OpenMed/multicare-articles huggingface dataset:
Radiofrequency catheter ablation for re-do procedure after single-shot pulmonary vein isolation with pulsed field ablation for paroxysmal atrial fibrillation: case report
Authors: Xinyan Yang, Mingjie Lin, Yan Zhang, Juntao Wang, Jingquan Zhong
Journal: Front Cardiovasc Med (2024)
Keywords: atrial fibrillation, catheter ablation, pulsed field ablation, re-do procedure, reconnection
MeSH terms: Case Reports

Background:
Catheter ablation is frequently used to manage recurrent atrial fibrillation (AF) resistant to drug therapy, with pulmonary vein isolation (PVI) as a key tactic. Pulsed field ablation (PFA) has emerged as an innovative technology for PVI but poses challenges for redo procedures.
Case presentation:
We report on a 73-year-old female patient who experienced recurrent AF after initial successful PVI using a novel PFA technology and subsequently underwent radiofrequency catheter ablation during a repeat intervention. The reconnection of pulmonary veins was discovered primarily in the anterior region of the right superior PV and the superior portion of the left superior PV. An anatomically-based segmental approach and larger circumferential PVI, followed by additional linear ablations at non-PV trigger sites, proved decisive in preventing further recurrence of atrial tachycardia.
Conclusion:
While PFA exhibits promise as a secure and efficient modality for PVI, it necessitates excellent contact quality to ensure lasting results. For patients experiencing AF recurrences post-PFI, expanded strategies incorporating both comprehensive PVI and linear ablations at targeted non-PV sites might enhance treatment outcomes.
Valsalva Retinopathy Presenting as Subretinal Hemorrhage
Authors: Lívia Conci, Eliza Pereira, Samia Navajas, Epitacio Silva Neto, Sérgio Pimentel, Leandro Zacharias
Journal: Case Rep Ophthalmol Med (2024)
MeSH terms: Case Reports

Purpose:
To describe a case of subretinal hemorrhage due to the Valsalva maneuver in a patient with no underlying chorioretinal disease.
Methods:
History and clinical examination, optical coherence tomography (OCT), fluorescein, and indocyanine green angiography.
Results:
We report a case of a 35-year-old man with a 4-day history of central vision loss in the left eye (OS) after a vomiting episode. His best-corrected visual acuity was 20/200 in OS. Fundus examination revealed a subretinal hemorrhage in the posterior pole, associated with a small preretinal hemorrhage in the superotemporal arcade. OCT confirmed the presence of a thick submacular hemorrhage and a focal hemorrhage beneath the inner limiting membrane along the superotemporal arcade. The patient was submitted to pars plana vitrectomy (PPV), subretinal injection of tissue plasminogen activator (tPA), and air tamponade on the following day. Most of the submacular hemorrhage was displaced, resulting in a satisfactory visual outcome (BCVA = 20/30 after 1 month of surgery). Fluorescein and indocyanine green angiography excluded conditions such as retinal arterial macroaneurysm, polypoidal chorioretinopathy, and choroidal neovascularization.
Conclusion:
Although rare, Valsalva retinopathy may present with submacular hemorrhage in a patient with no underlying chorioretinal disease. PPV and subretinal tPA injection may provide a good visual outcome.
Case report: isolation of Hydrogenophaga from septic blood culture following near-death drowning in lakewater
Authors: Stuart Feichtinger, Angela A Lazar, Megan A Luebbe, Molly A Accola, Brittney D Jung-Hynes, Patti J Anderson, Kelly M Koglin, Karen S Schliesman, William Ehlenbach, Jeannina Smith, Derrick J Chen, William M Rehrauer, Adam L Bailey
Journal: Access Microbiol (2023)
Keywords: 16s sequencing, maldi-tof, drowning, hydrogenophaga
MeSH terms: Case Reports

A patient suffered a non-fatal wet drowning in a freshwater lake and developed bacteraemia several days later. Blood culture grew a Gram-negative rod that could not be identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). 16S ribosomal RNA sequencing of the isolate identified the microbe as Hydrogenophaga laconesensis - an environmental microbe commonly found in freshwater. The recovery of multiple pathogenic micro-organisms (although not H. laconesensis ) from culture of respiratory specimens prompted the initiation of antibiotic therapy with cefepime and, later, vancomycin. The patient's clinical course gradually improved over the course of 2 weeks and she was ultimately discharged home with minimal sequelae. To our knowledge, this is the first evidence of human infection with bacteria in the genus Hydrogenophaga . Hydrogenophaga may be considered in cases of freshwater near-drowning, and MALDI-TOF MS databases should be updated to include H. laconesensis .
Ultrasound-assisted catheter-directed thrombolysis in a patient with COVID-19 infection and bilateral intermediate-to-high-risk pulmonary embolism: a case report
Authors: Grigorios Korosoglou, Dimitrios Mouselimis, Elke Koenig, Stavros Konstantinides
Journal: Eur Heart J Case Rep (2024)
Keywords: covid-19, case report, computed tomography angiography, intermediate-to-high-risk pulmonary embolism, right ventricular dilatation, ultrasound-assisted catheter-directed thrombolysis
MeSH terms: Case Reports

