OpenMed/multicare-articles huggingface dataset:
A case of a warfarinized renal cancer patient monitored for prothrombin time-international normalized ratio during methadone introduction
Authors: Kaoru Yoshioka, Katsuya Ohmori, Soshi Iwasaki, Kazunobu Takahashi, Akemi Sato, Hiromasa Nakata, Atsushi Miyamoto, Michiaki Yamakage
Journal: JA Clin Rep (2017)
Keywords: cyp2b6, cyp2c9, cyp2d6, cyp3a4, drug interaction, methadone, prothrombin time-international normalized ratio, warfarin

Background:
Warfarin, a widely used anticoagulant, interacts with various agents used in palliative care, such as oxycodone, morphine, acetaminophen, and non-steroidal anti-inflammatory drugs (NSAIDs); however, there are no reports of its interaction with methadone. We report a case of a patient receiving warfarin when methadone was introduced for pain control with monitoring of the prothrombin time-international normalized ratio (PT-INR) and deduced the pharmacological background.
Case presentation:
A 60-year-old male was emergently admitted to our university hospital for the sudden onset of severe back pain. Abdominal CT imaging revealed that the vertebral body of the ninth thoracic vertebra was occupied by bone metastasis and crushed, which caused his back pain. He received warfarin 3.5 mg/day for atrial fibrillation and tapentadol 100 mg p.o. daily for pain relief. The prothrombin time-international normalized ratio (PT-INR) was maintained at >2.2. The patient's history included diabetes mellitus and hypertension, but his laboratory test was unremarkable with the exception that his eGFR was 34 ml/min.Initially, a fentanyl dermal patch was used instead of tapentadol to avoid interactions with warfarin. We started concomitant administration of oxycodone and 2.4 g/day of acetaminophen while monitoring the PT-INR because acetaminophen increased the PT-INR to 2.93. A continuous intravenous infusion of oxycodone was introduced, in increments of the dose, resulting in an increase of the PT-INR to 3.41, which is required to reduce the dose of warfarin to 1.5 mg. Because of the lack of effective pain relief, methadone was introduced and the dose was gradually increased. The PT-INR was not changed and the dose of warfarin was not changed. An infusion of oxycodone and oral methadone was used to allow the patient to walk in his room, and he was later transferred to the palliative hospital.
Conclusions:
In an oral warfarinized patient, methadone seemed to undergo different metabolism than oxycodone. When warfarin and methadone are used together, we have to consider their interaction by comparing the competitive inhibition of CYP2C9 to the induction of CYP3A4 by methadone, because CYP3A4 metabolize various drugs including oxycodone.
Area Postrema Syndrome: A Rare Feature of Chronic Lymphocytic Inflammation With Pontine Perivascular Enhancement Responsive to Steroids
Authors: Weihe Zhang, Lei Cui, Mingrui Dong, Zhaohui Tian, Yujuan Jiao, Jinsong Jiao
Journal: Front Neurol (2020)
Keywords: clippers, mri, area postrema, misdiagnosis, neuroinflammation, neuromyelitis optica spectrum disorders
MeSH terms: Case Reports

Background: The area postrema syndrome (APS) is a unique diagnostic criterion for neuromyelitis optica spectrum disorders (NMOSD). However, APS has rarely been reported in cases of chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS). Case presentation: A 36-year-old woman presented with APS and clinical features of diffuse central nervous system involvement during the early stage of the disease. Owing to the absence of serum aquaporin 4 antibodies, she was initially misdiagnosed as a case of seronegative NMOSD. However, the distinct neuroimaging characteristics [symmetrical small punctuate gadolinium enhancing lesions (pepper-like)], typical clinical/radiological relapse, and intense steroid-dependence in this case, prompted us to correct the diagnosis as probable CLIPPERS. To prevent relapse, long-term oral steroids and an immunosuppressive agent were administered. Conclusions: CLIPPERS may present as APS, and should be considered in the differential diagnosis of NMOSD.
Coblator-Assisted Endoscopic Transnasal Resection of a Large Nasopharyngeal Pleomorphic Adenoma
Authors: Jonathan Bowman, Anu Daudia, Neil Sahasrabudhe, Antonio Belloso
Journal: Case Rep Otolaryngol (2019)
MeSH terms: Case Reports

