OpenMed/multicare-articles huggingface dataset:
ST-Elevation Myocardial Infarction in the Presence of Septic Shock
Authors: Leah Ishmael, Joseph Zalocha
Journal: Case Rep Crit Care (2020)
MeSH terms: Case Reports

Elevated cardiac enzymes are often seen in the setting of sepsis. The mechanism involves hypoperfusion and possible compromise to myocardial tissue. Electrocardiogram (ECG) changes in the setting of septic shock are less common and can vary widely. Rarely, ST-segment elevations can occur. This case describes a 54-year-old female who presented with septic shock secondary to pyelonephritis and Escherichia coli bacteremia. The patient was admitted to the intensive care unit on norepinephrine and required mechanical ventilation. A significant rise in troponin I (peak 19.8 ng/mL) was seen and ECG showed ST-segment elevations in leads I and aVL with reciprocal ST depressions in leads II, III, and aVF. The patient was taken urgently for left cardiac catheterization, which showed no evidence of obstructive coronary artery disease. When distinguishing between septic shock and cardiogenic shock, insertion of a pulmonary artery catheter may help with diagnosis and treatment of cardiogenic shock. Catheter hemodynamic monitoring can also confirm the diagnosis. In our patient's case, hemodynamic monitoring was initiated and was not consistent with cardiogenic shock. ST-segment elevations in the high lateral leads and elevated cardiac markers were likely due to severe transmural ischemia secondary to increased oxygen demand. The patient was continued on intravenous antibiotics for treatment of her septic shock. She was extubated and weaned off of norepinephrine within 48 hours. Repeat ECG performed after resolution of the infection showed normal sinus rhythm with no ST-segment changes. Cardiac dysfunction in the setting of septic shock is well described in medical literature; however, the mechanisms of dysfunction are not explicitly understood. Transient hypoperfusion, coronary vasospasm, and localized endothelial damage are possible components. It is important to think of varying etiologies, other than acute coronary syndrome when approaching patients in septic shock with acute ST-segment changes and elevated cardiac markers.
Renal sinus lipomatosis in transplanted kidneys: an unusual clinical case
Authors: Luca Apicella, Gianfranco Vallone, Sossio Vitale, Gianluca Garofalo, Luigi Russo, Riccardo Gallo, Stefano Federico, Massimo Sabbatini
Journal: Case Rep Transplant (2011)
MeSH terms: Case Reports

Renal sinus lipomatosis (RSL) represents an abnormal proliferation of the adipose tissue surrounding the renal pelvis of uncertain origin, associated with aging, obesity, steroid excess, infections, and calculosis. It represents a rare complication in transplanted kidneys, and, despite the accurate and prolonged radiological followup of transplanted organs, only a few cases of RSL have been described in graft recipients, with no remarkable effects on renal function. The diagnosis relies on ultrasonography (US), magnetic resonance imaging (MRI), computed tomography (CT), and, finally, percutaneous biopsy. We describe the case of an extensive RSL in a 38-year-old renal transplant recipient, diagnosed by ultrasonography and computed tomography. The patient underwent a radiologic study because of an acute, asymptomatic renal impairment, that led to the diagnosis of a RSL of unusual dimensions, associated with a discrete hydronephrosis. Paradoxically, after a short course of steroids, the recovery of renal function and the partial resolution of calyceal dilatation were observed. The rarity of this affection, the need of a differential diagnosis with fat-containing tumors, and the possibility of parenchymal inflammation associated with RSL, potentially responsive to steroids, are also discussed.
Myxoglobulosis of the appendix: a case associated with ruptured diverticulum
Authors: Panagiotis Aroukatos, Dionysios Verras, Gerassimos P Vandoros, Maria Repanti
Journal: Case Rep Med (2010)
MeSH terms: Case Reports

We describe a case of the extremely rare entity of myxoglobulosis of the appendix from a 45-year-old white man who was operated urgently with the clinical diagnosis of acute appendicitis. Sectioning of the appendix revealed the presence in the dilated appendiceal lumen of numerous whitish opaque globules ranging in size from 0.2 to 0.7 cm in diameter. A ruptured diverticulum and several smaller ones were also found. On microscopic examination, the globules consisted of faintly eosinophilic laminations of mucin surrounding an amorphous granular core. The mucin was identified by positivity with histochemical mucin stains. After thorough microscopic examination of the appendix, our case was diagnosed as myxoglobulosis due to mucosal hyperplasia, associated with ruptured diverticulum and acellular extra-appendiceal mucin deposits.
Imaging and pathological comparison of inflammatory pseudotumor-like follicular dendritic cell sarcoma of the spleen: A case report and literature review
Authors: Fuxing Chen, Junqiang Li, Pingkun Xie
Journal: Front Surg (2022)
Keywords: follicular dendritic cell sarcoma, magnetic resonance imaging, spleen tumor, tomography, x-ray computed
MeSH terms: Case Reports

