OpenMed/multicare-articles huggingface dataset:
Monitoring Patient Improvement Parameters following Pasireotide Treatment in Cushing's Disease
Authors: Chris Yedinak, Jessica Brzana, Maria Fleseriu
Journal: Case Rep Endocrinol (2013)

Cushing's disease (CD) is a disorder in which chronic excess adrenocorticotropic hormone production is associated with multiple comorbidities and diminished quality of life. Postsurgical monitoring is important, and newer therapies are available for the management of surgical failure or disease recurrence. In this clinical case, we illustrate the importance of the nursing role in long-term management of CD, particularly as nurses may be the first point of contact for patients with CD. Alertness to disease signs and symptoms is crucial for timely diagnosis and improved outcomes. Successful therapy for CD requires careful monitoring of hormonal control, metabolic parameters, and therapy complications. Ongoing management requires lifelong monitoring of metabolic parameters, of side effects of treatment, and of signs of disease recurrence. Appropriate referrals may be required to facilitate overall outcomes and patient wellbeing. This patient was enrolled in a Phase III trial that was registered in the USA with clinicaltrial.gov.
Anticoagulant-free venovenous extracorporeal membrane oxygenation for diffuse alveolar hemorrhage with bowel bleeding caused by antineutrophil cytoplasmic antibody-associated vasculitis: A case report
Authors: Ryo Esumi, Tadashi Kaneko, Asami Ito, Yohei Ieki, Yoshiki Yamamoto, Ayako Nakajima, Hiroshi Imai
Journal: Respir Med Case Rep (2021)
Keywords: computed tomography, heparin, thrombus
MeSH terms: Case Reports

Antineutrophil cytoplasmic antibody-associated vasculitis (AAV) is sometimes complicated by diffuse alveolar hemorrhage (DAH), which may cause respiratory failure. Venovenous extracorporeal membrane oxygenation (VV-ECMO) without an anticoagulant because of hemorrhagic status, showed the effectiveness for severe respiratory failure by DAH with AAV. A 44-year-old woman developed DAH with bowel bleeding following the onset of AAV, with positive anti-proteinase-3 (PR3) antibodies. Although ventilator management could not support her respiratory status, VV-ECMO was performed. The patient was given immunosuppressive therapy comprising a steroid pulse, plasma exchange, and cyclophosphamide. After about 10 days of VV-ECMO and immunosuppressive therapy, VV-ECMO was withdrawn, and on day 12, ventilator support was stopped. Although a thrombus developed within the inferior vena cava (IVC), which required IVC filtration, the patient was discharged on day 51. VV-ECMO support was effective for treating DAH in this patient with new-onset AAV, which takes some time to achieve remission with immunosuppressive therapy.
Intestinal tuberculosis previously mistreated as Crohn's disease and complicated with perforation: a case report and literature review
Authors: Yu-Feng Wu, Cheng-Maw Ho, Chang-Tsu Yuan, Chiung-Nien Chen
Journal: Springerplus (2015)
Keywords: bowel perforation, crohn’s disease, intestinal tuberculosis

Introduction:
Tuberculosis is known as a notorious mimicker and distinguishing between intestinal tuberculosis and Crohn's disease is a huge diagnostic challenge.
Case description:
Here, we report a case of hollow organ perforation due to intestinal tuberculosis that was previously mistreated as Crohn's disease. Staged operation with emergency resection of the diseased small bowel and temporary ileostomy was performed for the perforation, followed by 6-month standard treatment for miliary tuberculosis, which was diagnosed on the basis of the presence of acid-fast bacilli in the diseased bowel and positive culture of Mycobacterium tuberculosis from sputum, ascites, and stool samples. Ileostomy takedown was performed, and the continuity of the gastrointestinal tract was restored 6 months after the first surgery. The patient recovered well thereafter.
Conclusion:
Timely surgical intervention can help establish the finial diagnosis of tuberculosis, rescue the patient from abdominal emergency, and provide a chance for cure.
Hepatectomy and intrahepatic hepaticocutaneous jejunostomy for bilateral primary hepatolithiasis: Case report
Authors: André Luís Conde Watanabe, Alexandre Coutinho Teixeira de Freitas, Lucinei Stadnik, Júlio Cezar Uili Coelho
Journal: Int J Surg Case Rep (2020)
Keywords: case report, hepatectomy, lithiasis, liver
MeSH terms: Case Reports

