OpenMed/multicare-articles huggingface dataset:
Case Report: Contribution of [18F]FET PET in differential diagnosis between radionecrosis and progression in metastasis-reproducibility and superiority of dynamic acquisitions
Authors: Aurélien Callaud, Anne-Claire Dupont, Marie-Agnes By, Ilyess Zemmoura, Maria-Joao Santiago-Ribeiro
Journal: Front Nucl Med (2024)
Keywords: [18f]fet pet, cerebral metastasis, dynamic acquisition, progression, radionecrosis
MeSH terms: Case Reports

We present the case of a 67-year-old woman with metastatic invasive ductal carcinoma of the left breast, in whom a follow-up magnetic resonance imaging, 3 months after encephalic radiotherapy, revealed a significant increase in the size of two brain metastases, potentially indicating progressive disease within the radiation field. Subsequent [18F] fluorodeoxyglucose ([18F]FDG) and [18F] fluoroethyl-L-tyrosine positron emission tomography ([18F]FET PET) scans were performed to distinguish radionecrosis from tumor progression. Despite a dynamic [18F]FET time-activity curve (TAC) against progression, the exceeding of the 1.9 cutoff by mean tumor to brain ratio (TBR) and interdisciplinary considerations led to the resection of one lesion. Histopathology revealed necrosis due to radiotherapy, without viable tumor proliferation. To verify radionecrosis, a second [18F]FET PET scan was conducted, showing consistent findings. In metastasis differentiation, the mean TBR cutoff of 1.9 and TAC analysis achieved a sensitivity of 95% and specificity of 91%. The discrepancy between the TAC and TBR emphasizes the need for consideration, and a time delay between radiotherapy and PET may impact TBR cutoffs. In addition, differences in radiosensitivity suggest a lower metastasis pre-test probability of progression, and it might be why a TAC analysis could be more effective in distinguishing true progression from treatment related changes in metastasis. This case demonstrates the accuracy of dynamic [18F]FET PET and suggests its utility for post-treatment metastasis evaluation, and further research on post-treatment delay could lead to improved performances of dynamic [18F]FET PET.
Case report: Spontaneous mandibular body regeneration following unilateral subtotal mandibulectomy in a 3-month-old French bulldog
Authors: Alexandra L Wright, Santiago Peralta, Nadine Fiani
Journal: Front Vet Sci (2023)
Keywords: juvenile, mandibulectomy, oral neoplasia, spontaneous regeneration, squamous cell carcinoma

Objective:
To document a case of spontaneous regeneration of the mandibular body following subtotal mandibulectomy in a juvenile dog.
Case summary:
A 3-month-old male intact French bulldog was presented with papillary oral squamous cell carcinoma located at the dorsal aspect of the molar region of the left mandible. Initial biopsy of the mass was performed by the primary care veterinarian. Complete clinical staging revealed no signs of metastasis. Computed tomographic images of the head showed minimal contrast enhancement of the mass with no signs of periosteal or bone involvement. Subtotal mandibulectomy was performed. Histopathology indicated complete excision of the tumor. The patient returned 8-weeks later for follow up and cleft palate surgical repair, at which time bone was noted in the mandibulectomy area on palpation. Repeat computed tomography of the head revealed complete regeneration of the left mandibular body from the level of the ramus to the mandibular symphysis. No treatment for malocclusion was necessary due to the reformation of a functional mandible.
Clinical relevance:
The present case demonstrates that spontaneous regeneration of the mandibular body is possible following subtotal mandibulectomy in immature dogs. Subtotal mandibulectomy is a radical procedure that can lead to long term complications including mandibular drift, malocclusion, and oral pain. This case report provides evidence that these sequelae may be mitigated or eliminated in young patients undergoing this procedure.
Case report: Levodopa challenge test is important in identifying dopamine-induced freezing of gait in patient with Parkinson's disease
Authors: Shan-Shan Xu, Shi-Guo Zhu, Cheng-Xiang Yuan, Guo-Ling Zeng, Xiao-Tian Li, Rong-Pei Liu, Shi-Shi Huang, Xiong Zhang, Jian-Yong Wang
Journal: Front Hum Neurosci (2024)
Keywords: parkinson’s disease, case report, dopamine-induced fog, freezing of gait, levodopa challenge test
MeSH terms: Case Reports

