OpenMed/multicare-articles huggingface dataset:
Extended Scalp Reconstruction With a Free Supraclavicular Graft: A Case Report
Authors: Chrysoula Vardaxi, Paraskevi Karamitsou, James Philip Skliris, Spyridon Gougousis, Alexandros Poutoglidis
Journal: Cureus (2023)
Keywords: donor site, facial plastic surgery, skin reconstruction, supraclavicular graft, tissue transfer
MeSH terms: Case Reports

Skin restoration after tumor excision, trauma, or burns may be achieved with full or split-thickness skin grafts or local flaps. The success rate of a skin graft depends on several independent factors. The supraclavicular region is considered a reliable donor site for head and neck skin defects because of its easy access. We present a case of a supraclavicular skin graft harvested to cover a skin deficit after the excision of a squamous cell carcinoma of the scalp. The postoperative course was uneventful regarding graft survival, the healing procedure, and the cosmetic outcome.
Major CD4 T-Cell Depletion and Immune Senescence in a Patient with Chronic Granulomatous Disease
Authors: Adriana S Albuquerque, Susana M Fernandes, Rita Tendeiro, Rémi Cheynier, Margarida Lucas, Susana L Silva, Rui M M Victorino, Ana E Sousa
Journal: Front Immunol (2017)
Keywords: cd4 t-cell lymphopenia, chronic granulomatous disease, genetic phagocytic defect, gut mucosa, immune senescence, interleukin-17, primary immunodeficiency, reactive oxygen species

Chronic granulomatous disease (CGD) results from primary defects in phagocytic reactive oxygen species (ROS) production. T-cell evaluation is usually neglected during patients' follow-up, although T-cell depletion has been reported in CGD through unknown mechanisms. We describe here a 36-year-old patient with X-linked CGD with severe CD4 T-cell depletion <200 CD4 T-cells/μl, providing insights into the mechanisms that underlie T-cell loss in the context of oxidative burst defects. In addition to the typical infections, the patient featured a progressive T-cell loss associated with persistent lymphocyte activation, expansion of interleukin (IL)-17-producing CD4 T-cells, and impaired thymic activity, leading to a reduced replenishment of the T-cell pool. A relative CD4 depletion was also found at the gut mucosal level, although no bias to IL-17-production was documented. This immunological pattern of exhaustion of immune resources favors prompt, potentially curative, therapeutic interventions in CGD patients, namely, stem-cell transplantation or gene therapy. Moreover, this clinical case raises new research questions on the interplay of ROS production and T-cell homeostasis and immune senescence.
A Case Report on the Progression of Myeloid Sarcoma to Form Multiple Metastatic Deposits without Developing Acute Myeloid Leukaemia
Authors: Sunita Kohli, Mark Lee, Scott Marshall
Journal: Case Rep Hematol (2015)
MeSH terms: Case Reports

Introduction. Myeloid sarcomas (MS) are rare tumours occurring at extramedullary sites. They are usually associated with other haematology disorders such as acute myeloid leukaemia, myelodysplastic syndrome, and chronic myeloproliferative neoplasms. They frequently occur with a diagnosis of acute myeloid leukaemia (AML) or with relapse of preexisting disease. Patients with myeloid sarcomas without history or evidence of myeloid leukaemia typically progress to form AML. Case Presentation. A case report of a patient diagnosed with an isolated myeloid sarcoma that rarely did not transform to AML but instead spread to form multiple myeloid sarcomas throughout the body. Discussion. This case identifies the risk of metastatic spread of these tumours rather than the development of AML which is poorly documented in the literature, due to the rarity of cases, and may be significant in the investigation and management of isolated myeloid sarcomas. This case highlights the need for clinicians to consider repeat cross-sectional imaging to investigate unexplained clinical decline or symptoms, when there is no sign of AML progression and to consider radiotherapy treatment early.
Lenalidomide-Associated ITP
Authors: Christina I Herold, Cristina Gasparetto, Gowthami M Arepally
Journal: Case Rep Hematol (2011)
MeSH terms: Case Reports

Lenalidomide is a potent immunomodulatory agent being used increasingly for treatment of hematologic malignancies including multiple myeloma and myelodysplasia. The common toxicities of lenalidomide, including dose-limiting myelosuppression, are well described. However, the immunomodulatory properties of lenalidomide may give rise to unexpected autoimmune complications. Herein, we describe a case of immune thrombocytopenic purpura (ITP) associated with use of lenalidomide.
Case report: Rhabdomyolysis in children in acute and chronic disease-a challenging condition in pediatric emergency medicine
Authors: N Mand, C Donath, A Leonhardt, S Weber, M Kömhoff
Journal: Front Pediatr (2023)
Keywords: lpin1 mutation, acute kidney injury (aki), circulatory failure, hereditary metabolic disease, rhabdomyolysis
MeSH terms: Case Reports

