OpenMed/multicare-articles huggingface dataset:
Case reports: Intraoperative migratory retinal venous thrombus in proliferative diabetic retinopathy
Authors: Danni Lyu, Huan Liu, Yijiong Fang, Yao Wang
Journal: Front Med (Lausanne) (2024)
Keywords: fibrovascular membrane delamination, migratory retinal venous thrombus, proliferative diabetic retinopathy, tractional retinal detachment, vitrectomy
MeSH terms: Case Reports

Purpose:
This study aimed to study the characteristics, possible causes, and clinical implications of intraoperative migratory retinal venous thrombus in proliferative diabetic retinopathy (PDR).
Cases:
Two middle-aged Chinese patients with diabetes mellitus presented with blurred vision and were diagnosed with PDR and tractional retinal detachment (TRD). An interesting phenomenon was observed during pars plana vitrectomy in both patients. Movement of tiny white thrombi and interruption of blood flow were observed in a branch of the central retinal vein when the vein was pulled at the time of fibrovascular membrane delamination and disappeared with the elimination of retinal traction after finishing the process of delamination. Laboratory studies revealed abnormal erythrocyte sedimentation rate, fibrinogen, D-dimer, international normalized ratio, and IgA anti-β2-glycoprotein I in one patient and elevated fibrinogen and IgA anticardiolipin in the other. Follow-up examinations at 1 week, 1, 3, and 6 months postoperatively showed good prognosis. Fluorescein fundus angiography at 1 month postoperatively showed neither embolus sign nor prolonged venous filling time in both patients.
Discussion:
Local blood stasis of the retinal vein persistently dragged by the fibrovascular membrane may result in thrombogenesis, and traction of the retina during the delamination process may lead to the movement of thrombi. On the other hand, endothelial injury and disordered local blood stasis during delamination may also activate the biological coagulation process and instant thrombus formation. As well, antiphospholipid antibodies may also be a risk factor of ocular thrombogenesis.
Conclusion:
This study provides the first videos recording migratory thrombus in terminal vessels, which indicates that fibrovascular membrane in PDR can lead to thrombogenesis due to dragging and hemostasis of the involved retinal vein. PDR patients with fibrovascular membranes may benefit from early relief of vascular traction through fibrovascular membrane delamination.
Metastatic Ovarian Serous Adenocarcinoma Clinically Presenting as Inflammatory Breast Cancer
Authors: Lingling Xian, Rachel Hunter, Emily Smith, Rasha Mohammed, Carlina Madelaire, Guillermo A Herrera, Rodney E Shackelford
Journal: Case Rep Oncol Med (2024)
MeSH terms: Case Reports

Metastatic disease to the breast is a rare event, accounting for 0.5-2% of all breast cancers. Outside of metastases from the contralateral breast, malignant ovarian epithelial tumors are the most common origin of these metastases. Here, we present a very rare case of a high-grade ovarian serous adenocarcinoma presenting clinically as inflammatory breast cancer in a 70-year-old woman.
Combined helical tomotherapy and Gamma Knife stereotactic radiosurgery for high-grade recurrent orbital meningioma: a case report
Authors: Haomiao Zhang, Hanfeng Wu, Jianjie Lu, Wencheng Shao, Lili Yu
Journal: Front Oncol (2023)
Keywords: gamma knife, anaplastic meningioma, orbital meningioma, radiation therapy, stereotactic radiosurgery, surgery
MeSH terms: Case Reports

