OpenMed/multicare-articles huggingface dataset:
Clinical Aspects of IgG4-Related Orbital Inflammation in a Case Series of Ocular Adnexal Lymphoproliferative Disorders
Authors: Masayuki Takahira, Yoshiaki Ozawa, Mitsuhiro Kawano, Yoh Zen, Shoko Hamaoka, Kazunori Yamada, Kazuhisa Sugiyama
Journal: Int J Rheumatol (2012)

The most frequent ocular adnexal tumors and simulating lesions are lymphoproliferative disorders (LPDs), including malignant lymphomas and orbital inflammation with lymphoid hyperplasia or infiltration. IgG4-related orbital inflammation (IgG4-ROI) often involves lacrimal glands and other orbital tissues and is an important differential diagnosis. The present study evaluated clinical aspects of IgG4-ROI in a case series of orbital LPD. Sixty-two consecutive cases of orbital LPD, pathologically diagnosed from November, 2004, through March, 2011, were investigated. Histological types were 22 cases with MALT lymphoma, 11 cases with diffuse large B-cell lymphoma (DLBCL), 3 cases with other malignant lymphomas, 16 cases with IgG4-ROI, and 10 cases with non-IgG4-ROI. Ages of the IgG4-ROI group (56 ± 10 yrs) were significantly lower than the MALT lymphoma (71 ± 12 yrs) and DLBCL (75 ± 14 yrs) groups. Orbital lesions other than lacrimal glands were present in six cases including extraocular muscle swelling, mass lesions surrounding the optic nerve, and supraorbital and infraorbital nerves enlargements. Although none of the malignant lymphomas were related to IgG4, previous evidence suggested that malignant lymphomas can arise from IgG4-ROI. Based on this study (26%) and another report (33%), it is likely that nearly a quarter of orbital LPD are IgG4-ROI.
An Unusual Case of Invasive Kaposi's Sarcoma with Primary Effusion Lymphoma in an HIV Positive Patient: Case Report and Literature Review
Authors: Alexandra Millet, Sanmeet Singh, Genelle Gittens-Backus, Kim Ann Dang, Babak Shokrani
Journal: Case Rep Oncol Med (2015)

We report a case of AIDS-related Kaposi's sarcoma (KS) with Primary Effusion Lymphoma (PEL) in a 28-year-old, African American male. Kaposi's sarcoma is an AIDS defining disease and typically will disseminate early in the course of the disease affecting the skin, mucous membranes, gastrointestinal tract, lymph nodes, and lungs. This case reports an unusual presentation of the disease along with primary effusion lymphoma. Although the most common organ systems affected by KS are the respiratory and the gastrointestinal systems, the lungs of this patient did not show any evidence of KS. Additionally, the patient demonstrates the rarely seen liver and unique pancreatic involvement by KS along with unusual synchronous bilateral pleural and peritoneal cavity involvement by PEL, adding to the distinct pattern of invasive AIDS-related Kaposi's sarcoma.
Atrial Septal Defect with Eisenmenger Syndrome: A Rare Presentation
Authors: Arnold Nongmoh Forlemu, Muhammad Ajmal, Mehrdad Saririan
Journal: Case Rep Cardiol (2020)
MeSH terms: Case Reports

Atrial septal defects (ASDs) are common congenital heart defects (CHD). The clinical course in patients without closure of the ASD is associated with significant morbidity and mortality in advanced age. A small percentage of patients may develop pulmonary arterial hypertension (PAH) due to left to right shunting that impacts morbidity and mortality. Advances in prenatal screening and fetal echocardiography have allowed timely interventions. Nonetheless, some patients still may be diagnosed with ASD in adulthood as an incidental finding or presenting with clinical symptoms such as shortness of breath from right heart failure. We report a case of an adult female presenting with shortness of breath due to ASD causing PAH with Eisenmenger physiology.
Initial Presentation of Disseminated Coccidioidomycosis with Ocular Lesions
Authors: Edward J Quinlan, Veenu Gill
Journal: Case Rep Infect Dis (2020)
MeSH terms: Case Reports

