OpenMed/multicare-articles huggingface dataset:
Stress fracture of the scaphoid in an elite junior tennis player: a case report and review of the literature
Authors: Sho Kohyama, Akihiro Kanamori, Toshikazu Tanaka, Yuki Hara, Masashi Yamazaki
Journal: J Med Case Rep (2016)
MeSH terms: Athletic Injuries / diagnostic imaging, Braces, Fractures, Stress / diagnostic imaging, Immobilization, Scaphoid Bone / injuries, Tennis, Case Reports, Review, Adolescent, Athletes, Athletic Injuries / physiopathology, Athletic Injuries / therapy, Directive Counseling, Fracture Healing, Fractures, Stress / physiopathology, Fractures, Stress / therapy, Humans, Male, Return to Sport, Time Factors, Tomography, X-Ray Computed, Treatment Outcome, Wrist Joint

Background:
The carpal scaphoid is the most commonly fractured carpal bone in young adults after a fall on an outstretched arm that results in acute dorsal flexion of the wrist. However, stress fractures of the scaphoid are relatively rare. To the best of our knowledge, we describe the first case in the literature of carpal scaphoid stress fracture in a tennis player.
Case presentation:
An 18-year-old Japanese man who was an elite junior tennis player was referred to our hospital after radiography and computed tomography revealed a carpal scaphoid fracture. The patient presented with pain in the wrist joint and tenderness over the anatomical snuff-box with diffuse swelling and reduced active dorsal flexion and flexion of the right wrist. The patient was treated conservatively and resumed participation in competitive events 5 months after his initial presentation.
Conclusions:
In this case, the scaphoid stress fracture had resulted from repetitive practicing of the attacking backhand high volley, which involved excessive dorsal flexion of the wrist. Although rare, scaphoid stress fractures must be considered in tennis players with chronic wrist pain.
Posaconazole-Induced Hypertension Masquerading as Congenital Adrenal Hyperplasia in a Child with Cystic Fibrosis
Authors: Neha Agarwal, Louise Apperley, Norman F Taylor, David R Taylor, Lea Ghataore, Ellen Rumsby, Catherine Treslove, Richard Holt, Rebecca Thursfield, Senthil Senniappan
Journal: Case Rep Med (2020)
MeSH terms: Case Reports

Background:
Deficiency of 11β-hydroxylase is the second most common cause of congenital adrenal hyperplasia (CAH), presenting with hypertension, hypokalaemia, precocious puberty, and adrenal insufficiency. We report the case of a 6-year-old boy with cystic fibrosis (CF) found to have hypertension and cortisol insufficiency, which were initially suspected to be due to CAH, but were subsequently identified as being secondary to posaconazole therapy. Case Presentation. A 6-year-old boy with CF was noted to have developed hypertension after administration of two doses of Orkambi™ (ivacaftor/lumacaftor), which was subsequently discontinued, but the hypertension persisted. Further investigations, including echocardiogram, abdominal Doppler, thyroid function, and urinary catecholamine levels, were normal. A urine steroid profile analysis raised the possibility of CAH due to 11β-hydroxylase deficiency, and a standard short synacthen test (SST) revealed suboptimal cortisol response. Clinically, there were no features of androgen excess. Detailed evaluation of the medical history revealed exposure to posaconazole for more than 2 months, and the hypertension had been noted to develop two weeks after the initiation of posaconazole. Hence, posaconazole was discontinued, following which the blood pressure, cortisol response to the SST, and urine steroid profile were normalized.
Conclusion:
Posaconazole can induce a clinical and biochemical picture similar to CAH due to 11β-hydroxylase deficiency, which is reversible. It is prudent to monitor patients on posaconazole for cortisol insufficiency, hypertension, and electrolyte abnormalities.
Advanced pancreatic cancer with KRAS wild-type and EGFR-sensitive mutation respond favorably to furmonertinib: A case report
Authors: Xiaoting Ma, Xiu Liu, Kai Ou, Manman Zhang, Lizhen Gao, Lin Yang
Journal: Front Oncol (2023)
Keywords: egfr, furmonertinib, nimotuzumab, pancreatic cancer, targeted therapy
MeSH terms: Case Reports

