OpenMed/multicare-articles huggingface dataset:
Activity of afatinib in patients with NSCLC harboring novel uncommon EGFR mutations with or without co-mutations: a case report
Authors: Petros Christopoulos, Franziska Herster, Petra Hoffknecht, Markus Falk, Markus Tiemann, Hans-Georg Kopp, Andre Althoff, Anja Stammberger, Eckart Laack
Journal: Front Oncol (2024)
Keywords: egfr, afatinib, non-small cell lung cancer (nsclc), tyrosine kinase inhibitor, uncommon mutation
MeSH terms: Case Reports

Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) represent first-line standard of care in unresectable EGFR mutation-positive (EGFRm+) non-small cell lung cancer (NSCLC). However, 10-20% of patients with EGFRm+ NSCLC have uncommon EGFR variants, defined as mutations other than L858R substitutions or exon 19 deletions. NSCLC harboring uncommon EGFR mutations may demonstrate lower sensitivity to targeted agents than NSCLC with L858R or exon 19 deletion mutations. Prospective clinical trial data in patients with NSCLC uncommon EGFR mutations are lacking. Afatinib is a second-generation TKI and the only Food and Drug Administration-approved drug for some of the more prevalent uncommon EGFR mutations. We present a series of seven case reports describing clinical outcomes in afatinib-treated patients with NSCLC harboring a diverse range of extremely rare mutations with or without co-mutations affecting other genes. EGFR alterations included compound mutations, P-loop αC-helix compressing mutations, and novel substitution mutations. We also present a case with NSCLC harboring a novel EGFR::CCDC6 gene fusion. Overall, the patients responded well to afatinib, including radiologic partial responses in six patients during treatment. Responses were durable for three patients. The cases presented are in line with a growing body of clinical and preclinical evidence that indicating that NSCLC with various uncommon EGFR mutations, with or without co-mutations, may be sensitive to afatinib.
Multidrug-resistant tuberculous orchiepididymitis: a brief case report
Authors: César Augusto Tomaz de Souza, Jussemara Souza da Silva, Ademir Silva Correia, Denise Silva Rodrigues
Journal: Rev Inst Med Trop Sao Paulo (2023)
MeSH terms: Mycobacterium tuberculosis, Tuberculosis / drug therapy, Tuberculosis, Extrapulmonary, Tuberculosis, Multidrug-Resistant / diagnosis, Tuberculosis, Multidrug-Resistant / drug therapy, Tuberculosis, Multidrug-Resistant / epidemiology, Case Reports, Antitubercular Agents / therapeutic use, Humans, Antitubercular Agents

Tuberculosis (TB) is one of the leading causes of death by infectious diseases worldwide. Multidrug-resistant tuberculosis is a growing problem, especially in countries with high TB prevalence. Although the lungs are the organs most frequently affected by this disease, Mycobacterium tuberculosis can harm any organ, including the urogenital tract, causing extrapulmonary tuberculosis, which leads to a challenging diagnosis and consequent treatment delays. In this article, we present a case of orchiepididymitis caused by multidrug-resistant TB (MDR-TB) with a significantly delayed diagnosis, the proposed treatment according to the resistance profile, and the clinical outcomes.
Bilateral reversible optic neuropathy as the first sign of Waldenström macroglobulinema
Authors: Yoshiaki Shimada, Yoshiki Akatsuka, Kazuya Nokura
Journal: GMS Ophthalmol Cases (2024)
Keywords: waldenström macroglobulinemia, monoclonal gammopathy, multiple myeloma, optic neuropathy
MeSH terms: Case Reports

Objective:
To report a case of bilateral reversible optic neuropathy as the first sign of Waldenström macroglobulinemia (WM).
Methods:
Observational case report.
Results:
A 52-year-old man had a sudden loss of vision in the left eye. Examinations revealed the presence of a serum monoclonal immunoglobulin (IgM kappa) in the serum. Even after a session of steroid pulse therapy, optic neuropathy became bilateral and then resolved almost completely after 4 months. The condition progressed to WM with multiorgan lesions years later. There was no evidence of optic neuropathy recurrence. The literature revealed two cases of monoclonal gammopathy (MG): a 64-year-old man with multiple myeloma (MM) with IgA lambda and a 51-year-old man with MM with IgG kappa. These cases have similar conditions: 1) visual reduction as an initial symptom of MG, 2) bilateral involvement, 3) no sign of central nervous system (CNS) infiltration shown by normal brain magnetic resonance images, and 4) recovery to a visual acuity of ≥1.0 bilaterally with no reoccurrence. The excessive Igs or B-cell hyperactivity may activate an autoimmune mechanism that reversibly interferes with the bilateral optic nerves.
Conclusion:
Bilateral optic neuropathy was the initial symptom of WM. There was no evidence of CNS infiltration; it recovered and then did not reoccur. The pathogenesis remained unknown, but two cases of MG were reported in the literature with remarkably similar conditions.
First report of a post-pneumonectomy nocardia empyema
Authors: Jonathan A Nakata, Azzan Arif, Louis F Chai, Stacey Su
Journal: J Surg Case Rep (2024)
Keywords: nsclc, nocardia, nocardia nova, ppe, vats, adenocarcinoma, chest infection, empyema, immunocompetent, lung cancer, pneumonectomy, post-pneumonectomy empyema
MeSH terms: Case Reports

