OpenMed/multicare-articles huggingface dataset:
Persistent Bacillus cereus Bacteremia in an Immunocompetent Patient With a History of Polysubstance Abuse
Authors: Antoine Boustany, Noor Ramahi, Joya-Rita Hindy, Marcos Garcia, K V Gopalakrishna
Journal: Cureus (2023)
Keywords: antibiotics therapy, bacillus cereus, gram positive bacteremia, gram-positive meningitis, polysubstance use disorder
MeSH terms: Case Reports

Extraintestinal infections are rare with Bacillus cereus and include endocarditis, pneumonia, and meningoencephalitis. It has been primarily reported in immunosuppressed individuals with hematological malignancies and rarely in people who inject drugs (PWIDs). Herein, we report the case of a healthy adult woman with no underlying conditions except for injection drug use who presented with signs of meningitis. A 40-year-old female intravenous (IV) drug addict presented to the hospital with a chief complaint of severe headache. She had a fever of 38 °C, and her neurological examination was unremarkable. Laboratory results were significant for a white blood cell (WBC) count of 20.0 × 109/L (reference range: 4.5 to 11.0 × 109/L) and urine toxicology that was positive for amphetamines and cocaine. A lumbar puncture showed a total of 1,736 nucleated cells/µL, 88% neutrophils, a glucose level of 73 mg/dL, and a significantly elevated protein level of 155 mg/dL. B. cereus grew in blood cultures and cerebrospinal fluid (CSF) cultures. Once the growth of B. cereus was identified in the CSF, intravenous vancomycin was started. After leaving against medical advice (AMA), the patient presented again to the hospital, and a lumbar puncture was repeated. Cerebrospinal fluid showed total nucleated cells of 13 cells/µL, but the patient remained bacteremic. An echocardiogram, computerized tomography (CT) of the abdomen and pelvis, and tagged white blood cell scan could not identify a source for the bacteremia. Despite receiving two weeks of IV vancomycin, her blood cultures remained consistently positive for B. cereus without identifying a clear source of infection. Although B. cereus rarely affects the central nervous system, there have been a few cases where immunosuppression has been linked to the infection. We report an unusual case of a patient who continued to be bacteremic despite a thorough search for a source of B. cereus infection and IV vancomycin treatment. As a result, we raise the possibility of addictive behavior due to the patient's pattern of leaving the hospital against medical advice and returning with recurrent bacteremia. A thorough history and careful search for a source of infection are required when B. cereus grows persistently in blood cultures.
Violence-related periorbital trauma with a retained foreign body: a case report
Authors: Giovanni Dell'Aversana, Gaetano Marenzi, Pasquale Piombino, Domenico Testa, Giacomo De Riu, Vincenzo Abbate, Luigi Califano, Gilberto Sammartino
Journal: J Med Case Rep (2016)
MeSH terms: Foreign Bodies / diagnostic imaging, Maxillary Sinus / injuries, Orbital Fractures / diagnostic imaging, Tomography, X-Ray Computed, Violence, Case Reports, Adult, Foreign Bodies / complications, Foreign Bodies / surgery, Humans, Male, Maxillary Sinus / diagnostic imaging, Maxillary Sinus / surgery, Orbital Fractures / etiology, Orbital Fractures / surgery, Treatment Outcome

Background:
Orbital fracture usually occurs as a result of blunt orbital and facial trauma and may involve ocular injuries. International studies on orbital floor fracture show several differences in epidemiology, diagnostic criteria, surgical treatment modalities, and complication rates; therefore, any comparison should be made with caution. Here we describe an unusual case involving a 19-year-old man with violence-related periorbital trauma, wherein a foreign body (a plastic pen cap) traversed the median wall of the maxillary sinus and penetrated the lower turbinate.
Case presentation:
A 19-year-old Caucasian man was referred to our department with localized pain and swelling in the left suborbital region following a physical fight in May 2014. A clinical examination revealed no abnormalities in his eyeballs or eye movement, palpation of the orbital contour revealed no fractures, and ophthalmological evaluation showed no evidence of diplopia. A computed tomography scan revealed fractures in the left orbital floor, periorbital tissue herniation without muscular entrapment and left maxillary hemosinus were observed. A hypodense soft tissue mass was lodged in the left orbital floor, which extended to the median wall of the maxillary sinus and penetrated the left lower turbinate. Surgical exploration of the foreign body was conducted, revealing the foreign body to be a pen cap.
Conclusions:
History or clinical examination alone may be inadequate to raise the suspicion of a retained periorbital foreign body in a situation of orbital region trauma. Computed tomography is important for the evaluation of periorbital injuries, especially because it could reveal the presence of a foreign body. Periorbital foreign bodies can be observed distinctly on computed tomography, which remains the most sensitive study and should be the first imaging modality in such cases.
Course of Neuropsychiatric Symptoms during Flares of Systemic Lupus Erythematosus (SLE)
Authors: Gareth Garrett, Nicola Ambrose, Zaib Davids, Dorothea Bindman
Journal: Case Rep Psychiatry (2017)
MeSH terms: Case Reports