Orbital meningioma is a rare type of orbital tumor with high invasiveness and recurrence rates, making it extremely challenging to treat. Due to the special location of the disease, surgery often cannot completely remove the tumor, requiring postoperative radiation therapy. Here, we report a case of an elderly male patient with right-sided proptosis, visual impairment, and diplopia. Imaging diagnosis revealed a space-occupying lesion in the extraconal space of the right orbit. Pathological and immunohistochemical examination of the resected tumor confirmed it as a grade 3 anaplastic meningioma. Two months after surgery, the patient complained of right eye swelling and a magnetic resonance imaging (MRI) scan showed a recurrence of the tumor. The patient received helical tomotherapy (TOMO) in the postoperative tumor bed and high-risk areas within the orbit with a total dose of 48Gy. However, there was no significant improvement in the patient's right eye swelling, and the size of the recurrent lesion showed no significant change on imaging. Gamma knife multifractionated stereotactic radiosurgery (MF-SRS) was then given to the recurrent lesion with 50% prescription dose 13.5Gy/3f, once every other day. An imaging diagnosis performed 45 days later showed that the tumor had disappeared completely. The patient's vision remained unchanged, but diplopia was significantly relieved after MF-SRS. We propose a new hybrid treatment model for recurrent orbital meningioma, where conventional radiation therapy ensures local control of high-risk areas around the postoperative cavity, and MF-SRS maximizes the radiation dose to recurrent lesion areas while protecting surrounding tissues and organs.
Peritoneal Carcinomatosis: When Everything Is Not What It Seems
Authors: Sofia Perdigão, Rita Cunha, Catarina Costa, Cristiana Sousa, Antonio Teira
Journal: Cureus (2024)
Keywords: ascites, malignant peritoneal mesothelioma, peritoneal carcinomatosis, peritoneum, serous membrane neoplasm
MeSH terms: Case Reports

Malignant peritoneal mesothelioma (MPM) is a rare neoplasm with a low incidence rate worldwide but high morbidity and mortality rates. Due to its rarity, the studies are scarce. We present a case of a 73-year-old woman admitted to the internal medicine unit with constitutional syndrome, abdominal pain, and ascites. Throughout the investigation, aspects suggestive of peritoneal carcinomatosis were identified. An extensive study was then carried out in an attempt to identify the primary tumor, which proved to be unsuccessful. During the two weeks of hospitalization, the patient's clinical condition worsened, with an increase in ascites and a deterioration in her general health. This case was then discussed with an oncology consultant, and it was decided to biopsy a peritoneal implant with the support of interventional radiology. MPM was then diagnosed through histopathology. With this case, the authors intend to highlight that, although rare, this diagnosis should be considered when appropriate and that even in the suspicion of secondary disease, the primary tumor should always be identified, as localized MPM may be curable.
Autopsy findings of fatal retroperitoneal hemorrhage after traumatic rupture of bilateral renal angiomyolipoma
Authors: Enrico De Dominicis, Gian Luca Marella, Gabriele Giuga, Giulia Ceccobelli, Luca Savino, Alessandro Mauro Tavone
Journal: Autops Case Rep (2024)
Keywords: angiomyolipoma, fatal outcome, hemorrhage, retroperitoneal space
MeSH terms: Case Reports

The present work reports the autopsy findings of a unique case characterized by fatal retroperitoneal hemorrhage following the traumatic rupture of bilateral renal angiomyolipomas. Renal angiomyolipomas are generally benign tumors with an unpredictable clinical course, ranging from asymptomatic to sudden rupture and hemorrhagic shock. They may be associated with genetic disorders such as tuberous sclerosis complex. The case under investigation is unprecedented in the medical literature due to its bilateral nature and fatal outcome. Autopsy analysis revealed an extensive retroperitoneal hemorrhage originating from bilateral ruptured tumors. Microscopic examination found features consistent with bilateral renal angiomyolipoma. Circumstantial information identified a traffic accident before the death, considering it as the cause of the tumors' traumatic rupture. In this case, due to the severity of the situation, immediate medical measures-such as fluid resuscitation, coagulopathy correction, and surgical treatment, which are usually lifesaving-could not be performed. This led to the patient being declared dead at the scene of the crash.
Comprehensive Review of Mesothelioma Cases: From Diagnosis to Therapeutic Strategies
Authors: Abeer Qasim, Sai Vishnu Vardhan Allu, Patrik Schmidt, Harsh R Parikh, Sarah Moore, Laura Yapor, Maryam Soliman
Journal: Cureus (2024)
Keywords: biopsy, epitheloid asbestos exposure, malignant, mesothelioma, pleural mesothelioma
MeSH terms: Case Reports

