OpenMed/multicare-articles huggingface dataset:
Cutaneous tuberculosis-ambiguous transmission, bacterial diversity with biofilm formation in humoral abnormality: case report illustration
Authors: Przemysław Zdziarski, Mariola Paściak, Anna Chudzik, Monika Kozińska, Ewa Augustynowicz-Kopeć, Andrzej Gamian
Journal: Front Public Health (2023)
Keywords: actinobacteria, biofilm, cutaneous tuberculosis, diagnostic chain, microbiome, paraproteinemia, portal of entry/exit, translational medicine
MeSH terms: Tuberculosis, Case Reports, Research Support, Non-U.S. Gov't, Biofilms, Humans

Background:
Cutaneous tuberculosis (CTB) and its paucibacillary forms are rare and difficult to diagnose, especially in immunocompromised patients with significant comorbidity. The aim of the study was to introduce the modern concept of the microbiome and diagnostic chain into clinical practice (patient-centered care) with the presentation of an atypical form of cutaneous tuberculosis with necrotizing non-healing ulcers leading to polymicrobial infection.
Methods:
The study material included samples from sputum, broncho-alveolar lavage and skin ulcer, taken from a patient developing cutaneous tuberculosis. The microbiological investigation was performed, and identification of the isolates was carried out using genotyping and the matrix-assisted laser desorption ionization-time of flight mass spectrometry.
Results:
The immunocompromised patient with humoral abnormality (plasma cell dyscrasia) and severe paraproteinemia developed multiorgan tuberculosis. Although cutaneous manifestation preceded systemic and pulmonary symptoms (approximately half a year), the mycobacterial genotyping confirmed the same MTB strain existence in skin ulcers and the respiratory system. Therefore, the infectious chain: transmission, the portal of entry, and bacterial spreading in vivo, were unclear. Microbial diversity found in wound microbiota (among others Gordonia bronchialis, Corynebacterium tuberculostearicum, Staphylococcus haemolyticus, and Pseudomonas oryzihabitans) was associated with the spread of a skin lesion. The in vitro biofilm-forming capacity of strains isolated from the wound may represent the potential virulence of these strains. Thus, the role of polymicrobial biofilm may be crucial in ulcer formation and CTB manifestation.
Conclusions:
Severe wound healing as a unique biofilm-forming niche should be tested for Mycobacterium (on species and strain levels) and coexisting microorganisms using a wide range of microbiological techniques. In immunodeficient patients with non-typical CTB presentation, the chain of transmission and MTB spread is still an open issue for further research.
Topiramate-induced angle closure with acute myopia, macular striae
Authors: S Natesh, S K Rajashekhara, A S D Rao, B Shetty
Journal: Oman J Ophthalmol (2010)
Keywords: topiramate, macular striae, optical coherence tomography
MeSH terms: Case Reports

Topiramate is a sulfamate-substituted monosaccharide used in the treatment of seizures, and prophylaxis of migraine. A number of ocular side-effects have been described with use of topiramate, like bilateral angle closure, acute myopia and macular striae. Ultrasound biomicroscopy (UBM) clinches the diagnosis after ruling out other causes of shallow anterior chamber. Previous studies have not demonstrated internal limiting membrane folds presenting as macular striae. We report a case of topiramate-induced acute myopia with angle closure and macular striae in a young adult. This is the first report wherein striae formation after low doses of topiramate and their resolution have been documented by Optical Coherence Tomography (OCT).
Lag screws for reduction of bilateral lateral mass fractures due to spinal trauma
Authors: Massimimiliano Minardi, Alessandro Narducci, Giovanni Giulio Vercelli, Christian Francesco Carlino, Federico Griva, Pier Federico Pretti
Journal: Brain Spine (2022)
MeSH terms: Case Reports

