OpenMed/multicare-articles huggingface dataset:
A rare case report of bilateral Purtscher-like retinopathy in juvenile dermatomyositis
Authors: Nidhi Paharia, Shruti Agrawal, Nikhil Agrawal, Jayesh Shah
Journal: GMS Ophthalmol Cases (2024)
Keywords: purtscher flecken, purtscher-like retinopathy, juvenile dermatomyositis, pneumonitis
MeSH terms: Case Reports

Purpose:
To report a rare case of bilateral Purtscher-like retinopathy (PLR) in a young adult diagnosed with dermatomyositis.
Method:
A case report with multi-modal imaging.
Result:
A 17-year-old male presented with subacute marked diminution of vision along with arthralgia, weakness of all four limbs and development of multiple rashes around body. Fundus examination revealed bilateral multiple Purtscher flecken, pseudo-cherry red spot, and intra-retinal haemorrhages with cotton wool spots. Systemic and laboratory examinations, magnetic resonance imaging (MRI) and biopsy of tissue confirmed the diagnosis of juvenile dermatomyositis with PLR.
Conclusion:
Dermatomyositis, being a rare cause of PLR, should essentially be considered as one of the differentials as timely intervention can alter the course of disease and prove life-saving for the patient.
Neonatal Subcutaneous Emphysema Secondary to Chest Tube Placement Using the Trocar Technique: A Case Report
Authors: Taha S Jilani, Jocelin Loewen, Seham Azzam, Samer Bou Karroum, Olubukunola A Adesanya
Journal: Cureus (2024)
Keywords: chest tube, neonatal intensive care unit (nicu), neonate, pigtail, pneumothorax, subcutaneous emphysema, thoracostomy tube, trocar
MeSH terms: Case Reports

Subcutaneous emphysema is a type of air leak in which air accumulates within the subcutaneous layer of the skin underneath the dermal layers. The accumulation of air can be seen on imaging in relevant body areas such as the abdomen, chest, face, or neck. During physical examination, crepitus, the sensation or sound of crackling upon palpation, is the most common associated finding. Various causes for subcutaneous emphysema exist, with one such cause being thoracostomy or chest tube placement. The trocar technique, in particular, has been associated with greater complications when compared to other techniques. Here, we present a case of subcutaneous emphysema in a neonate occurring after placement of a chest tube using the trocar technique. At this time, much of the knowledge regarding subcutaneous emphysema related to chest tube placement is in the adult population. Clinicians should be aware of this complication in neonates as the body of knowledge regarding this topic continues to grow.
Fahr's syndrome as the initial imaging characteristics of MELAS syndrome with a possible seizure activity and cardiac arrest: a case report
Authors: Yan Zheng, Haohao Wu, Meng Zhang, Baogang Huang, Junsu Yang, Chuan Liu, Hanmin Wang, Kang Du
Journal: Front Genet (2024)
Keywords: fahr’s syndrome, lpd, melas syndrome, upjo, near-sudep
MeSH terms: Case Reports

This study reported a case of MELAS syndrome presenting as the initial imaging characteristics of Fahr's syndrome with "near" sudden unexpected death in epilepsy (SUDEP) and lateralized periodic discharges (LPD). The patient, a young boy, experienced loss of consciousness 2 days prior, which was followed by two limb and facial convulsions. He was later found in cardiac arrest during hospitalization, but regained consciousness gradually after receiving cardiopulmonary resuscitation and tracheal intubation. The patient exhibited short stature, intellectual disability, poor sports abilities, and academic performance since childhood, but had no family history. Emergency head computed tomography (CT) revealed high density calcification in bilateral caudate nucleus, lentiform nucleus, thalamus, and dentate nucleus with evidence of an acute process. The patient was transferred to the neurology department where he continued to recover consciousness, though he experienced dysarthria, left limb hemiplegia, and hemiparesthesia. Changes in head magnetic resonance imaging (MRI) findings were noted at admission, 1 month later, and 6 months later. LPD were observed in his video electroencephalogram. The CT urography indicated a narrow left ureteropelvic junction with left hydronephrosis, which was suggestive of ureteropelvic junction obstruction. Ultimately, a diagnosis of near-SUDEP was suspected in this patient, indicating a rare case of MELAS syndrome with near-SUDEP and LPD. The gene tests results revealed the presence of the mitochondrial DNA A3243G mutation, leading to the final diagnosis of MELAS syndrome. This case expands the clinical disease spectrum of the MELAS syndrome.
Total Thyroidectomy by Median Sternotomy for Treatment of Substernal Goiter: A Case Report
Authors: Henrique C Ferreira, Carolina P Diniz, Bernardo R Guimarães, João Bosco L Camargo Neto, Guilherme C Rezende
Journal: Cureus (2024)
Keywords: anterior mediastinal mass, hyperthyroidism, partial sternotomy, substernal goiter, thyroid
MeSH terms: Case Reports

