OpenMed/multicare-articles huggingface dataset:
Incorporating Cystatin C to Predict Methotrexate Elimination in Patients with CNS Lymphoma and Suspicious Renal Function
Authors: Jason N Barreto, Allison L McClanahan, Andrew D Rule, Carrie A Thompson, Erin Frazee
Journal: Case Rep Hematol (2018)
MeSH terms: Case Reports

High-dose methotrexate (MTX; ≥1 g/m2) is a renally eliminated and nephrotoxic first-line therapy for central nervous system (CNS) lymphoma. Creatinine-based estimation of renal function is the recommended approach to dosing MTX in these cases, but nonrenal determinants of creatinine production and elimination in cancer patients such as malnutrition and cachexia lead to overestimation of glomerular filtration rate (GFR) by this method and a heightened risk for drug toxicity. Serum cystatin C is one of the first readily available, relatively inexpensive, endogenous biomarkers to emerge as a practical adjunct to creatinine for estimation of renal function for drug dosing. In this report, we describe two cases where cystatin C was used in conjunction with creatinine to inform MTX dosing for CNS lymphoma. In both cases, the estimated GFR was nearly 40% lower with the combination of the two biomarkers compared to creatinine-only estimates. Empiric MTX dose reductions as a product of these results likely spared the patients sustained exposure to toxic drug concentrations and facilitated earlier administration of supportive care interventions. Further prospective investigations with validated dosing regimens including cystatin C are warranted for high-dose MTX.
Robot-Assisted Nephroureterectomy for Upper Tract Urothelial Carcinoma in a Patient with an Ileal Conduit
Authors: Raymond A Stemrich, Neel Hasmukh Patel, Jacob A Baber, Mark J Ferretti
Journal: Case Rep Urol (2022)
MeSH terms: Case Reports

Background:
Upper tract urothelial carcinoma remains an uncommon disease that is clinically difficult to identify early and surveil. Open nephroureterectomy is the gold standard for patients with high-grade disease, especially for patients in whom surveillance is complicated such as those with prior cystectomies/ileal conduits. This report presents a case of a patient with a history of radical cystectomy and ileal conduit construction who underwent a successful minimally invasive robotic surgery for treatment of upper tract urothelial carcinoma. Case Presentation. The patient is a 72-year-old Caucasian male with a history of recurrent superficial bladder tumors treated with cystoscopies with fulguration, Bacillus Calmette-Guerin, and a robot-assisted cystectomy with ileal conduit diversion presenting with recurrent urinary tract infections and hematuria secondary to a ureteral stricture. The patient was admitted previously for urosepsis during which time a percutaneous nephrostomy tube was inserted on the right side. Upon presentation, imaging revealed a lesion extending from the lower pole of the right kidney into the renal pelvis. The presence of a nephrostomy and urostomy allowed the surgical team to utilize a minimally invasive approach to remove the diseased kidney and ureter with visualization enhanced by indocyanine green.
Conclusion:
Minimally invasive robot-assisted approaches to treating upper tract urothelial carcinomas may offer an alternative to the open cases typically employed in cases of patients with prior ileal conduit. Furthermore, utilizing indocyanine green may expand the applicability of such approaches to uro-oncologic cases with greater complexity.
Management of a Gastrobronchial Fistula Connected to the Skin in a Giant Extragastric Stromal Tumor
Authors: Emilio Muñoz, Fernando Pardo-Aranda, Noelia Puértolas, Itziar Larrañaga, Judith Camps, Enrique Veloso
Journal: Case Rep Surg (2015)

Introduction. Gastrointestinal stromal tumors first treatment should be surgical resection, but when metastases are diagnosed or the tumor is unresectable, imatinib must be the first option. This treatment could induce some serious complications difficult to resolve. Case Report. We present a 47-year-old black man with a giant unresectable gastric stromal tumor under imatinib therapy who presented serious complications such as massive gastrointestinal bleeding and a gastrobronchial fistula connected with the skin, successfully treated by surgery and gastroscopy. Discussion. Complications due to imatinib therapy can result in life threatening. They represent a challenge for surgeons and digestologists; creative strategies are needed in order to resolve them.
Identifying a Novel DPYD Polymorphism Associated with Severe Toxicity to 5-FU Chemotherapy in a Saudi Patient
Authors: Nedal Bukhari, Faisal Azam, Mohammed Alfawaz, Mohammed Zahrani
Journal: Case Rep Genet (2019)
MeSH terms: Case Reports

