OpenMed/multicare-articles huggingface dataset:
Clinical characteristics and treatment outcomes in acromegaly, a retrospective single-center case series from Thailand
Authors: Poranee Ganokroj, Sarat Sunthornyothin, Rungsak Siwanuwatn, Kraisri Chantra, Patinut Buranasupkajorn, Sompongse Suwanwalaikorn, Thiti Snabboon
Journal: Pan Afr Med J (2021)
Keywords: acromegaly, gigantism, pituitary tumor
MeSH terms: Acromegaly / therapy, Adenoma / epidemiology, Insulin-Like Growth Factor I / metabolism, Acromegaly / diagnosis, Adenoma / pathology, Adolescent, Adult, Aged, Female, Follow-Up Studies, Humans, Male, Middle Aged, Retrospective Studies, Thailand, Treatment Outcome, Young Adult, IGF1 protein, human, Insulin-Like Growth Factor I

Introduction:
acromegaly, an overproduction of growth hormone (GH), is associated with high rate of morbidity and mortality particularly in case of delayed in diagnosis and treatment. A wide variation of clinical presentations, treatment outcomes and morbidities have been reported.
Methods:
a retrospective study was conducted to review clinical characteristics and treatment outcomes of patients with acromegaly treated in King Chulalongkorn Memorial Hospital, Bangkok, Thailand, between 2006 and 2018.
Results:
eighty-four patients (31 males and 53 females) were reviewed, mean age at diagnosis was 45.7 ± 12.6 years (±SD), mean time of disease onset was 7.6 ± 6.4 years and mean follow-up period was 7.8 ± 5.3 years. The most common presenting symptoms were maxillofacial change (96.8%) and acral enlargement (94.7%). Hypertension (39.3%), diabetes mellitus (28.6%) and dyslipidemia (23.8%) were prevalent co-existing conditions. Four patients were identified having cancer at presentation; however, no additional malignancy was reported during the follow up. Most patients harbored macroadenomas, only 10 were found to have microadenomas. The outcomes of treatment were controlled disease in 70% of microadenoma and 64.9% of macroadenoma. Permanent loss of pituitary function was found in about 21.3% and there was one case reported of mortality. The logistic regression analysis for controlled disease outcome showed the IGF-I index after surgery was associated with controlled disease outcome with statistically significant result (P-value=0.006).
Conclusion:
our study offers descriptive clinical data of case series of acromegalic patients, which had favorable outcomes comparable with previous reports. In addition, IGF-I index after surgery is a predictive parameter for outcome of treatment.
Anti-3-Hydroxy-3-Methylglutaryl-Coenzyme A Reductase Immune-Mediated Necrotizing Myopathy following mRNA SARS-CoV-2 Vaccination
Authors: Marta Rodrigues de Carvalho, Myrian Mathildes Sá de Deus Rocha, Vinícius Alves Bezerra, Maciel Eduardo de Pontes, Maria Cristina Del Negro, Julio Salgado Antunes, Vinícius Viana Abreu Montanaro, Rubens Nelson Morato Fernandez
Journal: Case Rep Neurol Med (2023)
MeSH terms: Case Reports

The new coronavirus (COVID-19) pandemic has resulted in the unprecedented production of vaccines. In this context, the possible adverse effects remain to be identified and reported. In this article, we report the case of a young female patient who developed anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (anti-HMG-CoA) immune-mediated necrotizing myositis (IMNM) after receiving the Pfizer-BioNTech (BNT162b2) COVID-19 vaccine. The diagnosis of probable post-vaccination IMNM was made due to the absence of other factors that may have led to the development of autoantibodies (medicines; e.g., statins, drugs) and the temporal relationship between exposure and event. This case report is the first to suggest that a COVID-19 vaccine may trigger anti-HMG-CoA reductase necrotizing myopathy.
High quality of 58-month life in lung cancer patient with brain metastases sequentially treated with gefitinib and osimertinib
Authors: Ying Zhang, Xiaowen Zhang, Fang Wang, Yan Feng, Huaping Tang
Journal: Open Med (Wars) (2021)
Keywords: t790m mutation, bone metastasis, brain metastases, exon 21 mutation, gefitinib, lung adenocarcinoma cancer, osimertinib
MeSH terms: Case Reports

