OpenMed/multicare-articles huggingface dataset:
Intrafat Sequestration of Artemisinin Disguised as a Purulent Collection during a Posterolateral Hip Approach
Authors: Atchi Walla, Batomayena Bakoma, Pilakimwé Egbohou
Journal: Case Rep Orthop (2019)
MeSH terms: Case Reports

The posterolateral hip approach is the oldest and most used way to implant total hip arthroplasty. The anterior part of the oblique portion of this posterolateral approach corresponds more or less to the superolateral quadrant of the buttock in which the intramuscular injection of various drugs, including the compounds derived from artemisinin, is carried out. Thus, in a malarial endemic area where gluteal injections of the compounds derived from artemisinin are not rare, poor performance of an injection by the deposition of the product in the fat and not deeply in the muscle can be at the origin of the sequestration of the drug in adipose tissue and give the macroscopic appearance of a pus. The authors present a case of intrafat sequestration of artemisinin taken for purulent collection during a posterolateral hip approach for total hip arthroplasty.
A new type of abdominal incision for emergencies in pregnancy: a case report
Authors: Hasan Yüksel, Tolga Atakul, Emre Zafer, Özgür Deniz Turan
Journal: Pan Afr Med J (2020)
Keywords: abdominal incision, adnexal mass, case report, pregnancy
MeSH terms: Adnexal Diseases / diagnosis, Ovarian Torsion / diagnosis, Pregnancy Complications / diagnosis, Case Reports, Abdominal Pain / etiology, Adnexal Diseases / surgery, Adult, Emergencies, Female, Humans, Ovarian Torsion / surgery, Pregnancy, Pregnancy Complications / surgery, Salpingo-oophorectomy / methods, Ultrasonography

Adnexal torsion in pregnancy is a rare gynecologic emergency that causes severe abdominal pain. The current paper reports a case of a woman with 18 weeks pregnancy who was referred to our tertiary clinic with sudden lower abdominal pain. Ultrasound scan showed a very large multicystic adnexal torsion mass on the right side displacing the gravid uterus to the anterior left. An oblique paramedian incision was made for right salpingo-oophorectomy. To our knowledge the incision presented in this case has not been described in the literature previously. We suggest an alternative incision to be used during pregnancy especially for emergencies due to an adnexal mass.
Rituximab Induced Pulmonary Edema Managed with Extracorporeal Life Support
Authors: Jacob R Miller, Warren Isakow, Muhammad F Masood, Patrick Aguilar, Kristen M Sanfilippo, Keki R Balsara, Akinobu Itoh
Journal: Case Rep Crit Care (2018)
MeSH terms: Case Reports

Though rare, rituximab has been reported to induce severe pulmonary edema. We describe the first report of ECLS utilization for this indication. A 31-year-old female with severe thrombotic thrombocytopenic purpura developed florid pulmonary edema after rituximab infusion. Despite advanced ventilatory settings, she developed severe respiratory acidosis and remained hypoxemic with a significant vasopressor requirement. Since her pulmonary insult was likely transient, ECLS was considered. Due to combined cardiorespiratory failure, she received support with peripheral venoarterial ECLS. During her ECLS course, she received daily plasmapheresis and high dose steroids. Her pulmonary function recovered and she was decannulated after 8 days. She was discharged after 23 days without residual sequelae.
Pre-sternal thyroid swellings: a case of rare aberrant site recurrence and review of literature
Authors: Lovenish Bains, Sushant Bhatia, Rohit Kaushik, Sudhir Kumar Jain, Chandra Bhushan Singh, Shramana Mandal, Daljit Kaur
Journal: Thyroid Res (2019)
Keywords: metastasis, papillary thyroid carcinoma (ptc), pre-sternal, recurrence, retrosternal, substernal
MeSH terms: Case Reports

