OpenMed/multicare-articles huggingface dataset:
Dual Processing Model for Medical Decision-Making: An Extension to Diagnostic Testing
Authors: Athanasios Tsalatsanis, Iztok Hozo, Ambuj Kumar, Benjamin Djulbegovic
Journal: PLoS One (2015)
MeSH terms: Clinical Decision-Making / methods, Decision Support Techniques, Prostate / pathology, Prostatic Neoplasms / diagnosis, Prostatic Neoplasms / therapy, Case Reports, Research Support, U.S. Gov't, Non-P.H.S., Aged, Biopsy / adverse effects, Disease Management, Evidence-Based Medicine, Humans, Male, Models, Statistical, Probability, Prostate / surgery, Prostatectomy / adverse effects, Prostatic Neoplasms / surgery

Dual Processing Theories (DPT) assume that human cognition is governed by two distinct types of processes typically referred to as type 1 (intuitive) and type 2 (deliberative). Based on DPT we have derived a Dual Processing Model (DPM) to describe and explain therapeutic medical decision-making. The DPM model indicates that doctors decide to treat when treatment benefits outweigh its harms, which occurs when the probability of the disease is greater than the so called "threshold probability" at which treatment benefits are equal to treatment harms. Here we extend our work to include a wider class of decision problems that involve diagnostic testing. We illustrate applicability of the proposed model in a typical clinical scenario considering the management of a patient with prostate cancer. To that end, we calculate and compare two types of decision-thresholds: one that adheres to expected utility theory (EUT) and the second according to DPM. Our results showed that the decisions to administer a diagnostic test could be better explained using the DPM threshold. This is because such decisions depend on objective evidence of test/treatment benefits and harms as well as type 1 cognition of benefits and harms, which are not considered under EUT. Given that type 1 processes are unique to each decision-maker, this means that the DPM threshold will vary among different individuals. We also showed that when type 1 processes exclusively dominate decisions, ordering a diagnostic test does not affect a decision; the decision is based on the assessment of benefits and harms of treatment. These findings could explain variations in the treatment and diagnostic patterns documented in today's clinical practice.
Intracranial varicella zoster virus infection may elicit an unusual hyperkinetic volitional tremor
Authors: Ryogo Shobatake, Hiroshi Kataoka, Tesseki Izumi, Eura Nobuyuki, Makoto Kawahara, Kazuma Sugie
Journal: Clin Park Relat Disord (2020)
Keywords: encephalitis, hyperkinésie volitionnelle, involuntary movement, tremor, varicella zoster virus
MeSH terms: Case Reports

Central nervous system manifestations of varicella zoster virus (VZV) infection are uncommon, and associated involuntary movement is rare. Herein, we describe a patient with VZV induced encephalopathy who presented with an unusual hyperkinetic volitional tremor.
A Case of Fulminant Meningococcemia: It Is All in the Complement
Authors: Kellie L Hawkins, Mariah Hoffman, Sonia Okuyama, Sarah E Rowan
Journal: Case Rep Infect Dis (2017)
MeSH terms: Case Reports

Eculizumab is a novel monoclonal antibody that inhibits complement-mediated hemolysis in patients with paroxysmal nocturnal hemoglobinuria (PNH). Complement deficiency is a well-known risk factor for meningococcal infection. We describe a case of a young patient with PNH treated with eculizumab who presented with a life-threatening case of nongroupable meningococcemia. As this new biologic agent becomes more widely prescribed, providers should be aware of the increased risk of meningococcemia. In addition to vaccination, providers may consider the use of oral penicillin for antibiotic prophylaxis against Neisseria meningitidis in these cases of functional complement deficiency.
Case report: Successful management of a refractory double-expressor diffuse large B-cell lymphoma patient under the guidance of in vitro high-throughput drug sensitivity test
Authors: Lijie Xing, Hui Wang, Dan Liu, Qiang He, Zengjun Li
Journal: Front Oncol (2023)
Keywords: atm, cd58, de-dlbcl, vtd, drug sensitivity screening
MeSH terms: Case Reports