Introduction:
Primary hepatolithiasis is a rare disease in western countries and it is associated with repeated attacks of acute cholangitis. Without proper treatment, hepatolithiasis can lead to progressive biliary strictures and secondary biliary cirrhosis.
Presentation of case:
A 40 years old male was admitted due to recurrent cholangitis during the last 18 years. Bilateral primary hepatolithiasis was diagnosed and treated by left hepatectomy with an intrahepatic hepaticocutaneous jejunostomy. There were no postoperative complications and the patient was discharged after 7 days.
Discussion:
The management of patients with primary hepatolithiasis remains a challenging task due to the high incidence of residual and recurrent stones after treatment.
Conclusion:
Primary bilateral hepatolithiasis is a complex disease that can be managed with partial hepatectomy with an intrahepatic hepaticocutaneous jejunostomy.
Ophthalmic examination as a means to diagnose Subacute Sclerosing Panencephalitis: an optical coherence tomography and ultrawide field imaging evaluation
Authors: Koushik Tripathy, Rohan Chawla, Kanhaiya Mittal, Rajni Farmania, Pradeep Venkatesh, Sheffali Gulati
Journal: Eye Vis (Lond) (2017)
Keywords: epilepsy, measles, optomap, optos, sspe, seizures, ultrawide field imaging
MeSH terms: Case Reports

Background:
Subacute sclerosing panencephalitis (SSPE) is a potentially fatal complication of measles. The authors report a case of recurrent myoclonic jerks under investigation, whose ophthalmic examination pointed to the diagnosis.
Case presentation:
A 12-year-old boy with recurrent episodes of myoclonic jerks was found to have optic disc pallor and an irregular macular scar with pigmentation in the left eye. The retinal finding proved to be a strong diagnostic clue for SSPE. There was a history of exanthematous fever in childhood. Antibodies against measles were detected in both the cerebrospinal fluid and serum. Retinitis with intraretinal and subretinal hemorrhage in the right eye was noted 6-weeks after the initial presentation.
Conclusion:
The authors describe the importance of ophthalmic evaluation in cases of recurrent myoclonic jerks. Optical coherence tomographic features and ultrawide field imaging characteristics of a case of SSPE are described.
Dexamethasone Induced Sino-Orbital Mucormycosis In a Patient Infected With COVID-19
Authors: Masoud Mardani, Ilad Alavi Darazam, Abdolreza Babamahmoodi
Journal: Caspian J Intern Med (2022)
Keywords: covid-19, pneumonia, severe acute respiratory syndrome coronavirus 2, spiral computed, tomography
MeSH terms: Case Reports

Background:
The most common causes of immunodeficiency are iatrogenic and the result of the widespread use of therapies which modulates the immune system, whether they are planned or haphazardly. Mucormycosis is an invasive fungal disease which is usually secondary to immunosuppression, diabetic ketoacidosis, and long-term use of antibiotics, corticosteroids, and cytotoxic drugs. There are researches which show patients with coronavirus disease 2019 (COVID-19), especially severely ill or immunocompromised, are more likely to suffer from invasive fungal infections. Patients with diabetes are at a higher risk for severe COVID-19 outcomes. However, there has been no clear evidence on the relationship between pre-diabetes state and mucormycosis as a complication of SARS-CoV-2 infection so far.
Case presentation:
Here, we report a case of sino-orbital mucormycosis in a pre-diabetic 54-year-old female without any underlying diseases. The patient suffered from COVID-19 pneumonia. She received 8 mg dexamethasone for 12 days. Afterwards, she returned three days after her discharge with a complaint of pre-orbital cellulitis, unilateral facial numbness and decreased visual acuity. Therefore, after primary diagnostic imaging, she was regarded as a candidate for invasive surgical intervention and was consequently treated with a combination of liposomal amphotericin B, radical recurrent surgery and posaconazole.
Conclusion:
It is very important to consider patients who are in the pre-diabetic state or possibly immunocompromised before prescribing steroids. The patients should be examined for invasive fungal infections in post-discharge period.
Id reaction and allergic contact dermatitis post-picosecond laser tattoo removal: A case report
Authors: Ian Ty Wong, Larry Wk Cheung
Journal: SAGE Open Med Case Rep (2021)
Keywords: picosecond laser, autoeczematization, interface dermatitis reaction, laser tattoo removal, red tattoo ink
MeSH terms: Case Reports