Background:
Thyroid swellings enlarge caudally into the mediastinum behind the sternum. Pre-sternal swelling of thyroid origin is very rare. We present our case of pre-sternal thyroid swelling which was albeit a surprisingly rare site of papillary thyroid carcinoma recurrence and review of pre-sternal thyroid swellings reported till date.
Case summary:
A 60 year old female presented with a painless, progressive swelling on the anterior part of the chest for the past 2 years. A 15 cm × 8 cm vertically aligned, non tender, well defined swelling was present on the pre-sternal region, with consistency ranging from soft to firm. The swelling was fixed to the underlying tissues and a fixed level IV lymph node was palpable on the right side. Ultrasonography revealed a large mass of 15 × 7 cm with multiple cystic areas. Fine needle aspiration cytology was inconclusive twice. Patient had undergone a total thyroidectomy for papillary carcinoma 10 years back. Computed tomography findings revealed a large 15 × 6.6 × 7 cm lobulated, pre-sternal, soft tissue lesion with solid & cystic components. The mass was infiltrating the right sided strap muscles and sternocleidomastoid. FNAC was inconclusive and thyroid scan could not pick up any activity in the mass. Henceforth a PET scan was done that showed increased FDG uptake by the lesion and the level IV lymph node. The patient underwent wide excision of the mass with right functional neck dissection, along with removal with both sternal head of sternocleido-mastoid, the strap muscles and the surrounding fascia. Histopathology confirmed papillary thyroid carcinoma. Patient received post-operative radioactive iodine ablation and is healthy with no recurrence up to 30 months of follow up.
Discussion:
The mechanisms for pre-sternal thyroid swelling are not understood due to paucity of cases. The mechanisms proposed are invasion of strap muscles and cervical linea alba and tumor cells spread anterior to sternum, truly ectopic thyroid tissue, de novo carcinogenesis in the embryonal remnants like the thyro-thymic residues, sequestered thyroid tissue which grows later or migration of thyroid cells, incomplete clearance at the time of primary surgery or intraoperative seeding.
Conclusion:
Pre-sternal region masses of thyroid origin are very rare. A proper work up, suspicion for thyroid mass and array of tests will be required to come to a provisional diagnosis. Since the masses reported in literature were primarily malignant, any such mass may be treated on lines of malignancy with radical surgery.
Angiographic embolization followed by piecemeal resection of giant posterior mediastinal schwannoma: Case report and concise review
Authors: Tyler J Loftus, Mauricio Pipkin, Tiago Machuca, Olusola Oduntan
Journal: Int J Surg Case Rep (2018)
Keywords: angiographic embolization, case report, resection, schwannoma, thoracic surgery, thoracotomy

Introduction:
Posterior mediastinal masses present unique diagnostic and therapeutic challenges, particularly when large highly vascularized tumors extend toward or emanate from the spinal cord. The rare nature of these tumors precludes the development of standardized management algorithms, underscoring the importance of case reports.
Presentation of case:
A 57 year old female presented with exertional dyspnea and right chest pressure. Chest radiography followed by computed tomography (CT) scan demonstrated a 13 cm posterior mediastinal mass involving the T7 vertebral body. CT-guided percutaneous biopsy confirmed benign schwannoma. During open exploration, the tumor bled easily with contact. Angiography with intercostal arterial embolization decreased tumor vascularity while preserving spinal cord perfusion. Subsequent piecemeal resection facilitated exposure of the tumor base and complete resection. Postoperative recovery was uneventful.
Discussion:
Neurogenic tumors are most commonly located in the posterior mediastinum. When untreated, schwannomas continue to grow, and will inevitably cause compressive symptoms if given sufficient time. Therefore, resection is recommended. This may be performed thoracoscopically in select patients with small tumors, avoiding the morbidity of a thoracotomy incision.
Conclusion:
Large posterior mediastinal schwannomas require posterolateral thoracotomy and resection. Preoperative angiography helps identify arteries shared by the tumor and the spinal cord, and embolization may reduce tumor vascularity and operative blood loss thereby permitting safer resection.
Transient antiphospholipid syndrome associated with primary cytomegalovirus infection: a case report and literature review
Authors: Tsuyoshi Nakayama, Mitsuteru Akahoshi, Kensuke Irino, Yasutaka Kimoto, Yojiro Arinobu, Hiroaki Niiro, Hiroshi Tsukamoto, Takahiko Horiuchi, Koichi Akashi
Journal: Case Rep Rheumatol (2014)

Viral infection is known to induce transient autoimmunity in humans. Acute cytomegalovirus (CMV) infection is implicated in occasional thrombosis formation. We here, for the first time, report a 19-year-old female who had an acute CMV infection, leading to a deep venous thrombosis and a pulmonary embolism along with transient appearance of lupus anticoagulant. The pathological role of antiphospholipid antibodies in CMV-mediated thrombosis is discussed.
Developmental Topographical Disorientation With Concurrent Face Recognition Deficit: A Case Report
Authors: Maria Luisa Rusconi, Giulia Fusi, Chiara Stampatori, Angelo Suardi, Chiara Pinardi, Claudia Ambrosi, Tommaso Costa, Flavia Mattioli
Journal: Front Psychiatry (2021)
Keywords: case report, cognitive map, developmental topographical disorientation, face recognition, neurodevelopmental disorders, spatial navigation
MeSH terms: Case Reports

