OpenMed/multicare-articles huggingface dataset:
Challenges in the diagnosis and management of atypical fungal keratitis during the COVID-19 pandemic: a case series
Authors: Dideeya Ali, Ajith Vijayan, Kashinatha Shenoy, Ann Tresa Antony, Reshmi Ramachandran
Journal: Access Microbiol (2023)
Keywords: atypical fungal keratitis, aureobasidium, covid-19, purpureocillium, scedosporium, trichosporon
MeSH terms: Case Reports

Fungal keratitis is a time-sensitive ocular infection that often requires a high index of suspicion followed by intensive medical/surgical interventions to achieve a successful clinical outcome. COVID-19 pandemic-related restrictions, necessitated the modification of conventional protocols and guidelines associated with the treatment of keratomycosis. We report four cases of atypical fungal keratitis with poorly differentiated clinical characteristics. The challenges faced during their management were (1) the dilemma of clinically differentiating fungal (Scedosporium and Purpureocillium lilacinum) and bacterial keratitis; (2) treatment of Scedosporium and Trichosporon keratitis with natamycin monotherapy; (3) mixed infection of Candida albicans and Aureobasidium pullulans and continuing medications before rescraping the corneal ulcer against the recommended treatment guidelines; (4) phenotypic identification and differentiation among morphologically resembling fungi; and (5) decision making arising out of disparities between KOH and fungal culture results. Three patients responded well to conservative treatments. The fourth patient underwent therapeutic keratoplasty but was lost to follow-up due to travel-related pandemic restrictions. This case series seeks to broaden the clinician's knowledge of rare and emerging moulds as presumptive aetiologies of keratomycosis. It also intends to emphasize the significance of early microbiological investigations, (direct microscopy and culture), in resource-limited settings, for initiating empirical treatment for a better visual prognosis.
Prosthodontic Rehabilitation of a Completely Edentulous Patient With a Cleft Palate: A Case Report
Authors: Shreya Colvenkar, Rathod Prakash, Summiya Fatima, Md Shakeel Ahmed, Gayam Kishore Reddy
Journal: Cureus (2023)
Keywords: cleft palate, congenital, denture, edentulous, obturator, prosthodontic rehabilitation
MeSH terms: Case Reports

Clefts of the lip and palate are congenital anomalies that affect the orofacial region. Completely edentulous patients with a cleft palate present a unique challenge during complete denture fabrication. Complete dentures with an obturator and palatal extension need to be accurately fabricated to fulfill the functions of esthetics, speech, deglutition, and mastication. The case report presents the successful prosthodontic rehabilitation of a cleft palate female patient using a complete denture with a palatal obturator and pharyngeal extension. The palatal obturator extension provided good retention and stability for the maxillary denture. The patient's skill and previous experience with her old dentures played an important role in successful treatment. The patient was satisfied with dentures in terms of esthetics, chewing, swallowing, and speech.
Extranodal diffuse large B-cell lymphoma with monoclonal gammopathy: an aggressive and primary refractory disease responding to an immunomodulatory agent
Authors: Patrizia Mondello, Vincenzo Pitini, Valeria Barresi, Elliott Joseph Brea, Cristian Di Mirto, Carmela Arrigo, Salvatore Cuzzocrea, Michael Mian
Journal: Exp Hematol Oncol (2016)
Keywords: diffuse large b-cell lymphoma, lenalidomide, monoclonal gammopathy, serum free light chain
MeSH terms: Case Reports

Background:
Although the clinical outcome of patients with diffuse large B cell lymphoma (DLBCL) has been improved by the addition of rituximab to standard chemotherapy, almost one-third fails or relapses after first line treatment. The presence of monoclonal gammopathy (MG) is a known adverse prognostic factor for DLBCL. Because this subset of patients does not benefit from R-CHOP, new therapeutic options are required. Herein, we report the first case of extranodal DBCL of the lung with a concomitant MG who achieved a long lasting complete remission with lenalidomide.
Case presentation:
The 73-year-old male patient presented with lateral cervical lymphadenopathy, B symptoms, lactate dehydrogenase and beta2-microglobulin elevation. Computed tomography (CT) showed mediastinal lymphadenopathy and bilateral lung involvement. Biopsy of both disease locations revealed the presence of DLBCL. Successive bone marrow trephine biopsy proved the presence of concordant DLBCL involvement. At the time of diagnosis, a MG was present as well. The patient did not respond to the standard treatments, and subsequently underwent lenalidomide 25 mg/m(2) days 1-21 q28 plus dexamethasone 40 mg days 1-4, 9-12 e 17-20. This therapeutic regimen was efficacious and safe as salvage therapy in extranodal DBCL with a MG. Furthermore, we observed a close association between DLBCL response to therapy and MG levels, suggesting that the amount of M-protein might be a surrogate marker of disease response.
Conclusion:
Although DLBCL associated with MG does not respond properly to the standard treatments, it is highly sensitive to lenalidomide, which is why we endorse its role as treatment of choice in this subset of patients. In addition, MG levels appear to correlate with tumor burden, suggesting that it might be a useful marker of disease response. Prospective trials to validate these observations are warranted.
The value of double balloon enteroscopy in diagnosing blue rubber bleb naevus syndrome: a case report
Authors: Fardod O'Kelly, Kheng Tian Lim, Narayanasamy Ravi, Nasir Mahmud, John V Reynolds
Journal: Cases J (2010)

