OpenMed/multicare-articles huggingface dataset:
Ganglion Impar Block: A Magic Bullet to Fix Idiopathic Coccygodynia
Authors: Bhanu P Swain, Sri Vidhya, Sharad Kumar
Journal: Cureus (2023)
Keywords: coccydynia, ganglion impar block, idiopathic coccygodynia, intra-coccygeal joint approach, local infiltration analgesia, trans-sacrococcygeal joint approach
MeSH terms: Case Reports

Coccygodynia (coccydynia) is a painful condition of the perineum in the region of the tailbone or coccyx, aggravated by sitting on hard surfaces. It is frequently associated with injuries to the coccyx following direct trauma. Nevertheless, idiopathic coccygodynia without antecedent trauma history is not uncommon. Most of these patients respond to anti-inflammatory medications and physical therapy. Those who are unresponsive may require additional intervention for pain relief. Blockade of ganglion impar, the terminal end of the pelvic sympathetic chain, can dramatically alleviate the pain in patients suffering from coccygodynia. In the current case series, four patients in the age range of 21 to 69 years suffering from chronic idiopathic coccygodynia (female: male ratio of 1:1) were treated with ganglion impar block. All four patients received a course of medical management, and two of the patients additionally received local infiltration of the coccyx before ganglion impar block administration. The block was performed with fluoroscopy guidance by either the trans-sacrococcygeal joint approach or the intra-coccygeal joint approach. The pre-intervention average numeric rating pain score (NRS) was 7.5. After a single ganglion impar block intervention, all four patients experienced complete pain relief (NRS=0). No patients required a repeat injection, and all were pain-free for the entire one-year follow-up period.
Endometrioma complicated by tubo-ovarian abscess in a woman with bacterial vaginosis
Authors: Shahryar K Kavoussi, Mark D Pearlman, William M Burke, Dan I Lebovic
Journal: Infect Dis Obstet Gynecol (2006)
MeSH terms: Abscess / complications, Endometriosis / complications, Fallopian Tube Diseases / complications, Ovarian Diseases / complications, Vaginosis, Bacterial / complications, Case Reports, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Abscess / pathology, Adult, Endometriosis / pathology, Fallopian Tube Diseases / pathology, Female, Humans, Ovarian Diseases / pathology

Background:
Tubo-ovarian abscess involvement of an endometrioma has been reported in cases of patients with polymicrobial sources such as Neisseria gonorrhoeae, Chlamydia trachomatis, and obligate anaerobic bacteria; however, bacterial vaginosis (BV) predisposing to abscess formation in an endometrioma has not been reported to date.
Case:
Superinfection of an endometrioma was surgically diagnosed in a patient with known advanced-stage endometriosis after she presented with acute pelvic inflammatory disease symptoms and was unresponsive to antibiotic therapy. Gram-negative rods were cultured from the endometrioma. On admission, cervical, blood, and urine cultures were negative; BV was diagnosed on normal saline wet prep and gram stain.
Conclusion:
This case raises the possibility of BV ascension to the upper genital tract predisposing to abscess formation in endometriomas. Therefore, aggressive treatment of BV in patients with known advanced-stage endometriosis may be considered to prevent superinfected endometriomas.
Pineal Gland Metastasis From Poorly Differentiated Carcinoma of Unknown Primary Origin
Authors: Joshua A Cuoco, Michael W Kortz, Michael J Benko, Robert W Jarrett, Cara M Rogers, Mark R Witcher, Eric A Marvin
Journal: Front Endocrinol (Lausanne) (2020)
Keywords: cancer endocrinology, carcinoma of unknown primary (cup), metastasis, neuroendocrinology, pineal gland
MeSH terms: Cell Differentiation, Neoplasms, Unknown Primary / pathology, Pinealoma / secondary, Case Reports, Aged, Humans, Male, Neoplasms, Unknown Primary / surgery, Pinealoma / surgery, Prognosis