Developmental topographical disorientation (DTD) has been defined as a developmental deficit in human navigational skills in the absence of congenital or acquired brain damage. We report the case of Lost In Space Again (LISA), a 22-year-old woman with a normal development and no clinical history of neurological or psychiatric diseases, evaluated twice, with an interval of 5 years. The magnetic resonance imaging (MRI) examination did not reveal any morphological alteration, while diffusion tensor imaging (DTI) showed a structural connectivity deficit (a decreased fractional anisotropy-FA) in the parieto-prefrontal and parieto-premotor pathway. The behavioral assessment showed different deficits in spatial and navigational tasks, which seemed to be connected to a poor ability to form a cognitive map of the environment. Moreover, LISA displayed a poor performance in high-level face encoding and retrieval. The aim of this case report is to share new insight about DTD in order to deepen the knowledge of this specific neurodevelopmental disorder. In conclusion, this novel DTD case (1) supports the hypothesis of the existence of different DTD subtypes; (2) sustains the evidence that DTD can co-occur (or not) with deficit in face recognition; and (3) highlights the need for an in-depth examination from both a neurocognitive and behavioral point of view of a possible common developmental defect between the formation of cognitive maps and the recognition of faces that might be in mental imagery skills. Future directions will be also discussed.
Case Report: FOXP3 Mutation in a Patient Presenting With ALPS
Authors: Afef Rais, Najla Mekki, Faten Fedhila, Mohammed Faraj Alosaimi, Monia Ben Khaled, Amal Zameli, Nourhen Agrebi, Maryam Kallel Sellami, Raif Geha, Imen Ben-Mustapha, Mohamed-Ridha Barbouche
Journal: Front Immunol (2021)
Keywords: alps, foxp3, ipex, ngs, inborn errors of immunity
MeSH terms: Autoimmune Lymphoproliferative Syndrome / genetics, Forkhead Transcription Factors / genetics, Case Reports, Research Support, Non-U.S. Gov't, Autoimmune Lymphoproliferative Syndrome / diagnosis, Autoimmune Lymphoproliferative Syndrome / immunology, Child, Humans, Male, Mutation, FOXP3 protein, human, Forkhead Transcription Factors

ALPS and IPEX are two well-characterized inborn errors of immunity with immune dysregulation, considered as two master models of monogenic auto-immune diseases. Thus, with autoimmunity as their primary clinical manifestation, these two entities may show clinical overlap. Traditionally, immunological biomarkers are used to establish an accurate differential diagnosis. Herein, we describe a patient who presented with clinical features and biomarkers fulfilling the diagnostic criteria of ALPS. Severe apoptotic defect was also shown in the patient's cell lines and PHA-activated peripheral blood lymphocytes. Sanger sequencing of the FAS gene did not reveal any causal mutation. NGS screening revealed a novel deleterious variant located in the N terminal repressor domain of FOXP3 but no mutations in the FAS pathway-related genes. TEMRA cells (terminally differentiated effector memory cells re-expressing CD45RA) and PD1 expression were increased arguing in favor of T-cell exhaustion, which could be induced by unrestrained activation of T effector cells because of Treg deficiency. Moreover, defective FOXP3 observed in the patient could intrinsically induce increased proliferation and resistance to apoptosis in T effector cells. This observation expands the spectrum of FOXP3 deficiency and underscores the role of NGS in detecting mutations that induce overlapping phenotypes among inborn errors of immunity with immune dysregulation. In addition, these findings suggest a potential link between FOXP3 and FAS pathways.
Angiomyolipoma of the right adrenal gland
Authors: Oktay Yener, Alp Ozçelik
Journal: ISRN Surg (2011)
MeSH terms: Case Reports