Introduction:
Double-expressor diffuse large B-cell lymphoma (DEL), harboring double expression of MYC and BCL2, has an inferior prognosis following standard first-line therapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP). We initiated a clinical trial to treat newly diagnosed DEL with R-CHOP plus Bruton's tyrosine kinase (BTK) inhibitor (BTKi) zanubrutinib (ZR-CHOP) and achieved a high complete response (CR) rate while four patients progressed during therapy, one of them carrying ATM and CD58 mutations. We applied an in vitro high-throughput drug sensitivity test for the prediction of clinical responses to different drugs in this patient.
Case presentation:
We report a 30-year-old female patient diagnosed with stage III (DEL), with ATM and CD58 mutations. The patient achieved partial response (PR) after two cycles of ZR-CHOP and remained PR after four cycles of ZR-CHOP, while the disease progressed after six cycles of ZR-CHOP. High-throughput drug screening using a panel of 117 compounds identified a range of therapies with efficacy for this patient. The primary tumor cells showed moderate sensitivity to bortezomib, thalidomide, and gemcitabine as a single agent and bortezomib, thalidomide, and dexamethasone (VTD) as a combined regimen. The patient was treated with two cycles of VTD regimen (bortezomib 1.3 mg/m2, d1, 4, 8, 11; thalidomide 100 mg, d1-21; dexamethasone 20 mg, d1, 2, 4, 5, 8, 9) and achieved PR with only a small lesion left. Another two cycles of VTD plus gemcitabine were then administered, and the patient achieved CR. Stem cells were mobilized, and autologous hematopoietic stem cell transplantation was carried out afterward. The patient remained CR for more than 3 months after transplantation.
Conclusion:
In this article, we present a first-line chemoresistant DEL patient with ATM and CD58 mutations who was treated successfully with VTD plus gemcitabine under the guidance of in vitro high-throughput drug sensitivity test.
Secondary Germline Finding in Liquid Biopsy of a Deceased Patient; Case Report and Review of the Literature
Authors: Maedah Veyseh, Charite Ricker, Carin Espenschied, Victoria Raymond, Anishka D'Souza, Afsaneh Barzi
Journal: Front Oncol (2018)
Keywords: cell-free dna, germline mutation, hereditary cancer syndromes, liquid biopsy, pancreaticobiliary neoplasms
MeSH terms: Case Reports

Liquid biopsies are increasingly used in the care of patients with advanced cancers. These tests are used to find mutations and other genomic alterations, quantify these findings over time, and guide treatment. It is not unexpected that germline mutations contributing to the development of cancer can be identified in cell-free DNA. Consequently, increased use of liquid biopsies has resulted in subsequent rise of secondary identification of germline mutations. Clinicians need to be aware of this potential use of liquid biopsies and the need to evaluate the patient and family members for confirmation. Our case documents a deceased patient's liquid biopsy result that was confirmed as a germline mutation through a methodical work-up of the patient's family members. Here, we present the case and provide a brief review of pertinent literature.
A vertebral artery dissection with basilar artery occlusion in a child
Authors: Katleen Devue, Annemie Van Ingelgem, Katrien De Keukeleire, Marc De Leeuw
Journal: Case Rep Emerg Med (2014)

This paper presents the case report of an 11-year-old boy with an acute dissection with thrombosis of the left vertebral artery and thrombosis of the basilar artery. The patient was treated with acute systemic thrombolysis, followed by intra-arterial thrombolysis, without any clinical improvement, showing left hemiplegia, bilateral clonus, hyperreflexia, and impaired consciousness. MRI indicated persistent thrombosis of the arteria basilaris with edema and ischemia of the right brainstem. Heparinization for 72 hours, followed by a two-week LMWH treatment and subsequent oral warfarin therapy, resulted in a lasting improvement of the symptoms. Vertebral artery dissection after minor trauma is rare in children. While acute basilar artery occlusion as a complication is even more infrequent, it is potentially fatal, which means that prompt diagnosis and treatment are imperative. The lack of class I recommendation guidelines for children regarding treatment of vertebral artery dissection and basilar artery occlusion means that initial and follow-up management both require a multidisciplinary approach to coordinate emergency, critical care, interventional radiology, and child neurology services.
A Rare Case of Sclerosing Stromal Tumor of the Ovary Presenting in Pregnancy: A Diagnostic Dilemma on Presentation
Authors: Minh Nguyen, Namarig Soumit, Abdul Waheed, Jack Sees, Erum Azhar
Journal: Case Rep Obstet Gynecol (2019)
MeSH terms: Case Reports

