OpenMed/multicare-articles huggingface dataset:
Atypical presentation of Pneumocystis jirovecii pneumonia in a patient with rheumatoid arthritis treated with tofacitinib: a case presentation
Authors: Ian F J Pirker, Jacqueline Krane-Nuber, Werner C Albrich, Rüdiger Müller, Thomas Neumann
Journal: BMC Rheumatol (2018)
Keywords: hypercalcemia, pneumocystis jirovecii pneumonia, rheumatoid arthritis, tofacitinib
MeSH terms: Case Reports

Background:
We report the case of a patient with rheumatoid arthritis (RA) treated with tofacitinib who developed severe Pneumocystis jirovecii pneumonia (PJP) with an atypical clinical presentation.
Case presentation:
A 78-year old male patient with RA treated with tofacitinib, methotrexate (MTX) and low dose corticosteroids was admitted to the hospital with arthralgia and nausea. Laboratory findings revealed hypercalcemia with normal levels of parathyroid hormone (PTH) and elevated 1,25-(OH)2 vitamin D levels. A lung CT scan showed bilateral interstitial pneumonic infiltrates. PCR from bronchoalveloar lavage was positive for Pneumocystis jirovecii. Hypercalcemia resolved under PJP treatment and was - after exclusion of other possible causes - probably fungal associated.
Conclusion:
Due to the increased risk of opportunistic infections in immunocompromised patients, the finding of hypercalcemia in conjunction with a pulmonary infection should raise high clinical suspicion of PJP.
Case Report: Paraganglioma in the sellar region: longitudinal observation and surgical outcome
Authors: Yingjie Wang, Xuan Yang, Qianquan Ma, Van Halm-Lutterodt Nicholas, Jianjun Sun, Xiaofang Zhao, Weihai Liu, Chenlong Yang
Journal: Front Oncol (2023)
Keywords: case report, extra-adrenal, paraganglioma, sellar, surgical treatment
MeSH terms: Case Reports

Background:
Paraganglioma in the sellar region is an extremely rare entity, with a limited number of cases reported in the literature. Due to the paucity of clinical evidence, the diagnosis and treatment of paragangliomas in the sellar region remain challenging. Herein, we reported a case of sellar paraganglioma with parasellar and suprasellar extension. Particularly, the dynamic evolution of this benign tumor within a 7-year longitudinal observation was presented. Additionally, the relevant literature regarding sellar paraganglioma was comprehensively reviewed.
Case description:
A 70-year-old woman presented with progressive visual deterioration and headache. Brain magnetic resonance imaging demonstrated a mass in the sellar region with parasellar and suprasellar extension. The patient refused surgical treatment. Seven years later, brain magnetic resonance imaging showed the lesion significantly progressed. Neurological examination revealed bilateral tubular contraction of visual fields. Laboratory examinations showed endocrine hormone levels were normal. Surgical decompression was performed via a subfrontal approach, and subtotal resection was achieved. Histopathological examination confirmed a diagnosis of paraganglioma. Postoperatively, she developed hydrocephalus, and ventriculoperitoneal shunting was performed. Eight months later, cranial CT showed no recurrence of the residual tumor, and the hydrocephalus had been relieved.
Conclusion:
Paraganglioma occurring in the sellar region is rare, and the preoperative differential diagnosis is difficult. Owing to the infiltration to the cavernous sinus and internal carotid, complete surgical resection is usually impracticable. There has been no consensus regarding postoperative adjuvant radiochemotherapy for the tumor residue. In-situ recurrence and metastasis have been reported in the literature, and close follow-up is warranted.
Benign mixed epithelial stromal tumor of the renal pelvis with exophytic growth: case report
Authors: Yuvaraja B Thyavihally, Hemant B Tongaonkar, Sangeeta B Desai
Journal: Int Semin Surg Oncol (2005)

