OpenMed/multicare-articles huggingface dataset:
Visual response and anatomical changes on sequential spectral-domain optical coherence tomography in birdshot chorioretinopathy treated with local corticosteroid therapy
Authors: Marisa Gobuty, Mehreen Adhi, Sarah P Read, Jay S Duker
Journal: Int J Retina Vitreous (2016)
Keywords: birdshot chorioretinopathy, choroidal thickness, choroidal thinning, choroidal vasculature, corticosteroids, cystoid macular edema, immunosuppression, retinal thinning, spectral-domain optical coherence tomography

Background:
Birdshot chorioretinopathy is a chronic bilateral inflammatory disease of unknown etiology characterized by bilateral retinal vasculitis, mild to moderate vitritis, retinal vascular leakage, cystoid macular edema (CME), and typical "birdshot" chorioretinal lesions. Typically, patients with birdshot chorioretinopathy are treated with systemic immunosuppressive and/or corticosteroid therapy in an effort to minimize loss of vision. Spectral-domain OCT (SD-OCT) has shown regional or generalized photoreceptor loss in addition to both retinal as well as choroidal thinning in these patients. The present study describes anatomical changes of the retina and alterations in choroidal thickness and vasculature on sequential spectral-domain optical coherence tomography (SD-OCT) in 4 patients with birdshot chorioretinopathy treated with local corticosteroids.
Methods:
A retrospective observational case series identified 4 consecutive patients (8 eyes) at New England Eye Center, Boston diagnosed with birdshot chorioretinopathy according to the research criteria of the international consensus conference that were managed by a single retina specialist and treated exclusively with local corticosteroid therapy (intravitreal/sub-tenon injections) without systemic immunosuppression. All patients underwent longitudinal SD-OCT imaging with both the 512 × 128 cube scan and the 1-line raster protocol. A chart review was performed to review the visual response to treatment. Two independent observers analyzed sequential SD-OCT images for retinal parameters such as occurrence of CME at any time during the course of disease, presence of retinal thinning and presence of hyper-reflective foci within the retina, and choroidal parameters including its thickness and its vasculature.
Results:
Mean age of the patients at diagnosis was 47 years (26-60 years). Mean duration of follow-up was 96 months. All patients were HLA-A29 positive. Visual acuity remained stable in 75 % of eyes, 63 % eyes had central retinal thinning, 75 % eyes had hyper reflective foci within the retina and 75 % eyes had CME during follow-up. Mean total sub-foveal choroidal thickness of all 8 eyes at the time of the last SD-OCT was significantly lower than at initial SD-OCT (p = 0.03).
Conclusions:
This case series suggests that treatment with local corticosteroids may have good visual outcome despite retinal and choroidal thinning. Future longitudinal studies are necessary to further determine the benefits of local corticosteroid therapy.
A Rare Case of Pancreatic Endometriosis Masquerading as Pancreatic Mucinous Neoplasm
Authors: Barton Huang, Annie Mooser, Danielle Carpenter, Grace Montenegro, Carrie Luu
Journal: Case Rep Surg (2021)
MeSH terms: Case Reports

Endometriosis is a relatively common condition among women, and pancreatic endometriosis has been reported on rare occasions. Such pancreatic lesions are difficult to diagnose and distinguish from other cystic lesions of the pancreas preoperatively. This report describes a case of pancreatic endometriosis in a 51-year-old female patient. Imaging demonstrated an enlarging cyst with findings concerning for a mucinous neoplasm. The patient underwent robotic distal pancreatectomy and splenectomy. Histopathology revealed an endometriotic cyst. Pancreatic endometriosis can be difficult to distinguish from other lesions of the pancreas. Surgical resection should be undertaken in cases where malignancy is suspected.
Adjuvant radiotherapy for synchronous bilateral testicular seminoma: a case report and a review of the pertinent literature
Authors: Daniel A Jones, Elizabeth C Ester, David Leavitt, Robert Sweet, Badrinath Konety, Gautam Jha, L Chinsoo Cho
Journal: Case Rep Urol (2013)

