OpenMed/multicare-articles huggingface dataset:
An unruptured, thrombosed 10 cm right coronary artery aneurysm mimicking a pericardial cyst
Authors: Aakash Chauhan, Harsha Musunuru, Richard L Hallett, Mark Walsh, Szabolcs Szabo, Walter Halloran
Journal: J Cardiothorac Surg (2013)
MeSH terms: Coronary Aneurysm / diagnosis, Mediastinal Cyst / diagnosis, Thrombosis / diagnosis, Case Reports, Cardiac Surgical Procedures, Diagnosis, Differential, Humans, Male, Middle Aged, Tomography, X-Ray Computed

Giant coronary artery aneurysms are a rare and potentially life-threatening condition. A 47 year old male presented with a progressive 6 month history of dyspnea and acute right sided chest pain. During the patients work-up, a 10 cm × 10 cm right coronary artery aneurysm was discovered on CT scan and confirmed by cardiac catheterization. The patient was emergently taken to the operating room for aneurysmal resection with placement of a greater saphenous vein bypass graft. There were no post-operative complications and the etiology of this patient's aneurysm was determined to be a congenital ectatic dilation of his right coronary artery. The patient is doing well at 2 years of clinical follow-up.
Meningioangiomatosis: a case report and literature review emphasizing diverse appearance on different imaging modalities
Authors: Osama N Kashlan, David V Laborde, Lakesha Davison, Amit M Saindane, Daniel Brat, Patricia A Hudgins, Robert E Gross
Journal: Case Rep Neurol Med (2011)
MeSH terms: Case Reports

Purpose. Meningioangiomatosis (MA) is a rare, benign lesion that commonly mimics other intracranial malformations in clinical presentation and appearance on imaging. The case presented and the literature review performed highlight the importance of combining MRI and CT results to better characterize intracranial lesions and including MA on the list of differential diagnoses of patients presenting with seizures. Methods. The case described is of a 19-year-old male with a 10-year history of worsening seizures refractory to multiple drug regimens. MRI revealed an atypical vascular malformation. The patient underwent surgical resection of the epileptogenic cortex. Results. Although the radiologic impression of the lesion was a vascular malformation, pathological examination revealed MA. A literature search performed highlights the variability of the appearance of MA on CT and MRI and suggests the utility of the T2 GRE sequence in illustrating the presence of calcification and, in a lesion with other characteristic features, the diagnosis of MA. Conclusion. MA can be a difficult diagnosis to make based on imaging findings alone. However, in a patient with a characteristic history and presentation, the presence of a calcified mass on CT and MRI brain susceptibility artifact on a T2 GRE sequence may suggest MA.
Nodular Lymphocyte Predominant Hodgkin Lymphoma of the Ileum
Authors: Aruna Rangan, Sarah W Grahn, Andrew L Feldman
Journal: Case Rep Pathol (2017)
MeSH terms: Case Reports

Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) is a rare lymphoma derived from germinal center B lymphocytes that typically presents with localized lymph node involvement and can mimic a variety of both reactive and other neoplastic conditions. Extranodal involvement is uncommon in NLPHL and typically occurs in the context of previously documented or synchronous nodal disease. Involvement of the gastrointestinal tract is exceedingly rare. Here, we present the first case to our knowledge of NLPHL involving the ileum that was discovered incidentally on routine screening colonoscopy in an asymptomatic patient. An awareness of the spectrum of clinical presentations, careful morphologic evaluation, and a comprehensive panel of immunohistochemical stains are essential for correct diagnosis of NLPHL presenting in unusual anatomic sites.
Sporadic Burkitt Lymphoma Presenting with Middle Cranial Fossa Masses with Sphenoid Bony Invasion and Acute Pancreatitis in a Child
Authors: Tal Dror, Virginia Donovan, Naomi Strubel, Sucharita Bhaumik
Journal: Case Rep Oncol Med (2021)
MeSH terms: Case Reports

