OpenMed/multicare-articles huggingface dataset:
An uncommon presentation of COVID-19: concomitant acute pulmonary embolism, spontaneous tension pneumothorax, pneumomediastinum and subcutaneous emphysema (a case report)
Authors: Zakariae Belarbi, Falmata Laouan Brem, Siham Nasri, Skiker Imane, El Ouafi Noha
Journal: Pan Afr Med J (2021)
Keywords: covid-19, case report, pneumomediastinum, spontaneous tension pneumothorax, subcutaneous emphysema
MeSH terms: COVID-19 / diagnosis, Respiratory Distress Syndrome / virology, Case Reports, Acute Disease, COVID-19 / complications, Hospitalization, Humans, Male, Mediastinal Emphysema / virology, Middle Aged, Pneumothorax / virology, Pulmonary Embolism / virology, Subcutaneous Emphysema / virology

The presenting symptoms and features of COVID-19 are non-specific and may be extrapulmonary complications such as thrombotic disorders but also pneumothorax, pneumomediastinum and subcutaneous emphysema; which are well-known complications of mechanical ventilation. Nevertheless, pneumothorax and/or pneumomediastinum, could complicate the course of a COVID-19 disease even in the absence of barotrauma involved. Herein, we report the case of a 55-year-old man with a previous history of erythroblastopenia due to thymoma admitted for COVID-19-related acute respiratory distress syndrome (ARDS) who simultaneously developed spontaneous tension pneumothorax, pneumomediastinum, subcutaneous emphysema and acute bilateral pulmonary embolism as presenting features of COVID-19 while on high-flow nasal cannula. This rare case highlights the importance of screening for other coexisting alternative diagnoses at the initial presentation of a patient suspected of COVID-19.
Cytoreductive Nephrectomy Promoted Abscopal Effect of Camrelizumab Combined With Radiotherapy for Metastatic Renal Cell Carcinoma: A Case Report and Review of the Literature
Authors: Min Wu, Jie Liu, Samuel Seery, Xue Meng, Jinbo Yue
Journal: Front Immunol (2021)
Keywords: mlr, abscopal effect, camrelizumab, clear cell renal cell carcinoma, pseudoprogression
MeSH terms: Antibodies, Monoclonal, Humanized / therapeutic use, Carcinoma, Renal Cell / therapy, Cytoreduction Surgical Procedures / methods, Kidney Neoplasms / therapy, Nephrectomy / methods, Case Reports, Research Support, Non-U.S. Gov't, Review, Aged, Carcinoma, Renal Cell / immunology, Carcinoma, Renal Cell / pathology, Combined Modality Therapy, Humans, Immune Checkpoint Inhibitors / therapeutic use, Kidney Neoplasms / immunology, Kidney Neoplasms / pathology, Lymphocyte Culture Test, Mixed, Male, Neoplasm Metastasis, Radiotherapy Dosage, Receptors, Antigen, T-Cell, alpha-beta / physiology, Tumor-Associated Macrophages / immunology, Antibodies, Monoclonal, Humanized, Immune Checkpoint Inhibitors, Receptors, Antigen, T-Cell, alpha-beta, camrelizumab

There is little evidence around Camrelizumab combined with cytoreductive nephrectomy (CN) and radiotherapy (RT) as a treatment option for metastatic renal cell carcinoma (mRCC). The influence of CN on immune responses and the abscopal effect are not well understood. In this paper, we report a case of anti-programmed cell death-1 (PD-1) treated with combined RT once CN reduced the primary tumor burden (TB). This patient also encountered an increased response to targeted radiotherapy after immune resistance. We also observed a macrophage-to-lymphocyte ratio (MLR) peak, which may be correlated with subsequent pseudoprogression after thoracic radiotherapy. Consequently, even with the disease, this patient has remained stable. This peculiar instance suggests there is a need to investigate the underlying mechanisms of CN in promoting the abscopal effect during immunotherapy when combined with RT. It also suggests that there is a need for further investigation into the role of RT in overcoming immune resistance, and the value of MLR in predicting pseudoprogression. We hypothesize that a heavy tumor burden might suppress the abscopal effect, thereby ensuring that CN promotes it. However, radiotherapy may overcome immune resistance during oligoprogression.
Primary hepatoid carcinoma of the ovary: a case report
Authors: Aicha Mazouz, Lamiae Amaadour, Hassania Ameurtesse, Laila Chban, Afaf Amarti, Fouad Kettani, Omar Addou, Siham Tizniti, Nawfel Mellas, Samia Arifi
Journal: Pan Afr Med J (2015)
Keywords: hepatoid carcinoma of the ovary, alpha-fetoprotein, immunohistochemical staining
MeSH terms: Adenocarcinoma / diagnosis, Ovarian Neoplasms / diagnosis, Case Reports, Adenocarcinoma / diagnostic imaging, Adenocarcinoma / drug therapy, Adenocarcinoma / pathology, Aged, Antineoplastic Combined Chemotherapy Protocols / administration & dosage, Diagnosis, Differential, Fatal Outcome, Female, Humans, Neoplasm Metastasis, Ovarian Neoplasms / diagnostic imaging, Ovarian Neoplasms / drug therapy, Ovarian Neoplasms / pathology, Ultrasonography

