OpenMed/multicare-articles huggingface dataset:
Stroke after Initiating IV Penicillin for Neurosyphilis: A Possible Jarisch-Herxheimer Reaction
Authors: Vineet Punia, Appaji Rayi, Adithya Sivaraju
Journal: Case Rep Neurol Med (2014)

Introduction. Syphilis incidence has increased in the US in the last decade. Jarisch-Herxheimer reaction (JHR) is a well-documented adverse effect of penicillin treatment in syphilis. Stroke has not been reported as part of its phenomenology. Case Report. A 57-year-old man presented with worsening memory. His minimental status examination score was 14/30. Serum RPR test was positive and VDRL test in the CSF was reactive. Within six hours of first dose of IV crystalline penicillin G, he was found to have hemineglect and difficulty moving the left leg. MRI of the brain showed multiple acute ischemic strokes. Immediate MRA ruled out vascular occlusion. Penicillin treatment was stopped. Four hours later, he was found to be febrile and had two episodes of generalized tonic-clonic seizures. Conclusions. We report a case of confirmed neurosyphilis with no known modifiable stroke risk factors, who developed acute ischemic stroke and other constitutional symptoms consistent with JHR after IV penicillin. This is the first reported case in literature where an acute ischemic stroke can be attributed to Jarisch-Herxheimer reaction. Given an increase in incidence of syphilis in recent years, our case underlies the importance of keeping in mind potential catastrophic drug adverse reactions in neurosyphilis patients.
Improved diabetes control and pancreatic function in a type 2 diabetic after omeprazole administration
Authors: I N Mefford, J T Mefford, C A Burris
Journal: Case Rep Endocrinol (2012)
MeSH terms: Case Reports

A 43-year-old man with type 2 diabetes, opposed to insulin use and poorly responsive to oral agents added sequentially over 6 years, was placed on 40 mg omeprazole twice daily. A linear decline in daily fasting blood glucose was observed over the first two-month treatment, and his hemoglobin A1c was reduced from 11.9% to 8.2%, then sustained at 8.1% after four months. Glucose, insulin, and C-peptide response to a 2-hour glucose tolerance test were consistently improved across this time period, and calculated beta-cell mass increased by 67%. We believe these responses are consistent with activation or neogenesis of pancreatic beta cells, possibly through a gastrin-mediated mechanism.
Cardiac MRI after Sudden Cardiac Arrest in a Young Woman Prompts Diagnosis of Familial Dilated Cardiomyopathy
Authors: Nico Hustings, Valerie Van Ballaer, Leticia Barrios
Journal: J Belg Soc Radiol (2023)
Keywords: cardiac mri, ttn gene mutation, echocardiography, familial dilated cardiomyopathy, late gadolinium enhancement, myocardial fibrosis, non-ischemic lge, sudden cardiac death, ventricular arrhythmia
MeSH terms: Case Reports

Teaching Point: Familial dilated cardiomyopathy (DCM) predisposes to malignant ventricular arrhythmias and sudden cardiac death, and magnetic resonance imaging (MRI) has important diagnostic value in demonstrating non-ischemic patterns of late gadolinium enhancement (LGE).
Post-infectious ankylosis of the cervical spine in an army veteran: a case report
Authors: Zachary A Cupler, Michael T Anderson, Eric T Stefanowicz, Chad D Warshel
Journal: Chiropr Man Therap (2018)
Keywords: ankylosis, cervical, military personnel, osteomyelitis, spondylodiscitis, veteran
MeSH terms: Ankylosis / diagnostic imaging, Ankylosis / etiology, Cervical Vertebrae / injuries, Osteomyelitis / complications, Case Reports, Aged, Cervical Vertebrae / diagnostic imaging, Humans, Male, Spondylosis, Veterans

