OpenMed/multicare-articles huggingface dataset:
Sarcoidosis-like reaction induced by immune checkpoint inhibitor in a patient with hepatocellular carcinoma: a case report
Authors: Alberto Torres-Zurita, Lucía Vázquez-Montero, Laura Gallego-López, María Dolores Mediano-Rambla, Luis de la Cruz-Merino
Journal: Front Immunol (2023)
Keywords: hepatocellular carcinoma, immune related adverse event (irae), immune-checkpoint inhibitor, nivolumab plus ipilimumab combination therapy, sarcoidosis
MeSH terms: Antineoplastic Agents, Immunological / adverse effects, Carcinoma, Hepatocellular / drug therapy, Liver Neoplasms / drug therapy, Sarcoidosis / chemically induced, Sarcoidosis / diagnosis, Sarcoidosis / drug therapy, Case Reports, Adult, Disease Progression, Humans, Immune Checkpoint Inhibitors / adverse effects, Male, Immune Checkpoint Inhibitors, Antineoplastic Agents, Immunological

Nowadays, immune checkpoint inhibitors (ICI) have become the cornerstone of treatment for many tumors, either as monotherapy or in combination with other therapies. However, these drugs are associated with several new side effects that need early detection. We present the case of a 41-year-old male patient who has been diagnosed with advanced hepatocellular carcinoma (HCC) with metastatic retroperitoneal lymph nodes and a subdiaphragmatic metastatic lesion, undergoing second-line treatment with a combination of nivolumab and ipilimumab. After completing four cycles, the patient was admitted to the hospital due to intermittent fever and profuse sweating. A CT scan showed multiple pathologically enlarged lymph nodes in several locations, raising suspicion of disease progression. The patient's clinical progress was favorable after symptomatic treatment (antipyretics) and was discharged one week after admission. Several days later, the patient complained about painful bilateral ocular redness and was diagnosed with bilateral anterior uveitis. Further blood tests showed elevated angiotensin-converting enzyme (ACE) levels of 67 U/L (normal range: 8 - 52) and decreasing alpha-fetoprotein (AFP) levels of 698 ng/mL (previously 1210 ng/mL), indicative of non-progression of the oncological disease. Finally, an excisional biopsy confirmed the presence of non-necrotizing granulomatous lymphadenitis, leading to the diagnosis of sarcoidosis-like reaction (SLR) induced by immunotherapy as the etiology of the polyadenopathy syndrome. SLR, although uncommon, is an adverse effect of ICI treatment resulting from immune system dysregulation, which can mimic disease progression. It is crucial to be aware of this adverse event and to understand the optimal management approach.
Ibrutinib-associated cutaneous mucormycosis due to an Apophysomyces species: report of a case and review of the literature
Authors: Trung Minh Nguyen, Eva Amenta, Lynne Chapman, Sarvari Yellapragada, Bhuvaneswari Krishnan, Jonathan Lim, Richard J Hamill
Journal: Ther Adv Infect Dis (2024)
Keywords: apophysomyces, ibrutinib, invasive fungal infection, mucormycosis
MeSH terms: Case Reports

The use of ibrutinib, a Bruton tyrosine kinase inhibitor, has been associated with invasive fungal infections (IFIs). We describe a case of Apophysomyces infection associated with long-term use of ibrutinib for the treatment of chronic lymphocytic leukemia as well as perform a literature review of Mucormycosis infections in patients on ibrutinib. Our review found that the onset of IFI can occur within months to years of starting tyrosine kinase inhibitors. These reports provide a more complete picture of the risk of IFI while patients are on ibrutinib. Our case also demonstrates the utility of molecular techniques in the diagnosis of IFI, as the diagnosis was made using 28S rDNA/internal transcribed spacer PCR.
Upper Gastrointestinal Bleeding Secondary to Sodium Polystyrene Sulfonate Use: A Rare Adverse Effect of Commonly Prescribed Treatment
Authors: Hamzah Shariff, Shiva Naidoo, Ghazal Ghafari, Hongjie Li, Manisha Devi, Kishore Kumar
Journal: Case Rep Gastrointest Med (2024)
MeSH terms: Case Reports

