OpenMed/multicare-articles huggingface dataset:
Coexistence of Diffuse Large B-Cell Lymphoma With Chronic Tubulointerstitial Nephritis: A Case Review and Pathophysiology
Authors: Kareem Zuhdi, Katsiaryna Khatskevich, Ellen C Riemer
Journal: Cureus (2024)
Keywords: chronic tubulointerstitial nephritis, diffuse large b cell lymphoma (dlbcl), end-stage renal disease (esrd), end-stage renal failure, pathological autopsy
MeSH terms: Case Reports

There is an association between lymphomas and kidney disease with renal abnormalities found both in patients with direct infiltration by lymphoma as well as in patients without gross or microscopic evidence of renal involvement. Multiple mechanisms to explain the link between lymphomas and renal disease have been proposed, ranging from direct renal metastasis by the lymphoma to chemokine signaling pathways. In addition, there is a correlation between certain genetic mutations and an increased risk of lymphoma metastasizing to other organs. We present a case of a 41-year-old male who passed away due to end-stage kidney disease and was found on autopsy to have chronic tubulointerstitial nephritis and diffuse large B-cell lymphoma (DLBCL) without direct renal involvement by the lymphoma. The patient had been previously healthy with no significant prior medical history, NSAID, or other contributory medication use of note with the only presenting symptom being renal failure. Only upon autopsy was DLBCL discovered throughout the abdomen with no direct lymphoma involvement evident in the kidneys. To the author's knowledge, this is one of the few reported cases of DLBCL in English literature without renal infiltration in which the presenting symptom and cause of death was renal dysfunction. Several mechanisms have been theorized for how lymphomas can lead to kidney damage without direct metastasizes; however, more research still needs to be done to better understand the underlying etiology. Given the rarity and the lack of direct infiltration of lymphoma into the kidneys in this patient, we hope reporting this case will allow further advancements in this field of study as well as more comprehensive management.
Musical hallucination or musical obsession? A differential diagnosis between two cases
Authors: Octavio Pennella Fenelon Costa, Maria Luiza Dalcim, Sumaia Inaty Smaira, Gustavo Bigaton Lovadini
Journal: Dement Neuropsychol (2024)
Keywords: charles bonnet syndrome, hallucinations, hearing impairment, obsessive behavior, obsessive-compulsive disorders
MeSH terms: Case Reports

Musical hallucinations and musical obsessions are distinct phenomena. The first can be understood as a manifestation of the musical ear syndrome, which produces deafferentation auditory hallucinations, while the latter is an obsessive symptom of obsessive-compulsive disorders. Both symptoms are often poorly understood and mistaken for one another or for signs of psychotic disorders. We report two cases, one characterized by musical hallucinations and the other by musical obsessions, both with comorbid hearing impairment, which is the main confounding factor in their differential diagnosis. We critically compare the two cases and their key features, allowing diagnostic differentiation and a targeted therapeutic approach.
Bilateral Optic Neuropathy Secondary to Intravenous Carboplatin Therapy
Authors: Arash Maleki, Mollie K Lagrew, Elizabeth D Slaney, Md
Journal: J Ophthalmic Vis Res (2024)
Keywords: disc edema, optic neuropathy, papilledema, carboplatin, chemotherapy-induced optic neuropathy
MeSH terms: Case Reports

Purpose:
To report a case of carboplatin-induced bilateral optic neuropathy in a patient with metastatic squamous cell carcinoma of the tongue.
Case report:
A 65-year-old man with a history of squamous cell carcinoma of the tongue with metastasis to the right axillary lymph node treated with carboplatin and paclitaxel was evaluated for decreased visual acuity in both eyes. Visual acuity was 20/70 in the right eye and no light perception in the left eye. On dilated fundus examination, optic disc edema was present in both eyes with more severity in the left eye, flame shape hemorrhages around the optic nerve head in both eyes and cotton wool spots around the left optic nerve head. Brain and orbital MRI demonstrated enhancement of the bilateral optic nerve sheaths. He was diagnosed with bilateral carboplatin-induced optic neuropathy.
Conclusion:
Our findings in this case justify monitoring of patients during their course of intravenous carboplatin therapy.
Bilateral Lung Injury with Delayed Pneumothorax following Preoperative Cryoanalgesia for Pectus Excavatum Repair in a 13-year-old Boy
Authors: Clara Massaguer, Laura Saura-García, Pedro Palazón, Gastón Echaniz, Maria Carme Roqueta Alcaraz, Xavier Tarrado
Journal: European J Pediatr Surg Rep (2024)
Keywords: minimally invasive pectus excavatum repair (mirpe), nuss procedure, cryoanalgesia, pectus excavatum, pneumothorax
MeSH terms: Case Reports