Background:
Vertebral osteomyelitis is a rare, life-threatening condition. Successful management is dependent on prompt diagnosis and management with intravenous antibiotic therapy or surgery in addition to antibiotics. Reoccurrence is minimal after 1 year. However, very little is reported in the conservative spine literature regarding the long-term follow-up and the changes to the spine following management of the spinal infection. We report the dramatic radiologic findings of the long-term sequela of a cervical spine infection following a gunshot wound from 1969. Most impressive to the spine specialist is this patient's ability to return to work despite significant alterations to spinal biomechanics.
Case presentation:
A 69 year-old caucasian male presented to the chiropractic clinic at a Veterans Affairs Medical Center with complaint of chronic left shoulder pain secondary to an associated full thickness tear of the left infraspinatus. An associated regional assessment of the cervical spine ensued. Radiological imaging on file revealed ankylosis C2/C3 to C7/T1. The patient reported a history of multiple fragment wounds in 1969 to the left anterior neck and shoulder 45 years earlier. Osteomyelitis of the cervical spine resulted from the wounds.
Conclusion:
Potential sequela of osteomyelitis is ankylosis of affected joints. In this particular case, imaging provides evidence of regional ankylosis of the cervical spine. Considering the patient did not complain of cervical pain or related symptoms apart from lack of cervical range of motion, and his Neck Disability Index score was 2 out of 50 (4%), no intervention was provided to the cervical spine. The patient reported he self-managed well, worked full-time as a postal worker after he was discharged due to the injury to his neck, and planned to retire in less than one month at age 70. The patient demonstrates successful return to work with pending retirement at age 70 following spondylodiscitis and subsequent ankylosis of the cervical region.
Blood Purification in Severe and Critical COVID-19 Patients: A Case Series of 5 Patients
Authors: Hongjun Chen, Leisheng Zhang, Wei Zhang, Lili Liu, Zhihua Dai, Miao Chen, Donghang Zhang
Journal: Front Public Health (2021)
Keywords: covid-19, blood purification, hemodiafiltration, hemofiltration, inflammatory cytokine storm
MeSH terms: COVID-19, Noninvasive Ventilation, Respiratory Insufficiency / therapy, Case Reports, Research Support, Non-U.S. Gov't, Adult, Aged, Aged, 80 and over, Humans, Male, Middle Aged, Oxygen Inhalation Therapy, SARS-CoV-2

Objective: The ongoing coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to a worldwide pandemic. Currently, supportive care measures remain the standard of care for severe and critical COVID-19 patients, such as ventilation oxygenation, fluid management and blood purification. In this study, we aimed to evaluate the effects of early blood purification therapy upon severe and/or critical COVID-19 patients. Patients and Methods: From January 31, 2020 to March 1, 2020, a total 5 patients with COVID-19 (3 critical type cases and 2 severe type cases) received early blood purification treatment in the intensive care unit (ICU) of Affiliated Hospital of Zunyi Medical University. Clinical indexes, including oxygen concentration, blood gas analysis, oxygenation index, and laboratory test as well as disease scores were recorded and analyzed before and after the treatment with blood purification. Results: Among the 5 patients, 4 were males ranging from 35 to 80 year old (Mean age = 63 ± 17.87). All cases with characteristics of OI <300 mm Hg, decline in lymphocyte (LYMPH)%, boost in lactate dehydrogenase (LDH), troponin T (TNT), B-type brain natriuretic peptide (BNP), interleukin-6 (IL-6) and interferon-alpha (IFN-a), three with high flow nasal cannula (HFNC), two with non-invasive ventilation (NIV) and acute kidney injury (AKI), and one with shock and IV. Blood purification therapy significantly decreased the serum levels of inflammatory cytokine, ameliorated the concomitant symptoms and complications. Finally, one case was discharged from the hospital, 4 cases were transferred to the general ward, and all the 5 cases survived. Conclusion: Continuous blood purification therapy held promising prospects for alleviating the deteriorative progression of severe and critical types of COVID-19 in the early stage, together with ameliorating the accumulation of inflammatory cytokine and the concomitant symptoms and complications by efficacious immunoadsorption. Trial Registration: www.chictr.org.cn, Identifier (ChiCTR2000031930).
Use of Objective Outcomes Measures to Verify the Effects of ICF-Based Gait Treatment in Huntington's Disease Patient on Globus Pallidus Deep Brain Stimulation: A Case Report
Authors: Tamine T C Capato, Rubens G Cury, Juliana Tornai, Erich T Fonoff, Renata Guimarães, Manoel T Jacobsen, Mônica S Haddad, Egberto R Barbosa
Journal: Front Rehabil Sci (2022)
Keywords: huntington's disease, icf, chorea, deep brain stimulation, gait, multidisciplinary treatment, physical therapy, rehabilitation
MeSH terms: Case Reports