Introduction:
Freezing of gait (FOG) is a disabling and heterogeneous symptom in patients with Parkinson's disease (PD). Among them, dopamine-induced FOG is rare and difficult to identify. The treatment of dopamine-induced FOG is complex.
Case presentation:
We herein presented a case of PD patient who complicated with refractory FOG. It was identified as dopamine-induced FOG during levodopa challenge test. Her symptoms were alleviated after we reduced the total equivalent dosage of levodopa.
Conclusion:
Our report emphasizes the importance of levodopa challenge test in identifying different types of FOG, which is very important for further adjusting treatment.
Case report: Sarcomatoid renal cell carcinoma masquerading as hydronephrosis
Authors: Shicheng Chen, Zhongcong He, Mi Meng, Zhong Tian, Cheng Zhu, Ni Fu, Bo Yu
Journal: Front Oncol (2024)
Keywords: aggressive renal cell carcinoma, hydronephrosis, misdiagnosis, rare disease, sarcomatoid renal cell carcinoma
MeSH terms: Case Reports

Sarcomatoid renal cell carcinoma (SRCC), a manifestation of sarcomatoid dedifferentiation in renal cell carcinoma, is characterized by elevated invasiveness and a grim prognosis. Typically, SRCC patients present with advanced or metastatic conditions and survival rates rarely extend beyond one year. In this study, we describe a case of SRCC characterized by the patient exhibiting right flank pain without hematuria. Initially, imaging interpretations led to a diagnosis of severe hydronephrosis. Subsequently, an open right nephrectomy post-surgery confirmed the pathology of sarcomatoid renal cell carcinoma.
Gastric, Colonic, and Rectal Amyloidosis in the Setting of Familial Mediterranean Fever: A Unique Cause of Intractable Diarrhea
Authors: Lefika Bathobakae, Nida Ansari, Anas Mahmoud, Shayee Hasan, Ruhin Yuridullah, Sohail Qayyum, Sam Rae
Journal: Case Rep Gastrointest Med (2024)
MeSH terms: Case Reports

Familial Mediterranean fever (FMF) is a hereditary disorder characterized by episodes of fever, polyserositis, or cutaneous inflammation. The FMF attacks last 1-3 days and have no apparent triggers. Recurrent deposition of the serum amyloid A (SAA) protein in the gut can cause intractable diarrhea, dysmotility, and recurrent abdominal pain. Gastrointestinal amyloidosis is a rare, but serious, complication of FMF. In this case report, we describe a rare case of chronic diarrhea and recurrent abdominal pain due to FMF-induced gastrointestinal amyloidosis.
A Case of Life-Threatening Abdominal Wall Hematoma Formation in a Patient on Warfarin Therapy with Concurrent Influenza Infection
Authors: Bhavani Nagendra Papudesi, Isabella M Alvarado, Parneet Kaur, Srikrishna V Malayala, Sivakoti N Guda, Mathew Mathew, Sai Deepika Potluri
Journal: Cureus (2024)
Keywords: case report, covid-19, hematoma, influenza, warfarin
MeSH terms: Case Reports

Warfarin therapy provides extensive antithrombotic benefits and, thus, is widely used in the general population. However, as with most medications, there are also risks associated with warfarin use. Specifically, because of the narrow therapeutic window of this drug, patients taking it are at a much higher risk of accidental bleeding. Additionally, patients may also present with bleeding complications when infected with illnesses with coughing as a symptom, such as influenza or COVID-19. These patients have the potential to suffer hemorrhagic morbidities related to the increased intra-abdominal and intra-thoracic pressures that are generated from coughing. Moreover, a synergistic effect is seen when patients find themselves in a situation where they are taking anticoagulation therapy and become infected with illnesses such as influenza or COVID-19. We present a case in which an individual on warfarin therapy was infected with Influenza A. This combination of factors eventually led to massive hemorrhage and large abdominal wall hematoma formation. This case brings to light the importance of having a low threshold for considering the prospect of massive hemorrhage in any patient who is anticoagulated and develops a condition that is associated with increased abdominal pressure. Because these bleeding events can have devastating effects, raising awareness of this risk is increasingly important. Early detection of massive hemorrhage will lead to better outcomes and can ultimately be life-saving for these patients.
Clostridioides difficile infection after extracorporeal membrane oxygenation support for acute myocardial infarction: a case report
Authors: Yanan Hu, Chang Hu, Jun Jiang, Jing Zhang, Yiming Li, Zhiyong Peng
Journal: Front Med (Lausanne) (2023)
Keywords: clostridioides difficile, clostridioides difficile infection, case report, extracorporeal membrane oxygenation, fecal microbiota transplantation
MeSH terms: Case Reports

