OpenMed/multicare-articles huggingface dataset:
Femoral Embolization after Cardiac Gunshot
Authors: Leonardo Toscano, Daniel Terra, Siul Salisbury
Journal: Case Rep Emerg Med (2018)
MeSH terms: Case Reports

Bullet embolism is an uncommon complication from heart gunshot injuries because most of the patients die immediately after trauma. The low frequency of this complication combined with the possible absence of symptoms makes the condition a challenge for the surgeon, delaying diagnostics and leading to severe complications or death. In this case, a small calibre bullet entered the left ventricle and then impacted the femoris artery.
Falsely Elevated 25-Hydroxy-Vitamin D Levels in Patients with Hypercalcemia
Authors: Moon Kyung Choi, Prapaipan Putthapiban, Patamaporn Lekprasert
Journal: Case Rep Endocrinol (2020)
MeSH terms: Case Reports

Symptomatic hypercalcemia is a commonly encountered clinical scenario. Though it is important to collect detailed history to find clinical clues connecting to the etiology of hypercalcemia, the diagnostic workup of hypercalcemia depends heavily on laboratory analysis. Accurate measurement of the parathyroid hormone and vitamin D levels is essential. However, commercial laboratory measurement of vitamin D levels can be erroneous in the setting of abundant paraprotein in the serum. One of the most common conditions that can cause an increased amount of paraproteins is multiple myeloma. We report 2 cases of falsely elevated 25-hydroxy-vitamin D levels in patients presenting with hypercalcemia and an underlying diagnosis of MM.
Incomplete Resolution of Deep Vein Thromboses during Rivaroxaban Therapy
Authors: Jonathan M Yaghoubian, Jacob Adashek, Bahareh Yaghoubian-Yazi, Menachem Nagar, Nojan Toomari, Richard J Pietras, Uri M Ben-Zur
Journal: Case Rep Cardiol (2017)
MeSH terms: Case Reports

We present the case of a patient with a deep vein thrombosis (DVT) who failed rivaroxaban therapy. Our patient initially presented with left lower extremity edema, erythema, and pain. He was subsequently started on rivaroxaban therapy for a combined treatment period of 12 months, during and after which he persisted to have evidence of a DVT. The patient's prescribed drug regimen was changed from rivaroxaban to warfarin, which demonstrated a rapid resolution of the DVTs as determined by ultrasound assessment of our patient's lower extremity veins. Rivaroxaban, a factor Xa inhibitor, is a well-known oral anticoagulant that is used for a variety of indications and has become a mainstay in the treatment of deep vein thrombosis. With the introduction and emergence of this medication in the clinic, postmarketing reports of efficacy or lack thereof are important to review. In conclusion, we anticipate that it is likely that there are other patients with DVTs who may not respond to rivaroxaban and for whom alternative anticoagulation therapies should be explored.
Hyperkalemic cardiac arrest induced by mannitol administration during craniotomy: A case report and review of the literature
Authors: Hua Zheng, Xueqin Cao, Feng Gao, Xinhua Li, Li Wan, Ailin Luo
Journal: Front Surg (2022)
Keywords: cardiac arrest, complication, craniotomy, hyperkalemia, mannitol
MeSH terms: Case Reports

Introduction:
Mannitol is the most widely used hyperosmolar agent during neurosurgical procedures. However, its use can lead to serious hyperkalemia with altered cardiac conduction.
Case presentation:
Here we report a case in which a 40-min cardiac arrest was caused by mannitol-induced hyperkalemia during craniotomy. In addition, we conducted a literature review through a PubMed (MEDLINE) search of the relevant literature published so far. Details of all cases are presented and discussed. The results suggest that male patients or patients with uncontrolled diabetes might be at higher risk to develop this phenomenon. The results also suggest that the high dose and rapid rate of infusion of mannitol might contribute to mannitol-induced hyperkalemia.
Conclusion:
Physicians should be aware of the existence of mannitol-induced hyperkalemia. Although the mechanism of this complication is not well established, it is prudent to administer mannitol cautiously, especially in patients with uncontrolled diabetes. Continuous electrocardiogram monitoring and frequent measurements of serum electrolytes can help to detect and treat possible life-threatening events induced by mannitol-induced hyperkalemia early.
Fluorosis varied treatment options
Authors: I Anand Sherwood
Journal: J Conserv Dent (2010)
Keywords: dental fluorosis, endemic fluorosis areas, fluorosis, treatment options for fluorosis
MeSH terms: Case Reports