Few cases of synchronous bilateral stage I seminomas have been reported in the world literature. We present a case of bilateral synchronous testicular seminoma, the current literature on the management of stage I seminoma, and the implications for radiotherapy. A forty-year-old man presented with synchronous bilateral classical seminomas, both stage IA. After undergoing bilateral inguinal orchiectomy, he received adjuvant external beam radiotherapy, with a standard paraaortic field. After 18 months of followup, he remains well, without evidence of recurrence. Bilateral germ cell tumors (BGCTs) are reported consistently at a low rate. Bilateral radical inguinal orchiectomy is standard of care, yet some groups have proposed an organ preservation approach. Of the reported cases of bilateral stage I synchronous GCT, with concordant seminoma histology, most of them were treated with bilateral orchiectomy and adjuvant radiotherapy. Although morbidity associated with radiotherapy directed at the abdomen is not negligible, adjuvant paraaortic radiotherapy remains safe and well-tolerated treatment regime. Bilateral synchronous stage I seminoma of the testes is rare. Organ preservation remains investigational. Chemotherapy is probably a reasonable option. We propose that patients with bilateral stage I synchronous GCT, with concordant seminoma histology, should be managed with bilateral orchiectomy, followed by paraaortic radiotherapy.
Endocarditis-Induced Mycotic Brain Aneurysm following Right MCA Stroke
Authors: Brandon Allen, Bobby Desai, Michael Falgiani
Journal: Case Rep Emerg Med (2012)
MeSH terms: Case Reports

The diagnosis of cerebrovascular accident is extremely common in emergency medicine; however, CVA resulting from hemorrhage following mycotic brain aneurysm following embolic stroke is extremely uncommon. This case reports such an event.
Diagnosis and Management of a Prolapsing Intravesical Ureterocele in a Man
Authors: Samir Derisavifard, Piruz Motamedinia, Zeph Okeke, Arthur Smith
Journal: J Endourol Case Rep (2015)
MeSH terms: Case Reports

Given the low incidence and delayed diagnosis, ureterocele management in the adult population is poorly described in the literature. Moreover, there is only one case report characterizing the condition with prolapse in an adult male. Approaches to therapy include transurethral incision or puncture with or without a combined percutaneous approach, and excision with or without partial nephrectomy for a duplicated system with a nonfunctioning upper pole moiety. We present a case of prolapsed, single intravesical ureterocele in a man presenting with hematuria and lower urinary-tract symptoms. A 54-year-old man with no significant medical history presents with increasing nocturia and urinary hesitancy. The development of gross hematuria prompted urologic evaluation. On imaging, the patient was found to have 4.3 × 3.3 cm bladder mass consistent with a prolapsed ureterocele that was managed by transurethral excision with a cutting loop. Postoperatively, the patient's symptoms resolved completely without complication. We suggest that complete transurethral ureterocele excision is an effective, definitive treatment option.
Prepatellar Bursitis with Abscess due to Corynebacterium ulcerans
Authors: Sachin M Patil, Phillip Paul Beck, Taylor B Nelson, Andres Bran Acevedo, William Roland
Journal: Case Rep Orthop (2021)
MeSH terms: Case Reports

Corynebacteria are ubiquitous and reside as skin and mucosa commensals in animals. They are considered contaminants in clinical specimens, but significant clinical data points to their virulence and pathogenic potential over the last two decades. Corynebacteria can cause both community-acquired and nosocomial infections. Corynebacterium diphtheriae (C. diphtheriae) responsible for diphtheria has declined over the previous two decades with an increase in a similar clinical syndrome by Corynebacterium ulcerans (C. ulcerans) in Europe. As per recent studies, C. ulcerans shares similar virulence factors with C. diphtheriae. C. ulcerans has been implicated in airway infections, skin and soft tissue infections, lymphadenitis, wound infections, and rarely necrotizing fasciitis. Pet or farm animals have been the source of these infections to humans, as per recent reports. Strains can be either toxigenic or nontoxigenic. Due to recent advances, methods to characterize strains have become easier with mass spectrometry. Antimicrobial susceptibility testing is a must for definite treatment as C. ulcerans can be resistant to first-line antibiotic therapy. If resources are available, it is prudent to find if there is any toxin production. Here, we describe a rural farmer in central Missouri presenting with acute-onset right knee pain diagnosed with right prepatellar bursitis with abscess due to C. ulcerans infection. He recovered with surgical debridement and antimicrobial therapy. This is the first case of C. ulcerans causing prepatellar bursitis with an abscess as per medical literature review.
Recurrent Catatonia due to Episodic Obsessive-Compulsive Disorder
Authors: Soumitra Das, Sakshi Prasad, Palak Atul Fichadia, Abhigan Babu Shrestha, Ozge C Amuk Williams, Anil Bachu
Journal: Case Rep Psychiatry (2022)
MeSH terms: Case Reports