Background:
Pleomorphic adenomas occurring in the adult nasopharynx are rare, with our literature search identifying only 11 previous English-language reports. We document the unusual case of a large nasopharyngeal pleomorphic adenoma that was resected using radiofrequency coblation via an endoscopic transnasal approach.
Methods:
A 39-year-old male presented with worsening nasal congestion, intermittent otalgia, and a progressive change in voice. Flexible nasendoscopy showed a large homogeneous mass occupying the postnasal space, and computed tomography confirmed a 28 × 31 × 22 mm nasopharyngeal tumour. The biopsy-proven benign tumour was locally dissected using a coblator-assisted transnasal approach.
Results:
Histology confirmed complete excision of a myoepithelial-rich pleomorphic adenoma. The patient was symptom-free postoperatively, and no signs of recurrence were seen at one-year follow-up.
Conclusions:
This is a useful addition to the existing literature on surgical procedures used to treat benign pathology in the nasopharynx. The minimally invasive technique was well tolerated and had favourable patient outcomes.
Cognitive orientation to daily occupational performance (CO-OP) approach as telehealth for a child with developmental coordination disorder: a case report
Authors: Hiroyasu Shiozu, Shigeki Kurasawa
Journal: Front Rehabil Sci (2023)
Keywords: co-op approach, coaching, developmental coordination disorder, occupational therapy, telehealth
MeSH terms: Case Reports

Aim:
This study aimed to propose a possible interventional form of occupational therapy through a case study report of the applied Cognitive Orientation to daily Occupational Performance (CO-OP) approach as telehealth for a child with developmental coordination disorder (DCD).
Methods:
The intervention method was CO-OP-based tele-occupational therapy for a boy with DCD and his mother; 10 sessions were conducted using a video-conferencing system. This study used the Canadian Occupational Performance Measure (COPM) and the Performance Quality Rating Scale (PQRS) as assessment tools. The PQRS evaluated each occupational performance based on videos recorded during the online sessions and videos taken by the mother of the child.
Results:
The CO-OP approach improved COPM performance and satisfaction as well as PQRS scores in the following five goals: (1) handwriting, (2) column addition, (3) jumping rope, (4) playing on the bar, and (5) riding a bicycle.
Conclusions:
An online approach based on the CO-OP was realistic and effective, to some extent. Continuing to develop telehealth interventions in the future is recommended.
Late-Onset Neutropenia after Rituximab Treatment for Adult-Onset Nephrotic Syndrome
Authors: Mayuko Yamazaki, Hidekazu Sugiura, Yosuke Iwatani, Mizuki Kyoda, Hirohiko Nokiba, Nobuyuki Amemiya, Kosaku Nitta, Ken Tsuchiya
Journal: Case Rep Nephrol (2019)
MeSH terms: Case Reports

A 41-year-old woman developed nephrotic syndrome at the age of 32 and was diagnosed with minimal change nephrotic syndrome based on a renal biopsy. Although remission was achieved with administration of prednisolone (PSL) and cyclosporine, the nephrotic syndrome recurred. She was also started on rituximab (RTX). She developed late-onset neutropenia after RTX treatment (R-LON) and improved 17 days later. Although the majority of R-LON cases undergo spontaneous remission, cases of death have been reported. This report is intended to warn about R-LON, since the use of RTX for adult-onset nephrotic syndrome is expected to increase in the future.
Stiff Person Syndrome: A Rare Neurological Disorder, Heterogeneous in Clinical Presentation and Not Easy to Treat
Authors: Susanne Buechner, Igor Florio, Loredana Capone
Journal: Case Rep Neurol Med (2015)

