OpenMed/multicare-articles huggingface dataset:
Colorectal Adenocarcinoma Metastasis to the Tongue
Authors: Kurren S Gill, Mark A Frattali
Journal: Case Rep Otolaryngol (2015)

This case presentation examines a rare clinical entity: colorectal adenocarcinoma (CRC) metastasis to the tongue. CRC is among the least common tumors to metastasize to the oral cavity. Objectives for this case report are to (1) maintain a high index of suspicion for oral cavity tumors representing metastatic disease, (2) consider appropriate surgical and adjunctive interventions, and (3) recognize the significance of identifying the primary tumor via immunohistochemical staining. We present a case of a 57-year-old male with a history of stage IV rectal adenocarcinoma metastatic to the lung who presented to our clinic with a painful mass of the right lateral tongue that he noticed one month before. MRI of the neck revealed a mass involving the anterior two-thirds of the right tongue with irregular margins and an ipsilateral enlarged right jugulodigastric lymph node. The patient underwent right partial glossectomy with primary reconstruction and right modified radical neck dissection. Pathology confirmed poorly differentiated adenocarcinoma consistent with a colorectal primary with lymphovascular and perineural invasion. The tumor was staged as T2N1, and the patient was referred for chemoradiation. In this report, we discuss the presentation, diagnosis, and treatment of this uncommon disease, with a thorough review of the world literature.
Clinical Case of Immune Dysregulation, Polyendocrinopaty, Enteropathy, X-Linked (IPEX) Syndrome with Severe Immune Deficiency and Late Onset of Endocrinopathy and Enteropathy
Authors: R Savova, M Arshinkova, J Houghton, M Konstantinova, M Gaydarova, E Georgieva, G Popova, V Genova, N Tomova, A Anadoliiska, K Koprivarova
Journal: Case Rep Med (2014)

Objective. To describe the clinical characteristics of IPEX syndrome in a child with FOXP3 mutation. Clinical Case. A boy aged 2.3 years was born from first normal pregnancy with a weight of 3420 gr. Family History. Two brothers of the mother died before the age of 3 years with severe infections, diarrhea, erythroderma, and elevated immunoglobulins class E (IgEs). Since first month of life, our patient suffered from septicemia, pneumonias, pyelonephritis, and meningitis, accompanied with eczematous dermatitis and IgEs up to 4000 IU/L (normal <10). At the age of 1.6 years, he developed type 1 diabetes mellitus (T1DM). He was underweighted (-3.42 SDS) and had some phenotypic features like coarse face, muscle hypotonia, joint hyperextensibility, eczematous dermatitis, and subcutaneous cold abscesses. Autoimmune thyroiditis and celiac disease were excluded. After diabetes, intermittent watery diarrhea appeared with progression to severe intractable form. Finally, aggravating symptoms of nephritis, cachexia, and respiratory insufficiency were the cause for his death at the age of 2 years and 3 months. The DNA analysis at the University of Exeter Medical School established mutation at exon 10 of FOXP3 gene c.1010G >A, p. (Arg337Gln), which confirmed IPEX syndrome. The same mutation in heterozygotic state was found in the mother. A prenatal diagnosis of her second pregnancy ensured a daughter carrier of the mutation.
Unusual contents of the femoral hernia
Authors: Ahmed Alzaraa
Journal: ISRN Obstet Gynecol (2011)
MeSH terms: Case Reports

Different contents in the femoral hernia have been reported in the literature, but herniation of the fallopian tube in a femoral hernia is very rare due to its normal anatomical position. Case Presentation. A female patient was admitted to the surgical ward for a lump in the right groin. Clinical examination confirmed a right femoral hernia. The patient underwent surgery to repair the hernia. Intraoperatively, the right uterine tube was found in the hernia. The tube was reduced back into the pelvic cavity and the hernia was repaired. After making good recovery, the patient was referred to the gynaecologist for further assessment. Conclusion. This case is educational as it highlights the importance of managing women with femoral masses with care.
Necrotizing fasciitis of chest and right abdominal wall caused by acute perforated appendicitis: Case report
Authors: Lotfi Rebai, Aziz Daghmouri, Ines Boussaidi
Journal: Int J Surg Case Rep (2018)
Keywords: acute appendicitis, case report, chest, necrotizing fasciitis, perforation

