OpenMed/multicare-articles huggingface dataset:
Takotsubo Cardiomyopathy With Inconspicuous Initial Electrocardiogram: A Potentially Serious Cardiac Pathology Related to Emotional Stress
Authors: Mohamed Elsayed, Bernhard J Connemann, Tillman Dahme, Temsgen Tesfay, Maximilian Gahr
Journal: Front Psychiatry (2019)
Keywords: takotsubo cardiomyopathy, acute coronary syndrome, electrocardiagram, emotional stress, major depressive disorder
MeSH terms: Case Reports

Introduction: Takotsubo cardiomyopathy (TCM) is frequently associated with emotional or physical stress. Thus, patients with TCM might present primarily at a psychiatric clinic. Appropriate diagnosis and therapy may thus be delayed. Case report: A 43-year-old female patient presented as an emergency to the psychiatric outpatient clinic after experiencing severe work-related bullying. On admission, she complained of acute left thoracic chest pain as well as depressed mood, low energy, anhedonia, generalized anxiety, and sleep difficulties, present for several weeks. The initial electrocardiogram (ECG) was unremarkable; serum troponin levels, however, were markedly elevated. The patient was transferred to the department of cardiology. Via cardiac catheterization and MRI, an acute coronary syndrome was excluded and apical ballooning and left ventricular dysfunction, compatible with TCM, was found. Conclusion: Patients with acute psychopathology, recent emotional or physical stress, and acute cardiothoracic symptoms should receive immediate cardiological investigations. As the ECG may be normal in patients with TCM, concurrent measurement of the troponin serum level is recommended. Psychiatrists should consider TCM in patients who report recent stressful events accompanied by cardiothoracic symptoms.
Recurrent Subclavian Steal Syndrome: A Novel Case of Vasculopathy
Authors: Daniel F Leach 3rd, Daniel M Radwanski, Paramjit Kaur, David D Das, Mamatha Kondapalli
Journal: Cureus (2023)
Keywords: digital subtraction angiography(dsa), orthostatic cerebral hypoperfusion syndrome, subclavian steal syndrome, transcranial doppler ultrasound, vertebrobasilar insufficiency (vbi)
MeSH terms: Case Reports

Subclavian steal syndrome (SSS) refers to the phenomenon of retrograde flow in an ipsilateral branch of the subclavian artery due to hemodynamically significant stenosis or occlusion of the ipsilateral proximal subclavian artery. While SSS is usually asymptomatic, it can manifest as vertebrobasilar insufficiency (VBI), ischemia of the affected extremity, or cardiac angina when an internal mammary artery (IMA) is used as a bypass graft. The underlying etiology is most often atherosclerosis but can include Takayasu arteritis, thoracic outlet syndrome, cervical rib, and stenosis secondary to surgical repair of aortic coarctation or tetralogy of Fallot. There are several case reports describing unique presentations of SSS as well as limited reports of double SSS, where the brachiocephalic steno-occlusive disease causes flow reversal in both the ipsilateral vertebral and carotid arteries. We report herein the first documented case, to our knowledge, of a patient with SSS previously treated with left subclavian artery stenting and left common carotid-subclavian bypass who developed recurrent SSS in conjunction with orthostatic cerebral hypoperfusion syndrome (OCHOS) secondary to severe vasculopathy. She presented with recurrent, paroxysmal vertigo and near-syncope associated with left upper extremity paresthesias that would only abate with sitting in the context of left subclavian artery stent restenosis and occlusion of her left common carotid-subclavian bypass graft. Interestingly, her initial presentation entailed retrograde flow from the left vertebral artery to the left subclavian artery, classic for SSS, but recurrence of her SSS involved retrograde flow from the left common carotid artery to the left subclavian artery, a phenomenon which has also not been described in the literature to our knowledge. As her symptoms of VBI appeared to be triggered by standing and not left arm movement, they were considered to be primarily secondary to OCHOS. Consequently, her primary treatment was to increase salt and fluid intake and thus increase intravascular volume for improved cerebral perfusion as she was not deemed to be a suitable candidate for regrafting of the left subclavian artery.
Exome sequencing and functional analysis identifies a novel mutation in EXT1 gene that causes multiple osteochondromas
Authors: Feng Zhang, Jinlong Liang, Xiong Guo, Yingang Zhang, Yan Wen, Qiang Li, Zengtie Zhang, Weijuan Ma, Lanlan Dai, Xuanzhu Liu, Ling Yang, Jun Wang
Journal: PLoS One (2013)
MeSH terms: Exons, Exostoses, Multiple Hereditary / genetics, Mutation, N-Acetylglucosaminyltransferases / genetics, Case Reports, Research Support, Non-U.S. Gov't, Adolescent, Adult, Codon, Exome, Exostoses, Multiple Hereditary / diagnosis, Female, Frameshift Mutation, High-Throughput Nucleotide Sequencing, Humans, Knee Joint / diagnostic imaging, Knee Joint / pathology, Male, Pedigree, Polymorphism, Single Nucleotide, Radiography, Young Adult, Codon, N-Acetylglucosaminyltransferases, exostosin-1

