OpenMed/multicare-articles huggingface dataset:
Persistent SARS-CoV-2 infection in patients with B-cell deficiency: a case series of successful antiviral treatment of four patients
Authors: Lisa Faxén, Marie Edvinsson
Journal: Ups J Med Sci (2023)
Keywords: b-cell deficiency, b-cell depletion, covid-19, anti-cd20, epcoritamab, immunosuppression, persistent infection, rituximab
MeSH terms: COVID-19, Case Reports, Antiviral Agents / therapeutic use, Humans, Rituximab / therapeutic use, SARS-CoV-2, Rituximab, Antiviral Agents

Persistent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in immunocompromised patients remains a major medical challenge. Diagnosing the syndrome is difficult as symptoms may mimic other diseases and treatment guidelines are lacking. We describe a case series of four patients with persistent SARS-CoV-2 infection that all had an underlying B-cell deficiency due to rituximab treatment (in one case in combination with epcoritamab). In all four patients, it was initially difficult to recognize the persistent disease, leading to a duration of illness between 45 and 242 days. Two patients were only positive for SARS-CoV-2 by polymerase chain reaction (PCR) in the nasopharynx at the beginning of the disease but were later repeatedly negative. However, when bronchoalveolar lavage was performed, a positive SARS-CoV-2 PCR was revealed from the lower airways in both patients. The difficulties establishing diagnosis contributed to these two patients' long disease course. The longest disease duration was in the patient treated with rituximab and epcoritamab, who also responded poorly to single standard antiviral treatment. This patient ultimately cleared the infection after administering a combination treatment with remdesivir and nirmatrelvir/ritonavir. After a confirmed diagnosis, the other three patients cleared the infection when they were finally treated with antivirals. Increasing clinicians' awareness of this condition is important as it might be treatable once diagnosed. Further studies are warranted to define the condition and treatment strategy with greater precision.
Serious Complications of the Percutaneous A1 Pulley Release: Case Reports and Literature Review
Authors: Dong Chul Lee, Kyung Jin Lee, Hohyung Lee, Sung Hoon Koh, Jin Soo Kim, Si Young Roh
Journal: Arch Plast Surg (2024)
Keywords: complications, percutaneous a1 pulley release, trigger finger

Percutaneous first annular pulley (A1 pulley) release, which has been increasingly used to treat trigger fingers, has been widely established as a safe and simple procedure. Multiple studies have reported positive results of percutaneous A1 pulley release. In this study, however, we report cases of patients who developed complications after undergoing percutaneous A1 pulley release at local clinics. A total of six patients visited our hospital for infectious complications after percutaneous A1 pulley release. Various sequelae such as damage to normal structures, insufficient procedure, and tissue necrosis were observed during the exploration. A retrospective study was conducted to identify the cause and trend of the observed complications by instruments (HAKI knife or needle). In the HAKI knife group, there was a tendency for damage to normal structures, while in the needle group, an insufficient release or serious soft tissue necrosis was observed. Based on these cases, our findings confirm the existence and characteristics of infectious complications following the percutaneous A1 pulley release. We further identify that the type of instrument used predicts the nature of complications. Thus, reliable and skilled performance of the procedure by experts is essential for safe treatment.
Case Report: Popliteal artery entrapment syndrome as a cause of deep vein thrombosis and subsequent popliteal artery occlusion
Authors: Sangho Lee, Deokbi Hwang, Woo-Sung Yun, Seung Huh, Hyung-Kee Kim
Journal: Front Surg (2024)
Keywords: case report, deep vein thrombosis, gastrocnemius muscle, popliteal artery entrapment syndrome, popliteal vein
MeSH terms: Case Reports

Background:
Popliteal artery entrapment syndrome (PAES) is a relatively rare cause of arterial insufficiency in young and physically active individuals; however, deep vein thrombosis (DVT) can develop in association with PAES.
Case report:
A 47-year-old man presented with a 6-day history of left leg swelling and discomfort which was diagnosed as DVT extending to the distal femoral vein and pulmonary embolism on computed tomography (CT). PAES was not suspected at this time, and the patient was administered anticoagulants for 1 year. Two years after the DVT diagnosis, the patient developed sudden-onset left calf claudication for 1 week. Repeat CT angiography showed popliteal artery (PA) occlusion caused by PA displacement from an abnormally lateral insertion of the medial gastrocnemius head. A retrospective review of the initial CT scan confirmed this, as well as compression of the popliteal vein between the displaced medial head and the normal lateral head of the gastrocnemius. The patient eventually underwent myotomy and resection of the PA with an interposition graft.
Conclusion:
This case underscores the potential of PAES as a rare etiology of DVT, emphasizing the importance of considering it in the differential diagnosis of DVT in younger patients lacking common predisposing factors.
Atypical Management of Stroke Caused by Mucormycosis: Case Report and Review of the Literature
Authors: Lina Okar, Boulenouar Mesraoua, Dirk Deleu
Journal: Int Med Case Rep J (2023)
Keywords: mucormycosis, stroke, thrombolysis
MeSH terms: Case Reports