Blue rubber bleb naevus syndrome is a rare vascular disorder associated with multiple gastrointestinal haemangiomas that have the potential for life-threatening haemorrhage. These may be difficult to diagnose, and have classically been described using computed tomographic studies and/or mesenteric angiography. Resected surgical specimens of these lesions, especially in the small bowel, have often been extensive and poorly localized. The recent advent and progressive development of double balloon enteroscopy has allowed the direct visualization and marking of these enteric lesions and serves as a valuable adjunct not only in diagnosis but also planning prior to surgery to allow accurate estimate of the extent of resection.
Ovarian Mature and Immature Teratomas in Monozygotic Twins: A Case Report of Simultaneous Presentation
Authors: Daisuke Shigemi, Naoki Kawai, Toshiyuki Takeshita
Journal: Case Rep Obstet Gynecol (2017)
MeSH terms: Case Reports

Mature cystic teratoma is one of the most common kinds of ovarian tumor, and immature teratoma is a rare tumor, representing less than 1% of all ovarian teratomas. Although there are some reports about familial occurrences of ovarian tumors, literature concerning the clinical cases of monozygotic twins is rare. We report the 5-year clinical courses of a 12-year-old Japanese girl with a recurrent bilateral ovarian mature teratoma and her monozygotic twin with a unilateral ovarian mature teratoma and contralateral ovarian immature teratoma. This is the first clinical report on mature and immature teratomas of the ovary in monozygotic twins. Our cases support future clarification of the molecular mechanism and pathogenesis of teratoma.
Endogenous Clostridium perfringens Panophthalmitis with Potential Entry Port from Diverticulitis Exacerbated by Proliferative Diabetic Retinopathy
Authors: Vamsee Neerukonda, Anny M S Cheng, Swetha Dhanireddy, Samuel Alpert, Han Y Yin
Journal: Case Rep Ophthalmol Med (2019)
MeSH terms: Case Reports

Purpose:
To report a rapid endogenous fulminating panophthalmitis from Clostridium perfringens in a patient with diverticulitis and proliferative diabetic retinopathy.
Methods:
A 61-year-old female with poorly controlled diabetes mellitus, active proliferative diabetic retinopathy, and recent diverticulitis presented with conjunctival injection, ocular discharge, and sudden onset of painful vision loss of the left eye. Patient denied history of ocular trauma, intraocular surgery, or intravenous drug abuse. Examination revealed an erythematous, proptotic eye with restricted extraocular movements, mucopurulent discharge, diffuse corneal edema, and vitreous haze and cell. Orbital computed tomography (CT) confirmed no retained intraocular foreign body.
Results:
Despite 48 hours of treatment with systemic broad spectrum antimicrobial therapy (vancomycin, meropenem, and amphotericin B), patient underwent enucleation due to declined condition and progressive infection. Patient's culture revealed gram-positive bacillus microbes (Clostridium perfringens). Patient's subsequent CT abdomen showed resolved diverticulitis after antimicrobial therapy.
Conclusion:
Although rare, Clostridium perfringens infection can be a cause of rapid loss of vision from fulminate endogenous panophthalmitis. Urgent extensive systemic work-up to identify potential port of entry from visceral pathology and rapid removal of source of infection are pivotal to avoid high rate of mortality.
A Rare Case of Staphylococcal Toxic Shock Syndrome in a Neonate
Authors: Nipun Shrestha, Alisha Joshi, Yumiko Hayashi, Dhruba Shrestha, Bhim Gopal Dhoubhadel
Journal: Case Rep Infect Dis (2022)
MeSH terms: Case Reports