Brain metastases (BMs) and bone metastases seriously affect the prognosis of lung cancer patients. How to optimize the use of existing targeted drugs is an important way to address the clinical needs of the central nervous system in the individualized treatment of non-small cell lung cancer (NSCLC). In this report, we describe an NSCLC patient with BMs who survived for 58 months, which is the longest survival case among lung cancer patients with BMs. The patient was initially diagnosed with lung cancer more than 5 years ago with simultaneous brain, bone, and lung metastases. After gefitinib resistance, she received osimertinib in sequence with no progress for 58 months in total and maintained very good quality of life.
Thrombotic Microangiopathy Associated with Pazopanib in a Kidney Transplant Recipient
Authors: Shabana Kalla, Robert J Ellis, Scott B Campbell, Brian Doucet, Nicole Isbel, Bibiana Tie, Dev Jegatheesan
Journal: J Kidney Cancer VHL (2021)
Keywords: kidney transplant, pazopanib, thrombotic microangiopathy, vascular endothelial growth factor inhibitors
MeSH terms: Case Reports

Thrombotic microangiopathy (TMA) is characterised by abnormalities in the walls of arterioles and capillaries, precipitated by hereditary or acquired characteristics, and culminating in microvascular thrombosis because of dysregulated complement activity. A number of drugs can precipitate TMA, including vascular endothelial growth factor (VEGF) inhibitors, because of their effects on endothelial repair. Pazopanib is a VEGF inhibitor used for the treatment of renal cell carcinoma (RCC); it is uncommonly associated with TMA. A 52-year-old male, 5 years post his second kidney transplant secondary to immunoglobulin (Ig) A nephropathy, presented with hypertension, fluid overload, and worsening graft function (peak creatinine 275 µmol/L, baseline 130-160 µmol/L) and nephrotic range proteinuria 2 months after commencing pazopanib for metastatic RCC. His maintenance immunosuppression included ciclosporin, mycophenolate, and prednisolone. Haematological parameters were unremarkable. Allograft biopsy demonstrated glomerular and arteriolar changes consistent with chronic active TMA, with overlying features of borderline cellular rejection. He was treated with intravenous methylprednisolone 250 mg for 3 days and commenced on irbesartan 75 mg daily. Drug-induced TMA from pazopanib was suspected, particularly given the documented association with other tyrosine kinase inhibitors (TKIs). In consultation with his medical oncologist, pazopanib was ceased, and an alternate TKI cabozantinib was commenced. Serum creatinine remained <200 µmol/L 3 months after admission. This is the first reported biopsy-proven case of TMA attributed to pazopanib in a kidney transplant recipient. With increasing clinical indications for and availability of TKIs, clinicians need to be aware of their association with TMA events in kidney transplant recipients, who are already susceptible to TMA due to abnormal vasculature, infectious triggers, ischaemia-reperfusion injury, and use of calcineurin inhibitor.
Case report: Severe combined immunodeficiency with ligase 1 deficiency and Omenn-like manifestation
Authors: Nel Dabrowska-Leonik, Agata Karolina Pastorczak, Katarzyna Bąbol-Pokora, Katarzyna Bernat-Sitarz, Barbara Piątosa, Edyta Heropolitańska-Pliszka, Magdalena M Kacprzak, Krzysztof Kalwak, Katarzyna Gul, Mirjam van der Burg, Marek Ussowicz, Malgorzata Pac
Journal: Front Immunol (2022)
Keywords: immunoglobilins, omenn-like, hematopoietic stem cell transplantation (hcst), immunodeficiency, ligase 1
MeSH terms: Anemia, Macrocytic, Hematopoietic Stem Cell Transplantation / methods, Severe Combined Immunodeficiency / diagnosis, Severe Combined Immunodeficiency / genetics, Severe Combined Immunodeficiency / therapy, Case Reports, Chimerism, DNA Ligase ATP / genetics, Female, Humans, Infant, DNA Ligase ATP

