OpenMed/multicare-articles huggingface dataset:
A Diagnostic Dilemma of a Case of Granulomatosis With Polyangiitis (GPA) Presenting With Thrombotic Vasculopathy
Authors: Aunchalee Jaroenlapnopparat, Peymaan Banankhah, Joseph Khoory, Chinmay Jani, Shiv Sehra
Journal: Cureus (2023)
Keywords: anca vasculitis, gpa, granulomatosis with polyangiitis, hemoptysis, thrombotic vasculopathy, wegener’s granulomatosis
MeSH terms: Case Reports

Granulomatosis with polyangiitis (GPA) is a rare disease with a prevalence of about three in 100,000 persons in the United States. GPA is an antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis affecting predominantly small-sized vessels. It can present with localized or systemic symptoms with multiple organ involvement, thus making diagnosis challenging. Common skin lesions in GPA are palpable purpura, petechiae, ulcers, and livedo reticularis. These lesions usually have underlying vasculitis with or without granuloma on histology findings. To date, there have been no previous reports about thrombotic vasculopathy in GPA before. We present a case of a 25-year-old female who presented with intermittent joint pain for weeks, purpuric rash, and mild hemoptysis for a few days. A review of systems was notable for a 15-pound weight loss in one year. Physical examination was significant for a purpuric rash on the left elbow and toe, and left knee swelling and erythema. Presenting laboratory results were notable for anemia, indirect hyperbilirubinemia, mildly elevated D-dimers, and microscopic hematuria. Chest radiograph revealed confluent airspace disease. Extensive infectious workup was negative. A skin biopsy of her left toe revealed dermal intravascular thrombi without evidence of vasculitis. The thrombotic vasculopathy did not favor vasculitis but raised concern for a hypercoagulable state. However, extensive hematologic workup was negative. Bronchoscopy findings were consistent with diffuse alveolar hemorrhage. Later, cytoplasmic ANCA (c-ANCA) and anti-proteinase 3 (PR3) antibody titers were positive. Her diagnosis was unclear since both skin biopsy and bronchoscopy were nonspecific and inconsistent with her positive antibody results. The patient eventually underwent a kidney biopsy, which showed pauci-immune necrotizing and crescentic glomerulonephritis. Finally, a diagnosis of granulomatosis with polyangiitis was made based on the kidney biopsy and positive c-ANCA. The patient was treated with steroids and IV rituximab and discharged home with outpatient rheumatology follow-up. Due to multiple signs and symptoms including thrombotic vasculopathy, there was a diagnostic dilemma requiring a multidisciplinary approach. This case highlights the importance of pattern recognition for the diagnostic framework of rare disease entities and the multidisciplinary collaborative efforts required to reach the final diagnosis.
A case of unusually persistent traumatic intrapulmonary hematoma
Authors: Sachi Kawagishi, Yuya Kogita, Itsuko Nakamichi, Takahiro Matsui, Toshiteru Tokunaga
Journal: Respir Med Case Rep (2021)
Keywords: ct, computerized tomography, chest injury, fdg-pet, 18f-fluorodexyglycose positron emission tomography, intrapulmonary hematoma, mri, magnetic resonance imaging, surgical resection
MeSH terms: Case Reports

Intrapulmonary hematomas are collections of blood within alveolar and interstitial spaces. They occur mainly following thoracic trauma. Typically, intrapulmonary hematomas without bleeding or infection spontaneously disappear after several weeks to 6 months. In the current case, the patient presented with an intrapulmonary nodule 17 months after a chest injury. The size of the nodule had not changed at 4 months after the first visit. Consequently, the patient was diagnosed with an intrapulmonary hematoma by surgical resection. To our knowledge, there are no previous studies that described the cause of the persistent intrapulmonary hematoma. This study reports the case of a patient who underwent surgical resection of a persistent traumatic intrapulmonary hematoma.
A Case of Spontaneous Transdiaphragmatic Intercostal Hernia with Contralateral Injury, and Review of the Literature
Authors: Alexander A Chapman, Steven B Duff
Journal: Case Rep Surg (2017)
MeSH terms: Case Reports