Background:
Acute pulmonary embolism (PE) is a common cardiovascular disorder, potentially associated with high morbidity and mortality rates.
Case summary:
Herein, we report on a patient with COVID-19 infection and bilateral PE, who presented after cardiovascular resuscitation with return of spontaneous circulation. Initially, an acute coronary syndrome was suspected but bedside echocardiography showed dilatation of the right ventricle (RV) and RV dysfunction, helping to establish the diagnosis of acute intermediate-to-high-risk PE, which was subsequently confirmed by contrast-enhanced computed tomography pulmonary angiography. The patient was successfully treated using low-dose (12 mg of tissue plasminogen) ultrasound-assisted catheter-directed thrombolysis, which resulted in prompt clinical improvement and reversal of RV dysfunction without bleeding complications.
Discussion:
This case demonstrates the importance of echocardiography for the differential diagnosis of PE and of catheter-directed thrombolysis for its treatment in patients with intermediate-to-high-risk and high-risk PEs.
Case Report: Low-grade glioma with NF1 loss of function mimicking diffuse intrinsic pontine glioma
Authors: Joshua D Bernstock, Paramesh V Karandikar, Jason A Chen, Jakob Seidlitz, Gregory K Friedman, David M Meredith, Kevin X Liu, Daphne Haas-Kogan, David A Reardon, Pier Paolo Peruzzi
Journal: Front Surg (2024)
Keywords: dipg, nf1, biopsy-based diagnosis, glioma, pontine glioma
MeSH terms: Case Reports

Intrinsic, expansile pontine tumors typically occur in the pediatric population. These tumors characteristically present as diffuse intrinsic pontine glioma (DIPG), which is now considered as diffuse midline glioma (DMG), H3K27-mutated of the pons. DIPG has limited treatment options and a poor prognosis, and the value of tissue diagnosis from an invasive biopsy remains controversial. This study presents the case of a 19-year-old female with clinical and imaging hallmarks of DIPG, who underwent a biopsy of a tumor in the region of the right middle cerebellar peduncle. Her lesional cells were negative for H3K27M alterations and had low-grade histologic features. Next-generation sequencing revealed a frameshift mutation in the NF1 gene as the likely driver mutation. These features suggest a diagnosis of a low-grade glioma associated with NF1 loss of function, with far-reaching consequences regarding both treatment strategy and prognosis. This case provides support for the utility of diagnostic tissue biopsy in cases of suspected DIPG.
Methylcobalamin Deficiency Presenting as Thalamic Syndrome in the Elderly: Association or Chance?
Authors: Varun Daiya, Abhinav Ahuja, Sunil Kumar, Sourya Acharya
Journal: Cureus (2024)
Keywords: geriatric population, homocysteine levels, macrocytic anemia, neuropsychiatric functioning, paresthesia, psychosis, vitamin b12 deficiency
MeSH terms: Case Reports

Vitamin deficiency is common in the geriatric population and is responsible for majorly imbalanced hematological, neurological, and neuropsychiatric functioning. Methylcobalamin deficiency or vitamin B12 deficiency can be underestimated in some cases and be misdiagnosed as other illnesses, such as thalamic syndrome. Timely diagnosis of this deficiency is essential, especially in the geriatric population, as it might cause irreversible structural brain damage. This is also presented as elevated levels of homocysteine and methylmalonic acid. Clinically, it presents with the following symptoms: lower sensitivity levels to touch and light, psychosis, paresthesia, anemia, imbalance, fatigue, cognitive disturbances, difficulty remembering, and confusion. Symptoms are usually progressive and worsen over a period of time. In this case report, we present the case of a 62-year-old male with clinical symptoms of numbness and tingling in the right side of the body. The neurological presentations resembled left thalamic infarct, but the underlying reason was methylcobalamin deficiency.
Infratemporal abscess: a rare complication of a common procedure
Authors: Rajesh Kotagiri, Matthew L Repp, Michael H Kim, Faissal Stipho
Journal: Access Microbiol (2024)
Keywords: eikenella corrodens, infratemporal abscess, streptococcus anginosus, coaggregation, wisdom teeth extraction
MeSH terms: Case Reports