Acute pancreatitis in children is usually due to infection, trauma, or anatomical abnormalities and is rarely due to obstruction from malignancy. Sporadic Burkitt lymphoma (BL) is an aggressive non-Hodgkin B-cell lymphoma that usually involves the bowel or pelvis, with isolated cases presenting as acute pancreatitis. We report a case of BL in a 12-year-old male presenting as acute pancreatitis with obstructive jaundice and a right middle cranial fossa mass invading the sphenoid bone. The common bile duct in this case was dilated to 21 mm in diameter on abdominal ultrasound and to 26 mm on magnetic resonance cholangiopancreatography (MRCP), significantly greater than any value reported in the literature for BL. Given the rapidly progressing nature of BL, we emphasize the importance of recognizing heterogeneous presentations of this disease to improve patient survival. We also conclude that it is important to consider malignancy in a child with acute pancreatitis, particularly in the presence of obstructive jaundice or multisystem involvement. Other Presentations. This case report has no prior publications apart from the abstract being accepted to the 2020 SIOP (International Society of Pediatric Oncology) meeting and 2020 ASPHO conference (canceled due to the COVID-19 pandemic) and subsequently published as an abstract only in Pediatric Blood and Cancer. We have also presented the abstract as a poster presentation at our institution's (NYU Langone Hospital-Long Island, previously known as NYU Winthrop) annual research day conference in 2020.
Breaking Therapeutic Inertia With Alirocumab in an 80-Year-Old Patient With Severe Hypercholesterolemia: A Case Report
Authors: Angela Dardano, Giuseppe Daniele, Giuseppe Penno, Roberto Miccoli, Stefano Del Prato
Journal: Front Med (Lausanne) (2021)
Keywords: ldl cholesterol, pcsk9 inhibitors, alirocumab, case report, elderly, hypercholesterolemia, therapeutic inertia
MeSH terms: Case Reports

Background: Therapeutic inertia, defined as the failure to initiate or intensify therapy in a timely manner as per evidence-based clinical guidelines, is an important barrier limiting optimal care in the elderly. Therefore, overcoming therapeutic inertia is the core challenge when dealing with geriatric patients. Case Description: The patient was an 80-year-old man that attended our Outpatient Lipid Clinic (Pisa University Hospital) because of persistent high LDL cholesterol (LDLc) levels in a setting of a statin contraindication. He underwent five percutaneous coronary angioplasties with drug-eluting stents. In 2014, upon starting treatment with rosuvastatin for LDLc level of 7.59 mmol/L, the patient was admitted to the Emergency Room for a presumptive diagnosis of rhabdomyolysis (creatine kinase 6685 U/L) secondary to statin. Patient developed acute kidney injury treated with dialysis. After resolution, he was discharged with ezetimibe (10 mg daily). This treatment however failed to effectively reduce LDLc levels that ranged between 5.9 and 6.6 mmol/L for the ensuing 4-years. In 2018, at the time of our evaluation, in consideration of the age, we performed a comprehensive geriatric assessment that showed good functional and mental status supporting a reliable treatment with a proprotein convertase subtilisin-kexin type 9 inhibitor. Therefore, alirocumab was prescribed as add-on to ezetimibe. At 24-month follow-up, the geriatric assessment showed no significant changes, and alirocumab was well-tolerated. LDLc was 82% lower as compared to baseline values (from 6.6 to 1.2 mmol/L). Conclusions: This report describes a case of therapeutic inertia despite a very high-risk profile. It is also instrumental in highlightening that appropriate intensification of therapy in an elderly patient at high cardiovascular risk, by means of a patient-centered approach, may allow reaching therapeutic targets and overcoming the condition of therapeutic inertia.
A case of bilateral thalamic infarct complicating tuberculous meningoencephalitis
Authors: Jehanne Aasfara, Wafa Regragui, Loubna El Ouardi, El Hachmia Ait Ben Haddou, Ali Benomar, Mohammed Yahyaoui
Journal: Pan Afr Med J (2019)
Keywords: tuberculosis, bithalamic, meningoencephalitis, movement disorders, stroke
MeSH terms: Brain Infarction / etiology, Meningoencephalitis / complications, Stroke / etiology, Tuberculosis, Meningeal / complications, Case Reports, Adolescent, Antitubercular Agents / administration & dosage, Brain Infarction / diagnosis, Humans, Male, Meningoencephalitis / drug therapy, Meningoencephalitis / microbiology, Prognosis, Stroke / diagnosis, Thalamus / pathology, Tuberculosis, Meningeal / drug therapy, Antitubercular Agents