Substernal goiter is a rare presentation of goiter but relatively frequent cause of anterior mediastinal mass. Symptomatic patients should be treated surgically with a total or partial thyroidectomy via a cervical or thoracic approach. This case report of a woman with a large symptomatic substernal goiter illustrates how the option to perform a partial median sternotomy may be useful when attempting a cervical approach. This allows for better visualization and resection of large masses and minimizes the risk of complications such as recurrent laryngeal nerve injury. Furthermore, it reinforces that cases of substernal goiter should be treated at specialized centers in order to minimize complications and reach better patient outcomes.
Lower Gastrointestinal Bleeding Secondary to Appendiceal Mucinous Neoplasm: A Report of Two Cases and a Review of the Literature
Authors: Jesús Omar Soto Llanes, Samanta Kin Dosal Limón, Ana Jimena Iberri Jaime, Mario Zambrano Lara, Billy Jiménez Bobadilla
Journal: Cureus (2024)
Keywords: appendectomy, appendicular mucinous neoplasms, lower gastrointestinal bleeding, pseudomyxoma peritonei, right hemicolectomy
MeSH terms: Case Reports

Appendicular mucinous neoplasms, constituting less than 1% of gastrointestinal tract neoplasms, are heterogeneous entities. They may be asymptomatic, discovered incidentally, or present as large tumors due to mucin accumulation. The lack of standardized treatment complicates management. Imaging studies, particularly CT scans, are crucial for diagnosis and follow-up. This case report presents two clinical cases of women in their sixth and seventh decades of life with a history of lower gastrointestinal bleeding, mild anemia in laboratory studies, and incomplete colonoscopies. The diagnosis, confirmed through CT scans, led to the decision for surgical intervention in both cases, involving laparoscopic right hemicolectomy with ileotransverse anastomosis. Subsequently, histopathological reports confirmed the diagnosis of high-grade appendicular mucinous neoplasms, and a follow-up plan was established with imaging studies every six months with no recurrence at two years. Over 50% of appendicular tumors are mucinous neoplasms originating from low-grade mucinous neoplasms. Given the low lymph node invasion (2%), appendectomy may suffice if the entire tumor is excised. Extensive resections or right hemicolectomy are reserved for larger tumors or high-grade neoplasms to minimize local recurrence risk. Mucinous neoplasms with acellular mucin and peritoneal invasion may require cytoreduction or right hemicolectomy, while those with mucinous epithelium may need hyperthermic intraperitoneal chemotherapy (HIPEC) due to the risk of local recurrence, worsened by the presence of extra appendiceal epithelial cells. Disease-free and overall survival depend on treatment and initial lesion characterization. A five-year survival rate of 86% is reported for low-grade mucinous neoplasms. Follow-up approaches lack an ideal standard, generally involving physical examinations and imaging studies every six months to one year during the first six years.
Repair of Dissecting Aortic Aneurysm in Post-LVAD Patient
Authors: Sanjay Chaubey, Parag Kale, Dan Meyer, Aldo Rafael
Journal: Methodist Debakey Cardiovasc J (2024)
Keywords: cf-lvad, aortic aneurysm, aortic dissection
MeSH terms: Aortic Aneurysm / diagnostic imaging, Aortic Aneurysm / etiology, Aortic Aneurysm / surgery, Aortic Dissection / diagnostic imaging, Aortic Dissection / etiology, Aortic Dissection / physiopathology, Aortic Dissection / surgery, Blood Vessel Prosthesis Implantation / adverse effects, Blood Vessel Prosthesis Implantation / instrumentation, Heart Failure / diagnosis, Heart Failure / etiology, Heart Failure / physiopathology, Heart Failure / surgery, Heart Failure / therapy, Heart-Assist Devices, Case Reports, Aortography, Computed Tomography Angiography, Humans, Male, Middle Aged, Prosthesis Design, Reoperation, Treatment Outcome, Ventricular Function, Left

