OpenMed/multicare-articles huggingface dataset:
Presumptive Cycad Toxicosis in a Dog. Clinical and Magnetic Resonance Imaging Findings: A Case Report
Authors: Christian Maeso, Carles Morales, Rafael Obrador, Eva Abarca, Inés Carrera
Journal: Front Vet Sci (2020)
Keywords: cycad revoluta, mri, case report, cycad, toxic encephalopathy, toxicosis, white matter
MeSH terms: Case Reports

Cases of cycad toxicosis have been described in dogs that have presented with gastrointestinal, hematologic, hepatic, neurological, and carcinogenic signs. This case report describes brain magnetic resonance imaging (MRI) lesions in a dog with gastrointestinal and neurological signs secondary to cycad toxicosis. A 5-year-old neutered female Jack Russell terrier presented with a 2-days history of gastroenteric signs, progressive generalized tremors, and altered mentation after possible ingestion of Cycad revoluta. Neurologic examinations revealed disorientation, a wide-based stance, severe spasticity of the four limbs, intention tremors, severe cerebellar ataxia, decreased postural reactions in all four limbs, and intermittent decreased menace response in both eyes-all of which are consistent with a multifocal intracranial disorder involving the forebrain and cerebellum. A brain MRI showed diffuse/ill-defined, intra-axial bilateral and symmetrical changes, predominantly affecting the white matter of the cerebral hemispheres, thalamus, hippocampus, and cerebellum. A presumptive diagnosis of toxic-metabolic encephalopathy was made. Medical management of the clinical signs was performed, and the dog was discharged 7 days after presentation with no neurological abnormalities. Two and 8 weeks later, complete blood count (CBC), chemistry, electrolytes, and 8 weeks later brain MRI were performed, revealing no abnormalities. To the best of the authors' knowledge, this is the first case report describing lesions detected by brain MRI secondary to cycad toxicosis as well as a complete resolution of brain lesions on a follow-up MRI 8 weeks later.
Aggressive lactating adenoma mimicking breast carcinoma: A case report
Authors: Huyen Thi Phung, Long Thanh Nguyen, Hung Van Nguyen, Chu Van Nguyen, Hoa Thi Nguyen
Journal: Int J Surg Case Rep (2020)
Keywords: breast adenoma, breast cancer, lactating adenoma
MeSH terms: Case Reports

Introduction:
Lactating adenoma is a rare breast tumor which is commonly found in late pregnancy or lactation period. Despite its benign nature, lactating adenoma might develop aggressively and can be misdiagnosed as breast cancer.
Case presentation:
We report a case of a 25-year-old female presenting with two large, ulcerative and bleeding breast masses. An open biopsy demonstrating lactating adenoma was considered discordant and surgery was performed to confirm the diagnosis.
Conclusion:
Careful clinical and histological evaluations are necessary to diagnose and manage lactating adenoma.
Anti-N-methyl-D-Aspartate Receptor Encephalitis Mimicking Sporadic Creutzfeldt-Jakob Disease
Authors: Jiao Liu, Liyan Chen, Jing Yang, Lan Wang, Huifang Shang, Xueping Chen
Journal: Front Neurol (2020)
Keywords: 14-3-3 protein, anti-nmdar encephalitis, differential diagnosis, immunomodulatory therapy, sporadic creutzfeldt-jakob disease
MeSH terms: Case Reports

Objectives: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis and sporadic Creutzfeldt-Jakob disease (sCJD) share similar clinical features. Here, we present two unusual cases of anti-NMDAR encephalitis who were misdiagnosed as sCJD at first. Methods: We described two patients' clinical manifestations, as well as the string of symptomatological evolution, treatments, and follow-up results. Results: Our patients presented with rapidly progressive dementia, memory problems, psychiatric symptoms, and movement disorders, and we considered all these symptoms as a presenting feature of sCJD at first, but the cerebrospinal fluid examination showed positive results for both the 14-3-3 protein and antibodies against NMDAR. Immunomodulatory treatment led to a resolution of these deficits, and both of them remained in remission after treatment. Conclusion: Anti-NMDAR encephalitis can present with rapidly progressive cognitive decline, and sometimes laboratory investigations can be misleading. The examination for the presence of NMDAR antibodies is necessary, even with the presence of 14-3-3 protein. Early immunomodulatory therapy should be considered, especially for patients with high titers of NMDAR antibodies.
Higher Tumor Mutation Burden and Higher PD-L1 Activity Predicts the Efficacy of Immune Checkpoint Inhibitor Treatment in a Patient With Four Lung Cancers. A Case Report
Authors: Katsuo Usuda, Yo Niida, Shun Iwai, Aika Funasaki, Atsushi Sekimura, Nozomu Motono, Sohsuke Yamada, Hidetaka Uramoto
Journal: Front Oncol (2020)
Keywords: immune checkpoint inhibitor (ici), lung cancer, microsatellite instability (msi), programmed death ligand 1 (pd-l1), tumor mutation burden (tmb)
MeSH terms: Case Reports