Ischemic stroke can result from multiple etiologies. It can also be a complication of tuberculous meningoencephalitis and determine its outcome. stroke secondary to tuberculous meningoencephalitis, occurs in 30% cases in the basal ganglia region, unusually in the thalamus. The mechanism of stroke in this condition is vasculitis. We report an unusual case of bilateral thalamic infarcts complicating tuberculous meningoencephalitis. Ischemic stroke in tuberculous meningoencephalitis is unpredictable with poor prognosis despite antituberculous drug treatment, emphasising the importance of primary prevention, particularly in tuberculosis endemic areas.
Human immunodeficiency virus and leprosy coinfection: challenges in resource-limited setups
Authors: Charles M Kwobah, Kara K Wools-Kaloustian, Jane N Gitau, Abraham M Siika
Journal: Case Rep Med (2012)
MeSH terms: Case Reports

Mycobacteria leprae(leprosy) and HIV coinfection are rare in Kenya. This is likely related to the low prevalence (1 per 10,000 of population) of leprosy. Because leprosy is no longer a public health challenge there is generally a low index of suspicion amongst clinicians for its diagnosis. Management of a HIV-1-leprosy-coinfected individual in a resource-constrained setting is challenging. Some of these challenges include difficulties in establishing a diagnosis of leprosy; the high pill burden of cotreatment with both antileprosy and antiretroviral drugs (ARVs); medications' side effects; drug interactions; scarcity of drug choices for both diseases. This challenge is more profound when managing a patient who requires second-line antiretroviral therapy (ART). We present an adult male patient coinfected with HIV and leprosy, who failed first-line antiretroviral therapy (ART) and required second-line treatment. Due to limited choices in antileprosy drugs available, the patient received monthly rifampicin and daily lopinavir-/ritonavir-based antileprosy and ART regimens, respectively. Six months into his cotreatment, he seemed to have adequate virological control. This case report highlights the challenges of managing such a patient.
Incidentally discovered huge retroperitoneal mucinous cystadenoma with successful laparoscopic management: Case report
Authors: Mohammed S Foula, Abdullah S AlQattan, Ahmed M AlQurashi, Hassan M AlShaqaq, M Khalid Mirza Gari
Journal: Int J Surg Case Rep (2019)
Keywords: laparoscopy, literature review, mucinous cystadenoma, retroperitoneal cyst

Introduction:
Retroperitoneal cystic lesions are uncommon heterogeneous clinical entities with no definite incidence. Their clinical presentations are different and their diagnosis is challenging. The management necessitates complete surgical excision, usually via laparotomy. Recently, laparoscopic approach is being increasingly used.
Case presentation:
A 29-year-old female patient was referred for an incidentally-discovered huge retroperitoneal cyst. Imaging studies revealed a retroperitoneal cyst, measuring 13 * 11 cm. Diagnostic laparoscopy showed a retroperitoneal cyst displacing the small bowel and the right colon to the left side. The peritoneal covering was dissected from the cyst with caution not to cause cyst rupture. The cyst was removed partially using Endobag, then aspiration of its content to facilitate its delivery. The patient had a smooth uneventful postoperative course.
Discussion:
The retroperitoneal space is large, expandable space which enables retroperitoneal cystic lesions to grow asymptomatic. CT scan remains the best imaging modality. Aspiration of its content is not routinely done as its sensitivity and specificity has been reported low. Moreover, it carries the risk of leakage of the cyst content into the peritoneal space. Open surgical complete excision is the traditional management and remains of choice. However, laparoscopic management can be tried with caution not to cause content spillage. Intraoperatively, controlled aspiration of the cyst helps in its retrieval.
Conclusion:
Primary retoperitoneal mucinous cystadenoma is a rare clinical entity that is usually incidentally discovered. Laparoscopic excision is safe and feasible if done by an expert laparoscopic surgeon. Care should always be taken not to cause spillage of its content.
Case Report: Sublingual Microcirculatory Alterations in a Covid-19 Patient With Subcutaneous Emphysema, Venous Thrombosis, and Pneumomediastinum
Authors: Sanjeev Grewal, Brita Harjo, Güclü Aykut, Bülent Ergin, Ralph Nowitzky, Can Ince, Sakir Akin
Journal: Front Med (Lausanne) (2021)
Keywords: covid-19, idf imaging, pneumomediastinum, subcutaneous emphysema, sublingual microcirculation, venous thrombosis
MeSH terms: Case Reports