Mesothelioma is a rare and aggressive malignancy typically associated with asbestos exposure. We present the clinical and diagnostic journey of a 63-year-old male carpenter, who presented with concerning symptoms of shortness of breath and total right lung "white-out" on imaging. Comprehensive medical evaluation revealed the presence of malignant pleural mesothelioma. This study underscores the importance of considering mesothelioma as a potential diagnosis in individuals with occupational asbestos exposure and highlights patterns in diagnosing and managing this devastating disease. Early recognition and intervention are essential in improving outcomes for patients diagnosed with mesothelioma.
Mechanical Bowel Obstruction Due to Secondary Sclerosing Peritonitis, Managed Conservatively: A Case Report
Authors: Laith Daraghmeh, Malak Eleiwi, Naim Qamhia, Iyad Maqboul
Journal: Cureus (2024)
Keywords: conservative and surgical treatment, peritoneal dialysis (pd), sclerosing peritonitis, small intestinal obstruction, surgical case reports
MeSH terms: Case Reports

An uncommon cause of intestinal obstruction is an abdominal cocoon, also known as sclerosing encapsulating peritonitis (SEP). We present the case of a 24-year-old female peritoneal dialysis patient who presented with a picture of complete intestinal obstruction. After reviewing the patient's medical history and acquiring relevant laboratory and imaging data, the decision was made to proceed with surgery. Intraoperatively, however, she had a picture of sclerosing peritonitis. The decision was to terminate the surgery and to take a conservative approach, including total parenteral nutrition. Her condition improved, obstruction was resolved, and she was discharged home in good clinical condition. Sclerosing peritonitis should be considered a possible etiology that can be managed conservatively in any peritoneal dialysis patient with intestinal obstruction.
Rehabilitating Long Edentulous Span by Using Pier Abutment as a Non-rigid Connector: A Case Report
Authors: Prasanna R Sonar, Aarati S Panchbhai, Ankita Pathak, Arushi Beri, Ravina Khairkar
Journal: Cureus (2024)
Keywords: fixed dental prosthesis, long span edentulous arch, non-rigid connector, pier abutment, stress breaker
MeSH terms: Case Reports

An abutment having edentulous space on both sides is referred to as a pier abutment. The rehabilitation of a patient whose primary concern when they first came to the hospital was missing teeth is discussed in this case report. When using a pier abutment for a fixed dental prosthesis, there is a problem with fulcrum and torqueing pressures at the intermediate abutment. Forces on the pier abutment may become localized as a result of using a rigid connector. It has been suggested that non-rigid connectors be used to overcome this. Here, using a non-rigid connector as a stress breaker resulted in less stress being placed on the prosthetic assembly and abutment. This article offers a clinical case report that details the use of a non-rigid connector in a pier abutment scenario for rehabilitation.
Amoxicillin-Induced Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) Syndrome With Acute Onset of Diffuse Rash and Acute Kidney Injury (AKI)
Authors: Marianne Cortes, Kyoung W Cho, Nayeem M Chowdhury, Jeffri-Noelle Mays, Chan H Shin
Journal: Cureus (2024)
Keywords: amoxicillin, drug rash, drug reaction with eosinophilia and systemic symptoms (dress) syndrome, nikolsky sign, regiscar, t-lymphocytes, urticaria
MeSH terms: Case Reports

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is an uncommon and potentially fatal adverse drug reaction that can affect individuals with immunosuppression, viral reactivation, pharmacogenetic susceptibility, and recent exposures to new medications. Due to the ambiguous symptomology of DRESS syndrome along with a lack of diagnosis and treatment criteria, there can be delays in diagnosis and management. Here, we present a case of a 60-year-old female with an uncommon presentation of DRESS syndrome due to a less commonly implicated drug. We aim to bring awareness to the various presentations associated with DRESS syndrome and inform readers about current diagnostic and treatment modalities used today. In addition, this case serves to provide insights that further evidence is needed to have standardized guidelines in place to effectively diagnose and manage affected patients.
A Fatal Case of 3-Hydroxyisobutyryl-CoA Hydrolase Deficiency in a Term Infant with Severe High Anion Gap Acidosis and Review of the Literature
Authors: Surasak Puvabanditsin, Ian Lee, Natasha Cordero, Keisha Target, Su Young Park, Rajeev Mehta
Journal: Case Rep Genet (2024)
MeSH terms: Case Reports

