OpenMed/multicare-articles huggingface dataset:
Topical Application of Fasudil Hydrochloride for Vasospasm during Soft Tissue Reconstruction Using a Free Flap
Authors: Kaoru Tada, Tadahiro Nakajima, Mika Nakada, Masashi Matsuta, Hiroyuki Tsuchiya
Journal: Case Rep Orthop (2019)
MeSH terms: Case Reports

Vasospasm is a phenomenon that can complicate microsurgery. We report a case in which vasospasm was quickly relieved by topical application of fasudil hydrochloride. A 36-year-old man underwent preoperative chemotherapy and wide excision for a malignant soft tissue tumor around the knee joint. We planned reconstruction using a free latissimus dorsi muscle flap for the resulting soft tissue defect and selected the peroneal vessels as the recipient vessels. However, there was no arterial blood flow from the peroneal vessels, which we diagnosed as vasospasm. Conventional treatment of the vasospasm was attempted, but blood flow was not achieved. Topical application of fasudil hydrochloride solution promptly relieved the vasospasm. To the best of our knowledge, this is the first clinical report of the use of fasudil hydrochloride for vasospasm during soft tissue reconstruction using a free flap.
Case Report: Cryptococcal eosinophilic meningitis in a patient with Hodgkin lymphoma
Authors: Fang Zhang, Yuchen Li, Huijun Shen, Jie Tao, Jie Wang
Journal: Front Neurol (2022)
Keywords: hodgkin lymphoma, cryptococcal lymphadenitis, cryptococcal meningitis, eosinophilia, eosinophilic meningitis
MeSH terms: Case Reports

Cryptococcal meningitis is the most common fungal meningitis in clinical practice. It primarily occurs in immunocompromised people and is typically associated with human immunodeficiency virus (HIV) infection. In rare cases, it is associated with Hodgkin lymphoma (HL). Eosinophilic meningitis (EM) is characterized by increased eosinophils in the cerebrospinal fluid (CSF) and is often caused by a parasitic infection of the central nervous system (CNS). EM caused by cryptococcal infection is rare; only four cases have been reported in the past 30 years. Here, we report a case of cryptococcal meningitis in a patient with HL who presented with an atypical eosinophil-predominant CSF cytology response. The patient's eosinophil proportion reached 91%; a proportion this high has not been reported previously and may be associated with HL. After antifungal therapy and tumor chemotherapy, the proportion of eosinophils decreased significantly. This case shows that cryptococcal meningitis and HL may be simultaneously contributing to CSF eosinophilia. HL should be considered in patients with eosinophilic cryptococcal meningitis and multiple adenopathies.
[Acute appendicitis with left clinical manifestation on complete common mesentery: about one case]
Authors: Aziz Elmadil, Hanan Bouamama, Mohammed Ramil, Khalid Khattal, Abderrahman Afifi, Youssef Bouabdallah
Journal: Pan Afr Med J (2010)
MeSH terms: Abdomen, Acute / etiology, Appendicitis / diagnosis, Intestines / abnormalities, Mesentery / abnormalities, Case Reports, Abdomen, Acute / diagnostic imaging, Adolescent, Appendectomy, Appendicitis / surgery, Diagnosis, Differential, Humans, Laparoscopy, Male, Mesentery / diagnostic imaging, Peritoneal Lavage, Radiography, Treatment Outcome

Abstract:
La malrotaion intestinale chez l’enfant est une anomalie rare due à un arrêt des phénomènes de rotation et d’accolement de l’intestin primitif. Elle peut être grave en cas de mésentère commun incomplet en se compliquant d’un volvulus du grêle ou asymptomatique si la rotation s’arrête à 90° se déclarant ainsi par des formes atypiques d’appendicite comme c’est le cas de notre observation. Il s’agit d’un garçon de 15 ans qui a présenté une semaine avant son admission des douleurs abdominales diffuses avec vomissements alimentaires évoluant dans un contexte fébrile et chez qui l’examen clinique avait montré une sensibilité de la fosse iliaque gauche. Le bilan biologique avait objectivé un syndrome inflammatoire biologique. Les examens radiologiques étaient en faveur d’un mésentère commun complet avec multiples adénopathies mésentériques et infiltration de la graisse mésentérique. L’exploration cœlioscopique a confirmé le diagnostic de malrotation avec appendicite aigue. L’évolution après l’appendicectomie était favorable. Si l’appendicite aigue dans sa forme habituelle est une urgence chirurgicale fréquente chez l’enfant, ses formes atypiques dans le cadre d’une malrotation intestinale ou d’un situs inversus restent très difficiles à diagnostiquer. L’imagerie moderne notamment la tomodensitométrie (TDM) abdominale puis la cœlio-chirurgie ont beaucoup contribué au diagnostic de ces forms.
Extracorporeal membrane oxygenation for acute pulmonary embolism after postoperative craniocerebral trauma: a case report
Authors: Xiaozu Liao, Xiaojuan Chen, Shi Zhong, Junlin Wen, Binfei Li
Journal: Front Cardiovasc Med (2023)
Keywords: va-ecmo, acute pulmonary embolism, anticoagulation, bleeding, craniocerebral trauma
MeSH terms: Case Reports