Rhabdomyolysis is a challenging condition in pediatric emergency departments (PED): It ranges from asymptomatic illness with isolated elevation of creatine kinase (CK) levels to a life-threatening condition associated with extreme elevations in CK, electrolyte imbalances, circulatory failure (CF), acute kidney injury (AKI), and multi-organ disease. Most common causes of rhabdomyolysis are viral myositis and trauma, hereditary metabolic myopathies must be considered when facing rhabdomyolysis in early childhood. We report two cases of severe rhabdomyolysis with CF in our PED, thereby summarizing first-line management of rhabdomyolysis.
PML-IRIS during Fingolimod Diagnosed after Natalizumab Discontinuation
Authors: J Killestein, A Vennegoor, A E L van Golde, R L J H Bourez, M L B Wijlens, M P Wattjes
Journal: Case Rep Neurol Med (2014)

Background. Natalizumab treatment is frequently discontinued and replaced by alternative medication in multiple sclerosis (MS) patients having a high risk of progressive multifocal leukoencephalopathy (PML). Case Presentation. We report a PML case that was missed on magnetic resonance imaging (MRI) at the time Natalizumab treatment was discontinued. The patient subsequently developed a PML-immune reconstitution inflammatory syndrome after the initiation of Fingolimod treatment, suggesting that immune reconstitution may occur even during Fingolimod induced lymphopenia. Conclusion. This report highlights the need for strict drug surveillance using MRI of Natalizumab-associated MS patients at the time of drug discontinuation and beyond. This is important with respect to pharmacovigilance purposes not only for Natalizumab, but also for alternative drugs used after Natalizumab discontinuation.
Case report: Castleman's disease in trachea
Authors: Hong Xie, Shi Zhou, Chaonan Deng, Jun Jiao, Chao Fan, Yan Zhang
Journal: BJR Case Rep (2017)
MeSH terms: Case Reports

Castleman's disease (CD) in trachea is rarely reported to date. This report introduces a case of CD in trachea with emphasis on its radiological presentation onCT. A female patient was admitted at our emergency department with dyspnoea. Plain and enhanced CT revealed a mass with distinct border and marked enhancement. Tracheotomy was planned and it turned out to be CD of hyaline type on pathological examination. Two similar case reports on intratracheal CD from 1954 to 2015 were reviewed as we searched in PubMed using key words "endotracheal Castleman's disease" or "Castleman's disease in trachea" or "Castleman's disease in tracheal". This will be the third case report of CD in trachea in English literature. In this case report, the radiological appearance of CD on multiple imaging modes is reviewed. Lesions that should be taken into consideration in differential diagnosis are mentioned. The two main surgical methods for such lesions are briefly described.
Complete response of liver metastasis of gastric cancer treated by s-1 chemoradiotherapy: a case report
Authors: Tomonori Miyazawa, Kazuyu Ebe, Norihiko Koide, Nobuhiro Fujita
Journal: Case Rep Oncol Med (2012)

This paper presents a case of suspected liver metastasis of gastric cancer and a virtual complete response to S-1 chemoradiotherapy. A 69-year-old man underwent distal gastrectomy for gastric cancer in 2008. Multiple liver metastases occurred in 2009. He underwent 15 courses of S-1 therapy and radiation therapy (37.5 Gy). Abdominal computed tomography showed virtual complete disappearance of liver metastasis after chemoradiotherapy. Hence, this case was interpreted as a complete response. No sign of recurrence was noted 18 months after complete response was confirmed. S-1 chemoradiotherapy is likely to be effective in treating patients with liver metastases of gastric cancer.
Central pontine and extrapontine myelinolysis: the great masquerader-an autopsy case report
Authors: Sajish Jacob, Harsh Gupta, Dejan Nikolic, Betul Gundogdu, Shirley Ong
Journal: Case Rep Neurol Med (2014)