DNA ligase I deficiency is an extremely rare primary immunodeficiency with only 6 patients reported in the literature. Most common manifestations include radiosensitivity, macrocytic anemia, lymphopenia with an increased percentage of gamma-delta T cells, and hypogammaglobulinemia requiring replacement therapy. Two-month-old girl with delayed development, T-B-NK+ SCID, and macrocytic anemia presented features of Omenn syndrome. Whole exome sequencing revealed two novel, heterozygous variants (c.2312 G&gt;A, p.Arg771Gly and c.776+5G&gt;T, p.Pro260*) in the LIG1 gene (NM_000234.1). Hematopoietic stem cell transplantation from a fully matched unrelated donor was performed at the age of 4 months using GEFA03 protocol. Mixed donor-recipient chimerism was observed, with 60-70% chimerism in the mononucleated cell compartment and over 90% in T-lymphocyte compartment, but autologous myeloid recovery. Stable CD4+ and CD8+ T-cell counts above 200/µL were achieved after 2 months, but the patient remained transfusion-dependent. Despite satisfactory immunological reconstitution, the second transplantation due to constitutional hemolytic defect has been considered. In light of possible re-transplantation, an issue of optimal conditioning protocol with sufficient myeloid engraftment is important. For the first time Omenn syndrome is described in a compound heterozygote carrying two the novel variants p.Arg771Gly and p.Pro260* in the LIG1 gene. Patients diagnosed with SCID and Omenn syndrome showing macrocytic anemia, should be screened for DNA ligase I deficiency.
Reversible Conduction Failure in Anti-lactosylceramide-antibody-positive Combined Central and Peripheral Demyelination
Authors: Masaya Harada, Shiroh Miura, Hiroshi Kida, Taiga Moritaka, Ken-Ichi Irie, Takashi Kamada, Yusuke Uchiyama, Sayuri Shima, Tatsuro Mutoh, Tomoaki Hoshino, Takayuki Taniwaki
Journal: Front Neurol (2019)
Keywords: combined central and peripheral demyelination (ccpd), encephalomyeloradiculoneuropathy (emrn), lactosylceramide, reversible conduction failure (rcf), steroid, therapy, total plasma exchange
MeSH terms: Case Reports

We describe a 60-year-old woman with combined central and peripheral demyelination who presented with obstinate constipation, weakness in the lower limbs, and a bilateral sensory disturbance below her chest followed by girdle sensation in the right region of the abdomen, which was responsive to steroid therapy and plasmapheresis. Serum anti-lactosylceramide antibody was positive without anti-neurofascin 155 antibody or anti-galactocerebroside antibody positivity. Two months later, the patient had a first relapse that was responsive to steroid treatment. A nerve conduction study confirmed reversible conduction failure (RCF) in both episodes. Our case is unique in that she had an RCF episode as well as some similarities to encephalomyeloradiculoneuropathy.
An Unusual Presentation of B-Cell Lymphoma as a Large Isolated Epiglottic Mass: Case Report and Literature Review
Authors: Changxing Liu, Sean Delaney, Tamara N Brown
Journal: Case Rep Otolaryngol (2016)

Extranodal presentation of B-cell lymphoma is uncommon. Isolated primary epiglottic B-cell lymphoma is even rarer. To our knowledge, there has been only one description of isolated B-cell lymphoma presenting as a large epiglottic mass. We report an unusual type of B-cell lymphoma of the epiglottis, as it could not be subtyped based on routine staining and hybridization. The lymphoma presented as a large isolated globular mass pedicled to the epiglottis, occupying most of the oropharynx, but did not have any ball-valving effect or increased respiratory efforts. Initial radiographic findings were nonspecific. The diagnosis of B-cell lymphoma was determined by transoral incisional biopsy under local anesthesia. The condition was treated successfully with chemoradiation. The current standard of treatment for high grade B-cell lymphoma is concurrent chemoradiotherapy, with excellent prognosis. Although rare, B-cell lymphoma should be considered when investigating pedunculated hypopharyngeal masses.
Flavorubredoxin, a Candidate Trigger Related to Thrombotic Thrombocytopenic Purpura: Screening of the Complete Genome of a Salmonella enterica Serovar Typhimurium Isolate From an AIDS Case
Authors: Zhouhan Wang, Hao Xu, Beiqing Gu, Yanqi Jin, Tianyuan Wang, Jindi Ma, Yingfeng Lu, Xiaopeng Yu, Beiwen Zheng, Yimin Zhang
Journal: Front Cell Infect Microbiol (2022)
Keywords: adamts13, hiv, salmonella, flavorubredoxin, thrombotic thrombocytopenic purpura
MeSH terms: Acquired Immunodeficiency Syndrome, Hemolytic-Uremic Syndrome, Purpura, Thrombotic Thrombocytopenic / diagnosis, Salmonella enterica / genetics, Case Reports, Review, Research Support, Non-U.S. Gov't, Humans, Phylogeny, Salmonella typhimurium / genetics, Serogroup