Sclerosing stromal tumor (SST) is a rare benign neoplasm of the ovary. There are only a few cases of sclerosing stromal tumor of the ovary during pregnancy that have been reported in the literature. The presenting symptoms are nonspecific, including pelvic pain or menstrual irregularities. We describe a case of a young 22-year-old pregnant woman who presented with pelvic pain in the second trimester. On imaging she was found to have a 12 cm left adnexal mass with solid features on MRI. The patient underwent exploratory laparotomy and removal of the mass that was attached to the left ovary via a stalk with preservation of the left ovary. The frozen section diagnosis was "sex cord stromal tumor, favor benign". The final pathology confirmed the diagnosis of the sclerosing stromal tumor of the ovary where characteristic features of SST including a heterogenous, pseudolobular growth pattern with hypercellular and hypocellular areas were identified along with prominent luteinized stromal cells attributed to pregnancy. In this case report and review of literature, we emphasize consideration of this rare ovarian tumor in the differential diagnosis for a young pregnant woman who presents with pelvic pain.
A Case Report and Review of the Literature: Infectious Aneurysm Formation in the Pulmonary Arteries-A Rare but Perilous Sequela of Persisting Infection With Klebsiella pneumoniae
Authors: Jannik Ruwisch, Bettina Fischer, Lea Häbel, Florian Laenger, Benjamin-Alexander Bollmann
Journal: Front Microbiol (2022)
Keywords: klebsiella pneumoniae, haemoptoe, infectious aneurysm, pulmonary artery, urosepsis

Septic aneurysms of the pulmonary artery are rare conditions, with few cases having been reported worldwide. They are assumed to result from septic emboli that cause a local inflammatory reaction of the arterial wall, ultimately leading to degenerative changes. We report the case of a 63-year-old female patient presenting with Klebsiella pneumoniae urosepsis and first diagnosis of diabetes mellitus, who developed a life-threatening infectious pulmonary artery aneurysm secondary to bacteremia with Klebsiella pneumoniae. The patient required a lobectomy due to pulmonary hemorrhage. We review the clinical hallmarks of Klebsiella pneumoniae related septic pulmonary embolic disease and summarize currently known risk factors for the development of infectious aneurysmatic disease including diabetes mellitus and other states of immunosuppression. The featured case aims to increase the awareness for this seldom but life-threatening complication of infectious diseases such as Klebsiella pneumoniae urosepsis.
Aggressive fibromatosis response to tamoxifen: lack of correlation between MRI and symptomatic response
Authors: M Libertini, I Mitra, W T A van der Graaf, A B Miah, I Judson, R L Jones, K Thomas, E Moskovic, Z Szucs, C Benson, C Messiou
Journal: Clin Sarcoma Res (2018)
Keywords: aggressive fibromatosis, anti-oestrogen therapy, mri features, symptoms, t2 weighted signal

Background:
One of the commonly used systemic agents for the treatment of aggressive fibromatosis is the anti-oestrogen drug tamoxifen. However, data on efficacy and optimum methods of response assessment are limited, consisting mainly of small case series and reports.
Methods:
A retrospective database was used to identify consecutive patients diagnosed with aggressive fibromatosis (AF) and treated with tamoxifen plus/minus non-steroidal anti-inflammatory drugs at our tertiary referral centre between 2007 and 2014. MRI and symptom changes were recorded.
Results:
Thirty-two patients (13 male 19 female, median age 41 years) were included. Median duration of treatment with tamoxifen was 316 days. Of 9 patients with progressive disease by RECIST 1.1 (28%): 4 patients experienced worsening symptoms; 3 patients had improved symptoms and 2 had no change in symptoms. Of 22 patients with stable disease (69%): 11 had no change in symptoms; 6 had improved symptoms and 5 patients had worsening symptoms. One patient achieved a partial response with improved symptoms.
Conclusions:
No relationship was identified between symptomatic benefit and response by RECIST 1.1 on MRI. Prospective studies in AF should incorporate endpoints focusing on patient symptoms.
Torsade de Pointes Induced by Hypokalemia from Imipenem and Piperacillin
Authors: Varun Kumar, Sandeep Khosla, Monica Stancu
Journal: Case Rep Cardiol (2017)
MeSH terms: Case Reports

Imipenem-cilastatin and piperacillin-tazobactam are two antibiotics with broad antimicrobial coverage. Besides the many well established adverse effects of these drugs, there have been few case reports of hypokalemia. Here we present an interesting case of resistant hypokalemia caused by these drugs leading to Torsades de Pointes which has never been reported in the past. Hypokalemia resolved with discontinuation of piperacillin.
Renal Papillary Hyperplasia as a Cause of Persistent Asymptomatic Microhematuria
Authors: Ortwin Heißler, Stephan Seklehner, Claus Riedl
Journal: J Endourol Case Rep (2018)
Keywords: asymptomatic, flexible ureterorenoscopy, microhematuria, renal papillary hyperplasia
MeSH terms: Case Reports