Staphylococcus toxic shock syndrome (TSS) is not well described in neonates. The present criteria for diagnosis of TSS have not yet been validated in neonates. Here, we present a case of a 13-day-old female baby who presented with acute kidney injury (AKI). She had a pus-draining lesion on the head, and the pus grew Staphylococcus aureus. Based on the clinical criteria of fever, desquamation, hypotension, and AKI and laboratory criteria of absence of growth of any organisms in blood and cerebrospinal fluid, we diagnosed the case as TSS. She was treated with antibiotics, oxygen, and fluids, along with inotropic support and mechanical ventilation, and she recovered fully and was discharged on day 17 of admission. As there is no single test to diagnose TSS and it is uncommon in neonates, physicians should be familiar with the clinical presentation of the disease to make early diagnosis.
Sinusoidal Obstruction Syndrome (SOS) in Multiple Myeloma with Renal Failure
Authors: Urvi A Shah, Sengottuvel Viswanathan, Beamon Agarwal, Aditi Shastri, Ioannis Mantzaris, Murali Janakiram, Noah Kornblum, Ira Braunschweig, Amit Verma, Yang Shi, John Reinus, Olga Derman
Journal: Case Rep Oncol Med (2018)
MeSH terms: Case Reports

SOS is a rare complication of stem cell transplantation and has significant morbidity and mortality. We present three cases of SOS and highlight underlying risk factors for its development, such as impaired clearance of alkylating agents (especially melphalan) in patients with renal failure and prolonged infection. Although, melphalan and cyclophosphamide cause SOS less commonly than alkylating agents such as busulfan, physicians must use caution when administering these drugs to patients with underlying comorbidities such as renal failure that may increase the likelihood of development of SOS. This is due to unpredictable pharmacokinetics in patients with renal failure and therefore close drug monitoring is required. With the recent FDA approval of defibrotide in 2016, outcomes of SOS have improved and physician awareness is important for prompt diagnosis and treatment.
A Novel Intergenic Gene Between SLC8A1 and PKDCC- ALK Fusion Responds to ALK TKI WX-0593 in Lung Adenocarcinoma: A Case Report
Authors: Jia Du, Baoming Wang, Mengxia Li, Chunyang Wang, Tonghui Ma, Jinlu Shan
Journal: Front Oncol (2022)
Keywords: pkdcc, slc8a1, wx-0593, fusion, inhibitor, intergenic-alk
MeSH terms: Case Reports

Background:
Expanding the druggable novel anaplastic lymphoma kinase (ALK) fusions list is crucial to the precise treatment of patients with cancer with positive ALK fusions. The intergenic-ALK fusions accounted for a substantial proportion of ALK fusions. However, they were typically considered of limited clinical significance due to the obscure functional partners. In this case report, a patient carrying intergenic-ALK fusion presents an excellent outcome after taking the new second-generation tyrosine kinase inhibitor (TKI) candidate, WX-0593.
Case presentation:
A 47-year-old Chinese female patient diagnosed with IVB lung adenocarcinoma was admitted to the hospital with large dimension lesions in the left lobe of the lung. After 1 week of first line chemotherapy, no response was found. A novel ALK rearrangement generated by a fusion of the intergenic region between SLC8A1 and PKDCC to the intron 19 of ALK was presented after next-generation sequencing and was further confirmed by Sanger's sequencing. High expression of ALK was revealed by immunohistochemistry. The patient was directed to engage in phase III clinical trial (NCT04632758) and received an orally active second-generation ALK inhibitor WX-0593. Over the course of 17 months, the partial response was obtained without significant side effects.
Conclusion:
In summary, a patient with non-small cell lung cancer harboring a novel intergenic-ALK fusion, whose intergenic breakpoint was located between SLC8A1 and PKDCC, benefited from a potent ALK TKI candidate WX-0593. This finding extended the scope of targetable ALK fusions. More importantly, it highlighted the advantages of next-generation sequencing in identifying rare but functional ALK fusions, which eventually benefit patients.
Effect of 4DryField® PH, a Novel Adhesion Barrier, on Recurrence of Intestinal Adhesions after Extensive Visceral Adhesiolysis
Authors: Gerhard Blumhardt, Matthias Haas, Stefanie Polte
Journal: Case Rep Surg (2018)
MeSH terms: Case Reports