We experienced a patient who had four lung cancers with different pathological features, with the most advanced being diagnosed as pStage IIA. A month after the resection, the original lung cancer had metastasized to the lung and to the liver. Of the original lung cancers that were resected, the biggest adenocarcinoma of S3 showed 50 × 31 × 17 mm (invasion 50 mm) and pT2bN0M0 (pStage IIA) with epidermal growth factor receptor (EGFR) mutation (-) and anaplastic lymphoma kinase (ALK) translocation (-), but expression of programmed death ligand 1 (PD-L1) (+) tumor proportion score (TPS) 80%. The pleomorphic carcinoma showed 23 × 20 × 17 mm (invasion 23 mm) and pT1cN0M0 (pStage Ic) with EGFR (-), ALK (-), PD-L1 (+), TPS 95%. Tumor mutation burden (TMB), microsatellite instability (MSI), and structural chromosome aberration analysis by DNA microarray were performed. One hundred somatic mutations in the adenocarcinoma and 75 somatic mutations in the pleomorphic carcinoma were identified, which showed an extremely high mutation rate, although only 16 somatic mutations were common between the two cancers. Chromosomal structural aberrations differed greatly between the two cancers, but common aberrations were found in chromosomes 8 and 10 and partially common aberration in chromosomes 4, 14, 17, and X. These results indicated that each lung cancer originated from a common ancestor clone and developed on an individual molecular evolution. The patient received a single injection of pembrolizumab and 13 injections of atezolizumab. Immune checkpoint inhibitor treatment made metastatic pulmonary and liver lesions reduce in size and show as Partial response (PR). Multiple lung cancers with high PD-L1 activity tend to be TMB-high, reflecting rapid molecular evolution and relevance to the patient's response to immune checkpoint inhibitors. Genomic examination could help determine what had happened in multiple cancers on progression and provide useful data to patient treatment. Each lung cancer originated from a common ancestor clone and developed on an individual molecular evolution.
Peripheral nerve injury with Nexplanon removal: case report and review of the literature
Authors: Rachel Lefebvre, Marianne Hom, Hyuma Leland, Milan Stevanovic
Journal: Contracept Reprod Med (2018)
Keywords: contraception complications, iatrogenic peripheral nerve injury, implant migration, neuroma
MeSH terms: Case Reports

Background:
Implantable devices offer convenient, long-acting, and reversible contraception. Injury to the peripheral nerves and blood vessels have been reported as rare complications of implantation and extraction.
Case presentation:
We present a case of ulnar nerve injury in a 21-year-old woman from attempted in-office removal of a deeply implanted Nexplanon® device. The injury resulted in an ulnar nerve palsy requiring surgical exploration, neuroma excision, and sural nerve cable grafting.
Conclusions:
In-office attempts to remove contraceptive implants that are deep or have migrated can cause iatrogenic nerve injury. Devices that are non-palpable, deep, or migrated should be imaged before formal surgical exploration and removal. Any patient with neurologic symptoms after placement or after attempted removal requires prompt diagnosis and referral to a peripheral nerve surgeon.
Endovascular treatment of aortic saccular aneurysms associated with Adamantiades-Behçet disease
Authors: Patrick Bastos Metzger, Kamilla Rosales Costa, Simone Lessa Metzger, Leonardo Cortizo de Almeida
Journal: J Vasc Bras (2021)
Keywords: behçet syndrome, aortic aneurysm, endovascular procedures
MeSH terms: Case Reports

Adamantiades-Behçet disease is a multisystemic disorder that classically presents with oral and genital ulcers and ocular involvement, with vascular involvement in up to 38% of cases. Aortic involvement is one of the most serious manifestations and is associated with high mortality rates, occurring in 1.5 to 2.7% of cases. We report a case of a saccular abdominal aorta aneurysm in a 49-year-old male patient with complicated Adamantiades-Behçet disease that was treated with endovascular repair.
Hypercalcemic Crisis in a Patient with Post-Surgical Hypoparathyroidism
Authors: Wannita Tingsarat, Chalermchai Lertanasit, Jaruwan Kongkit, Thiti Snabboon
Journal: Case Rep Endocrinol (2019)
MeSH terms: Case Reports