We present the case of a seventeen-year-old girl who presents with an interesting course of neuropsychiatric symptoms during several flares of SLE. The patient was diagnosed at the age of thirteen and has had four flares in total. The latter two flares included cutaneous and neuropsychiatric symptoms. The most recent flare occurred when she was aged seventeen. She had cutaneous symptoms which coincided with an episode of hypomania. Her mental state further deteriorated following steroid treatment. She exhibited affective and psychotic symptoms. Treatment with cyclophosphamide and olanzapine was associated with an improvement in both cutaneous and neuropsychiatric symptoms. Previously aged sixteen the patient had presented with cutaneous symptoms and a moderate depressive episode which was also exacerbated by steroid treatment. The patient's mood improved when the dose of oral steroids was reduced to a daily dose of 15-20 mg prednisolone.
Case Report: A Case of Locally Advanced Pancreatic Cancer Which Achieved Progression Free for Over 12 Months by Subsequent Therapy with Anlotinib Hydrochloride Plus Tegafur-Gimeracil-Oteracil Potassium (TS-1)
Authors: Dongcheng Luo, Sina Liao, Qian Li, Youzhi Lin, Junbao Wei, Yongqiang Li, Xiaoli Liao
Journal: Front Oncol (2022)
Keywords: ts-1, advanced pancreatic cancer, anlotinib, chemotherapy, gimeracil and oteracil potassium capsules, targeted therapy
MeSH terms: Case Reports

Titled the "most destructive of all cancers", pancreatic cancer is a malignant tumor with a very poor prognosis and has a poor response to systemic therapy. At present, several studies have shown that tegafur-gimeracil-oteracil potassium (hereinafter referred to as TS-1) is no less superior to gemcitabine in the treatment of advanced pancreatic cancer. In addition, a number of current clinical studies have shown that targeted therapy combined with chemotherapy reflects therapeutic advantages in pancreatic cancer. Moreover, in vitro and in vivo experiments have also demonstrated that anlotinib can curb the proliferation of pancreatic cancer cells and induce their apoptosis. Here, we report for the first time that a patient with locally advanced pancreatic cancer achieved good efficacy after switching to TS-1 chemotherapy combined with anlotinib targeted therapy. Previously, the disease of the patient still rapidly progressed without control following the first switch to abraxane combined with gemcitabine chemotherapy (AG regimen) due to the progression after chemo-radiotherapy. In this case, the patient achieved progression-free survival (PFS) of over 14 months via the treatment with anlotinib targeted therapy combined with TS-1 chemotherapy and secondary radiotherapy (prior to secondary radiotherapy, the patient achieved a PFS of nearly 12 months via the treatment with oral anlotinib combined with TS-1). Up to now, the progress of the disease is ceased. The oral administration of targeted therapy and chemotherapy are still in progress and the general condition of the patient is good. This suggests that patients with advanced pancreatic cancer may benefit from treatment with the anlotinib targeted therapy combined with TS-1 chemotherapy.
Exceptional response to alectinib for duodenal carcinoma with ALK fusion: A case report and literature review
Authors: Yuri Isaka, Akinori Sasaki, Akira Saito, Yasuaki Motomura, Yayoi Ando, Yoshiaki Nakamura
Journal: Front Oncol (2023)
Keywords: eml4-alk rearrangement, alectinib, duodenal cancer, gastrointestinal cancer, next-generation sequencing
MeSH terms: Case Reports