Introduction:
Bilateral fracture of the C1 lateral mass is a relatively uncommon type of traumatic lesion. Treatment of this kind of fractures is usually conservative, with either external immobilization or traction.
Research question:
Whether surgical management, with placement of lag screws in lateral mass of C1, could represent a first-line treatment.
Material and methods:
We describe a case of 67-years old man with bilateral fractures of lateral mass of Atlas due to road accident trauma without ligament lesion but severe gap between bone edges. We performed Computed Tomography and Magnetic Resonance scans for pre-operative imaging, X-Ray and CT scan for follow-up. Medtronic navigation system was used as intraoperative guidance for screw placement.
Results:
Radiological and clinical results were good, with optimal bone reduction and patient's early return to daily activities.
Discussion and conclusion:
Surgical management remains debateable for isolated C1 lateral mass fractures. Different surgical approaches have been described for atlas fractures, such as transoral anterior C1-ring plate osteosynthesis, posterior osteosynthesis with a lateral mass screw rod, and posterior C1 to C2 fusion and C0 to C2 fusion. Minimally invasive operative treatment with lag screw and reduction of fracture's edges without occiput-C1 or C1-C2 stabilization could be the optimal treatment with good result and decreasing rate of pseudoarthrosis, allowing to avoid Halo-vest discomfort and complications.
A Rare Presentation of Stage IV Large Cell Neuroendocrine Carcinoma of the Cervix with Metastasis to the Cranium
Authors: Neema Hooker, Sveta Mohanan, R Tucker Burks
Journal: Case Rep Obstet Gynecol (2018)
MeSH terms: Case Reports

Neuroendocrine tumors (NETs) are aggressive diseases developing from neuroendocrine cells that most frequently involve the gastro-entero-pancreatic tract and the lung, but more rarely are found in almost all body tissues. Limited biological and clinical data are currently available for NETs in uncommon sites, such as female genital tract. NETs represent 0.9% to 1.5% of the tumors of the uterine cervix. This case is reported on a 75-year-old Caucasian woman, presenting with dental and generalized pain for two weeks. Later during her admission, facial droop and diplopia were noticed. Radiological findings ruled out cerebrovascular accident but revealed multiple bone marrow lesions involving the left and the right clivus, right Meckel's cave, and posterior margin of the right cavernous sinus. Findings also included pulmonary nodules and adenopathy supporting diagnosis of likely stage IV metastatic carcinoma. Further imaging revealed homogeneous enhancement of the uterus suggestive of diffusely infiltrative carcinoma; pathology results confirmed large cell neuroendocrine carcinoma of the uterine cervix (LCNEC) giving her a 1.5-month median survival range.
Recurrent Wheezing and Cough Caused by Double Aortic Arch, Not Asthma
Authors: Qiao Zhang, Zhou Fu, Jihong Dai, Gang Geng, Wenlong Fu, Daiyin Tian
Journal: Case Rep Cardiol (2017)
MeSH terms: Case Reports

Introduction:
Double aortic arch is a congenital vascular abnormality in which the connected segments and their branches course between and compress the trachea and esophagus, often resulting in invariable airway compression.
Case presentation:
A 4-year-old boy with a history of recurrent wheezing was admitted to our hospital for evaluation of asthma based on his past medical history, persistent cough, wheezing, and airway hyperresponsiveness by lung function test. Double aortic arch was diagnosed with computed tomography angiogram. After surgery, the respiratory infection improved strikingly. Early diagnosis and treatment may prevent chronic, irreversible complications.
Conclusion:
We present a case of double aortic arch masquerading as asthma.
Letrozole induced hypercalcemia in a patient with breast cancer
Authors: Suleyman Hilmi Ipekci, Suleyman Baldane, Ercument Ozturk, Murat Araz, Huseyin Korkmaz, Fatih Colkesen, Levent Kebapcilar
Journal: Case Rep Oncol Med (2014)

Hypersecretion of PTHrP is a relatively common cause of malignancy-related hypercalcemia. However, there is only one case report of letrozole induced hypercalcemia. A 52-year-old female patient was referred to our clinic because of the recent discovery of hypercalcemia (11.0 mg/dL). The patient had a history of left breast carcinoma. She had started a course of letrozole (aromatase inhibitor; 2.5 mg dose/day) ten months earlier. Patient's parathyroid hormone-related protein levels were normal and a bone scintigram revealed no evidence of skeletal metastasis. Other potential causes of high calcium levels were ruled out. We recognized that, when letrozole was taken at one dose daily (2.5 mg), she had recurrent hypercalcemia. Our experience suggests that letrozole may precipitate hypercalcemia in a patient with breast cancer.
CASE REPORT Persistent Seromas in Abdominal Free Flap Donor Sites After Postmastectomy Breast Reconstruction Surgery: Case Reports and Literature Review
Authors: Abtin Sadeghi, Charles Malata
Journal: Eplasty (2013)