Fluorosis has been reported way back in 1901. The treatment options for fluorosis are varied depending upon individual cases. This article comes from Madurai in India where its surrounding towns are fluorosis-prone zones. The purpose of this article is to report various treatment options available for dental fluorosis; this is the first time that complete full mouth rehabilitation for dental fluorosis is being reported. This article also dwells on the need for the dentists to be aware of their local indigenous pathologies to treat it in a better manner.
Electroconvulsive therapy and corpus callosum aplasia: a 3-year followup
Authors: Ulrich Palm, Philipp Strauss, Christoph Born, Oliver Pogarell
Journal: Case Rep Psychiatry (2011)
MeSH terms: Case Reports

Electroconvulsive Therapy (ECT) is a powerful treatment option in severe or chronic catatonic states and has been reported to be useful in oligophrenic patients. We report the followup medical history of a patient with corpus callosum aplasia (or agenesis) who was continuously treated with ECT over three years. First, he improved considerably after a series of ECT, but relapses of catatonia made a continuous, weekly ECT necessary. Due to the severity of the brain malformation, an add-on medication with benzodiazepines and second generation antipsychotics was necessary to treat catatonic symptoms. This case emphasises the benefits of long-term ECT in oligophrenic patients.
Severe Lenalidomide-Associated Hyperbilirubinemia
Authors: Daniel T Gildea, Joseph L Roswarski
Journal: Cureus (2023)
Keywords: cholestatic liver injury, direct hyperbilirubinemia, extra-medullary plasmacytoma, hepatology, immunomodulatory imide drugs, oncology, treatment related toxicity
MeSH terms: Case Reports

Immunomodulatory drugs (IMids), such as thalidomide and lenalidomide, are used to treat plasma cell neoplasms and B-cell malignancies. We present a case of severe direct hyperbilirubinemia in a patient taking lenalidomide-based therapy for plasmacytoma. Imaging was unrevealing, and liver biopsy showed only mild sinusoidal dilation. Roussel Uclaf Causality Assessment (RUCAM) score was 6, indicating lenalidomide was a probable cause of the injury. To our knowledge, this is the highest reported direct bilirubin regarding lenalidomide drug-induced liver injury (DILI), with a peak bilirubin of 41mg/dL. While a clear pathophysiology was not identified, this case provides important considerations regarding lenalidomide safety.
Mixed Cryoglobulinemia in a Patient with Juvenile Idiopathic Arthritis
Authors: Fahad Bnatig, Leen Raddaoui, Talal Hijji, Lina El Kibbi
Journal: Case Rep Rheumatol (2019)
MeSH terms: Case Reports

