OpenMed/multicare-articles huggingface dataset:
A Case of Hepatotoxicity Induced by Therapeutic Ketamine Use for Sedation
Authors: Noah Yoo, Sarun Thomas, Michael Bender, Xian Jie Cindy Cheng
Journal: Case Rep Crit Care (2024)
MeSH terms: Case Reports

Ketamine, initially developed as an anesthetic, has shown versatility in medical applications, including pain management, treatment-resistant depression, and sedation in the intensive care unit (ICU). While generally well-tolerated, long-term use at high doses raises concerns about potential toxicities, particularly in the liver. We present a case of a 27-year-old female with a complex medical history who received ketamine infusion for ICU sedation and experienced a sudden rise in liver function tests (LFTs), indicating possible ketamine-induced liver injury (KILI). The patient's liver function normalized after ketamine discontinuation. KILI is infrequent with short-term ketamine use, but emerging case reports suggest it may be associated with chronic or intermittent exposure. The underlying mechanisms for KILI are not fully understood but may involve the accumulation of ketamine metabolites, causing direct toxic effects on the liver. As ketamine's use expands, especially in critical care settings, clinicians should be vigilant for the potential development of KILI. Further research is needed to better understand its risk factors and mechanisms, as early detection and management of KILI are crucial to ensuring patient safety and optimizing ketamine's therapeutic benefits.
Case report: Application of color Doppler sonography for the assessment of pulmonary consolidations in a dog
Authors: Katarzyna Kraszewska, Michał Gajewski, Søren R Boysen
Journal: Front Vet Sci (2023)
Keywords: color doppler, consolidation, dog, lung ultrasonography (lus), thromboembolic disease
MeSH terms: Case Reports

A 1,5-year-old male Maltipoo was presented to the emergency service for dyspnea, weakness, and cough. An echocardiographic examination showed evidence of pulmonary hypertension with a McConnell sign. Lung ultrasound, including color Doppler, was performed and identified two distinct populations of lung consolidation. Color Doppler analysis of the first type of consolidation showed the absence of blood flow within regions of the consolidation and flow amputation. These findings were consistent with the "vascular sign" reported in human medicine and prompted consideration of pulmonary thromboembolism as a differential diagnosis. In the second type of consolidation, color Doppler identified blood flow within the pulmonary vessels of the consolidated lung, forming a "branching tree-like" pattern that followed the anatomical course of the pulmonary vasculature. These findings suggested that blood flow was preserved within the pulmonary vasculature of the consolidated lung and prompted consideration of inflammatory causes of pulmonary pathology. On recheck 6 days later, recanalization of the first type of consolidation was identified with color Doppler. The case was followed serially once a month for 5 months with LUS, which showed continued improvement. Based on a positive fecal Baermann test, a final diagnosis of Angiostrongylus vasorum was made. New or Unique information Provided-this is the first report of color Doppler LUS being used to characterize and help differentiate the cause of lung consolidation in dogs.
Case report: A novel TLK2 variant with a neuropsychiatric phenotype from a Chinese family
Authors: Hongmei Huang, Yue Qian, Chenlu Yang, Shijie Li
Journal: Front Genet (2024)
Keywords: tlk2 gene, behavioral disorder, case report, heterozygous variant, neurodevelopmental disorder
MeSH terms: Case Reports

Background:
Tousled-like kinase 2 (TLK2) gene variant-related neurodevelopmental disorder was recently described. The haploinsufficiency of TLK2 was considered the most likely underlying disease mechanism, leading to a consistent neurodevelopmental phenotype. So far, only four studies, conducted on 49 patients from North America and Europe, have been reported.
Case presentation:
In this study, we reported a Chinese family with a TLK2-related neuropsychiatric phenotype. The proband, a boy aged 2 years and 6 months, presented with temper tantrums, mood lability, aggressiveness, congenital astigmatism, and distinctive facial dysmorphism. Whole-exome sequencing identified a novel heterozygous variation in TLK2 gene (c.49dupG, p. E17Gfs*10) in them. His father carried the same TLK2 gene variant and exhibited anxiety and irritability. The parental grandparents and other family members had no such variation. Moreover, the proband was found to have global developmental delay, autism-like symptoms, and mild elevated homo-vanillic acid (HVA) and 2,3-dihydroxy-2-methylbutyric acid levels tested in urine.
Conclusion:
Herein, we identified a novel TLK2 variant from a Chinese family and reported a new neuropsychiatric phenotype. This study also expanded the genotype profile of the newly defined TLK2-related neurodevelopmental disorder.
Phenotype-Genotype Discordance and a Case of a Disorder of Sexual Differentiation
Authors: Madeline Snipes, Stephanie Stokes, Amy Vidalin, Lee D Moore, Natalia Schlabritz-Lutsevich, James Maher 3rd
Journal: Case Rep Genet (2024)
MeSH terms: Case Reports