Background:
Inflammatory pseudotumor-like follicular dendritic cell sarcoma (IPT-like FDCS) is a rare subtype of follicular dendritic cell sarcoma (FDCS) that is mainly located in the liver and spleen (1). Splenic IPT-like FDCS is a rare low-grade malignancy with non-specific clinical manifestations and laboratory findings. Herein, we reported the pathological and imaging features of a case with splenic IPT-like FDCS.
Case presentation:
A 57-year-old woman was found to have a mass in the spleen during a physical examination and was hospitalized for further treatment. Her laboratory results were within the normal range. Unenhanced and contrast-enhanced computed tomography scans of the whole abdomen showed a round mass in the spleen, with a diameter of about 5 cm. After further examination with enhanced MRI, a provisional diagnosis of splenic hemangioma or splenic hamartoma was made. The patient underwent splenectomy, and the pathological diagnosis was splenic IPT-like FDCS. No tumor recurrence or metastasis was found during the 1-year follow-up after the operation.
Conclusions:
Herein, we reported a case of splenic IPT-like FDCS. Although the clinical examination and laboratory examination lack specificity, the imaging of this case showed that the lesion was a solid mass with progressive enhancement, and the central scar showed the characteristics of delayed enhancement, which facilitated the diagnosis.
Case report: Hashimoto's thyroiditis after CD19 chimeric antigen receptor T-cell therapy
Authors: Panpan Chen, Yongming Xia, Wen Lei, Shuhan Zhong, Huawei Jiang, Lingling Ren, Wenbin Qian, Hui Liu
Journal: Front Immunol (2022)
Keywords: car t, tgab, iraes, lyphoma, thyroditis
MeSH terms: Hashimoto Disease / drug therapy, Hashimoto Disease / therapy, Lymphoma, Large B-Cell, Diffuse / drug therapy, Receptors, Chimeric Antigen, Thyroiditis / etiology, Case Reports, Antigens, CD19, Cell- and Tissue-Based Therapy, Humans, Immunotherapy, Adoptive / adverse effects, Receptors, Antigen, T-Cell, Receptors, Chimeric Antigen, Receptors, Antigen, T-Cell, Antigens, CD19

Chimeric antigen receptor (CAR)-T cell therapy is a novel cell therapeutic approach that is increasingly being used to treat patients with relapsed refractory B-cell lymphoma. Despite the efficacy of CAR T cell therapy, it has various adverse effects that can affect any organ in the body. The application of immune checkpoint inhibitors such as programmed death 1 (PD-1), programmed death ligand 1 (PDL-1), and cytotoxic T-lymphocyte antigen 4 (CTLA-4) antibodies has previously been reported to be associated with immune-related adverse events such as thyroid dysfunction and thyroiditis. Reports of immune-related adverse reactions after CAR T therapy are currently extremely rare, with only one case of a cytokine storm (CRS) combined with severe arthritis in a patient with ALL after treatment. Here, we describe two cases of Hashimoto's thyroiditis secondary to CAR T therapy. Two patients with relapsed refractory diffuse large B-cell lymphoma developed elevated peroxidase and globulin antibodies secondary to CAR-T cell therapy and developed Hashimoto's thyroiditis. Complete remission was achieved in two patients at 1 and 3 months after CAR-T cell therapy. The inflammation of the thyroid tissue may be directly or indirectly related to CAR T cell therapy, and the mechanisms needs to be further investigated.
Implementation and evaluation in low intensity intervention programs from the CONNECT perspective of mixed methods: Application in a case of an autistic child
Authors: Eulàlia Arias-Pujol, Marina Mestres, Júlia Miralbell, Natalia Bachs, M Teresa Anguera
Journal: Front Psychol (2022)
Keywords: connect, autism, case study, mixed methods, polar coordinate analysis, psychoanalytic psychotherapy