Background:
Mixed epithelial and stromal tumor (MEST) is a distinctive benign composite neoplasm of the kidney predominantly seen in females mostly in the perimenopausal period. Although these tumors are known to arise from renal pelvis, our case was distinct in that it had no intrapelvic component growing in exophytic fashion.
Case report:
A 35 year old female patient presented to us with vague abdominal pain. She had undergone excision of bilateral ovarian cystic masses for cystic teratoma twelve years earlier. A computed tomography scan of abdomen and pelvis showed a 9 x 7 cm uniformly solid mass with poor contrast enhancement situated in the inferomedial aspect of the left kidney. On exploration, the mass was arising from the inferior and anterior aspect of left renal pelvis, and was attached to it with a narrow pedicle. There was no adherence or attachment to the renal parenchyma. The mass was excised preserving the kidney. Microscopically, the tumor was composed of large collagenized areas containing bundles of spindle cells and several 'microcysts' lined by cuboidal epithelium suggestive of a benign mixed epithelial stromal tumor.
Discussion:
Mixed epithelial tumors usually present in perimenopausal women as a partially cystic mass. Tumors are composed of irregular mixtures of cystic and solid areas, glands with variable complexity and distribution and the stromal component is characterized by a spindle cell proliferation. Commonly, it arises from the renal parenchyma and pelvis and nephrectomy is advocated to manage these tumors.
Conclusion:
MEST is a distinctive benign tumor of the kidney that should be distinguished from other renal neoplasms. MEST arising from the renal pelvis and growing exophytically is a rare entity. The overall prognosis is favorable.
Acute vitamin D intoxication possibly due to faulty production of a multivitamin preparation
Authors: Ahmet Anık, Gönül Çatlı, Ayhan Abacı, Ceyhun Dizdarer, Ece Böber
Journal: J Clin Res Pediatr Endocrinol (2013)
MeSH terms: Dietary Supplements, Vitamin D / adverse effects, Case Reports, Calcium / blood, Dose-Response Relationship, Drug, Drug Compounding / methods, Drug Compounding / standards, Female, Humans, Hypercalcemia / blood, Hypercalcemia / chemically induced, Hypercalciuria / blood, Hypercalciuria / chemically induced, Infant, Male, Parathyroid Hormone / blood, Vitamin D / administration & dosage, Vitamin D / blood, Vitamins / administration & dosage, Vitamins / adverse effects, Parathyroid Hormone, Vitamins, Vitamin D, Calcium

Vitamin D intoxication usually occurs as a result of inappropriate use of vitamin D preparations and can lead to life-threatening hypercalcemia. It is also known that there are a number of physicians who prescribe vitamin D supplements for various clinical conditions, such as poor appetite and failure to thrive. While inappropriate use of vitamin D supplements may lead to vitamin D intoxication, there are no reports of cases of vitamin D toxicity due to manufacturing errors of vitamin D preparations. Here, we present cases of hypervitaminosis D which developed following the use of a standard dose of a multivitamin preparation. All three cases presented with hypercalcemia symptoms and had characteristic laboratory findings such as hypercalcemia, hypercalciuria, low levels of parathyroid hormone. The very high serum 25(OH) vitamin D levels in these patients indicated vitamin D excess. The vitamin D level of the prescribed multivitamin preparation in the market was studied and was found to contain a very low level of vitamin D (10 IU/5 mL). Although the stated vitamin D content of the preparations ingested by these patients was not high, unproven but possible manufacturing errors were considered to be a possible cause of the hypervitaminosis D diagnosed in these three patients.
Ulipristal Acetate in Myomectomy Optimization in an Infertile Patient with Giant Myomas
Authors: Elena de la Fuente, María Dolores Borrás, Miriam Rubio, Nuria Abril
Journal: Case Rep Med (2016)

The use of ulipristal acetate (UPA) has been recently introduced in the treatment of uterine leiomyomas. This drug has proven useful to control menometrorrhagia and to reduce myoma size. In the case presented here, we show the benefits of UPA treatment in facilitating surgical removal of giant myomas in an infertile patient. In addition to myoma reduction and a better control of preoperative bleeding, the treatment with UPA reduced the duration and complexity of the surgery, as well as the area of uterine wall involved and the resulting scar. No side effects were observed and the patient became pregnant 6 months after the surgery and had a normal pregnancy and delivery. This case report shows the beneficial effects of UPA in the preoperative treatment of myomas which affect uterus function.
Case Report: 'Z' osteotomy - a novel technique of treatment in Blount's disease
Authors: Raju Karuppal, Rahul Mohan, Anwar Marthya, Gopakumar Ts, Sandhya S
Journal: F1000Res (2015)
Keywords: blount’s disease, infantile tibia vara, z tibial osteotomy