The infratemporal fossa (ITF) is an anatomically complex cavity that houses a variety of muscular and neurovascular structures at the base of the skull. Infections involving the ITF, though uncommon, can be fatal due to the difficulties of accessing this anatomical space and its proclivity to evolve into a cavernous venous thrombosis (CVT). As a result, a multi-disciplinary approach involving several surgical and medical subspecialists is often warranted. We present a case of an infratemporal fossa abscess (IFA) after wisdom teeth extraction with a very complicated clinical course and a distinct microbiologic profile.
Case report: Rapid resolution of grade IV ICANS after first line intrathecal chemotherapy with methotrexate, cytarabine and dexamethasone
Authors: Mikalai Katsin, Tatsiana Shman, Alexandr Migas, Dzmitry Lutskovich, Yuliya Serada, Yauheniya Khalankova, Yuliya Kostina, Simon Dubovik
Journal: Front Immunol (2024)
Keywords: cd19 car-t cells, icans, anakinra, corticosteroids, intrathecal chemotherapy
MeSH terms: Antineoplastic Combined Chemotherapy Protocols / adverse effects, Antineoplastic Combined Chemotherapy Protocols / therapeutic use, Cytarabine / administration & dosage, Cytarabine / therapeutic use, Dexamethasone / administration & dosage, Dexamethasone / therapeutic use, Injections, Spinal, Methotrexate / administration & dosage, Methotrexate / therapeutic use, Case Reports, Female, Humans, Immunotherapy, Adoptive / adverse effects, Lymphoma, B-Cell / drug therapy, Male, Middle Aged, Neurotoxicity Syndromes / diagnosis, Neurotoxicity Syndromes / etiology, Treatment Outcome

Corticosteroid therapy is the mainstay of immune effector cell-associated neurotoxicity syndrome (ICANS) management, although its use has been associated with worse overall survival (OS) and progression-free survival (PFS) after chimeric antigen receptor T-cell (CAR-T cell) therapy. Many options are being investigated for prophylaxis and management. Accumulating evidence supports the use of intrathecal (IT) chemotherapy for the management of high-grade ICANS. Here, we describe a case of a patient with stage IV Primary mediastinal B-cell lymphoma (PMBCL) successfully treated with IT methotrexate, cytarabine, and dexamethasone as first-line therapy for CD19 CAR-T cell-associated grade IV ICANS. The stable and rapid resolution of ICANS to grade 0 allowed us to discontinue systemic corticosteroid use, avoiding CAR-T cells ablation and ensuring preservation of CAR-T cell function. The described patient achieved a complete radiologic and clinical response to CD19 CAR-T cell therapy and remains disease-free after 9 months. This case demonstrates a promising example of how IT chemotherapy could be used as first-line treatment for the management of high-grade ICANS.
Staphylococcus lugdunensis Endocarditis Presenting with Brain Abscesses and Temporal Vision Deficits
Authors: Matthew S Linz, Diana Finkel, Eli S Goshorn
Journal: Case Rep Infect Dis (2024)
MeSH terms: Case Reports

Staphylococcus lugdunensis is a coagulase-negative staphylococcal bacterium (CoNS) that colonizes the skin. While infectious endocarditis (IE) caused by S. lugdunensis is rare, it is noteworthy because it has been associated with an aggressive clinical course. In this report, we present a case of culture-negative IE complicated by brain abscesses, vision deficits, and progressive heart failure that ultimately required mitral valve replacement. The causative agent was eventually identified as S. lugdunensis through molecular testing of valvular tissue.
Spinal muscular atrophy in Ghanaian children confirmed by molecular genetic testing: a case series
Authors: Charles Kumi Hammond, Emmanuel Oppong, Emmanuel Ameyaw, Joslin Alexei Dogbe
Journal: Pan Afr Med J (2023)
Keywords: spinal muscular atrophy, floppy infant, motor neuron disease, survival motor neuron
MeSH terms: Muscular Atrophy, Spinal / diagnosis, Muscular Atrophy, Spinal / genetics, Muscular Atrophy, Spinal / therapy, Spinal Muscular Atrophies of Childhood / diagnosis, Spinal Muscular Atrophies of Childhood / genetics, Spinal Muscular Atrophies of Childhood / therapy, Case Reports, Child, Female, Genetic Testing, Ghana, Humans, Infant, Newborn, Molecular Biology, Retrospective Studies