Mucormycosis is an opportunistic infection that affects immunocompromised patients, especially those with uncontrolled diabetes. Clinical presentation depends on the site of infection. Complications arise when the pathogen invades the host tissue causing vascular necrosisand distortion. Disease course is fast, and most of the time it has a poor or fatal outcome. Rhino-orbito-cerebral mucormycosis is the most common presenting form. Although initial complaints include fever, sinusitis, nasal discharge, headache, facial pain, and swelling, it should be kept in mind that patients might present during the complication period with a hemiparesis or altered mental status. Here, we present a case of patient who presented with a stroke and further workup revealed the presence of mucormycosis. According to our knowledge, this is the first case of mucormycosis complicated with stroke that was managed with thrombolysis.
Immune checkpoint inhibitor-induced cholangitis-a three-case series
Authors: Simon Gray, Nuria Santamaria, Anna Olsson-Brown
Journal: Explor Target Antitumor Ther (2024)
Keywords: immunotherapy, nsclc, cholangitis, immune checkpoint inhibitor, melanoma, renal cell carcinoma, toxicity
MeSH terms: Case Reports

Over the last decade, immune checkpoint inhibitors (ICIs) have dramatically improved the systemic treatment of multiple solid tumour types. However, they can also induce inflammation in an extensive range of normal tissues types. The entity of ICI-induced cholangitis is rare and has not been widely described. We present three cases of ICI-induced cholangitis which illustrate the difficulties associated with its diagnosis and management. We also present associated radiological findings that include intrahepatic duct abnormalities consistent with sclerosing cholangitis-progressive worsening of intrahepatic duct dilatation and pericholecystic haziness suggesting inflammation characteristic of this rare, but severe, toxicity.
A diabetic patient increased premature ventricular contractions after using liraglutide: a case report
Authors: Lilan Huang, He Yu, Ying Fang
Journal: Front Cardiovasc Med (2024)
Keywords: arrhythmia, diabetes mellitus, glucagon-like peptide-1 receptor agonists (glp-1ras), liraglutide, premature ventricular contractions
MeSH terms: Case Reports

The common adverse reactions of liraglutide are hypoglycemia and gastrointestinal reactions. This case reports a patient with type 2 diabetes mellitus who had an increase in ventricular premature beats after using liraglutide and a decrease in ventricular premature beats after stopping liraglutide, suggesting that clinicians should rule out the possibility of drug-related adverse reactions when using liraglutide in the treatment of diabetes mellitus complicated with coronary heart disease and arrhythmia.
Accessory first lumbrical muscle within the carpal tunnel: a case report
Authors: Yong-Seok Nam, Dong Yun Lee, Jung Soo Yoon, SooA Lim, SuRak Eo
Journal: Case Reports Plast Surg Hand Surg (2024)
Keywords: wrist, anomalous muscle belly, carpal tunnel release, carpal tunnel syndrome, lumbrical muscle, nerve compression
MeSH terms: Case Reports

Carpal tunnel syndrome is the most common entrapment neuropathy in the upper extremity. Palmaris longus, flexor digitorum superficialis, and lumbricals have infrequently been reported as causes of nerve compression. During routine Korean cadaver dissection, we incidentally identified an anatomic variant of first lumbrical muscle within the carpal tunnel in both wrists. The aberrant musculature originated from the radial side of the second FDS muscle at distal forearm level, running separately across the wrist beneath the flexor retinaculum. The dissected anomalous muscle was identified as an additional muscle belly of the first lumbrical muscle. Compression of the median nerve at the wrist might rarely be caused by the presence of such a tendon or muscle anomaly found in this study. Surgeons should be aware of possible anatomic variations in the carpal tunnel, and be prepared to modify their surgical plan accordingly.
Spinal myeloid sarcoma presenting as initial symptom in acute promyelocytic leukemia with a rare cryptic PLZF::RARα fusion gene: a case report and literature review
Authors: Xuejiao Zhang, Tao Wang, Pu Chen, Yan Chen, Zhimei Wang, Tianhong Xu, Pengfei Yu, Peng Liu
Journal: Front Oncol (2024)
Keywords: plzf
MeSH terms: Case Reports