Thrombotic thrombocytopenic purpura (TTP) is one of the two classic thrombotic microangiopathy (TMA) diseases which could be induced by infections. To the best of our knowledge, this is the first report of an acquired immunodeficiency syndrome (AIDS) patient with acquired TTP induced by infection with Salmonella enterica serovar Typhimurium (hereafter, S. Typhimurium) isolate, S. Typhimurium_zhang, which was confirmed by serology and genetic taxonomy. The literature review identified 17 TMA-related genes encoding the candidate triggers, which were searched in the annotated genome sequence of S. Typhimurium_zhang. Anaerobic nitric oxide reductase flavorubredoxin (FlRd), encoded by norV which is related to another TMA, haemolytic uraemic syndrome (HUS), was found in S. Typhimurium_zhang. Basic local alignment search tool (BLAST) analysis revealed that norV and FlRd in S. Typhimurium_zhang, as well as eight S. Typhimurium type strains, have high identity with HUS-related Escherichia coli O157:H7 strain TW14359. Similar results were obtained from the BLAST analysis of 73 S. enterica isolates for congenital TTP which was also previously reported to be triggered by S. enterica. Phylogenetic analysis and amino acid sequence alignment revealed that FlRd was functional and highly conservative on 69 Enterobacteriaceae, including S. Typimurium_zhang and TW14359. In brief, we found norV in the genome of a S. Typhimurium clinical isolate that induced TTP in an AIDS patient. FlRd, the protein encoded by norV, probably triggered the TTP and was highly conservative, functional, and widespread in S. enterica and Enterobacteriaceae. More in vitro and in vivo studies are required to confirm our findings and determine the underlying mechanism.
Trichosporon Endophthalmitis Following Cataract Surgery: A Case Report
Authors: Saritrasaraswathy Thilagaraj, Mimiwati Zahari, Krishnan Sarojini, Fazilawati A Qamarruddin
Journal: Cureus (2023)
Keywords: complication, exogenous endophthalmitis, fungal, normal ocular flora, phacoemulsification cataract surgery, trichosporon species, type-2 diabetes mellitus, voriconazole
MeSH terms: Case Reports

Fungal infections always pose a predicament to management and prognosis. The saprophytic fungus, Trichosporon inkin commonly causes endogenous infection in immunocompromised individuals. We report a case of exogenous T. inkin endophthalmitis successfully treated with voriconazole, pars plana vitrectomy, and removal of the source of infection. A 51-year-old gentleman with suboptimal control of diabetes presented with a right painful red eye for a week after undergoing an uneventful phacoemulsification with a posterior chamber intraocular lens implant more than a month prior. He presented with intense inflammation in the right anterior chamber that did not respond to steroid challenge. Ultrasound B scan showed vitreous opacities with no loculations. The culture of vitreous humor was negative. Systemic investigations were also normal. Despite being given multiple intravitreal antibiotics, his right eye got worse. He then underwent vitrectomy and intraocular lens explantation, in which the culture of the lens grew Trichosporon Inkin. He was subsequently started on the appropriate antifungals (topical, intravitreal, and systemic) based on the minimum inhibitory concentration of the antifungal sensitivity test. The patient eventually showed significant clinical improvement, and intraocular inflammation was subsiding after six months of treatment. His best corrected visual acuity improved to 6/12 with Snellen's visual acuity chart.
Bile acid nephropathy induced by anabolic steroids: A case report and review of the literature
Authors: Hamdan Al Awadhi, Sarah Al Qassimi, Aya Akhras, Leal Herlitz, Muriel Ghosn
Journal: Clin Nephrol Case Stud (2021)
Keywords: anabolic steroids, bile acid nephropathy, cholemic nephropathy, drug-induced liver injury

Bile acid nephropathy also known as cholemic nephropathy is a rare and overlooked form of acute kidney injury that occurs in the setting of severe hyperbilirubinemia. The exact etiology remains unknown, and there is a lack of treatment guidelines for this clinical condition. Anabolic steroids are known to cause hepatoxicity occasionally leading to acute kidney injury. We report the case of a 27-year-old male patient who developed bile acid nephropathy as a result of severe hyperbilirubinemia secondary to anabolic steroids-induced liver injury. He was conservatively managed. We review the current literature touching on the etiology, pathophysiology, diagnosis, and management of bile acid nephropathy in an attempt to shed light on this clinical condition, which may present as a diagnostic and therapeutic challenge.
Multimodal image characterization of paravenous atrophy
Authors: Carmen Alba-Linero, Glenda Espinosa Barberi, Victor Llorens, María Socorro Alforja Castella, Alfredo Adán
Journal: GMS Ophthalmol Cases (2019)
Keywords: autofluorescence, multimodal image, optical coherence tomography angiography, paravenous atrophy, retinitis pigmentosa-like
MeSH terms: Case Reports

