OpenMed/multicare-articles huggingface dataset:
Use of 18F-fluorodeoxyglucose positron emission tomography-computed tomography in patients affected by polymyalgia rheumatica and persistent increase of acute phase reactants
Authors: Michele Colaci, Jessika Dichiara, Maria Letizia Aprile, Massimo Ippolito, Claudia Schinocca, Giuliana Guggino, Lorenzo Malatino
Journal: Front Med (Lausanne) (2022)
Keywords: pet, arthritis, giant cell arteritis, inflammation, polymyalgia rheumatica

Polymyalgia rheumatica (PMR) is an inflammatory disease affecting older adults characterized by aching pain and morning stiffness of the shoulder and pelvic girdles. Moreover, PMR can be associated with giant cell arteritis (GCA). Generally, PMR is highly responsive to steroids, reaching complete remission in the majority of cases. However, the possibility of occult diseases, including extra-cranial GCA, should be excluded. 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) is able to detect the presence of peri-/articular or vascular inflammation, which may be both present in PMR, thus representing a useful diagnostic tool, mainly in presence of extra-cranial GCA. We retrospectively evaluated all consecutive patients who received the diagnosis of PMR in our rheumatology clinic, classified according to the 2012 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria, in the period between April 2020 and May 2022. Among this case series, we selected the patients who underwent 18F-FDG-positron emission tomography (PET) because of the persistent increase of acute phase reactants (APR) besides the steroid therapy. Eighty patients were diagnosed with PMR. Nine out of them also presented arthritis of the wrists during the follow-up, whereas none showed signs of cranial GCA at the diagnosis. Seventeen out of eighty subjects (mean age 71.5 ± 7.5 years; M/F 2/15) presented persistent increase of erythrocyte sedimentation rate (mean ESR 44.2 ± 20.8 mm/h) and/or C-reactive protein (mean CRP 25.1 ± 17 mg/l), thus they underwent total body 18F-FDG-PET/CT. Large vessel 18F-FDG uptake indicating an occult GCA was found in 5/17 (29.4%) cases. Twelve out of seventeen (70.6%) patients showed persistence of peri-/articular inflammation, suggesting a scarce control of PMR or the presence of chronic arthritis. Finally, in 2 cases, other inflammatory disorders were found, namely an acute thyroiditis and a hip prosthesis occult infection. 18F-FDG-PET/CT in PMR patients with persistent increase of APR is a useful diagnostic technique in order to detect occult GCA, persistence of active PMR or other misdiagnosed inflammatory diseases.
Congenital duplication of the urethra with urethral diverticulum: a case report
Authors: Darshan H Shah, Arvind P Ganpule, Ravindra B Sabnis, Mahesh R Desai
Journal: F1000Res (2014)

Duplication of the urethra is a rare congenital anomaly. Urethral duplication with the presence of diverticulum is a rare combination and to the best of our knowledge has not been previously reported. We report a case of a 16 month old male child with duplication of the urethra and diverticulum arising from the ventral urethra. We also cover the intricacies and challenges in the management of such a case. The opening of the narrowed accessory dorsal urethra at the verumontanum was cauterized and gradually the dorsal urethra became atrophied. The ventral urethral diverticulum was excised. This case is unique due to: The unusual presentation of swelling over the dorsum of the penis, together with duplication of the urethra with diverticulum.The use of cauterization as a treatment modality. Cauterization of the ventral urethra with a Bugbee electrode and diverticulectomy was performed. A glidewire helped in identifying the small opening of the dorsal urethra at the level of the verumontanum. The case also highlights the importance of endoscopic management of this clinical entity.
Bilateral congenital absence of the anterior cruciate ligament associated with bilateral knee and hip osteoarthritis: Case report
Authors: Kwang-Kyoun Kim, Tae-Hyeong Kim, Dae-Young Kim, Jae-Kyu Choi
Journal: Int J Surg Case Rep (2020)
Keywords: case report, congenital aplasia of cruciate ligament, knee instability, osteoarthritis
MeSH terms: Case Reports

