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Long-Term Pulmonary Damage From SARS-CoV-2 in an Infant With Brief Unexplained Resolved Events: A Case Report
Authors: Luana Nosetti, Massimo Agosti, Massimo Franchini, Valentina Milan, Giorgio Piacentini, Marco Zaffanello
Journal: Front Med (Lausanne) (2021)
Keywords: covid-19, breathing, infant, newborn, pneumonia, sleep disorders
MeSH terms: Case Reports

A brief unexplained resolved event (BRUE) is an event observed in a child under 1 year of age in which the observer witnesses a sudden, brief but resolved episode of change in skin color, lack of breathing, weakness or poor responsiveness. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of coronavirus disease-2019 (COVID-19). We report the case of a previously healthy, full-term infant infected with SARS-CoV-2 when he was 8 months old. Previous to this event, both his grandfather and great-uncle had died of severe pneumonia and his mother had developed respiratory symptoms and fever. Over the following month he was seen five times in the emergency room and was hospitalized twice for recurrent BRUE. At the first hospital admission, after the second emergency room visit, he twice tested positive for COVID-19 after nasopharyngeal swab tests. During his second hospital admission, after the fifth emergency room visit, chest computed tomography revealed typical SARS-CoV-2 pneumonia. During a follow-up examination 6 months later, mild respiratory distress required administration of inhaled oxygen (0.5 L/min) and chest computed tomography disclosed a slight improvement in pulmonary involvement. The clinical manifestation of pulmonary complications from COVID-19 infection was unusual. This is the first report of an infant at high-risk for BRUE, which was the only manifestation of long-term lung involvement due to SARS-CoV-2 pneumonia.
Recurrence of Chronic Myeloid Leukemia during Pregnancy Subsequently Achieving Complete Medical Remission
Authors: Sasha Mikhael, Ashlee Pascoe, Joseph Prezzato
Journal: Case Rep Oncol Med (2017)
MeSH terms: Case Reports

The treatment of chronic myeloid leukemia (CML) with tyrosine kinase inhibitors (TKIs) in reproductive-aged women poses major dilemmas concerning its associated teratogenicity as observed in many animal studies. Much controversy exists regarding continuation versus discontinuation of its use in pregnancy with some studies suggesting safety of TKIs before and during pregnancy and others reporting toxicity and adverse outcomes. TKIs have become a well-established treatment option for CML, significantly improving prognosis, and yet have been reported to be fetotoxic. We present a case of a 25-year-old woman who achieved successful pregnancy and delivery after withholding treatment, meanwhile relapsing, eventually achieving complete molecular remission after reinitiation of high dose dasatinib.
Juvenile Granulosa Cell Tumor of the Testis: Prenatal Diagnosis and Management
Authors: Fabrizio Vatta, Alessandro Raffaele, Noemi Pasqua, Stefania Cesari, Piero Romano, Gian Battista Parigi, Luigi Avolio
Journal: European J Pediatr Surg Rep (2019)
Keywords: juvenile granulosa cell tumor, prenatal ultrasound, testicular tumors
MeSH terms: Case Reports

Prepubertal primary testicular tumors account for ∼1% of all pediatric solid tumors. We report a new case of prenatal diagnosis of juvenile-type granulosa cell tumor (JGCT). A fetal ultrasound performed at the 38th week of gestation for suspected nonvertex presentation identified a left multilocular septated cystic testicular mass, suggestive for JGCT. At birth, a painless left scrotal mass was detected. Ultrasound re-evaluation excluded torsion of the testis. Tumor markers and abdominal ultrasound were normal for age. Inguinal exploration revealed a cystic mass beneath the tunica albuginea that had replaced all the normal parenchyma. Since organ-sparing surgery was thus not feasible, an orchiectomy was performed and diagnosis of JGCT was confirmed. At 7-year follow-up, the child presented an uneventful outcome. Our case shows that neonatal JGCT, which has an intrauterine genesis, can be diagnosed prenatally by ultrasound in the last weeks of pregnancy.
PRELIMINARY DATA ON LIVER TRANSPLANTATION IN HYDATIDOSIS DISEASE
Authors: Alexia Rangel de Castro, Elodie Bomfim Hyppolito, José Telmo Valença-Júnior, Gustavo Rego Coelho, José Huygens Parente Garcia
Journal: Arq Bras Cir Dig (2022)
MeSH terms: Cholangitis, Echinococcosis / surgery, Liver Transplantation / methods, Case Reports, Albendazole / therapeutic use, Female, Humans, Middle Aged, Preliminary Data, Retrospective Studies, Albendazole

