OpenMed/multicare-articles huggingface dataset:
Acute ischemic stroke secondary to iron deficiency anemia: a case report
Authors: Preema J Mehta, Sherita Chapman, Annapurni Jayam-Trouth, Mohankumar Kurukumbi
Journal: Case Rep Neurol Med (2012)
MeSH terms: Case Reports

A rare case of acute ischemic stroke in a young patient with iron deficiency anemia (IDA) is reported. IDA has been suggested to have an association with stroke, but few cases have proven it thus far. Three physiological mechanisms explaining IDA to ischemic stroke include a hypercoagulable state secondary to IDA, thrombocytosis secondary to IDA, and anemic hypoxia induced by IDA. Our paper shows an example of a hypoxia-induced stroke secondary to IDA in a young woman with menorrhagia. Thrombus formation was ruled out as the Magnetic Resonance Angiogram (MRA) showed no evidence. As all other known causes for stroke were ruled out, the patient's IDA is a reasonable cause for her stroke. Iron deficiency decreases the amount of hemoglobin, which consequently decreases the amount of oxygen in the blood resulting in low-oxygen delivery to the brain. This causes hypoxic conditions in the brain, leading to death of brain tissue. Thus, we suggest a possible relationship between IDA and ischemic stroke in young adults. Considering IDA as one of the risk factors for ischemic stroke and treating with timely transfusions would be an important step one can take to prevent stroke.
Silent Sinus Syndrome and Williams Syndrome: Two Rare Diseases Found in a Pediatric Patient
Authors: Maddalena Petraroli, Sara Riscassi, Arianna Panigari, Marilena Maltese, Susanna Esposito
Journal: Front Pediatr (2020)
Keywords: williams syndrome, genetic disease, maxillary sinus, rare diseases, silent sinus syndrome
MeSH terms: Case Reports

Silent sinus syndrome (SSS) is a rare disease process characterized by progressive enophthalmos and hypoglobus due to ipsilateral maxillary sinus hypoplasia and orbital floor resorption. Patients may also present with eye asymmetry, unilateral ptosis, or diplopia. Most reported cases in the literature describe its occurrence in adults, but it can also affect children. The etiology remains speculative, even though the most accepted theory is that during the first or second decade of life, occlusion of the maxillary ostium causes an interruption in normal sinus development. Williams syndrome (WS) is a rare genetic, multisystem disorder characterized by a constellation of distinctive phenotypic features, including psychomotor delay and cardiovascular abnormalities. We report a case of a 7-year-old female diagnosed at 1 year old with WS and who gradually developed SSS. This last condition was diagnosed at 7 years of age, when she started showing progressive facial asymmetry in addition to typical facial features of WS; subsequent neuroimaging definitively supported the diagnosis. This case report describes for the first time in the literature an uncommon situation in which SSS and WS, both rare syndromes, are present in the same pediatric patient. We speculate that the particular facial features typical of WS could either be the basis of the development of SSS in our patient or make the SSS clinical course more severe, with signs presenting at the age of 7 years. This case report shows for the first time that facial asymmetry in WS can be caused by SSS and highlights the need for early identification of this complication in patients with syndromes characterized by dysmorphic facial features. Further studies are needed to understand whether there is a link between the two syndromes as well as to evaluate the prevalence of SSS in patients with facial dysmorphisms and define the best management.
Kawasaki disease in two sets of monozygotic twins: Is the etiology genetic or environmental?
Authors: Xiaomei Zhang, Jinghui Sun, Shubo Zhai, Sirui Yang
Journal: Pak J Med Sci (2013)
Keywords: genetic susceptibility, infection, kawasaki disease, monozygotic twins
MeSH terms: Case Reports

Two sets of monozygotic (MZ) twins with Kawasaki disease (KD) from two different families are reported. Twin set 1, previously healthy 71-day-old MZ twin girls were diagnosed with incomplete KD and pneumonia. The symptoms occurred at the same time in both girls. Both girls had ectasia of right coronary arteries. In twin set 2, the younger of 18-month-old MZ twin boys was diagnosed with KD and bronchitis. After 53 days, his elder brother was diagnosed with the same disease. The symptoms occurred at different time, but were almost identical. Neither boy displayed coronary artery changes. These findings support the hypothesis that genes susceptible to KD and coronary-artery lesions may exist in families. The different clinical characteristics among MZ twins from different families also suggest diverse and complex nature of KD.
Pediatric Cryptococcal Lymphadenitis in the Absence of AIDS: Case Report and Literature Review
Authors: Fengchang Bao, Hongna Tan, Wei Liu, Yange Li, Huixia Li
Journal: Case Rep Pediatr (2013)