Spinal muscular atrophy (SMA) is an autosomal recessive inherited motor neuron disease characterized by progressive muscle weakness due to degeneration and loss of the anterior horn cells in the spinal cord and the brain stem nuclei from foetal life through infancy and childhood. SMA is prevalent in Ghanaian children, though not widely reported. Cases are likely missed or misdiagnosed due to lack of expertise and investigations. Newborn screening is not currently available in Ghana. The management remains supportive as newly approved genetic modifications therapies are currently not available. We present a retrospective folder review of children attending a tertiary pediatric neurology clinic who were diagnosed with SMA and confirmed by molecular genetic testing. Between January 2018 and August 2021, five (5) children from three families had molecular genetic tests confirming their diagnosis of SMA. Three (3) children had SMA I phenotype while 2 had SMA III phenotype. Two (2) of the 3 children with SMA I died from respiratory complications. The last surviving child with SMA I was diagnosed through newborn screening program overseas and received gene modification therapy. Careful history and physical examination remain the best approach to diagnosis as confirmatory genetic testing and supplemental investigations are not readily available. The current management of the children with SMA in Ghana include respiratory care, physiotherapy, and genetic counselling. Genetic modification therapies are currently not available.
Calcified cerebral toxoplasmosis associated with recurrent perilesional edema causing neurological manifestations in an HIV-infected individual: case report with a decade-long follow-up
Authors: Flávia Carolina Soares Bonato, René Leandro Magalhães Rivero, Hector Hugo Garcia, José Ernesto Vidal
Journal: Rev Inst Med Trop Sao Paulo (2024)
MeSH terms: HIV Infections / complications, HIV Infections / drug therapy, Neurocysticercosis / complications, Neurocysticercosis / diagnosis, Toxoplasmosis, Cerebral / complications, Toxoplasmosis, Cerebral / diagnosis, Case Reports, Edema / etiology, Follow-Up Studies, Humans

Four cases of people living with HIV/AIDS (PLWHA) with calcified cerebral toxoplasmosis associated with perilesional edema causing a single episode of neurological manifestations have recently been reported. Here, we describe the first detailed description of perilesional edema associated with calcified cerebral toxoplasmosis causing three episodes of neurological manifestations in a PLWHA, including seizures in two of them. These recurrences occurred over approximately a decade. Throughout this period, the patient showed immunological and virological control of the HIV infection, while using antiretroviral therapy regularly. This case broadens the spectrum of an emerging presentation of calcified cerebral toxoplasmosis, mimicking a well-described finding of neurocysticercosis in immunocompetent hosts.
Case report: Granzyme-B expression by T- and B- cells during severe AQP4-positive Neuromyelitis Optica spectrum disorder with fatal venous thromboembolism outcome
Authors: Vinícius Oliveira Boldrini, Mariana Rabelo Brito, Raphael Patrício Silva Quintiliano, Lucas Scárdua Silva, Clarissa Lin Yasuda, Fernando Cendes, Alessandro Santos Farias, Alfredo Damasceno
Journal: Front Neurol (2023)
Keywords: b cells, devic's syndrome, t lymphocytes, anti cd20 monoclonal antibody, deep vein thrombosis (dvt), granzyme-b, neuroinflammation, pulmonary thromboembolism
MeSH terms: Case Reports

Background:
The expression of serine protease granzyme-B (GzmB) by circulating CD8+ T lymphocytes has been recently suggested as a biomarker for poor immunotherapy response and severe disability in patients with Neuromyelitis Optica spectrum disorders (NMOSD). In parallel, venous thromboembolism (VTE) has been reported mainly in NMOSD patients exhibiting transverse myelitis.
Case presentation:
Here, we describe an Aquaporin-4 positive (AQP4-positive) NMOSD patient who showed short myelitis (SM) and experienced a fatal pulmonary thromboembolism/lower extremity deep vein thrombosis during anti-CD20 treatment. Flow cytometry analyses from the peripheral blood revealed an enhanced cytotoxic behavior through circulating CD8+GzmB+ T, CD4+GzmB+ T lymphocytes, and residual CD19+GzmB+ B cells.
Conclusions:
Fatal VTE may be a rare outcome, particularly in patients exhibiting SM, and may share poorly understood immunological mechanisms with AQP4-positive NMOSD severity.
Diabetic Ketoacidosis and Hypertriglyceridemia-Induced Acute Pancreatitis Requiring Plasmapheresis: A Case Report of a Rare Presentation of Type 2 Diabetes Mellitus in Adults
Authors: João Lourinho, José Proença, Letícia Santos, Vanessa Leite, Sara Ramalho, Conceição Escarigo
Journal: Cureus (2024)
Keywords: diabetic ketoacidosis (dka), hypertrygliceridemia, hypertrygliceridemic pancreatitis, ketosis-prone type 2 diabetes, lipid-lowering therapy, therapeutic plasmapheresis
MeSH terms: Case Reports