Left ventricular assist devices (LVAD) are frequently used in the management of end-stage heart failure, especially given the limited availability of donor hearts. The latest HeartMate 3 LVAD delivers non-physiological continuous flow (CF), although the impact on the aorta is not well established. We highlight a case of aortic aneurysm formation complicated by dissection formation that necessitated high-risk re-operative surgery in a patient post CF-LVAD.
Benign Pneumoperitoneum Following Mitral Valve Replacement
Authors: Ali Tariq Alvi, Luis E Santiago, Murali Shankar, Pallavi Aneja
Journal: Cureus (2024)
Keywords: benign pneumoperitoneum, free air in abdomen, heart surgery, mitral valve replacement, post-op complications
MeSH terms: Case Reports

The pneumoperitoneum refers to the presence of free air inside the abdominal cavity. This finding is usually a sequela of a gastrointestinal tract perforation. Still, in rare instances, it can present after cardiac surgery due to the proximity of the peritoneal cavity and pericardium, allowing air to enter the peritoneal cavity. Our patient was a 63-year-old female who initially presented for revision of the mitral valve replacement. A chest X-ray on postoperative day 13 revealed a 6.6 cm lucency under the right diaphragm suggestive of pneumoperitoneum. She was discharged after serial chest X-rays revealed a decrease in the size of the pneumoperitoneum. Twelve days later, our patient was readmitted, as another chest X-ray revealed that the size of the pneumoperitoneum was again increasing. An endoscopy was performed, but it did not reveal any lesions or etiology that would lead to a leak from the gastrointestinal tract. Finally, due to the benign nature of the pneumoperitoneum and the decrease in its size over the following days, we opted for conservative management, and she was discharged again. This case emphasizes the rare occurrence of benign pneumoperitoneum post-mitral valve surgery. While surgery may not always be required for asymptomatic cases, careful vigilance post-cardiac surgery remains crucial to detect potential abdominal complications promptly.
A 29-Year-Old Patient With Patau Syndrome: A Case Report on Medical Management
Authors: Shirley M Gandhi, Pruthvi Patel, Taylor Carter, Larry Stutts
Journal: Cureus (2024)
Keywords: anesthesia management, laparoscopic assisted vaginal hysterectomy, mosaic trisomy 13, optimal medical management, patau syndrome, rare genetic diseases, trisomy 13
MeSH terms: Case Reports

Patau syndrome (trisomy 13) is a chromosomal abnormality with multiple malformations due to an additional copy of chromosome 13. This genetic condition has a systemic impact on the development of the human body, which can result in, but is not limited to, microphthalmia, microcephaly, low-set ears, cleft palate, cardiac abnormalities, and abdominal wall defects. It is associated with severe physical and intellectual disabilities and a limited lifespan. Here, we present a 29-year-old female with a high suspicion of the mosaic form of Patau syndrome. She decided to opt for an elective robotic-assisted vaginal hysterectomy (RAVH) due to worsening menorrhagia and recurrent miscarriages. In addition, the importance of medical interventions from surgery to anesthesia is discussed, with their role in improving the quality of life of the patient.
Fusobacterium nucleatum Bacteremia Presenting as Isolated Superior Mesenteric Vein Thrombophlebitis
Authors: Alaukika Agarwal, Ekrem Yetiskul, Ronak Patel, Faris Qaqish, Hamzah Qandil, Neville Mobarakai
Journal: Case Rep Infect Dis (2024)
MeSH terms: Case Reports

Fusobacterium nucleatum (F. nucleatum) is a commensal Gram-negative anaerobic bacterium that lives in the oral cavity and gastrointestinal tract of humans. While it is a regular resident of the human oral cavity, F. nucleatum has been implicated in various infections and inflammatory conditions. This case report highlights an unusual association between F. nucleatum and isolated superior mesenteric vein (SMV) thrombosis.
Troubleshooting Paracentesis Using POCUS
Authors: Angelina Voronina, Nachelle Aurelien, Edward Bergin, Paula Roy-Burman
Journal: POCUS J (2023)
Keywords: ascites, complications, paracentesis, procedures
MeSH terms: Case Reports