Discordance between the genetic sex and phenotype seen on ultrasound can identify disorders of sexual development (DSD) that previously escaped detection until puberty. We describe a 46, XY disorder of sexual differentiation caused by a rare mutation in the SF1 gene (OMIM]184757, (NR5A1). The mutation (NR5A1)-c.205C > G (p. Arg69Gly) was discovered after a phenotype-genotype discrepancy was encountered during prenatal care. The baby with 46, XY DSD has female external genitalia but evidence of Y chromosome-related regression of Müllerian structures and the absence of palpable gonads. We discussed the literature on phenotype-genotype discrepancy and the importance of care coordination between the antenatal and postnatal teams to ensure a timely diagnosis of DSD.
Unravelling the unseen threat of polyhydramnios in patients with gestational diabetes mellitus: A case report
Authors: Syamimi Nadiah A Wahab, Abdul Hadi Said, Wan Hasmawati Wan Ismail
Journal: Malays Fam Physician (2023)
Keywords: congenital diaphragmatic hernia, edwards syndrome, gestational diabetes mellitus, polyhydramnios
MeSH terms: Case Reports

Polyhydramnios is defined as an increase in the amount of amniotic fluid during pregnancy. This article presents the case of a 35-year-old G4P3 lady at 28 weeks of gestation with suboptimised gestational diabetes Mellitus (GDM). Routine transabdominal ultrasound showed the presence of polyhydramnios, initially thought to be due to suboptimal glucose control. Further evaluation revealed a congenital diaphragmatic hernia with multiple soft markers. Identifying the underlying causes of polyhydramnios can be challenging in primary care settings, which can be attributed to various factors. Although primary care medical officers may not be required to perform detailed scans, they have a crucial role in identifying gross foetal abnormalities. This study highlights the potential for missed diagnoses in primary care settings and the importance of comprehensive prenatal assessments to ensure early detection and appropriate management of polyhydramnios-related conditions in women with GDM.
Giant Coronary Artery Aneurysm Due to Implantation of Drug-Eluting Stent
Authors: Ahmad Amir, Abbas Ali Qayyum
Journal: Cureus (2024)
Keywords: coronary artery aneurysm, cypher stent, giant coronary artery aneurysm, ischemic heart diseas, sirolimus-eluting stent, stent aneurysms
MeSH terms: Case Reports

Development of coronary artery aneurysm after implantation of a drug-eluting stent is a rare complication. The mechanism behind aneurysm formation is unknown, but studies suggest hypersensitivity and inflammatory reactions elicited by the stent polymer. Here, we report a case of a 57-year-old man who was treated with a sirolimus-eluting CypherTM stent in the left anterior descending artery due to stable angina pectoris and left circumflex artery due to dissection. Coronary aneurysm formation at the site of stent implantation was discovered three years after the stents were deployed, and progression of the aneurysms was seen in the coronary artery angiography. We hypothesize about the mechanism of aneurysm formation and present management of the aneurysms.
Is it early enough? The authentic meaning of the pediatric palliative approach between early and late referral in pediatric oncology: a case study
Authors: Anna Santini, Irene Avagnina, Maria C Affinita, Anna Zanin, Franca Benini
Journal: Front Oncol (2024)
Keywords: early referral to palliative care, integration of care, pediatric oncology and hematology, pediatric palliative care (ppc), team communication