Dihydropyrimidine dehydrogenase (DPD) is the major enzyme in the catabolism of 5-Fluorouracil (5-FU) and its prodrug capecitabine. We report a 65-year-old female with rectal adenocarcinoma who experienced severe toxicities secondary to standard dose 5-FU based chemotherapy. She was found to be heterozygous for rs371313778, c.2434G>A. This finding prompted restarting 5-FU at 50% dose reduction with further titration in subsequent cycles. We herein report the first case of rs371313778, c.2434G>A (p.Val812lle) DPYD polymorphism leading to severe 5-FU toxicities. The patient eventually completed a 6-month course of adjuvant treatment with modification of 5-FU dose.
Acute Heart Failure as a First Presentation of Pheochromocytoma Complicated with "Inverted" Takotsubo Syndrome
Authors: Jerrold Spapen, Jeroen de Filette, Stijn Lochy, Herbert Spapen
Journal: Case Rep Endocrinol (2020)
MeSH terms: Case Reports

Takotsubo syndrome is a rare but emerging form of acute reversible myocardial injury characterized by transient systolic LV dysfunction, often related to emotional or physical stress. Pheochromocytoma is increasingly recognised as another possible trigger. Pheochromocytoma is a rare catecholamine-secreting tumour arising from chromaffin cells within the adrenal medulla or extra-adrenal paraganglia. The pathognomonic quartet of paroxysmal hypertension, palpitations, headache, and diaphoresis is rarely present, and diagnosis is often delayed. We describe a 43-year-old formerly healthy patient with an adrenal pheochromocytoma, presenting as an "inverted" takotsubo syndrome complicated with acute heart failure and pulmonary oedema.
Gastrointestinal Bleeding Secondary to Portal Hypertensive Duodenopathy in a Patient with Decompensated Liver Cirrhosis
Authors: Rohini Krishna, Samuel O Igbinedion, Richie Diaz, Nazneen Hussain, Moheb Boktor
Journal: Case Rep Gastrointest Med (2018)
MeSH terms: Case Reports

With alcoholic cirrhosis and nonalcoholic fatty liver disease continuously on the rise in the United States, there is also a corresponding rise in portal hypertension. Portal hypertensive duodenopathy (PHD) is a complication of portal hypertension not commonly seen in cirrhotic patients. We present a case of a 46-year-old man who presented with decompensated liver cirrhosis secondary to gastrointestinal bleed. The patient underwent esophagogastroduodenoscopy (EGD) with findings indicative of PHD. Patient subsequently underwent transjugular intrahepatic portosystemic shunt (TIPS) with resolution of gastrointestinal bleed. We highlight TIPS as a management strategy in patients with PHD for whom less invasive measures are not effective.
Guidewire-Related Complications during Central Venous Catheter Placement: A Case Report and Review of the Literature
Authors: Faisal A Khasawneh, Roger D Smalligan
Journal: Case Rep Crit Care (2011)
MeSH terms: Case Reports

Seldinger's technique is widely used to place central venous and arterial catheters and is generally considered safe. The technique does have multiple potential risks. Guidewire-related complications are rare but potentially serious. We describe a case of a lost guidewire during central venous catheter insertion followed by a review of the literature of this topic. Measures which can be taken to prevent such complications are explained in detail as well as recommended steps to remedy errors should they occur.
Acquired form of angioedema of the head and neck related to a deficiency in c1-inhibitor: a case report with a review of the literature
Authors: Bassel Hallak, Propser Konu, Florian Lang, Christian Simon, Philippe Monnier
Journal: Case Rep Otolaryngol (2012)

Angioedema related to a deficiency in the C1-inhibitor protein is characterized by its lack of response to therapies including antihistamine, steroids, and epinephrine. In the case of laryngeal edema, mortality rate is approximately 30 percent. The first case of the acquired form of angioedema related to a deficiency in C1-inhibitor was published in 1972. In our paper, we present a case of an acquired form of angioedema of the oropharyngeal region secondary to the simultaneous occurrence of two causative factors: neutralization of C1-inhibitor by an autoantibody and the use of an angiotensin convertin enzyme inhibitor.
Epithelioid Myofibroblastoma in an Old-Male Breast: A Case Report with MRI Findings
Authors: Seyma Yildiz, Zuhal Gucin, Ezgi Basak Erdogan
Journal: Case Rep Radiol (2015)