Introduction:
Restored cardiopulmonary function is efficiently achieved by utilizing extracorporeal membrane oxygenation (ECMO). Nevertheless, the incidence of Clostridioides difficile infection (CDI) associated with ECMO is relatively uncommon.
Case presentation:
In this report, we present the case of a 59-year-old male with severe chest pain due to acute myocardial infarction, subsequently necessitating ECMO support. During the first day of hospitalization, pulmonary infections were observed, and piperacillin-tazobactam was prescribed for 7 days at low dosages. However, the patient developed severe diarrhea 4 days later. After ruling out common pathogens, we suspected the occurrence of CDI and performed genetic testing for C. difficile toxin, confirming our diagnosis. The prescription of vancomycin resulted in slight improvement, while fecal microbiota transplantation (FMT) proved to be more effective.
Conclusion:
In this case, temporary application of ECMO was applied, and the anti-infective treatment relied on the use of antibiotics at short-term, low-dose, and low CDI risk. Hence, the occurrence of CDI was considered an uncommon event, which may serve as a reference for future cases.
Case report: A toxoplasmic encephalitis in an immunocompromised child detected through metagenomic next-generation sequencing
Authors: Chuang-Wei Yu, Xiong-Feng Zhu, Chongjian Huang, Hua-Dong Meng, Xiao-Guang Cao
Journal: Front Public Health (2023)
Keywords: cns infections, diagnostic tool, immune dysfunction, mngs, toxoplasmic encephalitis
MeSH terms: Central Nervous System Infections, Encephalitis / cerebrospinal fluid, Encephalitis / diagnosis, Case Reports, Brain / diagnostic imaging, Child, Preschool, High-Throughput Nucleotide Sequencing / methods, Humans

There exist numerous pathogens that are capable of causing infections within the central nervous system (CNS); however, conventional detection and analysis methods prove to be challenging. Clinical diagnosis of CNS infections often depends on clinical characteristics, cerebrospinal fluid (CSF) analysis, imaging, and molecular detection assays. Unfortunately, these methods can be both insensitive and time consuming, which can lead to missed diagnoses and catastrophic outcomes, especially in the case of infrequent diseases. Despite the application of appropriate prophylactic regimens and evidence-based antimicrobial agents, CNS infections continue to result in significant morbidity and mortality in hospital settings. Metagenomic next-generation sequencing (mNGS) is a novel tool that enables the identification of thousands of pathogens in a target-independent manner in a single run. The role of this innovative detection method in clinical pathogen diagnostics has matured over time. In this particular research, clinicians employed mNGS to investigate a suspected CNS infection in a child with leukemia, and unexpectedly detected Toxoplasma gondii.
Case:
A 3-year-old child diagnosed with T-cell lymphoblastic lymphoma was admitted to our hospital due to a 2-day history of fever and headache, along with 1 day of altered consciousness. Upon admission, the patient's Glasgow Coma Scale score was 14. Brain magnetic resonance imaging revealed multiple abnormal signals. Due to the patient's atypical clinical symptoms and laboratory test results, determining the etiology and treatment plan was difficulty.Subsequently, the patient underwent next-generation sequencing examination of cerebrospinal fluid. The following day, the results indicated the presence of Toxoplasma gondii. The patient received treatment with a combination of sulfamethoxazole (SMZ) and azithromycin. After approximately 7 days, the patient's symptoms significantly improved, and they were discharged from the hospital with oral medication to continue at home. A follow-up polymerase chain reaction (PCR) testing after about 6 weeks revealed the absence of Toxoplasma.
Conclusion:
This case highlights the potential of mNGS as an effective method for detecting toxoplasmic encephalitis (TE). Since mNGS can identify thousands of pathogens in a single run, it may be a promising detection method for investigating the causative pathogens of central nervous system infections with atypical features.
Subclinical Cushing's Disease with High-Molecular-Weight Forms of Adrenocorticotropic Hormone Production
Authors: Takahiko Inukai, Nozomi Harai, Yukie Nakagawa, Tadatsugu Hosokawa, Airi Antoku, Yuko Muroi, Masakazu Ogiwara, Kyoichiro Tsuchiya
Journal: Case Rep Endocrinol (2024)
MeSH terms: Case Reports

