OpenMed/multicare-articles huggingface dataset:
Giant pelvic abscess with sepsis: Case report and review of current literature
Authors: Adel Elkbuli, Kyle Kinslow, Brandon Diaz, Shaikh Hai, Mark McKenney, Dessy Boneva
Journal: Int J Surg Case Rep (2019)
Keywords: pelvic abscess, sepsis, surgical drainage, surgical outcomes

Introduction:
Intra-abdominal and pelvic abscesses can develop because of multiple etiologies. Typically, these abscesses are managed via a combination of medical (antibiotics) and surgical (drainage) interventions. This is a unique case report of a giant idiopathic pelvic abscess with necrotizing fasciitis that failed conservative management with antibiotics, requiring urgent surgical intervention and complex closure of the wound.
Case presentation:
A 71-year-old female presented to the emergency department in sepsis, complaining of right hip and flank pain of one-month duration. Imaging revealed a giant right flank abscess with necrotizing fasciitis. The abscess extended from the pelvis to the right retroperitoneal space, traversing several soft tissue planes, to the skin. She was treated emergently with open surgical drainage, debridement, and delayed complex closure. The patient significantly improved post-operatively and was subsequently discharged.
Discussion:
Pelvic abscesses are commonly due to gastrointestinal, genitourinary, post-surgical, or rarely idiopathic causes. US, CT, or MRI are the imaging modalities effective in diagnosing and staging abscess severity. Currently percutaneous, image-guided abscess drainage is the primary management due to it being minimally invasive, having better outcomes and reduced hospital stay. In large, multi-loculated abscess as exhibited by our patient, open surgical drainage and debridement of the infected cavity was not only successful but imperative in effective resolution.
Conclusion:
Most pelvic abscesses can be treated with percutaneous drainage but those complicated by necrotizing fasciitis, or multi-loculated collections may be better treated with open drainage.
Tracking Potentiating States of Dissociation: An Intensive Clinical Case Study of Sleep, Daydreaming, Mood, and Depersonalization/Derealization
Authors: Giulia L Poerio, Stephen Kellett, Peter Totterdell
Journal: Front Psychol (2016)
Keywords: clinical case study, daydreaming, depersonalization, dissociation, emotion, experience-sampling methodology, mindwandering, sleep

This study examined in real time the role of sleep and daydreaming as potentiating states for subsequent dissociation in depersonalization/derealization disorder (DDD). Research and theory suggests that dissociation may be exacerbated and maintained by a labile sleep-wake cycle in which "dream-like" mentation intrudes into waking life and fuels dissociative symptoms. We explore and extend this idea by examining the state of daydreaming in dissociation. Daydreaming is a state of consciousness between dreaming and waking cognition that involves stimulus-independent and task-unrelated mentation. We report the results of a unique intensive N = 1 study with an individual meeting diagnostic criteria for DDD. Using experience-sampling methodology, the participant rated (six times daily for 40 days) current daydreaming, mood, and dissociative symptoms. At the start of each day sleep quality and duration was also rated. Daydreaming was reported on 45% of occasions and significantly predicted greater dissociation, in particular when daydreams were repetitive and negative (but not fanciful) in content. These relationships were mediated by feelings of depression and anxiety. Sleep quality but not duration was a negative predictor of daily dissociation and also negatively predicted depression but not anxiety. Findings offer initial evidence that the occurrence and content of daydreams may act as potentiating states for heightened, in the moment, dissociation. The treatment implications of targeting sleep and daydreaming for dissociative disorders are discussed.
Acute fibrinous and organising pneumonia following lung transplantation is associated with severe allograft dysfunction and poor outcome: a case series
Authors: Keith C Meyer, Jennifer Bierach, Jeffrey Kanne, Jose R Torrealba, Nilto C De Oliveira
Journal: Pneumonia (Nathan) (2015)
Keywords: acute fibrinous and organising pneumonia, interstitial, lung transplantation, pneumonia, thoracic
MeSH terms: Case Reports

