OpenMed/multicare-articles huggingface dataset:
First report of Nocardia wallacei infection in an immunocompetent patient in Zhejiang province
Authors: Wei Pan, Bingqian Zhuo, Sumei Wang, Jieping Long, Wei Xu, Mengyuan Chen, Xin Hong, Yumei Ge
Journal: Open Life Sci (2024)
Keywords: maldi-tof ms, nocardia wallacei, immunocompetent, linezolid, nocardiosis
MeSH terms: Case Reports

Nocardiosis is an infectious disease caused by Nocardia spp., mainly affecting immunocompromised hosts. Nocardia infection is not common; especially Nocardia wallacei infection is even rarer. The patient, female, 61 years old, farmer, has been working in the field for a long time and has normal immune function. Her main clinical manifestation was persistent back pain. Chest-enhanced computed tomography showed pulmonary inflammation. Rare pathogen Nocardia wallacei was detected in alveolar lavage fluid using matrix-assisted laser destructive ionization time-of-flight mass spectrometry. She received treatment with linezolid and was discharged after her condition improved.
A case report of a giant ileocecal cystic prolapse through the anus and literature review
Authors: Beige Zong, Xia Xiao, Nijiao Deng, Wenjing Wang, Li Peng, Dianliang Fang, Haoyu Wang, Song Hu, Zhongfu Li, Xin Zhang
Journal: Front Med (Lausanne) (2024)
Keywords: acute abdominal disease, enterogenous cyst, exploratory laparotomy, intestinal duplication, intussusception
MeSH terms: Case Reports

Intussusception refers to the invagination of a proximal loop of the bowel into an adjacent distal segment. This condition is rare in adults, especially when it involves a complete folding of the ileocecal area out of the body cavity. Meanwhile, enterogenous cysts are congenital malformations that are largely identified in childhood following symptoms of bowel obstruction. While surgical treatment is ultimately required for both diseases, deciding on the type of surgery and the right time to operate can be a challenge for clinicians. It is especially difficult to decide on treatment for an adult with the coincidental occurrence of both conditions and no definitive pathologic diagnosis prior to surgery. Here, we present the case study of a 19-year-old female patient who presented with a prolapsed anus due to intussusception caused by a large ileocecal mass. The patient was admitted to the emergency department with a "massive anal mass." She remained symptomatic after receiving conventional conservative treatment and had to undergo emergency surgery after developing an intestinal obstruction. While the patient's intraoperative condition also confirmed the preoperative CT findings, the situation became more complicated during surgery. The postoperative pathological report indicated the presence of an enterogenous cyst. After recovery from surgery, the patient was successfully discharged. Intussusception or intestinal obstruction caused by an intestinal mass is a surgical indication, and removal is the only way to cure the condition. This case study provides a helpful reference for general surgeons, especially anorectal surgeons, imaging physicians, and pathologists, and informs the diagnosis and treatment of this patient population.
Thoracic Vertebra Chance Fracture Resulting from Mechanical CPR
Authors: Thomas Saliba, Sanjiva Pather, Olivier Cappeliez
Journal: J Belg Soc Radiol (2024)
Keywords: cpr, chance, fracture, resuscitation, spine
MeSH terms: Case Reports

Chest compressions, used in cardiopulmonary resuscitation (CPR), cause rib and sternum fractures in around 79% and 54% of patients, respectively. Spinal fractures resulting from CPR are far rarer. We present the case of a 70-year-old man who underwent mechanical CPR after choking whilst eating. The patient received a cerebral and thoracic CT scan upon arrival to the hospital. The cerebral scan was normal, but the chest CT scan revealed signs of ankylosing spondylitis and an unstable Chance fracture of the 12th thoracic vertebra. The patient was hospitalised but passed away. This case highlights the need for awareness of uncommon spine fractures due to the high associated morbidity. Teaching point: In patients who have undergone thoracic compressions, one should not only search for rib fractures but also for spine fractures, which, though uncommon, have a far greater impact on the patient's morbidity, especially in patients with predisposing spine conditions.
Massive Osteolysis and Pseudotumor Formation following Maestro Total Wrist Arthroplasty
Authors: Marcus Sagerfors, Daniel Reiser
Journal: Case Rep Orthop (2024)
MeSH terms: Case Reports