Patients with advanced duodenal carcinoma usually have a poor prognosis due to limited effective chemotherapy options. The study for genotype-directed therapy in patients with duodenal carcinoma is progressing. However, no clinical data assessing the efficacy of molecularly targeted therapy are presently available. We report the case of a 64-year-old woman who was diagnosed with anaplastic lymphocyte kinase (ALK) fusion-positive advanced duodenal carcinoma. Echinoderm microtubule associated protein like-4 (EML4)-ALK rearrangement was detected by comprehensive genomic profiling after resistance to first-line chemotherapy. The patient received alectinib, an ALK inhibitor, with marked shrinkage in primary tumor and liver metastases. She is currently being treated with alectinib for 6 months or more. This is the first report of the efficacy of alectinib in a patient with duodenal carcinoma harboring ALK fusion. Additionally, this case report suggests that the practical use of next-generation sequencing may expand optimal treatment choices in rare solid tumors, including duodenal carcinoma.
Eculizumab in chemotherapy-induced thrombotic microangiopathy
Authors: Lena Schulte-Kemna, Barbara Reister, Lucas Bettac, Ulla Ludwig, Daniel Fürst, Joannis Mytilineos, Carsten Bergmann, Rene van Erp, Bernd Schröppel
Journal: Clin Nephrol Case Stud (2020)
Keywords: ahus, chemotherapy, complement, eculizumab, remission, thrombotic microangiopathy
MeSH terms: Case Reports

Thrombotic microangiopathy (TMA) is a rare but severe complication of tumors and their chemotherapeutic treatment. We report on two patients with chemotherapy-induced TMA who were successfully treated with a short course of the terminal complement inhibitor eculizumab. Both patients quickly achieved remission of microangiopathic hemolytic anemia and recovery of renal function. After withdrawal of eculizumab, remission was stable over an observation period of 47 months and 15 months, respectively. Our data show that eculizumab is effective in treating chemotherapy-induced TMA. Discontinuation of eculizumab is feasible once the complement-activating condition is controlled and the trigger is eliminated. Additional studies need to determine the optimal duration of complement-directed therapies and validate effective monitoring strategies after discontinuation of such therapy.
Case Report: Self-Administration of Omalizumab in an Adolescent With Severe Asthma During SARS-CoV-2 Infection
Authors: Erika Paladini, Mattia Giovannini, Simona Barni, Giulia Liccioli, Lucrezia Sarti, Elio Novembre, Francesca Mori
Journal: Front Pediatr (2021)
Keywords: covid-19, allergy, asthma, clinical practice, omalizumab, pediatrics
MeSH terms: Case Reports

Acute asthma remains one of the most frequent causes of children's access to healthcare. Asthma exacerbation is an essential defining characteristic of its severity, and respiratory infections entail increased risks of exacerbations with potential hospitalization. In the literature, contradictory findings have been reported about the risk and severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients affected by asthma, with several implications for its management. Anti-IgE monoclonal antibody therapy is meant for patients affected by severe persistent allergic asthma without adequate control with other treatments. Indeed, biological therapies, such as omalizumab, are used as add-on treatments (step 5 in the Global Initiative for Asthma report) for severe asthma with several benefits, including a reduction in the frequency of exacerbations. To the best of our knowledge, we hereby report the first case in which an adolescent with severe allergic asthma treated with omalizumab has switched to self-administration at home during SARS-CoV-2 infection. Based on our peculiar experience, physicians may consider switching to self-administration of omalizumab at home, even during the coronavirus disease 2019 pandemic. However, more extensive research data from future studies are needed to confirm these first findings.
Clinical outcomes and predictors of response to photodynamic therapy in symptomatic circumscribed choroidal hemangioma: A retrospective case series
Authors: Yeen-Fey Ho, Anne Chao, Kuan-Jen Chen, An-Ning Chao, Nan-Kai Wang, Laura Liu, Yen-Po Chen, Yih-Shiou Hwang, Wei-Chi Wu, Chi-Chun Lai, Tun-Lu Chen
Journal: PLoS One (2018)
MeSH terms: Choroid Neoplasms / drug therapy, Hemangioma / drug therapy, Research Support, Non-U.S. Gov't, Adult, Aged, Female, Humans, Male, Middle Aged, Photochemotherapy, Retrospective Studies, Treatment Outcome, Visual Acuity