Pineal metastasis is an exceedingly rare finding in patients with systemic malignancies. Such lesions are typically the manifestation of a primary lung cancer; nonetheless, a variety of malignancies have been reported to disseminate to the pineal gland including gastrointestinal, endocrine, and skin cancers, among others. However, to our knowledge, pineal gland metastasis without a primary origin has yet to be described. Carcinoma of unknown primary origin is a heterogeneous group of cancers characterized by the presence of metastatic disease without an identifiable primary tumor on metastatic workup. Here, we present a case of a 65-year-old male found to have a heterogeneously enhancing lesion of the pineal gland as well as an enhancing lesion of the left cerebellar hemisphere. Comprehensive metastatic workup demonstrated multifocal metastatic adenopathy without an identifiable primary lesion. Stereotactic biopsy of the pineal lesion revealed poorly differentiated carcinoma with an immunophenotype most consistent with gastrointestinal origin. To our knowledge, this is the first case to describe a pineal gland metastasis without a primary origin. We discuss the relevant literature on pineal gland metastases as well as carcinoma of unknown primary origin.
Orthodeoxia without Platypnea in Hereditary Hemorrhagic Telangiectasia in the Presence of a Cerebral Abscess and Multiple Pulmonary Arteriovenous Malformations: Unusual Complications and Transcatheter Endovascular Treatment
Authors: Carlos Salazar, Jacky Bruce Blank, Veronica Palmero
Journal: Case Rep Pulmonol (2017)
MeSH terms: Case Reports

Hereditary hemorrhagic telangiectasia is a rare autosomal-dominant condition affecting visceral blood vessel development. Cerebral and most commonly pulmonary arteriovenous malformations are found in the majority of symptomatic patients. The most common complications include embolic strokes and cerebral abscesses, which have been attributed to abnormal vessel communications. Platypnea orthodeoxia is a rare condition that presents dyspnea and oxygen desaturation when adopting an upright position and is relieved on decubitus. The association between hereditary hemorrhagic telangiectasia, pulmonary arteriovenous malformations, and platypnea orthodeoxia has been described in medical literature; however, orthodeoxia as a single entity without platypnea has not been described yet, especially associated with complications of this hereditary condition. We present the case of a 38-year-old male with persistent headaches, in whom a cerebral lesion was detected. Orthostatic tachycardia and severe orthodeoxia without platypnea were evidenced during physical examination. The patient was subsequently diagnosed with hereditary hemorrhagic telangiectasia and underwent cerebral abscess drainage as well as transcatheter endovascular closure of multiple pulmonary arteriovenous malformations. For this reason, the concept of platypnea orthodeoxia syndrome needs further revision. Patients presenting refractory hypoxemia should warn physicians to initially evaluate their oxygen saturation measurements during standing and decubitus position, even though platypnea may not be present.
Z-Bar Shoeing Demonstrates Potential for Long-Term Foot Pain Management during an Exercise Training Regimen in a Show Jumping Pony with Uniaxial Palmar Pain
Authors: Kanokpan Sanigavatee, Chanoknun Poochipakorn, Ponlakrit Charoenchanikran, Weena Joongpan, Metha Chanda
Journal: Case Rep Vet Med (2022)
MeSH terms: Case Reports

Z-bar shoeing has been implemented to relieve uniaxial palmar pain arising from the structures in the affected region. However, there have been no reports on the long-term application of the z-bar shoe during exercise training regimens. A 10-year-old mixed-breed show jumping pony presented with an occasional short stride and abnormal rhythm while turning during routine exercise for three months. Gait analysis conducted by trotting off on both hard and soft surfaces showed no lameness in the straight line on both types of surfaces. However, right forelimb lameness was detected with moderate and slight pain accompanying hard surface lunging in clockwise and counterclockwise directions, respectively. Sequential examination of uniaxial perineural anaesthesia confirmed that the pony suffered from medial palmar pain on the right foreleg. Mild distal border irregularity of the navicular bone was also observed radiographically. The z-bar shoe was designed relative to the palmar digital anaesthesia and subsequently applied on the lame leg. The pony demonstrated a marked reduction in lameness severity immediately post-Z-bar shoeing. Physical exercise was resumed a few days after the shoeing practice. The pony underwent routine exercise training while continuously fitting with the Z-bar shoe for 24 weeks without recurrent lameness or complications. Application of z-bar shoe showed the potential for long-term foot pain management during an exercise training regimen in a show jumping pony with uniaxial palmar pain.
Omphalocele Secondary to Spontaneous Rupture of Allantoic Cyst in the Third Trimester of Pregnancy
Authors: Giuliana Orlandi, Paolo Toscano, Lavinia Di Meglio, Letizia Di Meglio, Aniello Di Meglio
Journal: Case Rep Obstet Gynecol (2021)
MeSH terms: Case Reports