The novel picosecond lasers have emerged as a mainstay device in laser tattoo removal alongside Q-switch lasers, considered the gold standard in the field. Here, we present a 45-year-old female who developed a severe reaction to both her treated and untreated tattoos after two picosecond laser treatments and subsequent widespread eczematous eruption. Skin biopsies revealed findings consistent with hypersensitivity to exogenous red pigment. The clinicopathologic findings were consistent with an id reaction (autoeczematization) associated with allergic contact dermatitis to tattoo pigment. This case report highlights the potential for tattoo hypersensitivity following picosecond laser treatment and the dilemma associated with tattoo removal in sensitized patients. Additional therapeutic approaches are needed to provide patients with a safe means of tattoo removal while mitigating the risk of hypersensitivity reactions.
Concurrent Papillary Thyroid Carcinoma and Synovial Carcinoma of the Neck in an Adult Male
Authors: Haissan Iftikhar, Shabbir Akhtar, Nasir Uddin
Journal: Iran J Otorhinolaryngol (2019)
Keywords: head and neck, sarcoma neck, thyroid cancer
MeSH terms: Case Reports

Introduction:
Synovial sarcoma makes up 8-10% of all soft tissue sarcomas, and constitutes 3-10% of all sarcomas occurring in the head and neck region. It shows male predominance (3:2), and the mean age of presentation is 30 years.
Case report:
A 51-year-old gentleman presented with right-sided neck swelling which had been progressively increasing in size for the past 2 years. A computed tomography (CT) scan revealed a large heterogeneously enhancing mass on the right side of the neck measuring 7.5 × 6.2 cm. Biopsy of an enlarged node revealed papillary thyroid carcinoma. The patient subsequently underwent total thyroidectomy with right neck dissection. Final histopathology revealed a papillary carcinoma of the thyroid, and the right-sided mass was shown to be monophasic synovial sarcoma.
Conclusion:
We present a case of a concurrent pathology of neck papillary thyroid carcinoma with monophasic synovial sarcoma. We experienced difficulty in diagnosis and misdirection due to raised C-reactive protein (CRP) levels, until final histopathology of the neck mass.
Rare Abdominal Wall Metastasis following Curative Resection of Gastric Cancer: What Can Be Learned from the Use of Percutaneous Catheters?
Authors: Arthur A Parsee, Kerry L Thomas, Masoumeh Ghayouri, Rutika Mehta, Kujtim Latifi, Jennifer Sweeney, Daniel Jeong, Abraham Ahmed
Journal: Case Rep Oncol Med (2020)
MeSH terms: Case Reports

In cancer care, tissue seeding after curative resections is a known potential complication, despite precautions taken during surgical treatment. We present an uncommon case of an abdominal wall metastasis along the tract of a surgical drain following gastrectomy for gastric adenocarcinoma. To our knowledge, this is the first case of such an occurrence in the setting of a negative staging peritoneal lavage. Aside from the rarity of such a recurrence, this instance highlights an opportunity to reevaluate best practices with regard to the extent of coverage of postoperative salvage radiotherapy. The oncologic patient provides many challenges and may require multiple catheters for drainage and at times infusion of nutrition or therapeutic agents. These foreign bodies should be scrutinized both clinically and radiographically, as they may create vulnerabilities in keeping malignant diseases contained and controlled. We provide a review of the literature with reasonable treatment options for the benefit of future patients.
Imaging characteristics of nodal metastases in paraganglioma, ameloblastoma and olfactory neuroblastoma: case reports and literature review
Authors: Smita Deb, Tim Anton Iseli, Timothy Wong, Pramit M Phal
Journal: BJR Case Rep (2016)
MeSH terms: Case Reports

Paraganglioma, ameloblastoma and olfactory neuroblastoma are uncommon primary head and neck tumours. When nodal metastases from these tumours occur, they may present later than and with different imaging characteristics compared with squamous cell carcinoma (SCC), demonstrating appearances similar to the primary tumour type rather than features typical of metastatic nodal SCC. We present three cases in which imaging characteristics of nodal metastases in paraganglioma, ameloblastoma and olfactory neuroblastoma mimicked the primary tumour and discuss their implications for clinicoradiological follow-up.
Delayed Presentation of Posttraumatic Diaphragmatic Hernia Masquerading as Recurrent Acute Asthmatic Attack
Authors: A I El-Yakub, U M Bello, A A Sheshe, H U Naaya
Journal: Case Rep Med (2017)
MeSH terms: Case Reports