Blount's disease is a progressive form of genu varum due to asymmetrical inhibition of the postero medial portion of the proximal tibial epiphysis. The surgical treatments involved in correction of Blount's disease are often technically demanding, complicated procedures. These procedures can lead to prolonged recovery times and poor patient compliance. In such a context we are suggesting "fibulectomy with Z osteotomy" of the proximal tibia, a relatively simple and highly effective technique. This technique is based on correcting the mechanical axis of the lower limb thereby restoring growth from the medial physis of proximal tibia. We have used a new surgical technique, which includes fibulectomy followed by a Z-shaped osteotomy. We have used this simple technique in a 5 year-old boy with unilateral Blount's disease. The femoro-tibial angle was corrected from 18.2° of varus to 4.2° of valgus. The angular correction obtained after operation was 22°. There were no postoperative complications. This technique has the advantages of correcting both angular and rotational deformities simultaneously. The purpose of this case study is to introduce a new surgical technique in the treatment of Blount's disease.
Large irritation fibroma of hard palate: a case report of a rare clinical entity
Authors: Alexios Tsikopoulos, Charalampos Festas, Athanasios Fountarlis, Varvara Sidiropoulou, Nikolaos Chaitidis, Asterios Symeonidis, Angeliki Kotsiafti, Theano Papazi
Journal: Pan Afr Med J (2021)
Keywords: benign tumor, case report, hard palate, irritation fibroma
MeSH terms: Fibroma / diagnosis, Palatal Neoplasms / diagnosis, Palate, Hard / pathology, Case Reports, Aged, 80 and over, Female, Fibroma / pathology, Fibroma / surgery, Humans, Hyperplasia, Palatal Neoplasms / pathology, Palatal Neoplasms / surgery, Palate, Hard / surgery

Fibromas are benign tumors of connective tissue common in the oral cavity but rare on hard palate. This paper reports on an asymptomatic, slowly growing mass on the hard palate of a 90-year-old lady, with a reported use of denture for two decades. The patient presented with a 2.2cm, smooth-surfaced, well-circumscribed nodule attached with a stalk to the palatal mucosa. After excision, the histopathological examination revealed a mass of fibrous connective tissue, covered by stratified squamous epithelium with focal low-medium grade hyperplasia and hyperkeratosis. These findings were consistent with irritation fibroma of hard palate, a rare entity, which should be considered as a possible diagnosis for tumors of the area by every physician.
Interstitial inflammation and pulmonary fibrosis in COVID-19: The potential role of cytostatic therapy for severe lung injury
Authors: Elena V Filimonova, Lyubov A Davydova, Mariana A Lysenko, Sergey V Tsarenko
Journal: Respir Med Case Rep (2022)
Keywords: covid-19, cyclophosphamide, cytokine storm, extracorporeal membrane oxygenation, pulmonary fibrosis, respiratory failure
MeSH terms: Case Reports

The progression of secondary pulmonary damage in SARS-COV-2 infection, associated with interstitial damage, inflammation and alveolar consolidation and eventually resulted in the development of pulmonary fibrosis (PF), remains one of the key clinical dilemmas for the treatment of patients in intensive care units (ICU). Currently, there is no standardized algorithm for PF prevention and timely management, although few studies have discussed the use of antifibrotic agents in COVID-19 patients. One of the treatment options for patients with interstitial PF, when irresponsive to the given corticosteroid therapy, is the administration of cytostatic agents, in particular, cyclophosphamide. Cyclophosphamide is one of the well-studied drugs in the cytostatic group, which effectiveness in inhibiting systemic inflammation suggests its ability to reduce the progression of the secondary lung damage, interstitial abnormalities and PF caused by the so-called "cytokine storm". The presented case reports provide data on the use of cyclophosphamide (Сy) in the management of severe respiratory failure in COVID-19 patients stationed in ICU. We describe three clinical cases characterized by different types of respiratory support, including extracorporeal membrane oxygenation.
Postoperative outcome analysis of left-sided idiopathic diaphragmatic hernia: a case report
Authors: Anam Rajendra Sasun, Vishnu Diwakar Vardhan, Samiksha Vinod Sonone
Journal: Pan Afr Med J (2022)
Keywords: idiopathic diaphragmatic hernia, case report, laparotomy repair, physiotherapy interventions, tele-rehabilitation
MeSH terms: Hernias, Diaphragmatic, Congenital / diagnosis, Hernias, Diaphragmatic, Congenital / surgery, Case Reports, Abdominal Pain, Dyspnea, Fatigue, Humans, Laparotomy, Male, Middle Aged

