OpenMed/multicare-articles huggingface dataset:
Hypocalcemia and Hypophosphatemia following Concurrent Denosumab Injection and Ferric Carboxymaltose Infusion in a Patient with Normal Renal Function
Authors: Naomi Szwarcbard, Chloe Dawson, Lai-Ming Kathleen Pak, Kathryn L Hackman
Journal: Case Rep Endocrinol (2024)
MeSH terms: Case Reports

Hypocalcemia following denosumab administration is well described. Hypophosphatemia following an intravenous iron infusion is an increasingly recognized adverse effect. Intravenous iron preparations increase fibroblast growth factor 23 (FGF23) levels. This both stimulates renal phosphate excretion and reduces 1,25-dihydroxyvitamin D (1,25(OH)2D) levels, resulting in reduced calcium absorption. Both osteoporosis and iron deficiency are common and frequently co-occur. The convenience and efficacy of both denosumab, a subcutaneous injection, and ferric carboxymaltose (Ferinject®), a 15-minute intravenous infusion, both of which can be given in the primary care setting, make these preferred treatment options. However, prescribers are often unaware of potential adverse outcomes, especially when these medications are given in tandem. We present a case of symptomatic hypocalcemia and hypophosphatemia in a 29-year-old woman with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) and normal renal function, in the setting of concurrent denosumab and ferric carboxymaltose administration for treatment of glucocorticoid-induced osteoporosis and iron deficiency anemia.
Primary mediastinal seminoma presenting with paraneoplastic anti-Hu encephalitis: a case report and literature review
Authors: Chelsey M Williams, Derek B Allison, Adam B Coleman, Roshmita Bardhan, Jordan D Miller, Zin W Myint
Journal: Front Oncol (2023)
Keywords: anna-1, anti-hu, bilateral hearing loss, paraneoplastic encephalitis, primary mediastinal seminoma, rhombencephalitis
MeSH terms: Case Reports

Primary mediastinal seminomas are exceedingly rare tumors, often localized to the anterior mediastinum. They may present with numerous complications, including superior vena cava syndrome, chylothorax, and pericardial effusions. Less commonly, they may present with paraneoplastic encephalitis. In this report we describe a case of a 19-year-old male with no significant past medical history who presented with bilateral hearing loss, progressive neuropathy, and ataxia. Subsequently the patient was found to have mediastinal mass with a high-titer anti-Hu antibody. To our knowledge, only one other case of mediastinal seminoma presenting with anti-Hu antibodies has been described in the literature. In this report, we describe a rare case of mediastinal seminoma, describe treatment options, and discuss additional known cases presenting with paraneoplastic encephalitis.
Achy Breaky Heart: A Rare Case of Myopericarditis Secondary to Mesalamine in a Patient With Inflammatory Bowel Disease
Authors: Nikhila Appala, Hima Veeramachaneni, Anshika Khare, Preeyanka Sundar
Journal: Cureus (2024)
Keywords: drug-induced adverse reaction, ibd, life threatening complication, mesalamine, myopericarditis
MeSH terms: Case Reports

Mesalamine is a first-line drug used in the treatment of inflammatory bowel disease (IBD), specifically ulcerative colitis (UC), with side effects ranging from gastrointestinal effects to cardiotoxicity. We present a rare case of mesalamine-induced myopericarditis in a patient with IBD, who presented with epigastric pain and was found to have elevated an c-reactive protein (CRP) in the absence of chest pain and any other gastrointestinal symptoms. This case highlights the importance of including myopericarditis as a differential for IBD patients on mesalamine with an isolated elevated CRP, especially within the first month of initiating this medication, as drug cessation usually leads to immediate clinical improvement.
Diagnostic and Treatment-Related Challenges in Sinonasal Teratocarcinosarcoma: A Report of Three Cases
Authors: W F Julius Scheurleer, Weibel W Braunius, Bernard M Tijink, Luuk M Janssen, Frank A Pameijer, Gerben E Breimer, Ernst J Smid, Remco de Bree, Lot A Devriese, Johannes A Rijken
Journal: Case Rep Otolaryngol (2023)
MeSH terms: Case Reports

