OpenMed/multicare-articles huggingface dataset:
Hepatoid adenocarcinoma of the stomach with metastatic choriocarcinoma of the liver: A case report of a rare subtype of gastric cancer with a complex treatment course
Authors: Qiyang Zhou, Yudi Zhou, Yiming Ouyang, Weichang Chen, Xiaojun Zhou
Journal: Front Surg (2022)
Keywords: case report, chemotherapy, gastric hepatoid adenocarcinoma, hepatic choriocarcinoma, neoadjuvant therapy, radical surgery
MeSH terms: Case Reports

Gastric hepatoid adenocarcinoma and hepatic choriocarcinoma are rare diseases in clinical settings, and the case we report here is a combination of both. A 66-year-old woman presented with a chief complaint of abdominal discomfort. The patient was examined using gastroscopy and computed tomography (CT) scan, and these revealed an irregular surface ulcer on the wall of the gastric antrum. A mass, 2.0 cm in diameter, was found in the liver in April 2020. The endoscopic biopsy findings were consistent with a diagnosis of moderately to poorly differentiated hepatoid adenocarcinoma. She was then referred to our hospital for further treatment. Initially, neoadjuvant therapy was initiated for the patient. The CT scan showed that the liver metastases had progressed; hence, surgery was performed. Postoperative pathology showed that the gastric lesions were mostly hepatoid adenocarcinoma with no choriocarcinoma, while the liver lesions comprised approximately 10% hepatoid adenocarcinoma and 90% choriocarcinoma. One month later, the patient developed tumor recurrence in the liver as observed on CT imaging. Subsequently, a variety of chemotherapy regimens were tried with no obvious results. The patient eventually developed multiple organ metastasis and died in July 2021. The overall survival was 16 months. Based on findings from this case report, it appears that initial neoadjuvant therapy was not effective and radical surgery may be the best treatment for patients with hepatoid adenocarcinoma of the stomach.
Disseminated intravascular coagulation type of amniotic fluid embolism: a challenging case report with favorable outcome
Authors: Mouna Gara, Arij Draouil, Ahmed Ben Saad, Manel Njima, Asma Ladib, Ons Cherif, Ali Jlali, Lotfi Grati
Journal: Pan Afr Med J (2021)
Keywords: embolism, amniotic fluid, case report, obstetric delivery, prognosis
MeSH terms: Disseminated Intravascular Coagulation / diagnosis, Embolism, Amniotic Fluid / diagnosis, Case Reports, Adult, Delivery, Obstetric, Disseminated Intravascular Coagulation / therapy, Embolism, Amniotic Fluid / therapy, Female, Humans, Pregnancy

Amniotic fluid embolism (AFE) is an unforeseeable, life-threatening complication of pregnancy and child birth. Although rare in an absolute sense, most contemporary series of maternal deaths from developed countries report AFE as a leading cause of mortality in the pregnant population. It has a heterogeneous presentation. This clinical heterogeneity makes the diagnosis of AFE difficult based on a beam of clinical and para-clinical arguments. Rapid diagnosis and immediate interdisciplinary treatment are essential for a good outcome. The present is a case of AFE with a disseminated intravascular coagulation (DIC) and a cardiorespiratory collapse following a vaginal delivery.
Pancytopenia with severe thrombocytopenia in asymptomatic malaria in advanced pregnancy: a case report
Authors: Grant Murewanhema, Tapuwa Carol Musiniwa, Maxwell Takura Chimhina, Simbarashe Madombi, Munyaradzi Innocent Nyakanda, Mugove Gerald Madziyire
Journal: Pan Afr Med J (2022)
Keywords: zimbabwe, case report, malaria in pregnancy, pancytopenia, thrombocytopenia
MeSH terms: Anemia / complications, Antimalarials / therapeutic use, Malaria / complications, Malaria / diagnosis, Malaria / drug therapy, Malaria, Falciparum / diagnosis, Pancytopenia / diagnosis, Pancytopenia / etiology, Thrombocytopenia / diagnosis, Thrombocytopenia / etiology, Case Reports, Adult, Cesarean Section, Female, Humans, Pregnancy, Antimalarials