Ocular involvement with disseminated coccidiodal infection is rare. Even rarer is a patient presenting with symptomatic chorioretinitis first, followed weeks later by systemic symptoms of disseminated coccidioidomycosis. This highlights the need for physicians to have a heightened suspicion for testing for valley fever in patients living in endemic regions who present with ocular inflammation so that rapid and timely initiation of antifungal therapy may prevent loss of vision.
Successful antiviral triple therapy in a longstanding refractory hepatitis C virus infection with an acute kidney injury
Authors: David Callau Monje, Niko Braun, Joerg Latus, Kerstin Amann, Mark Dominik Alscher, Martin Kimmel
Journal: Case Rep Nephrol (2014)

Introduction. The HCV infection is a common disease with many chronically infected patients worldwide. So far, the standard therapy of a chronic HCV infection consisted of interferon as single therapy or in combination with ribavirin. After approval of the two protease inhibitors, boceprevir and telaprevir, the standard therapy for patients with genotype 1 changed. In patients with acute kidney injury (AKI) these therapies are not approved and have so far not been evaluated in studies. Case Report. In April 2012, a 58-year-old female was admitted due to a cryoglobulin-positive chronic HCV infection which had been treated with interferon and ribavirin. Currently, the patient was admitted because of severe complications with an acute kidney injury. We treated our patient successfully with a boceprevir based triple therapy. Conclusion. Limited data suggests that a therapy with ribavirin in patients with AKI seems to be safe under close monitoring. Our patient was treated successfully with a protease inhibitor based triple therapy. Nevertheless, it is necessary to plan an interventional study to evaluate the exact risk-benefit profile of triple therapy regimens in patients with AKI and hepatitis C.
Perinatal tuberculosis: a diagnostic and treatment challenge in a remote area of Asmat Regency of South Papua, Indonesia (case report)
Authors: Sitanaja Raymond, Helen Mayasari Subekti, Abed Ricky Hernando Sitompul
Journal: Pan Afr Med J (2022)
Keywords: perinatal tuberculosis, case report, neonate, perinatal, tuberculosis
MeSH terms: Respiratory Distress Syndrome, Shock, Septic / complications, Tuberculosis / complications, Tuberculosis / diagnosis, Tuberculosis / drug therapy, Tuberculosis, Pulmonary / diagnosis, Case Reports, Anti-Bacterial Agents / therapeutic use, Female, Fever / etiology, Humans, Indonesia, Infant, Newborn, Pregnancy, Anti-Bacterial Agents

Perinatal tuberculosis (TB) is a rare infectious disease. The diagnosis of perinatal TB is challenging due to its nonspecific clinical manifestations make it difficult to differentiate from other infections, resulting in a high mortality rate of 40-60%. Here we report a 26-day-old neonate with fever, cough, fast breathing, poor feeding, subcostal retraction, bilateral crackles, hepatomegaly, and signs of shock. Clinically, septic shock and pneumonia were suspected. Respiratory distress worsened despite broad-spectrum antibiotics, and kept getting worse up to the point that intubation and assisted mechanical ventilation were needed. The examination of acid-fast bacteria (AFB) stain on the endotracheal aspirate showed a positive result. The patient was diagnosed as having perinatal TB, then treated with anti-TB regimens (isoniazid, rifampicin, pyrazinamide, ethambutol), as well as prednisone and other supportive medical care. Recurrent septic shock, laryngeal edema, and a possibility of ventilator-associated pneumonia (VAP) worsened the patient's condition. The patient eventually passed away on the 71st day of care. In conclusion, perinatal TB should be suspected in any neonates with fever, respiratory distress, and hepatosplenomegaly, particularly in those from endemic areas, which fail to respond to broad-spectrum antibiotics. Early diagnosis and treatment are crucial to improve the prognosis of perinatal TB.
Case Report: Delayed Ventricular Pseudoaneurysm After Radiofrequency Ablation of Left Posteromedial Papillary Muscle Ventricular Tachycardia
Authors: Min Kim, Yoon Jung Park, Hee Tae Yu, Tae-Hoon Kim, Jae-Sun Uhm, Boyoung Joung, Hui-Nam Pak, Moon-Hyoung Lee
Journal: Front Cardiovasc Med (2022)
Keywords: catheter ablation, complication, intracardiac echocardiography, pseudoaneurysm, ventricular tachycardia
MeSH terms: Case Reports