Introduction:
Necrotizing fasciitis is an uncommon infection characterized by a necrotic infection that rapidly diffuse along the fascia and progresses to systemic sepsis. The combined occurrence of necrotizing fasciitis of the chest wall and acute appendicitis is extremely unusual.
Case presentation:
A 27-year-old man without any significant medical history presented to the emergency department, in the postoperative course of a laparotomy for perforated acute appendicitis, with septic shock and a large erythematous region over the right abdominal wall. Laboratory evaluation revealed leucocytosis and lactic acidosis. A new surgical exploration revealed a purulent peritonitis with necrotizing fasciitis involving the right lower abdomen, right psoas muscle and right retroperitoneum. On intensive care unit, the patient was managed with intravenous antibiotics and surgical debridement. In the following days, the patient developed extension of the necrosis to the right chest wall. A computed tomography scan of the chest showed right-sided pleural effusion with erosive aspect of the ribs. Necrotic tissues were debrided and antibiotic was changed due to wound superinfection with Acinetobacter Baumannii.
Discussion:
Necrotizing fasciitis of chest due to acute appendicitis is extremely unusual. The optimal treatment associates appropriate antibiotics, oxygenation of infected tissue, and surgical debridement.
Conclusion:
Acute appendicitis resulting in necrotizing fasciitis of chest is rare but life-threatening. Early diagnosis and treatment is essential to reduce morbidity and mortality.
Hyper IgG4-Related Disease Presenting with Orbital Tumor and Immune Deficiency
Authors: Caroline G Olson, Nancy Y Olson
Journal: Case Reports Immunol (2021)
MeSH terms: Case Reports

We report a case of IgG4-RD in a patient with high IgG4 levels, low functional antibodies, and low IgM levels. He presented with bilateral orbital pseudotumors and, after initial improvement on corticosteroids, relapsed with recurrent pleural effusion and pelvic pseudotumor. He had a grossly elevated serum IgG (1905 mg/dl) with elevations in all IgG subclasses but marked elevation in IgG4 (412 mg/dl), low IgM, and low pneumococcal antibodies. Orbital mass biopsy showed polyclonal lymphocytic infiltration and increased IgG4 plasma cells. The patient was started on prednisone and tried several immunosuppressive medications including mycophenolate mofetil, methotrexate, hydroxychloroquine, and azathioprine with decrease in size of the orbital pseudotumor. During a period when the patient stopped his medications, the pseudotumor enlarged with new development of recurrent pleural effusions. He was also found to have a pelvic mass that was biopsy positive for IgG4 proliferation. This case with progression to multiorgan involvement highlights the importance of identifying patients with IgG4-related disease. In contrast to previous cases with normal-to-high IgM, the IgM was low with impaired functional antibodies.
EBV-Associated Lymphoproliferative Disorder and Hemophagocytic Lymphohistiocytosis in a Patient with Severe Celiac Disease
Authors: John Jacob Kinross-Wright, Kalyan Chakravarthy Potu, Brandy Pownell, Randall Lamfers, Jonathan S Bleeker
Journal: Case Rep Hematol (2018)
MeSH terms: Case Reports

Background:
Epstein-Barr virus- (EBV-) associated lymphoproliferative disease (LPD) is a rare condition, usually occurring in immunocompromised patients. We report a case of EBV-associated LPD in a patient with severe celiac disease, the first report to describe this syndrome in a patient with this diagnosis.
Case summary:
A 69-year-old Caucasian woman with recent diagnosis of celiac sprue presented to our hospital with persistent diarrhea, abdominal pain, weight loss, and fatigue despite adherence to gluten-free diet for a number of weeks prior to presentation. She underwent evaluation for occult malignancy and was found to have diffuse intra-abdominal mesenteric lymphadenopathy on CT scan. Biopsy of mesenteric nodes revealed an EBV positive, CD20 positive mixed lymphoproliferative process with T-cell predominance, but without a monoclonal cell population felt to be consistent with EBV-associated LPD. Bone marrow biopsy revealed hemophagocytic lymphohistiocytosis, complicating her course. She was treated with steroids and rituximab but continued to decline, eventually developing MSSA bacteremia and succumbing to her disease.
Conclusion:
To our knowledge, this is the first report of the constellation of celiac sprue, EBV-associated LPD, and hemophagocytic lymphohistiocytosis. Providers caring for patients with severe, uncontrolled celiac disease and adenopathy should consider EBV-associated LPD.
Multispeciality approach in the management of patient with hereditary gingival fibromatosis: 1-year followup: a case report
Authors: T Ramakrishnan, Manmeet Kaur
Journal: Int J Dent (2010)
MeSH terms: Case Reports