The Corona virus disease 2019 (Covid-19) has brought a wide range of challenges in intensive care medicine. Understanding of the pathophysiology of Covid-19 relies on interpreting of its impact on the vascular, particularly microcirculatory system. Herein we report on the first use of the latest generation hand-held vital microscope to evaluate the sublingual microcirculation in a Covid-19 patient with subcutaneous emphysema, venous thrombosis and pneumomediastinum. Remarkably, microcirculatory parameters of the patient were increased during the exacerbation period, which is not a usual finding in critically ill patients mostly presenting with a loss of hemodynamic coherence. In contrast, recovery from the disease led to a subsequent amelioration of these parameters. This report clearly shows the importance of microcirculatory monitoring for evaluating the course and the adequacy of therapy in Covid-19 patients.
Disseminated life threatening Nocardia otitidiscaviarum infection in a young female with newly diagnosed systemic lupus erythematosus, case report and review of literature
Authors: Jabeed Parengal, Seham Mohsin Alebbi, Manal Mahmoud Mohamed Hamed, Hosam Mohammed Alqatami, Fatma Ben Abid
Journal: IDCases (2021)
Keywords: brain abscess, intracranial aneurysm, nocardia otitidiscaviarum, pneumonia, pustule, systemic lupus erythematosus
MeSH terms: Case Reports

Infection due to Nocardia is reported mainly in immunocompromised patients. It usually presents as a pulmonary or disseminated disease with a predilection for the brain. Infections are a rare etiology of intracranial vascular aneurysms. Herein we report a case of disseminated Nocardia otitidiscaviarum (N. otitidiscaviarum) in a young female newly diagnosed with systemic lupus erythematosus (SLE) complicated by the development of an infectious intracranial aneurysm. To the best of our knowledge this is the fourth case of nocardial infection-related intracranial aneurysm and the second case of N. otitidiscaviarum infection to be reported in a patient with systemic lupus erythematosus. Features of previously reported N. otitidiscaviarum related intracranial aneurysm are reviewed.
Necrotizing pneumonia and purulent meningitis caused by bloodstream infection of CA-MRSA in a child: A rare case report
Authors: Peng Li, Lizhong Dai, Ke Yuan, Chunlan Song, Yibing Cheng, Yu Jing, Na Chen, Junhao Cui, Yangji Wang, Shuqin Fu
Journal: Front Pediatr (2022)
Keywords: community-acquired methicillin-resistant staphylococcus aureus, infectious diseases, necrotizing pneumonitis, neurology, respiratory medicine, suppurative meningitis, young children
MeSH terms: Case Reports

Case presentation:
We report the case of a girl aged 2 years and 10 months who had fever for 2 days, vomiting, poor mental status for 1 day, and one episode of convulsions.
Symptoms and signs:
The patient experienced a rapid onset of symptoms with fever, vomiting, and convulsions. Upon physical examination on admission, she presented with the following: temperature 38.6°C; pulse 185 beats/min; respiration 49 beats/min; blood pressure 89/51 mmHg; drowsiness; piebald skin all over her body; rice-grain-sized pustular rashes scattered on the front chest and both lower limbs, protruding from the surface of the skin; bilateral pupils that were equal in size and a circle with a diameter of about 3.0 mm, and slow light reflex; cyanotic lips; shortness of breath; positive for the three-concave sign; a small amount of phlegm that could be heard in both lungs; capillary refill time of 5 s; cold extremities; and a positive Babinski sign.
Diagnostic method:
A chest computed tomography scan showed multiple nodular and flake-like high-density shadows of varying sizes in each lobe in bilateral lungs, and a cavity with blurred edges could be seen in some nodules. A cranial magnetic resonance imaging examination demonstrated that the hyperintensity of diffusion-weighted imaging could be observed on the left cerebellar hemisphere and left parietal blade. Blood cultures, sputum, cerebrospinal fluid, and bronchoalveolar lavage fluid (BALF) by fiberoptic bronchoscopy all indicated the growth of methicillin-resistant Staphylococcus aureus (MRSA).
Treatment methods:
After admission, the child was given meropenem combined with vancomycin, cefoperazone sulbactam combined with rifamycin, linezolid (oral) for anti-infection successively, and other adjuvant therapies.
Clinical outcomes:
The patient recovered clinically and was discharged from our hospital.
Recommended readers:
Neurology; Respiratory Medicine; Infectious Diseases Department.
Multiple Organ Failure Associated with SARS-CoV-2 Infection in a Child with Down Syndrome: Is Trisomy 21 Associated with an Unfavourable Clinical Course?
Authors: Perla Idalia Vazquez-Hernández, Alan Cárdenas-Conejo, Manuel Alejandro Catalán-Ruiz, Karla Navar-Gallegos, Emilio Zenteno-Salazar, Jose Rafael-Parra-Bravo, Ranferi Aragon-Nogales, Maribel Ibarra-Sarlat, Juan Carlos Núñez-Enríquez
Journal: Case Rep Pediatr (2021)
MeSH terms: Case Reports