Background:
Acute promyelocytic leukemia (APL) is rarely caused by the PLZF::RARα fusion gene. While APL patients with PLZF::RARα fusion commonly exhibit diverse hematologic symptoms, the presentation of myeloid sarcoma (MS) as an initial manifestation is infrequent.
Case presentation:
A 61-year-old patient was referred to our hospital with 6-month history of low back pain and difficulty walking. Before this admission, spine magnetic resonance imaging (MRI) conducted at another hospital revealed multiple abnormal signals in the left iliac bone and vertebral bodies spanning the thoracic (T11-T12), lumbar (L1-L4), and sacral (S1/S3) regions. This led to a provisional diagnosis of bone tumors with an unknown cause. On admission, complete blood count (CBC) test and peripheral blood smear revealed a slightly increased counts of monocytes. Immunohistochemical staining of both spinal and bone marrow (BM) biopsy revealed positive expression for CD117, myeloperoxidase (MPO), and lysozyme. BM aspirate showed a significant elevation in the percentage of promyelocytes (21%), which were morphologically characterized by round nuclei and hypergranular cytoplasm. Multiparameter flow cytometry of BM aspirate revealed that blasts were positive for CD13, CD33, CD117, and MPO. Through the integrated application of chromosome analysis, fluorescence in situ hybridization (FISH), reverse transcriptase polymerase chain reaction (RT-PCR), and Sanger sequencing, it was determined that the patient possessed a normal karyotype and a rare cryptic PLZF::RARα fusion gene, confirming the diagnosis of APL.
Conclusion:
In the present study, we report the clinical features and outcome of a rare APL patient characterized by a cryptic PLZF::RARα fusion and spinal myeloid sarcoma (MS) as the initial presenting symptom. Our study not only offers valuable insights into the heterogeneity of APL clinical manifestations but also emphasizes the crucial need to promptly consider the potential link between APL and MS for ensuring a timely diagnosis and personalized treatments.
Use of dupilumab for recalcitrant bullous pemphigoid: A case report
Authors: Jillian Lamb, Kerri Purdy, Ashley Sutherland
Journal: SAGE Open Med Case Rep (2024)
Keywords: bullous pemphigoid, biologics, bullous disease, dupilumab
MeSH terms: Case Reports

Bullous pemphigoid is an autoimmune blistering disease affecting the dermo-epidermal junction, most commonly seen in older patients. First-line treatment includes systemic, topical corticosteroids and/or steroid-sparing immunosuppressants. Treatment with these medications may be limited by their safety profile. Dupilumab is a humanized monoclonal antibody targeting interleukin-4 and interleukin-13 cytokines currently indicated for moderate-to-severe atopic dermatitis, severe asthma, chronic rhinosinusitis with nasal polyposis, and moderate-to-severe prurigo nodularis. We report a case of a patient with recalcitrant bullous pemphigoid effectively treated with dupilumab.
Transarterial Embolization of Type 2 Endoleak Post Thoracic Endovascular Aortic Repair (TEVAR) Using a Triaxial System With a 1.3-F Microcatheter: A Case Report
Authors: Yasuyuki Onishi, Hironori Shimizu, Masahide Kawatou, Kenji Minatoya, Yuji Nakamoto
Journal: Cureus (2024)
Keywords: distal access catheter, embolization, thoracic endovascular aortic repair, triaxial system, type 2 endoleak
MeSH terms: Case Reports

Although transarterial embolization is recognized as a treatment for type 2 endoleaks, it can occasionally be challenging. We report the case of an 86-year-old man who presented with an enlarging thoracoabdominal aortic aneurysm following thoracic endovascular aortic repair. Using a triaxial system with a 1.3-F microcatheter, transarterial embolization of a type 2 endoleak was successfully performed through a long and tortuous arterial route comprising the thoracodorsal and ninth intercostal arteries. The postoperative clinical course was uneventful, and computed tomography obtained six days later showed no endoleak in the thoracoabdominal aortic aneurysm. This case suggests the usefulness of a triaxial system with a 1.3-F microcatheter for transarterial embolization of type 2 endoleaks.
An Unusual Case of Flank Pain Late in Life: A Case Report
Authors: Kristel Sibaja, Harper Henderson, Alejandro Biglione, RaeAnn Tourangeau-Young
Journal: Cureus (2024)
Keywords: acute pain, congenital anomalies of the kidney and urinary tract (cakut), flank pain, fused kidney, horse shoe kidney, kidney anomaly
MeSH terms: Case Reports