Aim:
Hydatidosis is a rare and endemic parasitic disease in Brazil that causes the proliferation of cysts mainly in the liver, leading to many complications, such as compression of vessels and biliary ducts, liver failure, portal hypertension, and cirrhosis. The treatment of choice is the resection of the lesions combined with albendazole therapy. This disease is a rare indication for liver transplantation, a feasible treatment option in more advanced stages. The purpose of this study was to describe two cases of patients from northern Brazil who underwent liver transplantation due to hepatic hydatidosis.
Methods:
This is a retrospective study with data collected from medical records.
Results:
Case 1: A 51-year-old female patient presented pain in the right hypochondriac, dyspepsia, consumptive syndrome, and obstructive jaundice, with a previous diagnosis of Caroli's disease with no possibility of surgical resection and a MELD score of 24. She underwent liver transplantation, and the anatomopathological result demonstrated hydatidosis. Case 2: A 52-year-old female patient presented multiple episodes of cholangitis in 30 years, with three liver resections and clinical treatment with albendazole for hydatidosis. She underwent liver transplantation due to recurrent cholangitis with a MELD score of 20. Both patients underwent post-transplant clinical therapy with albendazole, had good outcomes, and remain in follow-up without complications after 5 and 96 months, respectively.
Conclusion:
The patients benefited from the procedure and have a good prognosis due to the absence of metastasis, early reintroduction of antiparasitic drugs, and continuous follow-up.
Characteristics and outcomes of COVID-19 patients in New York City's public hospital system
Authors: Roopa Kalyanaraman Marcello, Johanna Dolle, Sheila Grami, Richard Adule, Zeyu Li, Kathleen Tatem, Chinyere Anyaogu, Stephen Apfelroth, Raji Ayinla, Noella Boma, Terence Brady, Braulio F Cosme-Thormann, Roseann Costarella, Kenra Ford, Kecia Gaither, Jessica Jacobson, Marc Kanter, Stuart Kessler, Ross B Kristal, Joseph J Lieber, Vikramjit Mukherjee, Vincent Rizzo Jr, Madden Rowell, David Stevens, Elana Sydney, Andrew Wallach, Dave A Chokshi, Nichola Davis, New York City Health + Hospitals COVID-19 Population Health Data Team
Journal: PLoS One (2020)
MeSH terms: COVID-19 / ethnology, COVID-19 / mortality, COVID-19 / therapy, Ethnicity, Hospitals, Public, Pandemics, SARS-CoV-2, Research Support, N.I.H., Extramural, Adolescent, Adult, Age Factors, Aged, Child, Child, Preschool, Female, Follow-Up Studies, Humans, Infant, Infant, Newborn, Male, Middle Aged, New York City / epidemiology, New York City / ethnology, Retrospective Studies, Risk Factors, Sex Factors