We report a case of a 62-year-old man who was brought in by emergency medical services after a fall and change in mental status. He was found to have severe hyperkalemia, acute kidney injury, and rhabdomyolysis. The hyperkalemia was treated with sodium polystyrene sulfonate (SPS). During hospitalization, he witnessed having black tarry stools along with a significant drop in hemoglobin. Endoscopic evaluation demonstrated nonbleeding large diffuse gastric ulcers with stigmata of recent bleeding, and ulcer biopsy revealed findings consistent with SPS-induced gastric ulceration. No other source of bleeding was localized, suggesting acute upper gastrointestinal bleeding due to SPS mucosal injury.
Perineal papilliferous syringocystadenoma: An unusual localization
Authors: Hamza Ouzzaouit, Boubker Idrissi Kaitouni, Sekkat Hamza, Fouad Zouaidia, Yassine Berrada, Farid Sabbah
Journal: Int J Surg Case Rep (2024)
Keywords: cystic masse, perineal, surgery, syringocystadenoma papiliferum
MeSH terms: Case Reports

Introduction and importance:
Syringocystadenoma papiliferum (SCAP) is an infrequent, benign neoplasm originating from the apocrine or, less frequently, eccrine sweat glands. This condition predominantly manifests in regions such as the head, face, neck, and trunk. Notably, it is frequently associated with hamartomas of endocrine, sebaceous, or follicular origin, as well as with sebaceous nevi.
Case presentation:
In the context of this study, we present a clinical case involving a 65-year-old patient who exhibited an atypical anatomical presentation of syringocystadenoma papiliferum.
Clinical discussion:
This case highlights the importance of considering SCAP as a potential diagnosis of perineal cystic masses that need a surgical excision due to the risk of malignancy transformation.
Conclusion:
The uniqueness of the case under consideration lies in the rarity of syringocystadenoma papiliferum (SCAP), the atypical perineal localization, and its occurrence at an advanced age (65 years).
Case Report: Primary endodermal sinus tumor on the abdominal wall near the right liver: a diagnostic pitfall
Authors: Shuo Chen, Feng Chen, Xiao Xu
Journal: Front Oncol (2023)
Keywords: doppler, x-ray computed, abdominal wall, color, endodermal sinus tumor, magnetic resonance imaging, tomography, ultrasonography
MeSH terms: Case Reports

Background:
Endodermal sinus tumors are rare, especially extragonadal endodermal sinus tumors, which often occur in the midline of the brain, neck, chest, and abdomen.
Case summary:
We present the case of a 37-year-old woman with a mass on the right edge of the liver. Color Doppler ultrasound, computed tomography, and magnetic resonance imaging examinations were performed before the operation. Given these results and the elevation of alpha-fetoprotein, the diagnosis of hepatocellular carcinoma was made. Postoperative pathological examination indicated an endodermal sinus tumor on the abdominal wall near the right liver. The causes of misdiagnosis were analyzed, and the related literature was reviewed.
Conclusion:
Primary endodermal sinus tumors on the abdominal wall near the right liver are easily misdiagnosed as hepatocellular carcinoma due to liver compression and elevated alpha-fetoprotein. The key point of differentiation is the wide basal connection between the tumor and the abdominal wall near the liver. In addition, the enhancement mode of endodermal sinus tumors is different from the enhancement pattern of hepatocellular carcinoma.
Core tip:
Extragonadal endodermal sinus tumors often occur in the midline of the body. Here, we present a case of a primary endodermal sinus tumor on the abdominal wall near the right liver for the first time.
Case report: Intrafraction dose-guided tracking for gastrointestinal organ-at-risk isotoxicity delivery on an MR-guided radiotherapy system
Authors: Sreenija Yarlagadda, Yonatan Weiss, Michael David Chuong, Nema Bassiri, Alonso N Gutierrez, Rupesh Kotecha, Minesh P Mehta, Kathryn Elizabeth Mittauer
Journal: Front Oncol (2024)
Keywords: gi oar, mrgrt, sbrt, ablative dose, dose-guided tracking
MeSH terms: Case Reports

In the current era of high-precision radiation therapy, real-time magnetic resonance (MR)-guided tracking of the tumor and organs at risk (OARs) is a novel approach that enables accurate and safe delivery of high-dose radiation. Organ tracking provides a general sense of the need for daily online adaptation but lacks precise information regarding exact dosimetry. To overcome this limitation, we developed the methodology for monitoring intrafraction motion with real-time MR-guided isodose line-based tracking of an OAR in combination with anatomic tumor-based tracking and reported the first case treated with this approach. An isolated para-aortic (PA) nodal recurrence from carcinosarcoma of the endometrium was treated with an ablative dose of 50 Gy in five fractions using MR-guided radiotherapy (MRgRT). This report demonstrates the feasibility, workflow, dosimetric constraints, and treatment paradigm for real-time isodose line-based OAR tracking and gating to enable an isotoxicity delivery approach. This innovative treatment strategy effectively tracked the intrafraction motion of both the target and OAR independently and enhanced the accuracy of structure localization in time and space with a more precise dosimetric evaluation.
Subdural Empyema as a Complication of Sinusitis: A Diagnosis to Keep in Mind
Authors: Rosário Eça, Armando Graça, Rita Francisco, Jaime Pamplona
Journal: Cureus (2024)
Keywords: cross-sectional imaging, intracranial infections, neurologic deficit, sinusitis, subdural empyema
MeSH terms: Case Reports