Asymptomatic microscopic hematuria (AMH) is incidentally found during routine health screenings. In the clinical evaluation of persistent AMH imaging modalities, CT urography, MR urography, and retrograde pyelography are of diagnostic importance. In case of pathologic findings (e.g., contrast-filling defects), endoscopic evaluation is mostly performed. To our knowledge, we report the first case of a patient with persistent AMH caused by biopsy-proven renal papillary hyperplasia.
Five-Year Long-Term Followup of a Primary Lymph node Gastrinoma: Is a Pancreaticoduodenectomy Justified?
Authors: Bernd Jaenigen, Gian Kayser, Berthold Steinke, Oliver Thomusch
Journal: Case Rep Med (2009)
MeSH terms: Case Reports

Background. Gastrinoma-positive lymph nodes and failed localization of the primary tumor during surgical exploration are described. Specialists suppose that these lymph nodes are metastases rather than a primary gastrinoma. Methods. Case report with a five-year long-term followup. A 60-year-old patient with an confirmed gastrinoma was treated in our department. All preoperative evaluations including somatostatin-receptor-scintigraphy and F-Dopa PET failed to localize the gastrinoma. Explorative laparotomy revealed a gastrinoma in two peripancreatic lymph nodes. Despite extensive intraoperative exploration, no primary gastrinoma could be detected in typical localization. Results. Over a period of 5 years, the patient's gastrin level stayed in the normal range and the patient seems to be completely cured. Conclusion. A prophylactic partial pancreatoduodenectomy is not indicated to avoid recurrence, since complete biochemical cure by local resection of the lymph node gastrinoma is possible.
Brainstem Encephalitis With Low-Titer Acetylcholine Receptor Antibodies Mimicking Myasthenia Gravis
Authors: Ilya Ayzenberg, Gisa Ellrichmann, Christoph Schroeder, Lars Tönges, Anja Klasing, Vaia Pappa, Wolfgang Brück, Ralf Gold
Journal: Front Neurol (2019)
Keywords: gad, ma2, brainstem encephalitis, myasthenia gravis, sudden death
MeSH terms: Case Reports

Objective: To report a rare case of brainstem encephalitis with low-titer acetylcholine receptor antibodies mimicking myasthenia gravis. Methods: The patient was investigated with repeated brain MRI, CSF examination, repetitive nerve stimulation, thoracic CT, and serologic screening. Our patient passed away and finally autopsy revealed a definitive diagnosis. Written informed consent was obtained from the relatives of the patient for access to clinical files for research purposes and publication. Results: We present a young woman with a subacute bulbar syndrome, who was initially diagnosed with myasthenia gravis based on clinical finding and elevated acetylcholine receptor antibodies. Episodes of numbness in the pharynx and tongue and moderate saccadic horizontal and vertical pursuits were atypical. Despite initial stabilization with intravenous immunoglobulins she developed acute asphyxia after regurgitation of food and had to be resuscitated with ultimately lethal outcome. Autopsy revealed an autoimmune T-cell mediated brainstem encephalitis. Serological screening revealed positive GAD and Ma2 autoantibodies, indicating its probable paraneoplastic nature. Conclusions: Brainstem encephalitis is an important differential diagnosis even in seropositive bulbar myasthenia gravis, as several autoimmune processes often co-occur. Sudden unexpected death must be taken into account in brainstem encephalitis, requiring prolonged monitoring of the patients.
A Patient with Double-Negative VGKC, Peripheral Nerve Hyperexcitability, and Central Nervous System Symptoms: A Postinfectious Autoimmune Disease
Authors: Birte Eikeland
Journal: Case Rep Neurol Med (2020)
MeSH terms: Case Reports