Malaria in pregnancy is associated with significant morbidity and mortality, and requires early diagnosis and intervention. Plasmodium falciparum is responsible for 98% of malaria cases in Zimbabwe and causes the most severe disease. Abnormal haematological parameters are a frequent finding in patients with malaria; however, they are rarely the sole presenting feature. We present the case of a 32-year-old woman in her fifth pregnancy, with a history of one previous caesarean section, who presented for caesarean section and was incidentally noted to have severe thrombocytopenia. Subsequent investigations at a tertiary institution revealed a pancytopenia with thrombocytopenia as the most prominent feature in an asymptomatic patient. The unavoidable caesarean section done under platelet cover was eventful, with severe intractable haemorrhage necessitating an emergency hysterectomy. However, the patient made a full recovery with antimalarial treatment and blood product transfusions. This case is presented to illustrate the need to consider malaria as a differential diagnosis in pregnant patients from malaria-transmitting areas who have thrombocytopenia. Previous studies have shown that thrombocytopenia can be a predictor of malaria in patients who present with fever, and a marker of disease severity, but has no utility in prognostication and follow-up.
Case Report: Circulating Myeloid-Derived Suppressive-Like Cells and Exhausted Immune Cells in Non-Small Cell Lung Cancer Patients Treated With Three Immune Checkpoint Inhibitors
Authors: Giuseppe Bronte, Alberto Verlicchi, Serena De Matteis, Alice Rossi, Alessandra Affatato, Francesco Giulio Sullo, Caterina Gianni, Matteo Canale, Marco Angelo Burgio, Angelo Delmonte, Michele Milella, Lucio Crinò
Journal: Front Immunol (2021)
Keywords: ctla-4, lag-3, pd-1, t cell exhaustion, immune checkpoint inhibitor, myeloid-derived suppressor cells
MeSH terms: Adenocarcinoma of Lung / drug therapy, Antineoplastic Combined Chemotherapy Protocols / administration & dosage, Immune Checkpoint Inhibitors / administration & dosage, Lung Neoplasms / drug therapy, Myeloid-Derived Suppressor Cells / immunology, Case Reports, Adenocarcinoma of Lung / immunology, Aged, Humans, Ipilimumab / administration & dosage, Lung Neoplasms / immunology, Male, Middle Aged, Myeloid-Derived Suppressor Cells / drug effects, Nivolumab / administration & dosage, Tumor Escape / drug effects, Tumor Escape / immunology, Immune Checkpoint Inhibitors, Ipilimumab, Nivolumab

Immune checkpoint inhibition induced a great step forward in the treatment of non-small cell lung cancer patients. In cancer immune microenvironment many checkpoints were studied and their involvement could represent a mechanism of resistance to cancer immunotherapy. For this reason, the inhibition of multiple immune checkpoints is under development. However, myeloid-derived suppressor cells (MDSC) and exhausted immune cells could limit the efficacy of cancer immunotherapy. We analyzed the variation of circulating immune suppressive-like cell subsets and exhausted immune cells in three non-small cell lung cancer patients treated with the combination of anti-CTLA-4 plus anti-PD-1 plus anti-LAG-3 at T0 (baseline), T1 (after 2 months) and T2 (after 4 months). We also describe the clinical and radiological course of the disease during this treatment in all three patients. We observed both clinical differences and changes in the composition of immune suppressive-like cell subsets and exhausted immune cells between the patients receiving the same schedule of treatment with immune checkpoint inhibitors. The study on a wider patient population and experimental model design could help to clarify the kinetics of these cell subpopulations with the perspective to find new targets for treatment or new biomarkers for resistance to cancer immunotherapy.
Myasthenia Gravis Presenting as Graft versus Host Disease after Allogeneic Blood Stem Cell Transplant
Authors: Zarir Ahmed, Martin Schoen, Nabeel Rajeh
Journal: Case Rep Hematol (2018)
MeSH terms: Case Reports

Myasthenia gravis is a very rare manifestation of graft versus host disease after stem cell transplants. Herein, we describe a case of new-onset myasthenia gravis after a stem cell transplant 34 months ago in a patient with myelodysplastic syndrome.
Multiple Simultaneous Rare Distant Metastases as the Initial Presentation of Papillary Thyroid Carcinoma: A Case Report
Authors: Jing Yang, Yu Ma, Yanping Gong, Rixiang Gong, Zhihui Li, Jingqiang Zhu
Journal: Front Endocrinol (Lausanne) (2019)
Keywords: 18f-fdg-pet/ct, ptc, chemotherapy, palliative therapy, rare distant metastases
MeSH terms: Case Reports