Adrenal angiomyolipoma is rare. Only four cases have been reported so far. These are commonly found in Kidney but extrarenal sites are also mentioned. Angiomyolipoma arising in adrenal is very rare entity, usually asymptomatic, diagnosed incidentally on radiological investigation of abdomen for other conditions. We report our experience with a 45-year-old woman who presented with epigastric discomfort. A computerised tomography (CT) scan showed an adrenal mass. Laparoscopic adrenalectomy was performed and the histopathological features confirmed the diagnosis of adrenal angiomyolipoma. The patient recovered without any complications following surgery.
Placental Histomorphology in a Case of Double Trisomy 48,XXX,+18
Authors: Sujal I Shah, Lisa Dyer, Jerzy Stanek
Journal: Case Rep Pathol (2018)
MeSH terms: Case Reports

Background:
Approximately 50% of early spontaneous abortions are found to have chromosomal abnormalities. In these cases, certain histopathologic abnormalities are suggestive of, although not diagnostic for, the presence of chromosomal abnormalities. However, placental histomorphology in cases of complex chromosomal abnormalities, including double trisomies, is virtually unknown.
Case report:
We present the case of a 27-year-old G3P22002 female presenting at 19 weeks and 1 day of gestation by last menstrual period for scheduled prenatal visit. Ultrasound revealed a single fetus without heart tones and adequate amniotic fluid. Limited fetal measurements were consistent with estimated gestational age of 17 weeks. Labor was induced with misoprostol due to fetal demise. Autopsy revealed an immature female fetus with grade 1-2 maceration. The ears were low-set and posteriorly rotated. The fingers were short bilaterally, and the right foot showed absence of the second and third digits. Evaluation of the organs showed predominantly marked autolysis consistent with retained stillbirth. Placental examination revealed multiple findings, including focal pseudovillous papilliform trophoblastic proliferation of the undersurface of the chorionic plate and clustering of perpendicularly oriented sclerotic chorionic villi in the chorion laeve, which have not been previously reported in cases of chromosomal abnormalities. Karyotype of placental tissue revealed a 48,XXX,+18 karyotype and the same double trisomy of fetal thymic tissue by FISH.
Conclusion:
In addition to convoluted outlines of chorionic villi, villous trophoblastic pseudoinclusions, and clusters of villous cytotrophoblasts, the previously unreported focal pseudovillous papilliform trophoblastic proliferation of the undersurface of the chorionic plate and clustering of perpendicularly oriented sclerotic chorionic villi in the chorion laeve were observed in this double trisomy case. More cases have to be examined to show if the histology is specific for this double trisomy.
Case report: TP53 and RB1 loss may facilitate the transformation from lung adenocarcinoma to small cell lung cancer by expressing neuroendocrine markers
Authors: Jun Li, Bing Wei, Junnan Feng, Xinxin Wu, Yuxi Chang, Yi Wang, Xiuli Yang, Haiyan Zhang, Sile Han, Cuiyun Zhang, Jiawen Zheng, Harry J M Groen, Anke van den Berg, Jie Ma, Hongle Li, Yongjun Guo
Journal: Front Endocrinol (Lausanne) (2022)
Keywords: myc amplification, tp53 and rb1 loss, lung adenocarcinoma, osimertinib, small cell lung cancer transformation
MeSH terms: Adenocarcinoma of Lung / genetics, Lung Neoplasms / drug therapy, Lung Neoplasms / genetics, Lung Neoplasms / pathology, Small Cell Lung Carcinoma / genetics, Case Reports, Research Support, Non-U.S. Gov't, ErbB Receptors / genetics, Female, Humans, In Situ Hybridization, Fluorescence, Phosphatidylinositol 3-Kinases / genetics, Retinoblastoma Binding Proteins / genetics, Retrospective Studies, Tumor Suppressor Protein p53 / genetics, Ubiquitin-Protein Ligases / genetics, Tumor Suppressor Protein p53, Phosphatidylinositol 3-Kinases, ErbB Receptors, TP53 protein, human, RB1 protein, human, Ubiquitin-Protein Ligases, Retinoblastoma Binding Proteins