Research in the last few years has indicated that most voltage-gated potassium channel- (VGKC-) complex antibodies without leucine-rich glioma-inactivated protein 1 or contactin-associated protein-like 2 antibody specificity lack pathogenic potential and are not clear markers for autoimmune inflammation. Here we report on a patient with double-negative VGKC who developed severe peripheral nerve hyperexcitability, central nervous system symptoms with agitation and insomnia, dysautonomia, and systemic symptoms with weight loss, itch, and skin lesions. The disease started acutely one month after an episode of enteroviral pericarditis and responded well to immunotherapy. The patient is presumed to have developed a postinfectious immunotherapy-responsive autoimmune disease. In the setting of anti-VGKC positivity, it seems likely that anti-VGKC contributed to the pathogenesis of the patient's symptoms of nerve hyperexcitability and that the disease was caused by an acquired autoimmune effect on the neuronal kinetics of VGKC. It is still unknown whether or not there are unidentified extracellular molecular targets within the VGKC-complex, i.e., a novel surface antigen and a pathogenic antibody that can cause affected individuals to develop a peripheral nerve hyperexcitability syndrome. This case highlights the fact that less well-characterized autoimmune central and peripheral nervous system syndromes may have infectious triggers.
Inability to Utilize Retrograde Cardioplegia due to a Persistent Left Superior Vena Cava
Authors: Rohesh J Fernando, Sean D Johnson
Journal: Case Rep Anesthesiol (2017)
MeSH terms: Case Reports

A persistent left superior vena cava is a congenital abnormality that affects a minority of the general population. While this finding is not hemodynamically significant in all patients, failure to recognize the altered anatomy in any of these patients can be consequential during procedures such as central venous catheter placement, pacemaker/defibrillator wire placement, and use of retrograde cardioplegia during cardiac surgery. We present a case of an intraoperative diagnosis of a persistent left superior vena cava that altered the original plan to arrest the heart using retrograde cardioplegia. Echocardiography was instrumental in this diagnosis and avoided potentially inadequate myocardial protection during cardiopulmonary bypass.
Macrophage activation syndrome during Crohn´s disease: a case report
Authors: Oussama Kharmach, Nawal Lagdali, Imane Benelbarhdadi, Mohammed Borahma, Fatima-Zohra Ajana
Journal: Pan Afr Med J (2022)
Keywords: crohn’s disease, macrophage activation syndrome, case report, hemophagocytosis, infection
MeSH terms: Crohn Disease, Lymphohistiocytosis, Hemophagocytic, Macrophage Activation Syndrome, Case Reports, Adrenal Cortex Hormones, Female, Fever, Humans, Male, Tomography, X-Ray Computed, Adrenal Cortex Hormones

The macrophage activation syndrome (MAS) is a rare but potentially fatal disease. We report two cases of Crohn´s disease, one under 5-aminosalicylic acid and the other under corticosteroid, having developed MAS. The first was a male patient hospitalized for high fever, clinical examination found fever and left inguinal lymph node. The second case was a female patient hospitalized for asthenia, clinical examination found fever and oral mycosis. The biology tests revealed bi/pancytopenia, hyperferritinemia, hypofibrinogenemia. The myelogram showed hemophagocytosis. The identified infectious cause was Klebsiella pneumoniae in the urinary tract in one patient and oral Candida albicans in the other one. Thoraco-abdomino-pelvic computed tomography (CT) scan showed a thickening of the bladder in the male patient, and eliminated a deep infection and tumour cause in the female patient. The diagnosis of MAS was made, and both patients were placed on broad-spectrum antibiotic, in addition to local antifungal treatment and corticosteroid for the female patient, but the evolution was fatal for both. In conclusion, the management of MAS should be fast and multidisciplinary, based on treatment of the causal infectious agent, immunomodulatory treatment of haemophagocytosis, symptomatic treatment and replacement of organ failure.
Choroid Melanoma Metastasis to Spine: A Rare Case Report
Authors: Hiren Mandaliya, Nandini Singh, Sanila George, Mathew George
Journal: Case Rep Ophthalmol Med (2016)

Metastatic choroid melanoma is a highly malignant disease with a limited life expectancy. The liver is the most common site for metastasis of uveal melanoma followed by lung, bone, skin, and subcutaneous tissue. Metastasis from choroidal melanoma usually occurs within the first five years of treatment for primary tumours. Metastatic choroid melanoma to the spine/vertebrae is extremely rare. We report the first case of spinal metastasis from choroid melanoma in a 61-year-old man who had been treated for primary ocular melanoma three years earlier with radioactive plaque brachytherapy. Synchronously, at the time of metastasis, he was also diagnosed as having a new primary lung adenocarcinoma as well. The only other case reported on vertebral metastasis from malignant melanoma of choroid in literature in which primary choroid melanoma was enucleated.