OpenMed/multicare-articles huggingface dataset:
Case report: Posterior reversible encephalopathy syndrome, an adverse effect of lenvatinib and pembrolizumab combination therapy, in a patient with advanced endometrial cancer
Authors: Yuki Matsuura, Haruka Nishida, Takashi Kosaka, Kazuyuki Shigekawa, Kazuki Takasaki, Takayuki Ichinose, Mana Hirano, Haruko Hiraike, Kazunori Nagasaka
Journal: Front Oncol (2023)
Keywords: adverse effect, endometrial cancer, lenvatinib, pembrolizumab, posterior reversible encephalopathy syndrome
MeSH terms: Case Reports

Background:
Lenvatinib-pembrolizumab combination (LEAP) is an approved therapy in Japan for advanced endometrial cancer, based on the data from the KEYNOTE-775 clinical trial. We report a case of posterior reversible encephalopathy syndrome (PRES) in a patient who received LEAP therapy for advanced endometrial cancer.
Case presentation:
A 53-year-old patient with stage IVB endometrial cancer having rectal metastases, after four cycles of paclitaxel-carboplatin therapy, was found to have increased rectal invasion, peritoneal dissemination, and multiple paraaortic lymph node metastases. She was treated with LEAP therapy and discharged on day 12 without adverse events, except for mild anemia on day 11 of treatment. She was carefully managed in the outpatient department, but on day 18, she was admitted to the emergency department with severely impaired consciousness and generalized seizures. Computed tomography of the head and lumbar tap showed no abnormal findings, and the seizures resolved with anticonvulsant medication alone. Based on a thorough physical examination and findings on magnetic resonance imaging (MRI), which showed high signal intensity in the left occipital lobe, encephalopathy, rather than encephalitis, was the likely diagnosis. Symptomatic improvement was observed, and pembrolizumab monotherapy was resumed.
Conclusions:
If consciousness is impaired during LEAP treatment, it is necessary to differentiate between immunogenic encephalitis caused by pembrolizumab or encephalopathy caused by lenvatinib. MRI and lumbar tap can help in distinguishing between the two and diagnosing the responsible drug.
Inappropriate Defibrillator Shocks due to Mechanical Inference from an Investigational Device
Authors: Ying Chi Yang, Thein Tun Aung, Abdul Wase
Journal: Case Rep Cardiol (2019)
MeSH terms: Case Reports

Cardiac contractility modulation (CCM) is an investigational device-based therapy to enhance ventricular contractility in systolic heart failure patients who are not candidates for cardiac resynchronization therapy (CRT) owing to the absence of wide QRS complexes or who have failed to respond on CRT. The principal mechanism is based on the stimulation of cardiac muscles by nonexcitatory electrical signals to augment the influx of calcium ions into the cardiomyocytes. The majority of patients receiving CCM therapy have concurrent implantable cardioverter defibrillators, and the manufacturer declares both devices can be used in parallel without any interactions. Nevertheless, proper lead positioning of both devices are crucial, and it is mandatory to check device-device interactions during each and every cardiac electronic implantable device-related procedure to prevent adverse outcomes.
A Case of Granulomatosis with Polyangiitis (GPA) Where a Multicystic Nasal Septal Abscess Aided in the Diagnosis
Authors: Mayuko Sasawaki, Kazuhiro Omura, Teru Ebihara, Nobuyoshi Otori
Journal: Case Rep Otolaryngol (2022)
MeSH terms: Case Reports