Metallosis is a known complication of arthroplasty and has been reported for the hip, knee, and shoulder joints. Metallosis pseudotumors have been linked to an increased risk of implant failure. We report a case of pseudotumor with massive bone loss following total wrist arthroplasty (TWA) using the Maestro implant. Revision to arthrodesis is possible, but issues with bone loss have to be addressed. We recommend caution in offering TWA to young patients with high functional demands.
Endodontic Treatment of Maxillary Premolar With Three Roots: A Case Report
Authors: Chen Jiannan, Zhao Yangpeng, Sun Huanhuan, Zhu Qiang
Journal: Case Rep Dent (2024)
Keywords: anatomical variation, first premolars, pathological report, root canal abnormalities, root canal therapy, three root canals
MeSH terms: Case Reports

Background: The aim of this case was to understand and treat the intricate root canal anatomy observed in complex maxillary first premolars, particularly those exhibiting three root canals, emphasizing the significance of understanding root canal morphological variations in their treatment. Conclusions: This case reported the methods of treating three-root canal maxillary first premolars, including warm vertical compression technique, root canal microsurgery, and the application of rubber dam. The utilization of dental operating microscopes, various surgical strategies, and key assessments of X-rays and cone beam computed tomography (CBCT) scans were all essential steps for achieving accurate and safe root canal therapy.
Pathologic Femur Fracture in an Immunocompetent Healthy Young Adult due to Acute Osteomyelitis
Authors: Evan R J Goyette, Natalia Georgantzoglou, Darcy A Kerr, Yvonne Cheung, Eric R Henderson, Konstantinos Linos
Journal: Case Rep Pathol (2023)
MeSH terms: Case Reports

An immunocompetent 33-year-old woman presented with a pathologic femur fracture after one month of progressively worsening right thigh pain. Open biopsy demonstrated acute suppurative osteomyelitis despite the lack of clinical risk factors. The polymicrobial infection was successfully treated with three operative procedures and culture-specific antibiotic agents. Acute osteomyelitis, while an uncommon cause of pathologic fracture, must always be on the differential diagnosis, even when no obvious predisposing factors are present. When investigating for an infectious etiology in cases such as our own, considering immunodeficiency syndromes alongside the more typical causes of osteomyelitis is encouraged.
Case report: Bridging limbic network epilepsy with psychiatric, memory, and sleep comorbidities: case illustrations of reversible psychosis symptoms during continuous, high-frequency ANT-DBS
Authors: Lydia Wheeler, Samuel E Worrell, Irena Balzekas, Jordan Bilderbeek, Dora Hermes, Paul Croarkin, Steven Messina, Jamie Van Gompel, Kai J Miller, Vaclav Kremen, Gregory A Worrell
Journal: Front Netw Physiol (2024)
Keywords: ant-dbs, epilepsy, limbic network, psychosis, seizure
MeSH terms: Case Reports

The network nature of focal epilepsy is exemplified by mesial temporal lobe epilepsy (mTLE), characterized by focal seizures originating from the mesial temporal neocortex, amygdala, and hippocampus. The mTLE network hypothesis is evident in seizure semiology and interictal comorbidities, both reflecting limbic network dysfunction. The network generating seizures also supports essential physiological functions, including memory, emotion, mood, and sleep. Pathology in the mTLE network often manifests as interictal behavioral disturbances and seizures. The limbic circuit is a vital network, and here we review one of the most common focal epilepsies and its comorbidities. We describe two people with drug resistant mTLE implanted with an investigational device enabling continuous hippocampal local field potential sensing and anterior nucleus of thalamus deep brain stimulation (ANT-DBS) who experienced reversible psychosis during continuous high-frequency stimulation. The mechanism(s) of psychosis remain poorly understood and here we speculate that the anti-epileptic effect of high frequency ANT-DBS may provide insights into the physiology of primary disorders associated with psychosis.
Management of Aberrant Frenum by Z-plasty Procedure: A Case Report
Authors: Pavan Bajaj, Unnati Shirbhate, Chitrika Subhadaresanee, Shivani Thakre
Journal: Cureus (2024)
Keywords: frenectomy, frenum, midline diastema, mucogingival problems, ortho-perio, periodontal, plastic surgery, z-plasty
MeSH terms: Case Reports

