liposarcoma with lymph node metastasis after radical resection has been reported to explore novel strategies for the diagnosis, treatment and prognosis of this rare disease.
Case summary:
The present case involved a patient who was misdiagnosed as a left inguinal hernia for the first time two years ago, but was later diagnosed as mixed liposarcoma by using postoperative pathology. Currently, he is readmitted to the hospital with a recurrence of the left scrotal mass for more than 1 year. Combined with the patient's past medical history, we performed radical resection of the left inguinal and scrotal tumors and lymphadenectomy of left femoral vein. The postoperative pathology indicated that well-differentiated liposarcoma was accompanied by mucinous liposarcoma (about 20%), and lymph node metastasis of left femoral vein both of which occurred at the same time. After the operation, we recommended the patient to receive further radiation therapy, but the patient and his family refused, hence we followed up the patient closely for a long time. During the recent follow-up, the patient reported no complaints of discomfort, and no recurrence of mass in the left scrotum and groin area.
Conclusion:
After conducting extensive review of literature, we conclude that radical resection remains the key to treat primary paratesticular liposarcoma, while the significance of the lymph node metastasis is still unclear. The potential effects of postoperative adjuvant therapy depends on the pathological type, and hence close follow-up observation is essential.
Multidisciplinary management of a giant plexiform neurofibroma by double sequential preoperative embolization and surgical resection
Authors: Roberto Vélez, Sergi Barrera-Ochoa, David Barastegui, Mercedes Pérez-Lafuente, Cleofe Romagosa, Manuel Pérez
Journal: Case Rep Neurol Med (2013)

Plexiform neurofibromas are benign tumors originating from subcutaneous or visceral peripheral nerves, which are usually associated with neurofibromatosis type 1. Giant neurofibromas are very difficult to manage surgically as they are extensively infiltrative and highly vascularized. These types of lesions require complex preoperative and postoperative management strategies. This case report describes a 22-year-old female with a giant plexiform neurofibroma of the lower back and buttock who underwent pre-operative embolization and intraoperative use of a linear cutting stapler system to assist with haemostasis during the surgical resection. Minimal blood transfusion was required and the patient made a good recovery. This case describes how a multidisciplinary management of these large and challenging lesions is technically feasible and appears to be beneficial in reducing perioperative blood loss and morbidity. Giant neurofibroma is a poorly defined term used to describe a neurofibroma that has grown to a significant but undefined size. Through a literature review, we propose that the term "giant neurofibroma" be used for referring to those neurofibromas weighing 20% or more of the patient's total corporal weight.
The use of an omental flap for the reconstruction of a burn injury to the scalp: A case report
Authors: Noor H AlLababidi, Asal AlOmran, Fuad K Hashem
Journal: Int J Surg Case Rep (2018)
Keywords: burn injury, head and neck, omental flap, plastic surgery, reconstruction, scalp

Introduction:
Omental free flaps are used in reconstructing a wide range of clinical indications in the head and neck. The first omental flap case to be reported was in 1972 by McLean and Buncke.
Case presentation:
This case demonstrate the feasibility of minimal invasive procedure of harvest an omental flap laparoscopically to cover the entire scalp after a burn injury in a young male. It is first to be reported in Saudi Arabia at our institute, Riyadh, 2012. A 14-year-old male had an extensive flame burn at the age of 2 years in the head and neck area. He received multiple skin grafting procedures and an amputation of the right hand, due to his chronic condition of recurrent open wounds the patient was admitted for removal of the unstable ulcer sting and scarred skin of the scalp and for coverage with omental free flap and split thickness skin graft.
Discussion:
The coverage of wounds in the head and neck is usually done by using a local skin flap. The disadvantage of using the traditional skin flaps is difficulty to shape it in irregular, and large wounds.
Conclusion:
Owing its large size in covering wide defect, easy to shape in irregular edges over the bony surfaces, and high vascularity. This case demonstrate the feasibility of minimal invasive procedure of harvest an omental flap laparoscopically. We think that the use of omental flap is a useful flap and should be considered in the scalp and head and neck reconstruction.
Successful A2 to B Deceased Donor Kidney Transplant after Desensitization for High-Strength Non-HLA Antibody Made Possible by Utilizing a Hepatitis C Positive Donor
Authors: H Charli Karpel, Nicole M Ali, Nikki Lawson, Vasishta S Tatapudi, Rex Friedlander, Mary Carmelle Philogene, Robert A Montgomery, Bonnie E Lonze
Journal: Case Rep Transplant (2020)
MeSH terms: Case Reports