Acute fibrinous and organising pneumonia (AFOP) is a histopathologic variant of acute lung injury that has been associated with infection and inflammatory disorders and has been reported as a complication of lung transplantation. A retrospective chart review was performed for all patients transplanted at the University of Wisconsin Hospital and Clinics from January 1995 to December 2013 (n = 561). We identified 6 recipients whose clinical course was complicated by AFOP. All recipients were found to have AFOP on lung biopsy or at post-mortem examination, and 5 of the 6 patients suffered progressive allograft dysfunction that led to fatal outcome. Only 1 of the 6 patients stabilised with augmented immunosuppression and had subsequent improvement and stabilisation of allograft function. We could not clearly identify any specific cause of AFOP, such as drug toxicity or infection. Lung transplantation can be complicated by lung injury with an AFOP pattern on histopathologic examination of lung biopsy specimens. The presence of an AFOP pattern was associated with irreversible decline in lung function that was refractory to therapeutic interventions in 5 of our 6 cases and was associated with severe allograft dysfunction and death in these 5 individuals. AFOP should be considered as a potential diagnosis when lung transplant recipients develop progressive decline in lung function that is consistent with a clinical diagnosis of chronic lung allograft dysfunction.
Successful treatment of stent knot in the proximal ureter using ureteroscopy and holmium laser
Authors: Masters M Richards, Daniel Khalil, Ayman Mahdy
Journal: Case Rep Med (2011)
MeSH terms: Case Reports

Knotted ureteral stent is rare yet tedious complication that might represent a treatment challenge to the endourologist. Only twelve cases of knotted stent have been reported. Different management options have been reported, including simple traction, ureteroscopy, percutaneous removal, and open surgery. In this paper, we present the successful untying of the knot using ureteroscopy with holmium laser.
Why Does Therapy Work? An Idiographic Approach to Explore Mechanisms of Change Over the Course of Psychotherapy Using Digital Assessments
Authors: Allison Diamond Altman, Lauren A Shapiro, Aaron J Fisher
Journal: Front Psychol (2020)
Keywords: ambulatory assessment, case study, cognitive behavioral therapy, digital assessments, mechanisms

Background and objectives:
While psychotherapy treatments are largely effective, the processes and mechanisms underlying such positive changes remain somewhat unknown. Focusing on a single participant from a treatment outcome study that used a modular-based cognitive behavior therapy protocol, this article aims to answer this question by identifying changes in specific symptomatology over the course of the treatment. Using quantitative data derived from digital health methodology, we analyzed whether a given therapeutic intervention was related to downstream effects in predicted symptom domains, to assess the accuracy of our interventions.
Methods:
This case study employed an observational N-of-1 study design. The participant (n = 1) was a female in the age range of 25-35 years. Using digital health data from ambulatory assessment surveys completed prior to and during therapy, separate linear regression analyses were conducted to assess if hypothesized treatment targets reduced after a given module, or intervention.
Results:
Support was found for some of the hypothesized quantitative changes (e.g., decreases in avoidance after exposures module), yet not for others (e.g., decreases in rumination following the mindfulness module).
Conclusion:
We present data and results from our analyses to offer an example of a novel design that may allow for a greater understanding of the nature of symptom changes with increased granularity throughout the course of a psychological treatment from the use of digital health tools.
Case report: Immunotherapy plus chemotherapy and stereotactic ablative radiotherapy (ICSABR): a novel treatment combination for Epstein-Barr virus-associated lymphoepithelioma-like intrahepatic cholangiocarcinoma
Authors: Ruizhen Li, Ke Cheng, Xiaofen Li, Chen Chang, Wanrui Lv, Li Xiaoying, Pei Zhang, Heqi Yang, Dan Cao
Journal: Front Pharmacol (2023)
Keywords: epstein-barr virus-associated lymphoepithelioma-like intrahepatic cholangiocarcinoma, immunotherapy, long survival, stereotactic ablative radiotherapy, tumor immune microenvironment
MeSH terms: Case Reports

Epstein-Barr virus-associated lymphoepithelioma-like intrahepatic cholangiocarcinoma (EBVa LEL-ICC) is a rare tumor, characterized by a rich tumor immune microenvironment (TIME). While this tumor is reportedly sensitive to immunotherapy, its response has been inconsistent. This decreased sensitivity was associated with reduced TIME abundance. We report the case of a 53-year-old woman with EBVa LEL-ICC having reduced TIME abundance. The patient presented with a liver lesion, which was detected using ultrasound. Initially, the tumor was sensitive to immunotherapy and chemotherapy (IC), but resistance developed after a short interval. Subsequently, stereotactic ablative radiotherapy (SABR) was added to the patient's treatment, which now consisted of ICSABR. Successful tumor shrinkage was achieved with the combination therapy regimen. Thus, surgery and ICSABR are effective adjuncts to the first-line IC therapy in improving the survival rate of patients with EBVa LEL-ICC. The results of this study support multidisciplinary treatment as a viable treatment strategy for EBVa LEL-ICC.
Coexistence of plasma cell dyscrasia with prefibrotic stage of primary myelofibrosis: a case report
Authors: George Tsirakis, Peggy Kanellou, Maria Kaparou, Andrew Passam, Amalia Zampoulaki, Kostas Stylianou, Michael G Alexandrakis
Journal: ISRN Hematol (2011)
MeSH terms: Case Reports