Background. Stiff person syndrome (SPS) is a rare neurological disorder characterized by progressive rigidity of axial and limb muscles associated with painful spasms. SPS can be classified into classic SPS, paraneoplastic SPS, and SPS variants. Its underlying pathogenesis is probably autoimmune, as in most cases antibodies against glutamic acid decarboxylase (GAD) are observed. Similarly, paraneoplastic SPS is usually linked to anti-amphiphysin antibodies. Treatment is based on drugs enhancing gamma-aminobutyric acid (GABA) transmission and immunomodulatory agents. Case Series. Patient 1 is a 45-year-old male affected by the classic SPS, Patient 2 is a 73-year-old male affected by paraneoplastic SPS, and Patient 3 is a 68-year-old male affected by the stiff limb syndrome, a SPS variant where symptoms are confined to the limbs. Symptoms, diagnostic findings, and clinical course were extremely variable in the three patients, and treatment was often unsatisfactory and not well tolerated, thus reducing patient compliance. Clinical manifestations also included some unusual features such as recurrent vomiting and progressive dysarthria. Conclusions. SPS is a rare disorder that causes significant disability. Because of its extensive clinical variability, a multitask and personalized treatment is indicated. A clearer understanding of uncommon clinical features and better-tolerated therapeutic strategies are still needed.
Otitis Media Caused by V. cholerae O100: A Case Report and Review of the Literature
Authors: Peter Kechker, Yigal Senderovich, Shifra Ken-Dror, Sivan Laviad-Shitrit, Eiji Arakawa, Malka Halpern
Journal: Front Microbiol (2017)
Keywords: vibrio cholerae, antibiogram, case report, ear, otitis media, serogroup identification, virulence genes

Infections due to Vibrio cholerae are rarely documented in Israel. Here we report a case of recurrent otitis media in a young male, caused by V. cholerae non-O1/O139. This extra-intestinal infection was caused by V. cholerae O100 and has been associated with freshwater exposure and travel. Symptoms of chronic periodic earaches along with purulent exudate began about one week after the patient suffered a water skiing accident on a river in Australia. The condition lasted for three years, until his ear exudate was examined in a clinical laboratory, diagnosed and treated. Five bacterial isolates were identified as V. cholerae O100. The isolates were screened for genetic characteristics and were found positive for the presence of hapA, hlyA, and ompU virulence genes. All isolates were negative for the presence of ctxA. Based on antibiogram susceptibility testing, ciprofloxacin ear drops were used until the patient's symptoms disappeared. This case demonstrates that exposure to freshwater can cause otitis media by V. cholerae non-O1/O139 in young and otherwise healthy humans.
Incidental Abdominal Aortic Aneurysm in the Psoriasis Patient: A Case Report and Review of Literature
Authors: Neda Akhoundi, Taraneh Faghihi Langroud, Kiarash Shafizadeh, Mohamad Javad Jabbarzadeh, Sepehr Talebi
Journal: Galen Med J (2018)
Keywords: aortic aneurysm, cardiovascular, psoriasis
MeSH terms: Case Reports

Background:
Psoriasis is defined as a chronic inflammatory disease involving keratinocytes hyperproliferation of the epidermis with the acceleration in the epidermal turnover time, which is affected by various factors including genetic, immunologic, and environmental factors. There is a high risk for the development of premature cardiovascular diseases among patients with psoriasis as well as one of the life-threatening events is an aortic aneurysm (AA).
Case report:
We report a 60-year-old man with the diagnosed psoriatic disease that an enlargement of the abdominal AA was incidentally found by annual check-up.
Conclusion:
Further large-scale studies are needed to find the prevalence of abdominal AA in psoriasis and the appropriate screening time of that in this disease.
A Case of Lionfish Envenomation Presenting to an Inland Emergency Department
Authors: Rachel F Schult, Nicole M Acquisto, Crystal K Stair, Timothy J Wiegand
Journal: Case Rep Emerg Med (2017)
MeSH terms: Case Reports