Objective:
We report the first case in which the onset of omphalocele was after the spontaneous rupture of an allantoic cyst. We hypothesize a causal link between the spontaneous rupture of the cyst and the herniation of the viscera. Case Presentation. A 36-year-old woman was diagnosed with an allantoic cyst during the first trimester. The allantoic cyst underwent spontaneous rupture during the 32nd week of gestation, and an omphalocele developed secondary to the cyst's rupture. Two days after birth, the peritoneum covering intestinal loops broke spontaneously and the newborn underwent successful urgent surgery.
Conclusions:
This case may suggest that the relative benignity of the allantoid cysts may recommend a close ultrasound follow-up in order to identify the onset of any complications, as a late third trimester onset of omphalocele. Prenatal diagnosis of such complications may allow multidisciplinary management of the pregnancy with planned cesarean section, prenatal pediatric surgery consultation, and neonatal surgery.
Retained Foreign Body in Transplanted Liver
Authors: C Kayaalp, S Kırmızı, R Kutlu, M A Yagci, B Isik, S Yilmaz
Journal: Int J Organ Transplant Med (2015)
Keywords: foreign body, liver transplantation, portal vein, post-operative complication
MeSH terms: Case Reports

Liver transplantation is a technically complex and long surgical procedure. A large quantity of various materials such as catheters, sutures, needles and clips are frequently used during the procedure. These materials may enter in the liver from the vascular or biliary orifices inadvertently. A 50-year-old patient who had hepatic failure due to HBV underwent a deceased-donor liver transplantation. The deceased donor was a 75-year-old HbsAg(+) man. The recipient had subfebrile fever and leukocytosis post-operatively. A control computed tomography revealed a cuneiform ischemic area, and a foreign body inside the right anterior portal vein branch proximal to this ischemic region. A 10-F Nelaton catheter, 5-cm long, was removed from the portal vein by surgery. Retrospectively, we understood that the portal vein was cut during the back-table procedure and the portal vein catheter was replaced with a larger one for better irrigation. Most probably, the original catheter was cut together with the portal vein, and the tip of the catheter was retained in the portal system and migrated into the liver. As far as we know, such a complication of liver transplantation has never been described previously.
Isolated Langerhans Cell Histiocytosis of Orbit: A Case Report and Review of the Literature
Authors: Mayuresh Naik, Anuj Mehta, Neha Mehrotra, Anil Solanki
Journal: Case Rep Ophthalmol Med (2018)
MeSH terms: Case Reports

A 2-year-old male child presented with a painless progressive mass in the inferolateral aspect of right orbit of three-month duration. Differential leucocyte count revealed raised eosinophil count (13%). On radiological examination, CT scan showed 25 × 27 mm round well-defined smooth-outlined homogenously enhancing extraconal mass arising from the zygomatic bone at the inferotemporal periorbital area of right orbit with bone erosion. Histopathological examination of the incision biopsy revealed characteristic Langerhans cells and immunohistochemical studies were positive for S-100 protein and adenosine deaminase. A diagnosis of Langerhans Cell Histiocytosis (LCH) was made and PET-CT revealed no other foci of uptake anywhere else in the body. The patient received 12 cycles of vinblastine, 0.2 mg/kg body weight, along with oral prednisolone, 1 mg/kg body weight. On completion of three cycles of chemotherapy, a reduction in size of the mass was noticed. A repeat PET scan was done 3 months after completion of chemotherapy did not reveal any activity noted previously.
Retained Shrapnel from a Blast Injury as a Rare Cause of Secondary Osteoarthritis of the Hip Joint: A Case Report and Review of Literature
Authors: Oshan Basnayake, Ahamed Nihaj, Ranji Pitagampalage, Umesh Jayarajah, Yasith Mathangasinghe, Harsha Mendis
Journal: Case Rep Surg (2019)
MeSH terms: Case Reports

Background:
Complications related to intra-articular retained shrapnel are rare and primarily depend on the anatomical location and the reaction with the surrounding tissue. Retained bodies causing severe osteoarthritis with bone destruction and limb shortening are extremely rare. We describe a rare occurrence of retained shrapnel, possibly iron nails causing a late presentation of grade 4 secondary osteoarthritis of the hip joint with destruction of the femoral head and limb shortening.
Case presentation:
A 74-year-old otherwise healthy Sri Lankan male with a history of blast injury to the right hip 35 years ago presented with an isolated, right sided mild hip pain with a progressive limp for an 8-year duration. He had a true right limb shortening of 3.6 cm and limited range of motion. However, he had minimal functional disability. An X-ray of the pelvis and hip joints showed grade 4 osteoarthritis of the right hip joint with destruction of the right femoral head. There were three retained metallic nails (shrapnel) in the right hip joint of which two were intra-articular. Although he was offered a total hip arthroplasty, he opted for conservative management due to his minimal functional disability. Modified foot wear and simple analgesics were prescribed, and he had no worsening of symptoms at 6 months of follow up.
Conclusion:
Late presentation due to shrapnel-induced osteoarthritis with bone destruction and limb shortening is extremely rare. Initial assessment with radiographs is essential following blast injuries to exclude intra-articular or periarticular foreign bodies. Such foreign bodies should be removed to prevent the associated local and systemic complications.
Acute Progressive Visual Loss in a Case of Acute Myeloid Leukemia: Challenges in the Utility of Molecular Tests in Early Diagnose of Cytomegalovirus Retinitis
Authors: Ali Amanati, Nader Shakibazad, Bahman Pourabbas, Mohammad Hossein Nowroozzadeh, Soheila Zareifar, Omid Reza Zekavat
Journal: Case Rep Med (2018)
MeSH terms: Case Reports