Objectives:
Donor site seroma formation is a common occurrence following abdominal free flap breast reconstructions. Although such seromas usually resolve spontaneously after a few weeks or months, we recently encountered 3 patients with abdominal seromas persisting for up to 2 years postoperatively. We therefore investigated possible predisposing factors in our patient group.
Methods:
Patients with persistent abdominal seromas, arbitrarily defined as present after 3 months following abdominal free flap harvest were identified. Their demographic characteristics, comorbidities, reconstruction details, frequency, and volume of abdominal aspirations were documented.
Results:
Three obese patients (Mean body mass index = 35) with an average age of 49 years bilaterally reconstructed with superior inferior epigastric artery or deep inferior epigastric artery flaps fitted the aforementioned criteria. Seroma aspirations commenced at 3 weeks and continued for a maximum of 26 months postoperatively. The average number of aspirations was 11 with a mean volume of 338 mL (range: 100-864 mL) per visit. The patients were aspirated either weekly or fortnightly depending on the speed of seroma reaccumulation and symptoms. All the 3 patients needed excision of the seroma sac to achieve permanent resolution.
Discussion and conclusion:
In addition to their nuisance value (notably frequent aspirations and outpatient clinic visits), persistent seromas can cause significant morbidity and eventually require surgical excision. Possible predisposing factors in our patients included obesity, bilateral reconstructions, and superior inferior epigastric artery flap harvest. Such "high risk" patients should be warned about the likelihood of persistent seromas needing repeated aspirations and possible surgical interventions for ultimate resolution.
Dopaminergic and clinical correlates of pathological gambling in Parkinson's disease: a case report
Authors: Mette Buhl Callesen, K V Hansen, A Gjedde, J Linnet, A Møller
Journal: Front Behav Neurosci (2013)
Keywords: parkinson’s disease, decision-making, dopamine, impulse control disorders, pathological gambling

Dopaminergic medication for motor symptoms in Parkinson's disease (PD) recently has been linked with impulse control disorders, including pathological gambling (PG), which affects up to 8% of patients. PG often is considered a behavioral addiction associated with disinhibition, risky decision-making, and altered striatal dopaminergic neurotransmission. Using [(11)C]raclopride with positron emission tomography, we assessed dopaminergic neurotransmission during Iowa Gambling Task performance. Here we present data from a single patient with PD and concomitant PG. We noted a marked decrease in [(11)C]raclopride binding in the left ventral striatum upon gambling, indicating a gambling-induced dopamine release. The results imply that PG in PD is associated with a high dose of dopaminergic medication, pronounced motor symptomatology, young age at disease onset, high propensity for sensation seeking, and risky decision-making. Overall, the findings are consistent with the hypothesis of medication-related PG in PD and underscore the importance of taking clinical variables, such as age and personality, into account when patients with PD are medicated, to reduce the risk of PG.
Collateral damage: the impact of the COVID-19 pandemic on the care of a patient with tuberculous neuroretinitis in Lagos, Nigeria
Authors: Temiloluwa Moyosoreoluwa Abikoye
Journal: Pan Afr Med J (2020)
Keywords: covid-19, healthcare delivery, ophthalmology, tuberculous neuroretinitis
MeSH terms: Continuity of Patient Care, Coronavirus Infections / epidemiology, Health Services Accessibility, Pandemics, Pneumonia, Viral / epidemiology, Retinitis / drug therapy, Tuberculosis, Ocular / drug therapy, Case Reports, Antitubercular Agents / therapeutic use, COVID-19, Cell Phone, Delayed Diagnosis, Diagnostic Techniques, Ophthalmological, Drug Therapy, Combination, Female, Health Facility Closure, Humans, Macula Lutea / pathology, Nigeria / epidemiology, Photography, Quarantine, Retinitis / diagnosis, Telemedicine, Tomography, Optical Coherence, Treatment Outcome, Treatment Refusal, Tuberculosis, Ocular / diagnosis, Young Adult, Antitubercular Agents

Tuberculous neuroretinis, a relatively rare manifestation of extra-pulmonary tuberculosis, is characterized by optic disc edema, peripapillary and macula swelling, with hard exudates forming a partial or complete 'macular star' While the disease may present a diagnostic challenge for Ophthalmologists, prognosis is usually good, with proper management. The Coronavirus Disease 2019 (COVID-19) pandemic has presented a healthcare delivery dilemma in many parts of the world, with poor accessibility to, and under-utilization of, important healthcare services by non-COVID-19-related cases. Herein is a report of a case of tuberculous neuroretinitis in Lagos, Nigeria, whose care was negatively impacted by the ongoing pandemic through the combined factors of the interruption of clinical services during the lockdown, patient avoidance of healthcare facilities and the absence of robust telehealth services. These all culminated in the delayed institution of therapy which may be responsible for the poor visual outcome of no-light-perception.
Odynophagia after Cardiac Catheterization: A Rare Complication in the Presence of Aberrant Subclavian Artery
Authors: Moumita Naidu, Robby Singh, Marcel Zughaib
Journal: Case Rep Cardiol (2020)
MeSH terms: Case Reports