Background:
Adhesions occur after up to 97% of abdominal interventions causing chronic pain, infertility, and intestinal obstruction. Various concepts to prevent adhesions have been presented but mostly either have low efficacy or are not applicable in resective intestinal surgery or incomplete hemostasis. In this retrospective one-center clinical trial, the course of patients with extensive abdominal adhesiolysis and application of a recent starch-based formulation, 4DryField PH (4DF), is analyzed.
Case report:
Five female patients (age 65-83 years) underwent extensive open adhesiolysis with application of 4DF gel for adhesion prevention, premixed extracorporeally with saline or Ringer's solution (60-70 mL per 5 g 4DF) for homogeneous gel distribution on intestinal loops and in the peritoneal cavity. In addition, dry 4DF powder was dispersed on the greater omentum and subsequently transformed into a gel by dripping with saline or Ringer's solution directly before abdominal closure. Patients were followed up for more than two years, except for one patient who died after nine months due to metastases. One patient with complex situation due to Gore-Tex mesh in the lower abdomen showed no adhesions at scheduled second-look operation but after six months had relaparotomy for adhesiolysis. All other patients have remained free of adhesions or adhesion-related symptoms during follow-up.
Conclusion:
Considering the extent and complexity of adhesions, treatment with 4DF gel for adhesion prevention after open adhesiolysis appears promising. Prospective randomized trials should further elaborate on this clinical concept.
Total Mandibular Subapical Alveolar Osteotomy to Correct Class II Division I Dentofacial Deformity
Authors: Rafael Correia Cavalcante, Isabela Polesi Bergamaschi, Aline Monise Sebastiani, Fabiano Galina, Marina Fanderuff, Delson João da Costa, Nelson Luis Barbosa Rebellato, Rafaela Scariot, Leandro Eduardo Klüppel
Journal: Case Rep Surg (2018)
MeSH terms: Case Reports

Introduction:
Class II division I malocclusions are the most common dentofacial deformities seen in clinical practice. Severe cases or cases in which growth has ceased may require full correction combining orthodontic and surgical treatment. We report a case of a total mandibular subapical alveolar osteotomy, performed to correct a class II division I dentofacial deformity.
Case report:
A 19-year-old female patient was referred to the oral and maxillofacial surgery department at the Federal University of Paraná with chin aesthetic complaints as well as class II malocclusion. The proposed treatment was total mandibular subapical alveolar osteotomy, retaining the chin position and eliminating the need for genioplasty, since, although the patient presented with a class II dentofacial deformity, the chin was well positioned. Under general anesthesia, a "V-shaped" incision was conducted from the right retromolar region to the left retromolar region. A ring of cortical bone was removed around the mental foramen, with the aim to create a space around the mental nerve. Fixation was conducted with plates and screws of the 2.0 system. The patient on six-year follow-up showed osteotomy stability, a better overall occlusion, and outcome satisfaction.
A case of severe hemorrhagic cystitis caused by melphalan with successful bladder preservation by ligation of bilateral internal iliac arteries
Authors: Takumi Takeuchi, Masayoshi Zaitsu, Koji Mikami, Yuta Takeshima, Takashi Matsunaga, Naohiko Okamoto, Sadao Imao
Journal: Case Rep Med (2010)
MeSH terms: Case Reports

Hemorrhagic cystitis is a disorder which causes bleeding from diffusely inflammatory bladder mucosa. Here we present a case of severe hemorrhagic cystitis caused by melphalan. A 70-year-old man with multiple myeloma was presented with suddenly commenced massive gross hematuria. During an attempt of transurethral coagulation of bladder mucosa, bladder perforation into peritoneal cavity was suspected, then open laparotomy was indicated. We isolated bilateral internal iliac arteries and ligated them in order to control continued bleeding. After that, bladder bleeding was suddenly diminished. Ligation of internal iliac arteries may be a choice in controlling massive bleeding from bladder with severe hemorrhagic cystitis when laparotomy was inevitable.
Fostering productive conversations in a Kenyan tertiary intensive care unit: lessons learnt
Authors: Sayed Karar Ali, Jamila Nambafu, Feroza Daroowalla
Journal: Pan Afr Med J (2019)
Keywords: communication, intensive care unit, sub-saharan africa
MeSH terms: Communication, Critical Care / methods, Intensive Care Units, Case Reports, Female, Humans, Kenya, Middle Aged, Professional-Family Relations