Introduction. Coexistence of myeloproliferative neoplasms with lymphoproliferative syndromes has been described in the past, whereas plasma cell dyscrasias seem to be the most common cases. Case Presentation. We present a case of a 59-year-old Caucasian female of Greek origin who presented with thrombocytosis. Clinical and laboratory investigation disclosed the presence of a smoldering myeloma with coexisting histological and molecular characteristics of primary myelofibrosis. The patient had the acquired point mutation V617F in the JAK2 gene but not the bcr-abl rearrangement and was treated for myelofibrosis with subsequent improvement of all haematological parameters without evidence of myelomatic evolution. Conclusion. We present the first case in the literature of a smoldering myeloma coexisting with primary myelofibrosis. The underlying pathogenetic mechanism could be either related to the presence of a pluripotent neoplastic stem cell capable to differentiate into both lymphoid and myeloid cells or be related to two separate nosologic entities.
Papillary Fibroelastoma as a Cause of Cardiogenic Embolic Stroke in a β-Thalassemia Patient: Case Report and Literature Review
Authors: Re-I Chin, John J Monda, Maulik Sheth, William Ogle, Gloria Merenda, Debapriya De
Journal: Case Rep Cardiol (2017)
MeSH terms: Case Reports

We describe a case of a young male without stroke risk factors who presented with a sudden onset of left-sided weakness, left hand numbness, and left eye blurriness. CT scan of the head without contrast and diffusion-weighted MRI of the brain with contrast revealed an ischemic stroke in the right middle cerebral artery distribution. Transesophageal echocardiography (TEE) revealed a mobile pedunculated mass on the posterior surface of the mitral valve. This mass was resected and pathology showed a cardiac papillary fibroelastoma (CPFE), which was determined to be the cause of the patient's cardioembolic stroke. Further workup also found that patient had microcytic anemia secondary to β-thalassemia intermedia, a rare hematologic disorder due to defective hemoglobin synthesis. Recently, another case report suggested β-thalassemia major may underlie the pathogenesis of CPFE. β-Thalassemia major causes a state of chronic inflammation and endothelial damage, which can mediate CPFE formation. Based on literature review, this is the first case report of a CPFE in a patient with β-thalassemia intermedia. This hypothesis-generating case report calls attention to the need for elucidating the relationship between CPFE and β-thalassemia in future studies to better understand the diagnosis and management of a rare cardiac tumor.
Case Report: The First Reported Concurrence of Wilson Disease and Bilateral Retinitis Pigmentosa
Authors: Zifan Ye, Xiuhua Jia, Xin Liu, Qi Zhang, Kaijun Wang, Min Chen
Journal: Front Med (Lausanne) (2022)
Keywords: wilson disease, abnormal copper metabolism, concurrence, gene mutation, retinitis pigmentosa
MeSH terms: Case Reports