Production of the high-molecular-weight forms of adrenocorticotropic hormone (big-ACTH) has been reported in a small number of ectopic ACTH syndrome and ACTH-producing pituitary macroadenoma. However, perioperative changes in big-ACTH in patients with subclinical Cushing's disease have not been reported. A 63-year-old woman presented 25 × 20 × 20-mm-sized macroadenoma in the pituitary gland. Her early morning plasma ACTH and cortisol levels were 111 pg/mL and 11.6 μg/dL, respectively. Cushingoid features and diurnal variation in plasma cortisol levels were not observed. The patient's urinary free cortisol (UFC) was 59.3 μg/day. The corticotropin-releasing hormone (CRH) test showed that plasma ACTH levels were 1.5 times higher than the preload value. The overnight dexamethasone suppression test (DST) showed that the plasma cortisol level was not suppressed by 0.5 mg of dexamethasone (DEX) but was suppressed by 8 mg of DEX. Inferior pyramidal sinus sampling was consistent with Cushing's disease. Taken together, the patient was clinically diagnosed with subclinical Cushing's disease caused by an ACTH-producing pituitary adenoma. Endoscopic transsphenoidal adenomectomy was performed. In the postoperative CRH test, plasma ACTH levels showed six-fold increase. The postoperative DST showed cortisol suppression at 0.5 mg of DEX. The UFC levels decreased to 35.1 μg/day. Pituitary contrast-enhanced MRI revealed no residual tumor, and plasma ACTH and cortisol levels remained within normal ranges. Gel filtration of preoperative and postoperative plasma ACTH was performed, and a high molecular weight fraction of ACTH was detected, which markedly decreased postoperatively. The absence of Cushingoid features and the lack of significant cortisol hypersecretion in this case were thought to be due in part to big-ACTH, which has low bioactivity. By careful evaluation of laboratory and clinical findings, we identified it as a big-ACTH-producing adenoma. This is the first report of a case in which the big-ACTH transition was observed perioperative and is a valuable case.
ANCA-Negative Pauci-Immune Glomerulonephritis Associated with Bartonella Endocarditis
Authors: Camille Ng, Angela Penney, Rojin Sharaflari, Akash Pathak, John H Howard Iii, Kuang-Yu Jen
Journal: Case Rep Nephrol (2024)
MeSH terms: Case Reports

Kidney complications can occur due to infective endocarditis, one of which is glomerulonephritis. Most often, an immune complex or complement-mediated glomerulonephritis is seen on kidney biopsy. In a minor subset of cases, pauci-immune glomerulonephritis may be present. Most often, such patients will demonstrate the presence of antineutrophil cytoplasmic antibodies (ANCA) on serologic testing. A growing number of cases of ANCA-associated glomerulonephritis due to Bartonella endocarditis have been reported. This type of endocarditis can present diagnostic difficulties given that these patients are often culture negative. Herein, we report a challenging case of ANCA-negative pauci-immune glomerulonephritis showing florid crescents on biopsy that was associated with Bartonella endocarditis.
Case report: Dementia sensitivity to altitude changes and effective treatment with hyperbaric air and glutathione precursors
Authors: Edward F Fogarty, Paul G Harch
Journal: Front Neurol (2024)
Keywords: covid-19, altitude, dementia, glutathione, hyperbaric, pandemic, pre-cursors, wellness
MeSH terms: Case Reports

A 78-year-old man with dementia experienced waxing and waning of symptoms with changes in altitude as he traveled from his home in the Rocky Mountains to lower elevations and back. To replicate the improvement in his symptoms with travel to lower elevations (higher pressure), the patient was treated with a near-identical repressurization in a hyperbaric chamber using compressed air. With four 1-h treatments at 1.3 Atmospheres Absolute (ATA) and concurrent administration of low-dose oral glutathione amino acid precursors, he recovered speech and showed improvement in activities of daily living. Regional broadcast media had documented his novel recovery. Nosocomial COVID-19 and withdrawal of hyperbaric air therapy led to patient demise 7 months after initiation of treatment. It is theorized that hyperbaric air therapy stimulated mitochondrial biochemical and physical changes, which led to clinical improvement.
De Novo Onset of Myasthenia Gravis after Kidney Transplantation
Authors: Aaron de Souza, Rajesh Raj
Journal: Case Rep Transplant (2024)
MeSH terms: Case Reports