Desensitization using plasma exchange can remove harmful antibodies prior to transplantation and mitigate risks for hyperacute and severe early acute antibody-mediated rejection. Traditionally, the use of plasma exchange requires a living donor so that the timing of treatments relative to transplant can be planned. Non-HLA antibody is increasingly recognized as capable of causing antibody-mediated renal allograft rejection and has been associated with decreased graft longevity. Our patient had high-strength non-HLA antibody deemed prohibitive to transplantation without desensitization, but no living donors. As the patient was eligible to receive an A2 ABO blood group organ and was willing to accept a hepatitis C positive donor kidney, this afforded a high probability of receiving an offer within a short enough time frame to attempt empiric desensitization in anticipation of a deceased donor transplant. Fifteen plasma exchange treatments were performed before the patient received an organ offer, and the patient was successfully transplanted. Hepatitis C infection was treated posttransplant. No episodes of rejection were observed. At one-year posttransplant, the patient maintains good graft function. In this case, willingness to consider nontraditional donor organs enabled us to mimic living donor desensitization using a deceased donor.
Chronic mercury poisoning: Report of two siblings
Authors: Cahide Yilmaz, Mesut Okur, Hadi Geylani, Hüseyin Caksen, Oğuz Tuncer, Bülent Ataş
Journal: Indian J Occup Environ Med (2010)
Keywords: child, mercury, poisoning
MeSH terms: Case Reports

Mercury exists as organic inorganic and elementary forms in nature and is one of the most toxic metals that are poisonous for human beings. Mercury is commonly used in many different sectors of industry such as in insects formulas, agriculture products, lamps, batteries, paper, dyes, electrical/electronic devices, jewelry, and in dentistry. In this study, two siblings (one a 7-year-old boy and the other a 13 years old girl) are reported who developed chronic mercury poisoning as a result of long-term contact with batteries. Our aim is to emphasize the importance of mercury poisoning that is extremely rarely seen in childhood.
An Obscure Presence of Gastroduodenal Involvement in a Newly Diagnosed Ileocolonic Crohn's Disease Patient
Authors: Clive Jude Miranda, Murad Hayatt Ali, Muddasir Ayaz, Yousef Soofi, Thomas Christopher Mahl
Journal: Case Rep Gastrointest Med (2022)
MeSH terms: Case Reports

Whereas typical Crohn's disease is confined to the terminal ileum and presents with abdominal pain and diarrhea, gastroduodenal manifestations of Crohn's disease are rare, with often asymptomatic patient presentations and inconclusive diagnostic testing. It is, however, a more severe form of Crohn's disease and thus warrants treatment with steroids and biologics much earlier than its ileocolonic counterpart. We present the case of a young, otherwise healthy, male with newly diagnosed ileocolonic Crohn's disease with concurrent gastroduodenal involvement that initially failed management with biologic agents. We discuss the clinical manifestations and often obscure pathology of gastroduodenal Crohn's disease and highlight the necessity of performing a concurrent esophagogastroduodenoscopic evaluation on newly diagnosed ileocolonic Crohn's disease to assess the presence of upper gastrointestinal involvement.
Adenocarcinoma Ex Goblet Cell Carcinoid of Appendix: Two Case Reports
Authors: Yu-Ting Wang, Yi-Ru Li, Tuan-Ying Ke
Journal: Case Rep Pathol (2017)
MeSH terms: Case Reports

Adenocarcinoma ex goblet cell carcinoid is a rare tumor incidentally found in specimens of appendicitis. Most patients present with acute abdomen, similar to acute appendicitis. Here we present two cases, which were found incidentally after operation. We give a brief summary about clinical and biological behavior of this entity.
Case Report: Sequential Combination Targeted Therapy With Type I and II MET Inhibitors in a Metastatic EGFR-Mutated, MET-Amplified NSCLC Patient With Acquired MET Y1230H Mutation
Authors: Boning Cai, Xiaomo Li, Xiang Huang, Tonghui Ma, Baolin Qu, Wei Yu, Wei Yang, Pei Zhang, Jing Chen, Fang Liu
Journal: Front Oncol (2021)
Keywords: egfr mutation, met amplification, case report, non-small cell lung cancer (nsclc), targeted therapy resistance
MeSH terms: Case Reports

Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are the standard of care for advanced non-small-cell lung cancer (NSCLC) patients. However, most patients will eventually develop resistance. For EGFR-TKI resistance mediated by MET amplification, the combination of EGFR and MET TKIs has shown promising results in early clinical trials. However, acquired resistance to MET inhibitors forms a formidable challenge to this dual blockade approach. Here, we presented an NSCLC patient with EGFR exon 19 deletion (ex19del) who was resistant to first-line erlotinib treatment but responded to chemotherapy. Given the finding of MET overexpression/amplification after disease progression, the patient received gefitinib plus crizotinib with a partial response. Her disease progressed again, and molecular testing revealed a novel MET Y1230H mutation and a PD-L1 TPS score of 75%. She received a salvage regime consisting of gefitinib, cabozantinib, and pembrolizumab with a partial response. Since we now know that EGFR ex19del NSCLC patients generally do not respond to PD-1 blockade therapy, this response is more likely the contribution from gefitinib plus cabozantinib. Therefore, sequential use of type I and II MET inhibitors in EGFR/MET dual blockade may be an effective therapeutic option for EGFR-mutant, MET-amplified NSCLC.
Difficulties in choosing the right intraocular lens in a previously vitrectomized patient - the role of the tear film
Authors: Monica Mălăescu, Bogdana Tăbăcaru, Horia Tudor Stanca
Journal: Rom J Ophthalmol (2022)
Keywords: cataract, cornea, corneal ectasia, cylinder, keratoconus, monofocal iol, tear film
MeSH terms: Lenses, Intraocular / adverse effects, Phacoemulsification, Case Reports, Cornea / pathology, Corneal Topography, Dilatation, Pathologic / pathology, Dilatation, Pathologic / surgery, Humans, Lens Implantation, Intraocular, Refraction, Ocular