Lionfish envenomation can cause erythema, edema, necrosis, and severe pain at the exposed site. Treatment often includes supportive wound care, pain management, and hot water immersion. We report a case of lionfish exposure presenting to an inland emergency department treated successfully with these measures.
Priapism secondary to tamsulosin: A case report
Authors: Johannes Cansius Prihadi, Christopher Kusumajaya
Journal: Int J Surg Case Rep (2020)
Keywords: complication, corpora cavernosa, detumescence, erection, priapism, tamsulosin-induced-priapism
MeSH terms: Case Reports

Background:
Tamsulosin is the most potent adrenergic alpha-1 antagonist used for treatment of benign prostatic hyperplasia (BPH). Priapism has been reported as a rare side effect through direct inhibition of the sympathetic input necessary for detumesence.
Presentation of case:
We describe an otherwise healthy man with recurrent and then persistent unresolved priapism after the use of tamsulosin and concomitant use of ace inhibitor and beta blocker for hypertension. We then performed aspiration and intracavernosal irrigation of saline and vasoconstrictive agent.
Discussion:
Health-care professionals should inform all patients taking such medications about this rare but possible serious adverse effect. Tamsulosin is a useful medication for the management of Lower Urinary Tract Symptoms (LUTS) related to BPH and medical expulsion of distal ureteric calculi. However, its use may be associated on rare occasions with priapism, hence Health-care professionals should be aware in order to advice all patients taking such medications about this rare but serious adverse effect and to seek help as soon as possible.
Conclusion:
With caution against the use of tamsulosin in hypertension treated patient, the possibility of the adverse effect can be more noticed and encourage practitioners to look for other alternatives that are safer and better for dealing with LUTS in the future and develop better treatment strategies.
Brain Atrophy and Hypomyelination Associated with Iatrogenic Cushing Syndrome in an Infant
Authors: Sumeyra Dogan, Mehmet S Dogan, Filiz Tutunculer, Ozge Yapiciugurlar, Hakan Genchellac
Journal: Iran J Child Neurol (2018)
Keywords: brain atrophy, diaper dermatitis, iatrogenic cushing’s syndrome, magnetic resonance imaging, myelination
MeSH terms: Case Reports

Prolonged use of topical corticosteroids, particularly in infants, albeit rare, may lead to Cushing syndrome. Central nervous system abnormalities including brain atrophy and delayed myelination on cranial magnetic resonance imaging has been reported in patients with corticosteroid treatment. We herein report a 5-month-old female infant referred to Department of Pediatric Endocrinology, Edirne, Turkey with brain atrophy and myelination delay that might be due to iatrogenic Cushing syndrome caused by topical corticosteroid use.
Henoch-Schönlein Purpura /IgA Vasculitis Complicated by Coronary Artery Aneurysm: A Case Report and Literature Review
Authors: Zhijuan Kang, Wentao Wu, Mai Xun, Yunfeng Ding, Zhihui Li
Journal: Front Pediatr (2022)
Keywords: henoch-schönlein purpura, iga vasculitis, cardiac involvement, children, coronary artery dilation, renal involvement
MeSH terms: Case Reports