Introduction:
Congenital absence of the cruciate ligaments is very rare condition. Its association with congenital abnormalities of the spine, knee and hip, has been rarely reported. Most of the case reports were mostly reported before adolescence, so reports of the progression of this congenital disease at old age were extremely rare.
Presentation of case:
A 65-year-old woman had a 7-year history of both knee and hip pain. On physical examination, valgus and varus instability on both knees and painful limitation of motion in both hip joints were observed. Radiography and magnetic resonance imaging showed the absence of the anterior cruciate ligament with osteoarthritis on both knees and hip osteoarthritis. Total knee and hip arthroplasties were performed on both knee joints and total hip arthroplasty. The pain and instability of both knees and hips were lost for follow up of more than a year, and the patient is doing well in daily life.
Discussion:
Congenital absence of cruciate ligament may progress to osteoarthritis, do early detection and proper management is needed. In the treatment of older aged patients. Reports of treatment for this disorder are also very rare in older age. In old age, arthroplasty can be a useful treatment when the severe osteoarthritis is accompanied by instability.
Conclusion:
Since the congenital absence of the ACL in old age could lead to hip and knee osteoarthritis, periodic follow-up is necessary and arthroplasty can be a useful treatment when the severe osteoarthritis is accompanied by instability.
Primary Atypical Meningioma of the Nasal Cavity: A Case Report and Review of the Literature
Authors: Leison Maharjan, Yogesh Neupane, Bibhu Pradhan
Journal: Case Rep Otolaryngol (2018)
MeSH terms: Case Reports

Background:
Meningioma is a central nervous system tumor that typically arises in proximity to meninges. Extracranial primary atypical meningioma of sinonasal tract is a rare one.
Methods:
We discuss the clinical, radiological, and histological presentation of an elderly female with primary atypical meningioma of the nasal cavity, which was excised via endoscopic endonasal approach.
Results:
There was no recurrence even up to 20 months of follow-up after endoscopic excision.
Conclusion:
Extracranial primary atypical meningioma should be kept in mind as one of the differential diagnoses of nasal mass. Histopathological diagnosis along with immunohistochemistry should be used for definitive diagnosis.
Palpitations, headache and night sweats caused by a retroperitoneal mass: case report and short review
Authors: Laura Wuyts, Marc Pouillon, Marc Huyghe, Natacha Ruyssers, Gerda Goovaerts, Mattias Spaepen
Journal: BJR Case Rep (2017)
MeSH terms: Case Reports

A 31-year-old West-African female attended our emergency department presenting with palpitations, headache, fatigue and night sweats during the last 2 weeks. Clinical examination revealed tachycardia and a painful, palpable infraumbilical mass. Ultrasound examination of the abdomen showed a smoothly rounded soft-tissue mass with a diameter of 5 cm. On contrast-enhanced CT, a prevertebral mass with intense contrast enhancement was seen, located caudal to the aortic bifurcation. On PET-CT, there were no distant 18F-FDG-avid locoregional nodes or masses. A tumourectomy was successfully performed, during which manipulation of the retroperitoneal tumour triggered a sharp rise in blood pressure. Histological analysis confirmed the diagnosis of a paraganglioma. The clinical complaints of headache, paroxysmal palpitations and night sweats disappeared postoperatively. This case is a classic presentation of a paraganglioma occurring in the organs of Zuckerkandl, a collection of paraganglia. The diagnosis should be suspected in the presence of a heterogeneous, hypervascular mass in the retroperitoneum and typical clinical symptoms of hypertension, headache and palpitations. Treatment involves surgical resection, after accurate preoperative management. Genetic counselling is required, allowing a personal and genotype-based follow-up.
Aggressive Pituitary Macroadenoma Treated With Capecitabine and Temozolomide Chemotherapy Combination in a Patient With Nelson's Syndrome: A Case Report
Authors: Oriol Mirallas, Francesca Filippi-Arriaga, Irene Hernandez Hernandez, Anton Aubanell, Anas Chaachou, Alejandro Garcia-Alvarez, Jorge Hernando, Elena Martínez-Saez, Betina Biagetti, Jaume Capdevila
Journal: Front Endocrinol (Lausanne) (2021)
Keywords: nelson’s syndrome, aggressive pituitary tumors, capecitabine, case report, temozolomide
MeSH terms: Adenoma / drug therapy, Antineoplastic Combined Chemotherapy Protocols / therapeutic use, Nelson Syndrome / drug therapy, Pituitary Neoplasms / drug therapy, Case Reports, Adenoma / complications, Adenoma / pathology, Capecitabine / administration & dosage, Humans, Male, Middle Aged, Nelson Syndrome / complications, Neoplasm Invasiveness, Pituitary Neoplasms / complications, Pituitary Neoplasms / pathology, Spain, Temozolomide / administration & dosage, Treatment Outcome, Tumor Burden, Capecitabine, Temozolomide