A 13-year-old male patient with marfanoid features and pectus excavatum with Haller index 4 and correction index of 38% underwent the Nuss procedure with cryoanalgesia 9 days prior, which transpired uneventfully. Preoperative spirometry was normal, and echocardiogram showed light aortic valve dilation. A month later, during a routine outpatient checkup, he referred middle abdominal pain, denying respiratory symptoms nor thoracic pain. He presented bilateral apical and right basal hypophonesis. Chest X-ray revealed bilateral pneumothorax and right pleural effusion. Consequently, the patient was admitted to the emergency room, and a chest computed tomography was ordered, reporting right apical blebs. Bilateral thoracoscopy was performed, and apexes were checked for pulmonary blebs to rule out primary pneumothorax. In the right chest, a wedge resection of a distorted area on the apex and pleuroabrasion were done. Four air leaking eschars were found when performing lung expansion under water as leaking test, corresponding to cryoanalgesia intercostal eschars, and subsequently closed by primary suture. In the left chest, there were no blebs. However, another four pleural lesions with intact pleura in the left lower lobe were also found. Postoperative course was uneventful and chest drains were removed 48 hours after surgery. He remains asymptomatic 21 months after discharge. Cryoanalgesia in pectus excavatum is spreading due to the improvement in postoperative pain control. However, some complications may occur.
Two synchronous primary mesenteric neuroendocrine tumors in a patient: a case report
Authors: Elissavet Symeonidou, Ariadni Fouza, Ioannis Gkoutziotis, Christina Nikolaidou, Panagiotis Petras, Konstantinos Mpallas
Journal: Front Surg (2024)
Keywords: dotatate, net, bowel resection, laparoscopy, primary mesenteric neuroendocrine tumor, synchronous primary mesenteric net
MeSH terms: Case Reports

Primary mesenteric neuroendocrine tumors represent a rare clinical entity, challenging to manage, while a combination of imaging is demanded in order to differentiate it from metastatic disease, and set the diagnosis. If the tumor is resectable, surgery is the fundament of the therapeutic approach. The appearance of a second primary mesenteric tumor suggests an unacquainted scenario. The current article presents a case of a 40-year-old woman, who underwent laparoscopic excision of a mesenteric tumor located close to the left pararenal space. Pathology with immunohistochemistry examination reported neuroendocrine tumor grade 2. No further treatment was necessary. Seven months later, 68-Gallium DOTATATE detected another primary neuroendocrine tumor located at the right retroperitoneal space without other lesions. The second tumor was also resected laparoscopically, and the pathology confirmed the diagnosis of another neuroendocrine tumor G2. The postoperative course was uneventful, and six months later the patient is disease-free. The adequacy of 68-Gallium DOTATATE for the preoperative diagnosis of primary mesenteric tumors, the role of the laparoscopic approach, and the extent of lymph node resection are matters addressed in this article.
An Eye on the First Surgical Side: Appreciating the Potential Impacts of a Second DBS Lead on Ipsilateral Symptoms
Authors: Ariane Veilleux Carpentier, Jason L Chan, Joshua K Wong, Michael S Okun
Journal: Tremor Other Hyperkinet Mov (N Y) (2024)
Keywords: deep brain stimulation, essential tremor, ipsilateral, microlesion effect, patient selection, staged surgeries
MeSH terms: Deep Brain Stimulation / adverse effects, Deep Brain Stimulation / methods, Essential Tremor / physiopathology, Essential Tremor / surgery, Essential Tremor / therapy, Case Reports, Humans, Male, Middle Aged, Ventral Thalamic Nuclei / surgery