The triad of diabetic ketoacidosis, hypertriglyceridemia, and acute pancreatitis is a rare presentation of diabetes mellitus type 2 in adults. We report a case of a 41-year-old male who presented at the emergency department with a sudden onset of severe abdominal pain. Diagnosis of diabetic ketoacidosis, hypertriglyceridemia, and acute pancreatitis was made. Triglyceride level was 6056 mg/dL and glycated hemoglobin was 12.6%. Vigorous fluid therapy and continuous infusion of insulin were started, but due to maintained symptoms, a single plasmapheresis session was performed, with significant clinical improvement. This case emphasizes the diagnostic challenges of the triad and highlights the potential role of plasmapheresis in rapidly reducing triglyceride levels.
Successful use of Fenfluramine in super-refractory status epilepticus in a patient with tuberous sclerosis complex and Lennox-Gastaut syndrome
Authors: Thorsten Wildermann, Felicitas Becker, Sarah Jesse, Hartmut Baier, Jan Wagner
Journal: Epilepsy Behav Rep (2024)
Keywords: fenfluramine, lennox-gastaut syndrome, super-refractory status epilepticus, tuberous sclerosis complex
MeSH terms: Case Reports

A 24-year-old female patient with pre-existing refractory epilepsy caused by tuberous sclerosis (TSC) and electroclinical features of Lennox-Gastaut syndrome (LGS) was referred to our hospital from an external clinic. Upon arrival, she presented with super-refractory status epilepticus (SRSE) since anaesthetics had already been used in the referring clinic. Despite various changes in ASM-treatment and continuous administration of anaesthetics for more than two weeks, SRSE could not be terminated. On treatment day 24, we started Fenfluramin (FFA) which was soon titrated to a dose of 0,7 mg/kg/day. A few days after beginning the treatment with FFA, EEG and clinical situation improved dramatically. The following 6 weeks of treatment went without reported seizures. This case illustrates the successful use of FFA in SRSE in TSC and LGS and, to the best of our knowledge, represents the first report of FFA in this clinical context.
Case report: A rare case of malignant solitary fibrous tumor in an adult with an epithelioid pattern in the occipital region
Authors: Ke Huang, Wen-Wen Liu, Xiu-Wen Chen, Yin-Hua Hao, Sen-Yuan Luo, Ling-Ling Yuan, Yu-Gang Huang, Xian-Bin Tang
Journal: Front Oncol (2024)
Keywords: nab2-stat6 fusion, next-generation sequencing-ngs, case report, diagnostic pathology, malignant solitary fibrous tumor
MeSH terms: Case Reports

We illustrated a rare case of malignant solitary fibrous tumor (MSFT) with epithelioid morphology in the occipital region of a 59-year-old female, in which a rare NAB2ex7-STAT6 exon15/16 double fusion subtype was detected by the Next-generation sequencing (NGS) and STAT6 immunohistochemistry (IHC) was diffusely and strongly positively expressed, without recurrence after 20 months of postoperative follow-up. The morphological and molecular genetic aspects and the differential diagnosis are described, and the relevant literature was assessed in order to broaden our understanding and diagnostic capability of this malignancy.
A Case Report of Systemic Allergic Reaction to the Dual Glucose-Dependent Insulinotropic Polypeptide/Glucagon-Like Peptide-1 Receptor Agonist Tirzepatide
Authors: Trang Thi Bich Le, Le Huu Nhat Minh, Pooja Devi, Nabila Islam, Issac Sachmechi
Journal: Cureus (2024)
Keywords: allergic reaction, gip/glp-1 receptor agonist, hypersensitivity, safety, tirzepatide
MeSH terms: Case Reports

This report examines a case of systemic hypersensitivity to tirzepatide in a patient with type 2 diabetes. Tirzepatide (Mounjaro®), a dual agonist of glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor, has recently gained FDA approval. Additionally, a literature review was conducted to summarize recent research on tirzepatide's effectiveness and safety. A 67-year-old woman, previously treated with basal insulin, metformin, and semaglutide (a GLP-1 agonist), experienced severe disseminated pruritus and a generalized urticarial rash after her first dose of tirzepatide. This reaction, which subsided with antihistamines, raises questions about possible immunoglobulin E-mediated hypersensitivity. The report highlights the need for increased vigilance regarding allergic reactions to new diabetes medications, particularly in the context of GIP/GLP-1 receptor agonists.