Cryoglobulinemia is a rare illness of cryoglobulin accumulation in the blood which can typically present with arthralgia, purpura, skin ulcers, glomerulonephritis, and peripheral neuropathy. It is classified as mixed cryoglobulinemia when cryoglobulins contain more than one immune component such as IgM rheumatoid factor and polyclonal IgG. Typically, it presents in the setting of clonal hematologic disease, viral infection, or certain connective tissue diseases. Herein, we report the case of a 24-year-old man diagnosed and treated as mixed cryoglobulinemia in the setting of juvenile idiopathic arthritis (JIA). Investigations for viral etiologies, including HBV, HCV, and HIV, and all serologic tests were negative. Additionally serum protein and urine protein electrophoresis did not reveal monoclonal gammopathy; however, testing for plasma cryoglobulins was positive, and qualitative analysis revealed a faint polyclonal pattern. Thus, he was diagnosed with cryoglobulinemia in the setting of JIA, which has not been reported in the literature before. He dramatically improved upon initiation of rituximab and methotrexate.
The Implementation of Teleconsultations in a Physiotherapy Service During Covid-19 Pandemic in Brazil: a Case Report
Authors: Thaiana B F Pacheco, Dayse A Bezerra, João Pedro de S Silva, Ênio W A Cacho, Clécio G de Souza, Roberta O Cacho
Journal: Int J Telerehabil (2021)
Keywords: covid-19, physiotherapy, telehealth, telerehabilitation

Introduction:
The Brazilian Council of Physiotherapy and Occupational Therapy regulated the use of teleconsultation during the COVID-19 pandemic, creating uncertainty about its use in Brazil.
Objective:
To describe the experience of teleconsultations during the COVID-19 pandemic.
Methods:
Four patients participated in the study with the following diagnoses: Parkinson's disease, stroke, peripheral facial paralysis, and tibial plateau fracture. Patients underwent up to 10 physiotherapy sessions via digital tools. The 5-A self-management tool (Assess, Advise, Agree, Assist, Arrange) guided the sessions.
Results:
The teleconsultation type varied between synchronous (n = 1; 25%); asynchronous (n = 2; 50%) and synchronous/asynchronous (n = 1; 25%). There was 75% (n = 3) adherence and one withdrawal (25%). As the benefits of teleconsultations, the patients pointed out the convenience, maintenance of the exercises, and contact with the professional. The reported limitations were the lack of the use of physiotherapeutic devices.
Conclusion:
Teleconsultations contribute to the continuity of physiotherapy treatment during social isolation. Adherence to treatment was facilitated by access to the technology and by offering patients the choice of teleconsultation type.
Emergency Laparoscopic Repair of an Iatrogenic Gastric Perforation in a Hiatal Hernia following a Failed Endoscopic Closure
Authors: Benjamin L Reed, Lawrence E Tabone, Nova Szoka, Salim Abunnaja
Journal: Case Rep Surg (2020)
MeSH terms: Case Reports

Iatrogenic gastrointestinal perforation is a rare, life-threatening complication of endoscopic procedures, which requires either endoscopic or surgical repair. We report the account of an 82-year-old woman with an iatrogenic gastric perforation of a hiatal hernia secondary to an endoscopic retrograde cholangiopancreatography (ERCP) procedure. Despite immediate recognition of the complication and endoscopic closure with through-the-scope (TTS) clips, the patient developed mediastinitis, peritonitis, and sepsis. She subsequently underwent an emergency laparoscopic hiatal hernia dissection and repair of the perforation with mediastinal and peritoneal washout. Given the patient's age and the degree of insult, subdiaphragmatic anchoring with abdominal drain placement was performed, and the hiatus was left open for additional drainage. The use of a side-viewing duodenoscope with the presence of a large hiatal hernia contributed to the risk of gastric perforation. We conclude that performing endoscopic procedures in patients with a known hiatal hernia should be carefully undertaken. If a perforation in such patients occurs, laparoscopic repair of such complications is feasible as demonstrated in this case video.
Lenvatinib-Associated Cervical Artery Dissections in a Patient with Radioiodine-Refractory Metastatic Papillary Thyroid Carcinoma
Authors: Phillip J Groden, Thomas C Lee, Shamik Bhattacharyya, Jean Connors, Jochen Lorch
Journal: Front Med (Lausanne) (2018)
Keywords: arterial dissections, cancer, cardiovascular, thyroid, tyrosine-kinase inhibitors
MeSH terms: Case Reports