Papillary thyroid carcinoma (PTC) commonly metastasizes to regional lymph nodes. However, they infrequently cause rare distant metastases (RDMs), with the exclusion of lungs and bone metastases. RDMs are seldom identified prior to a primary thyroid cancer diagnosis. Therefore, cases initially presenting with synchronously multiple RDMs from PTC are extremely infrequent. This is a rare case of a 48-year-old man with initial diaphragm, pancreatic, and liver tumors from PTC. Following resection of the tumors, an ultrasound-guided fine-needle aspiration (US-FNA) cytology of a mass in the thyroid's left lobe revealed PTC. After postoperative recovery for more than 4 months, physical examination identified an irregular large nodule in the thyroid's isthmus and left lobe, a swollen lymph node in the left neck, and a mass in the right parotid gland. Ultrasound reexamination revealed numerous hypoechoic masses as follows: one in the thyroid's isthmus and entire left lobe (7.3 × 5.9 × 5.1 cm) and multiple in the thyroid's right lobe (0.2-0.3 cm). Ultrasound examination also showed several swollen lymph nodes in the left neck, a mass in the left gluteus maximus, and several masses in both the bilateral parotid and salivary region. The US-FNA's pathological examination confirmed metastatic PTCs in the left gluteus maximus and bilaterally located in the parotid and salivary gland. 18-fluorodeoxyglucose positron-emission tomography and computed tomography scan revealed abnormal uptakes in numerous locations (e.g., the thyroid's isthmus and left lobe, bilateral parotid gland, subcutaneous tissues, etc.). The patient underwent palliative therapy, including total thyroidectomy, bilateral central neck dissection, left lateral neck dissection, and excision of the bilateral parotid and salivary gland. A whole-body scan post-therapeutic radioactive iodine ablation showed exclusive thyroid bed uptake. Subsequently, the patient underwent continuous thyroid stimulating hormone repression therapy and was treated with lenvatinib chemotherapy for ~8 months. The primary thyroid tumor, pancreatic metastasis, and cervical lymph node metastasis were both positive for BRAF V600E and TERT promoter (C288T) mutations. After 13 months of follow-up, the patient is currently in stable clinical conditions. In conclusion, the present case is an extremely rare occurrence of simultaneous multiple RDMs from PTC as the initial presentation.
Successful treatment of HIV-associated multicentric Castleman's disease and multiple organ failure with rituximab and supportive care: a case report
Authors: Robin H Johns, Tomas Doyle, Marc C Lipman, Kate Cwynarski, Joanne R Cleverley, Peter G Isaacson, Steve Shaw, Banwari Agarwal
Journal: J Med Case Rep (2010)

Introduction:
Multicentric Castleman's Disease (MCD), a lymphoproliferative disorder associated with Human Herpes Virus-8 (HHV-8) infection, is increasing in incidence amongst HIV patients. This condition is associated with lymphadenopathy, polyclonal gammopathy, hepato-splenomegaly and systemic symptoms. A number of small studies have demonstrated the efficacy of the anti-CD20 monoclonal antibody, rituximab, in treating this condition.
Case presentation:
We report the case of a 46 year old Zambian woman who presented with pyrexia, diarrhoea and vomiting, confusion, lymphadenopathy, and renal failure. She rapidly developed multiple organ failure following the initiation of treatment of MCD with rituximab. Following admission to intensive care (ICU), she received prompt multi-organ support. After 21 days on the ICU she returned to the haematology medical ward, and was discharged in remission from her disease after 149 days in hospital.
Conclusion:
Rituximab, the efficacy of which has thus far been examined predominantly in patients outside the ICU, in conjunction with extensive organ support was effective treatment for MCD with associated multiple organ failure. There is, to our knowledge, only one other published report of its successful use in an ICU setting, where it was combined with cyclophosphamide, adriamycin and prednisolone. Reports such as ours support the notion that critically unwell patients with HIV and haematological disease can benefit from intensive care.
Osteochondritis Dissecans Lesion of the Trochlear Groove: A Case of Nonsurgical Management for a Rare Lesion
Authors: Paul Krebs, Nicholas Walla, David Flanigan
Journal: Case Rep Orthop (2021)
MeSH terms: Case Reports

Osteochondritis dissecans (OCD) lesions are potential causes of knee pain in pediatric patients, with lesions most frequently found on the lateral and medial femoral condyles. This case discusses an OCD lesion of the trochlear groove, a rare location for OCD lesions, in an 11-year-old female athlete. The patient presents after several years of knee pain that had acutely worsened, and both X-ray and MRI demonstrated the lesion, with MRI confirming a stable lesion. While previous literature has leaned towards surgical management, this patient was successfully managed nonoperatively in a locked knee brace for 12 weeks. She then went through 4 weeks of physical therapy and a 4 week progression back into soccer activity with return to full activity in 5 months.
Continuous Renal Replacement Therapy (CRRT) for Nonrenal Indications among Critically Ill Children with Malignancy
Authors: Wun Fung Hui, Kam Lun Hon, Alexander K C Leung, Karen Ka Yan Leung, Shu Wing Ku, Frankie W T Cheng
Journal: Case Rep Pediatr (2021)
MeSH terms: Case Reports