During or after the orthodontic closure, persistent diastemas are frequently the result of a high frenum attachment. A labial frenectomy is a complete removal of the frenum attachment, which typically attaches to the space between the upper two anterior teeth and the centre of the upper lip. It might be required if there is space between the teeth due to a frenulum positioned too high on the gums. Many surgical technique modifications, including Miller's technique, Z-plasty, and V-Y-plasty, have been established since the conventional classical frenectomy procedure was initially presented to cope with the difficulties associated with an aberrant labial frenum. This case report demonstrates that a Z-plasty approach was used to remove the 21-year-old female patient's high papillary-type labial frenum attachment and how orthodontic treatment led to the closure of the midline diastema. For several reasons, the frenectomy procedure with Z-plasty proved to be reliable and yielded outstanding aesthetic outcomes for the removal of the aberrant labial frenum connection. Understanding Z-plasty will enable primary intention-based tissue healing, reduce the risk of tissue contractures, shorten the patient's recovery, and enhance the patient's aesthetic outcomes.
Right Femoral Fragility Fracture in an Adolescent with Vitamin D Deficiency from COVID-19 Pandemic-Related Confinement
Authors: Suhasheni Rajendran, Ze Chen Lee, Chu Ee Seow, Chong Hui Khaw
Journal: Case Rep Endocrinol (2024)
MeSH terms: Case Reports

Background:
The COVID-19 pandemic has caused major impacts in various aspects of our life. In Malaysia, a Movement Control Order was imposed in March 2020. For almost two years, school going children and adolescents were not able to attend school physically, and their physical activity was confined within their room or house on most days. Case Description. We describe a case of a 14-year-old boy who was previously active in sports and sustained a low trauma fracture at the right neck of the femur following a prolonged period of extreme sedentary life along with poor dietary intake during the COVID-19 pandemic period. He underwent open reduction and screw fixation for the right neck femur fracture. He was thin with a low BMI (15.62 kg/m2) and a significant loss of muscle bulk in all limbs. Laboratory tests showed vitamin D deficiency (15.3 nmol/L) and the dual energy X-ray absorptiometry (DXA) showed a low Z-score for the total spine (-2.2) and total hip (-3.9). He was treated with activated vitamin D and vitamin D3 replacement. Sports physician was involved for individualized postoperative rehabilitation. Successive clinic visits showed remarkable improvements in physical fitness, sports participation, and normalization of vitamin D levels.
Conclusion:
A high degree of suspicion is needed to rule out secondary causes in adolescents who present with unusual fragility fractures.
Case report: The lesson from opioid withdrawal symptoms mimicking paraganglioma recurrence during opioid deprescribing in cancer pain
Authors: Elena Ruggiero, Ardi Pambuku, Mario Caccese, Giuseppe Lombardi, Ivan Gallio, Antonella Brunello, Filippo Ceccato, Fabio Formaglio
Journal: Front Pain Res (Lausanne) (2023)
Keywords: cancer pain, catecholamines, cortisol, opioid, opioid deprescribing, opioid withdrawal
MeSH terms: Case Reports

Pain is one of the predominant and troublesome symptoms that burden cancer patients during their whole disease trajectory: adequate pain management is a fundamental component of cancer care. Opioid are the cornerstone of cancer pain relief therapy and their skillful management must be owned by physicians approaching cancer pain patients. In light of the increased survival of cancer patients due to advances in therapy, deprescription should be considered as a part of the opioid prescribing regime, from therapy initiation, dose titration, and changing or adding drugs, to switching or ceasing. In clinical practice, opioid tapering after pain remission could be challenging due to withdrawal symptoms' onset. Animal models and observations in patients with opioid addiction suggested that somatic and motivational symptoms accompanying opioid withdrawal are secondary to the activation of stress-related process (mainly cortisol and catecholamines mediated). In this narrative review, we highlight how the lack of validated guidelines and tools for cancer patients can lead to a lower diagnostic awareness of opioid-related disorders, increasing the risk of developing withdrawal symptoms. We also described an experience-based approach to opioid withdrawal, starting from a case-report of a symptomatic patient with a history of metastatic pheochromocytoma-paraganglioma.
Dupilumab and the potential risk of eosinophilic pneumonia: case report, literature review, and FAERS database analysis
Authors: Xiyuan Zhou, Ge Yang, Xuemei Zeng, Lan Wang, Jing Xiang, Jinyu Zhao, Xuejun Chen, Lixia Zhang
Journal: Front Immunol (2024)
Keywords: faers database, case report, dupilumab, eosinophilic pneumonia, risk analysis
MeSH terms: Antibodies, Monoclonal, Humanized / adverse effects, Pulmonary Eosinophilia / chemically induced, Pulmonary Eosinophilia / diagnosis, Pulmonary Eosinophilia / drug therapy, Case Reports, Review, Comment, Aged, Databases, Factual, Eosinophils, Humans, Antibodies, Monoclonal, Humanized, dupilumab