Primary hepatoid carcinoma of the ovary (HCO) is a very rare type of high-grade invasive malignant ovarian tumor with hepatic differentiation and production of α-fetoprotein (AFP). We describe a 78-year-old Moroccan woman who presented to our hospital with abdominal distension and purplish nodules infiltrating the para umbilical skin with weight loss and impairment of her performance status. Excisional biopsy of the para umbilical nodule revealed a cutaneous localization of moderately differentiated adenocarcinoma and pelvic ultrasonography noted the presence of a tumoral right adnexal mass. The patient underwent an exploratory laparoscopy which found peritoneal carcinomatosis with pelvic adhesions allowing only a peritoneal biopsy. Diagnosis of primary hepatoid carcinoma of the ovary was established on the basis of classic histopathologic findings, immunohistochemical staining and marked elevation in serum of α-fetoprotein more than the carbohydrate antigen 125. The patient received 3 cycles of chemotherapy based on Carboplatin and Paclitaxel with disease progression. No second line chemotherapy was given because of the drop of patient's performance status to 3. The patient died one month later.
Optic Neuropathy Secondary to Polyarteritis Nodosa, Case Report, and Diagnostic Challenges
Authors: Kristian A Vazquez-Romo, Adrian Rodriguez-Hernandez, Jose A Paczka, Moises A Nuño-Suarez, Alberto D Rocha-Muñoz, Maria G Zavala-Cerna
Journal: Front Neurol (2017)
Keywords: ophthalmic emergency, ophthalmic inflammation, optic neuritis, optic neuropathy, polyarteritis nodosa, vasculitis
MeSH terms: Case Reports

Purpose:
To describe a case of optic neuropathy as a primary manifestation of polyarteritis nodosa (PAN) and discuss diagnostic challenges.
Methods:
Case report.
Results:
A 41-year-old Hispanic man presented with a 2-day history of reduced visual acuity in his left eye. Physical examination revealed a complete visual field loss in the affected eye. Best-corrected visual acuity (BCVA) in the left eye was hand motion, and fundus examination revealed a hyperemic optic disk with blurred margins, swelling, retinal folds, dilated veins, and normal size arteries. BCVA in the right eye was 20/20; no anomalies were seen during examination of the fundus. The patient was started on oral corticosteroids and once the diagnosis of PAN was made, cyclophosphamide was added to the treatment regimen. Six months later, the patient recovered his BCVA to 20/20 in his left eye.
Conclusion:
Rarely does optic neuropathy present as a primary manifestation of PAN; nevertheless, it represents an ophthalmologic emergency that requires expeditious anti-inflammatory and immunosuppressive treatment to decrease the probability of permanent visual damage. Unfortunately, diagnosing PAN is challenging as it necessitates a high index of suspicion. In young male patients who present for the first time with diminished visual acuity, ophthalmologists become cornerstones in the suspicion of this diagnosis and should be responsible for continuing the study until a diagnosis is reached to ensure rapid commencement of immunosuppressive treatment.
Going Bone Deep: Osseous Rosai-Dorfman Disease in an Adult with Recurrent, Culture-Negative Osteomyelitis
Authors: Dominick S DeFelice, Megan L Srinivas, Sara E Wobker, Jonathan B Parr
Journal: Case Rep Infect Dis (2018)
MeSH terms: Case Reports