Henoch-Schönlein purpura (HSP)/ IgA vasculitis (IgAV) is the most common form of systemic vasculitis in children and often involves the skin, gastrointestinal tract, joints, and kidneys, though cardiac involvement rarely occurs. We report on a 6-year-old male child with HSP/IgAV who had renal and cardiac involvement at the initial stage of the disease and in whom we found an extremely rare coronary artery aneurysm. After administration of glucocorticoid combined with mycophenolate mofetil, the renal involvement improved, but the coronary artery aneurysm remained. Pursuant to this case, we retrieved information on other cases of HSP/IgAV complicated with cardiac involvement from the PubMed database, and excluded cases of cardiac involvement accompanied by Kawasaki disease, polyarteritis nodosa, rheumatic fever, Takayasu arteritis, systemic lupus erythematosus, poststreptococcal glomerulonephritis, or sepsis. We then analyzed gender, age, cardiac involvement, renal involvement, treatment, and prognoses. To date, 24 cases of HSP/IgAV complicated with cardiac involvement have been reported. Among them, there were 22 male and 2 female patients, with the onset age ranging from 3 to 71 years old. A total of 10 children (including the child we examined) and 14 adults were identified, and 17 patients (70.8%) had HSP/IgAV complicated with renal involvement. The majority of patients were treated with glucocorticoid and/or immunosuppressants or biological agents, 4 patients died (16.7%), 8 patients were completely relieved (33.3%), and 3 patients had unknown prognoses. This article suggests that HSP/IgAV complicated with cardiac involvement may result in a poor prognosis and early treatment may therefore be essential. Our case revealed that glucocorticoid does not prevent the occurrence of renal and cardiac involvement in HSP/IgAV patients. If HSP/IgAV is complicated with coronary artery dilation, the therapeutic effect of glucocorticoid combined with immunosuppressants is not satisfactory, and early administration of biological agents or IVIG may be an effective therapeutic regimen.
Onyx Embolization of Ruptured Intracranial Aneurysm Associated with Behçet's Disease
Authors: Maher Kurdi, Saleh Baeesa, Mohammed Bin-Mahfoodh, Khalil Kurdi
Journal: Case Rep Vasc Med (2013)

Introduction. Intracranial aneurysms associated with Behçet's disease (BD) are a rare occurrence. They are fragile, thin-walled pseudoaneurysms, which have high tendency to rupture and present a therapeutic challenge. Case Presentation. We report a 26-year-old male with BD presented with subarachnoid hemorrhage due to ruptured middle cerebral artery aneurysm. Additionally, two unruptured aneurysms were identified. He underwent endovascular embolization using Onyx with successful obliteration of the ruptured aneurysm. Medical therapy resulted in regression of one and resolution of the other aneurysms. Conclusion. We describe the first report of the application of Onyx for obliteration of ruptured cerebral aneurysm in BD as a feasible and safe therapeutic option for patients who are not candidates for other techniques.
Double-Hit Primary Plasma Cell Leukemia with IGH/MYC and IGH/CCND1 Translocations
Authors: Masato Yasumi, Takaya Endo, Hiroshi Sata, Takahiro Karasuno
Journal: Case Rep Hematol (2020)
MeSH terms: Case Reports

Primary plasma cell leukemia (pPCL) is an aggressive variant of multiple myeloma (MM). Immunoglobulin heavy chain (IgH) translocations are found in a majority of pPCL cases, supporting a central relation to pathogenesis of pPCL. However, two independent IgH translocations are barely detected at the onset of pPCL, and their significance is yet to be elucidated. Here, we report a case of an aggressive pPCL with simultaneous IGH/MYC and IGH/CCND1 translocations. A 73-year-old man was referred to our hospital with back pain and diagnosed as having pPCL with more than 50% circulating plasma cells. Cytogenetic analysis revealed 47, Y, t (X; 8;14) (q24; q24; q32), t (11; 14) (q13; q32), and +18. IGH/MYC and IGH/CCND1 translocations were confirmed by fluorescence in situ hybridization analysis. Bortezomib and dexamethasone treatment achieved rapid elimination of peripheral malignant plasma cells, and the patient maintained a partial response for 18 months. After biological relapse, he received salvage therapy with ixazomib, lenalidomide, and dexamethasone, followed by pomalidomide and dexamethasone, and exhibited stable disease for an additional 14 months. Although IGH/MYC translocation in association with dysregulation of antiapoptotic pathway leads to worse prognosis in lymphomas, the novel agent-based regimen showed good efficacy, suggesting that IGH/MYC plays a different role in the pathogenesis of MM. IGH/CCND1 and IGH/MYC translocations may have contributed to abrupt onset of pPCL in this case.
Novel Influenza A (H1N1/09) Virus Infection during Pregnancy in a Kidney Transplant Recipient
Authors: Lars Rothermund, Reinhold Kreutz, Frieder Keller
Journal: Case Rep Nephrol (2011)
MeSH terms: Case Reports