Background:
New York City (NYC) bore the greatest burden of COVID-19 in the United States early in the pandemic. In this case series, we describe characteristics and outcomes of racially and ethnically diverse patients tested for and hospitalized with COVID-19 in New York City's public hospital system.
Methods:
We reviewed the electronic health records of all patients who received a SARS-CoV-2 test between March 5 and April 9, 2020, with follow up through April 16, 2020. The primary outcomes were a positive test, hospitalization, and death. Demographics and comorbidities were also assessed.
Results:
22254 patients were tested for SARS-CoV-2. 13442 (61%) were positive; among those, the median age was 52.7 years (interquartile range [IQR] 39.5-64.5), 7481 (56%) were male, 3518 (26%) were Black, and 4593 (34%) were Hispanic. Nearly half (4669, 46%) had at least one chronic disease (27% diabetes, 30% hypertension, and 21% cardiovascular disease). Of those testing positive, 6248 (46%) were hospitalized. The median age was 61.6 years (IQR 49.7-72.9); 3851 (62%) were male, 1950 (31%) were Black, and 2102 (34%) were Hispanic. More than half (3269, 53%) had at least one chronic disease (33% diabetes, 37% hypertension, 24% cardiovascular disease, 11% chronic kidney disease). 1724 (28%) hospitalized patients died. The median age was 71.0 years (IQR 60.0, 80.9); 1087 (63%) were male, 506 (29%) were Black, and 528 (31%) were Hispanic. Chronic diseases were common (35% diabetes, 37% hypertension, 28% cardiovascular disease, 15% chronic kidney disease). Male sex, older age, diabetes, cardiac history, and chronic kidney disease were significantly associated with testing positive, hospitalization, and death. Racial/ethnic disparities were observed across all outcomes.
Conclusions and relevance:
This is the largest and most racially/ethnically diverse case series of patients tested and hospitalized for COVID-19 in New York City to date. Our findings highlight disparities in outcomes that can inform prevention and testing recommendations.
Rhinolithiasis: about an observation of a rare condition
Authors: Jawad Lahma, Reda Hejjouji, Imane Azzam, Abdelilah Oujilal, Leila Essakalli
Journal: Pan Afr Med J (2018)
Keywords: rhinolithiasis, nasal endoscopy, nasal foreign body, nasal rhinorrhea, rhinoliths
MeSH terms: Lithiasis / diagnosis, Nasal Obstruction / etiology, Nose Diseases / diagnosis, Case Reports, Adolescent, Endoscopy / methods, Female, Humans, Lithiasis / surgery, Nose Diseases / surgery, Osteolysis / pathology

Rhinolithiasis is a rare condition often neglected or unknown that tends to disappear in developed countries and corresponds to a solid calcification by gradual deposition of calcareous salts around a central resorbable or non-resorbable foundation of varying shape and size. The most common symptom is a long-term unilateral purulent rhinorrhea and unilateral nasal obstruction. Nasal endoscopy and imaging are interesting for the positive diagnosis but especially to highlight the anatomical anomalies or related pathologies. Therapeutic management requires endonasal extraction of the rhinolith under general anesthesia. We report an observation of rhinolithiasis treated in our department associating a significant deformation of the nasal pyramid to osteolysis.
A Rare Case of Fungal Necrotising Otitis Externa Centred on the Left Temporomandibular Joint
Authors: A Khan, E Omakobia, S Hasnie, R Barton, P Gopalan, V Oktseloglou, I Smith
Journal: Case Rep Otolaryngol (2020)
MeSH terms: Case Reports