The role of continuous renal replacement therapy (CRRT) has been expanding beyond support for acute kidney injury (AKI) in recent years. Children with malignancy are particularly at risk of developing conditions that may require CRRT. We reported three children with malignancy who received CRRT for non-AKI indications. Patient 1 was a 17-year-old teenage girl who developed refractory type B lactic acidosis due to relapse of acute lymphoblastic leukemia (ALL). Her peak lactate level was 18 mmol/L, and the lowest pH and bicarbonate level was 7.13 and 6.0 mmol/L, respectively. She received three sessions of high-volume hemodiafiltration to bring down the lactate level. Patient 2 was a 15-year-old male with T-cell ALL who developed cytokine storm requiring mechanical ventilatory and high-dose inotropic support due to necrotizing enterocolitis complicated by pneumoperitoneum and Klebsiella pneumoniae septicemia. He received two sessions of hemoperfusion using a specific filter capable of endotoxin absorption and cytokine removal and was successfully weaned off all inotropes after the treatment. Patient 3 was an 8-year-old boy who received bone marrow transplantation and developed worsening hyperbilirubinemia and deteriorating liver function. He received a session of single-pass albumin dialysis for bilirubin removal prior to liver biopsy. Except for mild electrolyte disturbances, no major CRRT complication was encountered. Our report demonstrated that CRRT is an effective and safe procedure for a wide spectrum of nonrenal conditions among children with oncological diagnoses in the pediatric intensive care unit. However, the optimal dose, regime, timing of initiation, and monitoring target for these indications remain to be determined.
Maternal immunization with ovalbumin or Dermatophagoides pteronyssinus has opposing effects on FcγRIIb expression on offspring B cells
Authors: Aline Aparecida de Lima Lira, Marília Garcia de Oliveira, Luana Mendonça de Oliveira, Alberto José da Silva Duarte, Maria Notomi Sato, Jefferson Russo Victor
Journal: Allergy Asthma Clin Immunol (2014)
Keywords: allergy, dermatophagoides pteronyssinus, fcγriib, maternal immunization
MeSH terms: Case Reports

Background:
Over the last decade, our group has demonstrated that murine preconception immunization with allergens has a protective effect on allergy development in offspring. The murine model used in the present study allowed us to compare allergy induction by ovalbumin (OVA) and dust mite extract from Dermatophagoides pteronyssinus (Dp).
Findings:
Female mice were immunized with OVA or Dp. Pups from immunized and non-immune mothers were immunized at 3 days old (do) with the same antigen used for the maternal immunization. The offspring were analyzed at 20 do. Preconceptional immunization with OVA or Dp did not increase maternal IgE serum levels, although the immunizations induced an increase in allergen-specific IgG1 Ab levels. Offspring serum analyses revealed that maternal immunization with OVA suppressed IgE production only in offspring immunized with OVA. Both preconception immunization protocols inhibited cellular influx into the airways of immunized offspring compared with controls. Similar frequencies of offspring IgM + B cells were found in the OVA- and Dp-immunized groups compared with their respective control groups. Moreover, preconception immunization with OVA enhanced FcγRIIb expression on OVA-immunized offspring B cells. In contrast, decreased FcγRIIb expression was detected on Dp-immunized offspring B cells compared with cells from the offspring of non-immune mothers.
Conclusions:
Together, these results show that preconception OVA immunization and Dp immunization can inhibit allergy development but have opposite effects on FcγRIIb expression on offspring B cells.
Bilateral Well Leg Compartment Syndrome Localized in the Anterior and Lateral Compartments following Urologic Surgery in Lithotomy Position
Authors: Tatsuya Yamamoto, Atsuhiro Fujie, Hidenori Tanikawa, Atsushi Funayama, Kentaro Fukuda
Journal: Case Rep Orthop (2018)
MeSH terms: Case Reports