A 69-year-old male patient presented to the hospital with a chief complaint of nasal obstruction. Physical examination revealed swelling of the anterior nasal septum and nasal dorsum and tender indurated oedema of the dorsum of both hands. Blood tests showed an elevated inflammatory response, and contrast-enhanced computed tomography (CT) showed a polycystic abscess in the nasal septum. Emergency surgery and histopathology were performed on the day of the initial visit for incisional drainage. Intraoperative findings showed white necrosis between the nasal septal cartilage and nasal septal mucosa, as well as white necrosis and pus accumulation in the periosteum and soft tissue of the piriform aperture and the nasal bone. The patient underwent endoscopic dissection and drained as much as possible, and the abscess and surrounding normal nasal septal mucosa were sampled for diagnostic purposes. The patient was diagnosed with vasculitis based on the clinical findings, pathological examination results, and blood test results. After the diagnosis was confirmed, steroid and cyclophosphamide pulse administration was initiated, and the swelling of the anterior nasal septum and nasal dorsum and the bilateral dorsal indentation oedema improved markedly. The patient is now doing well and will continue to be carefully monitored in the outpatient clinic.
Case report: Successful immunomodulators combined with electromagnetic field therapy in a patient with methazolamide-induced Steven Johnson syndrome/toxic epidermal necrolysis overlap
Authors: Naiju Zhang, Tianjiao Su, Jingwen Yan, Mei Zhang, Shousong Zhao, Chuanmiao Liu, Tianping Chen
Journal: Front Med (Lausanne) (2023)
Keywords: steven johnson syndrome, adverse drug reaction, case report, electromagnetic field therapy, methazolamide, toxic epidermal necrolysis
MeSH terms: Case Reports

Methazolamide is used to treat patients with glaucoma. However, as a sulfonamide derivative, methazolamide shares the same adverse reaction profile as other sulfa-based medications. Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare delayed-type hypersensitivity cutaneous reactions with high morbidity and mortality. Here, we report a severe SJS/TEN overlap syndrome in an 85-year-old Chinese male patient who received methazolamide 25 mg twice daily for his left eye glaucoma. The causal relationship between SJS/TEN and methazolamide was categorized as "highly likely" on the algorithm for assessing drug causality for epidermal necrolysis. In addition to the treatments with methylprednisolone and immunoglobulin, we used a special electromagnetic spectrum therapeutic apparatus to provide skin wound care. The patient had a thoroughly satisfying recovery. This is the first case report to use electromagnetic field therapy in a patient with SJS/TEN. We share our experience here and suggest that electromagnetic field therapy can provide advanced skin wound care and facilitate the recovery of SJS/TEN.
Crowdsourcing the identification of organisms: A case-study of iSpot
Authors: Jonathan Silvertown, Martin Harvey, Richard Greenwood, Mike Dodd, Jon Rosewell, Tony Rebelo, Janice Ansine, Kevin McConway
Journal: Zookeys (2015)
Keywords: biodiversity, citizen science, crowdsourcing, identification, learning, learning design, social networking

Accurate species identification is fundamental to biodiversity science, but the natural history skills required for this are neglected in formal education at all levels. In this paper we describe how the web application ispotnature.org and its sister site ispot.org.za (collectively, "iSpot") are helping to solve this problem by combining learning technology with crowdsourcing to connect beginners with experts. Over 94% of observations submitted to iSpot receive a determination. External checking of a sample of 3,287 iSpot records verified > 92% of them. To mid 2014, iSpot crowdsourced the identification of 30,000 taxa (>80% at species level) in > 390,000 observations with a global community numbering > 42,000 registered participants. More than half the observations on ispotnature.org were named within an hour of submission. iSpot uses a unique, 9-dimensional reputation system to motivate and reward participants and to verify determinations. Taxon-specific reputation points are earned when a participant proposes an identification that achieves agreement from other participants, weighted by the agreers' own reputation scores for the taxon. This system is able to discriminate effectively between competing determinations when two or more are proposed for the same observation. In 57% of such cases the reputation system improved the accuracy of the determination, while in the remainder it either improved precision (e.g. by adding a species name to a genus) or revealed false precision, for example where a determination to species level was not supported by the available evidence. We propose that the success of iSpot arises from the structure of its social network that efficiently connects beginners and experts, overcoming the social as well as geographic barriers that normally separate the two.
A New Primary in Parotid Gland with History of Treated Mediastinal Solitary Fibrous Tumour
Authors: Siddiq Ahmed, Syed Iftikhar Ali, Faizan Farid, Muhammad Ali, Waqas Ahmed, Talat Youseef
Journal: Case Rep Surg (2019)
MeSH terms: Case Reports