Nelson's syndrome is considered a severe side effect that can occur after a total bilateral adrenalectomy in patients with Cushing's disease. It usually presents with clinical manifestations of an enlarging pituitary tumor including visual and cranial nerve alterations, and if not treated, can cause death through local brain compression or invasion. The first therapeutic option is surgery but in extreme cases of inaccessible or resistant aggressive pituitary tumors; the off-label use of chemotherapy with capecitabine and temozolomide can be considered. However, the use of this treatment is controversial due to adverse events, lack of complete response, and inability to predict results. We present the case of a 48-year-old man diagnosed with Nelson's syndrome with prolonged partial response and significant clinical benefit to treatment with capecitabine and temozolomide.
Onset of Microscopic Polyangiitis in Binephrectomied Patient on Chronic Hemodialysis-Case Report
Authors: Aleksandar Jankovic, Vesna Maslarevic-Radovic, Petar Djuric, Jelena Tosic-Dragovic, Ana Bulatovic, Nikola Simovic, Milos Mitrovic, Verica Stankovic-Popovic, Vesna Dopudja-Pantic, Snezana Arandjelovic, Nada Dimkovic
Journal: Front Immunol (2017)
Keywords: mpo-anca, binephrectomy, chronic hemodialysis, microscopic polyangiitis, pulmo

Introduction:
Microscopic polyangiitis (MPA) is one of the causes of the pulmonary-renal syndrome associated with elevated non-specific markers of inflammation and antineutrophil cytoplasmic autoantibody (ANCA) positivity in 50-75%. De novo occurrence of the disease in patients on chronic hemodialysis (HD) has not been described.
Case presentation:
We presented patient who developed MPO-ANCA-associated MPA with lung and musculoskeletal involvement after 4 years on regular HD due to bilateral nephrectomy. After excluding the other causes of MPO-ANCA positivity, diagnosis was confirmed even without renal biopsy. Patient received standard immunosuppression therapy and he is still in remission after 27 months.
Conclusion:
The onset of immune-mediated disease could be observed even after introduction of renal replacement therapy, which may be a diagnostic problem. Early recognition and traditional immunosuppressive regiment may provide successful outcome.
Recognition and Treatment of Tardive Dyskinesia in Individuals with Intellectual Disability
Authors: Robert O Morton, Lucas C Morton, Rissa Fedora
Journal: Case Rep Psychiatry (2020)
MeSH terms: Case Reports

Individuals with intellectual disability (ID) commonly suffer from comorbid psychiatric and behavioral disorders that are frequently treated by antipsychotic medications. All individuals exposed to first- and second/third- generation antipsychotics are at risk for developing tardive dyskinesia (TD), characterized by abnormal, involuntary movements of the mouth/tongue/jaw, trunk, and extremities. TD can be highly disruptive for affected individuals and their caregivers, causing embarrassment, isolation, behavioral disturbances, and reduced functioning and quality of life. Information on TD incidence in individuals with ID is limited, but 2 small US studies reported TD prevalence rates of 42-45% in inpatients with ID. The safety and efficacy of vesicular monoamine transporter type 2 (VMAT2) inhibitors approved for treatment of TD in adults have been demonstrated in multiple clinical trials, but they excluded individuals with ID. Clinical characteristics and treatment outcomes of 5 adults (aged 28-63 years) with mild-to-severe ID and TD are presented, illustrating TD symptoms before/after treatment. All individuals had multiple comorbid psychiatric, behavioral, and other medical conditions, history of antipsychotic exposure, and abnormal movements affecting the tongue/mouth/jaw (n = 5), upper extremities (n = 5), lower extremities (n = 3), and trunk (n = 2), resulting in diminished ability to speak (n = 2), ambulate (n = 3), and perform activities of daily living (n = 3). Treatment with valbenazine resulted in meaningful improvements in TD symptoms and improved daily functioning, demeanor, and social/caregiver interactions. Given the high likelihood of antipsychotic exposure in the ID population, it is appropriate to screen for TD at every clinical visit through careful monitoring for abnormal movements and questioning the individual/caregiver regarding abnormal movements or TD-related functional impairments (i.e., speaking, swallowing, eating, ambulating, and social functioning). In this study, 5 individuals with ID and TD received once-daily valbenazine and experienced marked improvement in TD symptoms and daily functioning, resulting in increased quality of life for affected individuals and caregivers.
A Recommendation for the Management of Illness Anxiety Disorder Patients Abusing the Health Care System
Authors: Mohammad Almalki, Ibrahim Al-Tawayjri, Ahmed Al-Anazi, Sami Mahmoud, Ahmad Al-Mohrej
Journal: Case Rep Psychiatry (2016)