A 74-year-old woman presented with incessant wide complex tachycardia that was refractory to cardioversions. Successful radiofrequency catheter ablation was performed on the left ventricular posteromedial papillary muscle. An inaudible steam pop has occurred during the procedure, but we confirmed that there were no complications during the procedure and short-term follow-up of echocardiography. Two months after the procedure, an asymptomatic pseudoaneurysm was identified at the ablation site that had not been observed in the short-term follow-up.
Upper Gastrointestinal Bleeding from Gastric Amyloidosis in a Patient with Smoldering Multiple Myeloma
Authors: Mihajlo Gjeorgjievski, Treta Purohit, Mitual B Amin, Paul J Kurtin, Mitchell S Cappell
Journal: Case Rep Gastrointest Med (2015)

Amyloidosis is a common complication of patients with monoclonal gammopathy of undetermined significance (MGUS), smoldering multiple myeloma (SMM), and multiple myeloma (MM). This proteinaceous material can be deposited intercellularly in any organ system, including the gastrointestinal (GI) tract. In the GI tract, amyloidosis affects the duodenum most commonly, followed by the stomach and colorectum. Gastric amyloidosis causes symptoms of nausea, vomiting, early satiety, abdominal pain, and GI bleeding. A case of upper GI bleeding from gastric amyloidosis is presented in a patient with SMM. Esophagogastroduodenoscopy (EGD) revealed a gastric mass. Endoscopic biopsies revealed amyloid deposition in the lamina propria, consistent with gastric amyloidosis. Liquid chromatography tandem mass spectrometry performed on peptides extracted from Congo red-positive microdissected areas of paraffin-embedded stomach specimens revealed a peptide profile consistent with AL- (lambda-) type amyloidosis. Based on this and multiple other case reports, we recommend that patients with GI bleeding and MGUS, SMM, or MM undergo EGD and pathologic examination of endoscopic biopsies of identified lesions using Congo red stains for amyloidosis for early diagnosis and treatment.
Simultaneous Hydatid Cyst of the Liver and Left Iliac Fossa: An Unusual Case Report
Authors: Tika Ram Bhandari, Sudha Shahi
Journal: Case Rep Surg (2019)
MeSH terms: Case Reports

Hydatid disease is a significant health problem in many livestock-rearing areas especially in the developing world, mainly caused by Echinococcus granulosus. The liver and lung are the most common affected sites. However, hydatid disease can occur anywhere in the body. Simultaneous involvement of two organs or sites is very unusual, mainly for organs other than the lung and liver. We thus report a very unusual combination of hepatic and left iliac fossa with hydatid disease in an adult patient. A 37-year-old farmer from a village presented with intermittent right upper quadrant and left iliac fossa pain associated with distention of abdomen for one month. Abdominal radiological investigations reported hydatid cyst disease; one cyst was found in the right lobe of the liver and another in the left iliac fossa. Positive IgG antibody by the ELISA test also confirmed the diagnosis. Pericystectomy and excision of hydatid cyst without spillage of content for the liver and left iliac fossa were done, respectively. Patient was discharged on the 10th postoperative day with an uneventful postoperative course. There was no recurrence of the lesion during one-year follow-up period. A combination of hydatid disease in the liver and iliac fossa is very unusual, so clinician should have thoughts regarding this rare entity as an important differential diagnosis.
Atypical presentation of syphilis: Rapidly progressive glomerulonephritis
Authors: Semir Abdi Usmael, Tesfay Atsbaha Gebremedhin
Journal: Clin Case Rep (2023)
Keywords: ethiopia, case report, hematuria, rapidly progressive glomerulonephritis, syphilis
MeSH terms: Case Reports