There has been a comprehensive development over the last few years of low intensity intervention programs that are implemented within a user context and that are made up of everyday life activities, and it has been necessary to adapt the necessary methodological channels in order to guarantee an adequate resolution pathway. The mixed method perspective offers a suitable framework, and observational methodology - in itself considered mixed method - is appropriate for studying the implementation and evaluation of low intensity intervention programs, allowing the development of the QUAL-QUAN-QUAL stages that correspond to the connect integration pathway of mixed methods. In this work it was applied to a single case, in a low intensity intervention, retrieving valuable information obtained, but systematizing it and applying quantitizing to the qualitative data that was treated quantitatively in a rigorous manner. The aim was to analyze the psychotherapist-patient interaction in psychoanalytic psychotherapy, in which we sought to identify which of the therapist's techniques stimulated actions of reciprocal social interaction in the child, and which techniques inhibited non reciprocal social interactions. The observational design was nomothetic, follow-up, and multidimensional. The patient was a 4-year-old boy with a diagnosis of severe autism spectrum disorder. We used an ad hoc observation instrument combining a field format and a category system. Interobserver agreement was analyzed quantitatively by Cohen's kappa using the free QSEQ5 software program. Polar coordinate analysis was carried out using the free program HOISAN 2.0. Polar coordinate analysis allows us to obtain an inter-relational map of the connections detected between focal behavior established in each case and the different categories. The results provide objective evidence - backed up by the application of polar-coordinate-based data analysis - that within a framework of psychoanalytic psychotherapy, the techniques of "verbalization" and "vocalization" significantly activate reciprocal social interaction behaviors and inhibit non-social reciprocal behaviors in a child with severe autism spectrum disorder with no language. On the other hand, direct gaze promotes the child's withdrawal. The results are of key importance as they show the therapist behaviors most useful for promoting social interaction in a child with severe autism.
Duodenal Villous Atrophy in a TTG-Negative Patient Taking Olmesartan: A Case Report and Review of the Literature
Authors: Tasha Kulai, Thomas Arnason, Donald MacIntosh, John Igoe
Journal: Can J Gastroenterol Hepatol (2016)
MeSH terms: Antihypertensive Agents / adverse effects, Collagenous Sprue / pathology, Diarrhea / pathology, Duodenum / pathology, Imidazoles / adverse effects, Tetrazoles / adverse effects, Case Reports, Review, Aged, Atrophy, Biopsy, Collagenous Sprue / chemically induced, Diarrhea / chemically induced, Humans, Hypertension / drug therapy, Male, Vomiting / chemically induced, Vomiting / pathology, Weight Loss, Antihypertensive Agents, Imidazoles, Tetrazoles, olmesartan, Diarrhea, Chronic, with Villous Atrophy

Olmesartan, an angiotensin II receptor antagonist used to treat hypertension, is associated with few adverse effects. Here, a case of severe sprue-like enteropathy and acute kidney injury is described in a 68-year-old male taking olmesartan for 3-4 years. He presented to hospital with a five-week history of diarrhea, vomiting, and a 20 lb weight loss. Anti-TTG was negative with a normal IgA. Biopsies of the distal duodenum and duodenal cap revealed marked blunting of the villi with near complete villous atrophy of the biopsies from the bulb. There was an increase in intraepithelial lymphocytes as well as neutrophils in the surface epithelium. The patient's diarrhea improved upon discontinuation of olmesartan and he returned to his previous weight. Repeat endoscopy four months later demonstrated complete resolution of inflammatory change with normal villous architecture. Long-term olmesartan use is associated with severe sprue-like enteropathy. The mechanism of intestinal injury is unknown. Duodenal biopsy results may mimic other enteropathies such as celiac disease. Physicians should consider medications as potential etiologies of enteropathy.
Dedifferentiated liposarcoma with a rare presentation of disseminated intraperitoneal sarcomatosis: A case report
Authors: Mingzhe Cai, Caroline Ching Hisa Siew, Timothy Kwang Yong Tay, Grace Hwei Ching Tan
Journal: Int J Surg Case Rep (2019)
Keywords: dedifferentiated liposarcoma, intraperitoneal sarcomatosis, liposarcoma, mdm2

Introduction:
Dedifferentiated liposarcoma is rare and tends to present with discrete tumors in the retroperitoneum, limbs and trunk. Majority of cases arise de-novo as primary tumors, while a minority occur as recurrences of well-differentiated liposarcomas. There has been no previous report of dedifferentiated liposarcoma presenting as disseminated intraperitoneal sarcomatosis.
Presentation of case:
This report describes a young Asian female with disseminated intraperitoneal sarcomatosis arising from de-novo dedifferentiated liposarcoma, and discusses the diagnostic challenges faced in this highly unusual disease presentation. Initial biopsy was unconclusive, and considerations included sclerosing mesenteritis or an inflammatory myofibroblastic tumor. Fluorescence in situ hybridization was subsequently performed and showed amplification of the MDM2 gene. A diagnosis of dedifferentiated liposarcoma was then made.
Discussion:
This was an extremely unusual presentation of advanced dedifferentiated liposarcoma that was eventually diagnosed using fluorescence in situ hybridization. Prognosis is poor and the only viable treatment options was palliative chemotherapy.
Conclusion:
The diagnosis of dedifferentiated liposarcoma should be considered early and surgery carried out when still feasible.
A rare case of papillary cystadenoma of epididymis presented with painless scrotal mass
Authors: Seyyed Hosein Ghasemi Shektaie, Hamid Shafi, Ali Falahi, Fatemeh Mahmoudlou, Emadoddin Moudi
Journal: Caspian J Intern Med (2021)
Keywords: myxosarcoma, transthoracic echocardiogram (tte)
MeSH terms: Case Reports