Clinical vignette:
A 63-year-old man with severe essential tremor underwent staged bilateral ventralis intermedius (Vim) deep brain stimulation (DBS). Left Vim DBS resulted in improved right upper extremity tremor control. Months later, the addition of right Vim DBS to the other brain hemisphere was associated with acute worsening of the right upper extremity tremor.
Clinical dilemma:
In staged bilateral Vim DBS, second lead implantation may possibly alter ipsilateral tremor control. While ipsilateral improvement is common, rarely, it can disrupt previously achieved benefit.
Clinical solution:
DBS programming, including an increase in left Vim DBS amplitude, re-established and enhanced bilateral tremor control.
Gap in knowledge:
The mechanisms underlying changes in ipsilateral tremor control following a second lead implantation are unknown. In this case, worsening and subsequent improvement after optimization highlight the potential impact of DBS implantation on the ipsilateral side.
Expert commentary:
After staged bilateral Vim DBS, clinicians should keep an eye on the first or original DBS side and carefully monitor for emergent side effects or worsening in tremor. Ipsilateral effects resulting from DBS implantation present a reprogramming opportunity with a potential to further optimize clinical outcomes.
Highlights:
This case report highlights the potential for ipsilateral tremor worsening following staged bilateral DBS and provides valuable insights into troubleshooting and reprogramming strategies. The report emphasizes the importance of vigilant monitoring and individualized management in optimizing clinical outcomes for patients undergoing staged bilateral DBS for essential tremor.
Recurrent Acute Methemoglobinemia in an Infant With Persistent Gastroenteritis: A Case Report
Authors: Nawarah A Alhamoud, Ryan A AlZugaibi, Waad M Aldoohan
Journal: Cureus (2024)
Keywords: cyanosis, gastroenteritis, methemoglobin, methemoglobinemia, well water
MeSH terms: Case Reports

Acute toxic methemoglobinemia is a rare and fatal condition with increased levels of oxidized hemoglobin. The clinical presentation of methemoglobinemia varies primarily based on total methemoglobin levels in the blood. Patients sometimes have significant cardiopulmonary compromise, but the majority are asymptomatic, with only cyanosis as the most prevalent sign. We report the case of a 41-day-old male who developed methemoglobinemia and persistent gastroenteritis after consumption of well water. In this case, we believe that the recurrence of acute methemoglobinemia episodes resulted from multifactorial reasons such as age at presentation, infection with nitrate-producing organisms, and consumption of nitrite-containing well water. The rationale for prophylactic therapy was implemented, aiming to prevent further episodes. This case report demonstrates the potential of prophylactic therapy as part of the management of infants with recurrent acute methemoglobinemia episodes.
Focal reactive nodular gliosis: an extremely rare retinal astrocytic tumor
Authors: Saúl Villoria-Díaz, María Antonia Saornil-Álvarez, Ciro García-Álvarez, Elena García-Lagarto, Irene Bermúdez-Castellanos
Journal: GMS Ophthalmol Cases (2023)
Keywords: ki-67 antigen, astrocytes, glial fibrillary astrocytic protein, gliosis, retinal neoplasm
MeSH terms: Case Reports

Focal reactive nodular gliosis (FRNG) is an extremely rare benign retinal reactive astrocytic tumor that results from the proliferation of well-differentiated glial cells secondary to a variety of retinal conditions. We describe a case of this tumor in a 64-year-old male in association with a chorioretinal scar he has had since childhood. The symptom was sudden painful vision loss. In the clinical examination, iris rubeosis, posterior synechiae, cataract, vitreous haze and a suspected fundus mass were showed. B-scan ultrasonography demonstrated a retinal mass consistent with choroidal melanoma. The magnetic resonance imaging (MRI) showed a well-circumscribed mass with T1 hyperintensity and T2 hypointensity. Enucleation was performed and histopathologic and immunohistochemical studies confirmed the diagnosis of FRNG.
Surgical treatment of a very rare case of a huge intraligamental leiomyoma of the uterus: A case report and mini‑review of the literature
Authors: Anna Thanasa, Efthymia Thanasa, Evangelos Kamaretsos, Vasiliki Grapsidi, Emmanouil Xydias, Apostolos Ziogas, Evangelos-Ektoras Gerokostas, Ioannis-Rafail Antoniou, Ioannis Paraoulakis, Ioannis Thanasas
Journal: Med Int (Lond) (2023)
Keywords: computed tomography, electrothermal bipolar vessel sealing device, intraligamental leiomyoma, intraoperative complications, magnetic resonance imaging, surgical treatment
MeSH terms: Case Reports