Abnormalities in renal fusion represent a subset of congenital anomalies of the kidneys and urinary tract (CAKUT). Horseshoe kidneys (HSKs) are the fusion of kidneys at their lower poles. It is the most common form of CAKUT. Symptoms are usually subtle. The diagnosis is usually made incidentally during childhood. Rarely does an HSK become symptomatic later in life. We present the case of an 88-year-old female with a history of HSK who presented to the emergency department (ED) with a three-week history of left-sided flank pain, intermittent nausea, and reduced urine output. Her inpatient workup included imaging that revealed an HSK and bilateral hydronephrosis, which was more prominent on the left. The onset of symptoms for an HSK late in life is extremely rare.
No Little Feet: Managing Pseudocyesis in a Homeless, Acutely Manic Patient with Schizoaffective Disorder, Bipolar Type
Authors: Talitha West, Omotola Ajibade, Anthony Fontanetta, Samreen Munir
Journal: Case Rep Psychiatry (2023)
MeSH terms: Case Reports

Pseudocyesis is a complex psychiatric manifestation of the physical symptoms of pregnancy. Although not pregnant, the pseudocyetic patient displays signs and symptoms consistent with pregnancy, such as abdominal distention, cramping, and/or sensations of fetal movement. Pseudocyesis is more common in developing countries than in the developed world, possibly due to the importance that traditional societies attach to childbearing and the low social status that these societies assign to women who are unable to produce children. Socioeconomically disadvantaged women in developed countries may also be at increased risk. Although the etiology, pathogenesis, diagnosis, and management of pseudocyesis are poorly understood, it manifests with real symptoms, which may complicate both the patient's perspective about her condition and the medical and psychiatric teams' approach to the patient. This case report is one of only a few in the literature to present an example of pseudocyesis developing in the context of acute mania. After describing the patient's clinical course, from her initial symptoms of pseudocyesis to their eventual resolution, this report will provide recommendations for the sensitive care of patients with this rare but significant condition.
The Gastric Obstruction Due to Orbeez Beads Ingestion: A Case Report With Esophagogastroduodenoscopy Findings
Authors: Marjan Haider, Aamir Saeed, Michael Zijlstra, Kevin Wenzke, Emily Tommolino
Journal: Cureus (2024)
Keywords: esophagogastroduodenoscopy, foreign bodies, gastrointestinal tract, orbeez beads, water-absorbing beads
MeSH terms: Case Reports

Ingestion of non-food entities poses a critical risk, particularly in children and young adults. Mostly foreign bodies can safely pass through the gastrointestinal tract if they traverse the pylorus; however, ingestion of Orbeez beads can present as a unique challenge. Orbeez beads have the potential to absorb water and can expand in the stomach and small intestine, and can result in complications including constipation, intestinal obstruction, perforation, and peritonitis. Timely diagnosis and management are crucial to improve patient outcomes. We present a case of a 19-year-old male who ingested Orbeez beads and presented with nausea, vomiting, and abdominal pain. A non-contrast CT scan of the abdomen confirmed the foreign bodies. Fifty to seventy beads were successfully removed via esophagogastroduodenoscopy (EGD) without any complications, and the patient is currently doing well.
Development of Peptic Ulcer following Second Shot of Sputnik V Vaccine: A Case Report and Literature Review of Rare Side Effects of Sputnik V Vaccine
Authors: Maryam Hasanzarrini, Amir Mohammad Salehi, Samira Nirumandi Jahromi
Journal: Case Rep Infect Dis (2023)
MeSH terms: Case Reports

Considering the global spread of the coronavirus disease 2019 (COVID-19), it is expected that vaccination against its causative agent, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), will reduce the related morbidity and mortality. However, the safety of the COVID-19 vaccines and their potential and unknown side effects are a matter of concern. With the ongoing development and implementation of COVID-19 vaccination programs around the world, the side effects, safety, and effectiveness of these vaccines are gradually being reported, providing researchers with valuable information that can affect the production and utilization of the COVID-19 vaccines. The present study intended to report a case of peptic ulcer disease (PUD) development following vaccination with Gam-COVID-Vac, a vector-based COVID-19 vaccine containing two recombinant human adenoviruses (rAd26 and rAd5).
Case report: Slipped capital femoral epiphysis: a rare adverse event associated with FGFR tyrosine kinase inhibitor therapy in a child
Authors: Meziane Brizini, Tina Drimes, Catherine Bourne, Jessica Streilein, Annie Drapeau, Jens Wrogemann, Lori Anne Archer, Marc Del Bigio, Magimairajan Issai Vanan
Journal: Front Oncol (2024)
Keywords: erdafitinib, on-target skeletal toxicity, slipped capital femoral epiphysis, fibroblast growth factor receptor inhibitors, hypothalamic obesity
MeSH terms: Case Reports