Eosinophilic pneumonia (EP) is a rare but noteworthy adverse effect linked to dupilumab, an interleukin-4 (IL-4) and IL-13 inhibitor used in the managing atopic diseases. The underlying mechanisms, potential predisposing factors, clinical characteristics, and optimal management strategies for dupilumab-induced EP remain unclear. We report a 71-year-old patient who developed acute EP after the first 600-mg dose of dupilumab. Eosinophils (EOSs) were also transiently increased (up to 1,600 cells/μl). After the acute EP was effectively treated with glucocorticoids, dupilumab treatment was continued. Rash, itching, and immunoglobulin E levels continued to decrease in the patient, and no further pulmonary adverse events occurred. We combined this case with a literature review of nine articles and analyzed data from 93 cases reported in the FDA Adverse Event Reporting System (FAERS) database of patients developing EP after dupilumab use. Our findings imply that dupilumab may induce EP, particularly in individuals over 45 years old, those with a history of respiratory diseases, and those who have previously used inhaled or systemic steroids. Vigilance is required, especially when there is a persistent elevation in peripheral blood EOSs during treatment. Although steroid treatment can effectively manage EP, more data are needed to determine the safety of resuming dupilumab treatment after controlling pneumonia.
Case report: Assessing criminal responsibility and recidivism risk in the behavioral variant of frontotemporal dementia
Authors: Anouk Karcher, Rayane Hamza, Camille Jantzi
Journal: Front Psychiatry (2024)
Keywords: criminal responsibility, forensic psychiatry, frontotemporal dementia, neurodegenerative diseases, neuroprediction, recidivism risk
MeSH terms: Case Reports

Frontotemporal dementia (FTD) affects the frontal and temporal lobes of the brain, leading to personality changes, language impairments, and behavioral disturbances, including impulsivity and disinhibition. Assessing responsibility and recidivism risk in forensic evaluations is challenging due to the evolving nature of FTD. Despite limited literature, we present a case of a 45-year-old man with no prior legal or medical history, who committed criminal acts due to behavioral changes linked to the behavioral variant of frontotemporal dementia (bvFTD). Initial assessment found him irresponsible, with a non-evaluable risk of recidivism. Subsequent evaluation showed a low recidivism risk based on clinical evolution. We discuss these findings considering existing literature and Swiss jurisprudence.
Case Report: Spectrum of interesting ocular manifestations following COVID-19 vaccination: a case series of real-world presentations
Authors: Iqbal Tajunisah, Shao Sze Tan, Irina Effendi-Tenang, Amir Samsudin, Kiet-Phang Ling, Wee Yong Tan, Sunder Ramasamy, Kenneth Choong Sian Fong
Journal: Front Cell Infect Microbiol (2023)
Keywords: covid-19 vaccination, acute multifocal placoid pigment epitheliopathy, herpes zoster uveitis, multifocal choroiditis, retinal pigment epitheliitis
MeSH terms: COVID-19 Vaccines / adverse effects, COVID-19 / prevention & control, Case Reports, Acute Disease, Eye, Humans, Vaccination / adverse effects, COVID-19 Vaccines