Myofibroblastoma of the breast (MFB) is a very rare benign stromal tumor. In recent years, increase in mammographic screenings has resulted in increased diagnosis of MFB. Most cases are old males and postmenopausal women. MFB may be confused as malignant, clinically, morphologically, or by imaging. Immunohistochemistry is essential for final diagnosis in these cases. We report a case of a pathologically diagnosed MFB in an 80-year-old male patient who had coexisting prostate cancer and describe its imaging characteristics, especially magnetic resonance imaging (MRI). In this paper, histopathological and MRI findings of the MFB were discussed.
Co-existence of severe coarctation of the aorta and aortic valve stenosis in adulthood: a case report
Authors: Mahassine El Harras, Amal El Ouarradi, Salma Abdeladim, Ilham Bensahi, Sara Oualim, Fatimazahra Merzouk, Najwa Benslima, Hicham El Malki, Said Makani, Mahdi Ait Houssa, Chafik Kettani, Mohamed Sabry
Journal: Pan Afr Med J (2021)
Keywords: aortic valve pathology, aortic coarctation, aortic valve stenosis, bicuspid aortic valve, case report
MeSH terms: Aortic Coarctation / diagnosis, Aortic Valve Stenosis / diagnosis, Chest Pain / etiology, Case Reports, Aortic Valve Stenosis / surgery, Dyspnea / etiology, Humans, Male, Middle Aged, Severity of Illness Index, Syncope / etiology

Aortic coarctation is a congenital heart disease that usually presents and is treated in the childhood. The aortic coarctation is often associated with concomitant cardiac pathologies, such as aortic stenosis and bicuspid aortic valve. We report the case of a 56-year-old man, admitted in our cardiologic unit, for sudden onset of chest pain, dyspnea and syncope. Aortic coarctation with aortic valve stenosis was diagnosed. The aortic valve was successfully replaced in the first stage; the coarctation had to be treated in a second time.
Successful Treatment of Pantoea agglomerans Bacteremia Using Oral Antibiotics
Authors: Megan Penner, Brittany Romans, Lauren Tah, Brianna Argubright, Matthew Strohmeyer
Journal: Case Rep Infect Dis (2022)
MeSH terms: Case Reports

A 30-year-old female with a medical history of gastrointestinal reflux and intravenous methamphetamine use was admitted to the hospital with complaints of fever and chills. Pantoae agglomerans was isolated in one out of two blood cultures. Although information was limited about the duration and efficacy of oral antibiotics to treat this type of infection, the patient recovered with oral antibiotic treatment following a short course of intravenous antibiotics.
Very Late Local Relapse of Ewing's Sarcoma of the Head and Neck treated with Aggressive Multimodal Therapy
Authors: J Thariat, A Italiano, F Peyrade, I Birtwisle-Peyrottes, L Gastaud, O Dassonville, A Thyss
Journal: Sarcoma (2008)
MeSH terms: Case Reports

Ewing's sarcoma's relapse rarely occurs more than two years after the initial diagnosis. We report the case of a 26-year-old man with a history of Ewing's sarcoma of the left maxillary sinus at the age of 10 who presented with a very late local relapse, 16 years after the first occurrence of disease. Ultimate control was achieved after multimodal therapy including surgery, high-dose chemotherapy, and radiotherapy. This report indicates that local relapses of Ewing's sarcoma can be treated with curative intent in selected cases.
Rubinstein-Taybi Syndrome in a Filipino Infant with a Novel CREBBP Gene Pathogenic Variant
Authors: Rhea Camille R Yumul, Mary Anne D Chiong
Journal: Case Rep Genet (2022)
MeSH terms: Case Reports

Rubinstein-Taybi syndrome (RSTS) is a rare genetic disorder characterized by dysmorphic facial features, broad thumbs and halluces, intellectual disability, and postnatal growth retardation. This report presents a male infant with microcephaly and characteristic facial features, namely, low anterior hairline, hirsutism, thin upper lip and micrognathia, broad thumbs and first toes, cryptorchidism, recurrent pneumonia, developmental delay, and growth retardation. Genetic testing showed a novel pathogenic variant in the CREBBP gene which is consistent with the clinical diagnosis of RSTS.
Biomechanical Analysis of Various Reconstructive Methods for the Mandibular Body and Ramus Defect Using a Free Vascularized Fibula Flap
Authors: Xian Li, Chao Jiang, Hui Gao, Chunjuan Wang, Chao Wang, Ping Ji
Journal: Biomed Res Int (2020)
MeSH terms: Ameloblastoma / surgery, Fibula, Free Tissue Flaps, Mandible / surgery, Mandibular Neoplasms / surgery, Mandibular Reconstruction, Plastic Surgery Procedures, Case Reports, Adult, Female, Humans