Intraligamental leiomyomas of the uterus are rare. Extremely rare are the huge intraligamental fibroids (>20 cm), whose pre-operative diagnosis and surgical management poses a challenge to everyday clinical practice. The present study describes the case of patient who was subjected to surgical treatment for a huge intraligamental leiomyoma of the uterus, which weighed 3,370 g. A 48-year-old patient, without menstrual disorders and with a medical history of atypical symptoms from the digestive tract, was referred for a gynecological examination. Upon a physical examination, the abdomen was found to be bloated and distended, with no signs of peritoneal irritation. An intra-abdominal mass was suspected, the upper margin of which was palpable at about the level of the xiphoid process. The findings of computed tomography and magnetic resonance imaging confirmed the presence of a huge intra-abdominal mass, which probably originated from the internal genital organs. Following consultation with the patient, surgical treatment with laparotomy was decided. Intraoperatively, a large pedunculated subserosal leiomyoma was found, arising from the right lateral wall of the uterus with retroperitoneal extension within the leaves of broad ligament. Following the resection of the intraligamental leiomyoma, which had significant surgical challenges, a total hysterectomy with bilateral adnexectomy was performed. The post-operative course was smooth. In addition, in the present study, a brief review of intraligamental leiomyomas of the uterus is presented, emphasizing the significant diagnostic and surgical challenges and potential intraoperative complications that may arise in the management of patients with this condition.
The Management of Hyperplastic Pulpitis in Immature Permanent Molar Using Vital Pulp Therapy: A Case Report with 12 Months Follow-Up
Authors: Anas Mando, Mohannad Laflouf, Yasser Alsayed Tolibah
Journal: Case Rep Dent (2024)
MeSH terms: Case Reports

Hyperplastic pulpitis is an irreversible type of pulpitis that primarily affects young patients. It occurs when an inflamed pulp becomes exposed due to factors such as dental caries, dental trauma, or other causes. Root canal treatment is commonly employed to manage hyperplastic pulpitis. However, vital pulp therapy can be considered as a less invasive option. The main objective of this treatment is to preserve the vitality and functionality of the remaining pulp tissue. This case report discusses the potential management of hyperplastic pulpitis in an immature molar using vital pulp therapy instead of a full root canal treatment. The report includes clinical and radiographic follow-up at six and twelve months.
Rivaroxaban Failure Presenting With Renal Infarction in a Patient With Persistent Atrial Fibrillation: A Case Report
Authors: Shudipan Chakraborty, Fnu Salman, Moaaz Baghal, Ayesha Tahir, Abdul Baqi, Hemindermeet Singh, Mohammed Taleb
Journal: Cureus (2024)
Keywords: echocardiography, echocardiography - heart failure - valvular heart disease, left atrial thrombus, mitral valve, thrombous
MeSH terms: Case Reports

Direct oral anticoagulants (DOAC) are the preferred choice of anticoagulation for patients with atrial fibrillation. DOACs are always preferred over vitamin K antagonists due to their better safety profile in terms of life-threatening bleeding and decreased need for INR (international normalised ratio) monitoring. Although the most commonly used anticoagulation, failure to DOAC has been reported. Here we present a rare case of rivaroxaban failure presenting with left renal infarction in a patient who had dense spontaneous echocardiographic contrast in the left atrium visualised by transthoracic echocardiography.
Trauma and chorioretinal shockwave injury from intra-orbital foreign body
Authors: Mehrdad Motamed Shariati, Naser Sahraei, Mahshid Sadeghi Kakhki
Journal: Clin Case Rep (2023)
Keywords: chorioretinal shockwave injury, chorioretinitis sclopetaria, intra‐orbital foreign body, ocular trauma
MeSH terms: Case Reports