Central pontine myelinolysis is a demyelinating disorder characterized by the loss of myelin in the center of the basis pontis usually caused by rapid correction of chronic hyponatremia. The clinical features vary depending on the extent of involvement. Demyelination can occur outside the pons as well and diagnosis can be challenging if both pontine and extrapontine areas are involved. We herein report a case of myelinolysis involving pons, lateral geniculate bodies, subependymal region, and spinal cord. To the best of our knowledge, this case represents the second case of spinal cord involvement in osmotic demyelination syndrome and the first case of involvement of thoracic region of spinal cord.
Rituximab-Induced Psoriasis in a Patient with Granulomatosis with Polyangitis Treated with Adalimumab
Authors: Hana S Alahmari, Nasser Y Alhowaish, Mohammed A Omair
Journal: Case Rep Rheumatol (2019)
MeSH terms: Case Reports

Rituximab (RTX) is a chimeric B-cell-depleting monoclonal antibody against CD-20 positive cells that has been approved for the induction and maintenance of granulomatosis with polyangiitis (GPA). Reports have identified RTX to cause drug-related psoriasis. Many theories of underlying pathways have been proposed. However, further workup around the mechanism and treatment is required. Here, we present a 38-year-old woman known to have GPA that developed drug-related psoriasis that was successfully treated with treatment discontinuation and starting adalimumab along with a literature review.
A pediatric case of hypomagnesemia 1 (HOMG1) caused by novel compound heterozygous mutations in TRPM6
Authors: Takeshi Goda, Hiroshi Komatsu, Kandai Nozu, Hisakazu Nakajima
Journal: Hum Genome Var (2019)
MeSH terms: Case Reports

Hypomagnesemia 1 (HOMG1) is an extremely rare disease with autosomal recessive inheritance that is caused by mutations in the transient receptor potential melastatin 6 gene (TRPM6). Here, we describe a pediatric HOMG1 case with novel compound heterozygous mutations of TRPM6 (c.1483 C > T [p.Gln495*] and c.2715del [p.Trp905*]) in a 2-month-old boy who developed refractory seizures due to hypomagnesemia with secondary hypocalcemia.
Percutaneous Retrieval of Left Atrial Appendage Closure Devices in Patients With Atrial Fibrillation: A Case Report
Authors: Saihua Wang, Juhua Zhang, Shuwen Hao, Luoning Zhu, Zhongping Ning, Zhihong Zhao
Journal: Front Cardiovasc Med (2022)
Keywords: atrial fibrillation, complications, dislodgment, left atrial appendage closure, retrieval
MeSH terms: Case Reports

Left atrial appendage closure (LAAC) devices can be inadvertently released into unfavorable locations, which may allow them to migrate to a different position within the left atrial appendage or embolize from the heart into the aorta. In such instances, it can be challenging to remove the LAAC device. Here, we present two cases in which patients with atrial fibrillation experienced LAAC device exposure at an inappropriate site because of interventional operator error and device mismatch: (a) the LAAC device was dislodged into the aortic arch and retrieved percutaneously from the femoral artery route, and (b) in the left atrium, which was dislodged into the left atrium and retrieved via atrial transseptal puncture of the femoral vein.
Diagnosis of an Umbilical Vein Aneurysm at 30 Weeks Gestation
Authors: Meredith S Campbell, Amanda M Craig, Jeff Reese, Alicia K Crum, Soha S Patel
Journal: Case Rep Obstet Gynecol (2021)
MeSH terms: Case Reports

Background:
Fetal umbilical vein aneurysm is an uncommon anomaly without clear guidelines regarding the management of these pregnancies. Case Presentation. We describe an ultrasound diagnosis of this condition involving a 38-year-old multigravid woman who presented at 30 weeks and 3 days gestation with severe fetal growth restriction, reverse end-diastolic flow on umbilical artery dopplers, elevated ductus venosus doppler, and an umbilical vein aneurysm. Due to nonreassuring fetal assessment in the setting of an umbilical vein aneurysm, she underwent a cesarean delivery with a favorable neonatal outcome.
Conclusions:
There are currently no guidelines for the management of an umbilical vein aneurysm. This case demonstrates a successful multidisciplinary approach for creating a plan of care focused on achieving a favorable outcome for a fetus with a large umbilical vein aneurysm. The approach took into account timing of delivery given the potential for fetal morbidity and mortality, while factoring in the risk of prematurity.
Persistent Bacteremia from Pseudomonas aeruginosa with In Vitro Resistance to the Novel Antibiotics Ceftolozane-Tazobactam and Ceftazidime-Avibactam
Authors: Louie Mar Gangcuangco, Patricia Clark, Cynthia Stewart, Goran Miljkovic, Zane K Saul
Journal: Case Rep Infect Dis (2016)