Multiple osteochondromas (MO) is an inherited skeletal disorder, and the molecular mechanism of MO remains elusive. Exome sequencing has high chromosomal coverage and accuracy, and has recently been successfully used to identify pathogenic gene mutations. In this study, exome sequencing followed by Sanger sequencing validation was first used to screen gene mutations in two representative MO patients from a Chinese family. After filtering the data from the 1000 Genome Project and the dbSNP database (build 132), the detected candidate gene mutations were further validated via Sanger sequencing of four other members of the same MO family and 200 unrelated healthy subjects. Immunohistochemisty and multiple sequence alignment were performed to evaluate the importance of the identified causal mutation. A novel frameshift mutation, c.1457insG at codon 486 of exon 6 of EXT1 gene, was identified, which truncated the glycosyltransferase domain of EXT1 gene. Multiple sequence alignment showed that codon 486 of EXT1 gene was highly conserved across various vertebrates. Immunohistochemisty demonstrated that the chondrocytes with functional EXT1 in MO were less than those in extragenetic solitary chondromas. The novel c.1457insG deleterious mutation of EXT1 gene reported in this study expands the causal mutation spectrum of MO, and may be helpful for prenatal genetic screening and early diagnosis of MO.
Recurrent Coronary Vasospasm: A Case of Kounis Syndrome from Anaphylaxis to Contrast Dye
Authors: Katherine Lee Chuy, Proddutur R Reddy, Aviral Vij
Journal: Methodist Debakey Cardiovasc J (2022)
Keywords: kounis syndrome, anaphylaxis, contrast dye, coronary artery disease, hypersensitivity, vasospasm
MeSH terms: Acute Coronary Syndrome / diagnostic imaging, Acute Coronary Syndrome / therapy, Anaphylaxis / chemically induced, Anaphylaxis / diagnosis, Anaphylaxis / therapy, Coronary Vasospasm / chemically induced, Coronary Vasospasm / diagnostic imaging, Coronary Vasospasm / therapy, Kounis Syndrome / diagnosis, Kounis Syndrome / etiology, Kounis Syndrome / therapy, Case Reports, Humans, Shock, Cardiogenic

Kounis syndrome is characterized by acute coronary syndrome due to coronary vasospasm or thrombosis following exposure to an allergic stimulus. The presentation can be compounded by cardiovascular collapse due to cardiogenic shock from coronary vasospasm and associated vasodilatory shock from anaphylaxis. A high index of suspicion is crucial for prompt initiation of treatment, which focuses on managing the allergic or anaphylactic process. Here we present a case of coronary vasospasm and anaphylactic shock due to contrast dye exposure during percutaneous coronary intervention of an unstable coronary lesion and its associated diagnostic and therapeutic challenges.
Suspected azathioprine induced liver cirrhosis: an unusual side effect
Authors: Aida Ben Slama Trabelsi, Eya Hamami, Ahlem Souguir, Mehdi Ksiaa, Salem Ajmi, Ali Jmaa
Journal: Pan Afr Med J (2014)
Keywords: azathioprine, crohn′s disease, hepatotoxicity, liver cirrhosis
MeSH terms: Azathioprine / adverse effects, Chemical and Drug Induced Liver Injury, Immunosuppressive Agents / adverse effects, Liver Cirrhosis / chemically induced, Case Reports, Female, Humans, Middle Aged, Immunosuppressive Agents, Azathioprine