Pancreatic cancer is the leading cause of cancer death, and treatment options are limited and mostly ineffective. The patient we report had an EGFR exon 19 deletion and had disease progression in the short term after receiving three front-line treatment regimens. We administered furmonertinib and observed tumor shrinkage, decreased CA19-9. The progression-free survival (PFS) of furmonertinib was 4.7 months, and no adverse effects were observed. However, the patient did not benefit from subsequent nimotuzumab-based therapy. Targeted therapy driven by the detection of genetic signatures in this patient shows potential clinical benefit in refractory advanced pancreatic cancer.
Multiple subcutaneous granulomas and severe rhinitis after intradermal deposition of epoxy: a case report
Authors: Steffen Roth, Anne Kristin Møller Fell
Journal: J Occup Med Toxicol (2016)
Keywords: epoxy, granuloma, occupation, rhinitis, skin, work-related
MeSH terms: Case Reports

Background:
We present an unusual case of subcutaneous granulomas that also highlights the importance of assessing possible associations between exposure and symptoms early in the diagnostic approach to prevent further adverse health effects. Granulomas of the skin are seen in association with several diseases and after foreign body penetration of soft tissue, but have not been described after contact with epoxy. Epoxy resins are commonly used in paints and other protective coatings, including flooring materials.
Case presentation:
We report a case of granulomatous inflammation in a 58-year-old man after accidental intradermal deposition of unhardened epoxy. Multiple subcutaneous nodules were present on his right forearm, from hand to elbow, for a period of 6 months after the incident. Biopsies and histological analysis showed a granulomatous inflammation without necrosis. Microscopic analysis of the biopsies did not show mycobacterium tuberculosis, other bacteria, or fungal elements. Standard patch testing was negative. The nodules disappeared gradually, but intense pruritus remained. The patient returned to exposure and developed severe work related rhinitis.
Conclusions:
This case report describes an unusual case of multiple subcutaneous granulomas after a small injury with an epoxy-contaminated tool. Initially no association between the granulomas and exposure was established and the patient returned to work and epoxy exposure. He subsequently developed severe work related rhinitis. The case highlights the challenges of establishing an association between exposure and dermal reactions and that exposure should be reduced or avoided when sensitisation to allergens may have occurred.
Primary hydatid cyst of the pancreas of the child: a case report
Authors: Achraf El Bakkaly, Nour Merouane, Omar Dalero, Houda Oubeja, Mounir Erraji, Fouad Ettayebi, Hicham Zerhouni
Journal: Pan Afr Med J (2017)
Keywords: pancreas, child, hydatid cyst, treatment
MeSH terms: Abdominal Pain / etiology, Choledochal Cyst / diagnosis, Echinococcosis / diagnosis, Pancreatic Diseases / diagnosis, Case Reports, Abdominal Pain / parasitology, Child, Preschool, Diagnosis, Differential, Echinococcosis / parasitology, Female, Humans, Pancreas / parasitology, Pancreatic Diseases / parasitology

Primary pancreatic hydatid lesions are very rare with an incidence of less than 1% in the adult population. We report an observation of a 5-year-old girl who consulted for isolated abdominal pain occurring for 2 weeks without vomiting, transit disorders or jaundice and evolving in a context of conservation of the general condition and apyrexia. Clinical examination and preoperative imaging have suggested the diagnosis of a choledochal cyst or duodenal duplication rather than a hydatid cyst of the pancreas due to the presence of a cystic hepatic image projecting into the liver hilum. During the procedure, a hydatid cyst was found occupying the head of the pancreas. Primary hydatidosis of the pancreas in children is extremely rare. Possible sources of infection include: blood diffusion, local spread via biliopancreatic ducts and peripancreatic lymphatic invasion. In the endemic areas, hydatid disease should be mentioned in the list of differential diagnoses of cystic lesions located around the biliopancreatic junction in children.
Midventricular Obstructive Hypertrophic Cardiomyopathy during Pregnancy Complicated by Pulmonary Embolism: A Case Report
Authors: Leila Abid, Ahmed Tounsi, Dorra Abid, Mourad Hentati, Samir Kammoun
Journal: Case Rep Med (2012)

Hypertrophic cardiomyopathy (HCM) with midventricular obstruction (MVO) is a rare condition occurring in 1% of HCM patients. It is characterized by asymmetric left ventricular hypertrophy with MVO and elevated intraventricular pressure gradients. Pulmonary embolism has been associated with mid-ventricular obstructive HCM. Briefly, this case presents an unusual clinical scenario where a young pregnant woman suffering from hypertrophic obstructive cardiomyopathy presents with dyspnea hemodynamic compromise related to pulmonary embolism illustrating hemodynamic challenges created by pregnancy and surgery. We concluded that simple measures such as communication between the cardiology and obstetric teams, understanding of the hemodynamic changes, anesthetic planning, and monitoring were paramount for the success in our patient.
Synchronous malignant otitis externa and squamous cell carcinoma of the external auditory canal
Authors: R Y Chin, T B V Nguyen
Journal: Case Rep Otolaryngol (2013)