Background:
Sinonasal teratocarcinosarcoma is a rare, aggressive malignancy located almost exclusively in the nasal cavity, paranasal sinuses, or anterior skull base. Histopathological diagnosis can be challenging due to the heterogeneous composition.
Methods:
Retrospective analysis of 3 patients with sinonasal teratocarcinosarcoma diagnosed and treated at the University Medical Center Utrecht was conducted.
Results:
Patients presented with nasal obstruction, epistaxis, headaches, or behavioral changes. All three patients had locally advanced disease, and one had lymph node metastases. Two patients underwent surgery followed by radiotherapy, and one underwent neoadjuvant chemotherapy followed by surgery. The follow-up duration ranged from 3 to 32 months. All three patients died due to progression of their disease.
Conclusion:
Sinonasal teratocarcinosarcoma is characterized by rapid, aggressive local expansion. The prognosis is poor due to a high risk of metastases and locally recurrent disease. Multimodality treatment consisting of surgery, followed by (chemo)-radiotherapy, is essential for optimizing outcomes. Neoadjuvant therapy offers a promising treatment option.
Vitreous metastasis from cutaneous melanoma: diagnosis and management
Authors: Noy Ashkenazy, J William Harbour, Sander R Dubovy, Thomas A Albini, Jayanth Sridhar, Nish Patel, Eric D Hansen, Eduardo Uchiyama, Patrick E Rubsamen, Zelia M Correa
Journal: Arq Bras Oftalmol (2023)
MeSH terms: Eye Neoplasms / pathology, Eye Neoplasms / secondary, Eye Neoplasms / therapy, Melanoma / pathology, Melanoma / secondary, Melanoma / therapy, Skin Neoplasms / pathology, Skin Neoplasms / secondary, Skin Neoplasms / therapy, Visual Acuity, Vitrectomy, Vitreous Body / pathology, Adult, Aged, Aged, 80 and over, Female, Humans, Male, Melanoma, Cutaneous Malignant, Middle Aged, Retrospective Studies, Treatment Outcome

Purpose:
To report the clinical findings, treatments, and outcomes in a series of patients with vitreous metastasis from cutaneous melanoma.
Methods:
This single-center, retrospective, interventional case series included patients with biopsy-confirmed vitreous metastasis from cutaneous melanoma diagnosed between 1997 and 2020. Standard 23- or 25-gauge pars plana vitrectomy was performed for diagnostic sampling. Sclerotomies were treated with double or triple freeze-thaw cryotherapy. Perioperative intravitreal injections of melphalan (32 µg/0.075 mL) were administered, when indicated. Visual acuity, intraocular pressure, and systemic and ocular treatment responses were reported.
Results:
Five eyes of five patients with unilateral vitreous metastasis from cutaneous melanoma were identified. The median age at diagnosis was 84 (range, 37-88) years. The median follow-up after ophthalmic diagnosis was 28 (8.5-36) months; one patient did not have a follow-up. The initial visual acuity ranged from 20/30 to hand motions. Baseline clinical findings included pigmented or non-pigmented cellular infiltration of the vitreous (5/5), anterior segment (4/5), and retina (3/5). Four patients had secondary glaucoma. Systemic therapy included checkpoint inhibitor immunotherapy (n=3, all with partial/complete response), systemic chemotherapy (n=2), surgical resection (n=3), and radiation (n=2). The median time from primary diagnosis to vitreous metastasis was 2 (2-15) years. One patient had an active systemic disease at the time of vitreous metastasis. The final visual acuity ranged from 20/40 to no light perception. Ophthalmic treatment included vitrectomy in all five patients, intravitreal administration of melphalan in three, and intravitreal administration of methotrexate in one. One patient required enucleation, and histopathology revealed extensive invasion by melanoma cells.
Conclusions:
Vitreous metastasis from cutaneous melanoma can present as a diffuse infiltration of pigmented or non-pigmented cells into the vitreous and may be misdiagnosed as uveitis. Diagnostic pars plana vitrectomy and periodic intravitreal chemotherapy may be indicated.
Case report: management of a young male patient with diabetic ketoacidosis and thyroid storm
Authors: Xiaoyu Huang, Yan Chen, Xinwei Huang, Jiahao Tang
Journal: Front Endocrinol (Lausanne) (2024)
Keywords: autoimmune polyendocrine syndrome, case report, diabetic ketoacidosis, recurrent diabetic ketoacidosis, thyroid storm
MeSH terms: Diabetes Mellitus, Type 1 / complications, Diabetic Ketoacidosis / complications, Diabetic Ketoacidosis / therapy, Thyroid Crisis / complications, Thyroid Crisis / diagnosis, Thyroid Crisis / therapy, Case Reports, Humans, Male, Young Adult