We report the first case of a pregnant renal transplant patient with H1N1/09 infection. The woman showed a mild clinical course after diagnosis of H1N1/09 infection and therapy with oseltamivir (2 × 45 mg per day). After delivery by cesarean section, the neonate exhibited moderate respiratory and circulatory dysregulation, which spontaneously normalised a few days postpartum. In conclusion, rapid diagnosis of H1N1/09 and dose-adapted therapy with oseltamivir resulted in successful delivery of a healthy infant in our renal transplanted patient but emphasized the need for consequent vaccination strategies in pregnant transplant recipients for new influenza A pandemics in the future.
Response to isolated limb perfusion and chemotherapy with epirubicin plus ifosfamide in a metastatic malignant ossifying fibromyxoid tumor
Authors: Salvatore Provenzano, Alessandra Raimondi, Rossella M Bertulli, Vittoria Colia, Salvatore L Renne, Paola Collini, Gianpaolo Dagrada, Dario Callegaro, Marco Fiore, Francesca G Greco, Paolo G Casali
Journal: Clin Sarcoma Res (2017)
Keywords: chemotherapy, epirubicin, ifosfamide, isolated limb perfusion, ossifying fibromyxoid tumor, soft tissue sarcoma
MeSH terms: Case Reports

Background:
Ossifying fibromyxoid tumor (OFMT) is a rare soft tissue neoplasm of uncertain lineage and intermediate biological potential. It is more common in middle-aged men, usually arising from the deep tissues of the extremities. It is now established that it is a translocation related tumor, most often marked by translocation of PHF1 gene. Surgery is the mainstay of treatment and proves usually curative, although, in rarer cases the disease shows malignant features and tendency to recur both locally and at distant sites. In such cases, no standard treatment exists.
Case presentation:
We report on a case of malignant advanced OFMT of the hand with lung metastases responding to isolated limb perfusion with human recombinant tumor necrosis factor and melphalan and chemotherapy with epirubicin and ifosfamide.
Conclusions:
To our knowledge, this is the first report of activity of soft tissue sarcoma-oriented chemotherapy in advanced OFMT.
Metastatic meningioma presenting as a malignant soft tissue tumour
Authors: Catherine McCarthy, Monika Hofer, Marianna Vlychou, Robar Khundkar, Paul Critchley, Simon Cudlip, Olaf Ansorge, Nick A Athanasou
Journal: Clin Sarcoma Res (2016)
Keywords: meningioma anaplastic, metastasis, soft tissue, tumour
MeSH terms: Case Reports

Background:
Extracranial metastasis of malignant meningioma to soft tissues is extremely rare and its clinical, radiological and pathological features are not well-characterised.
Case presentation:
We report a case of a 58 year old man who presented with a mobile mass within the left trapezius muscle. The patient had previously undergone surgery for a right frontal lobe high grade anaplastic meningioma. Histology of the soft tissue lesion showed metastatic anaplastic meningioma with clumps of pleomorphic tumour cells which expressed epithelial membrane antigen, cytokeratin and P63 but were negative for other epithelial and mesenchymal markers. A PET-CT scan revealed additional metastatic lesions in the left pleura, liver and iliac bone.
Conclusions:
Metastatic malignant meningioma can very rarely present as a high grade pleomorphic malignant soft tissue tumour and needs to be distinguished from soft tissue sarcomas and metastatic carcinomas that express epithelial antigens.