Diaphragmatic hernia following blunt abdominal injury is extremely rare and often diagnosed late. Missed diagnosis is also common with this condition. We herein present a delayed presentation of diaphragmatic hernia following blunt abdominal injury that was initially misdiagnosed as recurrent acute asthmatic attack due to repeated presentation with episodic difficulty in breathing.
An Interesting Case of Isolated False-Reactive Hepatitis B Surface Antigen
Authors: Victoria Costa, Zhen Zhao, Sabrina E Racine-Brzostek, Gadi Lalazar, He S Yang
Journal: Case Reports Hepatol (2021)
MeSH terms: Case Reports

The standard serologic markers used to diagnose hepatitis B infection include hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), total hepatitis B core antibody (anti-HBc), and IgM antibody to hepatitis B core antigen (IgM anti-HBc). Different markers or combinations of markers are used to identify different phases of HBV infection and determine whether a patient has acute or chronic infection or immunity due to prior infection or vaccination or is seronegative and susceptible to future infection. Isolated HBsAg seropositivity is a peculiar serological pattern that requires investigation. Herein, we present a case of an asymptomatic female without a history of liver disease or evident risk factors for hepatitis, who underwent screening for infectious disease prior to resection of basal cell carcinoma involving her eyelid. The patient's laboratory testing showed positivity for HBsAg and the HIV 1/2 screen. To investigate, we performed serial dilutions, utilized heterophilicantibody blocking tubes, and repeated analysis using a different commercial assay (Abbott Architect i2000), all in support of a false-positive result attributed to a heterophilic antibody. Hence, we demonstrate that heterophilic antibody interference can result in isolated HBsAg positivity and recommend considering this form of interference in the differential where there is low clinical suspicion for viral infection.
Biologics in paediatric Crohn's disease
Authors: Oliver Gouldthorpe, Anthony G Catto-Smith, George Alex
Journal: Gastroenterol Res Pract (2011)

Crohn's disease affects increasing numbers of children worldwide. Generally, childhood-onset disease runs a more severe course than in adults and has a greater impact on quality of life. Therapy in children must take account of a different set of risks for toxicity compared to adults, but also to their longevity. Biologic drugs present remarkable advantages in terms of disease control for children, especially in those whose disease cannot be controlled with conventional therapies, but their long-term risks are still being assessed. Data regarding biologic use in children is limited and mostly amounts to case series, but results have been promising, both in terms of controlling disease activity and improving growth parameters. Adverse reactions are infrequent in the short term, but loss of response is a long-term problem, particularly in children. More information is needed about very long term risks. Infliximab and adalimumab are the most studied agents in children, while there is relatively limited data on certolizumab and natalizumab. Further collection of data on these agents is still needed, but this should not restrict access to these agents for children in whom no other agent is effective.
Dual Retro-Aortic Left Renal Vein with Drainage into Left Common Iliac Vein: Rare Anomaly of Left Renal Vein
Authors: H C Sutariya
Journal: Int J Organ Transplant Med (2016)
Keywords: aorta, iliac vein, nephrectomy, renal veins, transplantation
MeSH terms: Case Reports

Knowledge of the renal vascular anatomy greatly contributes to the success of surgical, invasive and radiological procedures of the retroperitoneal region. In today's era of transplant, this knowledge is of utmost importance in performing donor nephrectomy so that number of fatal intra-operative complications can be prevented. Herein, we report on a rare anomaly of left renal vein in which dual retro-aortic left renal veins were noted and one of them drained into the left common iliac vein.
Atypical MRI Presentation of High-Grade Chondrosarcoma in the Proximal Femur
Authors: Nico Hustings, Valerie Van Ballaer, Geert Vanderschueren
Journal: J Belg Soc Radiol (2023)
Keywords: ct, mri, bone lymphoma, bone tumor, chondrosarcoma, pathology, radiography
MeSH terms: Case Reports

Teaching Point: Although magnetic resonance imaging (MRI) plays a considerable role in the detection and differentiation of chondrosarcoma (e.g., by cortical breakthrough, peritumoral soft tissue edema, and extra-osseous extension), it is important to be aware of atypical features of common bone tumors.
Tubular Duplication of the Midgut Presenting with Acute Abdomen and Hematochezia: A Case Report from Northern Tanzania
Authors: Ayesiga M Herman, David Msuya, Mwemezi Kaino, Hilary Shilanaiman, Joachim Magoma, Christian Issangya, Jay Lodhia, Murad Tarmohamed, Jeremia Pyuza, Patric Amsi, Alex Mremi, Ronald Mbwasi, Nuru Letara
Journal: Case Rep Surg (2018)
MeSH terms: Case Reports