Myasthenia gravis occurring de novo after kidney transplantation is a rare course of severe muscle weakness. A 57-year-old female on treatment with peritoneal dialysis following polycystic kidney disease received a renal transplant with standard basiliximab induction. She had no preceding history of neuromuscular problems. Three months after transplant she presented with progressive weakness and fatigability, finally needing a wheelchair to mobilise. Graft function was stable. Examination revealed patchy limb weakness, worsening on repeated exercise. There were no abnormalities in cranial nerves, reflexes, or sensation. Electromyography was normal, but repetitive nerve stimulation studies showed a postsynaptic neuromuscular transmission defect suggestive of myasthenia gravis. Serological testing revealed no putative antibodies. Initial treatment with pyridostigmine was not tolerated. Following an episode of hospitalisation with severe limb weakness, she received intravenous immunoglobulin and showed dramatic improvement, which persisted over the next few weeks. Approximately 6 months later, she had a relapse of her symptoms, which once again responded to intravenous immunoglobulin therapy. De novo myasthenia gravis after transplantation is a rare entity, infrequently reported in the literature. This illness is surprising since immunosuppression after transplant is usually sufficient to prevent immune-mediated disease. This patient had no history of similar illnesses. Delayed physical recovery after major surgery such as renal transplantation is often attributed to other causes such as deconditioning, and patients are often prescribed physiotherapy as a response. In this patient, the profound unexplained weakness that persisted for several weeks after transplant prompted referral to the neurologist, which enabled this rare diagnosis to be made. This story highlights the need to monitor unexpected symptoms closely and to consider a wide differential diagnosis when improvement after transplant is not along usual expected lines. Finally, this case also illustrates the benefits of multidisciplinary involvement in the care of these complex patients.
Case report: Dopamine Dysregulation Syndrome, mania, and compulsive buying in a patient with Parkinson's disease
Authors: Carlos Silva, Marta Rebelo, Inês Chendo
Journal: Front Neurol (2023)
Keywords: parkinson's disease, compulsive buying, dopaminergic dysregulation syndrome, impulsive-compulsive behaviors, mania
MeSH terms: Case Reports

Neuropsychiatric symptoms and syndromes are among the most common non-motor symptoms of Parkinson's Disease but they are frequently unrecognized and untreated. Dopamine Dysregulation Syndrome is an uncommon complication of the treatment of Parkinson's disease, characterized by an addictive use of dopamine far more than the dosage required for treatment of objective motor impairment, leading to severe dyskinesia, euphoria, aggressivity, or psychosis. We present a paradigmatic case of Dopamine Dysregulation Syndrome, Mania, and Compulsive Buying in a 55-year-old male with Parkinson's Disease. We also reviewed the risk factors and the therapeutic management of Dopamine Dysregulation Syndrome in Parkinson's Disease.
Case report: Challenging kidney transplantation in an adolescent patient with tetralogy of Fallot
Authors: Ante Jakšić, Berislav Barbalić, Lidija Orlić, Željko Župan, Božidar Vujičić, Antun Gršković, Tanja Ćelić, Ivana Koraca Chinchella, Neven Čače, Sanja Flajšman-Raspor, Ivan Bubić, Josip Španjol, Dean Markić
Journal: Front Med (Lausanne) (2024)
Keywords: cardio-renal syndrome, chronic renal insufficiency, congenital heart disease, kidney transplantation, tetralogy of fallot
MeSH terms: Case Reports

Tetralogy of Fallot is the most common cyanotic congenital heart disease. This severe disorder of cardiac physiology can impair renal function and lead to the development of cardiorenal syndrome and eventually to end-stage renal disease. Kidney transplantation may be the best option for renal replacement treatment in patients with tetralogy of Fallot, but only after correcting cardiac abnormalities and optimizing cardiac functions, all of which require a multidisciplinary approach. We report the first case of kidney transplantation in an adolescent patient with tetralogy of Fallot. Our findings confirms that kidney transplantation is a valuable treatment option in selected congenital heart disease cases.
An Adolescent Boy With Hypoxia, Microscopic Hematuria, and Hypertension
Authors: Melissa S Zhou, Clement D Lee, Benjamin J Lerman, Alanna Strong, Christopher LaRosa
Journal: Cureus (2024)
Keywords: alport syndrome, asymptomatic hematuria, hematuria, microscopic hematuria, recurrent hematuria
MeSH terms: Case Reports

A 13-year-old boy presented with hypoxia, microscopic hematuria, and elevated blood pressures. Persistent microscopic hematuria and hypertension led to investigation of glomerular and non-glomerular causes of hematuria. After reviewing his clinical course, family history, and laboratory testing, an additional test was sent, revealing the diagnosis.