Background:
To investigate the treatment outcomes and predictors of response to photodynamic therapy (PDT) in patients with symptomatic circumscribed hemangioma (CCH).
Methods:
This retrospective case series examined 20 patients with symptomatic CCH (10 submacular CCHs and10 juxtapapillary CCHs) who underwent standard PDT (wavelength: 662 nm; light dose: 50J/cm2; exposure time: 83 sec) with verteporfin (6mg/m2), either as monotherapy (n = 9) or in association with other treatments (n = 11), of which 7 received intravitreal injections (IVI) of anti-vascular endothelial growth factor (anti-VEGF). A post-PDT improvement of at least two lines in best-corrected visual acuity (BCVA) was the primary outcome measure. Predictors of response were investigated with binary logistic regression analysis.
Results:
Seventeen (85%) patients received one PDT session, and three patients (15%) underwent PDT at least twice. Ten patients (50%) achieved the primary outcome of a post-PDT BCVA improvement of at least two lines. Macular atrophy and recalcitrant cystoid macular edema in 2 patients. Binary logistic regression analysis revealed that younger age (< 50 years) (P = 0.033), pre-PDT BCVA of ≧20/200 (P = 0.013), exudative retinal detachment resolved within one month after PDT (P = 0.007), and a thinner post-PDT tumor thickness (P = 0.015) were associated with the achievement of a post-PDT BCVA improvement. Additional treatments to PDT including IVI anti-VEGF did not appear to improve visual and anatomical outcomes.
Conclusions:
Symptomatic CCHs respond generally well to PDT. Patients with younger age (< 50 years), pretreatment BCVA≥ 20/200, and thinner foveal edema are most likely to benefit from this approach.
Right Coronary Artery to Coronary Sinus Fistula Post Endomyocardial Biopsy: A Case Report of a Rare Complication
Authors: Aniket S Rali, Farhad Sami, Andrew Sauer, Zubair Shah
Journal: Case Rep Cardiol (2020)
MeSH terms: Case Reports

Endomyocardial biopsy (EMB) continues to remain the gold standard for surveillance of rejection post orthotropic heart transplantation (OHT). It can be performed under fluoroscopic or echocardiographic guidance. In the hands of an experienced operator, the complications of EMB are uncommon with <1% chance of any serious acute complications. Most common complications of EMB include access site-related complications, namely, venous thrombosis, carotid cannulation, hematoma, air embolism, and pneumothorax. We present a case of a rare complication of EMB in a patient with OHT causing a coronary sinus to right coronary artery (RCA) fistula.
A Case of Surgery Cancellation Following the Discovery of Anisocoria After Induction of General Anesthesia
Authors: Erika Harada, Aiji Sato-Boku, Mayuko Kanazawa, Naoko Tachi, Masahiro Okuda
Journal: Cureus (2023)
Keywords: adie’s pupil, anisocoria, cerebrovascular disorder, general anesthesia, pupillotonia
MeSH terms: Case Reports

Anisocoria after induction of general anesthesia may indicate a severe cerebrovascular disorder. We encountered a case in which anisocoria in the left and right eyes was noticed after induction of general anesthesia, and the surgery was canceled. The patient was a 53-year-old woman with a history of hypertension. She received general anesthesia 10 years ago, but the details were unknown. Anesthesia was induced with propofol, remifentanil, and rocuronium, followed by nasal intubation. No significant change was observed in vital signs during the induction of anesthesia. After intubation, the pupils were checked according to the protocol for observing pupil diameter. The pupil size was found to be unequal, measuring 1 mm in the left eye and 4 mm in the right eye. A cerebrovascular disorder was suspected; thus, the surgery was canceled, and the patient was awakened and extubated. Neurological symptoms such as limb movements were checked after awakening, and no disorientation or motor dysfunction was detected in the patient. However, her pupils remained unequal, measuring 2 mm in the left eye and 4 mm in the right eye. Regarding light reflex, the left eye was miotic, but the right eye remained mydriatic. The pupillary symptom persisted even during discharge the next day. Since our hospital is a solely dental hospital, following discharge, after consulting the ophthalmology department of a nearby medical university hospital, the patient was diagnosed with pupillotonia, as she had been experiencing light dazzling in only her right eye for seven years, had no light reflex but near reflex, and was miotic due to the use of pilocarpine hydrochloride eye drops, which promotes miosis. The patient has had these symptoms in the right eye for seven years, and it is possible that she had anisocoria during the preoperative examination at this time. If anisocoria had been detected and examined carefully during the preoperative examination, there would have been no need to cancel the surgery. In this case, we strongly felt that the pupils must be checked during the preoperative examination.
Myelodysplastic Syndrome/Acute Myeloid Leukemia Arising in Idiopathic Erythrocytosis
Authors: Stephen E Langabeer, Eibhlin Conneally, Catherine M Flynn
Journal: Case Rep Hematol (2018)
MeSH terms: Case Reports