This case report discusses the diagnosis and management of a 67-year-old male presenting with a spontaneous transdiaphragmatic intercostal hernia with contralateral intercostal hernia. The patient had a history of chronic obstructive pulmonary disease (COPD) exacerbations requiring multiple prolonged courses of steroids. The patient was ultimately diagnosed with computed tomography (CT) and underwent surgical repair via thoracotomy with primary repair of the diaphragmatic defect. The patient's postoperative course was uncomplicated. A review of the literature since the first similar case in 1977 recognizes the propensity of this injury to be found in patients with COPD and chronic steroid usage, as well as its diagnosis and management. The case reviewed is the second documented case of a concurrent abdominal wall herniation and the first one with a contralateral injury. It is important for clinicians to be aware of this pathology when evaluating patients with COPD and chronic steroid usage.
Bartonella-Associated Endocarditis with Severe Active Crescentic Glomerulonephritis and Acute Renal Failure
Authors: Ramanath Dukkipati, Benjamin Lawson, Cynthia C Nast, Anuja Shah
Journal: Case Rep Nephrol (2021)
MeSH terms: Case Reports

We report a case of severe acute kidney failure due to crescentic glomerulonephritis who presented initially with culture-negative endocarditis with vegetations on the aortic valve. Anti-nuclear and anti-phospholipid antibodies were positive with initially negative anti-neutrophil cytoplasmic antibodies (ANCAs). Kidney biopsy revealed severe acute crescentic glomerulonephritis with mesangial immune complex deposition. PR3-ANCA subsequently become positive, and the patient developed worsening kidney failure requiring hemodialysis. This case illustrates that Bartonella can present as culture-negative endocarditis with severe crescentic glomerulonephritis with positive PR-3 ANCAs and can mimic ANCA-associated crescentic glomerulonephritis.
Case report: Concomitant EGFR mutation and ALK rearrangement in non-small cell lung cancer
Authors: Haoyue Hu, Songtao Tan, Meng Xie, Peng Guo, Qiang Yu, Juan Xiao, Kangrui Zhao, Qiong Liao, Yi Wang
Journal: Front Pharmacol (2023)
Keywords: alk rearrangement, egfr mutation, case report, lung adenocarcinoma, targeted therapy
MeSH terms: Case Reports

In non-small cell lung cancer (NSCLC), two key genetic alterations, epidermal growth factor receptor (EGFR) mutations and anaplastic lymphoma kinase (ALK) rearrangements, are commonly believed to be mutually exclusive. Studies have reported that concurrent EGFR/ALK co-mutation in non-small cell lung cancer patients is rare, with a prevalence ranging from 0.1% to 1.6%. However, the clinical and pathological characteristics of these patients are not well-defined, and the optimal treatment approach for such cases remains controversial. In this report, we present a case of stage IV lung adenocarcinoma with both epidermal growth factor receptor and anaplastic lymphoma kinase mutations, along with high PD-L1 expression. The patient initially received treatment with epidermal growth factor receptor tyrosine kinase inhibitors (TKIs), but the disease progressed. However, following a switch to ALK-TKI therapy and local radiotherapy, the lesion showed regression. Our report also provides a comprehensive summary of the clinical and pathological features, as well as treatment strategies, for non-small cell lung cancer patients with concurrent epidermal growth factor receptor mutation and anaplastic lymphoma kinase rearrangement.
Neural Changes following Behavioral Activation for a Depressed Breast Cancer Patient: A Functional MRI Case Study
Authors: Michael J Gawrysiak, John P Carvalho, Baxter P Rogers, Christopher R N Nicholas, John H Dougherty, Derek R Hopko
Journal: Case Rep Psychiatry (2012)
MeSH terms: Case Reports

Functional neuroimaging is an innovative but at this stage underutilized method to assess the efficacy of psychotherapy for depression. Functional magnetic resonance imaging (fMRI) was used in this case study to examine changes in brain activity in a depressed breast cancer patient receiving an 8-session Behavioral Activation Treatment for Depression (BATD), based on the work of Hopko and Lejuez (2007). A music listening paradigm was used during fMRI brain scans to assess reward responsiveness at pre- and posttreatment. Following treatment, the patient exhibited attenuated depression and changes in blood oxygenation level dependence (BOLD) response in regions of the prefrontal cortex and the subgenual cingulate cortex. These preliminary findings outline a novel means to assess psychotherapy efficacy and suggest that BATD elicits functional brain changes in areas implicated in the pathophysiology of depression. Further research is necessary to explore neurobiological mechanisms of change in BATD, particularly the potential mediating effects of reward responsiveness and associated brain functioning.
Survival from cervical necrotizing fasciitis
Authors: Jeniffer S Gausepohl, Jonathan G Wagner
Journal: West J Emerg Med (2015)
MeSH terms: Fasciitis, Necrotizing / diagnosis, Streptococcal Infections / diagnosis, Streptococcus anginosus / isolation & purification, Case Reports, Humans, Male, Middle Aged

