OpenMed/multicare-articles huggingface dataset:
Effectiveness of an Innovative Pulsed Electromagnetic Fields Stimulation in Healing of Untreatable Skin Ulcers in the Frail Elderly: Two Case Reports
Authors: Fabio Guerriero, Emanuele Botarelli, Gianni Mele, Lorenzo Polo, Daniele Zoncu, Paolo Renati, Carmelo Sgarlata, Marco Rollone, Giovannoi Ricevuti, Niccolò Maurizi, Matthew Francis, Mariangela Rondanelli, Simone Perna, Davide Guido, Piero Mannu
Journal: Case Rep Dermatol Med (2015)

Introduction. Recalcitrant skin ulcers are a major burden in elderly patients. Specifically, chronic wounds result in significant morbidity and mortality and have a profound economic impact. Pulsed electromagnetic fields (PEMFs) have proved to be a promising therapy for wound healing. Here we describe the first reported case of an innovative PEMF therapy, Emysimmetric Bilateral Stimulation (EBS), used to successfully treat refractory skin ulcers in two elderly and fragile patients. Case Presentation. Two elderly patients developed multiple chronic skin ulcerations. Despite appropriate treatment, the ulcers showed little improvement and the risk of amputation was high. Both patients underwent daily EBS therapy and standard dressing. After few weeks of treatment, major improvements were observed and all ulcers had healed. Conclusion. In patients with refractory ulceration, EBS therapy may be of real benefit in terms of faster healing. This case supports the supportive role for PEMFs in the treatment of skin ulceration in diabetes and is suggestive of a potential benefit of EBS in this clinical condition.
Unusual Sequence of Events in a Case of Takotsubo Syndrome
Authors: C Henriquez, R Landau, N Sabharwal, D Rodriguez, V Virparia, A Sadiq, J Shani
Journal: Case Rep Cardiol (2018)
MeSH terms: Case Reports

A 73-year-old female with multiple comorbidities including coronary artery disease was admitted for an elective PCI of a lesion detected in the RCA. On the day of the planned PCI, shortly after right femoral artery cannulation, the patient developed a sudden complete heart block requiring the administration atropine and insertion of a temporary pacemaker. Concomitantly, the patient developed acute pulmonary edema, hypotension, and hypoxia requiring intubation for mechanical ventilation. Vasopressors were administered. A coronary angiogram showed patent left and right coronary arteries, unchanged when compared to the previous angiogram. An echocardiogram performed in the cardiac catheterization lab revealed global hypokinesis of the left and right ventricles, with severe LV systolic dysfunction (EF < 20%). Following an insertion of an intra-aortic balloon pump, the patient was transferred to the CICU. A repeat echocardiogram in the CICU two hours later revealed a classical echocardiographic presentation of Takotsubo syndrome, apical hypokinesis. By the next morning the patient's hemodynamic status significantly improved, the balloon pump was removed, and vasopressors were discontinued. Another echocardiogram was performed 24 hours after the event occurred and revealed a marked improvement in LV systolic function (EF 60%), with complete resolution of apical and septal wall motion abnormalities. Three days after the event, the patient was successfully discharged and asymptomatic at two-month follow-up. This case illustrates an atypical presentation of Takotsubo syndrome that was witnessed from onset to its complete resolution during the patient's hospital stay.
Cardiopulmonary rehabilitation in post-COVID-19 patients: case series
Authors: Cláudia Tozato, Bruno Fernandes Costa Ferreira, Jonathan Pereira Dalavina, Camila Vitelli Molinari, Vera Lúcia Dos Santos Alves
Journal: Rev Bras Ter Intensiva (2021)
MeSH terms: COVID-19 / rehabilitation, Cardiac Rehabilitation / methods, Dyspnea / rehabilitation, Fatigue / rehabilitation, Muscle Strength, Walk Test, Case Reports, Adult, Aged, Breathing Exercises / methods, COVID-19 / complications, Female, Humans, Male, Middle Aged, Respiratory Therapy / methods