Enteric duplication is one of the rare malformations affecting the small intestine more than the other parts of the gastrointestinal tract. It poses a challenge in diagnosis due to nonspecific symptoms that may mimic other pathologies. Furthermore, the management options including total resection, mucosal striping, and internal drainage of the duplicate depend on the presentation of the patient, site, and length of the involved bowel. We present the first documented case of enteric duplication in Tanzania, a 3-year-old male, who was found to have a 90 cm long jejunoileal duplicate. We discuss the presentation and management offered.
Ultrasonic misdiagnosis of giant pediatric testicular yolk sac tumor: A case report and literature review
Authors: Zilong Wang, Fuding Lu, Changze Song, Xinkun Wang, Naifa Li, Jiawen Zhai, Baohong Jiang, Jianpeng Yuan, Zheng Yang, Xujun Xuan
Journal: Front Pediatr (2022)
Keywords: afp, bep chemotherapy, case report, orchidectomy, ultrasonic misdiagnosis, yolk sac tumor
MeSH terms: Case Reports

Background:
Yolk sac tumor is the most common malignant nonseminomatous germ-cell tumor in children characterized by elevated level of α-fetoprotein (AFP), accounting for 70%-80% of all cases. However, giant yolk sac tumors that involve the entire testicle may be misdiagnosed by color Doppler ultrasonography as orchitis. Therefore, we described a case of a 2-year-old pediatric patient with a giant testicular yolk sac tumor that was misdiagnosed by ultrasonography as orchitis, in order to evaluate the role of measuring AFP levels in the initial diagnosis to aid in the accuracy of the definitive diagnosis of testicular yolk sac tumor.
Case presentation:
A 2-year-old boy received outpatient visits for unintentional swelling of the right scrotum for 7 days. Physical examination showed a rubbery swelling of the right scrotum with rejective touch. Then, the patient underwent perineal color Doppler ultrasonography in outpatient visits. The result showed a right testicle size of 29 mm × 22 mm × 20 mm with heterogeneous echogenicity and abundant blood ﬂow, supporting the initial diagnosis of orchitis. However, the initial surgeon was skeptical of the ultrasonography diagnosis. Thus, the patient was admitted to the Department of Andrology on day 2 for further serological and imaging examination. The serum AFP level on day 3 was 323.77 ng/ml. The results of CT and MRI showed a giant tumor of the right testis (26 mm × 21 mm × 29.6 mm) with multiple lymphoid hyperplasia in the inguinal region bilaterally. The patient received radical orchidectomy without lymph node dissection on day 9. The results of postoperative pathological examination confirmed giant testicular yolk sac tumor (T1N0M0S1, Stage Is) and was positive for AFP and SALL4 in immunohistochemistry staining. The patient received three courses of bleomycin-etoposide-cisplatin chemotherapy in the Department of Pediatrics after multidisciplinary team meeting on postoperative days 14, 37, and 58, respectively. During chemotherapy and follow-up, the patient's AFP and lactate dehydrogenase levels continued to decline, and eventually remained within normal range on postoperative day 84.
Conclusion:
Measuring the AFP level was necessary for initial diagnosis and follow-up in pediatric cases of testicular enlargement. Radical orchidectomy combined with postoperative bleomycin-etoposide-cisplatin adjuvant chemotherapy was an effective treatment strategy for pediatric giant testicular yolk sac tumors.
Facing the faceless patients - the emerging challenges of identity fraud in general surgery: A case series
Authors: Jason Cui, Rasika Hendahewa
Journal: Int J Surg Case Rep (2018)
Keywords: general surgery, health care system, identity fraud, laparoscopy

Introduction:
This case series highlights the challenges faced in general surgery when encountering patients who use multiple false identities and provide unreliable histories.
Presentation of cases:
We present two patients both with a background of mental health disorders and previous abdominal surgeries. After extensive workup with one patient almost proceeding to surgery, it was noted that these patients have had multiple presentations under different aliases to multiple different hospitals and had given inconsistent medical and surgical histories.
Discussion:
In such patients, history and clinical examinations are unreliable. Medical records are also not helpful given the patients' multiple aliases. Particularly in surgery, inaccurate knowledge of the patients' previous operative details can lead to significant harms. Extensive investigations are usually performed in assessing these patients, resulting in excessive radiation exposure and incurring significant costs to the health system. It is also important to recognise the potential legal repercussions and harms to the patients who have had their identities stolen.
Conclusion:
Identity fraud poses significant challenges to patient care, vigilance from clinicians and implementing strategies to reduce system error can help to limit harms to the patient and the health care system.