Cervical necrotizing fasciitis (CNF) is an uncommon, yet clinically significant infection that rapidly progresses to involve the deep neck spaces. Early recognition and aggressive surgical intervention and debridement are important, as this disease is associated with a high morbidity and mortality. In this report, we present a case of CNF and descending mediastinitis from a non-odontogenic source in a patient presenting with neck swelling and odynophagia.
Amoxycillin and clavulanic acid induced Stevens-Johnson syndrome: A case report
Authors: Maheen Zaidi, Syeda Kashaf Zaidi, Moomal Bhutto, Mohammad Yasir Umer
Journal: EXCLI J (2017)
Keywords: naranjo adverse drug reaction probability scale, stevens-johnson syndrome, amoxycillin and clavulanic acid, hypersensitivity, lesions
MeSH terms: Case Reports

Stevens-Johnson syndrome (SJS) is an immune mediated hypersensitivity reaction. Significant involvement of oral, nasal, eye, vaginal, urethral, GI and lower respiratory tract mucous membrane may develop. It is usually a reaction due to a medication or due to an infection. In 95 % of case reports, drugs were found to be an important cause for the development of SJS. In this case report, a 32 year old female reported chief complaint of itch skin eruptions all over the body along with erosive lesions on tongue, lips, buccal mucosa and genital mucosa. The reaction occurred after administration of augmentin (containing amoxycillin and clavulanic acid). She was treated with antimicrobials, antiallergics and conservative management. The patient improved and was discharged from the hospital. Causality assessment using Naranjo Adverse Drug Reaction Probability Scale revealed that amoxycillin and clavulanic acid combination was a possible cause for the adverse reaction with a score of 4.
Dermatomyositis with intrahepatic cholangiocarcinoma: a case report and data mining based on machine learning
Authors: Xusheng Zhang, Bendong Chen
Journal: Front Oncol (2023)
Keywords: mt1m, parp12, dermatomyositis, intrahepatic cholangiocarcinoma, paraneoplastic dermatomyositis
MeSH terms: Case Reports

Cancer secondary to dermatomyositis (DM) is defined as paraneoplastic dermatomyositis, which is one of the major subtypes of DM. However, cases of DM with intrahepatic cholangiocarcinoma (ICC) are rarely reported. In the course of our clinical work, we encountered a case of a middle-aged female patient who was diagnosed with DM for 7 years and then diagnosed with ICC, and we would like to share this case. In addition, in order to further investigate the deeper mechanism of ICC associated with DM, we also analyzed the dataset related to DM and ICC in the Gene Expression Omnibus (GEO) database based on the machine learning methods and found that poly(ADP-ribose) polymerase family member 12 (PARP12) and metallothionein 1M (MT1M) were closely associated with ICC secondary to DM. They are potentially important biomarkers for predicting the occurrence of ICC in patients with DM.
Case Report: Large nested variant urothelial carcinoma -invasive malignancy masquerading as low grade disease
Authors: Andrew Keller, Ai Jye Lim, Ahmad Ali
Journal: F1000Res (2014)
Keywords: lnvuc, urothelial carcinoma

Introduction The large nested variant of urothelial carcinoma (LNVUC) is a newly described and rare subtype of urothelial carcinoma. It is characterised by bland cytological features and a large nested architecture similar in appearance to low grade urothelial carcinoma with an inverted growth pattern. To date only 23 cases in a single series have been described. Case Report We describe the case of a 59 year old male with LNVUC whose tumour was initially misdiagnosed as a non-invasive low grade urothelial carcinoma. At a subsequent re-resection, his tumour was correctly re-classified as LNVUC with extensive invasion of the muscularis propria. Radical cystectomy and formation of an ileal conduit was performed. His operative specimen revealed invasion of prostatic stroma and perivesical fat, with all surgical margins clear. He is currently free from clinical recurrence 12 months after his cystectomy. Conclusion LNVUC is a newly described and rare urothelial carcinoma subtype. It characteristically possesses bland cytological features and may mimic low grade urothelial cancer. Despite its bland appearance it behaves aggressively with invasion, metastasis and death being common.
Biological versus Clinical Risk Factors in Acute Myeloid Leukemia: Is There a Winner?
Authors: M Malagola, N Polverelli, V Cancelli, E Morello, A Turra, E Borlenghi, F Cattina, B Rambaldi, S Bernardi, C Zanaglio, Elif Dereli Eke, L Gandolfi, M Farina, D Russo
Journal: Case Rep Hematol (2019)
MeSH terms: Case Reports