The natural history of the disease, and the treatment of post-COVID-19 patients, are still being built. Symptoms are persistent, even in mild cases, and the infection consequences include fatigue, dyspnea, tachycardia, muscle loss, and reduced functional capacity. Regarding cardiopulmonary rehabilitation, there seems to be an improvement in functional capacity, quality of life, and prognosis with the 6-Minute Walk Test used as a prognostic and therapeutic evaluator. Therefore, this case series report aims to present our experience with four cases of different severity levels, involved in a post-COVID-19 cardiopulmonary rehabilitation program. These patients were assessed with the 6-Minute Walk Test, peripheral muscle strength, and double product at rest, to assess the results after a three-month rehabilitation protocol of at least 300 minutes per week. The four patients had their distance covered during the walk test increased between 16% and 94%. Peripheral muscle strength was improved by 20% to six times the baseline values, and double product at rest was reduced by 8% to 42%. The cardiopulmonary rehabilitation program had a positive impact on these cases, improving functional capacity despite the different severity levels in these post-COVID-19 cases.
Infective Endocarditis, a Rare Complication of Late Neonatal Group B Strep Sepsis
Authors: Daniel McLennan, Gareth Morgan
Journal: Front Pediatr (2018)
Keywords: group b streptococcus, hemorrhagic stroke, infective endocarditis, mycotic aneurysm, neonate
MeSH terms: Case Reports

Background: Infective endocarditis (IE) is extremely rare in infants with structurally normal hearts. We present a case of Group B Streptococcus (GBS) endocarditis in a 5 week old. Clinical Case: A 5-week old male presented to his local hospital with fever and was diagnosed with GBS sepsis. He received 4 days of intravenous antibiotics and was discharged home with 6 days of oral antibiotics. He re-presented 5 days after discharge with severe sepsis as well as a new pathological pan systolic murmur and was diagnosed with IE following echocardiographic identification of a mitral valve vegetation. He was subsequently transferred to a tertiary cardiology center. Ten days after readmission he developed an intracranial hemorrhage associated with rupture of a mycotic aneurysm requiring emergency evacuation. Conclusion: Late-onset GBS sepsis is rare, but when improperly treated can have severe consequences. Infant IE is extremely rare. When diagnosed prompt treatment must be initiated to provide the best outcome for the patient, including consideration of surgical removal of the vegetation.
Coexistence of Axial Spondyloarthritis and Idiopathic Inflammatory Myopathy
Authors: Yongpeng Ge, Linrong He
Journal: Case Rep Rheumatol (2020)
MeSH terms: Case Reports

Both axial spondyloarthritis (axSpA) and idiopathic inflammatory myopathy (IIM) are infrequent, and their coexistence is even rarer; there are a few reported cases in the literature. The aim of this study was to assess their association and clinical and laboratory features in our patients. The clinical data of patients with axSpA and IIM diagnosed in China-Japan Friendship Hospital from July 2015 to February 2019 were retrospectively analyzed. This study included 7 patients with axSpA who met the IIM criteria, including 3 males and 4 females. The age of onset was 16 to 39 years. Four patients were HLA-B27 positive, and three were negative. All patients were first diagnosed as axSpA, and then IIM was detected after 0.5-20 years (mean ± SD, 9.9 ± 5.0 years). After being diagnosed to have axSpA and IIM, those patients were given prednisone and immunosuppressant drugs, and their symptoms gradually improved. Our study provides further evidence of the coexistence of IIM with axSpA. In patients with axSpA who have skin rash, interstitial lung disease (ILD), myalgia, or muscle weakness, we should suspect that they may have IIM.
Oral verruciform xanthoma: a case report and literature review
Authors: Yonara Maria Freire Soares Marques, Cleverton Roberto de Andrade, Suzana Cantanhede Orsini Machado de Sousa, Cláudia Maria Navarro
Journal: Case Rep Pathol (2014)

Oral verruciform xanthoma represents an uncommon entity, which affects mainly oral mucosa. This paper presents the major clinical and histological features of oral verruciform xanthoma and reports a case on the tongue. The differential diagnosis and a literature review are also provided in light of recent information.
Stress-Induced Cardiomyopathy: As a Diagnosis That Is Time Sensitive and Anticipative in Certain Individuals
Authors: Vishal Dhulipala, Prema Bezwada, Rashika Gottimukkula, Joseph Abboud
Journal: Case Rep Cardiol (2018)
MeSH terms: Case Reports