Introduction:
Down syndrome (DS) is one of the most frequent genomic disorders around the globe (∼1:700 births). During the COVID-19 pandemic, it has been recognized that children with DS are patients with a greater risk of presenting SARS-CoV-2 infection-related poor outcomes. Nonetheless, a few cases with DS and SARS-CoV-2 infection have been reported. Our aim is to describe the unfavorable clinical course of a child with DS infected with SARS-CoV-2 virus.
Case:
Female, 2 years old, karyotype 47,XX,+21[30], previously diagnosed with a cyanotic congenital heart disease (tricuspid atresia and infundibular pulmonary stenosis, type Ib) who started with diarrhea, developed shortness of breath, and cyanosis and was admitted to the hospital presenting low-oxygen saturation (33%) requiring invasive mechanical ventilation support. The patient tested positive for SARS-CoV-2 infection. During hospitalization, the patient presented hypotension, anuria, retarded capillary filling, and metabolic acidosis; management with vasoactive drugs was needed. Nonetheless, the patient developed respiratory and cardiac failure, acute renal injury (AKIN-III), and septic shock. After 24 days of hospitalization, the patient died.
Conclusions:
Multiple organ failure observed in the patient presented could be related to the triple gene dose of four interferon receptors (IFNAR1, IFNAR2, IFNGR2, and IL10RB) located at 21q22.11. Additionally, overexpression of TMPRSS2 at the pulmonary level, located also at 21q22.3, could be related with an increased susceptibility for the development of SARS-CoV-2 infection in DS patients.
Decompressive abdominal laparotomy for abdominal compartment syndrome in an unengrafted bone marrow recipient with septic shock
Authors: Derrick J N Dauplaise, Sean J Barnett, Jason S Frischer, Hector R Wong
Journal: Crit Care Res Pract (2010)
MeSH terms: Case Reports

Objective. To describe a profoundly immunocompromised (panleukopenia) child with septic shock who developed abdominal compartment syndrome (ACS) and was successfully treated with surgical decompression. Design. Individual case report. Setting. Pediatric intensive care unit of a tertiary children's hospital. Patient. A 32-month-old male with Fanconi anemia who underwent bone marrow transplantation (BMT) 5 days prior to developing septic shock secondary to Streptococcus viridans and Escherichia coli ACS developed after massive fluid resuscitation, leading to cardiopulmonary instability. Interventions. Emergent surgical bedside laparotomy and silo placement. Measurements and Main Results. The patient's cardiopulmonary status stabilized after decompressive laparotomy. The abdomen was closed and the patient survived to hospital discharge without cardiac, respiratory, or renal dysfunction. Conclusions. The use of laparotomy and silo placement in an unengrafted BMT patient with ACS and septic shock did not result in additional complications. Surgical intervention for ACS is a reasonable option for high risk, profoundly immunocompromised patients.
Multiple Imaging and Surgical Characteristics in Cardiac Metastasis from Undifferentiated Uterine Sarcoma
Authors: Hiroka Sasahara, Shoichiro Yatsu, Hideki Wada, Eiryu Sai, Soshi Moriya, Suguru Miyazaki, Kan Kajimoto, Manabu Ogita, Satoru Suwa
Journal: Case Rep Cardiol (2022)
MeSH terms: Case Reports

Although cardiac metastasis of malignant tumors has often been reported, undifferentiated uterine sarcoma (UUS) is a rare and aggressive uterine tumor. Thus, little is known of the UUS as a primary site of cardiac metastasis. We report a case of a 66-year-old woman, with a history of uterine myoma for 30 years, who was hospitalized with a large uterine tumor and cardiac masses. Although we investigated cardiac masses using imaging modalities, such as ultrasound, cardiac computer tomography, and magnetic resonance imaging, it was challenging to determine the masses as metastasis or thrombi. Cardiac masses were removed by surgery to assess the tissue characteristics and were later identified as tumors due to their appearance. Then, pathological findings revealed that UUS spreads to the right ventricle. We attempted chemotherapy after surgery; however, the disease progressed very quickly and the patient died on the 49th day of admission. In this report, we described the case of a patient with a difficult diagnosis and rapid disease progression of cardiac metastasis from UUS.