Background. Hereditary gingival fibromatosis is a fibrotic enlargement of the gingiva. It may exist as an isolated abnormality or as part of multisystem syndrome. This paper reports a case of 16-year-old male with generalized severe gingival overgrowth, involving the maxillary and mandibular arches and covering almost all teeth. Methods. Periodontal management of gingival enlargement included gingivectomy in both arches except in the lower right molar region where flap surgery was done under general anesthesia. After a 2-month followup period, orthodontic treatment was started with fixed appliances. Monthly periodontal checkups and maintainance (scaling and polishing) were scheduled to control the gingival inflammation. Results. Reevaluation of the patient of surgical treatment after two months did not show any recurrence of condition; however, minimal overgrowth was noted 1 month after the beginning of orthodontic treatment which was treated nonsurgically. Conclusions. Although the risk of recurrence is high with this condition, surgical treatment with correction of malocclusion and regular followup can provide excellent outcome as seen in this case.
Delayed Post-hypoxic Leukoencephalopathy (DPHL)-An Uncommon Variant of Hypoxic Brain Damage in Adults
Authors: Anne B Beeskow, Moritz Oberstadt, Dorothee Saur, Karl-Titus Hoffmann, Donald Lobsien
Journal: Front Neurol (2018)
Keywords: ct, dphl, mri, delayed post-hypoxic leukoencephalopathy, hypoxic brain damage in adults, ischemia, neuroradiology, white matter
MeSH terms: Case Reports

Delayed post-hypoxic leukoencephalopathy (DPHL) is an uncommon, potentially under-recognized, cause of hypoxia induced white matter injury. It characteristically follows a biphasic course: After an initial phase of altered neurologic status a recovery occurs which is then followed by a recurring phase of neurologic deterioration, typically 2-4 weeks after the initial event. At this time white matter changes can be identified on MRI, which are the hallmark of DPHL. The characteristics and the typical MR-imaging signs of DPHL are discussed in this case report.
Electrochemotherapy and Simultaneous Photodynamic Bone Stabilization of Upper Limbs in Metastatic Renal Cancer Disease: Case Report and Literature Review
Authors: Ugo Albertini, Andrea Conti, Nicola Ratto, Pietro Pellegrino, Michele Boffano, Raimondo Piana
Journal: Case Rep Med (2020)
MeSH terms: Case Reports

Introduction:
Metastatic bone disease represents a systemic pathology that heavily affects the quality of life of oncologic patients causing pain and functional disability. Methodology. We present the case of a patient with a history of renal cell cancer presenting pathologic fractures of both humeri and proximal right radius.
Results:
After a careful multidisciplinary approach, an adjuvant anticancer therapy and a photodynamic bone stabilization procedure were performed with a minimally invasive technique aiming to minimize pain and local disease progression, while restoring functional autonomy and improving the patient's quality of life. Electrochemotherapy was delivered on the lytic bone lesions with extraskeletal involvement of the proximal left humerus and the proximal right radius, and then polymeric bone stabilization was performed on both humeri. At two months of follow-up, the patient presented satisfactory functional scores (MSTS score: 12/30 bilaterally; DASH scores: 46.7/100 for the right side and 48.3/100 for the left one), and pain was well controlled with opioid analgesics. Radiographs showed good results in terms of ossification of lytic bone lesions and durability of polymeric stabilization. At four months of follow-up, the patient reported a stable clinical scenario. Six months after surgery, due to extremely poor prognosis after the progression of primary disease, the patient was referred to palliative care and died shortly thereafter.
Conclusion:
Over the last decade, the management of metastatic bone disease has changed. Low-toxicity and minimally invasive procedures such as electrochemotherapy and polymeric bone stabilization might be performed concomitantly in selected patients, as an alternative to radiation therapy and to more demanding surgical procedures such as plating and adjuvant cementing.
Isolated blast crisis relapse in the central nervous system of a patient treating for a chronic myelogenous leukemia
Authors: Houda Boudiaf, Khedaoudj Ezziane, Nassiba Ould Rouis, Meriem Himrane, Saliha Hakem, Hanifa Benchabane, Houria Boukhelal, Radja Arous, Lynda Chikhi
Journal: Pan Afr Med J (2020)
Keywords: chronic myeloid leukemia, blast crisis, central nervous system, imatinib
MeSH terms: Blast Crisis / diagnosis, Central Nervous System / pathology, Leukemia, Myelogenous, Chronic, BCR-ABL Positive / pathology, Leukemic Infiltration / diagnosis, Case Reports, Adolescent, Algeria, Antineoplastic Combined Chemotherapy Protocols / therapeutic use, Blast Crisis / etiology, Blast Crisis / pathology, Central Nervous System / diagnostic imaging, Female, Humans, Imatinib Mesylate / administration & dosage, Leukemia, Myelogenous, Chronic, BCR-ABL Positive / drug therapy, Leukemic Infiltration / drug therapy, Leukemic Infiltration / pathology, Recurrence, Imatinib Mesylate