This report describes a case of concomitant diabetic ketoacidosis (DKA) and thyroid storm (TS) in a 20-year-old male patient that presented both diagnostic and management challenges owing to their intricate interrelationship in endocrine-metabolic disorders. The patient, previously diagnosed with type 1 diabetes mellitus (T1DM) and hyperthyroidism, was admitted to the emergency department with symptoms of DKA and progressive exacerbation of TS. Initial treatment focused on correcting DKA; as the disease progressed to TS, it was promptly recognized and treated. This case emphasizes the rarity of simultaneous occurrence of DKA and TS, as well as the challenges in clinical diagnosis posed by the interacting pathophysiological processes and overlapping clinical manifestations of DKA and TS. The patient's treatment process involved multiple disciplines, and after treatment, the patient's critical condition of both endocrine metabolic diseases was alleviated, after which he recovered and was eventually discharged from the hospital. This case report aims to emphasize the need for heightened awareness in patients with complex clinical presentations, stress the possibility of concurrent complications, and underscore the importance of prompt and collaborative treatment strategies.
Neuroblastoma with superficial soft tissue mass as the first symptom: case reports with atypical ultrasonic image and literature review
Authors: Jiale Hu, Bei Xia, Xiuli Yuan, Haixing Chen, Fuxiang Ou, Longlong Huang, Lei Xu, Xia Feng
Journal: Braz J Med Biol Res (2023)
MeSH terms: Neuroblastoma / diagnostic imaging, Soft Tissue Neoplasms / diagnostic imaging, Soft Tissue Neoplasms / pathology, Review, Case Reports, Child, Diagnosis, Differential, Humans, Ultrasonics, Ultrasonography / methods

Neuroblastoma is one of the most common tumors in children. Cases where an isolated soft-tissue metastasis mass is the initial symptom are rare, with only four such cases reported to date. We describe the imaging findings of ten cases of neuroblastoma patients in our hospital with superficial soft tissue mass (SSTM) as the primary symptom. The main ultrasound finding of SSTM was hypoechoic masses or scattered speck-like hyperechoic masses. However, when this type of SSTM is caused by soft tissue metastasis, the location is often atypical, and ultrasound findings are difficult to distinguish from other benign diseases. Therefore, this research should remind clinicians to recognize atypical presentations of this common childhood malignant tumor. Radiologists should also consider the possibility of neuroblastoma when finding this type of SSTM with atypical ultrasound features.
A Cone Bean Computer Tomography Investigation of the Newly Formed Mandibular Anterior Ridge following the Treatment of an Extended Comminuted Fracture: A 12-Year Follow-Up
Authors: Pascal Grün, Florian Pfaffeneder-Mantai, Patrick Bandura, Benedikt Schneider, Anna Sophia Bandura, Dritan Turhani
Journal: Case Rep Dent (2024)
MeSH terms: Case Reports

Introduction:
Extensive comminuted fractures are associated with tooth loss that ultimately leads to dimensional changes in the hard and soft tissues of the alveolar ridge. Reconstruction of the lost mandibular anterior ridge is very complex due to the natural curvature of the region. Case Presentation. In this case report, the combination of the modified shell technique with autologous bone plates and the guided bone regeneration (GBR) technique was performed on an 18-year-old patient after a comminuted fracture, to ensure new bone formation in the anterior ridge with a natural curvature. After the treatment progressed without complications, three dental implants were placed. Annual cone beam computed tomography (CBCT) images were obtained and evaluated using the GNU Image Manipulation Program (GIMP© 2.10). This allowed measurements of the buccal and lingual bone around the implants, showing the annual bone loss in a twelve-year observation period. Discussion. The treatment of the comminuted fracture and the combination of the modified shell technique with autologous bone plates, the GBR technique, and implant placement can be considered successful. The three dental implants were osseointegrated in 2010, with the buccal bone level averaging 1.31 mm below the implant shoulder and the lingual bone level 1.57 mm above the implant shoulder. In 2021, the measurements showed a bone loss of 0.99 mm at the buccal implant shoulder and 0.69 mm at the lingual implant shoulder.
Conclusion:
The combination of the modified shell technique with autologous bone plates and the GBR technique is a reliable method to ensure new bone formation in the anterior ridge. The use of CBCT is an excellent method to evaluate bone resorption around dental implants, but due to minimal bone resorption in the observation period, an annual CBCT examination is exaggerated.
Case Report: Mycosis fungoides as an exclusive manifestation of common variable immunodeficiency in a family with a NFKB2 gene mutation
Authors: María Noel Spangenberg, Sofía Grille, Camila Simoes, Mariana Brandes, Joaquín Garcia-Luna, Ana Inés Catalán, Sabrina Ranero, Matilde Boada, Andreína Brugnini, Natalia Trias, Daniela Lens, Víctor Raggio, Lucía Spangenberg
Journal: Front Oncol (2023)
Keywords: cvid, bioinformactics, hereditary hematological disorders, human genomics, mycosis fungoides
MeSH terms: Case Reports