Objectives. To discuss the management of a squamous cell carcinoma in the presence of malignant otitis externa. Study Design. We present only the third reported case in the literature of a synchronous tumour with malignant otitis externa in the literature. Methods. A case report and review of malignant otitis externa and squamous cell carcinomas of the external auditory canal are discussed. Results. A 66-year-old female is presented here with a 2-month history of a painful, discharging left ear refractory to standard antibiotic therapy. Computerised tomography, magnetic resonance imaging, technetium 99 m, and gallium citrate Ga67 scans were consistent with malignant otitis externa. Biopsy in the operating theatre revealed a synchronous squamous cell carcinoma of the external auditory canal. Primary resection of the tumour and surrounding tissues was performed with concomitant treatment with intravenous antibiotics. Conclusions. This is only the third case to be reported in the literature and highlights several important diagnostic and management issues of these two rare conditions. Both conditions may present in a similar manner on clinical assessment and radiological investigations. Aggressive management with surgical resection and treatment with appropriate intravenous antibiotics is necessary to give the best chance for cure.
Renal Cell Carcinoma Associated with Mycosis Fungoides: A Paraneoplastic Syndrome
Authors: Jessica Tran, Auris Huen, Madeleine Duvic
Journal: Case Rep Nephrol (2020)
MeSH terms: Case Reports

Patients with mycosis fungoides have an increased risk for additional malignancies, particularly hematologic malignancies. Of the malignancies that have been associated with mycosis fungoides, renal cell carcinoma and other solid tumor malignancies have not been studied extensively. In this case series, we describe three mycosis fungoides patients who were diagnosed with clear cell renal cell carcinoma and discuss the potential pathophysiology underlying this association.
Right Valsalva Sinus Aneurysm Protruding Into the Right Ventricle: A Case Report
Authors: Ata H Afshar, Sergei Kolesnikov, Leili Pourafkari, Nader D Nader
Journal: J Cardiovasc Thorac Res (2015)
Keywords: aortic aneurysm, rupture of aortic aneurysm, sinus of valsalva
MeSH terms: Case Reports

A separation between the aortic media and annulus fibrosus causes a rare cardiac abnormality called sinus of Valsalva aneurysm (SVA) that may be congenital or acquired. It is more prevalent in the right coronary sinus (65%-85%) but it has been seen rarely in non-coronary (10%-30%) or Left coronary sinus (<5%). The most common complication is rupture of the Aneurysm. We present an 80-year-old male with expanding right Valsalva sinus aneurysm and protruding into right ventricle. The conventional treatment is surgical repair under cardio-pulmonary bypass or percutaneous catheter closure. The aneurysm was successfully excised surgically under direct guidance of trans-esophageal echocardiography (TEE).
STEMI in a Young Male after Use of Synephrine-Containing Dietary Supplement
Authors: Dileep Unnikrishnan, Radhika Annam, Aasems Jacob, Braghadheeswar Thyagarajan, Peter Farrugia
Journal: Case Rep Cardiol (2018)
MeSH terms: Case Reports

A twenty-two-year-old male with no significant past medical history who presented with chest pain was found to have ST-segment elevation in leads II, III, aVF, and V4-V6. On subsequent EKGs, patient had new ST-segment elevations in anterolateral leads with dynamic changes. Cardiac catheterization showed acute dissection with thrombosis of the distal left main coronary artery leading into the ostial left anterior descending artery. The patient had no cardiac risk factors including hypertension, hyperlipidemia, diabetes, or family history of early cardiac disease. On further inquiry, the patient was found to be on two separate performance-enhancing supplements which contained synephrine, a sympathomimetic chemical which was later attributed as the cause of his acute coronary syndrome. Synephrine acts on alpha-1 adrenergic receptors causing peripheral and coronary vasoconstriction, hypertension, and hyperglycemia. Increased hemodynamic stress on the coronary arteries can lead to fatal dissections. Ours is an atypical case of synephrine-induced nonatherosclerotic spontaneous coronary artery dissection which helps caution the physicians about the importance of dietary supplement use in the history and possible side effects of such performance-enhancing additives.
Carpal tunnel syndrome caused by lipoma: a case report
Authors: Mohamed Ali Sbai, Sofien Benzarti, Hichem Msek, Monia Boussen, Adel Khorbi
Journal: Pan Afr Med J (2015)
Keywords: lipoma, carpal tunnel syndrome, median nerve, nerve compression
MeSH terms: Carpal Tunnel Syndrome / etiology, Lipoma / complications, Soft Tissue Neoplasms / complications, Case Reports, Aged, Carpal Tunnel Syndrome / surgery, Female, Hand, Humans, Lipoma / diagnosis, Lipoma / surgery, Magnetic Resonance Imaging, Median Nerve / pathology, Paresthesia / etiology, Soft Tissue Neoplasms / diagnosis, Soft Tissue Neoplasms / surgery