Subdural empyema (SDE) is a rare form of intracranial infection associated with a high morbidity and mortality rate. Infections of the middle ear and paranasal sinuses are the most common predisposing factors that can lead to bacterial proliferation in the subdural space, usually by direct extension in young patients. Clinicians must have a high level of suspicion for patients presenting with concomitant neurological deficits and signs of sinus pathology. Cross-sectional imaging is mandatory for the diagnosis, preferably contrast-enhanced magnetic resonance imaging. Treatment requires a prolonged course of intravenous antibiotherapy and prompt neurosurgical drainage intervention. Here, we present the case of a 20-year-old patient with long-term neurological sequelae following a left paranasal infection complicated by an SDE. This case report highlights the rapid progression and devastating consequences of SDE, an ominous neurosurgical emergency.
Trigeminal neuralgia associated with dural arteriovenous fistula: a case report and literature reviews
Authors: Hao Zhou, Xingrong Wei, Defeng Zeng, Shuguang Zhang, Xueqian Hu, Zhenqin Wei, Yang Li
Journal: Front Neurol (2023)
Keywords: case report, dural arteriovenous fistula, embolization, microvascular decompression, trigeminal neuralgia
MeSH terms: Case Reports

Trigeminal neuralgia is a paroxysmal, intense electric shock-like, or knife-like, recurrent pain that affects one or more sense areas of the unilateral facial trigeminal nerve. It can be classified into two groups from an etiological standpoint: primary and secondary. The pain episodes brought on by such vascular compression are still categorized as primary trigeminal neuralgia, despite the fact that microvascular compression of the trigeminal nerve root has now been demonstrated to be the primary cause. A rare and complicated condition known as a dural arteriovenous fistula (DAVF) can irritate the Gasserian ganglion or compress the trigeminal nerve's root entry zone (REZ), leading to secondary trigeminal neuralgia (TN). At present, the treatment of DAVF-induced trigeminal neuralgia is not conclusive. This article reports a case of DAVF-induced trigeminal neuralgia cured by MVD and reviews the relevant literature.
Case report: Acute severe hyponatremia-induced seizures in a newborn: a community-acquired case and literature review
Authors: Haiting Li, Xiyang Chen, Linlin Chen, Jie Li, Xixi Liu, Caie Chen, Dengpan Xie, Junhui Yuan, Enfu Tao
Journal: Front Pharmacol (2024)
Keywords: amplitude-integrated electroencephalogram, case report, neonatal hyponatremia, newborn, seizures
MeSH terms: Case Reports