In recent years, the hepatotoxic potential of thiopurines, in particular 6-thioguanine (6-TG) has been discussed in literature. However, cirrhosis was exceptionally reported. We report the case of a 56-year-old woman with ileocaecal Crohn's disease treated with azathioprine. After taking azathioprine (2 mg/kg daily) for four years, she underwent surgical treatment for acute intestinal obstruction. In peroperative, we noticed a cirrhotic liver. A surgical biopsy was performed and the diagnosis of cirrhosis was confirmed. Autoimmune and viral liver diseases were ruled out by laboratory parameters. Therefore, Azathioprine is believed to be the causative actor for inducing liver cirrhosis. Thus, treating inflammatory bowel disease effectively while trying to limit iatrogenic disease is a continuous struggle.
Rivaroxaban Treatment for Warfarin-Refractory Thrombosis in a Patient with Hereditary Protein S Deficiency
Authors: Koken Ameku, Mariko Higa
Journal: Case Rep Hematol (2018)
MeSH terms: Case Reports

Protein S (PS) deficiency, an autosomal dominant hereditary thrombophilia, is more prevalent in East Asian populations than in Caucasians. PS-deficient patients have historically been administered a heparin product followed by warfarin for the treatment and secondary prevention of venous thromboembolism (VTE). However, warfarin can be ineffective or causes detrimental effects in rare cases. While direct oral anticoagulants (DOACs) are being increasingly used for the treatment and prevention of VTE, their efficacy in PS-deficient patients has not been established. We describe a 91-year-old woman who presented with chronic bilateral lower leg swelling with VTE that was refractory to warfarin anticoagulation therapy for over 1 year. Her recurrent VTE was diagnosed as quantitative hereditary PS deficiency. Rivaroxaban was administered as maintenance therapy instead of warfarin; after 8 weeks, the severities of the patient's leg swelling and venous ulcerations were significantly reduced with rivaroxaban compared to warfarin, thus demonstrating the efficacy of rivaroxaban for warfarin-refractory chronic VTE associated with hereditary PS deficiency. This case illustrates that rivaroxaban can potentially serve as therapeutic agents to treat warfarin-refractory VTE in PS-deficient patients. Further investigations are required to confirm the efficacy of rivaroxaban on the long term in this regard.
Case report: Be alert to herpes zoster after total knee arthroplasty
Authors: Zhanqi Wei, Xisheng Weng
Journal: Front Surg (2023)
Keywords: herpes zoster (hz), infection, pain, total knee arthroplasty (tka), varicella zoster virus (vzv)
MeSH terms: Case Reports

An 88-year-old woman started complaining of severe pain at the right knee and above at three weeks after right total knee arthroplasty (TKA). The empirical treatment cannot effectively control the progress of pain. The lesion was eventually diagnosed to be due to herpes zoster (HZ). The finding of HZ was unexpected in this case, because HZ is extremely rare in patients after TKA.
Case report of optic disc drusen with simultaneous peripapillary subretinal hemorrhage and central retinal vein occlusion
Authors: David Zhiwei Law, Francine Pei Lin Yang, Stephen Charn Beng Teoh
Journal: Case Rep Ophthalmol Med (2014)