Lenvatinib is a tyrosine kinase inhibitor (TKI) approved by the FDA for the treatment of radioiodine-refractory (RAIR) thyroid cancers. Side effects can be severe, however, and include headaches, hypertension, arterial and venous thromboembolic events, and fatalities. Cervical artery dissections (CADs) are leading contributors of cerebral ischemia in young adults, yet the pathophysiology is poorly understood. Here, we describe a case of a 34-year-old female with recurrent, metastatic, RAIR papillary thyroid cancer who, following her second week of lenvatinib treatment, developed significant CAD which resolved following the termination of the TKI therapy. Given the lack of risk factors for the disorder in the patient's history, the known cardiovascular events associated with the drug, previously described cases of arterial dissections linked to VEGF inhibitors, and the temporal relationship between the onset of symptoms and the treatment start date, a causal relationship between the CAD and lenvatinib is suggested.
Post-ERCP pancreatogastric fistula associated with an intraductal papillary-mucinous neoplasm of the pancreas--a case report and literature review
Authors: Masaru Koizumi, Naohiro Sata, Koji Yoshizawa, Munetoshi Tsukahara, Katsumi Kurihara, Yoshikazu Yasuda, Hideo Nagai
Journal: World J Surg Oncol (2005)

Background:
Fistula formation has been reported in intraductal papillary-mucinous neoplasms (IPMNs) with or without invasion of the adjacent organs. The presence or absence of invasion is mostly determined by postoperative histological examination rather than by preoperative work-up.
Case presentation:
A 72 year-old Japanese woman showed remarkable dilatation of the main pancreatic duct (MPD) in the distal region of the pancreas. Subsequent ERCP also showed MPD dilatation, after which the patient suffered moderate pancreatitis. A subsequent gastroscopy revealed a small ulceration that had not been observed in a gastroscopy performed 3 months prior. Mucinous discharge from the ulceration suggested it might be the orifice of a fistula connected to the MPD. En bloc resection including the distal region of the pancreas, spleen, stomach and part of the transverse colon was performed under the pre- and intraoperative diagnosis of an invasive malignant IPMN. However, histopathology revealed the lesion to be of "borderline malignancy" without apparent invasion of the stomach. Light microscopy showed inflammatory cellular infiltrates (mainly neutrophils) around the pancreatogastric fistula, but there was no evidence of neoplastic epithelia lining the fistulous tract.
Conclusion:
This case highlights that a pancreatogastric fistula can develop after acute inflammation of the pancreas in the absence of cancer invasion. Further information regarding IPMN-associated fistulae is necessary to clarify the pathogenesis, diagnosis, appropriate surgical intervention and prognosis for this disorder.
Case report: Successful treatment of mediastinal unicentric castleman disease using cardiopulmonary bypass
Authors: Wei Ran, Zhu Cuilin, Piao Hulin, Liu Kexiang
Journal: Front Cardiovasc Med (2023)
Keywords: cardiopulmonary bypass, castleman's disease, middle mediastinal tumor, mixed pathology, surgery
MeSH terms: Case Reports

Unicentric Castleman disease (UCD) is a rare, benign lymphoproliferative disorder. Mediastinal UCD has tumors with no clear boundaries that are highly vascularized. Resection surgery results in bleeding, leading to further challenges. Mixed-type UCD is rare. We report the case of a 38-year-old asymptomatic patient with mixed-type UCD; the tumor measured 7.8 cm in size and had unclear boundaries. The tumor was successfully resected by performing a cardiopulmonary bypass on the beating heart; the patient recovered uneventfully.
Levitronix bilateral ventricular assist device, a bridge to recovery in a patient with acute fulminant myocarditis and concomitant cerebellar infarction
Authors: Yi-Fan Huang, Po-Shun Hsu, Chien-Sung Tsai, Yi-Ting Tsai, Chih-Yuan Lin, Hong-Yan Ke, Yi-Chang Lin, Hsiang-Yu Yang
Journal: Cardiovasc J Afr (2018)
MeSH terms: Cerebral Infarction / complications, Heart-Assist Devices, Myocarditis / therapy, Ventricular Function, Left, Ventricular Function, Right, Case Reports, Adult, Cerebral Infarction / diagnostic imaging, Cerebral Infarction / physiopathology, Device Removal, Humans, Male, Myocarditis / complications, Myocarditis / diagnosis, Myocarditis / physiopathology, Prosthesis Design, Recovery of Function, Time Factors, Treatment Outcome

