OpenMed/multicare-articles huggingface dataset:
Case report: PD-1 inhibitor-based treatment strategies in gastric cancer complicated by bone marrow metastasis and disseminated intravascular coagulation: A report of two cases
Authors: Ren-Ze Huang, Nuo Chen, Yan Hu, Wan-Ming Hu, Feng-Hua Wang, Dong-Liang Chen
Journal: Front Oncol (2023)
Keywords: bone metastasis, disseminated intravascular coagulation, gastric cancer, immunotherapy, programmed death protein 1 inhibitors
MeSH terms: Case Reports

Introduction:
Gastric cancer (GC) complicated by bone marrow metastasis (BMM) and disseminated intravascular coagulation (DIC) represents poor prognosis and most of these patients would die in a few months. Active treatment strategies such as chemotherapy are effective in restoring coagulation function and prolonging patients' survival time. Immunotherapy including programmed death protein 1 (PD-1) or programmed death protein ligand 1 (PD-L1) inhibitors has emerged as a first-line treatment of gastric cancer. However, the efficacy of PD-1 inhibitor-based treatment strategies in these patients remains unknown.
Case description:
Herein, we presented two cases of advanced gastric cancer (AGC) complicated by BMM and DIC, in which two patients received chemotherapy and PD-1 inhibitor as the first-line treatment. Both of them achieved a partial response after treatment, and the coagulation function was restored. The patient who discontinued the PD-1 inhibitor after 6 months experienced DIC relapse, whereas the other patient who maintained the PD-1 inhibitor treatment cycle remained responsive after 10 months.
Conclusions:
We speculate that PD-1 inhibitor-based treatment strategies are effective and safe in prolonging survival against gastric cancer with BMM and DIC, and the coagulation function is well controlled by the treatment with a combination of immunotherapy and chemotherapy.
A Case for Doxycycline as an Effective Treatment for Confluent and Reticulated Papillomatosis (CARP)
Authors: Aishwarya Sharma, Deborah Moon, Dong Joo Kim
Journal: Case Rep Dermatol Med (2023)
MeSH terms: Case Reports

Confluent and reticulated papillomatosis (CARP) is a rare keratinization disorder that presents with asymptomatic, reticulated papules coalescing into plaques, which adversely affect, most often, young black persons. Minocycline is considered the drug of choice, but it is not without its host of potential side effects, including drug hypersensitivity, drug-induced lupus/vasculitis/hepatitis, blue-gray skin hyperpigmentation, acute eosinophilic pneumonia, pseudotumor cerebri, and vestibular instability, among others. Alternatively, doxycycline might be considered as another first-line agent for CARP as it can effectively clear lesions while offering a more favorable side effect profile in select patients. Herein, we present a case of CARP successfully resolved with doxycycline after a protracted treatment history of topical and oral antifungal medications for suspected tinea versicolor (TV).
Intestinal Obstruction following Ingestion of Metallic Instruments in a Psychiatric Patient
Authors: Oscar Kivike, Israel Soko, David Mgaya, Frank Sandi
Journal: Case Rep Surg (2018)
MeSH terms: Case Reports

Pica among psychiatric patients has been well documented. We report a 25-year-old female patient who presented with abdominal distension for one week. She is a known psychiatric patient for 5 years. Through history taking, physical examination, and investigations, the patient was found to have psychotic features and features of intestinal obstruction. Surgery was done by opening the abdomen and then the stomach. The stomach, together with the proximal intestine, was found to be filled with metallic instruments weighing 780 mg. The diagnosis of a metalophagia type of pica was reached. All instruments were removed and the patient did well postoperatively.
Case Report: Semantic Variant of Primary Progressive Aphasia Associated With Anti-Glial Fibrillary Acid Protein Autoantibodies
Authors: Niels Hansen, Winfried Stöcker, Jens Wiltfang, Claudia Bartels, Kristin Rentzsch, Caroline Bouter
Journal: Front Immunol (2022)
Keywords: anti-gfap antibody, autoimmunity, frontotemporal lobar degeneration (ftld), immunotherapy, semantic variant of primary progressive aphasia (svppa)
MeSH terms: Aphasia, Primary Progressive / immunology, Autoantibodies / immunology, Autoantigens / immunology, Glial Fibrillary Acidic Protein / immunology, Case Reports, Research Support, Non-U.S. Gov't, Aged, Female, Humans, Autoantibodies, Autoantigens, GFAP protein, human, Glial Fibrillary Acidic Protein, anti-GFAP autoantibodies