Severe neonatal hyponatremia represents a critical electrolyte imbalance with potentially severe neurological outcomes, a condition rarely documented in community-acquired, full-term newborns. This report underscores a unique case of a 23-day-old, previously healthy, full-term male neonate experiencing severe hyponatremia that precipitated seizures, underscoring the urgency of prompt recognition and intervention. The neonate presented with symptoms including vomiting, groaning, chills, fixed staring, and limb tremors. Critical findings upon admission encompassed hypothermia, hypotension, tachycardia, and tachypnea accompanied by significant weight loss. The clinical presentation was marked by dehydration, lethargy, weak crying, a fixed gaze, irregular breathing, and coarse lung sounds, yet a distended abdomen, hypertonic limb movements, and recurrent seizures were observed. Immediate interventions included establishing IV access, rewarming, mechanical ventilation, seizure management, volume expansion, dopamine for circulatory support, and initiation of empirical antibiotics. Diagnostic evaluations revealed a sodium ion concentration of 105.9 mmol/L, while amplitude-integrated electroencephalography (aEEG) detected pronounced seizure activity characterized by a lack of sleep-wake rhythmicity, noticeable elevation in both the lower and upper amplitude margins, and a sustained decrease in the lower margin voltage dropping below 5 μV, presenting as sharp or serrated waveforms. The management strategy entailed rapid electrolyte normalization using hypertonic saline and sodium bicarbonate, anticonvulsant therapy, and comprehensive supportive care, with continuous aEEG monitoring until the cessation of seizures. Remarkably, by the third day, the neonate's condition had stabilized, allowing for discharge in good health 10 days post-admission. At a 16-month follow-up, the child exhibited no adverse neurological outcomes and demonstrated favorable growth and development. Our extensive review on the etiology, clinical manifestations, aEEG monitoring, characteristics of seizures induced by severe neonatal hyponatremia, treatment approaches, and the prognosis for seizures triggered by severe hyponatremia aims to deepen the understanding and enhance clinical management of this complex condition. It stresses the importance of early detection, accurate diagnosis, and customized treatment protocols to improve outcomes for affected neonates. Additionally, this review accentuates the indispensable role of aEEG monitoring in managing neonates at elevated risk for seizures. Yet, the safety and efficacy of swiftly administering hypertonic saline for correcting severe hyponatremia-induced seizures necessitate further investigation through medical research.
Case report: Neural timing deficits prevalent in developmental disorders, aging, and concussions remediated rapidly by movement discrimination exercises
Authors: Teri Lawton, John Shelley-Tremblay, Ming-Xiong Huang
Journal: Front Neurol (2023)
Keywords: cognitive remediation, cortical plasticity, magnocellular deficits, perceptual learning, reading/attention/memory/executive control networks, timing deficits
MeSH terms: Case Reports

Background:
The substantial evidence that neural timing deficits are prevalent in developmental disorders, aging, and concussions resulting from a Traumatic Brain Injury (TBI) is presented.
Objective:
When these timing deficits are remediated using low-level movement-discrimination training, then high-level cognitive skills, including reading, attention, processing speed, problem solving, and working memory improve rapidly and effectively.
Methods:
In addition to the substantial evidence published previously, new evidence based on a neural correlate, MagnetoEncephalography physiological recordings, on an adult dyslexic, and neuropsychological tests on this dyslexic subject and an older adult were measured before and after 8-weeks of contrast sensitivity-based left-right movement-discrimination exercises were completed.
Results:
The neuropsychological tests found large improvements in reading, selective and sustained attention, processing speed, working memory, and problem-solving skills, never before found after such a short period of training. Moreover, these improvements were found 4 years later for older adult. Substantial MEG signal increases in visual Motion, Attention, and Memory/Executive Control Networks were observed following training on contrast sensitivity-based left-right movement-discrimination. Improving the function of magnocells using figure/ground movement-discrimination at both low and high levels in dorsal stream: (1) improved both feedforward and feedback pathways to modulate attention by enhancing coupled theta/gamma and alpha/gamma oscillations, (2) is adaptive, and (3) incorporated cycles of feedback and reward at multiple levels.
Conclusion:
What emerges from multiple studies is the essential role of timing deficits in the dorsal stream that are prevalent in developmental disorders like dyslexia, in aging, and following a TBI. Training visual dorsal stream function at low levels significantly improved high-level cognitive functions, including processing speed, selective and sustained attention, both auditory and visual working memory, problem solving, and reading fluency. A paradigm shift for treating cognitive impairments in developmental disorders, aging, and concussions is crucial. Remediating the neural timing deficits of low-level dorsal pathways, thereby improving both feedforward and feedback pathways, before cognitive exercises to improve specific cognitive skills provides the most rapid and effective methods to improve cognitive skills. Moreover, this adaptive training with substantial feedback shows cognitive transfer to tasks not trained on, significantly improving a person's quality of life rapidly and effectively.
Reverse Posterior Interosseous Artery Flap for Human Bite Injury to the Hand
Authors: Yusuke Hattori, Yohei Kawaguchi, Yuji Joyo, Hideki Okamoto, Hideki Murakami, Yuko Waguri-Nagaya
Journal: Case Rep Orthop (2024)
MeSH terms: Case Reports

Bite injuries frequently occur on human hands. Human bite injuries to the hand may lead to an infection because of limited soft tissue protection and wound contamination. However, no studies have reported severe bite injuries on hands treated by flaps. We report a case of an 80-year-old woman diagnosed with a major neurocognitive disorder. The patient accidentally had a self-bite injury accompanied with an open metacarpal fracture. Debridement and fixation of the first metacarpal fracture were performed. Afterward, skin necrosis occurred gradually on the dorsum of the hand. Therefore, a reverse posterior interosseous artery (PIA) flap was used, and the postoperative course was uneventful. Given the high risk of infection, human bite injuries, particularly hand bites, should be treated immediately. Delayed treatment for such injuries may lead to extensive soft tissue defects requiring reconstruction with flaps.
Respiratory Epithelial Adenomatoid Hamartoma: An Uncommon Differential of Nasopharyngeal Tumor
Authors: Taiwo Olufemi Solaja, Kenechukwu Chinemelum Uche-Okonkwo, Moses Ayodele Akinola, John Ifeanyi Nwadiokwu
Journal: Case Rep Otolaryngol (2023)
MeSH terms: Case Reports