In advanced stages of in Huntington's disease (HD) gait impairments and severe chorea are usually medication-refractory. The long-term effects on gait in HD of physiotherapy ICF-based management post- globus pallidus deep brain stimulation (GPi DBS) are not well-established. Physiotherapy has been recognized as an essential element in HD treatment. Here, we present a case report of a 56-year-old woman with HD on the advanced stage and severe chorea medication-refractory after GPi-DBS. We performed multidisciplinary motor assessments ICF-based to identify the disability at clinical and home-setting, including environmental and personal factors before and after GPi-DBS surgery and at 11-time points follow-up. The surgery was very successful and directly post GPi-DBS, there were a significant improvement in chorea and a substantial decrease in medication dose. A framework ICF- based physiotherapy protocol with external cues was developed to improve gait was delivered post-surgery and was continued three times/week during 18-months. Physiotherapy sessions consisted of a personalized protocol of exercises with functional movements, balance, and gait training with external cues. Improvements in gait were observed in 3-months post-intervention and were more expressive in 6-months follow-up. Our patient improved substantially HD motor symptoms and her quality of life after GPi-DBS intervention and a physiotherapy program ICF-based. The objective outcomes measures used to assess gait have served as endpoints to assessing the patient's motor profile during the pre-operative period. Assessments were helpful to verify the efficacy of the multidisciplinary intervention in long-term.
Conclusion:
Periodically assessing function and disability using outcome improvements may support clinicians' decisions about DBS, medication adjustments and guide physiotherapists to personalize the ICF-based intervention.
Rare Condition of Intrathoracic Phrenic Nerve Schwannoma Successfully Treated with Uniportal Video-Assisted Thoracoscopic Surgery
Authors: Lu Huu Pham, Kinh Quoc Nguyen, Hung Quoc Doan, Lanh Sy Nguyen, Ha Thi-Ngoc Doan
Journal: Case Rep Surg (2021)
MeSH terms: Case Reports

Introduction:
Neurogenic tumors in the mediastinum account for approximately 20-30% of all types of mediastinal tumors in adults. This pathology is usually benign and has no or very few symptoms. Schwannoma rarely involves the phrenic nerve. We report a unique case of schwannoma involvement of phrenic nerve. Case Presentation. The 43-year-old female patient has an annual check-up of computerized tomography to detect the mass in the right middle mediastinum, so the patient was admitted to the hospital. Chest computerized tomography image found a mass of the middle mediastinum with the size of 23 × 22.3 mm located between the right pulmonary artery and the pericardium with uniform margins and clear boundaries, not invading the surrounding organization. Very little contrast is absorbed after injection. She underwent a uniportal video-assisted thoracoscopic surgery, and this mass was found to be originating from the right phrenic nerve. Resection of the portion of phrenic nerve with mass was performed. Postoperatively, the patient was discharged from the hospital after 4 days of treatment in a clinical condition with no difficulty breathing and no chest pain; postoperative X-ray showed no abnormality, and the right diaphragm was unchanged.
Conclusion:
Although they are very rare, schwannomas of the phrenic nerve should be considered in the differential diagnosis of mediastinal tumors. Uniportal video-assisted thoracoscopic surgery is a preeminent option with properly sized tumors that deliver good results and have no postoperative complications associated with surgery.
Transfusion-related acute lung injury associated to intravenous immunoglobulin infusion in a pediatric patient
Authors: José Roberto Mendes Pegler, Ana Paula Beltran Moschione Castro, Antonio Carlos Pastorino, Mayra de Barros Dorna
Journal: Einstein (Sao Paulo) (2020)
MeSH terms: Immunologic Deficiency Syndromes, Lung Diseases, Transfusion-Related Acute Lung Injury, Case Reports, Adult, Aged, Female, Humans, Immunoglobulins, Intravenous / adverse effects, Infusions, Intravenous, Male, Middle Aged, Immunoglobulins, Intravenous

Case report of a patient with an immunodeficiency who demands regular replacement of intravenous immunoglobulin. She presented an episode of transfusion-related acute lung injury shortly after using an immunoglobulin product different than the one she usually received. The patient evolved with respiratory changes (hypoxia, dyspnea, change in pulmonary auscultation) minutes after the end of the infusion, and received non-invasive respiratory support. She was discharged after 36 hours with good outcome. The patient achieved full recovery, showing no further reactions in subsequent immunoglobulin infusions (no longer receiving the product that was used when she had the episode of transfusion-related acute lung injury). Although rare, this reaction is potentially serious and has no specific treatment other than supportive therapy. The literature is scarce regarding the risk of recurrence. The decision on whether to proceed with immunoglobulin therapy after this adverse effect should be analyzed individually, assessing the possible risks and benefits for the patient.
Human Amniotic Membrane Positioning in the Surgical Treatment of Temporomandibular Joint Degenerative Disorder
Authors: Luca Guarda-Nardini, Diletta Trojan, Giulia Montagner, Elisa Cogliati, Matteo Bendini, Daniele Manfredini
Journal: Case Rep Surg (2019)
MeSH terms: Case Reports