A 52-year-old Chinese gentleman presented with right eye floaters and photopsia over one week. His visual acuities were 20/20 bilaterally. Posterior segment examination showed a right eye swollen optic disc and central retinal vein occlusion (CRVO) associated with an area of subretinal hemorrhage adjacent to the optic disc. Fundus fluorescein (FA) and indocyanine green angiographies (ICGA) of the right eye did not demonstrate choroidal neovascularization (CNV), polypoidal choroidal vasculopathy (PCV), or retinal ischemia. Ultrasound B-scan revealed optic disc drusen (ODD). In view of good vision and absence of CNV, he was managed conservatively with spontaneous resolution after two months. Commonly, ODD may directly compress and mechanically rupture subretinal vessels at the optic disc, resulting in peripapillary subretinal hemorrhage, as was likely the case in our patient. Mechanical impairment of peripapillary circulation also results in retinal ischemia and may trigger the development of choroidal neovascularization (CNV) and/or polypoidal choroidal vasculopathy (PCV), leading to subretinal haemorrhage. Compromise in central venous outflow with increased retinal central venous pressure from the direct mechanical effects of enlarging ODD results in central retinal vein occlusion (CRVO). Patients with subretinal hemorrhage and CRVO from ODD should be monitored closely for the development of potentially sight-threatening complications.
Fulminant hepatic and multiple organ failure following acute viral tonsillitis: a case report
Authors: Ursina Bechtel-Grosch, Charles Beguelin, Sabina Berezowska, Jean-Francois Dufour, Jukka Takala, Joerg C Schefold
Journal: J Med Case Rep (2016)
MeSH terms: Acyclovir / therapeutic use, Antiviral Agents / therapeutic use, Herpes Simplex / complications, Herpesvirus 2, Human / isolation & purification, Liver Failure, Acute / virology, Multiple Organ Failure / virology, Tonsillitis / complications, Tonsillitis / virology, Case Reports, Acute Disease, Aged, Critical Care, Herpes Simplex / drug therapy, Herpes Simplex / physiopathology, Humans, Liver / virology, Liver Failure, Acute / drug therapy, Male, Multiple Organ Failure / drug therapy, Tonsillitis / surgery, Treatment Outcome, Antiviral Agents, Acyclovir

Background:
Pyogenic tonsillitis may often be observed in the general Western population. In severe cases, it may require antibiotic treatment or even hospitalization and often a prompt clinical response will be noted. Here we present an unusual case of progressive multiple organ failure including fulminant liver failure following acute tonsillitis initially mistaken for "classic" pyogenic (that is bacterial) tonsillitis.
Case presentation:
A 68-year-old previously healthy white man was referred with suspicion of pyogenic angina. After tonsillectomy, he developed acute liver failure and consecutive multiple organ failure including acute hemodynamic, pulmonary and dialysis-dependent renal failure. Immunohistopathological analysis of his tonsils and liver as well as serum polymerase chain reaction analyses revealed herpes simplex virus-2 to be the causative pathogen. Treatment included high-dose acyclovir and multiorgan supportive intensive care therapy. His final outcome was favorable.
Conclusions:
Fulminant herpes simplex virus-2-induced multiple organ failure is rarely observed in the Western hemisphere and should be considered a potential diagnosis in patients with tonsillitis and multiple organ failure including acute liver failure. From a clinical perspective, it seems important to note that fulminant herpes simplex virus-2 infection may masquerade as "routine" bacterial severe sepsis/septic shock. This persevering condition should be diagnosed early and treated goal-oriented in order to gain control of this life-threatening condition.
Necrotizing fasciitis versus pyoderma gangrenosum: securing the correct diagnosis! A case report and literature review
Authors: Kamal Bisarya, Silvan Azzopardi, George Lye, Peter James Drew
Journal: Eplasty (2011)