Stress-induced cardiomyopathy, also known as Takotsubo cardiomyopathy, presents as an acute coronary syndrome. However, the physiology and pathogenesis are different. It is imperative to treat stress-induced cardiomyopathy as an acute coronary syndrome, and once diagnosed, it is imperative to assess and treat heart failure and wait for the impaired myocardial energetics to resolve. At times, the myocardial recuperation is quick that we miss the diagnosis of Takotsubo cardiomyopathy.
Pure nongestational choriocarcinoma of the ovary: a case report
Authors: Youn Jin Choi, Keun Young Chun, Yong Wook Kim, Duck Yeong Ro
Journal: World J Surg Oncol (2013)
MeSH terms: Choriocarcinoma, Non-gestational / pathology, Ovarian Neoplasms / pathology, Case Reports, Adult, Antineoplastic Combined Chemotherapy Protocols / therapeutic use, Choriocarcinoma, Non-gestational / drug therapy, Choriocarcinoma, Non-gestational / surgery, Combined Modality Therapy, Dactinomycin / administration & dosage, Etoposide / administration & dosage, Female, Humans, Methotrexate / administration & dosage, Ovarian Neoplasms / drug therapy, Ovarian Neoplasms / surgery, Prognosis, Dactinomycin, Etoposide, Methotrexate

Pure ovarian choriocarcinoma can be gestational or nongestational in origin. Nongestational choriocarcinoma of the ovary is extremely rare, and its diagnosis is very difficult during the reproductive years. We present a case of a 33-year-old woman diagnosed with pure nongestational ovarian choriocarcinoma. Following surgery, multiple courses of a chemotherapy regimen of etoposide, methotrexate, and actinomycin-D (EMA) were effective.
Does a Lack of Awareness of Cycloid Psychosis Hamper Adequate Treatment for Patients Suffering From This Disorder? A Case Report
Authors: Armand Hausmann, Julia Dehning, Michel Heil, Laurin Mauracher, Georg Kemmler, Heinz Grunze
Journal: Front Psychiatry (2020)
Keywords: case-report, catatonia, classification systems, cyclicity, cycloid psychosis, lithium, mood stabilizers, valproic acid
MeSH terms: Case Reports

Categorial systems of nosology are based on a cross-sectional enumeration of symptoms with a predefined cut-off, but hardly capture rapid fluctuations of manifestation nor longitudinal characteristics, e.g., cyclicity. Especially with disorders presenting with an admixture or frequent change of psychotic and affective symptoms, diagnostic specifity of the DSM and ICD diminishes. In those instances, alternative concepts as cycloid psychosis might display more accurately the very characteristics and course of a mental disorder and help to tailor individualized treatments. Karl Leonhard described three major subtypes of cycloid psychosis: anxiety-happiness psychosis, confusion psychosis, and motility psychosis, all showing a pleiomorphic symptom profile resembling intraphasic switching of poles. Here we present the case of a 59-year-old woman suffering from cycloid psychosis as defined by the criteria of Perris. Between 2013 and June 2019, the patient was admitted 35 times for compulsory treatment. A frequent change of diagnoses, ranging from adjustment disorder to complex PTSD, and from unipolar depression to "pseudoneurotic schizophrenia," resembles the puzzling manifestations. Most of the time the patient was labeled as schizoaffective disorder despite never displaying clear psychotic core symptoms. Despite treatment with different antipsychotics including LAI the cumulative length of hospitalization increased steadily from 74 days in 2014 to 292 days in 2017. When reviewing the case in 2017 the longitudinal pattern of her disorder and the diverse acute manifestations were finally conceptualized as a cyclic on-off of an atypical psychosis. After starting lithium to pre-existing LAI antipsychotics and valproic acid, the number of days per year spent in inpatient care sharply dropped to 136 in 2018. We propose to reconsider cycloid psychosis as a useful clinical concept whose descriptive value, validity and utility for treatment decisions should be further evaluated. Lithium alone or in addition to valproic acid may act on cyclicity as a core symptom of cycloid psychosis as well as of bipolar disorder, even in the absence of major affective symptoms.
Primary leiomyosarcoma of thyroid gland: the youngest case
Authors: Mouna Ayadi, Azza Gabsi, Khdija Meddeb, Amina Mokrani, Yosra Yahiaoui, Feryel Letaief, Nesrine Chraiet, Henda Rais, Amel Mezlini
Journal: Pan Afr Med J (2017)
Keywords: thyroid, pathology, sarcoma, treatment
MeSH terms: Goiter, Nodular / pathology, Leiomyosarcoma / diagnosis, Thyroid Neoplasms / diagnosis, Case Reports, Adult, Age Factors, Female, Goiter, Nodular / surgery, Humans, Leiomyosarcoma / pathology, Leiomyosarcoma / surgery, Thyroid Neoplasms / pathology, Thyroid Neoplasms / surgery, Thyroidectomy / methods