Background:
Catatonia is regarded as a diverse type of motor dysregulation syndrome that includes mutism, immobility, catalepsy, negativism, stereotypies, and echo phenomena. Catatonia is known to coexist with a wide range of physical and mental health conditions, including mood disorders, schizophrenia, autoimmune disorders, and metabolic abnormalities. Albeit, the association between obsessive-compulsive disorder (OCD) and catatonia is underreported, and mechanisms are not well elucidated. Study. In this study, we present a case of a 36-year-old woman who developed episodes of catatonia during the course of her obsessive-compulsive disorder (OCD). Success rates have been recorded with both benzodiazepines and electroconvulsive therapy (ECT). Gauging the severity of her symptoms and poor drug compliance, the patient was opted for and successfully treated with ECT. She was also educated about OCD through a series of therapy sessions and exposure and response prevention (ERP) principles. She was maintained on ERP and adjunctive clonazepam upon discharge. On subsequent follow-ups, the patient seemed to be doing well and was eager to begin her job again.
Conclusion:
Our study shows a possible link between OCD and catatonia. Additionally, robust studies are needed in order to determine the pathophysiology of catatonia and the mechanism of ECT so that more beneficial therapeutics can be developed. A combination of ECT and antidepressants with ERP therapy for recurrent catatonia with OCD could be effective as a therapeutic modality.
Drug-Induced Liver Injury Associated with the Use of Everolimus in a Liver Transplant Patient
Authors: Serena Patel, Michel H Mendler, Mark A Valasek, Shirley M Tsunoda
Journal: Case Rep Transplant (2018)
MeSH terms: Case Reports

Drug-induced liver injury (DILI) has not been previously reported as a complication of treatment with everolimus. A 56-year-old Caucasian male liver transplant recipient developed DILI after receiving everolimus. Elevations in transaminase levels occurred within a week of starting everolimus and an upward trend in the transaminase levels continued with supporting histopathologic changes confirmed by liver biopsy. Within one week of drug discontinuation, his liver enzymes normalized to baseline. This report includes a brief review of the pharmacokinetic properties of everolimus, a review of the relevant literature, and an analysis using the RUCAM and Naranjo algorithms.
Case Report: Giant paratesticular liposarcoma was resected and refused radical orchiectomy
Authors: Qianming Zou, Shu Gan, Yuan Li, Qinzhan Huang, Shusheng Wang, Siyi Li, Chiming Gu
Journal: Front Oncol (2023)
Keywords: early diagnosis, paratesticular liposarcoma, pathology, radical orchiectomy, scrotal mass
MeSH terms: Case Reports

Paratesticular liposarcoma (PLS) causes scrotal mass changes, rarely in the urinary system. Before surgery, PLS causes scrotal mass changes that are difficult to distinguish from other causes. There has been a report of a giant paratestis liposarcoma resection and refusal to undergo orchiectomy. A 65-year-old man presented with finding the left scrotal mass after 2 years. Physical examination showed that the left scrotal mass was obviously difficult to retract. Pelvic CT showed that the left scrotal mass and flaky fat density shadow accompanied with left inguinal hernia. During surgery, laparoscopic exploration was performed to rule out inguinal hernia, and a scrotal exploration was also performed concurrently. The intraoperative frozen pathology considered lipogenic tumor, and the patient's wife refused to undergo simultaneous left radical orchiectomy. Later the mass was completely removed, and postoperative pathology confirmed paratestis liposarcoma. During a 15-month routine follow-up, the tumor did not recur locally or metastasize distantly. PLS should be focused on early diagnosis and treatment, preoperative examinations and postoperative pathology should be combined, and highly personalized treatment will be implemented.
Adult-Onset Acute Disseminated Encephalomyelitis with Epstein-Barr Virus Infection
Authors: Emika Murasawa, Masazumi Matsuda, Koichi Ishiyama, Tetsugaku Shinozaki, Toshiki Murata, Manabu Hashimoto
Journal: Case Rep Radiol (2022)
MeSH terms: Case Reports