Introduction:
Necrotising otitis externa (NOE) is a rare life-threatening complication of simple otitis externa which can be difficult to diagnose and manage. It is very rarely centred on the temporomandibular joint (TMJ). Fungi cause NOE in approximately 5-20% of patients, and a high index of suspicion is required for diagnosis, particularly when there is no improvement with prolonged topical and intravenous antibiotic therapy.
Objective:
To report a novel case of fungal NOE centred on the left TMJ in an immunocompromised adult male with a focus on investigations and optimal management. Case Report. A 67-year-old male with comorbid chronic renal impairment presented to our otolaryngology department with prolonged left otalgia and otorrhoea. Subsequent cross-sectional imaging demonstrated left NOE centred on the TMJ. Poor resolution with prolonged courses of systemic and topical anti-pseudomonal antibiotics prompted maxillofacial surgical input for left TMJ exploration, washout, and biopsy from the joint capsule. The causative organism was identified as Aspergillus flavus on PCR analysis. The patient was successfully treated with oral posaconazole and repeated topical insertions of amphotericin B-soaked ribbon gauze to the left ear. Discussion. A combination of various imaging modalities including CT, MRI, Tc-99, and gallium-67 are utilised in clinical practice both to diagnose NOE and subsequently monitor disease progression or resolution. Immunocompromised patients with confirmed fungal NOE may require a combination of treatments including surgical debridement and prolonged antifungal therapy for a number of months, if not lifelong, treatment. Initiating empirical antifungal therapy may be justified in some patients. However, this should be judged on a case-by-case basis and guided by discussion with the local microbiology and infectious diseases departments. However, there is no national guideline or consensus regarding treatment of these patients, especially in cases of fungal NOE.
Refractory fistula of bladder repaired with transurethral cystoscopic injection of N-butyl-2-cyanoacrylate
Authors: Sakurako Mukai, Shunsuke Shinmei, Masayuki Muto, Tomoya Hatayama, Hiroyuki Shikuma, Shunsuke Miyamoto, Shinsuke Fujii, Kousuke Sadahide, Yohei Sekino, Keisuke Hieda, Shogo Inoue, Tetsutaro Hayashi, Jun Teishima, Akio Matsubara
Journal: IJU Case Rep (2019)
Keywords: n‐butyl‐2‐cyanoacrylate, bladder fistula, cystoscopic injection
MeSH terms: Case Reports

Introduction:
Refractory fistulas of the bladder are not rare, but they can rarely be closed naturally. Bladder fistulas can be treated in various ways. We report the case of an old woman who had a refractory fistula of the bladder that was able to be repaired with transurethral cystoscopic injection of N-butyl-2-cyanoacrylate.
Case presentation:
For decades after being treated for cervical cancer in 1970s, the woman frequently suffered from fevers. A computed tomography scan showed pelvic abscess at the left side of her bladder, and cystography showed urine leakage at the wall. Thus, we diagnosed her with a pelvic abscess due to a bladder fistula after radiation. Then, we treated her with drainage, antibiotic agents, and N-butyl-2-cyanoacrylate. After that, she no longer had fevers, and cystography showed no leakage of urine.
Conclusion:
This result indicates transurethral cystoscopic injection of N-butyl-2-cyanoacrylate may treat bladder fistulas safely, minimally invasively, and quickly.
Delayed Diagnosis of an Eating Disorder in a Male Patient With Superior Mesenteric Artery Syndrome: Results From a Case Study
Authors: María Recio-Barbero, Sara Fuertes-Soriano, Janire Cabezas-Garduño, Mayte López-Atanes, Alvar Peña-Rotella, Margarita Sáenz-Herrero
Journal: Front Psychiatry (2019)
Keywords: wilkie’s syndrome, anorexia nervosa, eating disorders, gender bias, superior mesenteric artery syndrome
MeSH terms: Case Reports

Background: Eating disorders (EDs) are serious and life-threatening mental diseases characterized by abnormal or altered eating habits. The prevalence is variable, being influenced by diverse sociocultural factors. Historically, the prevalence of EDs has been higher in women (90%), although the incidence of these disorders in men appears to be increasing. In daily medical practice, when considering the presentation of other medical complications associated to the development of an ED, few is known about its real prevalence in men. Among them, some severe gastrointestinal complications that are rarely presented, such as the superior mesenteric artery syndrome (SMAS), can produce life-threatening results. Despite that, very few cases of men presenting this pathology are reported in literature. Case Presentation: A 38-year-old man without a history of psychiatric disease was admitted to the emergency department with nausea, abdominal pain, and severe malnutrition (body mass index 15.7 kg/m2). He was diagnosed with SMAS and was studied by multiple specialists on suspicion of a probable organic origin of his thinning. The suspected diagnosis of ED was rejected for months by some professionals, as well as by the patient and his family, until it was finally diagnosed with unspecified feeding and eating disorder (USFED). Conclusion: This case represents an example of diagnostic challenge where a delayed diagnosis of an ED in a male patient was made probably due to gender bias in clinical research and practice. In the literature, numerous reports were described in women diagnosed with SMAS with a previous diagnosis of an ED; however, few cases were found in men. In this clinical case, the patient suffered a significant diagnostic delay, probably due to the lack of diagnostic suspicion given by the differences in the prevalence and clinical presentation of EDs in women and men.
Advanced Esophageal Neoplasm with Subcutaneous Metastasis
Authors: Rivadávio A M de Oliveira, Tassiara da Silva, Mariana Miyasaki Piovesana, Carlos Eduardo Stecca, George A Lopes, Vitor Teixeira Liutti
Journal: Case Rep Oncol Med (2019)
MeSH terms: Case Reports