Introduction:
Massive pulmonary embolism (PE) is a life-threatening complication of major surgery with a mortality rate of up to 50%. Extracorporeal membrane oxygenation (ECMO) is primarily used for respiratory and circulatory support. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is used to stabilize patients with acute massive PE. Acute brain injury, vascular disease, and immunosuppression are contraindications to ECMO, as stated in the 2021 Extracorporeal Life Support Organization guidelines.
Case summary:
We report a case of a patient with craniocerebral trauma whose postoperative course was complicated by massive PE and subsequent cardiac arrest that required urgent VA-ECMO, followed by anticoagulation with heparin. The patient showed hemodynamic improvement and was discharged 68 days after hospitalization.
Discussion:
ECMO has gradually been accepted for patients with craniocerebral injuries. The safety and effectiveness of ECMO in patients with craniocerebral injury, along with the optimal duration of ECMO and anticoagulation strategies, require further study.
An unexpected complete remission of advanced intestinal-type vulvar adenocarcinoma after neoadjuvant chemotherapy: a case report and a literature review
Authors: Angela Musella, Claudia Marchetti, Laura Salerno, Laura Vertechy, Roberta Iadarola, Irene Pecorella, Pierluigi Benedetti Panici
Journal: Case Rep Obstet Gynecol (2013)

Vulvar cancer represents approximately 3%-5% of all gynecological malignancies. Squamous cell carcinoma is the most frequent histotype, whereas melanomas, adenocarcinomas, basal cell carcinomas, and sarcomas are much less common. Intestinal-type adenocarcinoma is a rare variant of vulvar carcinoma with only few cases found in the literature. The origin of this neoplasia is still much debated, but the most reliable hypothesis is the origin from cloacal remnants that may persist in the adult in different organs. Because of its extremely low incidence, the optimal management of this kind of vulvar cancer is still debated. We report the case of a woman affected by advanced intestinal-type vulvar adenocarcinoma, who achieved a complete clinical and pathological response after neoadjuvant chemotherapeutic treatment with platinum and paclitaxel.
Ixazomib-induced Sweet's syndrome: A case report
Authors: Jeanne Bellemare, Hannah Laure El Fassy, Alexandra Mereniuk
Journal: SAGE Open Med Case Rep (2023)
Keywords: sweet’s syndrome, case report, drug-induced, ixazomib, multiple myeloma
MeSH terms: Case Reports

Ixazomib, a proteasome inhibitor commonly used for the treatment of multiple myeloma, is a rare cause of Sweet's syndrome. We present a 62-year-old man who developed drug-induced Sweet's syndrome during his fifth cycle of ixazomib for treatment of refractory multiple myeloma. Monthly rechallenge led to the recurrence of symptoms. The patient was successfully treated with addition of weekly corticosteroids and resumed his cancer treatment.
Euglycemic Diabetic Ketoacidosis in Pregnancy: A Case Report and Review of Current Literature
Authors: Johnny F Jaber, Matthew Standley, Raju Reddy
Journal: Case Rep Crit Care (2019)
MeSH terms: Case Reports

Diabetic ketoacidosis (DKA) in pregnancy is associated with high fetal mortality rates. A small percentage of DKA occurs in the absence of high glucose levels seen in traditional DKA. Prompt recognition and management is crucial. We report a case of a 30-year-old pregnant woman with type 1 diabetes mellitus admitted with euglycemic DKA (blood glucose <200 mg/dL). Initial laboratory testing revealed a severe anion gap acidosis with pH 7.11, anion gap 23, elevated β-hydroxybutyric acid of 9.60 mmol/L, and a blood glucose of 183 mg/dL-surprisingly low given her severe acidosis. The ketoacidosis persisted despite high doses of glucose and insulin infusions. Due to nonresolving acidosis, her hospital course was complicated by spontaneous intrauterine fetal demise. Euglycemia and severe acidosis continued to persist until delivery of fetus and placenta occurred. It was observed that the insulin sensitivity dramatically increased after delivery of fetus and placenta leading to rapid correction of ketoacidosis. This case highlights that severe ketonemia can occur despite the absence of severely elevated glucose levels. We discuss the mechanism that leads to this pathophysiologic state and summarize previously published case reports about euglycemic DKA in pregnancy.
COVID-19-Induced Phlegmasia Cerulea Dolens
Authors: Stephanie Cohen, Joshua Lynch
Journal: Cureus (2023)
Keywords: covid-19, covid-related hypercoagulability, deep vein thrombosis (dvt), phlegmasia cerulea dolens, sars-cov2
MeSH terms: Case Reports