Syphilis is a sexually transmitted disease with a wide range of clinical manifestations. With the recent worldwide resurgence of syphilis, it is imperative to recognize various presentations of this great imitator. Renal syphilis is rare and most commonly present as nephrotic range proteinuria associated with pathological features of membranous glomerulonephritis. Rapidly progressive glomerulonephritis (RPGN) is a rare and atypical form of renal syphilis. A 50-year-old Ethiopian woman presented with periorbital swelling, hematuria, proteinuria, and rapidly progressive renal failure. Rapid plasma reagin and confirmatory Treponema pallidum hemagglutination (TPHA) tests were reactive. Treatment with a weekly Benzathine penicillin for 3 weeks resulted in a rapid return of renal function to baseline, with the increasing rate of new syphilis, clinicians should be mindful of the various renal manifestation of syphilis. This case highlights the significance of considering syphilis as a reversible cause in any patient presenting with a clinical feature suggestive of RPGN.
Distal cervical carotid artery dissection after carotid endarterectomy: a complication of indwelling shunt
Authors: Tomonori Tamaki, Node Yoji, Norihiro Saito
Journal: Int J Vasc Med (2010)
MeSH terms: Case Reports

The technical factors and surgical methods employed in carotid endarterectomy are controversial. In particular, whether or not to use an indwelling arterial shunt during carotid endarterectomy remains a source of conflict. We describe a rare case in which uncomplicated carotid endarterectomy was followed by distal internal carotid artery dissection and suggest that this devastating complication was due to intimal damage produced by the use of an indwelling arterial shunt.
Lymphadenitis as a Rare Side Effect of H1N1 Vaccine in a Child
Authors: Zuhal Gundogdu, Mualla Seyhogullari
Journal: Case Rep Med (2010)
MeSH terms: Case Reports

We present a 5-year-old boy who had the complaint of swelling and pain on the right vaccine shot and right axillary areas. The right axillary area was diagnosed as reactive lymphadenitis, which we believe is a rare local side effect of the swine flu vaccine. The key message to take away from this case is that the patient had lymphadenitis as a local side effect of the swine flu vaccine. Lymphadenitis should be reported as a possible local side effect of the swine flu vaccine.
Closed-Eye Visualizations in the Setting of Hyponatremia
Authors: Travis Peck, Christopher Mercogliano, Eugene York
Journal: Case Rep Med (2018)
MeSH terms: Case Reports

Purpose:
To report a case of closed-eye visualizations and to clarify the different types of hallucinations and their etiologies.
Methods:
Retrospective case report of a patient with closed-eye visualizations secondary to hyponatremia. Clinical findings, physical exam, laboratory assessment, treatment, and disease course from the patient's hospitalization were used in creating this report. Follow-up data after discharge were also obtained.
Results:
Closed-eye visualizations were diagnosed as secondary to hyponatremia, as they did not occur with the eyes open, and potential alternate causes were excluded. Serum sodium nadir was 119 mEq/L. Symptoms resolved with correction of hyponatremia via fluid resuscitation and electrolyte replenishment. There has been no recurrence of the symptoms.
Conclusion:
This patient had hallucinations exclusively with the eyes closed, which must be differentiated from the release hallucinations seen with the eyes open in Charles Bonnet syndrome. This patient had no visual loss or retinal disease, which should be suspected in open eye hallucinations.
Successful desensitization in a boy with severe cow's milk allergy by a combination therapy using omalizumab and rush oral immunotherapy
Authors: Masaya Takahashi, Shoichiro Taniuchi, Kazuhiko Soejima, Yasuko Hatano, Sohsaku Yamanouchi, Kazunari Kaneko
Journal: Allergy Asthma Clin Immunol (2015)
Keywords: cow’s milk, food allergy, omalizumab, rush oral immunotherapy
MeSH terms: Case Reports