Ceftazidime-avibactam and ceftolozane-tazobactam are new antimicrobials with activity against multidrug-resistant Pseudomonas aeruginosa. We present the first case of persistent P. aeruginosa bacteremia with in vitro resistance to these novel antimicrobials. A 68-year-old man with newly diagnosed follicular lymphoma was admitted to the medical intensive care unit for sepsis and right lower extremity cellulitis. The patient was placed empirically on vancomycin and piperacillin-tazobactam. Blood cultures from Day 1 of hospitalization grew P. aeruginosa susceptible to piperacillin-tazobactam and cefepime identified using VITEK 2 (Biomerieux, Lenexa, KS). Repeat blood cultures from Day 5 grew P. aeruginosa resistant to all cephalosporins, as well as to meropenem by Day 10. Susceptibility testing performed by measuring minimum inhibitory concentration by E-test (Biomerieux, Lenexa, KS) revealed that blood cultures from Day 10 were resistant to ceftazidime-avibactam and ceftolozane-tazobactam. The Verigene Blood Culture-Gram-Negative (BC-GN) microarray-based assay (Nanosphere, Inc., Northbrook, IL) was used to investigate underlying resistance mechanism in the P. aeruginosa isolate but CTX-M, KPC, NDM, VIM, IMP, and OXA gene were not detected. This case report highlights the well-documented phenomenon of antimicrobial resistance development in P. aeruginosa even during the course of appropriate antibiotic therapy. In the era of increasing multidrug-resistant organisms, routine susceptibility testing of P. aeruginosa to ceftazidime-avibactam and ceftolozane-tazobactam is warranted. Emerging resistance mechanisms to these novel antibiotics need to be further investigated.
[18F]FDG, [11C]PiB, and [18F]AV-1451 PET Imaging of Neurodegeneration in Two Subjects With a History of Repetitive Trauma and Cognitive Decline
Authors: David O Okonkwo, Ross C Puffer, Davneet S Minhas, Sue R Beers, Kathryn L Edelman, Jane Sharpless, Charles M Laymon, Brian J Lopresti, Steven Benso, Ava M Puccio, Sudhir Pathak, Milos D Ikonomovic, Joseph M Mettenburg, Walter Schneider, Chester A Mathis, James M Mountz
Journal: Front Neurol (2019)
Keywords: av-1451, cte, pet, pib, tbi, amyloid, neurodegeneration, tau
MeSH terms: Case Reports

Background: Trauma-related neurodegeneration can be difficult to differentiate from multifactorial neurodegenerative syndromes, both clinically and radiographically. We have initiated a protocol for in vivo imaging of patients with suspected TBI-related neurodegeneration utilizing volumetric MRI and PET studies, including [18F]FDG indexing cerebral glucose metabolism, [11C]PiB for Aβ deposition, and [18F]AV-1451 for tau deposition. Objective: To present results from a neuroimaging protocol for in vivo evaluation of TBI-related neurodegeneration in patients with early-onset cognitive decline and a history of TBI. Methods: Patients were enrolled in parallel TBI studies and underwent a comprehensive neuropsychological test battery as well as an imaging protocol of volumetric MRI and PET studies. Findings from two patients were compared with two age-matched control subjects without a history of TBI. Results: Both chronic TBI patients demonstrated cognitive deficits consistent with early-onset dementia on neuropsychological testing, and one patient self-reported a diagnosis of probable early-onset AD. Imaging studies demonstrated significant [18F]AV-1451 uptake in the bilateral occipital lobes, substantial [11C]PiB uptake throughout the cortex in both TBI patients, and abnormally decreased [18F]FDG uptake in the posterior temporoparietal areas of the brain. One TBI patient also had subcortical volume loss. Control subjects demonstrated no appreciable [18F]AV-1451 or [11C]PiB uptake, had normal cortical volumes, and had normal cognition profiles on neuropsychological testing. Conclusions: In the two patients presented, the [11C]PiB and [18F]FDG PET scans demonstrate uptake patterns characteristic of AD. [11C]PiB PET scans showed widespread neocortical uptake with less abnormal uptake in the occipital lobes, whereas there was significant [18F]AV-1451 uptake in both occipital lobes.
"This Is Not the Original Timeline": A Case Report of an Extended Dissociative Episode in a Healthy Young Male Accompanied with Severe Decline in Mental State
Authors: Godwin Tong, Kieran Groom, Louisa Ward, Muhammad Naeem
Journal: Case Rep Psychiatry (2021)
MeSH terms: Case Reports