A patient presented for medical care on three separate occasions over the course of two years with recurrent right knee pain attributed to chronic osteomyelitis. Careful assessment revealed that his symptoms were caused by osseous Rosai-Dorfman disease. This case presents an alternative diagnostic possibility for culture-negative chronic osteomyelitis.
Characterization of intragenic tandem duplication in the PAFAH1B1 gene leading to isolated lissencephaly sequence
Authors: Satoru Takahashi, Ryosuke Tanaka, Satomi Okano, Akie Okayama, Nao Suzuki, Hiroshi Azuma
Journal: Mol Cytogenet (2015)
Keywords: duplication, lissencephaly, microhomology, neuronal migration, pafah1b1
MeSH terms: Case Reports

Background:
Genetic aberrations in PAFAH1B1 result in isolated lissencephaly sequence (ILS), a neuronal migration disorder associated with severe mental retardation and intractable epilepsy. Approximately 60 % of patients with ILS show a 17p13.3 deletion or an intragenic variation of PAFAH1B1 that can be identified by fluorescence in situ hybridization (FISH) analysis or gene sequencing. Using multiplex ligation-dependent probe amplification (MLPA), 40-80 % of the remaining patients show small genomic deletions or duplications of PAFAH1B1. The intragenic duplications within PAFAH1B1 are predicted to abolish the PAFAH1B1 function, although a detailed characterization of the duplication regions have not been reported.
Results:
Here we describe a female patient with ILS occurring predominantly in the posterior brain regions. MLPA was used to identify a small duplication within PAFAH1B1. This result was confirmed by array-based comparative genomic hybridization analysis, revealing a duplication of the 29-kb region encompassing putative regulatory elements and exon 2 of PAFAH1B1. The region was characterized as an intragenic tandem duplication by sequencing, revealing a 28-bp microhomology sequence at the breakpoint junctions. Parental genetic testing confirmed that the tandem duplication occurred de novo. Reverse transcription-PCR on RNA extracted from peripheral blood leukocytes revealed that the expression level of PAFAH1B1 decreased to that in a patient with Miller-Dieker syndrome, a contiguous gene-deletion disorder characterized by classical lissencephaly and a facial dysmorphism.
Conclusions:
This study expanded the spectrum of PAFAH1B1 variants and identified a unique genomic architecture including microhomology sequences in PAFAH1B1 underlying an intragenic tandem duplication leading to ILS.
Possible Approach to Esophageal Lung with Long Tracheobronchial Gap
Authors: Martina Ichino, Lorenza Pugni, Andrea Zanini, Anna Morandi, Fabio Mosca, Francesco Macchini
Journal: European J Pediatr Surg Rep (2019)
Keywords: esophageal lung, pneumonectomy, thoracoscopy
MeSH terms: Case Reports

Esophageal lung is a rare bronchopulmonary foregut malformation characterized by an anomalous origin of one of the main bronchi which arises from the esophagus. Less than 30 cases are reported in the literature. Therefore, there are no standardized guidelines for the treatment of this condition. We report a case of right esophageal lung diagnosed in a neonate. The patient was treated with thoracoscopic closure of the ectopic main bronchus in the neonatal period, followed by delayed pneumonectomy at 5 months of age. No prosthetic substitute was implanted in the ipsilateral hemithorax after pneumonectomy. The patient is now 4 years old and doing well, postpneumonectomy syndrome was never observed. Our strategy and the possible alternatives are discussed here.
Diagnosis of Splenic Lymphoma by Endoscopic Ultrasound Guided Fine Needle Aspiration: A Case Report and Review of the Literature
Authors: Umar Darr, Zubair Khan, Muhammad Ali Khan, Anas Renno, Turki Alkully, Sehrish Kamal, Tariq Hammad, Yaseen Alastal, Muhammad Imran Khan, Ali Nawras
Journal: Case Rep Gastrointest Med (2017)
MeSH terms: Case Reports