We present a rare case of cryptococcal lymphadenitis without immunocompromization in a two-and-a-half-year-old child. He was referred to our center with a fifteen-day history of continued fever. Ultrasound and computed tomography (CT) revealed the enlargement of multiple lymph nodes and lung reticulonodular shadows. Hematological, immunological, and microbiological tests for hepatitis, lymphoma, AIDS, and immunoglobulin deficiencies were negative. Laboratory tests demonstrated elevated erythrocyte sedimentation rate, elevated plasma and urinary ß2-microglobulin (ß2-MG) levels, and elevated C-reactive protein and fibrinogen. Both blood routine and bone marrow aspiration showed elevated eosinophil granulocytes. The diagnosis of cryptococcal lymphadenitis was obtained by excisional biopsy of the cervical lymph nodes. The patient was treated with intravenous amphotericin B and oral flucytosine for five weeks, then with subsequent oral fluconazole for three months. The patient is now doing well. Our case suggests that the diagnosis of cryptococcal lymphadenitis is very difficult without etiology and pathology, especially for a patient with a normal immune system; lymph node biopsy is necessary to diagnose it, and immediate antifungal treatment is necessary to treat it.
Solitary necrotic nodule of the liver mimicking hepatocellular carcinoma: a case report
Authors: Spiros G Delis, Dionysia A Kelgiorgi, Anastasios A Sofianidis, Charikleia C Triantopoulou, Ioannis A Papailiou, Christos G Dervenis
Journal: Cases J (2009)

Introduction:
Solitary necrotic nodule of the liver is a rare lesion, with similar radiologic findings to those of hepatic metastases or other liver masses.
Case presentation:
We here report a case of a 30-year-old male with hepatic solitary necrotic nodule discovered after an episode of acute abdominal pain and high grade fever. Routine laboratory data revealed leukocytosis and abnormal liver function. The imaging features of the lesion suggested malignancy or liver adenoma. The patient underwent surgical resection of segments V and VI. Histology was compatible with solitary necrotic nodule and localized vein thrombosis at the periphery.
Conclusion:
Solitary necrotic nodule of the liver is a benign lesion which can mimic liver malignancies. Abdominal imaging and liver biopsy are often equivocal. In such circumstances liver resection is mandatory to exclude HCC or other malignant liver lesions.
Non-obstetric vulva haematomas in a low resource setting: two case reports
Authors: Ako Annabel Mangwi, Peter Vanes Ebasone, Desmond Aroke, Larry Tangie Ngek, Ako Simon Nji
Journal: Pan Afr Med J (2019)
Keywords: cameroon, non-obstetric haematomas, conservative management, surgical management, vulva haematoma
MeSH terms: Drainage / methods, Hematoma / therapy, Vulvar Diseases / therapy, Case Reports, Adolescent, Female, Hematoma / pathology, Humans, Vulvar Diseases / pathology, Young Adult

Vulva haematomas are uncommon outside the obstetric population, with an incidence of 3.7% and represent only 0.8% of all gynaecological emergencies. The first case is a 24-year-old G2P1011 referred after the failure of conservative management of a progressively increasing right labia majora swelling. Vulva incision, exploration and relieve of hematoma were done under local anaesthesia. The second case is a 17-year-old G1P1001, a student who presented with spontaneous pain and swelling of the left labia majora. The swelling was rapidly increasing, tense and tender. It spontaneously ruptured, clots were drained and the wound was packed. Vulva hematomas are not very common hence necessitating careful assessment, right diagnosis and management. Management could be conservative (analgesics, local compression) as well as surgical in cases of hemodynamic instability, rapidly increasing size of hematoma and pain intensity. Prompt surgical management reduces the risk of infection and longer hospital stays, which is important in low resource settings like ours.
Serotonin Syndrome Induced Tako-Tsubo Syndrome
Authors: Ian Lancaster, Jeffrey Steinhoff, Jose Mosco-Guzman, Deep Patel
Journal: Case Rep Cardiol (2022)
MeSH terms: Case Reports

Tako-tsubo syndrome is characterized by temporary systolic dysfunction of the left ventricle in the absence of coronary artery disease. Serotonin syndrome is a life-threatening condition associated with increased serotonergic activity in the central nervous system (CNS). We report a case of Tako-tsubo syndrome following seizures secondary to serotonin syndrome.
A Case of Hypermucoviscosity Phenotype of Klebsiella pneumoniae Liver Abscess Saved by Damage Control Strategy
Authors: Keita Sato, Koji Takahashi, Tsukasa Kusuta
Journal: Case Rep Surg (2022)
MeSH terms: Case Reports