Solitary fibrous tumours (SFTs) are rare tumours in the head and neck region. They have been reported in many anatomic sites but occurrence in the parotid gland is exceptional. We report a very rare finding of a benign SFT of the parotid gland in a patient with a past history of excision of a malignant type of mediastinal tumour. It is important that clinicians are aware of the possible existence of SFT in the parotid as a synchronous lesion or occurrence of the same disease later on elsewhere when SFT is diagnosed at one anatomical site. This case report illustrates that regular clinical and imaging follow-up is essential in SFTs to look for the appearance of new lesions in the other anatomic site.
Sporadic Fibrodysplasia Ossificans Progressiva in an Egyptian Infant with c.617G > A Mutation in ACVR1 Gene: A Case Report and Review of Literature
Authors: Mohammad Al-Haggar, Nermin Ahmad, Sohier Yahia, Amany Shams, Bothina Hasaneen, Rasha Hassan Hassan, Yahya Wahba, Nanees Abdel-Badie Salem, Dina Abdel-Hady
Journal: Case Rep Genet (2013)

Fibrodysplasia ossificans progressiva (FOP) is an autosomal dominant severe musculoskeletal disease characterized by extensive new bone formation within soft connective tissues and unique skeletal malformations of the big toes which represent a birth hallmark for the disease. Most of the isolated classic cases of FOP showed heterozygous mutation in the ACVR1 gene on chromosome 2q23 that encodes a bone morphogenetic protein BMP (ALK2). The most common mutation is (c.617G > A) leading to the amino acid substitution of arginine by histidine (p.Arg206His). We currently report on an Egyptian infant with a sporadic classic FOP in whom c.617G > A mutation had been documented. The patient presented with the unique congenital malformation of big toe and radiological evidence of heterotopic ossification in the back muscles. The triggering trauma was related to the infant's head, however; neither neck region nor sites of routine intramuscular vaccination given during the first year showed any ossifications. Characterization of the big toe malformation is detailed to serve as an early diagnostic marker for this rare disabling disease.
Genomic insights into the thiamin metabolism of Paenibacillus thiaminolyticus NRRL B-4156 and P. apiarius NRRL B-23460
Authors: David Sannino, Esther R Angert
Journal: Stand Genomic Sci (2017)
Keywords: hydroxymethyl pyrimidine, paenibacillus apiarius, paenibacillus dendritiformis, paenibacillus thiaminolyticus, thiamin, thiaminase i
MeSH terms: Case Reports

Paenibacillus thiaminolyticus is the model organism for studying thiaminase I, an enigmatic extracellular enzyme. Originally isolated from the feces of clinical patients suffering from thiamin deficiency, P. thiaminolyticus has been implicated in thiamin deficiencies in humans and other animals due to its ability to produce this thiamin-degrading enzyme. Its close relative, P. apiarius, also produces thiaminase I and was originally isolated from dead honeybee larvae, though it has not been reported to be a honeybee pathogen. We generated draft genomes of the type strains of both species, P. thiaminolyticus NRRL B-4156 and P. apiarius NRRL B-23460, to deeply explore potential routes of thiamin metabolism. We discovered that the thiaminase I gene is located in a highly conserved operon with thiamin biosynthesis and salvage genes, as well as genes involved in the biosynthesis of the antibiotic bacimethrin. Based on metabolic pathway predictions, P. apiarius NRRL B-23460 has the genomic capacity to synthesize thiamin de novo using a pathway that is rarely seen in bacteria, but P. thiaminolyticus NRRL B-4156 is a thiamin auxotroph. Both genomes encode importers for thiamin and the pyrimidine moiety of thiamin, as well as enzymes to synthesize thiamin from pyrimidine and thiazole.
Regeneration of the Fibula with Unidirectional Porous Hydroxyapatite
Authors: Koji Demiya, Toshiyuki Kunisada, Eiji Nakata, Joe Hasei, Toshifumi Ozaki
Journal: Case Rep Orthop (2019)
MeSH terms: Case Reports