We present the difficulties in choosing the right IOL, when facing a great variability of the keratometric measurements, in the case of a patient operated for epiretinal membrane and lamellar macular hole, who developed complicated cataract in the operated eye. Upon commencing the biometric measurements, inconsistency in keratometric values led to further investigations. Repeated placido disc topography initially showed corneal ectasia, which posed a problem on selecting the right type of intra-ocular lens. Ocular surface pathology was suspected, and after treatment, the topography was repeated with a Scheimpflug topographer, that showed an improved keratometric profile. The surgical solution was to implant an aspheric monofocal IOL, in the bag, with extended depth of focus that enhances intermediate vision, disregarding the previous keratometric measurements. Refractive and functional outcomes were good. In cases of biometric measurements that show inconsistency in keratometric values, ocular surface disease as well as corneal ectasia should be taken into consideration. The right implant should not be chosen based on a single measurement, but rather several measurements should be made and compared and the choice should not be made before treating the ocular surface.
Emotional Activity Is Negatively Associated With Cognitive Load in Multimedia Learning: A Case Study With EEG Signals
Authors: Xiang Guo, Tianshui Zhu, Chennan Wu, Zongliang Bao, Yang Liu
Journal: Front Psychol (2022)
Keywords: eeg signals, cognitive load, emotion dynamics, emotional activity, multimedia learning

We aimed to investigate the relationship between emotional activity and cognitive load during multimedia learning from an emotion dynamics perspective using electroencephalography (EEG) signals. Using a between-subjects design, 42 university students were randomly assigned to two video lecture conditions (color-coded vs. grayscale). While the participants watched the assigned video, their EEG signals were recorded. After processing the EEG signals, we employed the correlation-based feature selector (CFS) method to identify emotion-related subject-independent features. We then put these features into the Isomap model to obtain a one-dimensional trajectory of emotional changes. Next, we used the zero-crossing rate (ZCR) as the quantitative characterization of emotional changes ZCR EC . Meanwhile, we extracted cognitive load-related features to analyze the degree of cognitive load (CLI). We employed a linear regression fitting method to study the relationship between ZCR EC and CLI. We conducted this study from two perspectives. One is the frequency domain method (wavelet feature), and the other is the non-linear dynamic method (entropy features). The results indicate that emotional activity is negatively associated with cognitive load. These findings have practical implications for designing video lectures for multimedia learning. Learning material should reduce learners' cognitive load to keep their emotional experience at optimal levels to enhance learning.
Anomalous Papillary Muscle Insertion Causing Dynamic Left Ventricular Outflow Tract Obstruction without Hypertrophic Obstructive Cardiomyopathy
Authors: Ravi Korabathina, Katherine Chiu, Hugh M van Gelder, Arthur Labovitz
Journal: Case Rep Cardiol (2017)
MeSH terms: Case Reports

Anomalous papillary muscle insertion directly into the surface of the mitral valve leaflet is rare, especially in a subject without apparent evidence of hypertrophic cardiomyopathy. We present a case of this isolated congenital malformation producing two hemodynamic sequelae of dynamic left ventricular outflow tract obstruction and severe mitral regurgitation.
Accidental infection of laboratory worker with vaccinia virus
Authors: Nissin Moussatché, Mari Tuyama, Sayuri E M Kato, Ana Paula V Castro, Brian Njaine, Regina H Peralta, José M Peralta, Clarissa R A Damaso, Paulo F Barroso
Journal: Emerg Infect Dis (2003)
MeSH terms: Laboratory Infection / etiology, Vaccinia / etiology, Vaccinia virus / isolation & purification, Case Reports, Research Support, Non-U.S. Gov't, Adult, Antibodies, Viral / blood, DNA, Viral / analysis, Female, Humans, Immunoglobulin G / analysis, Laboratory Infection / diagnosis, Laboratory Infection / virology, Polymerase Chain Reaction, Polymorphism, Restriction Fragment Length, Vaccinia / diagnosis, Antibodies, Viral, DNA, Viral, Immunoglobulin G

We report the accidental needlestick inoculation of a laboratory worker with vaccinia virus. Although the patient had previously been vaccinated against smallpox, severe lesions appeared on the fingers. Western blot and polymerase chain reaction-restriction fragment length polymorphism were used to analyze the virus recovered from the lesions. The vaccinia virus-specific immunoglobulin G levels were measured by enzyme-linked immunosorbent assay. Our study supports the need for vaccination for laboratory workers that routinely handle orthopoxvirus.