Background:
Vascular complications from transradial cardiac catheterization are uncommon. Mediastinal hematoma is a rare complication with life-threatening potential. We present a case of a patient who underwent cardiac catheterization and subsequently experienced odynophagia from injury to an aberrant subclavian artery that led to a mediastinal hematoma. Case Report. A 59-year-old female with past medical history of coronary artery disease presented with complaints of angina and underwent a transradial cardiac catheterization. Immediately after the procedure, the patient complained of chest pain and odynophagia. EKG and echocardiogram were unremarkable, and a CT scan of the chest demonstrated an ill-defined fluid collection present in the superior mediastinum and an aberrant right subclavian artery. The patient was closely monitored in the Intensive Care Unit, and the patient remained hemodynamically stable throughout the admission. The patient was subsequently discharged home in good condition and did well on outpatient follow-up.
Conclusion:
Vascular injuries associated with delivery of standard radial catheters in the subclavian artery are rare, with very few cases reported in the literature. We presented the case of a patient who had a previously unidentified right aberrant subclavian artery with a retroesophageal course which precipitated the hematoma and subsequently resulted in odynophagia despite an uncomplicated catheterization. This rare complication of a commonplace procedure necessitates prompt recognition, appropriate hemodynamic management, and possible repair of the injured vessel to appropriately manage a potentially life-threatening condition.
Application of vascularized fibular graft for reconstruction and stabilization of multilevel cervical tuberculosis: A case report
Authors: Jian Zhang, Wen-Si He, Cheng Wang, Yi-Guo Yan, Zhi-Hua Ouyang, Jing-Bo Xue, Xue-Lin Li, Wen-Jun Wang
Journal: Medicine (Baltimore) (2018)
MeSH terms: Cervical Vertebrae / surgery, Fibula / blood supply, Fibula / transplantation, Spinal Fusion, Tuberculosis, Spinal / surgery, Case Reports, Female, Humans, Middle Aged

Multilevel cervical reconstruction and fusion after cervical tuberculosis has always been a challenge. The current implantation materials for cervical fusion, including titanium mesh, cage, and plate are limited by its inferior biological mechanical characteristics and the properties of the metallic material. This has led to the increased risk of recurrent infection after surgery. In addition, the unique nature of tuberculosis infection results in the low rate of cervical fusion and high risk of recurrence. This case report presents 1 patient who suffered from long segmental cervical tuberculosis and had reconstruction surgery using a vascularized fibula graft. The patient had successful graft incorporation 3 months postsurgery and was followed-up for 30 months. In this review, we detail the advantages of using vascularized fibular grafts and compare it with other types of grafts.
Acute aseptic meningitis as the initial presentation of a macroprolactinoma
Authors: Marina Boscolo, Danielle Baleriaux, Nathalie Bakoto, Bernard Corvilain, France Devuyst
Journal: BMC Res Notes (2014)
MeSH terms: Hypopituitarism / etiology, Meningitis, Aseptic / etiology, Pituitary Neoplasms / diagnosis, Prolactinoma / diagnosis, Case Reports, Review, Adult, Anti-Bacterial Agents / therapeutic use, Blindness / etiology, Cabergoline, Combined Modality Therapy, Ergolines / therapeutic use, Fever / etiology, Headache / etiology, Hormone Replacement Therapy, Humans, Hydrocortisone / therapeutic use, Hypophysectomy, Hypopituitarism / drug therapy, Male, Meningitis, Aseptic / diagnosis, Neoplasm Invasiveness, Pituitary Neoplasms / complications, Pituitary Neoplasms / drug therapy, Pituitary Neoplasms / surgery, Prolactinoma / complications, Prolactinoma / drug therapy, Prolactinoma / surgery, Sella Turcica / pathology, Third Ventricle / pathology, Thyroxine / therapeutic use, Anti-Bacterial Agents, Ergolines, Cabergoline, Thyroxine, Hydrocortisone, Combined Pituitary Hormone Deficiency