3-hydroxy isobutyl-CoA hydrolase (HIBCH) deficiency is a recently described, rare inborn error of valine metabolism associated with a Leigh syndrome-like phenotype, neurodegenerative symptoms, and caused by recessive mutations in the HIBCH gene. We report the most severe case to date of an intrauterine growth-restricted term male who presented with severe acidosis and a high anion gap soon after birth. The manifestation was fatal that led to death within 36 hours of life. The diagnosis was made postnatally by Whole Genome Sequencing (WGS). We report a rapid and fatal event of HIBCN in a neonate and review of the literature.
Cervical Ectopic Pregnancy: Combination Treatment With Multi-Dose Methotrexate Regimen, Uterine Artery Embolization, and Suction Curettage
Authors: Larissa L Aroche Gutierrez, Jason Bunn, Gabriele Duvernois, Courtney Baker
Journal: Cureus (2024)
Keywords: cervical ectopic, fertility-sparing treatment, multi-dose methotrexate, suction curettage, uterine artery embolization
MeSH terms: Case Reports

Cervical ectopic pregnancy is a rare condition associated with significant morbidity. With early ultrasound, fertility preservation options have become more common. No consensus on treatment exists, but many treatment modalities have been reported with good outcomes. This case report exemplifies the advantages of combination treatment for a patient with difficult outpatient follow-up, achieving a rapid resolution without increased morbidity.
Extensive thoracoabdominal aortic aneurysm as initial presentation in Takayasu arteritis: case series and literature review
Authors: Anupam Jena, Subasis Mishra, Binayananda Padhee, Surya Kant Jena, Nelson Ghosh, Prasanta Padhan, Nikunja Kishore Rout, Panchanan Sahoo
Journal: Eur Heart J Case Rep (2023)
Keywords: aortic aneurysm, case series, chimney evar, endovascular repair, takayasu’s arteritis, thoracoabdominal aneurysm
MeSH terms: Case Reports

Background:
Aortic aneurysm as a presenting feature in Takayasu's arteritis is very rare. Here, we report three cases of extensive thoracoabdominal aortic aneurysm in Takayasu's arteritis as initial presentation.
Case summary:
All three cases were males and presented with complaints of abdominal pain and refractory hypertension. The diagnosis was made from the finding of thickened and calcified aortic wall, stenosis of visceral arteries, and age < 40 years at diagnosis. Case 1 was a 34 years male with aortic aneurysm extending from left subclavian artery to infrarenal aorta. He underwent endovascular repair of aneurysm by sandwich chimney technique in view of impending aneurysm rupture. Case 2, a 37 years male had aortic aneurysm from descending thoracic aorta (D4 vertebral body) to infrarenal aorta (L4 level). While being evaluated for repair, he had sudden death probably due to ruptured aneurysm. Case three, a 40 years male had aortic aneurysm extending from left subclavian artery to aortic bifurcation and stenosis of visceral arteries. He did not consent for repair and died one year later due to chronic kidney disease and related complications.
Discussion:
Thoracoabdominal aortic aneurysm is a very rare manifestation in Takayasu's arteritis; more common in males. Endovascular repair is challenging but feasible. Long-term monitoring and repeat intervention may be needed due to young age of patients and disease progression.
Acute Brucella infection associated with splenic infarction: a case report and review of the literature
Authors: Limei Shi, Shuang Wang, Xiaohua Li, Xin Li, Yuxiang Li, Yang Wang
Journal: Front Cell Infect Microbiol (2023)
Keywords: brucella abortus, acute pancreatitis, brucellosis, splenic infarction, vasculitis
MeSH terms: Brucellosis / complications, Brucellosis / diagnosis, Brucellosis / drug therapy, Splenic Infarction / diagnostic imaging, Splenic Infarction / etiology, Review, Case Reports, Brucella abortus, Humans, Male, Middle Aged, Rifampin / therapeutic use, Streptomycin, Rifampin, Streptomycin