Background:
Rush oral immunotherapy (OIT) combined with omalizumab (OMB) has been reported to be an effective and safe treatment for severe milk allergies. However, no report has described long-term follow-up observations after OMB discontinuation. The purpose of this case report was to evaluate the safety and efficacy of rush OIT in combination with OMB during a long period of treatment.
Case presentation:
A 5-year-old boy presented with a past history of two severe episodes of anaphylaxis (at the age of 2 and 3 years) after consuming small amounts of cow's milk (CM). Before the OIT, the total immunoglobulin E (IgE) level was 654 IU/mL, and specific-IgE (sIgE) levels for CM, casein, and β-lactoglobulin were 77.0 kUA/L, 86.2 kUA/L and 12.0 kUA/L, respectively. The skin prick test (SPT) for CM showed a wheal (diameter, 20 mm) and erythema (diameter, 50 mm). In the open food challenge, he reacted to a 0.2 mL ingestion of CM and presented with dyspnea and laryngospasms, and he was then administrated 150 mg OMB every 2 weeks for 8 weeks. In the 9th week, he was admitted to hospital for the rush phase of the OIT. Once he was able ingest a dose of 200 mL CM without having an adverse reaction, he was discharged and allowed to continue a daily dose of 200 mL CM at home. During this phase, the sIgE levels were elevated, but the end-point titration values from the SPT gradually decreased, and the SPT was negative after 1 year of OMB treatment. Five months after discontinuation of OMB, the daily CM ingestion was ceased for a 2-week period, followed by an oral food challenge (OFC) that was negative. The patient experienced only five mild adverse events during the course of rush OIT, even after the discontinuation of OMB and his quality of life improved dramatically afterwards.
Conclusions:
The combination therapy of rush OIT and OMB successfully maintained desensitization to CM in a boy with severe allergies. We propose that a negative SPT may be useful to guide discontinuation of OMB in such patients.
Leptomeningeal Carcinomatosis in Urothelial Carcinoma of the Urinary Bladder: A Report of a Patient with a Fulminant Course Who Died of Cancer after Definitive Therapies
Authors: Masayuki Tomioka, Makoto Kawase, Daiki Kato, Manabu Takai, Koji Iinuma, Kengo Horie, Keita Nakane, Natsuko Suzui, Tatsuhiko Miyazaki, Takuya Koie
Journal: Case Rep Urol (2021)
MeSH terms: Case Reports

A 45-year-old Japanese man visited a community hospital with the chief complaint of asymptomatic macrohematuria. He was diagnosed with muscle-invasive bladder cancer (MIBC), and he received intra-arterial chemotherapy followed by radiation therapy at another institution. Twenty-eight months after chemoradiotherapy, magnetic resonance imaging (MRI) revealed MIBC recurrence. After neoadjuvant chemotherapy, robot-assisted radical cystectomy was performed. Pathological examination indicated high-grade urothelial carcinoma with lymphovascular invasion, a positive surgical margin, and skip lesions of cancer cells in the perivesical adipose tissue. Three months after surgery, he was brought to our hospital in an ambulance with the chief complaint of rotatory vertigo and was speaking inarticulately. Head and whole spine MRI revealed meningeal metastasis along both the vestibulocochlear nerves and cauda equina. Analysis of the cerebrospinal fluid revealed malignant cells. The patient was diagnosed with leptomeningeal carcinomatosis originating from the MIBC. He received whole-brain radiotherapy followed by the administration of pembrolizumab. Unfortunately, the patient's condition quickly deteriorated, and he died of cancer 4 months after surgery.
Pancreatic pseudocyst presenting as dysphagia: a case report
Authors: Charles Panackel, Arun T Korah, Devadas Krishnadas, Kattoor R Vinayakumar
Journal: Saudi J Gastroenterol (2008)
Keywords: pancreatic pseudocyst, alcoholic pancreatitis, dysphagia, mediastinal cyst