Background:
It is a rare cardiac malignant primary tumor that seems to derive from the same cellular line as myxomas, but the prognosis is very different. It is a rare cardiac malignant primary tumor that seems to derive from the same cellular line as myxomas, but the prognosis is very different. It is a rare cardiac malignant primary tumor that seems to derive from the same cellular line as myxomas, but the prognosis is very different. Cardiac myxosarcoma is a rare neoplasm that appears to rise from the same cellular source like myxoma. It is difficult to differentiate a myxoma tumor from a myxosarcoma tumor because of its appearance and pathology examination. Myxosercoma tumor requires surgery and chemoradiotherapy, but myxoma is treated only by surgery.
Case presentation:
We describe a case of a 58-year-old patient with a left atrium myxosarcoma, presenting with congestive heart failure. Transthoracic echocardiogram (TTE) showed a large polypoid and mobile mass in the left atrium, the patient underwent cardiac surgery and the tumor was successfully extracted, and histopathological result revealed typical features of myxoma. 15 days after surgery, he underwent explorative laparatomy because of progressive GI bleeding. Laparatomy revealed extensive metastatic masses in abdomen and the pathology diagnoses was myxosaroma. Unfortunately, in spite of supportive care, the patient expired on postoperative day one.
Conclusion:
It is difficult to differentiate a myxoma tumor from a myxosarcoma tumor because of its appearance and pathology examination. Maybe magnetic resonance imaging can help us to achieve more data suggesting malignancy.
A Heart Gone Bananas: Allergy-Induced Coronary Vasospasm due to Banana (Kounis Syndrome)
Authors: Lauren Reinhold, Stephen Lynch, Carl B Lauter, Simon R Dixon, Andrew Aneese
Journal: Case Reports Immunol (2023)
MeSH terms: Case Reports

Kounis syndrome encompasses a variety of cardiovascular signs and symptoms associated with mast cell activation in the setting of allergic or hypersensitivity and anaphylactic or anaphylactoid insults. It can manifest as coronary vasospasm, coronary, or in-stent thrombosis, and acute myocardial infarction with plaque rupture. Various medications as well as foods including fish, shellfish, mushroom, kiwi, and rice pudding have been implicated as causal agents. We present what we believe to be the first documented case of Kounis syndrome manifesting as coronary vasospasm as the result of an allergy to banana. This case highlights the importance of considering allergic causes of angina and allergy referral in a patient with known atopy and an otherwise negative cardiovascular workup. It also emphasizes to consider food allergy, especially banana, as a cause of Kounis syndrome.
Central Sleep Apnea Syndrome Can Complicate Neuromyelitis Optica Spectrum Disorder: A Case Report
Authors: Céline Morelli, Alec Aeby, Sonia Scaillet, Grammatina Boitsios, Daphné Vens, Cynthia Prigogine, Dominique Biarent, Alfredo Vicinanza
Journal: Front Pediatr (2020)
Keywords: area postrema syndrome, case report, central sleep apnea syndrome, children, neuromyelitis optica spectrum disorder, noninvasive ventilation, sleep-disordered breathing
MeSH terms: Case Reports

Neuromyelitis optica spectrum disorder is a rare, relapsing autoimmune disease of the central nervous system. Various initial presentations can delay diagnosis and treatment. A 14-year-old girl was admitted to the emergency department owing to respiratory insufficiency. Repeated history-taking and neuroimaging revealed an area postrema syndrome. A diagnosis of neuromyelitis optica spectrum disorder with positive aquaporin-4 antibodies has finally been established. The patient improved significantly with immunosuppressive therapy. However, her 3-year follow-up still showed sleep-disordered breathing requiring nocturnal bilevel positive airway pressure therapy. We report an original case of NMOSD leading to persistent central sleep apnea syndrome.
Bronchus Associated Lymphoid Tissue Lymphoma Presenting with Immunodeficiency and Multiple Pulmonary Nodules
Authors: Sermin Borekci, Murat Ozbalak, Ezel Ersen, Hilal Akı, Muhlis Cem Ar, Sema Umut
Journal: Case Rep Pulmonol (2017)
MeSH terms: Case Reports