Objective:
To highlight the key differences in history, examination, and management of pyoderma gangrenosum and necrotizing fasciitis and to outline the importance of distinguishing these 2 conditions.
Method:
We present a case report of a gentleman with a background of ulcerative colitis having a 1-week history of an erythematous wound and localized abscess to the right leg that failed to respond to antibiotic treatment and later on to surgical debridement of a presumed necrotizing fasciitis. Following referral to our plastic surgery unit, a diagnosis of pyoderma gangrenosum was made and this was confirmed following a response to steroid therapy within 48 hours. A literature review of pyoderma gangrenosum cases misdiagnosed for necrotizing fasciitis was carried out to compare and contrast pitfalls in misdiagnosing these 2 conditions.
Results:
Literature review of 10 cases confirmed the association of pyoderma gangrenosum with inflammatory bowel disease, hematological disease, and surgical trauma. The presence of necrotic tissue in a pyoderma gangrenosum lesion can be a diagnostic pitfall; although blood and tissue culture investigations are usually negative in pyoderma gangrenosum, this may not always be the case. Inflammatory markers can be significantly high in pyoderma gangrenosum and pyrexia is not a feature limited to necrotizing fasciitis.
Conclusions:
Inappropriate surgical debridement of pyoderma gangrenosum can cause rapid extension of the lesion by enhancing the posttraumatic response and lead to potential reconstructive challenges with psychological repercussions. On the contrary, treating necrotizing fasciitis with immunosuppressive therapy may worsen the condition. The importance of understanding the pathogenesis, clinical features, and management of both conditions cannot be overemphasized.
Case Report of Ectopic Liver on Gallbladder Serosa with a Brief Review of the Literature
Authors: Vishnu R Mani, Mohammad S Farooq, Utsav Soni, Aleksandr Kalabin, Ajai S Rajabalan, Leaque Ahmed
Journal: Case Rep Surg (2016)

This case describes an intraoperative incidental finding and surgical removal of ectopic liver tissue attached to the gallbladder during a standard laparoscopic cholecystectomy for acute cholecystitis. These anomalies are rare, with interesting associations and possible clinically relevant complications. The details of the case, along with a brief literature review of embryology, common ectopic sites, and associations/complications, are presented in this paper. Since laparoscopic cholecystectomy is a very common procedure, it is important to increase vigilance of ectopic liver tissues during surgeries to minimize complications and provide optimal management.
COVID-19 Infection and Acute Pancreas Transplant Graft Thrombosis
Authors: Umasankar Mathuram Thiyagarajan, Khaled Dajani, Blaire Anderson, David Bigam, A M James Shapiro
Journal: Cureus (2023)
Keywords: acute abdomen in covid-19, covid-19, graft failure, graft thrombosis, pancreas transplantation, surgical acute abdomen, transplant pancreatectomy
MeSH terms: Case Reports

The coronavirus disease 2019 (COVID-19) pandemic created an unprecedented challenge for healthcare, and the world continues to struggle in recovering from its aftermath. COVID-19 has been clearly linked to hypercoagulable states and can lead to end-organ ischemia, morbidity, and mortality. Immunosuppressed solid organ transplant recipients represent a highly vulnerable population for the increased risk of complications and mortality. Early venous or arterial thrombosis with acute graft loss after whole pancreas transplantation is well-described, but late thrombosis is rare. We herein report a case of acute, late pancreas graft thrombosis at 13 years post pancreas-after-kidney (PAK) transplantation coinciding with an acute COVID-19 infection in a previously double-vaccinated recipient.
Case Report: Life-Threatening Macrophage Activation Syndrome With Fulminant Myocarditis Successfully Rescued by High Dose Intravenous Anakinra
Authors: Alessandra Meneghel, Giorgia Martini, Angela Amigoni, Andrea Pettenazzo, Massimo Padalino, Francesco Zulian
Journal: Front Pediatr (2021)
Keywords: ecmo, anakinra, macrophage activation syndrome, myocarditis, systemic juvenile idiopathic arthritis
MeSH terms: Case Reports