A fibula graft is one of the most common orthopedic procedures for reconstruction of a bone defect, and some complications related to persistent defects of the fibula have been reported previously. We believe that regeneration of the fibula may be critical for postoperative function and prevention of complications. This report describes a 9-year-old female with Ewing sarcoma of the pelvis who was treated with the double-barrel fibula grafts for pelvic bone defect following tumor resection. The defect after fibular resection was filled with unidirectional porous hydroxyapatite (UDPHAp) implants. A plain radiograph revealed new bone formation and a callus-like structure at one month after surgery and bony union between each UDPHAp implant 5 months after surgery. Resorption of implanted UDPHAp was identified, and partial remodeling of the bone marrow cavity could be seen 1 year 2 months after surgery. A radiograph at final follow-up (5 years 10 months after surgery) demonstrated almost complete absorption of the implanted UDPHAp and clear formation of the cortex and bone marrow in the resected part of the fibula. The patient is able to walk well without any walking supports and to take part in sports activities.
Case report: Successful experience using continuous infusion of meropenem in a geriatric patient with hip fracture complicated by sepsis
Authors: Assiya Kadralinova, Assema Zh Bekniyazova, Maiya E Konkayeva, Aigerim A Yeltayeva, Aidos K Konkayev
Journal: Front Med (Lausanne) (2023)
Keywords: case report, continuous infusion, hip fracture, meropenem, pneumonia, sepsis
MeSH terms: Case Reports

This article highlights a clinical case of successful treatment of a 79-year-old multimorbid patient with a hip fracture resulting from a household injury. On the first day, the patient's injury was complicated by infection and pneumonia. As a result, arterial hypotension, tachysystole, and respiratory failure progressed. With manifestations of sepsis, the patient was transferred to the intensive care unit. Surgical treatment in such a situation was contraindicated due to the high operational and anesthesiological risks, the unstable severe condition of the patient, as well as the presence of concomitant pathology in the form of coronary heart disease, obesity, and schizophrenia. According to the new sepsis management guideline, it was decided to use a continuous 24-h infusion of meropenem in addition to the complex treatment of sepsis. The use of continuous infusion of meropenem in this clinical situation may have caused the patient's clinical improvement, which increased her quality of life and decreased the length of ICU stay and total hospital stay, despite an unfavorable cumulative prognosis and a high risk of in-hospital mortality.
The case series of functional adrenal tumors: Experience of two tertiary hospitals in Yaoundé, Cameroon
Authors: L O Mbouché, F G Epoupa Ngallé, Z Sando, S P Choukem, F F Angwafo 3rd
Journal: Int J Surg Case Rep (2020)
Keywords: adrenal tumor, adrenalectomy, corticoid, cushing syndrome

Introduction:
Adrenal tumors are often found incidentally during abdominal imaging. Functioning adrenal tumors are less frequent than these incidentalomas discovered unexpectedly. We report treatment outcomes (major complications) of 7 cases of symptomatic adrenal masses from 2009 to 2019.
Presentation of the cases:
Seven cases of functioning adrenal tumors: four adenomas presenting with Cushing's syndrome, two adrenal carcinomas, and one pheochromocytoma are described. The preoperative diagnoses were made through clinical manifestations, an increase in urinary free cortisol with normal ACTH, elevated metanephrine and enlarged masses on CT. The diagnoses were established on histopathology of adrenalectomy specimens. Adrenal insufficiency in two patients following surgery was corrected with corticoid replacement therapy. One patient died of hypovolemia the day of surgery and another from anaphylactic shock (allergy) late in the post-operative period.
Discussion:
Pre, intra and post-operative complications from vascular instability often complicate surgery in functioning adrenal tumors. Adrenal adenomas manifest as Cushing's syndrome in 10-15 % of patients. They are the most common adrenal tumor although the diagnosis is most often coincidental to abdominal imaging. The incidence of adrenal adenoma increases with age, up to 7 % in the seventh decade. Laparoscopic adrenalectomy, which was not available in our hospitals then, is standard treatment for most tumors. It is alleged to have better outcomes in trained and tested hands.
Conclusion:
Surgery of functioning adrenal tumors demands close collaboration of multiple clinical disciplines to manage vascular instability and adrenal insufficiency, especially in resource strapped communities.
Small Bowel Obstruction Caused by Internal Hernia through a Peritoneal Defect of the Pouch of Douglas: Report of a Case and Review of the Literature
Authors: Pyong Wha Choi
Journal: Case Rep Surg (2017)
MeSH terms: Case Reports