We present the case of a 22-year-old man who was diagnosed with tonsillitis and treated with antibiotics. Although the symptoms subsided, 1 week later, he presented with weakness in the lower limbs and was hospitalized. The weakness in the lower limbs worsened; he developed difficulty speaking and was transferred to our hospital. Laboratory tests showed a white blood cell count of 10,600/μL (24% atypical lymphocytes). Positive results were obtained for immunoglobulin M (IgM) antibody against Epstein-Barr virus (EBV) viral capsid antigen. EBV-deoxyribonucleic acid quantification in blood yielded positive results. Magnetic resonance imaging (MRI) revealed a hyperintensity in the spinal cord at the Th11 level of the lower spine on T2-weighted imaging (T2WI). In addition, T2WI and fluid-attenuated inversion recovery imaging showed hyperintense lesions on the right cerebral peduncle, bilateral thalami, posterior leg of the left internal capsule, and right corona radiata. We diagnosed acute disseminated encephalomyelitis (ADEM) with EBV and initiated steroid pulse therapy. Symptoms, along with the lesions seen on MRI, subsequently ameliorated. This case suggests that ADEM can be difficult to diagnose, but careful diagnosis is crucial since appropriate treatment is necessary to improve the symptoms.
Case of Stroke from Cerebral Vasculitis following Carfilzomib, Lenalidomide, and Dexamethasone Therapy in a Patient with Relapsing Multiple Myeloma
Authors: Deborah Osafehinti, Kaveh Zivari
Journal: Case Rep Hematol (2019)
MeSH terms: Case Reports

Lenalidomide, a synthetic derivation of thalidomide, in recent years, has been the backbone of multiple myeloma treatment leading to improved survival. Common adverse effects from lenalidomide-based regimens include hypertension, heart disease, and venous thromboembolism. Hence, thromboprophylaxis is recommended to reduce the risk of stroke. We report a case of stroke from cerebral vasculitis in a patient receiving carfilzomib, lenalidomide, and dexamethasone for relapsing multiple myeloma, not previously published. Medical oncologists should be aware of other causes of stroke among multiple myeloma patients receiving a lenalidomide-based regimen to prevent its occurrence.
Dysplastic L5-S1 Spondyloptosis in a 3-Year-Old Child: A Case Report and Review of the Literature
Authors: Vikas Tandon, Rahul Kaul, Harvinder Singh Chhabra, Ankur Nanda
Journal: Case Rep Orthop (2017)
MeSH terms: Case Reports

A three-year-old girl presented with primary complaint of severe low back pain with radiation to both lower limbs below the knees since 2 months following history of fall and marked restriction of her daily routine activities. After clinicoradiological evaluation she was diagnosed of having dysplastic L5-S1 spondyloptosis. A staged procedure was planned after thorough discussion with her parents. During initial stage she underwent posterior decompression along L5-S1 segment including exposure of bilateral L5 and S1 nerve roots followed by instrumented reduction (L3-S2 5.5 mm pedicle screws) utilizing a rotational-translational technique. No interbody fusion was done at L5-S1 level and inner nuts of bilateral L3, L4, and S2 screws were intentionally kept loose. Subsequently after about symptom-free three-year follow up, she presented with recurrence of symptoms and underwent revision surgery as per initial plan discussed with her parents. Removals of posterior implants were done followed by stabilization with larger diameter pedicle screws (6.5 mm) at L5 and S1 level. During the same stage through anterior transperitoneal approach L5-S1 interbody fusion was done. At one-year follow-up after second-stage definitive surgery, patient remains symptom-free and fully active without any radiological evidence of reduction loss or implant failure.
Clear lens extraction and intraocular lens implantation in a case of microspherophakia with secondary angle closure glaucoma
Authors: Harsha Bhattacharjee, Kasturi Bhattacharjee, Jnanankar Medhi, Sushobhan DasGupta
Journal: Indian J Ophthalmol (2010)
MeSH terms: Glaucoma, Angle-Closure / etiology, Lens Diseases / surgery, Lens Implantation, Intraocular / methods, Lens, Crystalline / abnormalities, Phacoemulsification / methods, Case Reports, Capsulorhexis / methods, Diagnosis, Differential, Follow-Up Studies, Glaucoma, Angle-Closure / diagnosis, Glaucoma, Angle-Closure / surgery, Gonioscopy, Humans, Intraocular Pressure, Lens Diseases / congenital, Lens Diseases / diagnosis, Lens, Crystalline / surgery, Male, Visual Acuity, Young Adult

Phacoemulsification with implantation of single-piece acrylic foldable intraocular lens (IOL) in a 19-year-old boy with microspherophakia, high myopia and angle closure glaucoma is described. The associated myopia and angle closure glaucoma was severely compromising the quality of life. Post-surgical visual recovery was 20/20 with sustained normal intraocular pressure. Management of such cases at times calls for innovations in current surgical technique.
Fetal heart rate patterns in monochorionic twins following acute twin-twin transfusion
Authors: Shunji Suzuki, Nao Iwasaki, Shuichi Ono, Miwa Igarashi, Tomoaki Murata
Journal: Obstet Gynecol Int (2009)
MeSH terms: Case Reports