Calcium alkali syndrome (CAS), a relatively unusual etiology of hypercalcemia, is characterized by a classical triad of hypercalcemia, azotemia, and metabolic alkalosis. This condition has been described in patients who have taken an excess dose of calcium with an alkali or with a volume-depletion status. To diagnose CAS it requires a high index of suspicion and a detailed history of medication/supplement intake specifically for calcium-containing drugs and a history of all possible ingested alkali. We reported a case of post-surgical hypoparathyroidism whom later on was presented with hypercalcemic crisis due to CAS. The proposed mechanism of CAS and management are also included.
Endoscopic Treatment of a Severe Vaginal Stenosis Following Battery Insertion in an 11-Year-Old Girl
Authors: Riccardo Guanà, Andrea Carpino, Giuseppe Garbagni, Cecilia Morchio, Salvatore Garofalo, Alessandro Pane, Federico Scottoni, Elisa Zambaiti, Giulia Perucca, Elena Madonia, Fabrizio Gennari
Journal: European J Pediatr Surg Rep (2022)
Keywords: children, endoscopic treatment, hematometrocolpos, vaginal stenosis
MeSH terms: Case Reports

Acquired vaginal strictures are rare entities in children. As a result, they are generally difficult to manage and tend to recur despite appropriate initial therapy. This case study reports the staged management of vaginal stenosis following the insertion of a button battery. In this case, an 11-year-old girl experienced at 4 years old a battery insertion in the vaginal canal by her neighbor's son, who was 6-year-old at the time. Two weeks from insertion, the parents noted the foreign body discharge spontaneously. The girl had not complained of any symptoms at the time and had been asymptomatic for many years. In November 2020, she came to the emergency department reporting cramping abdominal pain accompanied by mucopurulent discharge. An abdominal ultrasound showed the presence of hematometrocolpos, and a vaginal stenosis dilation under general anesthesia was performed the following day. After 3 weeks, the stenosis was still present, preventing the passage of Hegar number 4. The girl was subjected to a vaginoscopic stenosis resection utilizing a monopolar hook passed through an operative channel. A Bakri catheter filled with 120 mL of water was left in place. After 10 days, the girl was discharged home with the Bakri inserted. Two weeks after discharge, she was reevaluated in the outpatient setting, where the Bakri was removed with no signs of residual stenosis. Acquired vaginal stenosis could be demanding to treat, particularly with the sole conservative approach. A first-line option can be the Hegar dilation. The endoscopic approach can be a second-line, minimally invasive treatment, but long-term outcomes are difficult to predict.
Acute disseminated encephalomyelitis: a call to the clinicians for keeping this rare condition on clinical radar
Authors: Liaqat Ali Chaudhry, Waseem Babur, Ghazala Aslam Chaudhry, Feddah Eid Al-Atawi, Asirvatham Alwin Robert
Journal: Pan Afr Med J (2018)
Keywords: encephalomyelitis, acute onset encephalopathy, multiple sclerosis
MeSH terms: Cough / etiology, Encephalomyelitis, Acute Disseminated / diagnosis, Fever / etiology, Case Reports, Encephalomyelitis, Acute Disseminated / diagnostic imaging, Encephalomyelitis, Acute Disseminated / physiopathology, Humans, Male, Middle Aged

Acute disseminated encephalomyelitis is a rare disease of central nervous system, which can present with a variety of clinical manifestations. That is why first attack of ADEM, in particular remains a diagnostic puzzle. Early anticipation and diagnosis is important for better outcomes. We present a case of acute disseminated encephalomyelitis which initially had atypical clinical features with cough, expectoration, fever and later manifested strange neurological features, diagnosed to be a case of acute disseminated encephalomyelitis based on radio-imaging.
Cutaneous-Pericardial Fistula: Rare Complication of Transapical Aortic Valve Replacement-Case Report and Literature Review
Authors: Andrei Tarus, Mihail Enache, Igor Nedelciuc, Iulian Rotaru, Alberto Emanuel Bacusca, Grigore Tinica
Journal: Case Rep Surg (2020)
MeSH terms: Case Reports