Herniation of small bowel through the peritoneal defect of the Pouch of Douglas is extremely rare type of internal hernia, and this type of internal hernia has been described as an entity of perineal hernia. Here, we describe a case of a 26-year-old female without history of abdominal surgery presenting with incarcerated small bowel hernia through a peritoneal defect of the Pouch of Douglas. She visited an emergency department presenting with abdominal pain and distension. Without improvement symptom by conservative management, an operation was performed. During the operation, the distal ileum had been herniated through a peritoneal defect of the Pouch of Douglas, and there were no specific findings on gynecological examination. Reduction of the herniated bowel and primary repair of the peritoneal defect were performed. The case represents a very rare type of internal hernia and provides published cases of hernia through a peritoneal defect of the Pouch of Douglas.
Streptococcus gordonii: A Rare Cause of Infective Endocarditis
Authors: Natalia Mosailova, Justina Truong, Tyson Dietrich, John Ashurst
Journal: Case Rep Infect Dis (2019)
MeSH terms: Case Reports

Infective endocarditis is a rare but life-threatening disease seen across the globe. Organisms from the oral cavity still represent a large proportion of pathogens seen in endocarditis and can be from either daily dental routines or invasive procedures. With the recent changes to antibiotic prophylaxis for infective endocarditis prior to dental procedures, the physician must have a heightened degree of suspicion when presented with a patient with undifferenced sepsis following dental procedures. The authors present a case of infective endocarditis caused by Streptococcus gordonii after the drainage of a dental abscess.
Rare periodontal ligament drainage for periapical inflammation of an adjacent tooth: a case report and review of the literature
Authors: Hongmei Guo, Wei Lu, Qianqian Han, Shubo Li, Pishan Yang
Journal: Case Rep Dent (2014)

Aim. To report a case with an unusual drainage route of periapical inflammation exiting through the gingival sulcus of an adjacent vital tooth and review probable factors determining the diversity of the discharge routes of periapical inflammation. Summary. An 18-year-old male patient presented with periodontal abscess of tooth 46, which was found to be caused by a periapical cyst with an acute abscess of tooth 45. During endodontic surgery, a rarely reported drainage route for periapical inflammation via the gingival sulcus of an adjacent vital tooth was observed for the first time. Complete periodontal healing of the deep pocket of tooth 46 and hiding of the periapical cyst of tooth 45 followed after root canal treatment and periapical surgery with Bio-Oss Collagen implantation on tooth 45. The drainage routes of periapical inflammation are multivariate and the diversity of drainage pathways of periapical inflammation is mainly related to factors such as gravity, barriers against inflammation, and the causative tooth itself.
Variant of Lemierre's Syndrome Secondary to Trauma
Authors: Sani M Bukari, Renato Roxas, Deepak Kamat
Journal: Int J Pediatr (2010)
MeSH terms: Case Reports

Classic Lemierre's syndrome is a septic internal jugular venous (IJV) thrombophlebitis secondary to oropharyngeal anaerobic infection in adolescent and young adult. Though upper respiratory tract infection is the most common antecedent, it has also been described following skin, soft tissues, genitourinary and gastrointestinal infections. Fusobacteria necrophorum is the commonest pathogen isolated from blood and tissue cultures but other bacteria like Eikenella correndens, Bacteroides melaninogenicus and Non Group A Streptococcal species have also been reported. The overall incidence of Lemierre's and Lemierre's like syndromes has declined since the first case report in 1936. There is however, a resurgence of cases in recent years due to more judicious use of antibiotics for treatment of upper respiratory tract infection among medical practitioners. The main stay of treatment of complete Lemierre's syndrome is prolonged antibiotic coverage and surgical drainage of nonresolving abscesses. Currently, there is no consensus opinion on the use of anticoagulation in patient with complete Lemierre's syndrome complicated by septic internal jugular thrombosis and embolism. High index of suspicion is required for early diagnosis of Lemierre's and Lemierre's like syndromes. Early and effective antibiotics therapy may prevent the development full spectrum of the syndrome and its associated complication.