Background:
Wilson disease (WD) and retinitis pigmentosa (RP) are common genetic disorders in clinical practice, however, the concurrence of WD and RP has never been reported before. WD occurs due to mutations that cause copper metabolic abnormalities; in turn, change in copper metabolism has been suggested to be related with RP. Here, we report the first case of concurrent WD and bilateral RP, and investigate possible pathogenesis to illuminate whether the two genetic disorders are causality or coincidence.
Case presentation:
The patient was a 43-year-old Chinese female diagnosed with WD 12 years ago. She had suffered from night blindness since childhood and faced diminution of bilateral vision within 10 years, for which she was referred to our Eye Center during hospitalization for routine copper excretion treatment. The ceruloplasmin, skull magnetic resonance imaging (MRI), and abdominal ultrasound results accorded with hepatolenticular degeneration. Ocular examinations revealed corneal Kayser-Fleischer (K-F) ring, sunflower-like cataract, retinal osteocyte-like pigmentation, bilateral atrophy of outer retina, cystoid macular edema (CME), and tubular vision in both eyes. Phacoemulsification combined with intraocular lens implantation was performed in the right and left eye, but there was limited improvement in her visual acuity. Whole exome sequencing (WES) detected a deleterious homozygous mutation in the ATP7B gene related to WD, and a homozygous mutation in the CNGA1 gene very likely to cause RP.
Conclusions:
We reported the first case of concurrent WD and RP. WES detected two pathogenic gene mutations, ATP7B and CNGA1. Though we cannot completely rule out a causal effect of WD-related abnormal copper metabolism with RP, we speculate that the two gene mutations lead to the coincidence of the two genetic disorders, respectively.
Bicervical normal uterus with normal vagina and anteroposterior disposition of the double cervix
Authors: José Morales-Roselló, Núria Peralta Llorens
Journal: Case Rep Med (2011)
MeSH terms: Case Reports

We report a very uncommon uterine anomaly consisting on a normal uterus, a double cervix with an anteroposterior disposition, and absence of vaginal septum. A 36-years-old woman with one child and absence of past reproductive disorders was examined for a routine checkup. Clinical and transvaginal ultrasound examinations showed a normal uterus with a double cervix disposed in an anteroposterior fashion with the absence of vaginal septum. A review of the theories concerning müllerian fusion is done, and implications of this case in relation with these theories are discussed. This is the first case of a normal uterus with a double cervix situated in an anteroposterior fashion and absence of vaginal septum. This case is in concordance with theories that consider the fusion of the caudal part of Müllerian ducts to be the result of a complex process. It proves that at least in some cases the most caudal part of müllerian ducts is fused in an anteroposterior disposition.
Inguinal ovary in adult women-case report and literature review
Authors: Mette L Josefsson, Surajit Mitra, Sanjay Gupta
Journal: Springerplus (2013)
MeSH terms: Case Reports

This paper describes a rare finding of an inguinal ovary in an adult woman who presented with pelvic pain. Inguinal ovary may occur if the gubernaculum fails to attach to the uterus or if the canal of Nuck remains open during fetal development.
Case Report: Psychopathological Syndromes in the Course of Lupus Erythematosus and the Co-occurrence of Lupus Erythematous With Mental Disorders
Authors: Ewa Stelmach, Jolanta Masiak
Journal: Front Psychiatry (2021)
Keywords: affective and psychotic disorders, bipolar disorder, neuropsychiatric systemic lupus erythematosus, steroid-induced mood and psychotic disorders, systemic lupus erythematosus
MeSH terms: Case Reports

Background: Systemic lupus erythematosus (SLE) is an autoimmune disease that leads to a chronic inflammatory process in tissues and organs. The neuropsychiatric systemic lupus erythematosus (NPSLE) is a set of neuropsychiatric symptoms that derive from the central and peripheral nervous system and are observed in the course of SLE. Case Report and Final Diagnostic and Therapeutic Results: A diagnostic and therapeutic process in a patient with the signs and symptoms of SLE and bipolar disorder (BD) has been described. Bipolar disorder has been diagnosed as a primary disorder while SLE as a comorbid disease. Discussion: Common immunological mechanisms in BD and SLE are the reason for difficulties in diagnosing BD with co-occurring SLE. It should be determined whether BD is a primary disorder or a secondary component of a clinical picture of SLE (NPSLE) or whether mood and/or psychotic disorders are the result of steroid therapy in the course of SLE (steroid-induced mood and psychotic disorders, SIMPD). Conclusion and the Patient's Perspective: The presented case report is a unique description of a patient with a primary diagnosis of BD with comorbid SLE.
Mucormycosis in a case of multisystem inflammatory syndrome in children: "double trouble" (case report)
Authors: Keta Vagha, Revat Meshram, Sham Lohiya, Spandana Madirala, Chitturi Venkata Sai Akhil, Patel Zeeshan Jameel, Jayant Vagha
Journal: Pan Afr Med J (2022)
Keywords: covid-19, sars-cov-2, case report, mucormycosis, multisystem inflammatory syndrome, pediatric
MeSH terms: COVID-19 / complications, COVID-19 / diagnosis, Connective Tissue Diseases, Mucormycosis / diagnosis, Case Reports, Academies and Institutes, Adolescent, Child, Female, Humans, pediatric multisystem inflammatory disease, COVID-19 related