Cutaneous-pericardial fistula is a rare complication of transapical aortic valve replacement; only a few cases are reported in the literature. It is part of a wide range of surgical site infection manifestations that could emerge after surgery. Due to its proximity to the heart, the risk of infectious lesions of adjacent structures and inoculation of pathogens on the prosthetic valve can lead to life-threatening complications. We report here a case of successful surgical treatment through reduced ribs and soft tissue operative trauma.
A Case of Orf Disease Complicated with Erythema Multiforme and Bullous Pemphigoid-Like Eruptions
Authors: Shahriar Alian, Fatemeh Ahangarkani, Sara Arabsheybani
Journal: Case Rep Infect Dis (2015)

Parapoxvirus infection in sheep and goats is usually referred to as contagious pustular dermatitis/ecthyma, or orf, and the corresponding human infection is referred to as orf. In humans, after a brief incubation period of 3 to 5 days, lesions begin as pruritic erythematous macules and then rise to form papules, often with a target appearance. Lesions become nodular or vesicular, and orf lesions often ulcerate after 14 to 21 days. Erythema multiforme and bullous pemphigoid have been associated with parapoxvirus infections and they are rare complications of orf disease. In this case report, we presented a 36-year-old woman with history of contact with sheep, developing a typical orf lesion that is complicated with erythema multiforme and bullous pemphigoid-like eruptions.
A Case of Kikuchi's Disease Without Cervical Lymphadenopathy
Authors: Shinya Tomori, Seigo Korematsu, Taichi Momose, Yasuko Urushihara, Shuji Momose, Koichi Moriwaki
Journal: Case Rep Pediatr (2022)
MeSH terms: Case Reports

Background:
Kikuchi's disease with only extracervical lymphadenopathy is rare. Case Presentation. A 15-year-old male has presented with a fever lasting more than 1 week and right axillary lymphadenopathy. An axillary lymph node biopsy revealed coagulation necrosis, nuclear decay products, infiltration of histiocytes, and enlarged lymphocytes; he was diagnosed with Kikuchi's disease. The only four adult patients with Kikuchi's disease presenting without cervical lesions have been previously reported.
Conclusion:
This is the only pediatric case of Kikuchi's disease presenting without cervical lymphadenopathy. Kikuchi's disease should be included in the differential diagnosis even in cases of extracervical lymphadenopathy alone.
Jejuno-jejunal intussusception in a post-lung transplant patient from a gastrojejunostomy tube: A case report
Authors: Takashi Harano, Pablo G Sanchez, Graciela Bauza, John F McDyer, Jonathan D'Cunha
Journal: Int J Surg Case Rep (2019)
Keywords: gastro-jejunostomy tube, jejuno-jejunal intussusception, surgical reduction of intussusception

Introduction:
Gastro-jejunostomy tube is used for post-pyloric feeding for critical-ill patient who cannot tolerate oral alimentation. Jejuno-jejunal intussusception is a rare complication of gastrojejunostomy tube.
Presentation of case:
A 39-year-old male with history of severe combined immunodeficiency, Achalasia and end-stage lung disease underwent double lung transplantation. After lung transplantation, he required gastrojejunostomy(GJ) tube placement due to his esophageal disease. Four days after gastrojejunostomy tube placement, he developed jejuno-jejunal intussusception. A 15 cm segment of thickened and enlarged bowel, which consisted of the intussusception were identified laparoscopically. Surgical reduction was performed without bowel resection.
Discussion:
Intussusception is uncommon in adults compared to pediatric population. In this rare case, the jejunal limb of the GJ tube placed in jejunum was the cause of jejunojejunal intussusception serving as the lead point. The GJ tube should not be placed farther down from ligaments of Treiz to prevent jejuno-jejunal intussusception.
Conclusions:
A heightened index of suspicion for this rare complication should exist with a presenting patient has signs of proximal bowel obstruction and CT evidence of intussusception.
Acute Seronegative Toxoplasma gondii Hepatitis Allergic to First-Line Treatment
Authors: Fernando De la Garza-Salazar, Carlos Alejandro Cortéz-Hernández, Horacio Decanini-Arcaute, Adrián Camacho-Ortiz
Journal: Case Rep Infect Dis (2018)
MeSH terms: Case Reports