Introduction. Illness anxiety disorder (IAD) entails a preoccupation with having a serious, undiagnosed illness in which somatic symptoms are, if present, mild in intensity (American Psychiatric Association, 2013). Case Report. This is a case of seventy-three-year-old Saudi man who started visiting the primary health care center around twenty-five years ago. With concerns of having cancer, the patient continuously visited the hospital, costing over $170,000. Throughout this period, the patient has been exposed to extensive unnecessary imaging studies and laboratory tests that have effects on his life in all aspects with such concerns. Five years ago, a family doctor has put an end to that by directing the patient to the right path. The doctor made several actions; most importantly, he directed the patient to a cognitive behavioral therapy which significantly improved a range of hypochondriacal beliefs and attitudes. This patient's case demonstrates the fundamental importance of a proper health system that limits such patients from abusing the health system and depleting the medical resources. Moreover, this case emphasizes the important role of the family physician who can be the first physician to encounter such patients. Thus, proper understanding of the nature of such disorder is a key element for better diagnosis and management.
Possible Abscopal Effect Observed in Frontal Meningioma After Localized IMRT on Posterior Meningioma Resection Cavity Without Adjuvant Immunotherapy
Authors: Danielle Golub, Kevin Kwan, Jonathan P S Knisely, Michael Schulder
Journal: Front Oncol (2019)
Keywords: abscopal effect, immunotherapy, meningioma, off-target effect, radiation
MeSH terms: Case Reports

Background: Localized radiation therapy (RT) is known to infrequently cause off-target or "abscopal" effects at distant metastatic lesions. The mechanism through which abscopal effects occur remains unknown, but is thought to be caused by a humoral immune response to tumor-specific antigens generated by RT. Combination treatment regimens involving RT and immunotherapy to boost the humoral immune response have demonstrated synergistic effects in promoting and accelerating abscopal effects in metastatic cancer. Nevertheless, abscopal effects, particularly after RT alone, remain exceedingly rare. Case Presentation: We report the case of an 84-year-old man with an atypical meningioma, who demonstrated a radiographically significant response to an untreated second intracranial lesion, likely also a meningioma, after intensity-modulated radiation therapy (IMRT) to a separate, detatched resection cavity. Serial annual MRI imaging starting at 2- to 3.5-year (most recent) post-IMRT follow-up demonstrated a persistent decrease in both tumor size and surrounding edema in the untreated second lesion, suggestive of a possible abscopal effect. Conclusions: We describe here the first report of a potential abscopal effect in meningioma, summarize the limited literature on the topic of abscopal effects in cancer, and detail the existing hypothesis on how this phenomenon may occur and possibly relate to the development of future treatments for patients with metastatic disease.
Case Report: Benign Infantile Seizures Temporally Associated With COVID-19
Authors: Marcos García-Howard, Mercedes Herranz-Aguirre, Laura Moreno-Galarraga, María Urretavizcaya-Martínez, Josune Alegría-Echauri, Nerea Gorría-Redondo, Laura Planas-Serra, Agatha Schlüter, Marta Gut, Aurora Pujol, Sergio Aguilera-Albesa
Journal: Front Pediatr (2020)
Keywords: covid-19, prrt2 mutations, sars-cov-2, afebrile seizures, benign familial infantile epilepsy, coronavirus, non-febrile seizures, pediatric covid-19
MeSH terms: Case Reports