The literature widely supports the benefits of early integration of palliative care into pediatric oncological care; however, many barriers to its successful integration remain. Integrating palliative care as early as possible in the oncology pathway is critical, but other criteria are relevant to positive results. This paper aims to contribute to the early/late referral dualism in pediatric palliative care (PPC) and highlight the importance of a collaborative approach between oncologists and palliative care teams. This study investigates the impact of early versus late referral to PPC, intersecting it with the synergy work between services and the related outcomes. The four pediatric cancer cases were selected based on clinical (e.g., disease duration, multiple treatments, and pain management), management (e.g., involvement of multiple services and multiple home-hospital transitions), and relevance of multidisciplinary team (e.g., difficult clinical decisions and ethical discussions) criteria. A mixed-methods approach was employed, combining qualitative case analysis using clinical diaries, literature review, and practice guidelines development. Critical clinical information, time course, clinician-family communication, and patient involvement were analyzed. The outcomes show how simultaneous care creates continuous discussion and dialogue between professionals. The results indicate the importance of better communication and care coordination to improve patient and family satisfaction, highlighting the uniqueness of the pediatric field and the relationship with children and families. Through the discussion of clinical cases and a literature review, we provide practical guidance for clinicians working in oncology and PPC. These findings underscore the crucial need for a multidisciplinary approach in pediatric oncology, advocating policy changes to support early PPC integration and translate it into complementarity best operating practices. In conclusion, besides assessing the timeliness of referral to the PPC service, the synergy, harmony, and choral work of the professionals involved are equally valuable for a quality-of-life-oriented care plan.
Case Report: Primary low-grade dedifferentiated liposarcoma of the urinary bladder with molecular confirmation
Authors: Jian Cui, Ran Peng, Yahan Zhang, Yang Lu, Xin He, Min Chen, Hongying Zhang
Journal: Front Oncol (2023)
Keywords: 12q13-15 amplification, jun amplification, mdm2 amplification, atypical lipomatous tumor/well-differentiated liposarcoma, dedifferentiated liposarcoma, urinary bladder, whole exome sequencing
MeSH terms: Case Reports

Liposarcomas originating in the urinary bladder are extremely rare. Only six cases of bladder liposarcoma have been reported, and all have been described as myxoid liposarcomas. Notably, none of the patients underwent molecular testing. Here, we report a dedifferentiated liposarcoma (DDL) that occurred in the urinary bladder, primarily in a 69-year-old Chinese woman, with infrequent low-grade dedifferentiation. Computed tomography (CT) revealed an ill-defined solid mass in the anterior bladder wall. The patient underwent a partial bladder resection. Histologically, the tumor cells with mild-to-moderate nuclear atypia were arranged in fascicular and storiform patterns, mimicking a low-grade fibroblastic tumor. In addition, scattered small foci of typical lipoma-like well-differentiated components were identified. Immunohistochemically, the tumor tested positivity for MDM2, CDK4, and p16. Fluorescence in situ hybridization revealed MDM2 gene amplification in the neoplastic cells. Whole-exome sequencing showed that this tumor also harbored CDK4, TSPAN31, and JUN amplification. At the latest follow-up (85 months after surgery), the patient was alive, with no evidence of disease. To the best of our knowledge, this is the first example of a molecularly confirmed primary bladder liposarcoma and the first case of DDL at this site.
Repeating late-phase pseudo-progression in a patient with non-small cell lung cancer treated with long-term nivolumab monotherapy; a case report
Authors: Rikako Ebisuda, Naoki Furuya, Takeo Inoue, Shotaro Kaneko, Yu Numata, Yusuke Shinozaki, Masamichi Mineshita
Journal: Front Oncol (2024)
Keywords: long-term response, long-term survival, lymph node enlargement, nivolumab, non-small cell lung cancer, pseudo-progression
MeSH terms: Case Reports