Toxoplasma gondii infects up to one-third of the world's population, making it the protozoan that most infects people worldwide. Among the forms of presentation of toxoplasmosis, hepatitis is probably the least frequent with only a few case reports in the world's medical literature. Despite the fact that the first diagnostic test is the serology using the ELISA technique because its sensitivity is close to 100% in our case, it was reported negative. The biopsy gave the definitive diagnosis, and we were able to start treatment immediately. Although the first line of treatment is sulfadiazine and pyrimethamine, our sulfate allergic patient received an alternative regimen of doxycycline, clindamycin, and azithromycin with a good response. This is the only case of Toxoplasma hepatitis reported in Mexico and the only one in the world with negative serology with a good response to second-line treatment.
Actual Management of Anterior Calyceal Diverticular Calculi: A Challenging Flexible Retrograde Endoscopic Approach
Authors: Ali Barki, Anouar El Moudane
Journal: Case Rep Urol (2020)
MeSH terms: Case Reports

Calyceal diverticula is a cavity that communicates with the collecting system through a narrow isthmus of the kidney. The incidence of the formation of stones in calyceal diverticula is 10-50%. This paper reports three cases of two females and one male who presented with calyceal diverticular calculi; the patients have been, arbitrarily, selected between August and February 2019 at the urology department of our university hospital. A minimally invasive treatment includes extracorporeal lithotripsy (ESWL), and F-URS (flexible ureteroscopy) was performed. We report this case series.
A Rare Case of Complete Heart Block in a Young Patient
Authors: Zakaria Hindi, Yousef Hindi, Rami Batarseh
Journal: Case Rep Cardiol (2018)
MeSH terms: Case Reports

Introduction:
Complete heart block (CHB) is considered as one of the dangerous rhythms since it can progress to lethal arrhythmias such as ventricular tachycardia. It can be congenital or acquired. Patients may present with frequent palpitations, presyncope, dyspnea, or chest pain but also may remain asymptomatic. Extensive work-up should be conducted to exclude secondary causes such as infections, cardiac ischemia or myopathies, autoimmune diseases, or endocrinological diseases. In our paper, we would like to present a case of CHB in the setting of aortic abdominal thrombus that nearly occluded both renal arteries. The CHB in this case is thought to be caused by hypertensive cardiomyopathy due to ongoing uncontrolled hypertension, which is caused by bilateral renal artery stenosis.
Case presentation:
A 31-year-old male with history of active smoking was incidentally found to have high blood pressure, bradycardia, and CHB on electrocardiogram. The patient was admitted to a cardiology ward and extensive work-up revealed hypokinesia of the left ventricle with low ejection fraction and left ventricle concentric hypertrophy, large abdominal aortic thrombus with bilateral renal artery stenosis, and evidence of arterial collateral connections, which suggest chronicity. The patient then was placed on four antihypertensive medications but eventually, he underwent bilateral renal artery stenting and insertion of permanent pacemaker for his CHB. The patient's blood pressure then was under control with only one medication, and subsequent CT angiogram showed no evidence of stenosis of both renal arteries.
Conclusion:
Uncontrolled hypertension can lead to hypertensive cardiomyopathy, which in turn can cause conduction abnormalities such as CHB. Although hypertension can be secondary to a treatable underlying cause, permanent pacemaker is essential to treat CHB.
Rhabdomyolysis in a Young Patient due to Hypothyroidism without Any Precipitating Factor
Authors: Dhineshreddy Gurala, Kartikeya Rajdev, Roshan Acharya, Pretty Sara Idiculla, Saad Habib, Michael Krzyzak
Journal: Case Rep Endocrinol (2019)
MeSH terms: Case Reports

Hypothyroidism is characterized by decreased hormone production, which results in various clinical manifestations in different organ systems. Muscular symptoms are common in patents with clinical hypothyroidism which includes muscle cramps, myalgia, and mild to moderate elevation of creatinine kinase less than five times the upper limit of normal. However, rhabdomyolysis due to hypothyroidism is rare and in most of the reported cases a precipitating factor has been found. We report a unique case of a 35-year-old male with no past medical history who presented with rhabdomyolysis due to newly diagnosed hypothyroidism without any precipitating factors and was treated successfully with intravenous fluids and levothyroxine.
Ileocaecal Tuberculosis Presenting with Massive Hematochezia: A Rare Clinical Manifestation
Authors: Neha Mehta, Man Bahadur Paudyal, Sangam Shah, Rajan Chamlagain, Moon Shrestha, Ashish Mehta, Prabin Bhattarai
Journal: Case Rep Gastrointest Med (2021)
MeSH terms: Case Reports

Abdominal pain, diarrhea, weight loss, anorexia, and fever are common symptoms of intestinal tuberculosis, while bleeding from the lumen, intestinal obstruction, perforation, and fistula formation are uncommon presentations in ileocaecal tuberculosis. Here, we present a case of a 33-year-old male with intestinal tuberculosis who initially presented with massive bleeding per rectum.