Liver abscess caused by the Hypermucoviscosity phenotype of Klebsiella pneumoniae (HKp) is characterized by high tissue invasiveness and multiple systemic infections. This leads to sepsis, multiple organ failure, and coagulopathy. An 80 year old man came to our hospital with a complaint of malaise and went into hemorrhagic shock after percutaneous transhepatic drainage of a liver abscess caused by HKp. An emergency laparotomy was performed, but the patient suffered from severe coagulopathy and underwent damage control surgery. HKp liver abscesses must be operated on in the presence of multiple organ failure and disseminated intravascular coagulation (DIC) complications when medical treatment is refractory. In these situations, a two-stage damage control strategy should be considered: hemostasis and infection control at the initial surgery and hepatic resection.
DIEP breast reconstruction following multiple abdominal liposuction procedures
Authors: Mohammed Farid, Simon Nicholson, Ashutosh Kotwal, Augustine Akali
Journal: Eplasty (2014)
Keywords: diep, angiography, breast reconstruction, free flap, liposuction
MeSH terms: Case Reports

Objective:
Previous abdominal wall surgery is viewed as a contraindication to abdominal free tissue transfer. We present two patients who underwent multiple abdominal liposuction procedures, followed by successful free deep inferior epigastric artery perforator flap. We review the literature pertaining to reliability of abdominal free flaps in those with previous abdominal surgery.
Methods:
Review of case notes and radiological investigations of two patients, and a PubMed search using the terms "DIEP", "deep inferior epigastric", "TRAM", "transverse rectus abdominis", "perforator" and "laparotomy", "abdominal wall", "liposuction", "liposculpture", "fat graft", "pfannenstiel", with subsequent appraisal of relevant papers by the first and second authors.
Results:
Patient 1 had 3 episodes of liposuction from the abdomen for fat grafting to a reconstructed breast. Subsequent revision reconstruction of the same breast with DIEP flap was preceded by CT angiography, which demonstrated normal perforator anatomy. The reconstruction healed well with no ischaemic complications. Patient 2 had 5 liposuction procedures from the abdomen to graft fat to a wide local excision defect. Recurrence of cancer led to mastectomy and immediate reconstruction with free DIEP flap. Preoperative MR angiography demonstrated a large perforator right of the umbilicus, with which the intraoperative findings were consistent. The patient had an uneventful recovery and good healing with no fat necrosis or wound dehiscence.
Conclusions:
We demonstrate that DIEP flaps can safely be raised without perfusion-related complications following multiple liposuction procedures to the abdomen. The safe interval between procedures is difficult to quantify, but we demonstrate successful free flap after 16 months.
Ovarian carcinoma in situ of presumable fallopian tube origin in a patient with Lynch syndrome: A case report
Authors: Kayo Inoue, Hiroshi Tsubamoto, Hiroyuki Hao, Kazuo Tamura, Tomoko Hashimoto-Tamaoki
Journal: Gynecol Oncol Case Rep (2013)
Keywords: carcinoma in situ, lynch syndrome, ovarian cancer

•Occult ovarian carcinoma of presumable fallopian tube origin in Lynch syndrome•Atypical endometrial hyperplasia during a 10-year follow-up period after colon cancer•Synchronous ovarian serous carcinoma in situ and borderline tumor in Lynch syndrome.
Nocardia spp. Pneumonia in a Solid Organ Recipient: Role of Linezolid
Authors: George Mwandia, Hari Polenakovik
Journal: Case Rep Infect Dis (2018)
MeSH terms: Case Reports

We describe a rare infection with Nocardia spp. (N. pseudobrasiliensis species identification based on high-performance liquid chromatography analysis) in a 68-year-old renal transplant recipient. He presented with pneumonia complicated by hypoxic respiratory failure. He was allergic to sulphonamides. He was initially successfully treated with linezolid. However, he suffered severe sensory neuropathy after 4 months of therapy, necessitating linezolid cessation and completion of treatment with azithromycin. He had clinical and radiological resolution of his pneumonia and was disease free at subsequent follow-up 4 years later. This case highlights the need for alternative therapies for nocardiosis for patients that cannot be treated with sulphonamides due to allergies or/and infection with multidrug-resistant pathogens. It also illustrates the treatment limiting side effects of long-term therapy with linezolid.
Laser Treatment to avoid Trabeculectomy and to recover the Aqueous Outflow after Iris Incarceration in a Patient with NPDS
Authors: Alfonso Vasquez Perez, Jorge Loscos Arenas, Julio De La Camara Hermoso
Journal: J Curr Glaucoma Pract (2013)
Keywords: glaucoma, gonioscopy, intraocular pressure, trabeculectomy
MeSH terms: Case Reports