Well leg compartment syndrome (WLCS) is a rare but severe complication after the surgery in lithotomy position. We present a case of bilateral WLCS that occurred after the prolonged urologic surgery in lithotomy position. A 50-year-old man complained of severe bilateral lower leg pain and swelling sixteen hours after the surgery. Physical examination, elevated serum creatine kinase value, contrasting computed tomography, and elevated compartment pressure strongly suggested the development of bilateral WLCS localized in the anterior and lateral compartments. Emergent single-incision fasciotomy was performed four hours after diagnosis. The patient was treated successfully without any neuromuscular dysfunction. An early and accurate diagnosis is important to avoid the delay of treatment and development of neuromuscular dysfunction.
Minimally Invasive Surgery for Sternoclavicular Joint Infection with Osteomyelitis, Large Abscesses, and Mediastinitis
Authors: Hideki Ota, Hirotaka Ishida, Hidekazu Matsumoto, Tomoharu Ishiyama
Journal: Case Rep Surg (2022)
MeSH terms: Case Reports

Background:
Sternoclavicular joint infections require en bloc resection for radical cure; however, this aggressive procedure may result in multiple adverse events. Therefore, performing minimally invasive surgery is desirable. In this report, we describe a case of sternoclavicular joint infection complicated by osteomyelitis, large abscesses, and mediastinitis that was successfully treated with incision and drainage. Case Presentation. A 42-year-old man with no medical history presented to our hospital with complaints of painful swelling in the left chest wall and acute dyspnea. Computed tomography revealed arthritis of the left sternoclavicular joint, osteomyelitis of the clavicle and sternum, anterior mediastinitis, and abscesses in the neck, chest wall, and retrosternal and extrapleural spaces. Gram staining of the aspirated pus revealed clusters of gram-positive cocci. A diagnosis of Staphylococcus aureus sternoclavicular joint infection with locoregional spread was made. Emergency surgery was performed following adequate resuscitation. A skin incision was made in the second intercostal space. The joint capsule was widely opened, necrotic tissue was curetted, and closed suction drains were placed in the abscess cavities and connected to a negative pressure system. The wound was then closed using primary sutures. The postoperative course was uneventful. Methicillin-sensitive Staphylococcus aureus was cultured from the pus. The patient was discharged on postoperative day 14. Osteomyelitis worsened within a few weeks after surgery but recovered with wound management and six weeks of antibiotic therapy. The patient has had no recurrence of infection for two years.
Conclusions:
Incision and drainage proved to be an effective minimally invasive surgical treatment for sternoclavicular joint infection with osteomyelitis, large abscesses, and mediastinitis caused by methicillin-sensitive Staphylococcus aureus.
A Rare Case of Chylothorax after Heart Transplantation
Authors: Amit Alam, Linle Hou, Dreamy James, Kanika Mody, Deepa Iyer, Aziz Ghaly, Jesus Almendral
Journal: Case Rep Cardiol (2019)
MeSH terms: Case Reports

Chylothorax is an exceedingly rare but serious complication of orthotopic heart transplantation (OHT). Prompt diagnosis and appropriate management are essential for a good outcome. Management is similar to that of nontransplant patients, but special attention must be given to patients' nutritional and immunological status. Relevant literature on this topic is limited. We describe our experience in the management of chylothorax after OHT and provide a summary of reported cases of this complication after isolated heart and combined heart/lung transplant.
A Rare Association of Takotsubo Cardiomyopathy with High-Degree Atrioventricular Block
Authors: Eder Hans Cativo, Rachna Valvani, Tuoyo O Mene-Afejuku, Diana P Cativo, Savi Mushiyev
Journal: Case Rep Cardiol (2017)
MeSH terms: Case Reports

Here we present a case of a patient who got trapped in an elevator; on initial evaluation patient was found with bradycardia; on further evaluation electrocardiogram (EKG) showed new onset 2nd-degree Mobitz type 2 AV block. On admission patient developed ischemic changes on EKG and troponin elevation. Transthoracic echocardiogram showed reduced ejection fraction as well as apical inferior, anterior, lateral, and septal hypokinesia. Coronary angiography showed nonobstructive coronary artery disease and ventriculogram demonstrated anterolateral and apical hypokinesia suggesting takotsubo cardiomyopathy (TCM). Atrioventricular block (AV) is rarely seen as initial presentation of TCM and has a prevalence of about 2.9%. AV block during early presentation of TCM poses a therapeutic dilemma with regard to the timing and the need to place a temporary or permanent pacemaker. The decision to place a permanent pacemaker may be on a case-by-case basis and more research is needed on formulating standardized recommendations in patients with TCM and conduction tissue abnormalities.