Background. We present here 2 cases of acute twin-twin transfusion occurred during vaginal labor in monochorionic-diamniotic twin pregnancies. Case. Fetal heart rate tracings showed tachycardia in the donor twin in the first case, while they showed reassuring patterns in both twins in the second case. Conclusion. These differences in changes of fetal heart rate in the donor twins following acute twin-twin transfusion may be resulted from the differences in amount of transfusion and elapsed time.
Management of Pacemaker Implantation during COVID-19 Infection
Authors: Luigi Rivetti, Roberto Mantovan, Nadir Sitta, Ricarda Marinigh, Giuseppe Allocca, Moemen Mohammed, Fausto Pizzino, Giuseppe Nucifora
Journal: Case Rep Cardiol (2020)
MeSH terms: Case Reports

The management of device implantation during the COVID-19 infection has not well defined yet. This is the first case of complete atrioventricular block in a symptomatic patient affected by the COVID-19 infection treated with early pacemaker implantation to minimize the risk of virus contagion.
Myometrial cystic formation after local methotrexate application into cornual gestational sac: a case report of an unexpected complication
Authors: Zehra Sema Ozkan, Banu Kumbak, Ekrem Sapmaz, Mehmet Simsek
Journal: Case Rep Obstet Gynecol (2011)
MeSH terms: Case Reports

Cornual pregnancy is a rare type of ectopic pregnancy, and diverse therapeutic options exist for the management. Medical treatment despite high initial beta HCG values is not thought to be safe. We reported a 39-year-old woman with an initial beta HCG value of 22000 mIU/mL and diagnosed of a cornual pregnancy. Patient was managed successfully with the administration of combined systemic and ultrasonographically guided local injection of methotrexate into the gestational sac. During followup with serial beta hcg measurements, 27 × 20 mm cystic area in myometrium has been detected. Beta hcg <1 mIU/mL value was reached three months later, and this cystic area resolved spontaneously. Systemic methotrexate administration combined with ultrasound-guided local methotrexate injection into the gestational sac might be considered as the first-line treatment in the management of hemodynamically stable patients having cornual pregnancy even with high beta HCG values and risk of myometrial cystic formation.
Utilizing Heart Rate Variability for Coaching Athletes During and After Viral Infection: A Case Report in an Elite Endurance Athlete
Authors: Laura Hottenrott, Thomas Gronwald, Kuno Hottenrott, Thimo Wiewelhove, Alexander Ferrauti
Journal: Front Sports Act Living (2021)
Keywords: athlete monitoring, cardiac autonomic control, endurance sport, heart rate variability, marathon, orthostatic test, return to sport, viral infection
MeSH terms: Case Reports

Background: Viral diseases have different individual progressions and can lead to considerable risks/long-term consequences. Therefore, it is not suitable to give general recommendations on a time off from training for athletes. This case report aims to investigate the relevance of detecting heart rate (HR) and HR variability (HRV) during an orthostatic test (OT) to monitor the progression and recovery process during and after a viral disease in an elite endurance athlete. Methods: A 30-year-old elite marathon runner contracted a viral infection (upper respiratory tract infection) 4 weeks after a marathon race. RR intervals in HR time series in supine and standing positions were monitored daily in the morning. Analyzed parameters included HR, the time-domain HRV parameter root mean square of successive difference (RMSSD), peak HR (HRpeak) in a standing position, and the time to HR peak (tHRpeak). Results: During the 6-day viral infection period, HR increased significantly by an average of 11 bpm in the supine position and by 22 bpm in the standing position. In addition, the RMSSD decreased from 20.8 to 4.2 ms, the HRpeak decreased by 13 bpm, and the tHRpeak increased by 18 s in the standing position significantly. There were no significant changes in the pre-viral infection RMSSD values in the supine position. The viral infection led to a significant change in HR and HRV parameters. The cardiac autonomic system reacted more sensitively in the standing position compared to the supine position after a viral infection in the present case study. Conclusion: These data have provided supportive rationale as to why the OT with a change from supine to standing body position and the detection of different indicators based on HR and a vagal driven time-domain HRV parameter (RMSSD) is likely to be useful to detect viral diseases early on when implemented in daily routine. Given the case study nature of the findings, future research has to be conducted to investigate whether the use of the OT might be able to offer an innovative, non-invasive, and time-efficient possibility to detect and evaluate the health status of (elite endurance) athletes.