Post-pneumonectomy empyema (PPE) is an uncommon but serious complication that carries significant therapeutic challenges. We present a late-onset PPE due to Nocardia nova in an immunocompetent individual. Nine years after a right pneumonectomy for non-small cell lung cancer, surveillance scans revealed new right pleural thickening and FDG avidity concerning for recurrence. Thoracoscopic pleural biopsies were negative for malignancy, but tissue cultures grew N. nova. Nocardia empyema is rare with few reported cases. Most occur in immunocompromised hosts, and all were associated with pulmonary or disseminated nocardiosis. Our case describes the first report of a PPE secondary to Nocardia.
CD4+ T cell count in HIV/TB co-infection and co-occurrence with HL: Case report and literature review
Authors: Pingping Xiao, Xuyan Chen, Yongquan Chen, Wei Fan, Zhigao Dong, Jinmei Huang, Yi Zhang
Journal: Open Life Sci (2023)
Keywords: cd4+ t cells, hiv, hodgkin’s lymphoma, antiretroviral therapy, tuberculosis
MeSH terms: Case Reports

In the human immunodeficiency virus (HIV)-infected population, especially HIV with concomitant tuberculosis (TB) or Hodgkin's lymphoma (HL), numerous risk factors have been reported in recent years. Among them, the decreased CD4+ T cell count was recognized as the common risk factor. We report a case of a patient with HIV and TB and HL co-occurrence, in which patient's CD4+ T cell count was inconsistent with disease. A 58-year-old male presented with fever and shortness of breath that persisted for 2 months. The patient had a 4-year history of HIV infection and underwent antiretroviral therapy (ART) effectively. After blood test, computed tomography, bone biopsy, and lymphoma biopsy, the patient was diagnosed with skeletal TB and HL, underwent TB treatment and received ART, and underwent four cycles of chemotherapy. CD4+ T cell count was not decreased before diagnosed with TB/HL and increased in this case after the fourth cycle of chemotherapy. We collected and analyzed CD4+ T cell counts in our case and reviewed relevant literature. It is suggested that CD4+ T cell count may be insufficient to predict the risk of HIV-related disease, especially lymphoproliferative disorders.
Regenerative Endodontic Treatment in Dentinogenesis Imperfecta-Induced Apical Periodontitis
Authors: Ying Liao, Ting Pan, Xianghui Xing
Journal: Case Rep Dent (2024)
MeSH terms: Case Reports

Pulp involvement of immature permanent teeth with dentinogenesis imperfecta is challenging and could lead to extraction. A case of dentinogenesis imperfecta-induced periapical periodontitis of an immature permanent tooth was treated with regenerative endodontic treatment (RET), and root maturation was observed in 12-month follow-up. An 8-year-old girl presented acute pain and swelling in central mandibular region. Clinical and radiographic examination revealed "shell teeth" appearance of teeth 31, 41, and 42. Periapical lesion of tooth 31 was observed. Tooth 41 was previously treated with apexification. RET was planned and carried out for the necrotic tooth (tooth 31) with dentinogenesis imperfecta. The 1-, 3-, 7-, and 12-month postoperative recall revealed complete healing of periapical lesions. Root maturation characterized by elongation of root, thickening of dentinal walls, and closure of root apex was observed with radiographic examinations. We show that RET could be a desirable treatment for necrotic immature permanent teeth with dentinogenesis imperfecta and lead to resolution of endodontic lesions as well as maturation of dental root. The findings of this case suggest that RET should be considered by endodontist and pediatric dentist to treat teeth with similar dental anomalies and apical periodontitis.
Pregnancy-Induced Thrombotic Microangiopathy in Systematic Lupus Erythematosus: A Case Report
Authors: Basil Alnasrallah, Eman Alabbad, Mohammed M Aljishi, Zainab A Alkhuraidah, Sumayah Alsabaa
Journal: Cureus (2024)
Keywords: acute kidney injury(aki)), pregnancy-related complications, systemic lupus erythromatosus, therapeutic plasma exchange (tpe), thrombotic microangiopathy (tma)
MeSH terms: Case Reports