Lipoma is a relatively frequent, benign soft-tissue tumor rarely located in the hand. A lipoma of the hand causing a carpal tunnel syndrome by compression of the median nerve is exceptional. We report the case of a 70-year-old female presenting with a carpal tunnel syndrome. A compression of the median nerve by a lipoma was discovered during surgery. Transverse carpal ligament release with lipoma excision and neurolysis of the median nerve were performed. Histopathological study of the resected mass was consistent with a lipoma. Two-month postoperatively, the patient recovered full hand function with entire disappearance of acroparesthesia. Carpal tunnel syndrome caused by space occupying lesions is rare. Diagnosis is difficult, usually based on the clinical study, electrophysiology and magnetic resonance imaging (MRI). Transverse carpal ligament release and excision of lipoma provides excellent functional recovery.
Spontaneous Pneumomediastinum due to Anti-Melanoma Differentiation-Associated Protein 5 Requiring a Bilateral Lung Transplant
Authors: Amrit Singh Jhajj, James Hok Shun Yeung, Fergus To
Journal: Case Rep Rheumatol (2021)
MeSH terms: Case Reports

Anti-melanoma differentiation-associated protein 5 (anti-MDA5) is a subset of dermatomyositis associated with respiratory complications, in which rapidly progressive interstitial lung disease (RPILD) is commonly cited, and spontaneous pneumomediastinum (SPM) is a rare complication. In medical literature, aggressive immunosuppressive therapy has been the mainstay of anti-MDA5-associated SPM management. Here, we report the first MDA5 case with SPM which was successfully treated with a double-lung transplant. We present a 48-year-old male who presented with multiple constitutional symptoms such as fevers, weight loss, malaise, and arthralgias, in association with erythroderma over the ears and fingers. Imaging of the chest demonstrated peripheral airspace disease, and myositis-specific serology returned positive for anti-Jo1 (medium-positive), anti-Ro52 (high-positive), and anti-MDA5 (weak-positive) autoantibodies. Therefore, the patient was begun on immunosuppressive therapy as the leading diagnosis included autoimmune myositis, possibly antisynthetase syndrome with interstitial lung disease (ILD). A year later, the patient presented with progressive shortness of breath, widespread macular erythematous facial rash, and new erythematous ulcerations over the fingertips. Imaging demonstrated a new SPM at this juncture. As the patient's respiratory status continued to decline despite the use of immunosuppressive agents, a double-lung transplant was performed. Therefore, we propose that lung transplantation should be considered early in MDA5-SPM.
Spontaneous Renal Artery Dissection in COVID-19 Pneumonia: Potential Danger of Cytokine Storm
Authors: Jitendra Parmar, Tapan Patel, Sandip Shah, Jay Kothari, Sameer Dani, Sagar Vyas
Journal: Case Rep Crit Care (2021)
MeSH terms: Case Reports

The coronavirus disease (COVID-19) pandemic has rapidly spread across the globe since its first detection in March 2020. Its widespread manifestations and vascular complications are increasingly being reported even in young and middle-aged patients. Hyperinflammation is a continuum of host's exaggerated inflammatory response representing cytokine dysregulation/storm which produces coagulopathy and vascular endothelial dysfunction, apart from a prothrombotic state. Cytokine storm or direct viral invasion of the vascular endothelial cells through surface angiotensin-converting enzyme 2 receptors may result in endothelial dysfunction which can potentially result in dissection. Only a few case reports have been published in the literature describing vascular dissection without any inciting factors in COVID-19 patients. Herein, we present the first case report of bilateral renal artery dissection in a 41-year-old male patient who recently recovered from COVID-19 and was managed successfully in stages after many medical hurdles.
Cooccurrence of Metastatic Papillary Thyroid Carcinoma and Salmonella Induced Neck Abscess in a Cervical Lymph Node
Authors: Jae-Myung Kim, Ju-Yeon Kim, Eun Jung Jung, Eun Jin Song, Dong Chul Kim, Chi-Young Jeong, Young-Tae Ju, Young-Joon Lee, Soon-Chan Hong, Sang-Kyung Choi, Woo-Song Ha
Journal: Case Rep Med (2017)
MeSH terms: Case Reports