Objective:
This report is aimed at describing a rare clinical condition of advanced esophageal cancer with subcutaneous metastasis.
Case report:
The present case refers to a patient diagnosed with stage IV esophageal squamous cell carcinoma which started with dysphonia and cervical nodules. Soon after that, the patient developed dysphagia and subcutaneous lesions on the right flank. Later in time, we documented a disease progression, with worsening of subcutaneous implants, lymph node, bone, and pulmonary metastases in addition to malignant hypercalcemia.
Conclusion:
This illustrates a rare presentation of an advanced esophageal neoplasm. Subcutaneous metastasis from internal malignancies is unusual, corresponding to less than 10% of cases. Its occurrence in patients with esophageal cancer is even less common with very few cases reported in literature.
Primary Squamous Cell Carcinoma of the Sigmoid Revealed by Acute Intestinal Occlusion in Moroccan Young Male Patient: A Case Report and Literature Review
Authors: Mohamed Amine Haouane, Jouabri Badr, Mohamed Kaakoua, Mohamed Amine Azami
Journal: Cureus (2023)
Keywords: cancer, colon, intestinal occlusion, squamous cell carcinoma (scc), surgery
MeSH terms: Case Reports

Primary colorectal squamous cell carcinoma (SCC) is an extremely rare subtype of colon cancer, with an incidence of less than 1% of colorectal malignancies. We report a case of a 40-year-old male patient admitted to the emergency department with symptoms of acute intestinal obstruction. Histopathological evaluation of colonoscopic biopsies revealed squamous cell carcinoma. A sigmoidectomy was performed. In order to enrich the medical literature, we add our case to the collection of colorectal squamous cell carcinoma cases by analyzing and summarizing the clinical, pathological, and therapeutic features of this rare entity.
One-stage combined thoracic ancient schwannomas total removal and coronary artery bypass
Authors: Kadri Ceberut, Erdinc Naseri, Atac Celik, Ahmet Muslehiddinoglu, Ismail Ergin
Journal: Case Rep Med (2011)
MeSH terms: Case Reports

Ancient schwannoma is a rare variant of neural tumors though rarely seen in the thorax. The combination with coronary artery diseases is also rare. Here we describe a 66 year-old male who had undergone one-stage combined surgery for thoracic ancient schwannomas removal and coronary artery disease. The masses were, respectively, 13 cm in the middle mediastinum and 5 cm in diameter originating from the intercostal nerve. The tumors were successfully removed using sternotomy, and then a coronary artery bypass grafting was performed. Here we discuss this rare tumor in relation to the relevant literature.
Case report: immunotherapy successfully treated brain metastasis in intrahepatic cholangiocarcinoma and literature review
Authors: Peiyi Xie, Lei Guo, Bo Zhang, Yongfeng Xu, Qi Song, Hongcheng Shi, Qinghai Ye, Hui Li, Yongsheng Xiao
Journal: Front Oncol (2022)
Keywords: pd1, advanced intrahepatic cholangiocarcinoma (icca), brain metastasis, immune checkpoint inhibitors (icis), immunotherapy
MeSH terms: Case Reports