Diaphragmatic hernia of an idiopathic cause is a rare pathology that occurs due to absence of any trauma or congenital cause. The aim of the study was to report a case of left-sided diaphragmatic hernia without traumatic aetiology. A 59-year-old male had complained of epigastric pain, vomiting, nausea, and breathing difficulties for the past 15 days. After investigations and diagnosis of the condition, the patient subsequently underwent laparotomy surgery to repair the defect. Outcome measures like FIM, NPRS, Incentive Spirometry, ICU-MS, CPaX, and HADS were used to assess the recovery of the patient. Surgical management of the condition was achieved, but to bring the patient back to his pre-pathology life without signs of breathlessness, and fatigue, a comprehensively designed physiotherapy rehabilitation is very beneficial. Our case report is the first-ever report made on physiotherapy management of diaphragmatic hernia after surgery. Tele-rehabilitation had been absolutely vital in patient follow-up.
Clinical undergraduate training and assessment in primary health care: experiences gained from Crete, Greece
Authors: George Belos, Christos Lionis, Michael Fioretos, John Vlachonicolis, Anastas Philalithis
Journal: BMC Med Educ (2005)
MeSH terms: Education, Medical, Undergraduate, Family Practice / education, Medical Records / standards, Primary Health Care / standards, Rural Health Services / standards, Clinical Laboratory Techniques, Curriculum, Educational Measurement, Greece, Home Care Services / standards, Home Care Services / statistics & numerical data, Humans, Primary Health Care / statistics & numerical data, Quality Indicators, Health Care, Rural Health Services / statistics & numerical data, Schools, Medical

Background:
Primary health care (PHC) is increasingly being introduced into undergraduate medical education. In Greece, the Faculty of Medicine of the University of Crete was the first to introduce a 4-week long training in primary health care. This paper presents the experiences gained from the initial implementation of the teaching of practice-based primary care in rural Crete and reports on the assessment scale that was developed.
Methods:
284 students' case write-ups from the 6 primary care units (PCUs) where they were allocated for the period 1990 to 1994 were analysed. The demographic data of the students and patients and the number of home visits were studied. Content analysis of the students' write-ups was carried out, using an assessment scale consisting of 10 dichotomous variables, in order to quantify eight (8) primary qualitative criteria.
Results:
Internal reliability was estimated by the index KR20 = 0.67. Face and content validity was found to conform to the standards set for the course, while logistic linear regression analysis showed that the quality criteria could be used as an assessment scale. The number of home visits carried out varied between the various different PCUs (p < 0.001) and more were reported in the write-ups that fulfilled criteria related to the biopsychosocial approach (p < 0.05). Nine quantitative criteria were fulfilled in more than 90% of case reports, but laboratory investigations were reported only in 69.0% of case reports. Statistically significant differences between the PCUs were observed in the fulfilment of criteria related to the community approach, patient assessment and information related to the patient's perception of the illness, but not to those related to aspects of clinical patient management. Differences in reporting laboratory investigations (p < 0.001) are explained by the lack of such facilities in some PCUs. Demographic characteristics of the patients or the students' do not affect the criteria.
Conclusion:
The primary health care course achieved the objectives of introducing students to comprehensive, community oriented care, although there was variation between the PCUs. The assessment scale that was developed to analyse the case-write ups of the students provided data that can be used to evaluate the course.
Intraneobladder Hem-o-Lok Migration with Stone Formation after Orthotopic Neobladder Cystectomy
Authors: Zeng Shu-Xiong, Zhang Zhen-Sheng, Yu Xiao-Wen, Li Hui-Zhen, Lu Xin, Sun Ying-Hao, Xu Chuan-Liang
Journal: Case Rep Urol (2014)