Cytomegalovirus (CMV) retinitis is one of the rare but debilitating presentations of the CMV infection in children with leukemia. Herein, we report a 12-year-old boy with acute myeloid leukemia complicated by rapid progressive visual loss during relapse of leukemia. The definite diagnosis of CMV retinitis was made after vitreous aspiration. Despite prompt treatment and ophthalmologic intervention, he died because of AML relapse. Viral infections, especially cytomegalovirus infection, may present with vague clinical pictures during any time of chemotherapy, which may not be easily distinguishable from bacterial or fungal retinitis and also chemotherapy-induced retinopathies. Clinician should consider CMV retinitis in seropositive patients especially those without detectable viremia.
T Cell Histiocyte Rich Large B Cell Lymphoma Presenting as Hemophagocytic Lymphohistiocytosis: An Uncommon Presentation of a Rare Disease
Authors: Uroosa Ibrahim, Gwenalyn Garcia, Amina Saqib, Shafinaz Hussein, Qun Dai
Journal: Case Rep Oncol Med (2017)
MeSH terms: Case Reports

T cell histiocyte rich large B cell lymphoma (THRLBCL) is a rare subtype of non-Hodgkin's lymphoma characterized by malignant B cells with reactive T lymphocytes. The pathophysiology is thought to involve cytokine-mediated evasion of T cell immune response by malignant B cells. It usually presents at an advanced stage with extranodal involvement. An extremely unusual manifestation of the disease is hemophagocytic lymphohistiocytosis (HLH) which is a hyperinflammatory disorder. We present a case of a 43-year-old male who presented with recurrent fever and recent radiologic imaging showing splenomegaly and right inguinal lymphadenopathy. On presentation, he had a fever of 105°F. Laboratory work-up was consistent with pancytopenia, elevated lactate dehydrogenase, elevated D-dimer, and a ferritin of 24,247 ng/mL. The patient was started on steroid therapy. An excisional biopsy of the right inguinal lymph node was consistent with a diagnosis of THRLBCL and the patient subsequently received six cycles of chemotherapy with R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone) after which a PET-CT scan showed no evidence of biologically active disease and ferritin was down to 822 ng/mL. We discuss the clinical manifestations and diagnostic and therapeutic considerations of this rare disease along with a review of reported cases in the literature.
Tonsillitis-Related Arthritis: Advanced Understandings of Tonsillitis and Sterile Inflammatory Arthritis
Authors: Shigeto Kobayashi, Issei Kida, Yuuki Makiyama, Yoshinori Taniguchi, Kurisu Tada, Naoto Tamura
Journal: Case Rep Rheumatol (2021)
MeSH terms: Case Reports

A 49-year-old man developed acute aseptic arthritis of the nonmigratory and asymmetrical type in his knee, ankle, and bilateral metatarsal joints 13 days after treatment with antibiotics for acute tonsillitis. He was diagnosed with tonsillitis-related arthritis after other rheumatic diseases were ruled out. Treatment with salazosulfapyridine, methotrexate, and methylprednisolone for 3 months did not completely improve. Then, tonsillectomy was undertaken and arthritis rapidly improved. Finegoldia magna (previously Peptostreptococcus magnus) was cultured from the microabscesses of the resected tonsils. After outpatient follow-up, the patient did not experience a relapse of arthritis for more than 2.7 years without any treatment. Poststreptococcal reactive arthritis (PSRA) is well described. However, up to 40% of patients with tonsillitis-related arthritis did not demonstrate evidence of streptococcal infection. It is noted that tonsillectomy is necessary to remove the tonsillar microabscesses and eradicate bacterial infection of the tonsils, especially for patients with a prolonged and/or recurrent course of PSRA and/or tonsillitis-related arthritis.
Facial skin metastasis due to small-cell lung cancer: a case report
Authors: Nikolaos Barbetakis, Georgios Samanidis, Dimitrios Paliouras, Elpida Samanidou, Zoi Tzimorota, Christos Asteriou, Persefoni Xirou, Christodoulos Tsilikas
Journal: J Med Case Rep (2009)