Background:
Temporomandibular joint (TMJ) arthritis is a degenerative pathology that may cause pain and dysfunction. Nonsurgical therapy is the traditional treatment of TMJ diseases but if ineffective, TMJ surgery can be performed and may include arthroplasty with interposition of autograft. The encouraging results reported with the use of human amniotic membrane (HAM) in different surgical fields have highlighted its potential, but approaches providing the positioning of HAM within the intra-articular space of arthritic TMJs have never been investigated.
Case presentation:
A 48-year-old woman was presented with limited mouth opening and pain with palpation at the left joint. A severe TMJ degeneration was diagnosed, and a surgical treatment was necessary. In the present case report, the authors describe the application of a cryopreserved HAM patch within the joint space as a disc-replacing film during major surgeries for discectomy and arthroplasty. Three months after the intervention, the patient reported an overall improvement in chewing efficiency as well as the absence of pain.
Conclusions:
According to the regenerative effects of HAM, the design of trials on the topic should be encouraged for its possible inclusion within the field of TMJ disease practice.
An extremely rare case of indirect hernia type co-existing with testicular ectopia
Authors: Christos Plataras, Ioannis Alexandrou, George Bourikis, Dimitris Bourikas, Efstratios Christianakis
Journal: Pan Afr Med J (2020)
Keywords: hernia, child, undescended testis
MeSH terms: Cryptorchidism / diagnosis, Hernia, Inguinal / diagnosis, Testis / abnormalities, Case Reports, Cryptorchidism / surgery, Hernia, Inguinal / surgery, Humans, Infant, Male, Scrotum, Testis / surgery

We present an extremely rare case of inguinal hernia coexisting with testicular ectopia in a child. Male infant 9.5 month old presented with an empty scrotum and the ipsilateral intravaginal testis lying in a high iliac crest position. When crying a moving right inguinal bulge appeared on clinical examination. This grew bigger in moments of increased abdominal pressure and seemed to move upwards towards the right ileac crest. No abdominal wall defect could be palpated. At operation a large hernia sac fixed in the area of the right iliac crest was identified. Adjacent was the fixation point of the gubernaculum and the testis was found in an ectopic location. We removed the large sac after separating the vas and vessels and the testis and we strengthened the dorsal inguinal wall and fixed the testis in a subdartos scrotal pouch. No postoperative complications happened. An undescended testis may present as an iliac crest ectopy, coexisting with moving inguinal hernia. In our case we propose that the higher position of the aponeurosis of the external oblique in combination with ectopia of gubernacular fixation in the ipsilateral scrotum may have caused the ectopic fixation of the sac in the ipsilateral inguinal crest.
Multiple congenital epulis in alveolar ridges of maxilla and mandible in a newborn: a rare case report
Authors: Nader Saki, Somayeh Araghi
Journal: Case Rep Otolaryngol (2014)

Congenital granular cell lesion (CGCL) or congenital epulis is an uncommon benign of the oral cavity tumor appearing at birth with typical clinical and pathologic features. It predominately affects females, mainly on the anterior maxillary alveolar ridge, and occurs usually as a single mass, although sometimes as multiple. The left side incisor area is the most common site. The etiology and histogenesis of the lesion remain obscure. Though it is a benign lesion, the tumor may cause feeding and respiratory problems if there are too large or multiple tumors. We report a case of a three-day-old, female newborn, who was referred to our hospital with multiple congenital oral swellings arising from the maxilla and mandible. The tumors caused a feeding problem and, hence, they were resected by surgical excision under general anesthesia.
Early bifrontal brain injury: disturbances in cognitive function development
Authors: Christine Bonnier, Aurélie Costet, Ghassan Hmaimess, Corinne Catale, Christelle Maillart, Patricia Marique
Journal: Neurol Res Int (2010)
MeSH terms: Case Reports