We present a case of a patient with a three-month history of peripheral blood cytopenia without a confirmed diagnosis of myelodysplastic syndrome, who developed a favourable-risk acute myeloid leukemia (AML), according to the European Leukemia Net (ELN) criteria. The patient achieved a complete remission with incomplete platelet recovery (CRi) after induction. The patient achieved the morphological CR after the first consolidation and completed the first-line treatment with a syngeneic stem cell transplantation (SCT). A disease relapse occurred after one year of CR (blast cell count in the bone marrow 15%), and the patient was offered a haplo-SCT, which he refused due to personal reasons. In this paper, we discuss the interplay between clinical and biological risk factors in non-high-risk AML patients and speculate that some old clinical risk factors (e.g., age of the patient, achievement of CR after induction, and previous history of myelodysplastic syndrome) may still impact on the treatment decision algorithm of some of these patients.
Myonecrosis in sickle cell anemia-overlooked and underdiagnosed
Authors: Nishant Tageja, Marius Racovan, Jason Valent, Jeffrey Zonder
Journal: Case Rep Med (2010)
MeSH terms: Case Reports

Medical literature detailing muscular complications of sickle cell anemia is sparse and limited to a few case-reports. Features consistent with myositis and myonecrosis are often overlooked and patients are inadequately treated, leading to unforeseen complications. We report an interesting case of sickle cell myonecrosis and review the existing literature on this subject.
Surgical Excision of an Adrenal Neuroblastoma in a Dog
Authors: Lisa Alexandra Mestrinho, Maria Inês Marques, Sandra Jesus, Hugo Pissarra, Maria Peleteiro, Antonio Ferreira
Journal: Front Vet Sci (2019)
Keywords: adrenal gland, dog, embryonal tumor, neuroblastoma, surgery
MeSH terms: Case Reports

A 11-month-old, intact male, Rhodesian Ridgeback was presented to the Veterinary Teaching Hospital with signs of inappetence, lethargy, and abdominal pain for 3 days. A large and well-defined abdominal retroperitoneal mass, related with the left kidney, at the expected location of the adrenal gland, was revealed by radiography, ultrasound, and computed tomography. The mass extended caudally to the iliac artery bifurcation, compressing the aorta, caudal vena cava, and both kidneys. Cytology findings were compatible with a malignant round cell tumor. The most probable diagnosis was neuroblastoma. Following a comprehensive discussion with the owners about a treatment plan, surgical excision was performed. Because a wide excision would compromise major vessels, excision was performed after careful dissection of the aorta and vena cava. The left kidney was removed because the proximal ureter could not be separated from the tumor. The animal recovered successfully. Diagnosis was confirmed by histopathology and immunohistochemistry, but the owners decided not to pursue any further treatment. Clinical signs of abdominal pain recurred within 1 month following surgery. Therefore, the animal was euthanized upon the owners' request. This report describes the diagnosis, surgical treatment, and follow-up of a dog with an abdominal peripheral neuroblastoma.
Rhino-Orbital-Cerebral Mucormycosis: A Rare Complication of Uncontrolled Diabetes
Authors: Rahaf F Alanazi, Abdulrahman Almalki, Ali Alkhaibary, Fahd AlSufiani, Ahmed Aloraidi
Journal: Case Rep Surg (2022)
MeSH terms: Case Reports