Introduction:
Cutaneous metastases in the facial region occur in less than 0.5% of patients with metastatic cancer. They are an important finding and are not often the first sign leading to diagnosis.
Case presentation:
We describe the case of a 64-year-old male patient who presented with dyspnea, pleuritic pain, loss of weight and a nodule on his left cheek. A chest X-ray revealed a left upper lobe mass with mediastinal lymphadenopathy. Excision biopsy of the facial nodule revealed small-cell lung carcinoma. Palliative chemo-radiotherapy was administered and the patient survived for 12 months.
Conclusion:
A high index of suspicion is necessary for the early detection of facial cutaneous metastases. Appropriate treatment may prolong patient survival.
False Positive 18F-FDG Uptake in Mediastinal Lymph Nodes Detected with Positron Emission Tomography in Breast Cancer: A Case Report
Authors: Gamze Uğurluer, Mustafa Kibar, Sinan Yavuz, Akin Kuzucu, Meltem Serin
Journal: Case Rep Med (2013)

Breast cancer is the most frequently diagnosed cancer among females. It is accepted that lymph node involvement with metastatic tumor and the presence of distant metastasis are the most important prognostic factors. Accurate staging is important in determining prognosis and appropriate treatment. Positron emission tomography with computed tomography detects malignancies using 2-[18F]-fluoro-2-deoxy-d-glucose (18F-FDG PET CT) with high accuracy and they contribute to decisions regarding diagnosis, staging, recurrence, and treatment response. Here, we report a case of false positive metastatic mediastinal lymph nodes that were diagnosed by 18F-FDG PET CT in a 40-year-old breast cancer patient who had undergone preoperative evaluation. Right paratracheal, prevascular, aorticopulmonary, precarinal, subcarinal, hilar, and subhilar multiple conglomerated mediastinal lymph nodes were revealed in addition to left breast mass and axillary lymph nodes. Mediastinoscopy was performed with biopsy and pathology was reported as granulomatous lymphadenitis. In conclusion, any abnormal FDG accumulation in unusual lymph nodes must be evaluated carefully and confirmed histopathologically.
Restenosis of Coronary Arteries in Patients with Coronavirus Infection: Case Series
Authors: Gulnara Batenova, Lyudmila Pivina, Evgeny Dedov, Altay Dyussupov, Zhanar Zhumanbayeva, Yerbol Smail, Tatyana Belikhina, Laura Pak, Diana Ygiyeva
Journal: Case Rep Med (2023)
MeSH terms: Case Reports

Introduction:
Coronavirus infection is a risk factor for vascular thrombosis. This is of particular importance for patients undergoing myocardial revascularization since this infection can be a trigger for the formation of restenosis in the area of a previously implanted coronary stent. Understanding the risk factors for stent thrombosis and restenosis is of particular importance in individuals at risk for adverse outcomes. The rarity of such situations makes the present study unique.
Objective:
Studying the peculiarities of restenosis and thrombosis of the coronary arteries in patients after coronavirus infection.
Methods:
The study was performed in the Department of Cardiovascular Surgery of Emergency Hospital, Semey City, in 2021. We have examined the medical records of 10 consecutive patients with restenosis of coronary arteries after coronavirus infection and 10 matched-by-age patients with similar restenosis of coronary arteries who did not have coronavirus infection as a comparison group. To determine statistically significant differences between independent samples, we calculated the Mann-Whitney U test.
Results:
The average age of patients was 65.7 years. Only one case was classified as early restenosis (within 8 days of previous revascularization), two cases represented late restenosis, and seven cases were very late restenoses. In 70% of cases, restenosis was localized in the left anterior descending artery, in 30% of cases, it was in the right coronary artery, and in 40% of cases, it was in the left circumflex artery. In comparison with patients who did not have a coronavirus infection, there were statistically significant differences regarding IgG (P < 0.001) and fibrinogen (P=0.019).
Conclusion:
Patients with myocardial revascularization in the past have a higher risk of stent restenosis against the background of coronavirus infection due to excessive neointimal hyperplasia, hypercoagulability, increased inflammatory response, and endothelial dysfunction.