Introduction. Laparoscopic and robot-assisted laparoscopic surgery are widely performed in urology field, so Hem-o-Lok clips are thus extensively used in the laparoscopic procedures. We describe the first case of Hem-o-Lok clip which migrated into the neobladder with calculus formation 26 months after laparoscopic orthotopic neobladder cystectomy, which causes symptoms of gross hematuria and frequent urination. Case Presentation. A 57-year-old man with T2a muscle invasive bladder cancer underwent laparoscopic orthotopic sigmoid neobladder reconstruction after cystectomy which was complicated by intestinal anastomosis leak and peritoneal abscess requiring transverse colostomy and drainage 15 days postoperatively. Twenty-six months after cystectomy, he complained of gross hematuria and frequent urination. Computerized tomography and plain pelvic X-ray revealed a stone measuring approximately 2.8 cm in diameter in the neobladder. During cystoscopy, a closed whitish Hem-o-Lok clip was seen in the center of the calculi. No anastomotic leak or neoplasm was found during cystoscopy. Conclusion. Hem-o-Lok clip migration into the bladder after laparoscopic orthotopic neobladder cystectomy is a rare complication; the first reported case in the literature. To prevent Hem-o-Lok clip migration, it is recommended to avoid extensive use of Hem-o-Lok clip close to anastomosis site, and any loose Hem-o-Lok clip should be retrieved before closure.
Locked-in syndrome after basilary artery thrombosis by mucormycosis masquerading as meningoencephalitis in a lymphoma patient
Authors: Fausto Maffini, Emilia Cocorocchio, Giancarlo Pruneri, Guido Bonomo, Fedro Peccatori, Laura Chiapparini, Silvia Di Vincenzo, Giovanni Martinelli, Giuseppe Viale
Journal: Ecancermedicalscience (2013)
Keywords: cutaneous lymphomas, infectious disease, mucorales fungi, mycosis, oncology, stroke, thrombosis
MeSH terms: Case Reports

Locked-in syndrome is a rare clinical syndrome due to basilary artery thrombosis generally associated with trauma, vascular, or cardiac malformation. It can present as various types of clinical evolution and occasionally masquerades as other pathological conditions, such as infective meningoencephalitis. These complications are the cause of diagnostic delay, if not promptly recognised, followed by patient death. We report the case of a 42-year-old female with a systemic B and cutaneous T-cell non-Hodgkin's lymphoma, with a severe neutropenia lasting over a year, who eventually developed a rapid and fatal fungal mucormycosis sepsis following a skin infection on her right arm, associated with locked-in syndrome and meningoencephalitis.
Spontaneous Closure of a Coronary Artery Bypass Graft Pseudoaneurysm Embedded in a Mediastinal Hematoma
Authors: Daniel L Hess, Gaither W Horde, Karan Sarode, William S Morgan, Salmaan Z Kamal, Jubal R Watts, Gregory D Chapman
Journal: Case Rep Cardiol (2023)
MeSH terms: Case Reports

Coronary artery bypass graft (CABG) pseudoaneurysms are a rare but often unrecognized clinical entity. They are prone to rupture and hemodynamic compromise and should therefore be on the differential in the appropriate patient. We present a case of a gentleman with a recent CABG surgery who presented with acute onset dyspnea and a large pleural effusion. Imaging revealed a saphenous vein graft pseudoaneurysm embedded in a mediastinal hematoma. Four weeks later, prior to planned stenting, the pseudoaneurysm had spontaneously closed. This case highlights an unusual acute presentation of a CABG pseudoaneurysm and a multidisciplinary approach to its management.
Case Report: Parvovirus B19 infection complicated by hemophagocytic lymphohistiocytosis in a heart-lung transplant patient
Authors: Xuewu Zhang, Jingxia Wang, Xiaohan Huang, Yue Zhu, Yijing Zhu, Lingling Tang, Hongliu Cai, Xueling Fang, Lingtong Huang
Journal: Front Immunol (2023)
Keywords: hlh, hemophagocytic lymphohistiocytosis, hemophagocyticsyndrome, parvovirus b19, transplantation
MeSH terms: Erythema Infectiosum / complications, Heart-Lung Transplantation / adverse effects, Lymphohistiocytosis, Hemophagocytic / diagnosis, Lymphohistiocytosis, Hemophagocytic / drug therapy, Parvoviridae Infections / complications, Parvoviridae Infections / diagnosis, Parvovirus B19, Human, Case Reports, Research Support, Non-U.S. Gov't, Humans, Immunoglobulins, Intravenous / therapeutic use, Immunoglobulins, Intravenous

Immunosuppressed patients can contract parvovirus B19, and some may experience hemophagocytic lymphohistiocytosis (HLH). Herein, we describe the first report of hemophagocytic lymphohistiocytosis in a heart-lung transplant patient with concomitant parvovirus B19 infection. The patient was treated with intravenous immune globulin (IVIG) and the features of HLH were remission. This instance emphasizes the significance of parvovirus B19 monitoring in transplant patients with anemia; if HLH complicates the situation, IVIG may be an adequate remedy. Finally, a summary of the development in diagnosing and managing parvovirus B19 infection complicated by HLH is provided.