Introduction. Splenic tumor is usually found as an incidental finding on CT of abdomen. Traditionally, ultrasound (US) or computed tomography (CT) guided biopsies were employed for the purpose of sampling; however they have been reported to have a complication rate of 5.3%. Endoscopic ultrasound-fine needle aspiration (EUS-FNA) has been recently utilized for the purpose of sampling splenic tumors. In literature there are 7 reported instances where splenic lymphoma was diagnosed using EUS-FNA. We present a case of follicular B cell lymphoma of the spleen diagnosed using EUS-FNA. Case Report. 58-year-old female presented to her primary care physician for left upper quadrant abdominal pain for one week. Physical exam was significant for left upper quadrant tenderness. Her laboratory tests were within normal limits. She underwent CT scan of abdomen which revealed approximately 5 cm × 5 cm mass in spleen. EUS-FNA of the spleen revealed a large hypoechoic, heterogeneous, well-demarcated mass measuring 54.7 mm × 43.0 mm. Fine needle aspiration was performed, and the sample was submitted for cytology and flow cytometry. Flow cytometry revealed a lambda monotypic population of B cells displaying dim CD19 and CD10. Diagnosis of B cell non-Hodgkin low grade follicular lymphoma was made. Conclusion. Endoscopic ultrasound with fine needle aspiration is a very rare but safe, reliable method of diagnosis of splenic lymphomas.
Posterior Reversible Encephalopathy Syndrome Resolving Within 48 Hours in a Normotensive Patient Who Underwent Thoracic Spine Surgery
Authors: Kunal Vakharia, Ioannis Siasios, Vassilios G Dimopoulos, John Pollina
Journal: J Clin Med Res (2016)
Keywords: cortical blindness, posterior reversible encephalopathy syndrome, prone surgery
MeSH terms: Case Reports

Posterior reversible encephalopathy syndrome (PRES) usually manifests with severe headaches, seizures, and visual disturbances due to uncontrollable hypertension. A patient (age in the early 60s) with a history of renal cell cancer presented with lower-extremity weakness and paresthesias. Magnetic resonance imaging (MRI) of the thoracic spine revealed a T8 vertebral body metastatic lesion with cord compression at that level. The patient underwent preoperative embolization of the tumor followed by posterior resection and placement of percutaneous pedicle screws and rods. Postoperatively, the patient experienced decreased visual acuity bilaterally. Abnormal MRI findings consisted of T2 hyperintense lesions and fluid-attenuated inversion recovery changes in both occipital lobes, consistent with the unique brain imaging pattern associated with PRES. The patient's blood pressure was normal and stable from the first day of hospitalization. The patient was kept on high-dose steroid therapy, which was started intraoperatively, and improved within 48 hours after symptom onset.
Hypercalcemia in Lung Cancer due to Simultaneously Elevated PTHrP and Ectopic Calcitriol Production: First Case Report
Authors: Saed Nemr, Sunitha Alluri, Dhivya Sundaramurthy, Daniel Landry, Gregory Braden
Journal: Case Rep Oncol Med (2017)
MeSH terms: Case Reports

Calcitriol-mediated hypercalcemia has been reported in malignant lymphomas and granulomatous diseases but not in lung carcinoma. We describe a patient with squamous cell lung carcinoma with hypercalcemia and elevated calcitriol levels. A 60-year-old Caucasian male patient with stage IIIB squamous cell lung cancer developed hypercalcemia at 14.8 mg/dL two years after receiving chemotherapy and radiotherapy where labs showed a serum intact PTH: 7 pg/mL, PTHrP: 30 pmol/L, 1,25-hydroxyvitamin D (calcitriol): 76 pg/mL, and 25-hydroxyvitamin D levels: <4 ng/mL. Calcitriol levels were elevated despite undetectable 25-hydroxyvitamin D levels. There are no reported lung cancer cases with elevated calcitriol as an etiology of hypercalcemia. We believe that the elevated calcitriol levels in this case were due to a PTHrP-independent mechanism, possibly from either ectopic production of calcitriol in tumor cells or from increased activity of 1-alpha hydroxylase in the same cells. The patient died before the effects of prednisone therapy could be assessed. Studies are needed to investigate the cellular source of calcitriol and its role in hypercalcemia in patients with lung cancer.
Undifferentiated Pleomorphic Sarcoma and the Importance of Considering the Oncogenic and Immune-Suppressant Role of the Human T-Cell Lymphotropic Virus Type 1: A Case Report
Authors: Sergio Lupo, Carolina Berini, Camila Cánepa, Eduardo Santini Araujo, Mirna Biglione
Journal: Front Oncol (2017)
Keywords: htlv-1, immunodeficiency, mutation, myelolpathy, sarcoma
MeSH terms: Case Reports