The advantages of the nonpenetrating deep sclerectomy (NPDS) compared with the trabeculectomy are based on faster recovery and lower incidence of complications. The incarceration of the iris at the trabeculo-Descemet's membrane is one complication of NPDS and leads frequently to the reoperation of the patient. We report one case operated of NPDS with iris incarceration post-Nd:YAG goniopuncture in which we also documented spontaneous returning of the prolapsed iris during gonioscopy 3 hours after the onset of symptoms. With an argon laser iridoplasty, the iris returned completely to its position and a wide Nd:YAG laser iridotomy prevented recurrences. After this episode, the patient have always had intraocular pressure measures lower than 15 mm Hg. How to cite this article: Perez AV, Arenas JL, La Camara Hermoso JD. Laser Treatment to avoid Trabeculectomy and to recover the Aqueous Outflow after Iris Incarceration in a Patient with NPDS. J Current Glau Prac 2013;7(1):36-37.
Severe starvation-induced hepatocyte autophagy as a cause of acute liver injury in anorexia nervosa: a case report
Authors: S Restellini, L Spahr, L Rubbia Brandt
Journal: Case Reports Hepatol (2013)

Introduction. Mild elevation of transaminase may be observed in anorexia nervosa, but acute liver injury is uncommon. A complex programmed cell death in response to starvation, called autophagy, has been described in experimental and human studies. Case Presentation. A 24-year-old woman suffering from anorexia nervosa was hospitalized for severe malnutrition. At admission, there were biological signs of acute liver injury but no electrolytic imbalance. After having ruled out the most common causes of liver injury, the patient was carefully refed. As liver tests remained abnormal, liver biopsy was performed. At histology and electron microscopy, numerous signs suggestive of starvation-induced hepatocyte autophagy were found. Discussion. Severe starvation can be associated with acute liver injury that is slowly reversible with careful enteral nutrition. In this clinical situation, profound hepatic glycogen depletion in association with autophagy appears as the leading cause of liver injury.
Klippel-trenaunay syndrome and pregnancy
Authors: Tuğba Güngor Gündoğan, Y Jacquemyn
Journal: Obstet Gynecol Int (2010)
MeSH terms: Case Reports

Klippel-Trenaunay syndrome is a rare congenital vascular disorder, and only few cases have been described in pregnancy. We describe two cases, in one patient without complications, the other patient developed postpartum deep venous thrombosis.
A Curious Case of Hemolytic Anemia with Pseudoreticulopenia
Authors: Scott Mayer, Nikhilesh Srinivasan, Jenny Nguyen, Ryan Spilman, Dmitriy Scherbak
Journal: Case Rep Hematol (2022)
MeSH terms: Case Reports

Herein, we present a unique case of a Coombs-negative, steroid-refractory autoimmune hemolytic anemia (AIHA) complicated by pseudoreticulopenia, describe its clinical presentation, histopathologic findings, and management, and review the salient literature. Coombs-negative, steroid-refractory AIHAs represent fewer than 1% of all AIHAs. Diagnosis of the disease is difficult and often delayed due to the pursuit of alternate diagnoses following a negative Coombs test. However, when suspicion remains high for an autoimmune process, the super-Coombs test may be utilized for the diagnosis of AIHA that the traditional Coombs test fails to detect. A majority of cases respond to rituximab as the indicated second-line therapy, but delays in diagnosis and subsequent treatment may increase morbidity. Reticulopenia may be associated with AIHAs secondary to bone marrow dysfunction, but this patient had a normal function marrow confirmed on biopsy. Indeed, reticulopenia in this case was a diagnostic conundrum that further obscured the diagnosis and delayed treatment. Ultimately, reticulopenia was determined to be pseudoreticulopenia secondary to an alteration in the maturation of the erythroid lineage due to an independent, newly diagnosed pernicious anemia. The interaction of these multiple coexisting disease processes is not previously described in the literature. Increased physician awareness of steroid-refractory, Coombs-negative AIHA, and the development of pseudoreticulopenia as a laboratory finding in pernicious anemia may help to improve patient outcomes.
Lenvatinib Administered via Nasogastric Tube in Poorly Differentiated Thyroid Cancer
Authors: Eleonora Molinaro, David Viola, Nicola Viola, Pierpaolo Falcetta, Francesca Orsolini, Liborio Torregrossa, Paola Vagli, Alessandro Ribechini, Gabriele Materazzi, Paolo Vitti, Rossella Elisei
Journal: Case Rep Endocrinol (2019)
MeSH terms: Case Reports