High-velocity projectile trauma could lead to intra-orbital foreign body and concomitant chorioretinal shockwave injury in the absence of open-globe injury. Management depends on the types, size, and location of foreign bodies.
Anorectal Malformations: The Pivotal Role of the Good Clinical Practice
Authors: Filomena Valentina Paradiso, Sara Silvaroli, Riccardo Rizzo, Lorenzo Nanni
Journal: Case Rep Pediatr (2023)
MeSH terms: Case Reports

Anorectal malformations (ARM) without a fistula are a rare congenital condition. Although may seem more simple to repair compared with ARM with fistulas, surgery has proved to be challenging. We report the case of a newborn who presented a well-formed anus and normal genitalia; a blind-ending anal canal was detected after the insertion of a rectal probe, thus allowing the diagnosis of ARM. Anal probing straight after birth avoids the possible complications related to intestinal obstruction due to a missed diagnosis of ARM. Examination of the perineal region is an important step in the evaluation of the newborn and represents the tool for a prompt identification of ARM. Adding anal probing to accurate inspection perineum is a good clinical practice and should always be performed even in presence of a normal-looking perineum.
Case report: Genotype-phenotype characteristics of nine novel PKD1 mutations in eight Chinese patients with autosomal dominant polycystic kidney disease
Authors: Jing Zhuang, Ailima Aierken, Dilina Yalikun, Jun Zhang, Xiaoqin Wang, Yongfang Ren, Xuefei Tian, Hong Jiang
Journal: Front Med (Lausanne) (2023)
Keywords: pkd1 gene mutation, autosomal dominant polycystic kidney disease, genetic kidney disease, genotype-phenotype characteristics, second-generation sequencing
MeSH terms: Case Reports

Introduction:
Autosomal dominant polycystic kidney disease (ADPKD) is a common genetic disorder. The PKD1 gene is responsible for the majority of ADPKD cases, and the mutations in this gene exhibit high genetic diversity. This study aimed to investigate the association between genotype and phenotype in ADPKD patients with PKD1 gene mutations through pedigree analysis.
Methods:
Eight Chinese pedigrees affected by ADPKD were analyzed using whole-exome sequencing (WES) on peripheral blood DNA. The identified variants were validated using Sanger sequencing, and clinical data from the patients and their families were collected and analyzed.
Results:
Nine novel mutation sites in PKD1 were discovered across the pedigrees, including c.4247T > G, c.3298_3301delGAGT, c.4798A > G, c.7567G > A, c.11717G > C, c.7703 + 5G > C, c.3296G > A, c.8515_8516insG, and c.5524C > A. These mutations were found to be associated with a range of clinical phenotypes, including chronic kidney disease, hypertension, and polycystic liver. The age of onset and disease progression displayed significant heterogeneity among the pedigrees, with some individuals exhibiting early onset and rapid disease progression, while others remained asymptomatic or had milder disease symptoms. Inheritance patterns supported autosomal dominant inheritance, as affected individuals inherited the mutations from affected parents. However, there were instances of individuals carrying the mutations who remained asymptomatic or exhibited milder disease phenotypes.
Conclusion:
This study highlights the importance of comprehensive genotype analysis in understanding the progression and prognosis of ADPKD. The identification of novel mutation sites expands our knowledge of PKD1 gene mutations. These findings contribute to a better understanding of the disease and may have implications for personalized therapeutic strategies.
A case of acquired thrombotic thrombocytopenic purpura following near-drowning
Authors: Natnicha Leelaviwat, Shanti Parkash, Sharma Prabhakar
Journal: Clin Nephrol Case Stud (2024)
Keywords: near-drowning, refractory thrombotic thrombocytopenic purpura, thrombotic thrombocytopenic purpura
MeSH terms: Case Reports

A 19-year-old woman with a history of asthma presented with acute confusion following a near-drowning event 2 weeks prior to admission. She was found to have severe thrombocytopenia and microangiopathic hemolytic anemia (MAHA). The treatment for thrombotic thrombocytopenic purpura (TTP) was started on the day of admission due to high clinical suspicion. Subsequent workup confirmed a diagnosis of TTP with no clear etiology except the near-drowning incident. TTP following a near-drowning event has never been reported in the literature. Furthermore, she developed refractory TTP that required reinitiation of therapeutic plasma exchange and rituximab. After discharge, the patient had been doing well over a year of follow-up without remission.