Introduction:
Soft-tissue sarcomas account for 0.7% of all malignant tumors, with an incidence rate of 3 per 100,000 persons/year. The undifferentiated pleomorphic sarcoma (UPS) with giant cells, a high grade tumor of soft tissue, is very unusual, especially in young adults before the age of 40. Human T-cell lymphotropic virus type 1 (HTLV-1) is a human retrovirus, classified as group 1 human carcinogens by The International Agency for Research on Cancer, that causes an aggressive malignancy known as adult T-cell lymphoma/leukemia and a progressive chronic inflammatory neurological disease named HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). HTLV-1 causes accumulation of genetic mutations in the host genome that could contribute to cellular transformation, one of the oncogenic features of HTLV-1.
Case report:
We describe a case of a young woman with UPS who suffered from HAM/TSP with 3 years of evolution. In 2013, the patient started with neurological symptoms: weakness in the legs and bladder dysfunction. One year later, the patient developed a mild paraparesis in both extremities, anti-HTLV-1 antibodies were detected in plasma and in cerebrospinal fluid, and HAM/TSP was confirmed. In November 2015, a benign ganglion cyst was first suspected without intervention and by March 2016 a sarcoma was diagnosed. Three weeks after surgical resection, the tumor aroused in deep tissue and behaved aggressively, implicating a curative wide resection of the fibula, joint reconstruction, and soft-tissue graft. Histopathological examination confirmed UPS with giant cells.
Concluding remarks:
The unapparent subclinical immunodeficiency state due to HTLV-1 infection deserves to be considered in order to carefully monitor the possibility of developing any type of cancer. Besides, reaching an accurate and timely diagnosis of UPS can be challenging due to the difficulty in diagnosis/classification and delayed consultation. In this particular case, considering the high grade of UPS and the progressive invalidating myelopathy caused by HTLV-1, treatment should be carefully evaluated to positively impact on the patient's life expectancy.
Tolosa-Hunt Syndrome: A Painful Ophthalmoplegia
Authors: Marcellin Bugeme, Ousmane Cissé, Olivier Mukuku, Amadou Gallo Diop
Journal: Case Rep Neurol Med (2020)
MeSH terms: Case Reports

Tolosa-Hunt syndrome is a painful ophthalmoplegia characterized by recurrent unilateral orbital pain, ipsilateral oculomotor paralysis, and a rapid response to steroids. Our report describes a 37-year-old young woman who presented with right ptosis, ipsilateral ophthalmoplegia, and painful headache with no other neurological deficits in which all biological and neuroimaging investigations were normal. Complete recovery within one week of corticosteroid therapy was observed. This is probably the first case of Tolosa-Hunt syndrome reported in Dakar, Senegal.
Localized Subcutaneous Insulin-Derived Amyloidosis Excised after Evaluation Using Ultrasonography in a Patient with Type 2 Diabetes Mellitus
Authors: Seiya Hagiwara, Shinji Taneda, Takaya Fukumoto, Kazuya Hagiwara, Minoru Kikuchi, Tetsunori Kimura, Hidetaka Nakayama, Naoki Manda
Journal: Case Rep Endocrinol (2017)
MeSH terms: Case Reports

A 62-year-old man with type 2 diabetes mellitus, who had been on insulin therapy for the past 20 years, was found to have subcutaneous mass formation in the abdomen during a workup of worsened glycemic control. Because of suspected amyloid deposition, he was advised to avoid injections to the mass, which led to improvement of glycemic control. However, he strongly requested mass excision and was hospitalized. After evaluation using ultrasonography and computed tomography, a total mass excision was performed, and a diagnosis of insulin-derived amyloidosis was made. Comparison of the ultrasonographic and histopathological findings demonstrated that the location of the amyloid deposition nearly corresponded to the hypoechoic region. This case highlights that ultrasonography, which is a noninvasive imaging modality, can be useful for detection of insulin-derived amyloidosis.
Successful Treatment of Actinic Keratosis with Kanuka Honey
Authors: Saras Mane, Joseph Singer, Andrew Corin, Alex Semprini
Journal: Case Rep Dermatol Med (2018)
MeSH terms: Case Reports

Actinic keratoses form as rough, scaly plaques on sun-exposed areas; they can be an important step in premalignant progression to squamous cell cancer of the skin. Currently, pharmacological treatments consist of topical immunomodulatory agents with poor side effect profiles. Use of honey has been common in both ancient and modern medicine, where it is now a key therapy in the management of wound healing. In vitro studies show the New Zealand native Kanuka honey to have immunomodulatory and antimitotic effects, with recent evidence suggesting efficacy of topical application in a variety of dermatological contexts, including rosacea and psoriasis. Here, we present a case report of a 66-year-old gentleman with an actinic keratosis on his hand, which had been present for years. Regular application of Kanuka honey over three months resulted in remission immediately following the treatment period with no signs of recurrence at nine months.