We describe six psychomotor, language, and neuropsychological sequential developmental evaluations in a boy who sustained a severe bifrontal traumatic brain injury (TBI) at 19 months of age. Visuospatial, drawing, and writing skills failed to develop normally. Gradually increasing difficulties were noted in language leading to reading and spontaneous speech difficulties. The last two evaluations showed executive deficits in inhibition, flexibility, and working memory. Those executive abnormalities seemed to be involved in the other impairments. In conclusion, early frontal brain injury disorganizes the development of cognitive functions, and interactions exist between executive function and other cognitive functions during development.
Spontaneous Coronary Dissection: "Live Flash" Optical Coherence Tomography Guided Angioplasty
Authors: Angela Pimenta Bento, Renato Gil Dos Santos Pinto Fernandes, David Cintra Henriques Silva Neves, Lino Manuel Ribeiro Patrício, José Eduardo Chambel de Aguiar
Journal: Case Rep Cardiol (2016)

Optical Coherence tomography (OCT) is a light-based imaging modality which shows tremendous potential in the setting of coronary imaging. Spontaneous coronary artery dissection (SCAD) is an infrequent cause of acute coronary syndrome (ACS). The diagnosis of SCAD is made mainly with invasive coronary angiography, although adjunctive imaging modalities such as computed tomography angiography, IVUS, and OCT may increase the diagnostic yield. The authors describe a clinical case of a young woman admitted with the diagnosis of ACS. The ACS was caused by SCAD detected in the coronary angiography and the angioplasty was guided by OCT. OCT use in the setting of SCAD has been already described and the true innovation in this case was this unique use of OCT. The guidance of angioplasty with live and short images was very useful as it allowed clearly identifying the position of the guidewires at any given moment without the use of prohibitive amounts of contrast.
Completion Pancreaticoduodenectomy for Hereditary Pancreatitis After Prior Puestow Procedure: A Case Report
Authors: James R Nellen, Adam G Strickland, Charles J Yeo
Journal: J Pancreat Cancer (2018)
Keywords: puestow, completion pancreatectomy, ethanol nerve block, hereditary pancreatitis, pancreaticoduodenectomy
MeSH terms: Case Reports

Background: Hereditary pancreatitis (HP) is an uncommon condition resulting from an imbalance of pancreatic proteases. Most commonly, protease serine 1 genetic mutations are causative for HP and often result in recurrent early onset episodes of acute pancreatitis typically progressing to chronic pancreatitis, with a high risk of pancreatic cancer. Case Presentation: A 46-year-old female with HP, confirmed by genetic testing, presented with a 7-month history of recurrent pancreatitis. She had previously undergone a distal pancreatectomy and Puestow procedure in 1992 at 21 years of age, after having pancreatitis as a teenager. The patient now had a completion pancreaticoduodenectomy and celiac ethanol nerve block. Conclusion: A completion pancreatectomy in patients with HP can be performed after previous pancreatic surgical intervention to treat disease manifestations and as a prophylaxis against an increased risk of pancreatic adenocarcinoma.
Catatonia Associated with Hyponatremia: Case Report and Brief Review of the Literature
Authors: Vaios Peritogiannis, Dimitrios V Rizos
Journal: Clin Pract Epidemiol Ment Health (2021)
Keywords: benzodiazepines, catatonia, delirium, hyponatremia, psychogenic polydipsia, schizophrenia-spectrum disorders
MeSH terms: Case Reports

Background:
Catatonia is a syndrome of altered motor behavior that is mostly associated with general medical, neurologic, mood and schizophrenia-spectrum disorders. The association of newly onset catatonic symptoms with hyponatremia has been rarely reported in the literature.
Case presentation:
We present a rare case of a young female patient with schizophrenia, who presented with catatonic symptoms in the context of hyponatremia due to water intoxication. The symptoms were eliminated with the correction of hyponatremia. There are only a few reports of hyponatremia-associated catatonia in psychiatric and non-psychiatric patients. Sometimes, catatonic symptoms may co-occur with newly onset psychotic symptoms and confusion, suggesting delirium. In several cases, the catatonic symptoms responded to specific treatment with benzodiazepines or electroconvulsive therapy.
Conclusion:
Hyponatremia may induce catatonic symptoms in patients, regardless of underlying mental illness, but this phenomenon is even more relevant in patients with a psychotic or mood disorder, which may itself cause catatonic symptoms. It is important for clinicians not to attribute newly-onset catatonic symptoms to the underlying psychotic or mood disorder without measuring sodium serum levels. The measurement of sodium serum levels may guide treating psychiatrists to refer the patient for further investigation and appropriate treatment.