Multisystem inflammatory syndrome (MIS-C) in the pediatric age group is a clinical syndrome in children and adolescents which is recognized in association with a high local prevalence of Corona Virus Disease-2019 (COVID-19). Mucormycosis is a severe form of fungal infection and often affects immunocompromised patients. It is associated with high morbidity and mortality and is characterized by extensive angioinvasion and necrosis of the affected tissue. Currently, this dreaded mucormycosis is rising among COVID-19 pediatric patients during their treatment period or after their discharge from the hospital. It is also called COVID-19- associated mucormycosis (CAM) or black fungus. In the head and neck area, rhino-orbital-cerebral mucormycosis is the most common presentation and a fatal clinical entity associated with COVID-19 infections. There are several cases of mucormycosis reported in cases with COVID-19 infection, but there is limited data available for the development of mucormycosis in MIS-C. Here, we report a case of a nine years old girl who developed mucormycosis while suffering from MIS-C. The patient was brought to our institute with complaints of fever for 3 days associated with redness of the eyes and swelling behind both ears and bilateral conjunctival congestion. Subsequently, she started showing signs of end organ damage in form oliguria and deranged liver function. Her COVID-19 antibody titer was positive and hence was diagnosed as MIS-C. She had prolonged hospitalization during which she started developing black discoloration over the nose. The histopathology report of the lesion was suggestive of mucormycosis. Eventually, the patient died due to multiple organ dysfunction. There is not only an association of mucormycosis in COVID-19- positive patients, but it shows some association with its complications like MIS-C. There is very limited data available for the association of mucormycosis and MIS-C but early diagnosis and intervention play a vital role in the outcome of the patient.
Compound Heterozygous SCN5A Mutations in Severe Sodium Channelopathy With Brugada Syndrome: A Case Report
Authors: Aleksandra Nijak, Alain J Labro, Hans De Wilde, Wendy Dewals, Steve Peigneur, Jan Tytgat, Dirk Snyders, Ewa Sieliwonczyk, Eline Simons, Emeline Van Craenenbroeck, Dorien Schepers, Lut Van Laer, Johan Saenen, Bart Loeys, Maaike Alaerts
Journal: Front Cardiovasc Med (2020)
Keywords: brugada syndrome, scn5a, cardiac arrhythmia, case report, compound heterozygosity
MeSH terms: Case Reports

Aims: Brugada syndrome (BrS) is an inherited cardiac arrhythmia with an increased risk for sudden cardiac death (SCD). About 20% of BrS cases are explained by mutations in the SCN5A gene, encoding the main cardiac sodium Nav1.5 channel. Here we present a severe case of cardiac sodium channelopathy with BrS caused by SCN5A compound heterozygous mutations. We performed a genetic analysis of SCN5A in a male proband who collapsed during cycling at the age of 2 years. Because of atrial standstill, he received a pacemaker, and at the age of 3 years, he experienced a collapse anew with left-sided brain stroke. A later ECG taken during a fever unmasked a characteristic BrS type-1 pattern. The functional effect of the detected genetic variants was investigated. Methods and Results: Next-generation sequencing allowed the detection of two SCN5A variants in trans: c.4813+3_4813+6dupGGGT-a Belgian founder mutation-and c.4711 T>C, p.Phe1571Leu. A familial segregation analysis showed the presence of the founder mutation in the proband's affected father and paternal aunt and the de novo occurrence of the p.Phe1571Leu. The functional effect of the founder mutation was previously described as a loss-of-function. We performed a functional analysis of the p.Phe571Leu variant in HEK293 cells alone or co-expressed with the β1-subunit. Compared to the SCN5A wild type, p.Phe1571Leu displayed a hyperpolarizing shift in the voltage dependence of inactivation (loss-of-function), while the activation parameters were unaffected. Using the peptide toxin nemertide α-1, the variant's loss-of-function effect could be restored due to a toxin-dependent reduction of channel inactivation. Conclusion: This is the first report providing support for the pathogenicity of the p.Phe1571Leu SCN5A variant which, together with the c.4813+3_4813+6dupGGGT founder mutation, explains the severity of the phenotype of cardiac sodium channelopathy with BrS in the presented case.