Background:
Frontotemporal lobar degeneration is a heterogeneous disorder entailing a semantic variant of primary progressive aphasia (svPPA). A subtype of frontotemporal dementia associated with glutamate receptor subunit 3 (GluA3) antibody of the α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR) was recently identified. Here, we describe the novelty of a svPPA associated with anti-glial fibrillary acid protein (GFAP) antibodies.
Methods:
To diagnose this 68-year-old woman we conducted a clinical examination, neuropsychological testing, CSF analysis, MRI and 18F-fluorodeoxyglucose (18F-FDG) Positron Emission Tomography (PET)/computed tomography (CT) imaging.
Results:
The clinical phenotype corresponds to a svPPA based on impaired confrontation naming and single-word comprehension. In addition, we observed spared speech production, impaired object knowledge, and surface dyslexia - further supporting the diagnosis of svPPA. Additional characteristic imaging features such as anterior temporal hypometabolism in 18F-FDG PET/CT confirmed patient's svPPA diagnosis. CSF analysis revealed signs of axonal degeneration, as both tau and phosphorylated tau proteins exceeded normal levels. Her serum showed anti-GFAP autoantibodies.
Conclusion:
We diagnosed a svPPA in this patient and report an association between serum anti-GFAP antibodies and svPPA never reported in the literature so far, thereby expanding the clinical spectrum of svPPA and anti-GFAP-antibody related disease. Further research is needed to elucidate the underlying immunopathology of this disease entity to ultimately improve treatment.
Pre-operative CT-guided wire localization of a retroperitoneal mass for laparoscopic surgery
Authors: Hsi-Ping Chi, Roberto Tozzi, Niall R Moore
Journal: BJR Case Rep (2016)
MeSH terms: Case Reports

A 48-year-old female with a 9-year history of granulosa cell tumour presented with progression of a mass in the left flank after the recent gradual rise of her inhibin B levels. She had experienced multiple recurrences and had undergone multiple operations to resect previous tumour recurrences. Initial laparoscopy did not identify the most recent recurrent mass. MRI was repeated a month after the surgery; it confirmed the presence of the mass and demonstrated an increase in the size of the tumour. Owing to difficulties in finding the tumour, a CT-guided wire localization of the mass was performed immediately prior to a second elective laparoscopy, leading to successful removal of the recurrent granulosa cell tumour. We describe the use of a conventional localization wire under CT guidance to facilitate the resection of a unique retroperitoneal tumour. This case report discusses the current applications of the wire localization technique, the evolution of the hook wire system, the potential complications that may occur and the factors influencing the likelihood of success of wire localization in the retroperitoneal space.
Myocardial Infarction After High-Dose Catecholamine Application-A Case Report From an Experimental Imaging Study
Authors: Niklas Beyhoff, David Lohr, Arne Thiele, Anna Foryst-Ludwig, Robert Klopfleisch, Laura M Schreiber, Ulrich Kintscher
Journal: Front Cardiovasc Med (2020)
Keywords: case report, catecholamines, diffusion tensor imaging, echocardiography, heart failure, magnetic resonance imaging, myocardial infarction, speckle tracking
MeSH terms: Case Reports

Although heart failure following myocardial infarction (MI) represents a major health burden, underlying microstructural and functional changes remain incompletely understood. Here, we report on a case of unexpected MI after treatment with the catecholamine isoproterenol in an experimental imaging study in mice using different state-of-the-art imaging modalities. The decline in cardiac function was documented by ultrahigh-frequency echocardiography and speckle-tracking analyses. Myocardial microstructure was studied ex vivo at a spatial resolution of 100 × 100 × 100 μm3 using diffusion tensor magnetic resonance imaging (DT-MRI) and histopathologic analyses. Two weeks after ISO treatment, the animal showed an apical aneurysm accompanied by reduced radial strain in corresponding segments and impaired global systolic function. DT-MRI revealed a loss of contractile fiber tracts together with a disarray of remaining fibers as corresponding microstructural correlates. This preclinical case report provides valuable insights into pathophysiology and morphologic-functional relations of heart failure following MI using emerging imaging technologies.
Ocular Manifestations of the NAA10-Related Syndrome
Authors: Angela S Gupta, Hind Al Saif, Jennifer M Lent, Natario L Couser
Journal: Case Rep Genet (2019)
MeSH terms: Case Reports