Primary leiomyosarcomas of the thyroid gland are extremely rare. We report a case of a 32 year-old women with a multinodular goiter. She underwent total thyroidectomy. The tumor histology showed spindle-shaped cells that expressed desmine, caldesmone and smooth muscle actine but were negative cytokeratins.
Aneurysmal bone cyst of the mandible: A case report and review of literature
Authors: Parvathi Devi, Vb Thimmarasa, Vishal Mehrotra, Mayuri Agarwal
Journal: J Oral Maxillofac Pathol (2011)
Keywords: aneurysmal bone cyst, benign bone lesions, mandible, psuedocyst
MeSH terms: Case Reports

Aneurysmal bone cyst (ABC) is rare benign lesions of bone which are infrequent in craniofacial skeleton. ABC's are characterized by rapid growth pattern with resultant bony expansion and facial asymmetry. We describe a case of ABC in a 25 year old male patient affecting the body of the mandible with expansion and thinning of the buccal and lingual cortical plates. Treatment consisted of surgical curettage of the lesion. A one year follow- up showed restoration of facial symmetry and complete healing of the involved site.
A rare presentation of hepatolithiasis in an adolescent patient: A case report
Authors: Jonathan Freise, Jorge Mena, Kwun Wah Wen, Marshall Stoller, Sunita Ho, Carlos Corvera
Journal: Int J Surg Case Rep (2020)
Keywords: adolescent, case report, hepatic duct, hepatolithiasis, intrahepatic stone
MeSH terms: Case Reports

Introduction:
Hepatolithiasis (intrahepatic stones) is rare in adolescent patients and requires complex management strategies to prevent recurrent infections and progression to hepatic fibrosis. Surgical management is often required. In cases of unclear etiology, further work-up is indicated to provide insight into future management. In this report we describe an extensive stone analysis.
Presentation of case:
A 20-year-old Caucasian female presented with known hepatolithiasis and multiple prior recurrent bouts of abdominal pain requiring hospitalization. Magnetic resonance cholangiopancreatography (MRCP) demonstrated an abnormal left-sided hepatic biliary ductal system dilatation. She was treated surgically with a formal left hepatectomy and preservation of the caudate lobe. The right ductal system had no stones or evidence of inflammation, and her bile and stones cultures were negative for organism growth. An extensive analysis demonstrated stone composition primarily of cholesterol.
Discussion:
Adolescent presentations of hepatolithiasis are rare and considerations in the differential diagnosis include primary sclerosing cholangitis, bile acid transporter defects, and other known genetic diseases. This case is unique because only the left half of the intrahepatic ductal system had evidence of stone disease and the bile was sterile. A detailed stone analysis demonstrating cholesterol supersaturation provides additional context though the etiology remains unclear in this case and will require lifelong follow-up.
Conclusion:
Early-onset hepatolithiasis is rare and requires expert management, and in some cases definitive surgical management with life-long follow-up. Extensive stone analysis and genetic testing can be performed to help identify disease etiology in unique cases.
Hypersensitivity Pneumonitis From Fire-Retardant Spray in a Patient With Multiple Lung Pathologies and Elevated Immunoglobulin E
Authors: Rohan Madhu Prasad, Tyler Kemnic, Abdullah Al-Abcha, Akhil Sharma, Shilpa Kavuturu
Journal: Ochsner J (2021)
Keywords: alveolitis–extrinsic allergic, chemical fire-retardant spray, cigarette smoking, immunoglobulin e, nonmetalworking fluids
MeSH terms: Case Reports

Background: Hypersensitivity pneumonitis, also known as extrinsic allergic alveolitis, is a pulmonary disease with large knowledge gaps, including etiology, pathogenesis, diagnosis, and treatment. Case Report: A 58-year-old male with a pertinent history of recurrent Mycobacterium malmoense presented to a tertiary emergency department after 1 week of difficulty breathing. He also reported a productive cough and fevers. The patient was an active smoker and was recently exposed to chemical fire-retardant spray. Chest x-ray showed extensive bilateral pulmonary infiltrates. The tertiary center initiated cefpodoxime 200 mg twice daily for 5 days and home azithromycin for possible pneumonia. However, the patient returned the next day with worsening symptoms. After the patient transferred to our institution, physical examination revealed a hypoxic patient with bibasilar crackles and wheezes. Laboratory tests revealed elevated white blood cell count, sedimentation rate, and immunoglobulin E. Chest computed tomography demonstrated growth of a previously noted right upper lobe intracavitary lesion and new onset diffuse interstitial pulmonary ground-glass airspace opacities. Hypersensitivity pneumonitis panel demonstrated positive antibodies to Aspergillus fumigatus antibody precipitin 1 and Micropolyspora faeni. The patient was given oral prednisone and advice on proper respiratory precautions in the workplace. Conclusion: This case illustrates that hypersensitivity pneumonitis can develop via chemical fire-retardant spray. Additionally, patients with a smoking history and elevated immunoglobulin E should be evaluated for severe forms of the disease.
A Case of Diabetic Ketoacidosis in a Patient on an SGLT2 Inhibitor and a Ketogenic Diet: A Critical Trio Not to Be Missed
Authors: Samantha Steinmetz-Wood, Matthew Gilbert, Katherine Menson
Journal: Case Rep Endocrinol (2020)
MeSH terms: Case Reports