Thrombotic microangiopathy (TMA) is a severe systemic disorder with multiorgan manifestations due to thrombosis of the microvasculature. Pregnancy and post-partum are particularly high-risk periods for many forms of TMA. The disease progression is rapid and can lead to organ failure and even death; therefore, urgent recognition and treatment are paramount. The presence of other triggers such as infections or autoimmune diseases like systematic lupus erythematosus (SLE) can add further complexity, which emphasizes the need for definitive diagnostic investigations such as kidney biopsy to promptly direct further diagnosis and management. We describe a case of a 27-year-old female with post-partum severe acute kidney injury and nephrotic range proteinuria. She had a new diagnosis of active SLE and was found to have TMA on kidney biopsy without conclusive features of lupus nephritis. She was managed successfully with plasma exchange with rapid improvement of her kidney markers.
Eosinophilic gastroenteritis in an elderly men associated with antibiotic use post maxillofacial space infection: a case report
Authors: Ran Lin, Kangjie Ye, Min Hong, Jiqiang Li, Zhongde Zhang, Xi Zhang
Journal: Front Med (Lausanne) (2024)
Keywords: antibiotic, colonic tubulovillous adenoma, eosinophilia, eosinophilic gastroenteritis, infection
MeSH terms: Case Reports

A 79-year-old man underwent operative drainage and 2-week cephalosporin treatment due to a maxillofacial space infection (bilateral submaxillaris, submentum, and left face). However, he experienced anorexia, nausea, vomiting, and emaciation in the following 2 months. It was initially considered that a malignancy might be present, thus a series of examinations were performed. Laboratory investigations showed increases in inflammatory markers and a significant eosinophilia, which seemed to be a hematological system disease. Combined with the gastrointestinal endoscopes and histology examination, the patient was diagnosed with eosinophilic gastroenteritis (EGE). After cessation of antibiotic treatment and administration of corticosteroid, our patient experienced a rapid progress in his clinical condition. Despite the low incidence, EGE should be considered in patients with unknown cause of gastrointestinal disorder, elevated eosinophilia, and so on.
Point-of-care ultrasound in early diagnosis and monitoring of deep abscess in newborns: a case report of two cases
Authors: Bang Du, Fengdan Xu, Biying Deng, Baimao Zhong, Ning Li, Xiaoguang He
Journal: Front Pediatr (2024)
Keywords: deep abscess, early diagnosis, fever, monitoring, newborn, point-of-care ultrasound
MeSH terms: Case Reports

Objective:
This study sought to analyze the value of point of care ultrasound (POCUS) in early diagnosis and monitoring of deep abscess in newborns.
Methods:
Retrospective analysis of the clinical data of two newborns admitted to the Neonatal Intensive Care Unit (NICU) of our hospital and diagnosed with deep abscess of the newborn. Combined with literature analysis, the value of POCUS in early diagnosis and monitoring of deep abscess of the newborn was evaluated.
Results:
The two newborns reported in this article were all admitted to NICU due to" "fever". POCUS was used to assist in early diagnosis of "liver abscess" and "lung abscess". Subsequently, POCUS was used to monitor lesion changes and adjust treatment plans. All patients were cured and discharged with a good prognosis.
Conclusions:
Deep abscesses in newborns are very rare and often life-threatening, but apart from fever, they often have no specific clinical manifestations and are easily misdiagnosed or missed. POCUS, as a bedside auxiliary examination tool, has high accuracy, radiation free, non-invasive, and convenient, and has high diagnostic and monitoring value in early diagnosis and monitoring of deep abscess in newborns.
Chiropractic Management of Lumbar Disc Herniation in a Patient With Co-existing Liver Cancer: A Case Report
Authors: Eric Chun-Pu Chu, Shun Zhe Piong, Cliff Tao
Journal: Cureus (2024)
Keywords: chiropractic, chiropractor, disc herniation, liver cancer, lumbar disc herniation
MeSH terms: Case Reports