Cervical lymph node metastasis is common in patients with papillary thyroid carcinoma (PTC). Salmonella species are rarely reported as causative agents in focal infections of the head and neck. The cooccurrence of lymph node metastasis from PTC and a bacterial infection is rare. This report describes a 76-year-old woman with a cervical lymph node metastasis from PTC and Salmonella infection of the same lymph node. The patient presented with painful swelling in her left lateral neck region for 15 days, and neck ultrasonography and computed tomography showed a cystic mass along left levels II-IV. The cystic mass was suspected of being a metastatic lymph node; modified radical neck dissection was performed. Histopathological examination confirmed the presence of PTC in the resected node and laboratory examination of the combined abscess cavity confirmed the presence of Salmonella Typhi. Following antibiotic sensitivity testing of the cultured Salmonella Typhi, she was treated with proper antibiotics. Cystic lesions in lymph nodes with metastatic cancer may indicate the presence of cooccurring bacterial infection. Thus, culturing of specimen can be option to make accurate diagnosis and to provide proper postoperative management.
Lymphoma and Differentiated Thyroid Cancer: A Case Series
Authors: Amitha Sherief, Sugeeth M Thambi, Deepa Susan Joy Philip, Abhilash Menon, Sreekumar A
Journal: Cureus (2023)
Keywords: chemotherapy, differentiated thyroid carcinoma, hodgkin lymphona, non hodgkin's lymphoma, papillary carcinoma thyroid
MeSH terms: Case Reports

Occurrences of lymphoma and differentiated thyroid cancer are rare. Usually, involvement of the thyroid gland is seen as a part of extranodal involvement or as a part of radiation-induced malignant transformation in previously treated lymphoma patients. The incidence of synchronous hematological malignancy with differentiated thyroid cancer is 7%. The synchronous occurrence of differentiated thyroid cancer and lymphoma poses a significant diagnostic and treatment dilemma. Here we report a case series of four patients with lymphoma and differentiated thyroid cancer. All four patients had lymphoma treated first followed by definitive management of thyroid malignancy.
A case report of a brain herniation secondary to cryptococcal meningitis with elevated intracranial pressure in a patient with Human Immunodeficiency Virus/Acquired immunodeficiency syndrome (HIV/AIDS)
Authors: Nehemias Guevara, Abdulrasheed Akande, Mailing Flores Chang, Jane Atallah, Carol Epstein
Journal: IDCases (2022)
Keywords: aids, cryptococcal meningitis, hiv, meningitis, brain herniation, intracranial pressure
MeSH terms: Case Reports

Background:
Cryptococcal meningitis is a major opportunistic infection in individuals with HIV. The worldwide annual incidence is estimated to be approximately one million cases per year, with the most significant burden in sub-Saharan Africa. HIV-associated cryptococcal meningitis continues to have a high mortality rate despite widespread availability and use of HAART.
Case:
36-year-old male with a past medical history of AIDS and a CD4 count of 35 cells/mm3 presented with altered mental status initially thought to be related to using crystalline methamphetamine as reported by EMS. However, a lumbar puncture performed in the emergency department showed elevated CSF opening pressure of 29 cmH2O and positive CSF and serum cryptococcal antigen. The patient was admitted and commenced treatment according to the current IDSA guideline but continued to have waxing and waning mental status. On the fourth day of admission, he complained of headache, had a witnessed seizure, and was taken emergently for a CT scan of the brain, which was negative for any acute intracranial process, but suffered a cardiac arrest before it could be done. He was intubated and transferred to the intensive care unit. CT brain follow-up showed anoxic encephalopathy, development of marked cerebral edema, and complete effacement of the basilar cisterns, suggestive of downward transtentorial herniation; he continued to deteriorate and expired on the seventh day of admission.
Objectives:
1.Describe a case of brain death secondary to increased intracranial pressure due to cryptococcal meningitis in a patient with HIV/AIDS.2.Explain the mechanisms of elevation in intracranial pressure in patients with cryptococcal meningitis.3.Discuss the options for managing elevated intracranial pressure in patients with cryptococcal meningitis.4.Create awareness in the medical community about the importance of prompt and efficient management of increased intracranial pressure in patients with cryptococcal meningitis.
Conclusion:
This case highlights the importance of aggressive management of elevated intracranial pressure in cryptococcal meningitis. It reiterates the need for more data regarding the optimal timing and frequency of therapeutic lumbar puncture and the use of temporary lumbar drainage catheters and ventriculostomy to manage this potentially fatal complication.