Background:
Immune check point inhibitors (ICIs) are standard treatment for patients with non-small cell lung cancer (NSCLC). Nearly a decade has passed since nivolumab was approved by the FDA for NSCLC patients. However, long-term outcomes and clinical features remain unclear for individual cases. Pseudo-progression is a well-known paradoxical radiological response pattern under ICI treatment which occurs when tumor index lesions regress after apparent initial progression. We herein report a unique case of NSCLC with repeating pseudo-progression in late phase treated with nivolumab monotherapy for 8.5 years.
Case presentation:
A 56-year-old male diagnosed with Non-sq NSCLC clinical stage IVA, at the left upper lobe primary lesion. The primary lesion was PD-L1 negative with no oncogenic driver mutations. He had multiple pulmonary metastases and a left adrenal gland metastasis, and subsequently, received nivolumab as third-line therapy. After initiation of nivolumab, the lung lesion and adrenal metastasis shrank rapidly; however, the patient experienced three late-phase pseudo-progressions in the mediastinal lymph node (LN). This patient is still receiving nivolumab with no symptoms and PS 0. Acquired resistance should be judged carefully in patients with LN-only oligo-progression to avoid unnecessary local therapies and the misjudgment of treatment.
Case report: Methicillin-resistant Staphylococcus aureus with penicillin susceptible (PS-MRSA): first clinical report from a psychiatric hospital in China
Authors: Fei Yan, Mi Yang, Yuting Sun, Qin Tang, Lu Yuan
Journal: Front Med (Lausanne) (2024)
Keywords: alzheimer’s disease, mrsa, ps-mrsa, staphylococcus aureus, meca, penicillin
MeSH terms: Case Reports

This case report documents the first instance of Penicillin-Susceptible Methicillin-Resistant Staphylococcus aureus (PS-MRSA) in a Chinese psychiatric hospital. The strain was isolated from a patient with Alzheimer's disease who had a lower respiratory tract infection. Clinical and laboratory analyses, including mass spectrometry, antibiotic susceptibility testing, and whole-genome sequencing, confirmed the PS-MRSA strain. In this case, we systematically introduce the clinical symptoms, laboratory findings, and treatment responses associated with this PS-MRSA strain. This discovery offers a new perspective on our understanding of resistance mechanisms and expands our considerations for existing antibiotic treatments. It may fill a gap in the classification of MRSA strains, enhance the spectrum of MRSA resistance, and complete the therapeutic strategies for MRSA.
A Rare Case Report of Extraosseous Ameloblastic Carcinoma and Review Article on Diagnosis and Treatment Dilemma
Authors: Sukkarn Themkumkwun, Puangwan Lapthanasupkul, Kanin Arunakul
Journal: Case Rep Dent (2024)
MeSH terms: Case Reports

Peripheral ameloblastic carcinoma is an extremely rare odontogenic carcinoma. Its histopathological feature is identical to the intraosseous type. This case report details a case of peripheral ameloblastic carcinoma at the right posterior maxilla region in a 60-year-old Thai male. The patient underwent a definitive treatment by partial maxillectomy and reconstruction with buccal fat pad. After 1-year follow-up, no recurrence of the lesion was found.
Spontaneous cervical hematoma caused by giant parathyroid adenoma in an elderly patient: A case report
Authors: Belén Matías-García, Fernando Mendoza-Moreno, Manuel Díez-Alonso, Enrique Ovejero-Merino, Cristina Vera-Mansilla, Alma Blázquez-Martín, Ana Quiroga-Valcárcel, Rubén Jiménez-Martín, Rebeca D'Amico, Inmaculada Lasa-Unzúe, Alberto Gutiérrez-Calvo
Journal: Med Int (Lond) (2023)
Keywords: cervical hematoma, parathyroid adenoma, primary hyperparathyroidism, thyroidectomy
MeSH terms: Case Reports

Spontaneous cervical hematoma usually occurs as a consequence of extracapsular bleeding from a parathyroid gland, generally due to the presence of an adenoma (giant adenoma), glandular hyperplasia, cystic component, or, less frequently, due to the existence of a carcinoma. The hematoma can be confined to the cervical compartment or extend to the mediastinum, potentially causing airway compression. Despite this, the recommended management in hemodynamically stable patients consists of surveillance and hospital monitoring with delayed surgery after a few weeks. On the other hand, in those patients with airway compromise and instability, emergency surgery, consisting of cervicotomy and drainage, is mandatory. The present study describes the case of a 78-year-old patient with a medical history of high blood pressure, non-insulin-dependent diabetes mellitus, dyslipidemia, moderate aortic stenosis, chronic kidney disease and sarcoidosis under pharmacological treatment who attended the emergency department due to symptoms of neck pain, an increase in soft tissue, and dyspnea on moderate exertion with an evolution leading to respiratory failure. This was secondary to a diagnosis of spontaneous cervical hematoma that required urgent surgical intervention. The results of histopathological analysis revealed that a giant parathyroid adenoma was responsible for the bleeding. The patient had a complicated post-operative period with a prolonged admission to the intensive care unit.
Atypical scrotal edema - Case report
Authors: Ariana Nateghi, Rose Noël, Andréanne Waddell, Mylène Veilleux
Journal: SAGE Open Med Case Rep (2024)
Keywords: filariasis, lymphedema, tropical disease
MeSH terms: Case Reports