Brain metastasis from intrahepatic cholangiocarcinoma (iCCA) is extremely rare, and no standard therapeutic strategy has been established. Camrelizumab is a programmed cell death protein 1 (PD-1) inhibitor that has been widely studied in treating liver cancer. Combined immunotherapy and targeted therapy are a promising approach for treating advanced iCCA. Despite that immune checkpoint inhibitor (ICI)-based neoadjuvant therapy on iCCA has shown a significant response rate and resection rate, few reports have shown the therapeutic efficacy of immunotherapy in treating brain metastasis from iCCA. Although PD-1 inhibitors such as pembrolizumab, nivolumab, or camrelizumab are increasingly applied in clinic practice to treat multiple malignancies, to the best of our knowledge, we report the first case of an iCCA patient with brain metastasis successfully treated with a combined immunotherapy and targeted therapy. The patient is a 54-year-old man with metastatic iCCA in brain treated though camrelizumab plus lenvatinib therapy with a complete response (CR). By the time of writing, he has had a progression-free survival of 17.5 months and did not experience any severe side effects related to this therapy. Camrelizumab plus lenvatinib therapy showed favorable efficacy and manageable toxicity for this patient with advanced iCCA and could be of interest for more prospective randomized trials to further verify the potential clinical benefits.
Neuro-Behçet's masquerading as progressive bulbar palsy: a case report and literature review
Authors: Theodoros Paschalis, Noor M Shami, Amit Kj Mandal, Constantinos G Missouris
Journal: JRSM Open (2019)
Keywords: brain stem/cerebellum, clinical, neuroimaging, neurology
MeSH terms: Case Reports

In patients with progressive bulbar palsy without an obvious cause, there should be a high index of suspicion for the potential diagnosis of Neuro-Behçet's Disease, even in the absence of the acute classical peripheral manifestations of Bechet's Disease, with emphasis in prompt diagnosis using 'The International Criteria for Behçet's Disease' and rapid, effective treatment in order to improve outcome.
Progressive Multifocal Leukoencephalopathy in a Patient With Classic Hodgkin's Lymphoma Post-Bone Marrow Transplant: A Case Report
Authors: Ibad Rehman, Zafar Ali, Sana Rasheed, Irfan Ullah, Abdulqadir J Nashwan
Journal: Cureus (2023)
Keywords: bone marrow transplant, hodgkin's lymphoma, multifocal leukoencephalopathy, non-hodgkin's lymphoma, post bone marrow transplant complications
MeSH terms: Case Reports

A 29-year-old male patient underwent an autologous bone marrow transplant. He was initially diagnosed with Hodgkin's lymphoma and treated with 12 cycles of chemotherapy. Three months later, he presented with intermittent fever and underwent an MRI scan and a brain biopsy. Eventually, he was diagnosed with progressive multifocal leukoencephalopathy. For effective treatment and a plan of action, such cases necessitate multidisciplinary board meetings with input from experts in surgery, pathology, cancer, and infectious diseases.
Enhanced Interaction between Warfarin and High-Dose Ketoconazole: A Case Report
Authors: Cynthia A Jackevicius, Mannhu N Ton
Journal: Case Rep Med (2009)
MeSH terms: Case Reports

This case describes the increased anticoagulation effect associated with the use of high-dose ketoconazole. A 59-year-old man treated with warfarin for aortic valve replacement was prescribed high-dose ketoconazole and hydrocortisone for the treatment of prostate cancer. Despite lowering the warfarin dosage by 35% during the start of high dose ketoconazole, an additional dose reduction was required subsequently when the INR rose from 2.62 to 3.82 within nine days. After a total dose reduction of 43%, the INR returned to therapeutic range within two weeks. The Naranjo probability scale revealed a probable adverse reaction of increased anticoagulant effect associated with high dose ketoconazole. Due to the inhibition of warfarin metabolism by ketoconazole, patients taking high dose ketoconazole concomitantly with warfarin may need their warfarin dosage reduced by more than is currently recommended, as well as receive more frequent INR monitoring to avoid over anticoagulation.