Introduction:
Transformation from lung adenocarcinoma (LUAD) to small cell lung cancer (SCLC) is one of the mechanisms responsible for acquired EGFR-TKIs resistance. Although it rarely happens this event determines a rapid disease deterioration and needs specific treatment.
Patient and method:
We report a case of 75-year-old LUAD female with a p.L858R mutation in Epidermal Growth Factor Receptor (EGFR) who presented with SCLC transformation after responding to first line osimertinib treatment for only 6 months. To understand the underlying molecular mechanism, we retrospectively sequenced the first (LUAD) and the second (SCLC) biopsy using a 56 multi-gene panel. Immunohistochemistry (IHC) staining and Fluorescence In Situ Hybridization (FISH) was applied to confirm the genetic aberrations identified.
Results:
EGFR p.E709A and p.L858R, Tumor Protein p53 (TP53) p.A159D and Retinoblastoma 1 (RB1) c.365-1G>A were detected in both the diagnostic LUAD and transformed SCLC samples. A high copy number gain for Proto-Oncogene C-Myc (MYC) and a Phosphoinositide 3-Kinase Alpha (PIK3CA) p.E545K mutation were found in the transformed sample specifically. Strong TP53 staining and negative RB1 staining were observed in both LUAD and SCLC samples, but FISH only identified MYC amplification in SCLC tissue.
Conclusion:
We consider the combined presence of MYC amplification with mutations in TP53 and RB1 as drivers of SCLC transformation. Our results highlight the need to systematically evaluate TP53 and RB1 status in LUAD patients to offer a different therapeutic strategy.
Gossypiboma Resection after Eight Years in a Patient with Rheumatoid Arthritis and Diabetes
Authors: Kenley Unruh, Hsien Sing Sam Hsieh
Journal: Case Rep Surg (2017)
MeSH terms: Case Reports

Gossypiboma is the term used to refer to a mass formed by surgical material left in the body cavity after surgery. We present the case of a middle-aged woman with a history of rheumatoid arthritis controlled with corticosteroids and biologic therapies, uncontrolled type II diabetes mellitus, and cesarean section with postoperative bleeding eight years earlier, who presents with right lower quadrant abdominal pain and is found to have a gossypiboma from her previous operation. A subsequent operation is undertaken to remove the gossypiboma. After the procedure, our patient's diabetes and chronic back pain greatly improve, raising the question of gossypiboma's role in these diseases. A review of our patient's records found that a correct sponge count was recorded after her cesarean section, raising questions about the operating room policies regarding surgical counts, the presence of falsely correct counts, and the need for postoperative plain films in procedures with an increased risk of a retained object. Our patient's presentation eight years after the inciting surgery raises questions about the involvement her immunosuppressive therapy may have had in cloaking the gossypiboma. Our case also raises the question of surgical culpability, including the ethical and legal considerations for apology from the culpable surgeon.
Rare case of exogenous Candida dubliniensis endophthalmitis: a case report and brief review of the literature
Authors: Brian Douglas McMillan, Gary James Miller, John Nguyen
Journal: J Ophthalmic Inflamm Infect (2014)
Keywords: candida dubliniensis, enucleation, exogenous endophthalmitis, ocular trauma

Background:
Candida dubliniensis is a recently described opportunistic fungal pathogen that rarely infects the eye. Reported cases of C. dubliniensis endophthalmitis have been of endogenous etiology and demonstrated recovery of visual acuity with timely treatment. We herein report an unusual case of severe C. dubliniensis endophthalmitis requiring enucleation.
Findings:
This is a retrospective, descriptive case report with a brief literature review. A 41-year-old Caucasian man, with a history of blunt trauma 8 months prior, presented to the emergency department with left eye pain and loss of vision 2 days after complicated cataract surgery. He was first evaluated by an outside ophthalmologist 3 months after trauma for left eye pain and progressive vision loss. He was found to have light perception vision with non-granulomatous anterior uveitis but no sign of ruptured globe. A dense cataract developed while he was treated with topical and subtenon's corticosteroids for which he underwent cataract surgery. Our examination revealed no light perception vision with a relative afferent pupillary defect, elevated intraocular pressure, moderate anterior chamber reaction, pupillary membrane, vitritis, and choroidal thickening on B-scan ultrasonography. Diagnostic vitrectomy revealed purulent vitreal debris, retinal detachment with severe retinal necrosis, and choroidal infiltrates. Operative fungal cultures grew C. dubliniensis. Despite intravitreal and systemic anti-fungal treatment, vision and pain did not improve, resulting in subsequent enucleation.
Conclusion:
C. dubliniensis endophthalmitis is uncommonly encountered and typically has reasonable visual outcomes. This is the first reported case of C. dubliniensis, likely exogenous endophthalmitis, resulting in enucleation, illustrating the potential virulence of this newly described organism.