Several different methods exist for reconstructing the mandibular body and ramus defect with the use of a free vascularized fibula flap, but none have adequately addressed the long-term mechanical stability and osseointegration. The aim of this study is to compare the biomechanics of different surgical methods and to investigate the best approach for reconstructing the mandibular body and ramus defect. Five finite element models based on different reconstructive methods were simulated. Stress, strain, and displacement of connective bone sections were calculated for five models and compared. The models were printed using a 3D printer, and stiffness was measured using an electromechanical universal testing machine. The postoperative follow-up cone beam computed tomography (CBCT) was taken at different time points to analyze bone mineral density of connective bone sections. The results showed that the "double up" (DU) model was the most efficient for reconstructing a mandibular body and ramus defect by comparing the mechanical distribution of three sections under vertical and inclined loading conditions of 100 N. The stiffness detection showed that stiffness in the DU and "double down" (DD) models was higher compared with the "single up" (SU), "single down" (SD), and "distraction osteogenesis" (DO) models. We used the DU model for the surgery, and postoperative follow-up CBCT showed that bone mineral density of each fibular connective section increased gradually with time, plateauing at 12 weeks. We conclude that a free vascularized fibula flap of the DU type was the best approach for the reconstruction of the mandibular body and ramus defect. Preoperative finite element analysis and stiffness testing were shown to be very useful for maxillofacial reconstruction.
A Case of Lower-Pole Moiety Ureteral Stenosis Close to Ureteropelvic Junction in an Incomplete Duplicated Collecting System Managed by Retrograde Balloon Dilatation that Needed a 2nd Ureteral Stent to the Upper-Pole
Authors: Seiichi Saito
Journal: Case Rep Urol (2020)
MeSH terms: Case Reports

A 71-year-old woman presented at our institution with the chief complaints of left back pain and fatigue. Radiographic examination revealed left ureteral stenosis close to ureteropelvic junction of the lower-pole with a left incomplete duplicated collecting system. Transurethral retrograde balloon dilatation under general anesthesia was performed, and a ureteral stent was inserted to the lower-pole; however, there was urinary leakage from the upper-pole at the dilated ureteral stenosis lesion, and therefore, another ureteral stent was inserted to the upper-pole just after the first stent insertion. Both stents were removed at 6 weeks and subsequent intravenous pyelography confirmed resolution of the obstruction. The patient has remained asymptomatic during 2 years of follow-up.
Clinical data analysis of 86 patients with invasive infections caused by Malassezia furfur from a tertiary medical center and 37 studies
Authors: Xiaohui Zhang, Fei Jin, Fang Ni, Yuqiao Xu, Yanfei Lu, Wenying Xia
Journal: Front Cell Infect Microbiol (2023)
Keywords: malassezia furfur, amphotericin b, fungemia, indwelling catheter, invasive infection, premature infant, pulmonary infection
MeSH terms: Fungemia / etiology, Fungemia / microbiology, Malassezia, Case Reports, Review, Adult, Amphotericin B / therapeutic use, Catheters / adverse effects, Humans, Infant, Infant, Newborn, Infant, Premature, Amphotericin B

Objective:

Malassezia furfur (M. furfur) is a lipophilic, conditionally pathogenic yeast that mainly causes skin infections, but the reports of related invasive infections are increasing. The aim of this study is to provide clinical data to assist physicians in the management of patients with invasive infections caused by M. furfur.
Methods:
A case of pulmonary infection caused by M. furfur in a hematopoietic stem cell transplant patient for aplastic anemia was reported. In addition, the literature on invasive infection by M. furfur published in PubMed and Web of Science in English until 31 July 2022 was reviewed.
Results:
Clinical data analysis of 86 patients (from 37 studies and our case) revealed that most of them were preterm (44.2%), followed by adults (31.4%). M. furfur fungemia occurred in 79.1% of the 86 patients, and 45 of them were clearly obtained from catheter blood. Other patients developed catheter-related infections, pneumonia, peripheral thromboembolism, endocarditis, meningitis, peritonitis and disseminated infections. Thirty-eight preterm infants had underlying diseases such as very low birth weight and/or multiple organ hypoplasia. The remaining patients had compromised immunity or severe gastrointestinal diseases. 97.7% of patients underwent invasive procedures and 80.2% received total parenteral nutrition (TPN). Fever, thrombocytopenia and leukocytosis accounted for 55.8%, 38.4% and 24.4% of patients with M. furfur invasive infections, respectively. 69.8% of the patients received antifungal therapy, mainly amphotericin B (AmB) or azoles. Of 84 patients with indwelling catheters, 58.3% underwent the removal of catheters. TPN were discontinued in 30 of 69 patients. The all-cause mortality of 86 patients was 27.9%.
Conclusions:

M. furfur can cause a variety of invasive infections. These patients mostly occur in premature infants, low immunity and severe gastrointestinal diseases. Indwelling catheters and TPN infusion are major risk factors. AmB, l-AmB and azoles are the most commonly used agents, and simultaneous removal of the catheter and termination of TPN infusion are important for the treatment of M. furfur invasive infections.
Case Report: Antibodies to the N-Methyl-D-Aspartate Receptor in a Patient With Multiple Sclerosis
Authors: Ran Zhou, Fei Jiang, Haobing Cai, Qiuming Zeng, Huan Yang
Journal: Front Immunol (2021)
Keywords: anti-n-methyl-d-aspartate receptor antibody, case report, disease modifying treatment, impaired consciousness, multiple sclerosis
MeSH terms: Autoantibodies / immunology, Multiple Sclerosis / diagnosis, Multiple Sclerosis / immunology, Receptors, N-Methyl-D-Aspartate / immunology, Case Reports, Research Support, Non-U.S. Gov't, Review, Adolescent, Autoantibodies / blood, Autoimmunity, Biomarkers, Female, Humans, Magnetic Resonance Imaging, Multiple Sclerosis / therapy, Neuroimaging / methods, Symptom Assessment, Autoantibodies, Biomarkers, Receptors, N-Methyl-D-Aspartate

The association between multiple sclerosis and anti-N-Methyl-D-Aspartate receptor encephalitis is limited to merely a few case reports, and the exploration of the pathogenic mechanisms underlying the overlap of these two disease entities is very limited. Therefore, case reports and literature review on N-Methyl-D-aspartate receptor antibody in patients with multiple sclerosis are unusual and noteworthy. A young female had the first episode of paresthesia and motor symptoms with positive anti-N-Methyl-D-Aspartate receptor antibody and recovered after immunotherapy, and at the first relapse, the patient developed disorders of consciousness with positive anti-N-Methyl-D-Aspartate receptor antibody, findings of magnetic resonance imaging showed features of autoimmune encephalitis, which was also controlled by immunotherapy. At the second relapse, anti-N-Methyl-D-Aspartate receptor antibody turned negative while oligoclonal bands presented positive, and findings of magnetic resonance imaging showed features of multiple sclerosis. Afterwards, we followed the patient after receiving disease modifying treatment to monitor the efficacy and safety of teriflunomide. Based on literature review, demyelinating diseases patients with anti-neuronal antibody have complex, diverse and atypical symptoms; therefore, high attention and increased alertness are necessary for neurologists. Conclusively, anti-neuronal antibody may present in many neuroinflammatory conditions, and diagnostic criteria should be used with caution if the clinical presentation is atypical, and neurologists should not rely excessively on laboratory tests to diagnose neurological diseases. Timely and comprehensive examination and consideration as well as early standardized treatment are the key factors to reduce patient recurrence and obtain a good prognosis.
Hematologic Chaos in Lupus Flare: A Case of Fulminant and Simultaneous Antiphospholipid, Anti-ADAMTS13, and Red Blood Cell Autoantibodies
Authors: Jafar Al-Mondhiry, Caroline Y Chen, Michael H Rosove
Journal: Case Rep Rheumatol (2020)
MeSH terms: Case Reports

Systemic lupus erythematosus may present with several distinct autoimmune phenomena simultaneously. We report a patient presenting with three serious hematologic disorders: thrombotic thrombocytopenic purpura, catastrophic antiphospholipid syndrome, and warm-type IgG red cell autoantibodies. The case is an example of the complex clinical nature of lupus and the importance of accurately identifying individual complications in order to optimize management.
Necrotizing pneumonia and sepsis due to Clostridium perfringens: a case report
Authors: Cristina Palmacci, Manuela Antocicco, Lorenzo Bonomo, Fabio Maggi, Alberto Cocchi, Graziano Onder
Journal: Cases J (2009)

Clostridia are uncommon causes of pleuropulmonary infection. Clostridial species infecting the pleuropulmonary structures characteristically cause a necrotizing pneumonia with involvement of the pleura. Most cases have iatrogenic causes usually due to invasive procedures into the pleural cavity, such as thoracentesis or thoracotomy, or penetrating chest injuries. Rarely clostridia pleuropulmonary infections are not related to these factors. The clinical course of pleuropulmonary clostridial infections can be very variable, but they may be rapid and fatal. We report a rare case of necrotizing pneumonia and sepsis due to Clostridium perfringens not related to iatrogenic causes or injuries in an 82 years old woman.