Bronchus Associated Lymphoid Tissue Lymphoma (BALTOMA) is a rare subgroup of pulmonary non-Hodgkin's lymphomas (NHLs) comprising less than 1% of all cases. It constitutes 3.6% of all extranodal lymphomas and only 0.5-1% of primary pulmonary malignancies. They are usually low grade B-cell lymphomas and are considered to originate from the mucosa associated lymphoid tissue (MALT) of the bronchi. Here, we represent a rare case of BALTOMA presenting with immunodeficiency and multiple pulmonary nodules.
Asymmetric Bilateral Lichen Striatus: A Rare Presentation following Multiple Blaschko's Lines
Authors: Jeffrey S Dickman, McKay D Frandsen, Andrew J Racette
Journal: Case Rep Dermatol Med (2018)
MeSH terms: Case Reports

Lichen striatus (LS) is an uncommon, acquired, self-limited, and benign linear dermatosis of unknown etiology that most often occurs unilaterally and is confined to the lines of Blaschko. A healthy 7-year-old girl presented to our clinic with bilateral asymmetric LS occurring on the right arm and left leg of 1-year duration. Very few cases of bilateral LS have been previously reported in the literature, with none from clinics within the United States. The etiology of LS is currently unknown; however its confinement to Blaschko's lines, which represent embryologic migration of skin cell clones, does provide insight into a possible pathogenesis. It seems most likely that an individual's development of LS is linked to their genetic predisposition and a subsequent triggering event. Our case serves as a strong example of a rare presentation of LS and facilitates discussion of the clinical diagnostic process and possible pathogenesis of this dermatosis.
Severe congenital neutropenia caused by the ELANE gene mutation in a Vietnamese boy with misdiagnosis of tuberculosis and autoimmune neutropenia: a case report
Authors: Quang Van Vu, Taizo Wada, Tham Thi Tran, Duc Ngoc Ngo, Thuc Van Dinh, Cuong Hung Nguyen, Huong Thi Minh Le, Akihiro Yachie, Sang Ngoc Nguyen
Journal: BMC Hematol (2015)
Keywords: autoimmune neutropenia, congenital severe neutropenia, elane, severe bacterial infection

Background:
Severe congenital neutropenia (SCN) is an immunodeficiency disease characterized low blood neutrophil counts, early bacterial infections, and risk of leukaemia development. Heterozygous mutations in the ELANE gene coding neutrophil elastase are associated with SCN. Patients with SCN suffer from recurrent bacterial infections and often succumb them. To our knowledge, this is the first report of SCN from Vietnam.
Case presentation:
A 6-year-old boy was admitted due to severe bacterial infection and severe neutropenia. He had recurrent infections from 8 months of age, and was misdiagnosed with tuberculosis and and autoimmune neutropenia in infancy at 21 and 41 months of age, respectively. His medical report has showed severe neutropenia for many times. In direct DNA sequencing analysis, we found an ELANE gene mutation (R81P), which had been confirmed to cause SCN.
Conclusion:
The missed and delayed diagnosis may be attributable to insufficient awareness of this rare disease on the background of frequent infections even in the immunocompetent pediatric population in Vietnam. Our results indicate further evidence for the role of ELANE in SCN.
Intraligamentous Hematoma of the Anterior Cruciate Ligament
Authors: Yasuaki Tamaki, Daisuke Hamada, Tadashi Mitsuhashi, Tokio Kasai, Takuya Mishiro, Takahiko Tsutsui, Kenichiro Kita, Koichi Sairyo
Journal: Case Rep Orthop (2019)
MeSH terms: Case Reports

Lesions of the anterior cruciate ligament (ACL) are rare entities in clinical practice. Here, we present the case of an intraligamentous hematoma of the ACL. A 20-year-old man (height 173 cm, weight 62.9 kg, body mass index 21) with no significant past medical history developed progressively worsening pain and limitation of range of motion in the left knee due to minor trauma. No abnormality was found on plain radiography; however, magnetic resonance imaging revealed a cystic lesion in the intercondylar fossa that was hypointense on T1-weighted imaging and hyperintense on T2-weighted imaging. We performed knee arthroscopy, made a longitudinal incision in the anterior aspect of the ACL, and identified a hematoma. The patient's postoperative course was uneventful. There is no evidence of recurrence at one year after surgery. Although the ACL is a relatively hypovascular structure, it does contain microscopic blood vessels. In this case, we speculate that the intraligamentous hematoma was the result of rupture of these very small blood vessels in response to a minor injury.