Objective: The objective is to describe a clinical case of paravenous atrophy using a multimodal image. Methods: A 48-year-old man was visited and followed in the ophthalmology department of Hospital Clinic (Barcelona). Visual acuity, slit-lamp exam, retinography, autofluorescence, visual field, optical coherence tomography, and electrophysiology test were performed. Results: The patient had a history of Behcet's disease. Autofluorescence revealed hypoautofluorescence at the paravenous region, th visual field was also altered and electrophysiologic test were reduced. Conclusion: Paravenous atrophy is a rare entity not well described currently. Patients are frequently misdiagnosed. Multimodal image could help to characterize this condition properly and improve the management.
An alternative technique for surgical management of poststernotomy osteomyelitis and reconstruction of the sternal defect
Authors: Petros Konofaos, Eleftherios Spartalis, Grigorios Karagkiouzis, Christos Kampolis, Periklis Tomos
Journal: Case Rep Surg (2013)

Introduction. Sternal osteomyelitis with or without mediastinal infection is a severe and rare complication of median sternotomy. In this paper, an alternative technique for the reconstruction of sternal defects with the use of bilateral pectoralis major pedicled muscle flaps is presented. Case presentation. A 70-year-old man with the diagnosis of poststernotomy osteomyelitis underwent reconstruction of his sternal defect with the use of bilateral pectoralis major muscle flaps. The patient had an uneventful recovery, and the physical examination revealed a normal range of motion for both upper limbs and sternal stability. Conclusion. The proposed technique incorporates a simple mobilization of the two pectoralis major muscles to be used as flaps to fill the sternal defect without the need for humeral detachment or a second cutaneous incision. Using this technique, a muscular implant is made that seals the dead space, which has no tension due to the presence of a second layer. Postoperative results are excellent, not only regarding infection and functionality but also from an aesthetic point of view.
A large verrucous plaque on the buttocks: a case report of an atypical presentation of tuberculosis verrucosa cutis
Authors: Yulia Asmarani, Rizki Citra Mulia, Anni Adriani
Journal: Pan Afr Med J (2020)
Keywords: atypical, annular hyperkeratotic plaque, central healing, tuberculosis verrucosa cutis
MeSH terms: Antitubercular Agents / administration & dosage, Buttocks / pathology, Tuberculosis, Cutaneous / diagnosis, Case Reports, Adult, Humans, Male, Treatment Outcome, Tuberculosis, Cutaneous / drug therapy, Tuberculosis, Cutaneous / physiopathology, Antitubercular Agents

Although the incidence of cutaneous tuberculosis (TB) has declined among all cases in dermatology outpatient settings, atypical cases are still being reported worldwide. These atypical forms can imitate other conditions hence delaying the diagnosis and increased morbidity. We report a case of an atypical presentation of extensive Tuberculosis Verrucosa Cutis (TVC) on the buttocks presenting as an annular hyperkeratotic plaque with central healing. Suspicious clinical manifestations and histopathological features followed by an excellent response with antituberculosis therapy confirmed the diagnosis of TVC. Recalcitrant chronic lesions even with adequate standard treatment should raise suspicion of cutaneous TB, especially in endemic areas.
Case Report: Using ultrasound to prevent a broken catheter from migrating to the heart
Authors: Pieter J Schraverus, Suzanne van Rijswijk, Pieter Roel Tuinman
Journal: F1000Res (2017)
Keywords: broken catheter, echography, ultrasound

Peripheral intravenous (IV) catheters can break off while still in the patient, with possible detrimental effects such as upstream migration to the heart. These catheters have probably been damaged by the needle during a difficult insertion. A peripheral IV catheter was removed in a 90 year old patient and only half of the catheter was retrieved. By using ultrasound examination the remaining part of the IV catheter was identified, and retrieved surgically, before it could migrate towards the heart. This case report suggests that ultrasound should not only be used for difficult placement of a peripheral IV catheter, but can also be used when removal is complicated.
Liver transplantation from a donor with multiple biliary hamartomata
Authors: R F Saidi, V Yoon, N Jabbour, S A Shah, A Bozorgzadeh
Journal: Int J Organ Transplant Med (2013)
Keywords: biliary hamartoma, liver, liver transplantation, benign lesions
MeSH terms: Case Reports

Biliary hamartomata are rare benign lesions. Herein, we report on a 48-year-old man with a history of end-stage liver disease secondary to alcoholic liver disease. The patient received an orthotropic liver transplant from a brain-death woman. At the time of recovery, there were multiple lesions in the transplanted liver measuring 7-10 mm. Pathology revealed multiple biliary hamartomata. The postoperative course of the recipient was uncomplicated and he was discharged home 10 days after the transplantation.