Background:
The tyrosine kinase inhibitors (TKIs) are indicated for the treatment of locally advanced or metastatic progressive thyroid carcinoma (CDT), refractory to radioactive iodine. The following report describes the efficacy of lenvatinib administered through a nose-gastric tube (SNG) in a patient affected with a poorly differentiated thyroid carcinoma (PDTC) which determined a stenosis of the esophagus.
Material and methods:
A patient was followed up for papillary thyroid carcinoma follicular variant (T3NxMx), subjected to total thyroidectomy and treated with iodine-131 radio metabolic therapy. Two years after surgery, following the onset of dysphonia and dysphagia, patient was submitted to a computed tomography (CT) scan of the neck that showed the presence of a lesion of 6 × 2.5 × 3.5 cm, which determined trachea deviation and cervical esophagus compression. The biopsy indicated the presence of PDTC, triggering tracheal lumen reduction and sub-stenosis of the cervical esophagus for an ab-extrinsic compression. A nose-gastric tube (SNG) was placed and lenvatinib was started at a dose of 20 mg/day, administered via this probe after opening the capsules and diluting the drug in 10 ml of saline solution.
Results:
One month later, CT showed a significant cervical lesion reduction. Bronchoscopy confirmed tracheal infiltration, but the residual caliber was improved from 50% to 75%. At the esophagogastroduodenoscopy (EGDS), the sub stenosis of the cervical esophagus was no longer appreciated; however, a double perforation of the esophagus was found, without fistula.
Conclusion:
Lenvatinib therapy is effective also when administered via SNG. Our result is of particular relevance in the management of thyroid cancer patients, especially in the presence of subjects unable to swallow. Further studies are needed to validate the administration of lenvatinib by SNG, in order to extend the indications to this alternative administration way, beside the oral one.
Case Report: Cervical chondrocalcinosis as a complication of Gitelman syndrome
Authors: Zahra Iqbal, Paul Mead, John A Sayer
Journal: F1000Res (2016)
Keywords: gitelman syndrome, slc12a3, chondrocalcinosis, hypomagnesaemia, musculoskeletal

Gitelman syndrome is an inherited tubulopathy leading to a hypokalaemic metabolic alkalosis with hypomagnesaemia and hypocalciuria. Most cases are due to mutations in SLC12A3, encoding the apical thiazide sensitive co-transporter in the distal convoluted tubule. Musculoskeletal effects of Gitelman syndrome are common, including muscle weakness, tetany and cramps. Chronic hypomagnesaemia can lead to chondrocalcinosis, which often affects knees but can affect other joints. Here we present a case of Gitelman syndrome complicated by cervical chondrocalcinosis leading to neck pain and numbness of the fingers. Treatments directed at correcting both hypokalaemia and hypomagnesaemia were initiated and allowed conservative non-surgical management of the neck pain. Recognition of chondrocalcinosis is important and treatments must be individualised to correct the underlying hypomagnesaemia.
Tofacitinib citrate for ulcerative keratitis in a patient with rheumatoid arthritis
Authors: Philip B Meadow, Jacqueline Nguyen, Keerthana Kesavarapu
Journal: Case Rep Rheumatol (2014)

Purpose. To report a case of a patient with rheumatoid arthritis (RA) treated with tofacitinib citrate. Methods. Observational case report. Results. A 59-year-old patient, with a history of rheumatoid arthritis, on methotrexate 10 mg PO qwk and IV abatacept 750 mg/month, presented with photosensitivity, foreign body sensation, pain, redness, and blurry vision of her right eye (RE). Visual acuity of the RE was 20/200 and 20/20 of the left eye (LE). The slit lamp examination of the RE revealed dryness, 2+ injection of the conjunctiva, and pericentral ulceration of the cornea with 20-30% stromal thinning, pannus, and diffuse punctate epithelial erosions. The anterior chamber appeared normal. Laboratory values revealed elevated levels of rheumatoid factor, anticyclic citrullinated peptide antibodies, and C-reactive protein. The patient was switched to tofacitinib citrate 5 mg PO b.i.d, underwent corneal gluing, and was given prednisone acetate 1% gt TID, polytrim gt TID, neomycin-polymyxin-dexameth gt QD, FreshKote lubricant 1.8% gt QID, moxifloxacin 0.5% gt QID, and preservative free artificial tears Q1H. Within one week, laboratory values normalized, symptoms diminished, and the cornea reepithelialized. Conclusion. RA can present with ulcerative keratitis. Tofacitinib citrate, steroids, and corneal gluing were found to halt the progression of keratolysis and promote reepithelialization.