The NAA10-related syndrome is a rare X-linked neurodevelopmental condition that was first described in 2011. The disorder is caused by pathogenic variants in the NAA10 gene located on chromosome X at position Xq28. Clinical features typically include severe psychomotor developmental delay, cardiac disease, dysmorphic features, postnatal growth failure, and hypotonia, although there is significant variability in the severity of the phenotype among affected individuals. We describe a 5-year-old female with the syndrome; massively parallel exome sequencing and analysis revealed the c.247C>T (p.Arg83Cys) pathogenic variant that has been previously reported in ten affected individuals. Ocular manifestations of the NAA10-related syndrome are not uncommon, although they have not been well characterized in literature reports. From a systematic review of previously published cases to date, ocular abnormalities are present in more than half of patients with the syndrome. Common ocular findings reported include astigmatism, hyperopia, cortical vision impairment, microphthalmia/anophthalmia, and hypertelorism. Our patient presented with growth restriction, dysmorphic features, and hypotonia. Ocular manifestations identified in this child include downslanting palpebral fissures, myopic astigmatism, nystagmus, and exotropia. We speculate that the type and severity of ocular defects present in individuals with the NAA10-related syndrome are dependent on the specific NAA10 pathogenic variant involved.
Systematic analysis and case series of the diagnosis and management of trichilemmal carcinoma
Authors: Jiachen Sun, Lihua Zhang, Minglu Xiao, Shiyi Li, Runkai Chen, Ying Li, Yuguang Yang
Journal: Front Oncol (2023)
Keywords: mohs micrographic surgery, epidemiology, immunohistochemistry, metastasis, recurrence, trichilemmal carcinoma

Background:
Trichilemmal carcinoma (TLC) is a rare malignant cutaneous adnexal neoplasm, with no relatively comprehensive research.
Objective:
The aim of this study is to perform an updated statistical analysis so as to better understand TLC's epidemiology, clinical features, diagnosis, and treatment.
Methods:
The diagnosis and treatment of three TLC cases in our department were summarized. Then, all TLC cases published in the literature were retrieved for a comprehensive analysis, followed by the analysis of global trends and regional distribution, demographic characteristics, clinical features, pathogenesis, histopathological features, and treatment and prognosis of TLC.
Results:
Of the 231 cases, the incidence of TLC has shown an upward trend recently, especially in China, in Asia. The susceptible population is men aged 60-80 and women over 80, and the most prone location is head and neck. The phenotype of TLC is not always typical and may be misdiagnosed because of the coexistence of other diseases. There is a linear relationship between the diameter and its duration or thickness. UV, locally present skin lesions, trauma, scarring, organ transplantation, and genetic disorders may trigger the occurrence of TLC. Periodic acid-Schiff staining and CD34, but not Epithelial Membrane Antigen (EMA), were helpful in the diagnosis of TLC. Although effective, surgical excision and Mohs micrographic surgery need further improvement to reduce recurrence of TLC. Carcinoma history is an independent risk factor for TLC recurrence.
Limitations:
The limitation of this study is the lack of randomized controlled trial on TLC treatment and recurrence.
Conclusion:
TLC has the possibility of invasive growth and recurrence, especially in patients with longer duration and carcinoma history.
Hypokalemic Paralysis Secondary to Immune Checkpoint Inhibitor Therapy
Authors: Pragathi Balakrishna, Augusto Villegas
Journal: Case Rep Oncol Med (2017)
MeSH terms: Case Reports

Introduction of immune checkpoint inhibitors (ICIs) has led to significant improvements in the treatment of multiple malignancies. Anti-programmed cell death protein 1 (PD-1) and anti-cytotoxic T-lymphocyte antigen 4 (CTLA-4) are two essential ICIs that have been FDA approved since 2011. As the use of immunotherapy in melanoma and other malignancies increases, the potential of adverse events also increases. Overall, anti-PD-1 agents are well tolerated. In rare instances, colitis, endocrinopathies, skin, and renal toxicities have been observed. A 58-year-old male with a history of stage 4 cutaneous melanoma presented with quadriplegia while on nivolumab. Routine blood test revealed low potassium, low bicarbonate, and high serum creatinine. Admission diagnosis included hypokalemia, acute kidney injury, and renal tubal acidosis. The offending drug was discontinued, and the patient was started on high-dose corticosteroids. On discharge, paralysis was resolved. Renal function and potassium were normalized. Nivolumab was discontinued, and he was started on pembrolizumab. Literature suggests that, although rare, patients receiving ICE may develop immune-mediated nephritis and renal dysfunction. The mainstay of immune-related adverse event (irAE) management is immune suppression. Hence, given the increasing frequency of immunotherapy use, awareness should be raised in regard to irAEs and their appropriate management.
Idiopathic Isolated Right Ventricular Cardiomyopathy: A Rare Case Report
Authors: Vivek Mohanty, Shubham Kumar Sharma, Sourabh Goswami, Rahul Gudhage, Surender Deora
Journal: Avicenna J Med (2023)
Keywords: cardiomyopathy, idiopathic, right ventricle
MeSH terms: Case Reports