Paracentesis is a procedure routinely performed at the bedside in the evaluation and management of ascites. While point of care ultrasound (POCUS) assistance during paracentesis is known to reduce the risk of procedure-related complications, intraprocedural POCUS to overcome commonly occurring issues, such as obstructed flow through the centesis catheter, remain poorly described. In this report, we present two cases in which bowel adhered to the catheter during paracentesis. POCUS was used in an attempt to restore flow. Based on our literature review and procedural experience, we propose an algorithm to surmount this routinely encountered problem.
Case Report: ASCENIV use in three young children with immune abnormalities and acute respiratory failure secondary to RSV infection
Authors: Constance Bindernagel, Shannon Sotoudeh, Minh Nguyen, Gene Wetzstein, Panida Sriaroon, Jolan Walter
Journal: Front Immunol (2023)
Keywords: asceniv, ivig, rsv, acute respiratory failure, immune dysregulation, immunodeficiency, pediatric, respiratory viral infections
MeSH terms: Respiratory Insufficiency / etiology, Respiratory Insufficiency / therapy, Respiratory Syncytial Virus Infections / complications, Respiratory Syncytial Virus Infections / drug therapy, Respiratory Syncytial Virus, Human, Case Reports, Child, Child, Preschool, Hospitalization, Humans, Immunoglobulin G / therapeutic use, Immunoglobulins, Intravenous / therapeutic use, Infant, Immunoglobulins, Intravenous, Immunoglobulin G

Respiratory syncytial virus (RSV) is the most common etiology of bronchiolitis in young children. While most children clinically improve with care at home, RSV is the leading cause of hospitalization among infants aged 12 months or less. Common modalities of treatment for children with immune dysregulation include respiratory support and best supportive care, which may include immunoglobulin therapy. All immunoglobulin therapies adhere to Food and Drug Administration (FDA) - established standards for antibodies against measles, polio, and diphtheria, but there are no required standards for problematic respiratory viral pathogens, including RSV and others. ASCENIV is an approved IVIG that is manufactured from blending normal source plasma with plasma from donors that possess high antibody titers against RSV and other respiratory pathogens of concern. ASCENIV was developed, in part, to the unmet need that exists in immunocompromised patients who lack sufficient antibodies against problematic viral pathogens. ASCENIV is not a currently approved treatment for severe RSV and other viral infections. There is a lack of research regarding its potential benefits in the acute treatment period for RSV and in the pediatric population. Therefore, this case series was developed to describe real-world experiences of ASCENIV use in this less well studied clinical scenario. This case series reviews three pediatric patients ≤ 5 years of age with immune dysregulation and who were severely ill with RSV. Despite receiving best supportive care, and standard immunoglobulin therapy for some, the patients' clinical status continued to decline. All patients received ASCENIV in an intensive care setting. Each patient had ultimately recovered due to the various medical interventions done. This case series demonstrated that ASCENIV (500mg/kg) administration may have contributed to the treatment outcomes of a less well studied age-cohort of patients. In addition, no adverse side effects were observed after ASCENIV administration. Further analysis of the benefits of ASCENIV for the acute and preventative treatment in patients younger than 12 years of age with immune dysregulation should continue to be explored.
Severe Ulcerative Colitis Complicated by Malakoplakia Resulting in Proctocolectomy
Authors: Lotus Alphonsus, Theshani A De Silva, David Driman, Vipul Jairath
Journal: ACG Case Rep J (2023)
Keywords: malakoplakia, ulcerative colitis
MeSH terms: Case Reports

We report a 45-year-old man with medically refractory ulcerative colitis with superimposed colonic malakoplakia, presumed related to chronic use of azathioprine and biologics. This is the first reported case of malakoplakia in a patient requiring high doses of combination therapy. Treatment of malakoplakia is not standardized, but can involve systemic antibiotics, or surgical resection, which in this case resulted in proctocolectomy.
Case Report: Acute common peroneal nerve injury after posterior lumbar decompression surgery
Authors: Peng Wei Wang, Ming Hsuan Chung, Dueng Yuan Hueng, Chung Ching Hsia
Journal: Front Surg (2024)
Keywords: common peroneal nerve neuropathy, intraoperative neuromonitoring (ionm), perioperative peripheral nerve injury, prone position, spine surgery adverse events
MeSH terms: Case Reports