A 44-year-old male with a history of deep venous thrombosis (DVT) and pulmonary embolism (PE) with the inferior vena cava (IVC) filter in place and peripheral vascular disease (PVD) status post lower extremity vascular stenting presented from a COVID-19 rehabilitation center with bilateral phlegmasia cerulea dolens and no palpable popliteal or dorsalis pedis pulses, at risk for venous gangrene and loss of limbs. The patient was anticoagulated and taken emergently to the operating room for vascular surgery where thrombolysis with alteplase and mechanical thrombectomy were performed. Bilateral thrombolysis infusion catheters were placed for two days. The patient had a return of arterial signals in the feet and decreasing clot burden. The patient is expected to make a full recovery.
5-azacytidine in chronic myelomonocytic leukemia: case report and review of literature
Authors: M Greco, M Criscuolo, L Fianchi, E Fabiani, L Pagano, Mt Voso
Journal: Mediterr J Hematol Infect Dis (2011)
MeSH terms: Case Reports

Hypomethylating drugs are useful in the management of Myelodysplastic syndromes, but there are only few reports on chronic myelomonocycitic (CMML) leukemia patients. We describe our experience in 3 CMML patients treated with azacitidine. Two patients obtained partial response after 4 treatment cycles with only minor toxicity and are in continuous partial response, with stable peripheral blood counts, at 29 and 30 cycles from treatment start.
Altered mental status and a not-so-benign rash
Authors: Aakash N Bodhit, Latha Ganti Stead
Journal: Case Rep Emerg Med (2011)
MeSH terms: Case Reports

Introduction. The authors are presenting a case of Thrombotic Thrombocytopenic Purpura (TTP) that presented with complaints of altered mental status and found to have petechiae. Case Presentation. An 81-year-old female patient presented to the Emergency Department (ED) of a tertiary care hospital with chief complains of dizziness, slurred speech, and weakness. She was found to have lower extremity petechiae on physical examination. On blood exam, she had thrombocytopenia, and her peripheral blood smear showed schistocytes. Her renal function was also impaired. The CT scan of head was without any abnormality. She was finally diagnosed as having TTP and transferred to ICU but ultimately passed away. Conclusion. TTP is a rare syndrome with preventable mortality if diagnosed early and managed appropriately with plasmapheresis. The Emergency Department physicians should be aware of the presenting symptoms and signs of TTP.
Pain of chronic sacro-iliac joint atrhopathy: managed successfully with conventional bipolar radiofrequency procedure: a case report
Authors: Awisul Ghazali, Gautam Das, Khaled Horani, Gs Anand Kumar, Palak Mehta, Debjyoti Dutta
Journal: Anesth Pain Med (2012)
Keywords: anaesthetics, pain, sacroiliac joint
MeSH terms: Case Reports

Background:
Chronic sacroiliac (SI) joint pain constitutes 16% to 30% of the total prevalence of chronic low back pain, which is commonly unilateral. Apart from conservative management, various interventional pain management procedures have been reported. Intraarticular deposteroid injection has been described as the most evidence-based, but different various radio frequency (RF) procedures have been described with varied success. Conventional bipolar RF is relatively new in the management of SI joint pain. We have successfully managed pain of the SI joint origin.
Case report:
A 53-year-old female who presented with unilateral back pain with radiation to the leg was diagnosed with pain from SI joint arthropathy by clinical and diagnostic interventional procedures. She was treated conservatively without any result. Deposteriod gave good but very short-term relief. She underwent a bipolar RF procedure. An RF needle was placed at the L5 medial branch, and 2 were placed on each lateral side of the sacral foramina for the lateral branches of the S1, S2, and S3 nerve roots. Conventional RF was performed at 80°C for 90 seconds.
Discussion:
This case report supports the use of bipolar RF nerve ablation for chronic sacroiliac joint pain that does abate with deposteroid injection. In this patient, the Rt L5 medial branch nerve was ablated using conventional RF technique, followed by conventional bipolar RF nerve ablation for the S1, S2 and S3 lateral branches. We recommend the use of bipolar RF nerve ablation for chronic sacroiliac joint pain that has an inadequate response to deposteroid injection.
Antibody-Negative Relapse of Goodpasture Syndrome with Pulmonary Hemorrhage
Authors: Charlene L Rohm, Sara Acree, Aseem Shrivastava, Asif A Saberi, Louis Lovett
Journal: Case Rep Med (2019)
MeSH terms: Case Reports