Chronic myeloid leukemia (CML) is a myeloproliferative disorder associated with the Philadelphia chromosome t (9;22) and the BCR-ABL fusion gene. The condition is relatively rare, accounting for 2.0% to 3.0% of childhood leukemia cases. CML has historically been a triphasic disease. Most patients are diagnosed in chronic phase. Without treatment, it inevitably progresses into a more aggressive accelerated phase and blast crisis. Some proportion of CML cases of blastic transformation develop an extramedullary disease that involves rarely central nervous system. This report describe an extremely rare case of 13-year-old girl with CML and extramedullary blast crisis in the central nervous system. Treatment options and monitoring of disease response are discussed.
Case Report: Pancreatic Neuroendocrine Tumor With Liver Metastasis and Portal Vein Thrombosis
Authors: Yulong Tian, Xingshun Qi, Afaf Aljbri, Ke Xu, Hongshan Zhong
Journal: Front Oncol (2022)
Keywords: anticoagulant therapy, interventional therapy, liver metastases, pancreatic neuroendocrine tumor, portal vein
MeSH terms: Case Reports

Introduction:
Pancreatic neuroendocrine neoplasms (PNENs) are rare pancreatic tumors originating from pancreatic neuroendocrine cells. There is no consensus on the treatment for PNENs with unresectable liver metastases. Transcatheter arterial chemoembolization (TACE) is the preferred treatment for unresectable primary liver cancer. But the efficacy of TACE and anticoagulation in PNENs with unresectable liver metastases and portal vein thrombosis has never been reported.
Methods and results:
We present the case of a 50-year-old male patient with hepatitis C who was found to have a single liver mass during a regular physical examination in 2016. The liver mass was surgically removed. Postoperative pathology suggested a neuroendocrine tumor of the liver, and it was suggested to look for the primary tumor. The patient was followed up until 2020, and the primary pancreatic tumor was found, along with multiple liver metastases and portal vein thrombosis. After transcatheter arterial embolization, anticoagulation, and endocrine therapy, the patient's tumor load was relieved, and the portal vein was recanalized.
Conclusion:
The article reports the disease course in a case of a functional pancreatic neuroendocrine tumor with liver metastasis and portal vein thrombosis and reviews previous literature. To our knowledge, we reported for the first time the efficacy of TACE and anticoagulation in PNENs with unresectable liver metastases and portal vein thrombosis.
Oral Leiomyoma in an Adult Male: A Case Report
Authors: Amanda Phoon Nguyen, Agnieszka M Frydrych
Journal: Open Dent J (2017)
Keywords: benign neoplasms, eosinophilic cytoplasm, hard palate, histopathological assessment, interlacing fascicles, oral leiomyoma

Introduction:
Oral leiomyomas are rare, benign neoplasms of smooth muscle origin, presenting as a solitary, asymptomatic, nodular mass.
Case presentation:
Here we present the case of a 54-year-old male with a lesion in the midline of his hard palate, which was diagnosed as a localized benign leiomyoma, along with a review of the recent literature.
Discussion:
Diagnosis of a leiomyoma must be based on the histopathological assessment of tissue as the clinical appearance is non-specific. The peak prevalence of head and neck leiomyoma is observed in the 4th and 5th decade of life with uncertain gender predilection. Histological features include interlacing fascicles of smooth muscle small cells with eosinophilic cytoplasm. Complete excision is usually curative and recurrence is rare.
Conclusion:
Due to their rare nature, it is important that cases of oral leiomyoma can be reported in the literature to improve our understanding of this entity.
Eikenella corrodens, cause of a vulvar abscess in a diabetic adult
Authors: Nefise Oztoprak, Ulkü Bayar, Güven Celebi, Mustafa Basaran, Füsun Cömert
Journal: Infect Dis Obstet Gynecol (2009)
MeSH terms: Abscess / microbiology, Diabetes Mellitus, Type 2 / microbiology, Eikenella corrodens / isolation & purification, Gram-Negative Bacterial Infections / microbiology, Vulvar Diseases / microbiology, Case Reports, Abscess / drug therapy, Abscess / pathology, Anti-Bacterial Agents / therapeutic use, Female, Gram-Negative Bacterial Infections / diagnosis, Gram-Negative Bacterial Infections / drug therapy, Gram-Negative Bacterial Infections / pathology, Humans, Middle Aged, Vulvar Diseases / drug therapy, Vulvar Diseases / pathology, Anti-Bacterial Agents