Background: Non-febrile illness seizures may present in previously healthy children as afebrile seizures associated with minor infections, such as mild gastroenteritis or respiratory tract infections, and are linked to a genetic predisposition. For the novel human coronavirus SARS-CoV-2, causing COVID-19, fever, cough, and gastrointestinal complaints are the most common symptoms in children, and a hyperimmune response may be present. No detailed temporally associated neurological complications have been documented in pediatric case series so far. Case description: We present the case of a 3-months-old girl with non-febrile repeated seizures in a COVID-19 family setting. The infant started with a mild fever and cough that lasted for 2 days. At day 6 from onset, the girl presented with two focal motor seizures with impaired consciousness and awareness. All investigations ruled out signs of meningo-encephalitis or active epilepsy, including normal electroencephalogram and cerebral magnetic resonance imaging. PCR from nasal and throat swabs was positive for SARS-CoV-2. Remarkably, blood ferritin and D-dimer levels were increased. At day 9, the infant presented another afebrile motor seizure, and levetiracetam dose was modified there was a favorable response within 3 months of the follow-up. Much interest has been raised with regards to host genetic determinants to disease severity and susceptibility to COVID-19. We thus performed whole exome sequencing, revealing a pathogenic frameshift mutation in the PRRT2 gene in both the mother and the infant. The mother had presented two late infantile febrile convulsions with normal outcome afterwards. Discussion: The hyperimmune response described in adult cases with COVID-19 can be seen in infants, even in the absence of respiratory symptoms. Moreover, COVID-19 may present in infants as non-febrile seizures, triggering early onset seizures in infants with a genetic predisposition. In this pandemic situation, precision medicine using massive sequencing can shed light on underlying molecular mechanisms driving the host response to COVID-19.
Post-Endovascular Abdominal Aortic Aneurysm Repair Abdominal Pain: A Learning Experience
Authors: Asim Kichloo, M Zatmar Khan, El-Amir Zain, Navya Sree Vipparla, Farah Wani
Journal: J Investig Med High Impact Case Rep (2019)
Keywords: abdominal aortic aneurysm, endovascular abdominal aortic aneurysm repair
MeSH terms: Abdominal Pain / etiology, Aortic Aneurysm, Abdominal / surgery, Endoleak / diagnosis, Endovascular Procedures / adverse effects, Postoperative Complications / etiology, Case Reports, Aged, Aortic Aneurysm, Abdominal / diagnostic imaging, Endoleak / diagnostic imaging, Endoleak / etiology, Humans, Male, Postoperative Complications / diagnostic imaging, Tomography, X-Ray Computed

Abdominal aortic aneurysm (AAA) is one of the important pathologies involving the abdominal aorta, as it can have adverse consequences if it goes unnoticed or untreated. AAA is defined as an abnormal dilation of the abdominal aorta 3 cm or greater. Endovascular abdominal aortic aneurysm repair (EVAR) has recently emerged as a treatment modality for AAA. It does have a few inherent complications that include endoleak, endograft migration, bleeding, ischemia, and compartment syndrome. This case report discusses a patient who came in with abdominal pain and a pulsatile mass, which raised concerns regarding endoleak. The patient had a 9.9-cm AAA, which was repaired in the past, as was made evident by computed tomography findings of the stent graft in the aneurysmal segment. This case stands out because it highlights the importance of comparing the size of the AAA at the time of the EVAR to the current scenario where the patient presents with abdominal pain of unknown etiology. Also, this case report highlights the importance of computed tomography and other imaging forms in following-up with patients who have EVAR for AAAs.
Report of a rare case and review of adult intestinal duplication at the opposite side of mesenteric margin
Authors: Zhi-Hao Huang, Zi-Hao Wan, Vikash Vikash, Sindhu Vikash, Cong-Qing Jiang
Journal: Sao Paulo Med J (2018)
MeSH terms: Intestinal Obstruction / diagnostic imaging, Intestine, Small / abnormalities, Case Reports, Review, Humans, Intestinal Obstruction / surgery, Intestine, Small / diagnostic imaging, Intestine, Small / surgery, Male, Middle Aged, Tomography, X-Ray Computed

Context:
To study the previously discovered clinical entity of adult intestinal duplication and its treatment, and propose an extension to its existing classification.
Case report:
We report the case of an adult male with abdominal pain, constipation and vomiting. This patient underwent surgical separation of adhesions, reduction of torsion and intestinal decompression. Postoperative pathological findings confirmed the rare diagnosis of intestinal duplication.
Conclusion:
Adult intestinal duplication is quite rare. Its clinical manifestations are nonspecific. From this finding of intestinal duplication originating at the opposite side of the mesenteric margin, a further extension of the existing anatomical classification is proposed.