Lymphatic filariasis is an endemic parasitic infection in 72 countries. It is caused by a filarial worm transmitted through mosquito bites. Acute nonspecific symptoms can occur, such as fever and edematous inflammatory plaques, while its chronic state is commonly characterized by lymphedema.
Perforated Gastric Cancer: A Case Report and Literature Review
Authors: Kai Wang, Aye Thida, Gyuhee Seong, Edwin Chiu
Journal: Cureus (2024)
Keywords: gastric cancer (gc), gastric perforation, hyperthermic intraperitoneal chemotherapy, laparoscopy, perforated gastric cancer
MeSH terms: Case Reports

Gastric cancer perforation is a rare but life-threatening complication of gastric cancer. We present the case of a 53-year-old male with acquired immune deficiency syndrome (AIDS) who presented to the emergency department with severe abdominal pain, was found to have an acute abdomen, and was eventually diagnosed with gastric perforation due to metastatic gastric cancer. This case highlights the challenges in diagnosing and managing perforated gastric cancer and discusses the surgical management options, including the use of laparoscopic techniques and the role of chemotherapy, particularly hyperthermic intraperitoneal chemotherapy (HIPEC).
Case report: Ultrasound misdiagnoses atypical parathyroid adenoma as malignant thyroid tumor
Authors: Yilin Hou, Lei Zhao, Jiayue Sun, Yun-Fei Zhang
Journal: Front Oncol (2024)
Keywords: atypical parathyroid adenoma, case report, diagnostic errors, thyroid malignancy, ultrasonic diagnosis
MeSH terms: Case Reports

Atypical Parathyroid Adenoma (APA) is a type of tumor that lies somewhere between parathyroid adenoma and parathyroid carcinoma. It often affects adults over the age of 60, and the clinical symptoms are consistent with those of hyperparathyroidism. This condition has a low occurrence, and its ultrasonographic signs are strikingly similar to thyroid malignant tumors, making it easily misdiagnosed. As a result, a case of APA ultrasonography misdiagnosis admitted to our hospital was recorded in order to serve as a reference point for APA diagnosis.
Enhancing ectasia screening using advanced AS-OCT: a case series of challenging refractive candidates
Authors: Niklas Mohr, Stefan Kassumeh, Nikolaus Luft, Martin Dirisamer, Siegfried G Priglinger, Wolfgang J Mayer
Journal: Front Ophthalmol (Lausanne) (2024)
Keywords: as-oct, corneal tomography, ectasia screening, epithelial mapping, keratorefractive surgery

Purpose:
Ectasia screening in candidates for laser refractive surgery is mandatory during preoperative evaluation. Despite the availability of modern imaging techniques, refractive surgeons often face borderline decisions when patients present with suspicious tomographic findings. This case series presents refractive candidates with suspicious tomographic findings and demonstrates how to interpret them using Scheimpflug imaging and additional anterior segment optical coherence tomography (AS-OCT).
Setting:
Department of Ophthalmology, University Hospital, LMU Munich.
Case series:
This case series examines six potential candidates for refractive surgery with a mean age of 29.2 ± 3.9 years, whose corneal assessments using Scheimpflug imaging raised suspicion for ectasia. Each candidate was additionally examined with AS-OCT and reevaluated. The mean manifest subjective spherical equivalent was -3.67 ± 1.8 diopters. The total corneal thickness measured 537 µm ± 30 µm at its thinnest point. None of the candidates had any reported underlying corneal or ophthalmic diseases, and slit lamp examinations revealed no abnormal morphological findings.
Conclusions:
Both Scheimpflug imaging and AS-OCT are appropriate tools for screening refractive candidates for ectasia. While topographic and elevation analyses yielded comparable results regarding corneal structure, the epithelial mapping provided by AS-OCT played a critical role in decision-making for cases with borderline tomographic findings. Establishing a global consensus on the use of epithelial mapping in ectasia screening is necessary.