Effective communication remains key in delivery of comprehensive care to patient especially in the intensive care unit (ICU) setting. However, many providers, for various reasons, struggle with the art of effective communication adversely affecting relationship with patients and their families. Little is known or has been published about effective communication in ICUs within sub-Saharan Africa.
Case Report: Disappearance of Coronary Anastomotic Aneurysm by Steroid Therapy in Takayasu Arteritis: Pseudorepair of Pseudoaneurysm?
Authors: Shuichi Naraoka, Hiroki Uchiyama, Toshiyuki Yano, Takuma Mikami, Ryo Harada, Yosuke Kuroda, Yuki Toda, Atsuko Muranaka, Taro Sugawara, Tadashi Hasegawa, Tetsuji Miura, Nobuyoshi Kawaharada
Journal: Front Cardiovasc Med (2021)
Keywords: aneurysm, aortic regurgitation, ruptured sinus of valsalva, steroid, takayasu arteritis
MeSH terms: Case Reports

Background: Takayasu arteritis (TA) is a large vessel vasculitis of unknown etiology characterized by chronic inflammatory changes of the aorta and its major branches. Complications such as anastomotic aneurysm and valve detachment have been reported in active TA patients who received aortic valve replacement and graft replacement of aorta. Case Summary:A 61-year-old man with a history of emergency aortic valve replacement and patch closure of the noncoronary sinus of Valsalva due to acute heart failure induced by acute aortic regurgitation and ruptured sinus of Valsalva 4 years ago was referred for exertional dyspnea. Dilatation of the sinus of Valsalva together with protrusion of the right sinus of Valsalva and ostial stenosis of the left coronary artery were newly found by computed tomography (CT). A Bentall operation with concomitant coronary artery bypass grafting was successfully performed with a composite graft. Diagnosis of TA was made on the basis of histological analyses of the resected sinus of Valsalva, though other arterial manifestations were not detected by 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography. Three months later, a follow-up study revealed left coronary ostial pseudoaneurysm at the anastomotic site together with strong 18F-FDG uptake, leading to commencement of steroid therapy. Eight months later, disappearance of left coronary ostial pseudoaneurysm was found by a follow-up CT scan. Conclusion: This is a rare TA case in whom spontaneous resolution of coronary anastomotic aneurysm by steroid therapy was found without reconstructive surgery.
Anti-N-Methyl-D-Aspartate Receptor Encephalitis Associated With Clear Cell Renal Carcinoma: A Case Report
Authors: Jianhua Yang, Bin Li, Xiaoquan Li, Zhaohui Lai
Journal: Front Oncol (2020)
Keywords: anti-n-methyl-d-aspartate receptor encephalitis, autoimmune encephalitis, clear cell renal cancer, paraneoplastic syndrome, recurrence, seizure
MeSH terms: Case Reports

Background: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a cause of autoimmune encephalitis and is characterized by epileptic seizures, psychosis, and consciousness impairments. It mostly affects young adults with ovarian cancers. We herein reported a case of anti-NMDAR encephalitis associated with clear cell renal carcinoma. Case Presentation: A 54-year-old male with headache for 1 week and mood and behavioral changes for 3 days was presented, but his clinical presentation and poor response to antiviral treatment did not support a diagnosis of viral encephalitis. Positive anti-NMDAR antibodies in serum and cerebrospinal fluid confirmed autoimmune encephalitis. A subsequent evaluation revealed a paraneoplastic etiology of a renal mass, and this was then resected and pathologically confirmed as clear cell renal carcinoma. The patient's symptoms showed improvement after resection of the mass. The patient relapsed 6 months after discharge, and the symptoms completely disappeared after treatment with corticosteroids and intravenous immunoglobulin. Conclusion: Our findings suggested that NMDAR encephalitis might be associated with clear cell renal carcinoma. When patients present with unexplained seizures, neuropsychiatric disorder, or other brain symptoms, clinicians should be careful with paraneoplastic neurological disorders. Early diagnosis and treatment of primary tumors might show improvement.
Contralateral total hip arthroplasty after hindquarter amputation
Authors: Scott M M Sommerville, James T Patton, Jonathan C Luscombe, Robert J Grimer
Journal: Sarcoma (2006)
MeSH terms: Case Reports

We describe the management and outcome of a 62-year old lady who developed severe osteoarthritis of the hip, nine years after a hindquarter amputation for radiation-induced sarcoma of the contralateral pelvis. The difficulties of stabilising the pelvis intraoperatively and the problems of postoperative rehabilitation are outlined. The operation successfully relieved her pain and restored limited mobility.