Respiratory epithelial adenomatoid hamartoma (REAH) is an uncommon tumor-like lesion that has been reported within the nose, paranasal sinuses, and less frequently in the nasopharynx. While it is believed to be benign, its clinical presentation, radiological characteristics, and microscopic features may closely mimic more aggressive tumors of the upper respiratory tract, potentially leading to needless life-altering treatment. Prior to now, there had been no reported cases of this lesion in West Africa. We present a 35-year-old male with persistent bilateral nasal obstruction, difficulty with swallowing, and bilateral reduction in hearing, whose CT findings were highly suggestive of a nasopharyngeal tumor, but upon biopsy and histology showed features most consistent with REAH. Surgery completely alleviated his symptoms with no clinical evidence of recurrence after a 1-year follow-up period.
Potential proarrhythmic side effect of high dose and prolonged infusion of sodium nitroprusside through calcium ion reduction: a case report
Authors: Luca Fazzini, Mauro Gori, Christian Cadeddu Dessalvi, Michele Senni
Journal: Eur Heart J Case Rep (2023)
Keywords: advanced heart failure, arrhythmias, case report, pharmacology, sodium nitroprusside
MeSH terms: Case Reports

Background:
Sodium nitroprusside (SNP) is an excellent drug in acute decompensated heart failure (HF) patients with high vascular peripheral resistance. Its prolonged administration may cause thiocyanate accumulation and toxicity. A proarrhythmic side effect has never been reported.
Case summary:
Herein, we report a case of an adult male affected by advanced HF due to a valvular cardiomyopathy admitted to our intensive cardiology unit with severe decompensation and waiting for a heart transplant. He was treated for several weeks with high-dose SNP, due to severe pulmonary hypertension and an extremely labile haemodynamic profile. He progressively developed high thiocyanate levels and, concomitantly, free calcium ion depletion, despite normal total calcium levels, with iterative ventricular arrhythmias. Calcium ion depletion was not responsive to calcium supplementation. We suspected a causative role of thiocyanate since the negatively charged sulfur atom of the thiocyanate molecules could bind the positively charged free calcium ions, leading to a free calcium ion depletion. Thus, we cautiously reduced SNP dosage, according to the patient's haemodynamic profile, with concomitant progressive free calcium ion normalization, thus reducing the arrhythmic burden of the patient, being able to finally perform heart transplantation.
Conclusion:
We describe for the first time a proarrhythmic side effect of prolonged SNP administration, namely, calcium ion depletion, likely related to thiocyanate toxicity. Despite aggressive calcium supplementation, the only way to reduce the arrhythmic burden was SNP down titration.
Toripalimab plus cetuximab combined with radiotherapy in a locally advanced platinum-based chemotherapy-insensitive nasopharyngeal carcinoma patient: a case report
Authors: Ying Piao, Yao Yang, Shihai Wu, Ling Han
Journal: Front Oncol (2024)
Keywords: cetuximab, nasopharyngeal carcinoma, platinum-insensitive, radiotherapy, toripalimab
MeSH terms: Case Reports

Background:
Locoregionally advanced nasopharyngeal carcinoma (NPC) is an epithelial malignancy that primarily occurs in East and Southeast Asia, and it is associated with relatively poor overall survival (OS). Currently, there is no reliably effective standard treatment for NPC that progresses after first-line therapy with platinum-based chemotherapy.
Case report:
A 55-year-old woman diagnosed with stage IVa NPC received two cycles of platinum-based chemotherapy but encountered an increase in the size of cervical lymph nodes and suffered from adverse events. The patient was then switched to toripalimab plus cetuximab combined with radical radiotherapy and had a complete clinical response within 2 months following the completion of radiotherapy without severe treatment-related adverse events.
Conclusion:
This case report showed that toripalimab plus cetuximab combined with radiotherapy for the treatment of patients with locoregionally advanced nasopharyngeal carcinoma may result in a fast and durable response with a manageable safety profile.