The current case report outlines the chiropractic management of a 30-year-old male construction worker who presented with symptoms of lumbar disc herniation with co-existing stage IV liver cancer. The patient reported experiencing substantial lower back pain and decreased sensation in his right leg following a fall at work, impacting his mobility and quality of life. The complexity of this case is underscored by the challenge of differentiating between pain due to metastatic disease and that related to the fall. The chiropractic treatment plan included gentle joint mobilization, instrument-assisted soft tissue mobilization, and low-impact exercises tailored to the patient's overall health status. The treatment protocol markedly improved pain levels, range of motion, and overall quality of life. This case highlights the potential role of chiropractic care in managing complex cases of lumbar disc herniation, even in the presence of severe illnesses such as liver cancer. This study provides valuable insights into the importance of personalized and adaptable treatment strategies in managing such cases, contributing a unique perspective to the scientific literature.
Emotionally-oriented design in museums: a case study of the Jewish Museum Berlin
Authors: Zhihui Zhang, Jing Lu, Xiuying Zhang
Journal: Front Psychol (2024)
Keywords: architectural psychology, emotional architecture, emotionally-oriented design, environmental psychology, museum design, visitor experience

Objective:
This study examines the intricate interplay between architectural design and visitor emotional responses at the Jewish Museum Berlin, focusing on how specific spatial elements such as the Holocaust Tower, Garden of Exile, The Voids, and The Axis elicit varied affective experiences. The research aims to extend the discourse on environmental psychology and architectural empathy, particularly within the context of memorial museums.
Method:
Employing a non-intrusive approach, the study gathered emotional response data using the Positive and Negative Affect Schedule (PANAS) from 113 museum visitors, with 102 valid responses analyzed. Environmental conditions such as light, sound, and spatial design were quantitatively measured to correlate with emotional responses captured at the end of visitors' tours across the designated museum spaces.
Results:
Findings revealed that architectural elements significantly influence emotional responses. High levels of negative emotions like fear and anxiety were markedly evident in the Holocaust Tower due to its minimal lighting and stark concrete structure. Conversely, the Garden of Exile induced more positive emotions through its use of natural light and greenery, emphasizing the role of biophilic design in enhancing emotional well-being. Statistical analysis supported these observations, with variations in emotional impact across different spaces demonstrating the profound effect of architectural design on visitor experiences.
Conclusion:
This study confirms that a variety of design elements and spatial strategies not only facilitate the presentation of historical narratives but also actively sculpt the emotional involvement and experiences of visitors. Our findings highlight the efficacy of emotionally-oriented architectural design in deepening the impact and engagement of museum visitors, emphasizing the transformative power of these environments in shaping visitor perceptions and interactions.
Histoplasmosis: An epidemiological and clinical update in China, review and a case report
Authors: Lihua Chen, Danyang Hu, Congming Zhang, Tianrui Wu, Xiangning Cheng, Ferry Hagen, Hui Zhu, Shuwen Deng
Journal: Mycology (2023)
Keywords: china, histoplasma capsulatum, histoplasmosis, epidemiology, hemophagocytic lymphohistiocytosis
MeSH terms: Review

Histoplasmosis is a systemic mycosis caused by the dimorphic fungus in the genus Histoplasma. Histoplasmosis is overlooked in China. This study aims to provide an epidemiological and clinical update on histoplasmosis in China by literature review. We reviewed cases of histoplasmosis reported in recent 11 years and described a case of histoplasmosis-triggered hemophagocytic lymphohistiocytosis (HLH) in an immunocompetent patient. A total of 225 cases of histoplasmosis diagnosed in China between 2012 and 2022 were involved in this study, compared with 300 cases reviewed from 1990 to 2011, an increasing number of cases of histoplasmosis have been diagnosed in the last 11 years. The majority of cases of histoplasmosis were autochthonous cases, mainly from provinces Sichuan (56/225, 24.9%), Hunan (50/225, 22.2%), Guangdong (31/225, 13.8%), and Yunnan (24/225, 10.7%). Higher incidence (52.5%, 53/99) of histoplasmosis occurred in immunocompetent patients which is similar to those from the previous 21 years, and the prevalence of the disease did not vary highly over time. Of note, the number of histoplasmosis cases is increasing, and the geographic distribution is shifting southwards over time. Improved awareness is critically important for informing clinical practice in China.
Case Report: Bilateral targeted intraoperative radiotherapy: a safe and effective alternative for synchronous bilateral breast cancer
Authors: Fardeen Bhimani, Maureen McEvoy, Anjuli Gupta, Jessica Pastoriza, Areej Shihabi, Amar Basavatia, Wolfgang A Tomé, Jana Fox, Keyur Mehta, Sheldon Feldman
Journal: Front Oncol (2023)
Keywords: iort, targit, bilateral iort, bilateral breast cancer, bilateral breast irradiation, breast cancer, intraoperative radiotherapy
MeSH terms: Case Reports