Goodpasture syndrome is a rare autoimmune disease comprising antiglomerular basement membrane (anti-GBM) crescentic glomerulonephritis and pulmonary capillaritis with circulating anti-GBM antibodies. Rarely, antibody-negative cases have been described. We report a young, African American adult woman admitted with flank pain and hematuria with laboratory testing and kidney biopsy demonstrating anti-GBM crescentic glomerulonephritis with elevated anti-GBM antibody levels. She received treatment but remained dialysis-dependent. She was seronegative and clinically stable until she presented 8 months later with dyspnea and hemoptysis requiring mechanical ventilation. Bronchoscopy revealed diffuse alveolar hemorrhage. She was treated for relapse of Goodpasture syndrome. However, anti-GBM antibodies were undetectable. This case emphasizes prompt diagnosis and treatment of Goodpasture syndrome to preserve renal function. Additionally, clinical manifestations of Goodpasture syndrome and its degree of activity do not necessarily correlate with the actual antibody titer on relapse. Clinicians should have enhanced awareness of this atypical presentation of a rare disease.
Case report: Thoracoscopic ablation for a patient with atrial fibrillation and persistent left superior vena cava
Authors: Haozhong Liu, Tong Tan, Hailong Qiu, Jimei Chen, Jian Liu, Peijian Wei, Huiming Guo
Journal: Front Cardiovasc Med (2023)
Keywords: atrial fibrillation, persistent left superior vena cava, surgical ablation, thoracoscopic surgery, virtual reality
MeSH terms: Case Reports

Persistent left superior vena cava (PLSVC) is a relatively rare congenital anomaly in the general population. It plays an important role in initiating and maintaining atrial fibrillation (AF) in some patients. Radiofrequency catheter ablation is the major treatment for patients with AF and PLSVC in most publications. Here, we reported a case of thoracoscopic ablation for a patient with atrial fibrillation and persistent left superior vena cava. After preprocedural simulation using virtual reality, we successfully completed box-lesion, ablation line from superior vena cava to inferior vena cava, left atrial appendage (LAA) excision, and PLSVC ablation. It provides a new perspective on surgical treatment for patients with AF and PLSVC.
A TYK2 Gene Mutation c.2395G>A Leads to TYK2 Deficiency: A Case Report and Literature Review
Authors: Peilin Wu, Suqing Chen, Bin Wu, Junhong Chen, Ge Lv
Journal: Front Pediatr (2020)
Keywords: bcg, tyk2 deficiency, hyperimmunoglobulin e syndrome, mutation, primary immunodeficiency
MeSH terms: Case Reports

Tyrosine kinase 2 (TYK2) deficiency was formerly defined in patients suffering from autosomal recessive hyperimmunoglobulin E syndrome (AR-HIES). In recent years, it was proposed that human TYK2 deficiency is probably not a common cause of the AR-HIES but a distinctive illness object. In the current work, a recessive TYK2 deficiency is reported in a patient suffering from BCG disease and recurrent respiratory infection. It was implied that this patient carried novel missense homozygous mutation (c.2395G>A, p. G799R) in the TYK2. Both the in vivo and in vitro experiments indicated the inhibition effects of the c.2395G>A homozygous mutation on the TYK2 gene and protein expression. By literature review, we summarized the clinical manifestations, gene mutations, and related cytokine responses of formerly reported patients possessing TYK2 deficiency. The core manifestation of these patients is infected by intracellular pathogens, such as mycobacteria and/or viruses. Therefore, the possibility of TYK2 deficiency should be considered when a patient has repeated intracellular bacteria (including tuberculosis bacillus infection), repeated viral infection or eczema.
Multimodal Imaging Analysis in a Case with Congenital Fovea-Involving Retinal Macrovessel and Excellent Visual Acuity
Authors: Vishal Shah, M Ashwin Reddy, Vasilios P Papastefanou
Journal: Case Rep Ophthalmol Med (2017)
MeSH terms: Case Reports