We report a case of Eikenella corrodens causing vulvar abscess in a diabetic patient. Eikenella corrodens is a slow growing, nonmotile, facultative anaerobic, Gram-negative bacillus which is commensal of the oral cavity, intestinal and genital tracts. The most common clinical sources of this organism are human bite wounds, head and neck infections and respiratory tract infections. In our knowledge, the presented case is the first report of Eikenella corrodens causing vulvar abscess in a diabetic patient.
Anatomical Shaping for Zirconia Custom Implant Abutment to Enhance Anterior Esthetic: A Clinical Technique
Authors: Mohammed Alshehri, Mohammed Alghamdi, Abdullah S Alayad
Journal: Int J Dent (2020)
MeSH terms: Case Reports

Abutments are used in dentistry to attach dental crowns to dental implant. Currently, zirconia custom abutment is the one which is mostly used in restorations, since it offers several advantages, especially better esthetics and prevention from infection. Several innovations are done in the implant designs and procedures to achieve better esthetics. Computer-aided design & computer-aided manufacturing (CAD/CAM) system is widely used innovative technology in dentistry. This technology offers custom implants that help to achieve better esthetics and good internal fit. This procedure used a novel technique of anatomical modification of the final abutment incisal edge from straight anatomical edge to irregular one with a mamelon-incisal effect to enhance esthetic, shade matching, and anatomical replication of incisal structure that resembles the natural incisor. Usually, dental technicians will perform facial and incisal cut-back and apply porcelain layers to the crown in order to reproduce the translucency and the other optical effects that most closely match that of natural dentin and enamel, especially at the incisal edge. These optical effects will make the prosthetic crown look more natural and esthetically pleasant. By this presented technique will help the dental technician to achieve highly esthetic crown with completely digital workflow without the need for porcelain layering. The procedure was also followed up to 3, 6, and 12 months after the surgery and found no complications or complaints from the patient and esthetically satisfied.
Lithium: one drug, five complications
Authors: Jeremy Zaworski, Pierre-Yves Delannoy, Nicolas Boussekey, Damien Thellier, Hugues Georges, Olivier Leroy
Journal: J Intensive Care (2017)
Keywords: diabetes insipidus, lithium, pancytopenia, poisoning, polyneuropathy
MeSH terms: Case Reports

Background:
Lithium poisoning could trigger multiple complications. We report the case of a lithium poisoning with five complications that are described for the first time together.
Case report:
A 60-year-old woman was admitted in our intensive care unit for altered consciousness. Severe lithium intoxication was diagnosed (lithium plasmatic level 8.21 mmol/l) associated with acute oliguric kidney failure. Continuous renal replacement therapy was started immediately. Orotracheal intubation was quickly required because of status epilepticus. Medullary aplasia happened 48 h after the patient was intubated. Infectious and immunological causes were ruled out and lithium poisoning was considered as the most likely etiology. Iterative blood and platelet transfusion were required. Severe polyneuropathy was diagnosed on the 5th day after admission. The patient showed a peripheral tetraparesia and cranial nerve failure while lithium plasmatic level had decreased to a therapeutic level. Conversely, urine output increased and hypernatremia promptly occurred, which led to diabetes insipidus diagnosis. Neuropathy decreased in 72 h and the patient was definitely extubated by the 11th day. Hematologic disturbances decreased and no blood transfusion would be required after the 8th day. The patient would keep sequellas of the poisoning. Thin motricity would still be altered and polyuria would remain. Diffuse alopecia was promptly observed, with no iron deficiency or thyroid disturbance.
Conclusion:
In addition to presenting this case report, we herein discuss the drug causality, the consequences, and the plausible pathophysiology of these five situations.
Iatrogenic IVC Perforation after Successful Catheter-Directed Thrombolysis
Authors: Ata Firoozi, Jamal Moosavi, Omid Shafe, Parham Sadeghipour
Journal: Case Rep Vasc Med (2017)
MeSH terms: Case Reports

Central vein perforation as a rare complication of venous interventions is considered a nightmare if occurring in thoracic cage but behaves benignly in abdominal or pelvic region. This is not a rule, as we unfortunately encountered during the procedure of venous intervention in our patient. Although mechanical control of iatrogenic perforation or rupture is the first and most critical step during interventional procedures, the importance of anticoagulant and thrombolytic agents reversal should not be overlooked.