Purpose:
We report the ocular findings that patients experienced after receiving the coronavirus disease 2019 (COVID-19) vaccination in three different eye centers in Malaysia.
Observations:
A total of four cases were reported. Three patients received the Pfizer-BioNTech vaccine, while the other received the Oxford AstraZeneca type. Ocular symptoms occurred after the first vaccine dose in two patients and after the second vaccine dose in the other two. Three out of four patients required active treatment for their vision complications postvaccination. The first patient had acute-onset retinal pigment epitheliitis within 3 h of vaccination and was treated conservatively. The second patient developed unilateral choroidal neovascularization 3 days after vaccination and required intravitreal antivascular endothelial growth factor injection. The third patient presented with bilateral acute multifocal placoid pigment epitheliopathy a week after vaccination and responded to intravenous methylprednisolone. The fourth patient presented with herpes zoster infection and unilateral anterior nongranulomatous uveitis 2 weeks after vaccination and was treated with oral acyclovir and topical corticosteroids. All patients reported some amount of visual recovery.
Conclusions and importance:
Visual symptoms and various ocular adverse events can occur following COVID-19 vaccination, which warrants further investigation and urgent intervention if necessary. We would suggest patients receiving the COVID-19 vaccination be aware of possible ocular complications and report any symptoms, regardless of severity.
Effectiveness of Chemotherapy on Long-Term Survival in a Case of Advanced Juvenile Hepatocellular Carcinoma Without Viral Hepatitis Infection
Authors: Masamichi Kimura, Koji Nishikawa, Jun Imamura, Kiminori Kimura
Journal: Cureus (2024)
Keywords: alpha-fetoproteins, antinuclear antibodies, chemotherapy response, hepatocellular carcinoma (hcc), non-b non-c juvenile hepatocellular carcinoma
MeSH terms: Case Reports

Hepatocellular carcinoma (HCC) usually occurs in settings of cirrhosis and chronic hepatitis B or C virus (HBV and HCV, respectively) infection; it is extremely rare in patients <40 years of age since viral- or alcohol-induced chronic hepatitis develops over a prolonged period. Juvenile HCC is mostly associated with persistent HBV infection; cases unrelated to HBV or HCV infection (non-B, non-C juvenile HCC) are sporadic and treated in the same way as classical HCC. A woman in her late 30s was diagnosed with HCC in a healthy liver; her imaging findings were typical of HCC with bone metastasis. She was administered a combination of tyrosine kinase inhibitors, immune checkpoint inhibitors, and vascular endothelial growth factor inhibitors. Throughout chemotherapy, the liver reserve was Grade A on the Child-Pugh classification and tumor markers remained under control without marked elevation. Our patient is the first reported long-term survivor of unresectable non-B, non-C juvenile HCC following chemotherapeutic treatment.
SMN1 c.5C>G (p.Ala2Gly) missense variant, a challenging molecular SMA diagnosis associated with mild disease, preserves SMN nuclear gems in patient-specific fibroblasts
Authors: Sara L Cook, Christian Stout, Lindsey Kirkeby, Noemi Vidal-Folch, Devin Oglesbee, Linda Hasadsri, Duygu Selcen, Margherita Milone, Daniel Anderson, Nathan P Staff
Journal: Front Genet (2024)
Keywords: smn1, c5c>g, diagnostic testing, exon 1, nuclear gems, pala2gly, spinal muscular atrophy

Introduction:
Spinal muscular atrophy (SMA) is caused by homozygous loss of the SMN1 gene with SMN2 gene copy number correlating with disease severity. Rarely SMA is caused by a deletion on one allele and a pathogenic variant on the other. The pathogenic missense variant c.5C>G (p.Ala2Gly) correlates with a mild disease phenotype that does not correlate with SMN2 copy number. In a mouse model the c.5C>G transgene produces SMN that is thought to form partially functional SMN complexes, but levels in humans have not yet been investigated.
Methods:
We identified two patients with mild SMA caused by a heterozygous deletion of SMN1 and the heterozygous variant, c.5C>G. Molecular findings were confirmed with deletion/duplication analysis and Sanger sequencing. Skin fibroblasts were collected and cultured, and SMN expression was analyzed using immunofluorescence.
Results:
Two patients with slowly progressing mild weakness were confirmed to have heterozygous pathogenic missense variant c.5C>G and a heterozygous deletion of SMN1. Their clinical presentation revealed much milder disease progression than patients with matched SMN2 copy number. Analysis of the patients' fibroblasts revealed much higher numbers of SMN nuclear complexes than a patient with a homozygous SMN1 deletion and matched SMN2 copy number.
Conclusions:
These case reports reinforce that the rare c.5C>G variant causes mild disease. Furthermore, the analysis of SMA nuclear gems in patient samples supports the theory that the p.Ala2Gly SMN can form partially functional SMN complexes that may carry out essential cellular functions and result in mild disease.