Idiopathic isolated right ventricular cardiomyopathy is an extremely rare cause of right ventricular failure. Here, we report a case of 65-year-old male presented with chief complaints of dyspnea, fatigue, and bilateral pedal edema for the last 6 months. On clinical evaluation, grade II/III pansystolic murmur was present in left parasternal area. Investigations and imaging revealed dilated right atrium and ventricle with normal pulmonary artery pressure without any etiology. Magnetic resonance imaging ruled out other common causes of right ventricular cardiomyopathy; thus, the patient was diagnosed as a case of idiopathic isolated right ventricular cardiomyopathy that is a diagnosis of exclusion.
Chorea Hyperglycemia Basal Ganglia Syndrome in a 63-Year-Old Male
Authors: Michael Sperling, Roshan Bhowansingh
Journal: Case Rep Med (2018)
MeSH terms: Case Reports

Chorea hyperglycemia basal ganglia syndrome (CHBG) is a rare condition that manifests within the setting of uncontrolled nonketotic diabetes mellitus. The objective of this case report is to present a patient found to have CHBG and provide a timeline in terms of his workup and subsequent treatment. We also present a commentary on the current understanding of the pathophysiology and treatment and how this was applied to our patient. The case involves a 63-year-old poorly controlled diabetic male who presented with a one-week history of uncontrolled choreiform movements of his left upper extremity. His initial glucose level was 339 mg/dl. HbA1C was 9.9%. CT scan of the head demonstrated an abnormal increased intensity within the right lenticular nucleus and right caudate head most likely due to microcalcifications/mineralization. MRI of the brain demonstrated nonspecific T1 and T2 hyperintense abnormalities in the same area about the right basal ganglia. These findings were consistent with the movement pattern he was displaying and with a diagnosis of CHBG. Gradual control of his blood sugar levels over 48 hours led to resolution of his choreiform symptoms. After better medication adherence as an outpatient, endocrinology follow-up 6 months after discharge found his HbA1C drop to a level of 7.1%. There was no recurrence of his symptoms. CHBG is a rare manifestation of poorly controlled diabetes but is the one that clinicians should be aware of. Early recognition and gradual treatment of elevated blood glucose levels appear to lead to total resolution of choreiform symptoms.
Evaluating the Safety of Ultra-Low-Dose Estrogen Contraception in Sickle Cell Trait With Focus on Cerebral Venous Sinus Thrombosis
Authors: Cameron Kahn, Azeem Rathore, Tara Kronen, Ameen Fahad, Ryan Crooks
Journal: Cureus (2023)
Keywords: cerebral venous thrombosis, loestrin, oral contraceptive pills, sickle cell trait, superior sagittal sinus thrombosis, ultra-low-dose estrogen
MeSH terms: Case Reports

Ultra-low-dose combination estrogen-progestin contraceptive pills (OCP) have been marketed as being safer to use than previously higher estrogen-containing OCPs. While multiple large studies have shown a dose-dependent association between estrogen and deep vein thrombosis, there remains sparse guidance or data as to whether patients with sickle cell trait should avoid estrogen-containing OCPs regardless of the dosage. We present a case of a 22-year-old female with a history of sickle cell trait who had recently been started on an ultra-low-dose norethindrone-ethinyl estradiol-iron (1-20 mcg) that presented with headache, nausea, vomiting, and obtunded. Initial neuroimaging was significant for an extensive superior sagittal sinus thrombosis with extension into the confluence of dural venous sinuses, right transverse sinus, right sigmoid sinus, and right internal jugular vein which ultimately required systemic anti-coagulation. Her symptoms largely resolved within four days after starting anti-coagulation. She was discharged on day six to complete a six-month course of oral anti-coagulation. At her neurology follow-up three months later, the patient reported resolution of all symptoms. This study evaluates the safety of ultra-low-dose estrogen-containing contraceptive pills in the sickle cell trait population with special focus on cerebral sinus thrombosis.
Severe lactic acidosis in a patient with B-cell lymphoma: a case report and review of the literature
Authors: Farn Huei Chan, Daniel Carl, Laurel J Lyckholm
Journal: Case Rep Med (2009)
MeSH terms: Case Reports