Spine surgery is a prevalently performed procedure. Some authors have proposed an age-related surge in surgical and general complications. During spine surgery, patients are placed in positions that are not physiologic, would not be tolerated for prolonged periods by the patient in the awake state, and may lead to complications. Understanding these uncommon complications and their etiology is pivotal to prevention and necessary. The patient is a 76-year-old woman referred to the outpatient department of neurosurgery in February 2022 by her physiatrist with a chief complaint of chronic low back pain and numbness over the left leg. Lumbar spine magnetic resonance imaging revealed degenerative disc disease and posterior disc bulging at the levels of L2/3∼L5/S1 with compression of the thecal sac. After receiving anti-inflammatory medication, nerve block and caudal block, her symptoms persisted. She was referred to a neurosurgeon for surgical intervention. We diagnosed spinal stenosis with left L3 and L4 radiculopathy, and elective decompression surgery was scheduled a few days later. We performed discectomies at L2/3 and L3/4 and left unilateral laminectomy at L2 and L3 for bilateral decompression. Following an uneventful surgery, the patient was extubated, and her left leg pain improved, but pain over the right outer calf with drop foot developed. A second lumbar MRI the next day revealed no evidence of recurrent disc herniation or epidural hematoma. Then, she received nerve conduction velocity and needle electromyogram on postoperative day 2, and the studies indicated right common peroneal nerve entrapment neuropathy. After medication with steroids and foot splint use, right leg pain improved. However, weak dorsiflexion of the right ankle persisted. We referred this patient to a physiatrist and OPD for follow-up after discharge. Perioperative peripheral nerve injury (PPNI) is most commonly caused by peripheral nerve ischemia due to abnormal nerve lengthening or pressure and can be exacerbated by systemic hypotension. Any diseases affecting microvasculature and anatomical differences may contribute to nerve injury or render patients more susceptible to nerve injury. Prevention, early detection and intervention are paramount to reducing PPNI and associated adverse outcomes. The use of intraoperative neuromonitoring theoretically allows the surgical team to detect and intervene in impending PPNI during surgery.
Case report: Successful autologous hematopoietic stem cell transplantation in a patient with GAD antibody-spectrum disorder with rapidly progressive dementia
Authors: Caio César Diniz Disserol, Dora Pedroso Kowacs, Samir Kanaan Nabhan, Hélio Afonso Ghizoni Teive, Pedro André Kowacs
Journal: Front Neurol (2023)
Keywords: autoimmune diseases of the nervous system, dementia, encephalitis, glutamic acid decarboxylase, neurocognitive disorders
MeSH terms: Case Reports

The prevalence of neurological syndromes associated with antibodies to glutamic acid decarboxylase is increasing. While cognitive impairment is a common feature of this condition, it seldom emerges as the primary symptom. In this study, we discuss a case of refractory dementia associated with the glutamic acid decarboxylase spectrum disorder. Interestingly, this case showed a favorable outcome following autologous hematopoietic stem cell transplantation. We also provide an in-depth review of the current literature on the use of this therapeutic approach for the treatment of this disease.
Unintentional Suture Fistula Between the Proximal and Distal Esophagus in a Preterm Neonate with Type C Esophageal Atresia
Authors: Julia E Menso, Maud A Reijntjes, Carlijn M Mussies, Michiel P van Wijk, Sander Zwaveling
Journal: European J Pediatr Surg Rep (2024)
Keywords: esophageal atresia, fistula formation, tracheoesophageal fistula
MeSH terms: Case Reports

We present the case of a patient with gross type C esophageal atresia in a preterm neonate (gestational age of 31 weeks + 1 day) with a birth weight of 1,470 g. The fistula was released via a thoracotomy, but no primary anastomosis could be made, due to an unexpected long gap. The distal esophagus was closed and approximated to the blind pouch using traction sutures until an adjacent position was reached. A gastrostomy was created for enteral feeding. Although a second attempt to make an anastomosis was unsuccessful, the patient unexpectedly developed a suture fistula 6 weeks after the first procedure, enabling feeding via a nasogastric tube. Over time, six dilations were necessary. Full enteral feeding was achieved at the age of 6 months. Our case confirms sparse reports that deliberately creating a suture fistula may be a solution in esophageal atresia patients when an unexpected long gap prohibits a primary anastomosis.
A case report of atypical chronic myeloid leukemia with complete hematological and major molecular response to Venetoclax/Azacitidine treatment
Authors: Hongxia Chen, Ning Wang, Yin Li, Xiaohong Xie, Yi Yang
Journal: Front Oncol (2024)
Keywords: azacitidine, venetoclax, allo-transplantation, atypical chronic myeloid leukemia, combination therapy
MeSH terms: Case Reports

Atypical Chronic Myeloid Leukemia (aCML), a myeloproliferative neoplasm with poor prognosis, was reclassified as aCML by the ICC classification, and as MDS/MPN with neutrophilia by the WHO 2022 classification. Due to the heterogeneity of its clinical features and the lack of unique biomarkers, as well as limited treatment options, aCML currently lacks a standardized treatment protocol. In this case report, we reviewed a young man diagnosed with aCML who achieved complete clinical and hematologic remission subsequent to receiving a therapeutic regimen combining Venetoclax and Azacitidine.