Results from major clinical trials have shown significant cardiorenal-protective benefits of SGLT2 inhibitors in patients with type 2 diabetes (T2DM), leading to increased popularity. A rare but serious side effect of SGLT2 inhibitors is euglycemic diabetic ketoacidosis (EDKA), which presents more covertly but has been described. Identification and report of modifiable risk factors would be an important step in helping clinicians appropriately counsel patients. In this case report, we present DKA in a patient on an SGLT2 inhibitor and ketogenic diet (KD). A 47-year-old male with a history of poorly controlled T2DM on metformin and empagliflozin presented to the emergency department (ED) with several days of pharyngitis, dyspnea, emesis, abdominal pain, and anorexia. Of note, one month prior to this event, he presented to the ED with malaise and was found to have an anion gap of 21, a bicarbonate level of 13 mmol/L, a pH level of 7.22, 3+ ketonuria, and a glucose level of 7 mmol/L (127 mg/dl). Additional workup was negative, and findings were attributed to his KD. His use of empagliflozin was not identified on his medication list. At second presentation, the patient was tachypneic and tachycardic and had mild abdominal tenderness. Labs revealed anion gap 28, bicarbonate 5 mmol/l, pH 6.94, 3+ ketonuria, glucose 14.9 mmol/L (269 mg/dl), and beta-hydroxybutyrate 8.9 mmol/L. The patient was diagnosed with DKA and was treated accordingly. With closure of anion gap, the patient was transitioned to insulin and metformin, and his empagliflozin was discontinued indefinitely. Before prescribing this medication class, physicians should inquire about low-carbohydrate diets given the higher risk for DKA, though knowledge of this risk is still not widespread.
Cerebellar Neurocysticercosis as Long-Term Complication of Allogeneic Haematopoietic Stem Cell Transplantation from Haploidentical Donor
Authors: Federico Meconi, Giulia Ciangola, Benedetta Mariotti, Raffaella Cerretti, Laura Cudillo, William Arcese, Alessandra Picardi
Journal: Case Rep Infect Dis (2019)
MeSH terms: Case Reports

Neurocysticercosis, an infection of the central nervous system with the larval stage of the cestode Taenia solium, is uncommon in developed countries. We report a case of allogeneic haematopoietic stem cell transplantation from a haploidentical donor complicated, in the long term, by T. solium infection of the central nervous system and successfully treated with empiric antiparasitic therapy with albendazole plus dexamethasone. Revised diagnostic criteria proposed by Del Brutto et al. were used for the definitive diagnosis of cerebellar neurocysticercosis.
Hyperhemolysis Syndrome without Underlying Hematologic Disease
Authors: Lauren Anne Eberly, Diaa Osman, Nathaniel Perryman Collins
Journal: Case Rep Hematol (2015)

Introduction. Hyperhemolysis is characterized by a life-threatening hemolytic transfusion reaction, with hemoglobin (Hb) and hematocrit (Hct) dropping markedly lower than before transfusion. This phenomenon, commonly described in sickle cell disease, is a rare occurrence in patients without hemoglobinopathies. Case Report. A 55-year-old male presented to the hospital after a motorcycle crash and received 10 units of cross-matched blood for active bleeding. The patient was blood group O, with a negative antibody screen. Ten days later, he represented complaining of dyspnea and was found to have a hematocrit of 12%. The direct antiglobulin test was positive for anti-immunoglobin G and complement. Indirect antiglobulin test was positive for anti-Jka alloantibodies. The presence of Jka antigen was revealed in one unit of previously transfused blood; patient's RBCs were negative for the Jka antigen. Laboratory data demonstrated findings consistent with DHTR, as well as reticulopenia and elevated ferritin levels. He continued to show signs of active hemolysis, requiring a total of 4 subsequent units of pRBCs. Each transfusion precipitated a drop in Hb and Hct to levels lower than before transfusion; once transfusions were held, the patient slowly recovered. Discussion. Hyperhemolysis in the setting of a DHTR can occur in patients without hematologic disease.