We report on the case of a 27-year-old male who presented to our emergency room with chest tightness, dyspnoea and cold sweats. The 12-lead electrocardiogram showed diffuse ventricular tachycardia with wide QRS complexes. Troponin-I level was elevated to 100 ng/ml. The coronary angiogram showed good patency of all three coronary vessels, and acute fulminant myocarditis was suspected. The patient underwent cardiopulmonary resuscitation in the catheter room and high-dose inotropic support was initiated to stabilise his haemodynamic status. After resuscitation, the patient was in a coma and acute stroke was highly suspected. In addition, deteriorating cardiogenic shock with acute renal failure and pulmonary oedema were also detected. Due to haemodynamic compromise despite high-dose inotropic support, a Levitronix® bilateral ventricular assist device (Bi-VAD) was implanted on an emergency basis for circulatory support. Postoperative brain computed tomography revealed acute left cerebellar infarction. Because the patient had left cerebellar infarction with right hemiplegia, heart transplantation was contraindicated. Eventually, cardiac systolic function recovered well and the patient underwent successful Bi-VAD removal after a total of 18 days on Levitronix® haemodynamic support. He was weaned from the ventilator two weeks later and was discharged 10 days later.
Misidentification of Scedosporium boydii Infection as Aspergillosis in a Patient with Chronic Renal Failure
Authors: Yuying Jiang, Amira F Gohara, Robert E Mrak, Kenneth L Muldrew
Journal: Case Rep Infect Dis (2020)
MeSH terms: Case Reports

Aspergillosis is a commonly diagnosed fungal infection. Histopathologic examination alone can have diagnostic pitfalls due to the overlapping of fungal morphology. We report a case of Scedosporium boydii infection initially misdiagnosed as aspergillosis. The patient presented to the hospital with shortness of breath and chest and abdominal pain. Laboratory tests revealed leukocytosis and elevated serum liver enzymes, myoglobin and lipase. He died of hypotensive shock and brain abscesses despite antibiotic treatment. Autopsy revealed invasive fungal infection in the heart, thyroid, and brain with presence of 45-degree angled, branching hyphae. The initial diagnosis of aspergillosis was made; however, further molecular studies identified the organism as S. boydii. This report reveals the potential pitfalls of morphologic diagnosis alone; and the necessity of other testing modalities to render an accurate diagnosis which is crucial for appropriate.
Extranodal Marginal Zone Lymphoma Presenting within the Meckel Diverticulum as Diverticulitis: A Case Report
Authors: A Nael, M L Wu, P Nagesh Rao, S Rezk, X Zhao
Journal: Case Rep Pathol (2014)

Meckel diverticulum is the most common congenital defect of the gastrointestinal tract. It can be asymptomatic or mimic appendicitis and may be complicated by bleeding, diverticulitis, obstruction, and, rarely, neoplasia. We report the first case of extranodal marginal zone lymphoma occupying a Meckel diverticulum. A 44-year-old man with history of colonic diverticulitis presented to the emergency department for evaluation of acute abdominal pain. Radiography showed enteric obstruction, prompting diagnostic laparoscopy. Above the level of mid-ileum an intact Meckel diverticulum was identified. Microscopy showed extensive infiltration of sheets of small lymphocytes with abundant cytoplasm (monocytoid B-cells) prominently in submucosa and focally transmural involving serosal adipose tissue with multiple reactive germinal centers. The immunostains showed positivity for CD20, BCL-2, and CD43 (weak) and negativity for CD3, CD5, BCL-1, CD10, and BCL-6 in monocytoid B-cells. Fluorescence in situ hybridization studies revealed API2-MALT1 fusion signals consistent with t(11;18)(q21;q21), which confirmed the diagnosis of extranodal marginal zone lymphoma, also known as mucosa associated lymphoid tissue lymphoma.
Bilateral renal cortical necrosis in meningococcal meningitis
Authors: C Kennedy, S Khilji, A Dorman, J Walshe
Journal: Case Rep Nephrol (2011)
MeSH terms: Case Reports