Background:
Meningitis is an uncommon complication of an untreated pituitary macroadenoma. Meningitis may occur in patients with macroadenomas who have undergone transsphenoidal surgery and radiotherapy and is usually associated with rhinorrhea. Less commonly, cerebrospinal fluid rhinorrhea has been reported as a complication of treatment of prolactinomas by dopamine agonists. Cerebrospinal fluid rhinorrhea in cases of untreated pituitary macroadenoma is reported only in isolated cases. Acute bacterial meningitis without rhinorrhea in patients with an untreated pituitary macroadenoma is an exceptional finding with only three previously reported cases.
Case presentation:
A 31-year-old male was urgently admitted for headache, fever and visual loss. Neuroimaging disclosed an invasive pituitary lesion. Cerebrospinal fluid leakage was not clinically detected. Lumbar puncture showed acute meningitis. Blood tests revealed increased inflammatory markers, a serum prolactin of 9000 ng/ml (2.5-11 ng/ml) and panhypopituitarism. Intravenous antibiotics and hydrocortisone replacement therapy were initiated, leading to a favorable clinical outcome. An endoscopic transsphenoidal debulking procedure was performed, it showed that the sphenoid floor was destroyed and the sinus occluded by a massive tumor.
Conclusions:
Meningitis should be ruled out in patients with a pituitary mass who present with headache and increased inflammatory tests, even in the absence of rhinorrhea.
Paroxysmal Nocturnal Hemoglobinuria in Pregnancy: A Dilemma in Treatment and Thromboprophylaxis
Authors: Arpan Patel, Athira Unnikrishnan, Martina Murphy, Robert Egerman, Sarah Wheeler, Ashley Richards, John Wingard
Journal: Case Rep Hematol (2017)
MeSH terms: Case Reports

Paroxysmal nocturnal hemoglobinuria (PNH) is a hematologic disorder characterized by an acquired somatic mutation in the phosphatidylinositol glycan class A gene which leads to a higher risk for increased venous and arterial thrombosis. Current treatment for PNH includes eculizumab. Pregnant patients who have PNH have higher risk for thrombosis and hemorrhage with both pregnancy and their underlying PNH. Treatment frequently poses conundrum. The safety and efficacy of eculizumab during pregnancy and breast feeding have not been extensively studied and contraception has been recommended due to potential for teratogenicity. We present a case of a patient who was safely on both eculizumab and modest prophylactic anticoagulation for 6 weeks post-partum.
Case report: Blue rubber bleb nevus syndrome with Kasabach-Merritt phenomenon in a neonate
Authors: Mengqi Pi, Lei Zhao, Weiyang Xu, Miao Xu, Yu Ding
Journal: Front Pediatr (2023)
Keywords: kasabach-merritt phenomenon, blue rubber bleb nevus syndrome, glucocorticoids, neonate, sirolimus, treatment
MeSH terms: Case Reports

Blue rubber bleb nevus syndrome (BRBNS) is a rare disease characterized by multifocal venous malformations that can affect any organ or tissue. Kasabach-Merritt phenomenon (KMP) is a serious and extremely rare complication of BRBNS. This report describes a neonate with BRBNS with KMP who was successfully diagnosed and treated with low-dose sirolimus and glucocorticoids. A 13-day-old female infant was born with multiple tumors on her head, neck, shoulder, back, abdomen, limbs, perineum, etc. some of which were blue. Laboratory examinations showed thrombocytopenia, anemia and coagulopathy. BRBNS with KMP was diagnosed. Oral low-dose sirolimus combined with glucocorticoids was administered. After 6 months of regular follow-up, the lesions in the child were significantly decreased, and there were no signs of KMP recurrence. The presence of KMP should be considered in patients diagnosed with BRBNS who present with thrombocytopenia, anemia and coagulopathy. Sirolimus combined with glucocorticoid therapy can be administered to save the patient's life.
Plasma cell mucositis of Oro- and hypopharynx: a case report
Authors: Mark Puvanendran, Anja Lieder, Wolfgang Issing
Journal: Case Rep Otolaryngol (2012)

Objective. To raise awareness of plasma cell mucositis as a rare differential diagnosis for oral mucosal ulceration and its macroscopic similarity to malignancy. Method. We report a patient who presented with oral features suggestive of malignancy. A biopsy revealed plasma cell mucositis. Results. The patient successfully had a full excision of one lesion and a spontaneous resolution of the other. Conclusion. With the increasing incidence of oral mucosal pathology, physicians should be aware of this differential diagnosis.