Brucella infection often involves multiple organ systems with non-specific clinical manifestations, and cutaneous involvement is uncommon. Splenic infarction and leukocytoclastic vasculitis also rarely occur together in the course of brucellosis infection. We report the case of a 47-year-old man with Brucella combined with splenic infarction. The patient presented with fever; large liver, spleen, and lymph nodes; muscle and joint pain; positive laboratory tests for blood cultures (Brucella abortus); and imaging suggestive of splenic infarction. After treatment with streptomycin, doxycycline, and rifampicin, the patient's clinical symptoms and splenic damage improved. Detailed history taking, correct interpretation of laboratory results, and knowledge of rare complications of human brucellosis facilitate early diagnosis and treatment of the disease.
A Case of Acute Necrotizing Encephalopathy With Multiple Organ Failure Following COVID-19
Authors: Naohiko Maejima, Shotaro Matsumoto, Itaru Hayakawa, Kentaro Koike, Yuichi Abe
Journal: Cureus (2024)
Keywords: acute necrotizing encephalopathy, covid-19, cytokine, intravenous methylprednisolone, multiple organ failure, therapeutic plasma exchange
MeSH terms: Case Reports

Neurological complications are frequent non-respiratory complications associated with coronavirus disease 2019 (COVID-19), and acute encephalopathy (AE) has been reported to occur in 2.2% of patients. Among many phenotypes of AEs, acute necrotizing encephalopathy (ANE) is associated with multiple organ failure (MOF), leading to severe neurological morbidity and mortality. A previously healthy seven-year-old girl presented with a one-day history of fever followed by 12 hours of vomiting and altered consciousness. On arrival, the patient was in shock. Blood tests revealed severe acute liver failure and kidney injury, accompanied by coagulopathy. The serum interleukin-6 levels were also elevated. PCR testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was positive. A head CT scan showed heterogeneous low-density areas in the bilateral thalamus, without brainstem involvement. She was diagnosed as ANE complicated with MOF (ANE severity score = 6). Intravenous methylprednisolone and therapeutic plasma exchange (TPE) were initiated with neurocritical care. After the introduction of TPE, hemodynamics improved rapidly, followed by gradual improvement in neurological manifestations. Upon follow-up after two months, no neurological or systemic sequelae were noted. Although further studies are needed, our case suggests that early immunomodulatory therapy and TPE may have contributed to the improvement in ANE and MOF associated with COVID-19.
Stevens-Johnson syndrome induced by toripalimab in a previously EGFR-TKI-treated advanced lung adenocarcinoma patient harboring EGFR mutations 19 del/T790M/C797S in trans and cis: a case report
Authors: Yang Chen, Hanhan Hong, Shujun Bao, Hao Tang
Journal: Front Pharmacol (2023)
Keywords: egfr tyrosine kinase inhibitor, stevens–johnson syndrome, adverse reaction, non-small-cell lung cancer, toripalimab
MeSH terms: Case Reports

Background: The treatment paradigm for advanced non-small-cell lung cancer (NSCLC) is rapidly changing. Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) and anti-programmed death-1 (PD-1) antibodies have increasingly been incorporated into routine care for nearly all patients with NSCLC. Toripalimab was recently approved as the first-line treatment for advanced non-squamous NSCLC in combination with chemotherapy. Stevens-Johnson syndrome (SJS) is a rare but potentially fatal complication of TKI and anti-PD-1 therapy. We reported a case of SJS after sequential use of EGFR-TKIs and toripalimab in an NSCLC patient with EGFR mutations 19 del/T790M/C797S in trans and cis. Case presentation: A 58-year-old man with stage IV NSCLC received gefitinib because next-generation sequencing (NGS) revealed an EGFR 19del, followed by osimertinib and pemetrexed with the emergence of EGFR T790M. Four EGFR mutations 19 del/T790M/C797S in trans and cis were detected after osimertinib resistance. The combination of toripalimab and docetaxel was administered as a third-line treatment. The patient developed SJS at 21 days, and toripalimab was discontinued. After treatment with methylprednisolone and prednisolone, the skin toxicity of the patient gradually decreased and eventually disappeared. The patient received osimertinib and anlotinib after recovery, and SJS has not recurred. The ongoing treatment is still effective and results in stable disease. Conclusion: We reported the first case of SJS induced by toripalimab in a patient with lung adenocarcinoma harboring multiple EGFR mutations. The TKI treatment after SJS was well tolerated and effective.