Bacterial meningitis is a relatively common infection of the cerebrospinal fluid (CSF) and leptomeninges. The clinical picture evolves rapidly and, if treatment is delayed, can result in a variety of long-term sequelae, including death. Acute kidney injury in the setting of bacterial meningitis usually results from hypotension and volume depletion and resolves with appropriate treatment. Meningococcaemia with profound hypotension, and/or disseminated intravascular coagulopathy (DIC) may very rarely lead to bilateral renal cortical necrosis. In this context, renal recovery is extremely unlikely. We present two cases of meningococcaemia complicated by bilateral renal cortical necrosis and, ultimately, end stage kidney disease. We also present a review of the literature on the subject. The cases outline the importance of early aggressive intervention by a multidisciplinary team.
Endobronchial Epstein-Barr Virus Associated Post-transplant Lymphoproliferative Disorder in Hematopoietic Stem Cell Transplantation
Authors: S Feuillet, V Meignin, J Brière, P Brice, V Rocha, G Socié, A Tazi, A Bergeron
Journal: Clin Med Case Rep (2009)
Keywords: bronchoscopy, endobronchial patterns, epstein-barr virus, hematopoietic stem cell transplantation, post transplant lymphoproliferative disorders
MeSH terms: Case Reports

The Epstein-Barr virus (EBV) associated Post-Transplant Lymphoproliferative Disorders (PTLD) are increasingly recognized as a fatal complication of hematological stem cell transplantation (HSCT). Thoracic involvement, that may be isolated or part of a disseminated disease, usually encompasses pulmonary nodules or masses and mediastinal lymph node enlargement. The current case study presents 2 patients who underwent HSCT, one allogenic and the other autologous, who developed an exceptional endobronchial EBV related PTLD. The first patient had a fleshy white endobronchial mass resulting in a right upper lobe atelectasis and the second had an extensive necrotising mucosa from trachea to both basal bronchi without any significant change of lung parenchyma on the CT scan. In both cases, the diagnosis was made by bronchial biopsies. Physicians should be aware of an endobronchial pattern of EBV associated PTLD after HSCT to permit quick diagnosis and therapeutic intervention.
Prevertebral abscess associated with meningitis: Double cause of neck stiffness
Authors: Hidenori Higashi, Ken-Ichiro Kobayashi, Anna Eto, Tadahiro Goto
Journal: IDCases (2022)
Keywords: meningitis, neck stiffness, prevertebral space infection, vertebral osteomyelitis
MeSH terms: Case Reports

While neck stiffness belongs to the classic triad of meningitis symptoms together with fever and altered mental status, it can also be attributed to inflammation from prevertebral space infection. We describe a difficult-to-diagnose case of prevertebral abscess associated with meningitis. Prevertebral space infection, vertebral osteomyelitis, and meningitis are reported to be associated with each other. When a patient presents with an altered mental status due to meningitis, signs and symptoms may be obscured and physicians may be unable to conduct detailed physical examinations or identify symptoms beyond neck stiffness. The threshold for imaging evaluation may need to be lowered for patients at high risk for prevertebral abscess or vertebral osteomyelitis. Physicians need to recognize this clinical entity, as prompt referral to specialists in head and neck surgery is essential for timely drainage.