The term "idiopathic erythrocytosis (IE)" is applied to those cases where a causal clinical or pathological event cannot be elucidated and likely reflects a spectrum of underlying medical and molecular abnormalities. The clinical course of a patient with IE is described manifesting as a persistent erythrocytosis with a low serum erythropoietin level, mild eosinophilia, and with evidence of a thrombotic event. The patient subsequently developed a myelodysplasic syndrome (MDS) and acute myeloid leukemia (AML), an event not observed in erythrocytosis patients other than those with polycythemia vera (PV). Application of a next-generation sequencing (NGS) approach targeted for myeloid malignancies confirmed wild-type JAK2 exons 12-15 and identified a common SH2B3 W262R single-nucleotide polymorphism associated with the development of hematological features of myeloproliferative neoplasms (MPNs). Further NGS analysis detected a CBL L380P mutated clone expanding in parallel with the development of MDS and subsequent AML. Despite the absence of JAK2, MPL exon 10, or CALR exon 9 mutations, a similarity with the disease course of PV/MPN was evident. A clonal link between the erythrocytosis and AML could be neither confirmed nor excluded. Future molecular identification of the mechanisms underlying IE is likely to provide a more refined therapeutic approach.
Atypical primary pulmonary meningioma: a report of a case suspected of being a lung metastasis
Authors: Daniela Lepanto, Fausto Maffini, Francesco Petrella, Marzia Colandrea, Carlo Putzu, Massimo Barberis, Giovanni Paganelli, Giuseppe Viale
Journal: Ecancermedicalscience (2014)
Keywords: atypical meningioma, lung metastasis, meningioma
MeSH terms: Case Reports

Primary extracranial and extraspinal meningiomas are very rare tumours, and primary pulmonary ones are even more uncommon. They present as a solitary pulmonary nodule, and most of them are benign, except for three cases. We describe a primitive atypical pulmonary meningioma first suspected of being a metastasis in a patient during follow-up ten years after therapy for breast cancer.
Investigation into psychological contract in ethically disciplined group: a case study of academics in Chinese higher education
Authors: Yao Fu, Yuan Xu
Journal: Front Psychol (2023)
Keywords: ethical framework, ethically disciplined occupational group, job performance, organizational psychology, professional ethics, psychological contract

Ethical values and beliefs are increasingly realized as important factors in the operation of psychological contract for their potential role in determining individuals' attitudes toward employment relationships by valuing mutual exchange. However, to incorporate ethical terms into psychological contract analysis is challenging because they are often confused with relational contract, and ethics of professions can be difficult to summarize and interpret. This study has demonstrated how psychological contract operates within academics in Chinese higher education, an occupational group that is typically considered ethically disciplined and culturally bonded to their identity. Here, we designed a questionnaire survey focusing on transactional/relational psychological contract, ethical framework, and job performance, and statistically analyzed the responses to this survey from 230 Chinese higher education academics. It finds that the sample population perceived psychology contact with a relatively low contribution from monetary terms, while a strong correlation was observed between ethics and relational terms. In addition, the influence of emotional and ethical terms on job performance was clearly differentiated in statistics. From analyzing through a mediation model, it suggested an intermediated role of ethics between psychological contract and job performance. Findings in this study have demonstrated that ethically disciplined groups exhibit unique features in both their perceptions of psychological contract and their correlation with ethics and job performance, which is anomalous in other occupations. This study provides a protocol demonstrating the role of ethical framework in the operation of psychological contract, particularly within occupational groups bonded strongly to their identity/profession and constrained by ethics imposed by the society.