Macrophage activation syndrome (MAS) is a rare, potentially life-threatening, condition triggered by infections or flares in rheumatologic and neoplastic diseases. The mainstay of treatment includes high dose corticosteroids, intravenous immunoglobulins and immunosuppressive drugs although, more recently, a more targeted approach, based on the use of selective cytokines inhibitors, has been reported. We present the case of a two-year-old boy with 1-month history of high degree fever associated with limping gait, cervical lymphadenopathy and skin rash. Laboratory tests showed elevation of inflammatory markers and ferritin. By exclusion criteria, systemic onset Juvenile Idiopathic Arthritis (sJIA) was diagnosed and steroid therapy started. A couple of weeks later, fever relapsed and laboratory tests were consistent with MAS. He was promptly treated with high doses intravenous methylprednisolone pulses and oral cyclosporin A. One day later, he developed an acute myocarditis and a systemic capillary leak syndrome needing intensive care. Intravenous Immunoglobulin and subcutaneous IL-1-antagonists Anakinra were added. On day 4, after an episode of cardiac arrest, venous-arterial extracorporeal membrane oxygenation (VA-ECMO) was started. Considering the severe refractory clinical picture, we tried high dose intravenous Anakinra (HDIV-ANA, 2 mg/Kg q6h). This treatment brought immediate benefit: serial echocardiography showed progressive resolution of myocarditis, VA-ECMO was gradually decreased and definitively weaned off in 6 days and MAS laboratory markers improved. Our case underscores the importance of an early aggressive treatment in refractory life-threatening sJIA-related MAS and adds evidence on safety and efficacy of HDIV-ANA particularly in acute myocarditis needing VA-ECMO support.
New variant of varicella-zoster virus
Authors: Graham A Tipples, Gwen M Stephens, Chris Sherlock, Margrit Bowler, Benny Hoy, Darrel Cook, Charles Grose
Journal: Emerg Infect Dis (2002)
MeSH terms: 2-Aminopurine / analogs & derivatives, Genome, Viral, Herpes Zoster / physiopathology, Herpesvirus 3, Human / genetics, Case Reports, 2-Aminopurine / therapeutic use, Aged, Antiviral Agents / therapeutic use, Child, Famciclovir, Herpes Zoster / drug therapy, Herpesvirus 3, Human / classification, Herpesvirus 3, Human / pathogenicity, Humans, Male, Polymerase Chain Reaction, Serotyping, Antiviral Agents, 2-Aminopurine, Famciclovir

In 1998, a varicella-zoster virus glycoprotein E (gE) mutant virus (VZV-MSP) was isolated from a child with chickenpox. VZV-MSP, representing a second VZV serotype, was considered a rarity. We isolated another VZV-MSP-like virus from an elderly man with herpes zoster. These gE mutant viruses may have arisen through independent mutation or may represent a distinct VZV subpopulation that emerged more than 50 years ago.
Brown tumor complicating end-stage kidney disease
Authors: Michael Wiederkehr
Journal: Clin Nephrol Case Stud (2020)
Keywords: brown tumor, case report, end-stage kidney disease, hyperparathyroidism, metabolic bone disease, mineral and bone disorder, spinal cord compression
MeSH terms: Case Reports

Longstanding, severe hyperparathyroidism (HPT) can lead to the formation of "brown tumors". A brown tumor is a radiolucent bone lesion that is locally destructive; it is not a neoplasm, but rather a stromal mass consisting of fibrous tissue, poorly mineralized woven bone, and supporting vasculature. These tumors are a rare complication of advanced primary or secondary HPT. We present a young female with chronic kidney disease (CKD) on hemodialysis with uncontrolled secondary HPT (SHPT). The patient presented with progressive lower extremity weakness and back pain. CT imaging showed multiple lytic bone lesions involving several ribs and the spine. Subsequent MRI imaging of the thoracic and lumbar spine confirmed expansile bone lesions consistent with brown tumors. One mass protruded into the spinal canal causing severe stenosis at T3 with underlying cord edema. The other lesion at T12 caused only moderate spinal canal stenosis. Our patient underwent urgent neurosurgical resection of the tumor at T3 followed by subtotal parathyroidectomy (PTX).