Background:
Common variable immunodeficiency disorders (CVIDs), which are primary immunodeficiencies characterized by the failure of primary antibody production, typically present with recurrent bacterial infections, decreased antibody levels, autoimmune features, and rare atypical manifestations that can complicate diagnosis and management. Although most cases are sporadic, approximately 10% of the patients may have a family history of immunodeficiency. Genetic causes involving genes related to B-cell development and survival have been identified in only a small percentage of cases.
Case presentation:
We present the case of a family with two brothers who presented with mycosis fungoides as an exclusive symptom of a common variable immunodeficiency disorder (CVID). Whole-exome sequencing of the index patient revealed a pathogenic variant of the NFKB2 gene. Based on this diagnosis and re-evaluation of other family members, the father and brother were diagnosed with this rare immune and preneoplastic syndrome. All CVID-affected family members presented with mycosis fungoides as their only symptom, which is, to the best of our knowledge, the first case to be reported.
Conclusion:
This case highlights the importance of high-throughput sequencing techniques for the proper diagnosis and treatment of hereditary hematological disorders.
Bilateral Vocal Cord Palsy Secondary to Rheumatoid Arthritis
Authors: Liam D Hyland, Rachel Saville, Nada Dwiddar, Milind Sovani
Journal: Cureus (2024)
Keywords: adducted, airway obstruction, biphasic, expiratory, inspiratory, paradoxical breathing, respiratory failure, rheumatoid arthritis, stridor, vocal cord palsy
MeSH terms: Case Reports

Rheumatoid arthritis (RA) can cause a number of laryngeal manifestations; however, most of these do not cause an airway emergency. Airway obstruction due to vocal cord fixation of one or both vocal cords occurs late in the disease process of RA and can present as an inspiratory stridor. We report the case of an elderly lady who presented with acute stridor secondary to RA-induced bilateral vocal cord palsy and describe the various management options that were considered. An 85-year-old woman presented to A&E Resus with tachypnoea, stridor, and drowsiness. An arterial blood gas (ABG) was performed which showed hypercapnic respiratory failure on 60% oxygen with blood tests revealing moderately raised infective markers and a chest X-ray displaying right lower zone consolidation. A flexible nasendoscopy was performed which demonstrated bilaterally fixed and adducted vocal cords due to bilateral cricoarytenoid joint fixation, with a rima glottidis measurement of approximately 3 mm and evidence of paradoxical breathing. The patient had been admitted with a similar presentation 18 months before, however not as severe, and once again, the bilateral vocal cord palsy had been attributed to her longstanding RA. She was stabilised with non-invasive ventilation and transferred to the acute respiratory care unit. Long-term surgical options were thoroughly discussed including tracheostomy, vocal cord lateralisation, cordotomy, and arytenoidectomy, but ultimately, these options were all deemed unsuitable for the patient and so a palliative care approach was adopted following the withdrawal of bilevel positive airway pressure. Stridor is a late but life-threatening complication of RA that has viable surgical options of tracheostomy and static glottis enlarging procedures; however, the appropriateness of such procedures should always be correlated with the patient's current clinical status and the extent to which they may impact on the patient's quality of life.
Bilateral Metastatic Gynecomastia from Small-Cell Lung Tumors in a Man: A Report of a Rare Case
Authors: Karima El Houari, Sophie Vandewalle
Journal: J Belg Soc Radiol (2024)
Keywords: gynecomastia, breast metastasis, immunohistochemistry, male, small-cell carcinoma
MeSH terms: Case Reports