Background:
The incidence of bilateral breast cancer (BBC) ranges from 1.4% to 11.8%. BBC irradiation is a challenge in current clinical practice due to the large target volume that must be irradiated while minimizing the dose to critical organs. Supine or prone breast techniques can be used, with the latter providing better organ sparing; both, however, result in lengthy treatment times. The use of Intra-operative radiotherapy (IORT) in breast cancer patients who choose breast conservation has been highlighted in previous studies, but there is a scarcity of literature analyzing the utility and applicability of IORT in BBC. This case series aims to highlight the applicability of administering bilateral IORT in patients with BBC.
Case reports:
Five patients with bilateral early-stage breast cancer (or DCIS) were treated with breast-conserving surgery followed by bilateral IORT. Of the 10 breast cancers, 8 were diagnosed as either DCIS or IDC, while the other 2 were diagnosed as invasive lobular carcinoma and invasive carcinoma, respectively. During surgery, all patients received bilateral IORT. Furthermore, 1 patient received external beam radiation therapy after her final pathology revealed grade 3 DCIS. The IORT procedure was well tolerated by all five patients, and all patients received aromatase inhibitors as adjuvant therapy. Additionally, none of these patients showed evidence of disease after a 36-month median follow-up.
Conclusion:
Our findings demonstrate the successful use of IORT for BCS in patients with BBC. Furthermore, none of the patients in our study experienced any complications, suggesting the feasibility of the use of IORT in BBC. Considering the benefits of improved patient compliance and a reduced number of multiple visits, IORT may serve as an excellent patient-centered alternative for BBC. Future studies are recommended to reinforce the applicability of IORT in patients with BBC.
Long-Standing Overt Ventriculomegaly in Adults (LOVA) With Absent Septum Pellucidum and Spontaneous Ventriculostomy: Report of a Rare Case
Authors: Jichang Seong, Rakhimov Akmal, Kadyrkhodjayeva Nigora
Journal: Cureus (2024)
Keywords: absent septum pellucidum, hydrocephalus, lova, macrocephaly, spontaneous ventriculostomy, ventricular rupture, ventriculomegaly
MeSH terms: Case Reports

Long-standing overt ventriculomegaly in adults (LOVA) is a type of chronic hydrocephalus with presumable infant onset characterized by macrocephaly and massive ventriculomegaly that causes clinical presentations in later adult life. We report a case of a 20-year-old man who was referred from the ophthalmology department for further investigation of his visual disturbances. MRI of the head revealed massive ventriculomegaly with an Evan's index of 0.44. A careful investigation revealed coexisting aqueductal stenosis, absent septum pellucidum, ventricular rupture, and spontaneous ventriculostomy. The clinical presentations were relatively mild compared to his MRI findings. He was referred to a neurosurgeon for potential surgical interventions after the administration of conservative hyperosmolar drugs and neuroprotective agents.
Repair and remodeling of the mandibular head of the condylar process in four immature dogs
Authors: Christopher P Sauvé, Nadine Fiani, Santiago Peralta, David C Hatcher, Boaz Arzi
Journal: Front Vet Sci (2023)
Keywords: tmj, canine, computed tomography, condylar process, regeneration, remodeling, repair, temporomandibular joint
MeSH terms: Case Reports

Spontaneous repair and remodeling of the mandibular head of the condylar process is a rarely reported outcome following condylectomy. This clinical report describes the spontaneous repair and subsequent remodeling of the mandibular head of the condylar process in four immature dogs that sustained traumatic injuries, necessitating surgical intervention through arthroplasty via partial or complete condylectomy, or caudal mandibulectomy. In subsequent evaluations, it was observed that all dogs exhibited clinically functional TMJs, as evidenced by an appropriate range of motion. These findings were corroborated by the owners' reports of the patient's normal eating and drinking abilities. Conventional and cone-beam computed tomography studies demonstrated the repair and remodeling of the osseous tissues of the mandibular head of the condylar process. Histopathology was unavailable to assess the novel tissues. No evidence of intraarticular or extraarticular ankylosis or osteoarthritic changes was observed.