Dissociation is a disconnection between a person's thoughts, memories, feelings, actions, or sense of who he or she is. Dissociative disorders can be described and understood using the combination of five core symptoms: amnesia, depersonalisation, derealisation, identity confusion, or identity alteration. They are frequently associated with previous experience of trauma. The challenge in diagnosis and the lifetime prevalence of approximately 10% in the general population and clinical psychiatric setting ensures the relevance of this case. We write about a 21-year-old gentleman with history of autism and obsessive compulsive disorder, but no significant medical history was presented to the emergency department with increased anxiety, subsequently progressing to agitation, pacing, and becoming nonverbal. No significant findings were uncovered on laboratory blood testing (other than prolactin 737 mu/L and phosphate 0.35 mmol/L), lumbar puncture, or brain imaging. Consequently, he was admitted to a psychiatric unit for assessment. The patient continued to present with severe disorientation, limited speech, and altered state of consciousness with occasional spastic-like movements. Antipsychotic and benzodiazepine medication was initiated, with no significant change in presentation. The patient continued to be witnessed wandering and having incoherent speech. First signs of improvement came 21 days postadmission with brief conversation and lucidity. This continued to improve over the next 7 days where he was reported to be at his baseline mental state. Environmental stressors including university examinations, the COVID-19 pandemic, and recent contact with his estranged father were possible precipitants to the episode. The patient reported almost complete unawareness of the psychiatric admission. A diagnosis of dissociative disorder, unspecified, was given. This case shows the management and diagnostic challenges of patients presenting with the aforementioned symptoms. There are no formal guidelines for the management of treating dissociative episodes, and this case report suggests the possible benefits of a drug-free period of watchful waiting upon admission.
Osteomalacia in an HIV-infected man receiving rifabutin, a cytochrome P450 enzyme inducer: a case report
Authors: Mark J Bolland, Andrew Grey, Anne M Horne, Mark G Thomas
Journal: Ann Clin Microbiol Antimicrob (2008)
MeSH terms: Anti-Bacterial Agents / adverse effects, Cytochrome P-450 Enzyme System / metabolism, HIV Infections / complications, Mycobacterium avium-intracellulare Infection / drug therapy, Osteomalacia / etiology, Rifabutin / adverse effects, Case Reports, AIDS-Related Opportunistic Infections / drug therapy, Alkaline Phosphatase / analysis, Anti-Bacterial Agents / metabolism, Anti-Bacterial Agents / therapeutic use, Bone Density, HIV Infections / drug therapy, Humans, Hyperparathyroidism, Secondary / etiology, Male, Middle Aged, Mycobacterium avium-intracellulare Infection / diagnosis, Osteomalacia / chemically induced, Osteomalacia / drug therapy, Rifabutin / metabolism, Rifabutin / therapeutic use, Vitamin D Deficiency / chemically induced, Vitamin D Deficiency / drug therapy, Vitamin D Deficiency / etiology, Anti-Bacterial Agents, Rifabutin, Cytochrome P-450 Enzyme System, Alkaline Phosphatase

Introduction:
People infected with human immunodeficiency virus are frequently treated with medications that can induce or inhibit cytochrome P450 enzymes.
Case presentation:
A 59 year old man treated with zidovudine, lamivudine, indinavir, and ritonavir for infection with human immunodeficiency virus volunteered to take part in a study of bone loss. He was found to have vitamin D insufficiency with secondary hyperparathyroidism and received vitamin D and calcium supplementation. He suffered a recurrence of infection with Mycobacterium avium intracellulare for which he received treatment with ciprofloxacin, rifabutin, and ethambutol. Subsequently, he developed worsening vitamin D deficiency with hypocalcaemia, secondary hyperparathyroidism and elevated markers of bone turnover culminating in an osteomalacic vertebral fracture. Correction of the vitamin D deficiency required 100,000 IU of cholecalciferol monthly. Rifabutin is a cytochrome P450 inducer, and vitamin D and its metabolites are catabolised by cytochrome P450 enzymes. We therefore propose that treatment with rifabutin led to the induction of cytochrome P450 enzymes catabolising vitamin D, thereby causing vitamin D deficiency and osteomalacia. This process might be mediated through the steroid and xenobiotic receptor (SXR).
Conclusion:
Treatment with rifabutin induces the cytochrome P450 enzymes that metabolise vitamin D and patients treated with rifabutin might be at increased risk of vitamin D deficiency. In complex medication regimens involving agents that induce or inhibit cytochrome P450 enzmyes, consultation with a clinical pharmacist or pharmacologist may be helpful in predicting and/or preventing potentially harmful interactions.