A case of a man with the recent onset of painful bilateral firm gynecomastia is reported. Mammography confirmed increased breast density. Biopsy characterized both masses as metastases of a small-cell lung tumor. This case highlights the atypical presentation and complements the literature regarding the rarity of breast metastases from small-cell lung cancer in men. Teaching point: Bilateral gynecomastia in a man with a long history of cigarette smoking should be considered with caution.
Case report: Ureteric bud intestinal-type adenocarcinoma involving the cervix was misdiagnosed as a large cervical fibroid
Authors: Li-Li Zhang, Li Wang, Dan-Ni Zhang, Jun-Tong Wu, Yuan Liu, Yan-Ping Wang
Journal: Front Med (Lausanne) (2024)
Keywords: cervical metastatic intestinal-type adenocarcinoma, large cervical fibroid, metastatic malignancy, surgical treatment, ureteric bud intestinal-type adenocarcinoma
MeSH terms: Case Reports

Background:
Malignant tumors of the ureteric bud are not common, and cervical involvement is even rarer. So far, there have been no such cases in the literature.
Case summary:
A 50-year-old woman developed intermittent light bleeding in the past 7 months and lower abdominal pain in the past 2 months. The human papillomavirus 16 (HPV) DNA, P16 chemical staining, thinPrep cytology test (TCT), and cervical and cervical canal tissue biopsy were all negative. Pelvic color Doppler ultrasound exhibited incomplete mediastinal uterus and heterogeneous echo from the cervical canal to the posterior wall of the cervix. Pelvic contrast-enhanced CT showed left cervical mass, left retroperitoneal mass, absence of the left kidney, and mediastinal uterus. An increase in human epididymal protein 4 (HE4) (133.6 pmol/L) was detected, while other tumor markers were at normal levels. Based on these examination results, a diagnosis of "cervical fibroids, left retroperitoneal mass, incomplete mediastinal uterus, left kidney deficiency"[SIC] was conducted, and expanded hysterectomy, right adnexectomy, and left retroperitoneal mass resection were performed. Through intraoperative rapid pathological diagnosis, postoperative pathological diagnosis combined with the re-evaluation of laboratory, and imaging and intraoperative examination results, the patient was diagnosed with ureteric bud intestinal-type adenocarcinoma involving the cervix. The patient has been tracked and followed up for approximately 11 months. She underwent six courses of chemotherapy. At present, the medication has been discontinued for 4 months, and there is no recurrence, metastasis, or deterioration of the tumor.
Conclusion:
For large masses of the cervix, it is feasible for the operation to be performed, improving the prognosis. There were a few limitations. A preoperative aspiration biopsy of masses was not performed to differentiate benign from malignant. Preoperative urography was not performed to clarify the function of the malformed urinary system structure. Partial cystectomy should be performed simultaneously with the resection of the ureteric bud for intestinal-type adenocarcinoma. In this case, a partial cystectomy was not performed, which can only be compensated with postoperative chemotherapy. Moreover, this patient did not undergo genetic screening, and it is currently unclear whether there are any genetic mutations associated with ureteric bud intestinal adenocarcinoma.
Chronic systemic capillary leak syndrome with lymphatic capillaries involvement and MYOF mutation: case report and literature review
Authors: Dehua Gao, Wen Zhong, Weiru Zhang, Xuan Wang, Weiping Li, Jun Liu
Journal: Front Genet (2023)
Keywords: myof gene variant, vegf, chronic systemic capillary leak syndrome, chylous polyserous effusions, edema, hypotrichosis, lymphatic capillaries
MeSH terms: Case Reports

Introduction: Idiopathic systemic capillary leak syndrome (SCLS) is a rare disorder characterized by hemoconcentration, hypoproteinemia and edema. Chronic SCLS (cSCLS) presents as intractable edema, distinguishing it from the classic acute form, and only about 10 cases were reported worldwide. Nevertheless, the underlying pathogenesis of both types is obscure. Case presentation: We report a case of a 58-year-old man with chronic edema persisting for 8 years, complicated by unique chylous polyserous effusions and hypotrichosis, which was successfully relieved by treatment with dexamethasone, intravenous immunoglobulin, and thalidomide. Furthermore, a variant c.5594A>G (p.K1865R) in the MYOF gene was identified as a potentially pathogenic mutation through whole-exome genetic sequencing. The proposed mechanism involves its impact on VEGF signaling, leading to increased capillary permeability. Conclusion: Our case illustrates possible lymphatic capillaries involvement in SCLS, which may plays a potential role in immune disorder, and revealed a possible causative genetic mutation of SCLS.