Introduction:
Fungal infection of the central nervous system has become more common over the past two decades. It is frequently diagnosed in patients with underlying pathological conditions. We herein report a case of rhino-orbital-cerebral mucormycosis by outlining the clinical presentation, radiological images, histopathological findings, management plan, and its clinical outcome. Case Description. A 47-year-old man, known to have type 2 diabetes mellitus, presented with severe headache involving the left side of the face, numbness along the left V2 trigeminal nerve, ptosis and dryness of the left eye, short-term memory loss, and right hand numbness. He had a social history of being a bee farmer for which he was exposed to bee stings several times in the past. Neuroradiological imaging showed a left temporal ring-enhancing lesion, suggestive of abscess. The patient underwent craniotomy and resection of the lesion. The histopathological evaluation was suggestive of cerebral mucormycosis, fungal sinusitis, and invasive skull base mucormycosis.
Conclusion:
Rhino-orbital-cerebral mucormycosis is a fulminant fungal infection commonly diagnosed in patients with uncontrolled diabetes. Early diagnosis with radiological and histopathological evaluation is required to identify patients at risk of rhino-orbital-cerebral mucormycosis.
A First Human Case of Ocular Dirofilariosis due to Dirofilaria repens in Northeastern France
Authors: Nicolas Argy, Marcela Sabou, Alain Billing, Christian Hermsdorff, Ermanno Candolfi, Ahmed Abou-Bacar
Journal: J Trop Med (2011)
MeSH terms: Case Reports

We report the first case of ocular dirofilariasis to be diagnosed in northeast France (Alsace region), in a man who presented with a suborbital mass after a journey to Senegal. Microscopic examination of the surgical specimen identified Dirofilaria repens.
Vas Deferens Abscess Rupture: A Case Report
Authors: Beom Kyun Pak, Dong Min Kang, Sang Heon Kim
Journal: J Belg Soc Radiol (2022)
Keywords: abscess, lower urinary tract infections, multidetector computed tomography, vas deferens
MeSH terms: Case Reports

A vas deferens abscess is a very rare complication of acute vasitis and lower urinary tract infection. A case of vas deferens rupture due to an abscess with severe pelvic inflammation requiring surgical drainage is reported. Teaching Point: Vas deferens abscess rupture is an example of a very rare complication of severe inflammation of the vas deferens.
Conservative Management of Cesarean Scar Pregnancy: A Case Report and Literature Review
Authors: Manuel Sánchez-Prieto, María Jesús Puy, Núria Barbany, Betlem Graupera, Maria Angela Pascual, Pere Barri-Soldevila
Journal: Case Rep Obstet Gynecol (2022)
MeSH terms: Case Reports

Cesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy located in the lower uterine segment. The current increase in the percentage of cesarean sections is accompanied by significant growth in the incidence of CSP, while advances in ultrasound diagnostic techniques have led to a greater number of CSP diagnoses. A misdiagnosed CSP, or one that is diagnosed too late, is life-threatening to the pregnant patient and predisposes her to complications such as uterine bleeding or rupture, which often require hysterectomy and thus result in the irreversible loss of fertility. We present the case of a 50-year-old woman with a history of undiagnosed CSP after multiple consultations for intermittent bleeding and hemorrhage. She was diagnosed by ultrasound and the diagnosis was confirmed by hysteroscopy. She underwent conservative medical treatment that was successful.
Expectant Management of a Twin Pregnancy with Complete Hydatidiform Mole and Coexistent Normal Fetus
Authors: Colin Johnson, Caroline Davitt, Rachel Harrison, Meredith Cruz
Journal: Case Rep Obstet Gynecol (2019)
MeSH terms: Case Reports

Twin pregnancies complicated by complete hydatidiform mole coexisting with a viable fetus are rare and may result in significant complications. We describe the expectant management and our surgical approach in a 27-year-old Rh-negative woman presenting with recurrent episodes of vaginal bleeding and a twin pregnancy consisting of a molar pregnancy coexisting with a normal fetus. Inpatient management was undertaken with close maternal and fetal monitoring until cesarean delivery of a healthy female infant and histopathologically confirmed complete hydatidiform molar pregnancy (karyotype 46XX) at 34 weeks with no evidence of malignancy.
Pulmonary Edema Following Intrathecal Fluorescein Injection; a Case Report
Authors: Faranak Behnaz, Masih Ebrahimy Dehkordy, Hamidreza Azizi Faresani, Mohammadreza Shahmohammadi
Journal: Arch Acad Emerg Med (2019)
Keywords: pulmonary edema, cerebrospinal fluid leak, complications, emergency treatment, fluorescein, injections, spinal
MeSH terms: Case Reports

Intrathecal Fluorescein has been used widely for detection of cerebrospinal fluid (CSF) leakage. After administration of fluorescein many serious complications may happen. Pulmonary edema is one of the most serious complications that require emergency responses. In this study, we report a complicated case of pulmonary edema following Intrathecal fluorescein injection.