Pancreatic pseudocysts are relatively common complications of acute pancreatitis. However, extension of pseudocysts into the mediastinum rarely occurs. In such situations they commonly present with chest pain or shortness of breath. We herein report the case of a patient with a pseudocyst presenting with dysphagia. The clinical presentation, current modalities of diagnosis and management of mediastinal pancreatic pseudocyst is reviewed in this article.
Cardiac metastasis mimicking STEMI-impact of point-of-care ultrasound on clinical decision-making: A case report
Authors: Anh Ngoc Le, Anh Van Nguyen, Trang Ngoc Nguyen, James N Kirkpatrick, Huyen Thi Nguyen, Hoai Thi Thu Nguyen
Journal: Front Cardiovasc Med (2023)
Keywords: st-segmental elevation, cardiac metastasis, case report, myocardial infarction, point-of-care ultrasound
MeSH terms: Case Reports

Introduction:
The manifestations of cardiac metastases are extremely variable depending on their location and extension.
Case presentation:
A 62-year-old man was admitted to the cardiac emergency department presenting with chest pain, worsening shortness of breath and palpitations. He had a history of esophageal squamous cell carcinoma treated with chemoradiotherapy, and he was not diagnosed with cardiovascular disease before. The electrocardiogram showed significant ST-segment elevations in leads II, III, and aVF. Initially, the patient was diagnosed with ST-segment elevation myocardial infarction. A cardiac point-of-care ultrasound was performed immediately revealing two large heterogeneous masses in the left ventricular wall and the apex, which changed the diagnosis and the management strategy. There was no significant change in serial cardiac biomarkers in the setting of persistent STE. Thoracic computed tomography and cardiac magnetic resonance confirmed that the patient was suffering from cardiac and lung metastases.
Conclusion:
ECG findings of localized and prolonged STE without Q waves or changes in biomarkers may suggest myocardial tumor invasion, especially in the cancer setting. Cardiac point-of-care ultrasound is an effective, convenient, noninvasive imaging modality to guide real-time clinical decision-making.
An Unusual Case of Resistant Hypokalaemia in a Patient with Large Bowel Obstruction Secondary to Neuroendocrine Carcinoma of the Prostate
Authors: Umasankar Mathuram Thiyagarajan, A Ponnuswamy, A Bagul, A Gupta
Journal: Case Rep Surg (2017)
MeSH terms: Case Reports

Neuroendocrine Carcinoma of the Prostate (NECP) is rare and only few cases have been reported, constituting less than 0.5% of prostatic malignancies. We report a rare case of large bowel obstruction from NECP posing a further challenge in management due to resistant hypokalaemia. A 70-year-old man presented with clinical signs of large bowel obstruction who was known to have prostatic carcinoma three years ago, treated initially with hormone therapy then chemoradiation. The blood profile showed a severe hypokalaemia and CT scan revealed liver and lung metastases apart from confirming large bowel obstruction from local invasion of NECP. Severe hypokalaemia was believed to be caused by paraneoplastic syndrome from tumor burden or by recent administration of Etoposide. Intensive potassium correction through a central venous access in maximal doses of 150 mmol/24 hours under cardiac monitoring finally raised serum potassium to 3.8 mmol/L. This safe period allowed us to perform a trephine colostomy at the left iliac fossa. The postoperative period was relatively uneventful. This first case report is presenting a rare cause of large bowel obstruction from a neuroendocrine carcinoma of prostate and highlights the importance of an early, intensive correction of electrolytes in patients with large tumor burden from NECP.