Lactic acidosis is commonly observed in clinical situations such as shock and sepsis, as a result of tissue hypoperfusion and hypoxia. Lymphoma and leukemia are among other clinical situations where lactic acidosis has been reported. We present a case of a 59-year-old female with lactic acidosis who was found to have aggressive B-cell lymphoma. There have been 29 cases of lymphoma induced lactic acidosis reported thus far; however all reported cases have abnormal vital signs or concomitant medical conditions that may lead to lactic acidosis. The pathogenesis of malignancy-induced lactic acidosis is not well understood; however associated factors include increased glycolysis, increased lactate production by cancer cells, and decreased hepatic clearance of lactate. When it occurs, lactic acidosis is a poor prognostic sign in these patients. Prompt diagnosis and treatment of underlying lymphoma or leukemia remains the only way to achieve complete resolution of lactic acidosis in these patients.
Spinal Cord Stimulation for the Treatment of Refractory Pain From Tarlov Cysts: A Case Report
Authors: Jungmin On, Javier J Polania Gutierrez, Miguel Plaza-Lloret, Anterpreet Dua, Zhuo Sun
Journal: Cureus (2023)
Keywords: chronic low back pain (clbp), chronic pain management, interventional pain medicine, spinal cord stimulation (scs), tarlov cyst
MeSH terms: Case Reports

Tarlov cysts are extradural meningeal cysts with a collection of cerebrospinal fluid that most often affects sacral nerve roots, causing chronic low back pain and radiculopathy. Still, there is no consensus regarding the best treatment for symptomatic cysts. We describe a patient who developed worsening lower back pain and radiculopathy after interventional drainage and surgical management. Medication and various procedures failed to relieve the pain. Subsequently, the patient received significant pain relief from spinal cord stimulation (SCS). This case provides evidence that SCS could be used to manage refractory pain from Tarlov cysts that have failed to respond to other treatment modalities.
Floating Forearm Injury: Monteggia Variant Fracture With an Ipsilateral Distal Radius and Ulna Fracture
Authors: Zehong Chen, Sreenadh Gella, Kanthan Theivendran
Journal: Cureus (2023)
Keywords: distal radial and ulnar fracture, floating forearm, intraarticular fracture distal radius, monteggia's fracture, surgical case report
MeSH terms: Case Reports

Monteggia variant fracture is a Monteggia fracture (proximal third ulna fracture with radial head dislocation) with an associated radial head fracture, coronoid fracture or complex pattern of injury. We report a rare case of an 80-year-old lady with a right Monteggia variant fracture with an ipsilateral distal radius and ulna fracture leading to a floating forearm injury. To our knowledge, this is the first case report to describe this injury pattern. We describe the multidisciplinary team approach and detailed surgical technique in managing this rare and complex injury.
Pelvic splenosis-a very unusual location
Authors: Raquel Lameiras, António P Matos, Carlos Luz, João Palas, Miguel Ramalho
Journal: BJR Case Rep (2017)
MeSH terms: Case Reports

We present a rare case of pelvic splenosis, and its imaging findings, in a 54-year-old female complaining of pelvic pain and vaginal bleeding for several months. Splenosis is a benign acquired condition defined as heterotopic auto-transplantation of splenic tissue to other compartments of the body and occurs after rupture of the spleen, either traumatic or iatrogenic. Symptoms are unspecific and vary according to the location of the implants; commonly the presenting symptom is abdominal pain or enlarging abdominal mass. Owing to its intrinsic properties and safety, magnetic resonance imaging is a valuable imaging modality, in which the splenosis implants may be securely identified, showing the same signal characteristics and enhancing patterns of the normal spleen, especially visualization of serpiginous enhancement on the arterial phase is virtually diagnostic.
Neonatal diabetes mellitus: improved screening and early management of an underestimated disease
Authors: Maëlle Wirth, Jean-Marc Jellimann, Stéphanie Jellimann, Jean-Michel Hascoët
Journal: Clin Case Rep (2017)
Keywords: glycated hemoglobin, hyperglycemia, intrauterine growth restriction, neonatal diabetes mellitus
MeSH terms: Case Reports

Neonatal diabetes mellitus is underdiagnosed in the neonatal period because of the metabolic adaptation capacities of the newborns. However, it is associated with increased risk of short- and long-term morbidity; when transient it may recurs in adulthood. It is important to improve screening and early management with appropriate guidelines.