We report a case of slipped capital femoral epiphysis (SCFE), an on target skeletal toxicity of a pan-FGFR TKI inhibitor, erdafitinib. A 13-year-old boy was diagnosed to have an optic pathway/hypothalamic glioma with signs of increased intracranial pressure and obstructive hydrocephalus requiring placement of ventriculo-peritoneal (VP) shunt. Sequencing of the tumor showed FGFR1-tyrosine kinase domain internal tandem duplication (FGFR1-KD-ITD). He developed hypothalamic obesity with rapid weight gain and BMI >30. At 12 weeks of treatment with erdafitinib, he developed persistent knee pain. X-ray of the right hip showed SCFE. Erdafitinib was discontinued, and he underwent surgical pinning of the right hip. MRI at discontinuation of erdafitinib showed a 30% decrease in the size of the tumor, which has remained stable at 6 months follow-up. Our experience and literature review suggest that pediatric patients who are treated with pan-FGFR TKIs should be regularly monitored for skeletal side effects.
Retrospective assessment of the use of extended-release cabergoline in the management of equine pituitary pars intermedia dysfunction
Authors: Tania Sundra, Erin Kelty, Gabriele Rossi, David Rendle
Journal: Front Vet Sci (2024)
Keywords: acth, dopamine, endocrine, geriatric, horse, laminitis

Introduction:
Dopaminergic agonists are accepted as the most effective treatment for pituitary pars intermedia dysfunction. However, some horses are refractory to daily oral pergolide, the recommended registered treatment. Extended-release cabergoline (ERC) injection may offer an alternative. The objective of this retrospective case series was to describe clinical and endocrinological responses to ERC.
Methods:
Medical records of horses treated with weekly intramuscular injections of ERC (5 mg/mL, BOVA Aus) at either 0.01 mg/kg (high dose, HD) (n = 10) or 0.005 mg/kg (low dose, LD) (n = 30) were reviewed. Short-term ACTH responses were assessed at 5-8 days using a Wilcoxon signed ranked test. Longer-term ACTH responses (30 to 365 days) were assessed using generalised estimating equations.
Results:
Five to eight days after the first dose of LDERC, median adrenocorticotropic hormone (ACTH) concentration was lower (p = 0.001), changing from 153 pg/mL (IQR: 78, 331) to 57 pg/mL (IQR: 30, 102). With HDERC, median ACTH concentration was also 153 pg/mL (IQR: 96, 185) before and then 56 pg/mL (IQR: 29, 86) after 5-8 days of treatment (p = 0.047). Over 12 months of treatment, ACTH concentration ranged from 14 to >1,250 pg/mL (median: 51 pg/mL) in horses treated with LDERC and 20 to 472 pg/mL (median: 50 pg/mL) in horses treated with HDERC. Measurements remained above the seasonal reference range in 39.3 and 52.3% of horses treated with LDERC and HDERC, respectively. Clinical improvement was reported by owners in 78.3 and 100% of horses treated with LDERC and HDERC, respectively. Partial, self-limiting inappetence was reported in 30.0% of LDERC and 60% HDERC cases. Seven horses exhibited lethargy (5 LDERC, 2 HDERC). Insulin concentrations measured 30 days post-ERC treatment were no different from baseline.
Discussion:
Clinical and endocrinological responses were consistent with results of previous reports of oral pergolide treatment. Weekly injection of ERC may be an effective alternative to pergolide; the 0.005 mg/kg dose appeared to be as effective, with less risk of inappetence, than the 0.01 mg/kg dose that has been reported previously.
Case report: Treatment response of NF-1-associated bladder ganglioneuroma to trametinib
Authors: Marcus C Y Chan, Kevin K F Fung, Wai-Fu Ng, Ho-Ming Luk, Dennis T L Ku, Anthony P Y Liu
Journal: Front Oncol (2024)
Keywords: mapk pathway, mek inhibitor, ganglioneuroma, neurofibromatosis type 1 (nf-1), targeted therapy
MeSH terms: Case Reports

We present the clinical course of a 4-year-old girl with neurofibromatosis type 1-associated, unresectable, symptomatic urinary bladder ganglioneuroma. She was initially trialed on sirolimus without response and subsequently responded to MEK inhibitor trametinib, with improvement clinically and radiographically over 10 months. This report broadens the repertoire of therapeutic strategies for MEK inhibition in diseases related to the MAPK pathway.