Purpose:
Congenital retinal macrovessels (CRM) represent rare aberrant vasculature of the retinal vessels that can supply or drain the macula. In this report, the optical coherence tomography angiography features of a congenital retinal macrovessel are discussed.
Methods:
The history and examination findings are presented alongside swept-source OCT angiography with corresponding B scan and en face OCT imaging.
Patients:
The case is a 12-year-old female patient with excellent best-corrected visual acuity in both eyes.
Results:
Swept-source OCT angiography demonstrated considerable loss of the foveal avascular zone at the levels of the superficial and deep capillary plexus.
Discussion:
In this case there was no detrimental effect on vision despite anatomical loss of the foveal avascular zone.
Spontaneous perforation of jejunal gastrointestinal stromal tumor: A case report
Authors: Ghassan T Al-Swaiti, Mohammad H Al-Qudah, Mohammad A Al-Doud, Alaa R Al-Bdour, Walid Al-Nizami
Journal: Int J Surg Case Rep (2020)
Keywords: acute abdomen, gastrointestinal stromal tumor, perforation
MeSH terms: Case Reports

Introduction:
The incidence of small bowel tumors is comparatively rare when compared to colonic tumors. They comprise less than 10% of all gastrointestinal neoplasms. Gastrointestinal stromal tumor (GIST) is the most common mesenchymal neoplasm of the gastrointestinal tract; however it accounts for less than 1% of all gastrointestinal tumors.
Aim:
To report a rare case of jejunal gastrointestinal stromal tumor presenting as a life-threatening emergency in a young adult male who was treated in the General Surgery department in the Jordanian Royal Medical Services (JRMS), Amman, Jordan.
Presented case:
We report a 59-year-old male who presented to our emergency department with severe generalized abdominal pain. The patient was in a hypovolemic shock. Abdominal examination revealed a massively distended, tender abdomen. Abdomenal CT scan with IV contrast showed significant fat stranding around the jejunum associated with pneumoperitoneum and free fluid. Exploratory laparotomy was emergently performed, revealing diffuse peritonitis secondary to perforated small bowel tumor. En bloc resection was performed. Histopathologic examination confirmed the presence of malignant gastrointestinal stromal tumor of the jejunum with R0 clearance.
Discussion:
Gastrointestinal stromal tumors are relatively rare and the jejunum is the least affected among other parts of the GI tract. The majority of ruptured GISTs occur spontaneously, and are located in the stomach and small bowel. Most ruptured GISTs are associated with dismal prognosis.
Conclusion:
A jejunal gastrointestinal stromal tumor can rarely present with spontaneous perforation. However, it is important to highlight this condition, as early emergency intervention constitutes the key to a good outcome.
Acute Disseminated Encephalomyelitis: An Unusual Presentation of Human Immunodeficiency Virus Infection
Authors: Pedro Martínez-Ayala, Miguel Angel Valle-Murillo, Oscar Chávez-Barba, Rodolfo I Cabrera-Silva, Luz A González-Hernández, Fernando Amador-Lara, Moises Ramos-Solano, Sergio Zúñiga-Quiñones, Vida Verónica Ruíz-Herrera, Jaime F Andrade-Villanueva
Journal: Case Rep Infect Dis (2020)
MeSH terms: Case Reports

Background:
Acute disseminated encephalomyelitis (ADEM) is a rare inflammatory and demyelinating disorder of the central nervous system, with a distinct tendency to a perivenous localization of pathological changes. Children are the most affected population and frequently presented after exanthematous viral infections or vaccination. Due to the rarity of this disease, the annual incidence rate in the population is not precisely known. Case Presentation. Here, we present a 28-year-old male HIV-1 positive patient with an acute confusional state, a diminished alert status characterized by somnolence, hypoprosexia, and complex visual hallucinations. Neuroimages reported white matter demyelinating lesions, mainly affecting the semioval centers, the frontal lobe, and the left parietal lobe; hypointense on T1-weighted images, hyperintense on T2-weighted images and fluid-attenuated inversion recovery weighted images, DWI with restricted diffusion, and a parietal ring-enhancing lesion after IV gadolinium administration. Discussion. In HIV positive patients, the demyelinating disorders have a broader clinical spectrum that could be explained by the immunosuppressed state of the patients, the evolution of the disease, the use of medications, the opportunistic infections, and the environment. Due to this highly variable clinical spectrum, ADEM is a significant challenge for the physicians in HIV positive patients, causing a delay in the diagnosis and treatment.
Conclusion:
We suggest that ADEM should be considered among the differential diagnosis in HIV-infected patients with focal or multifocal neurological symptoms, particularly in encephalopathies with multifocal central nervous system involvement without severe immunosuppression.