OpenMed/multicare-articles huggingface dataset:
Phosphaturic mesenchymal tumor with de novo liver metastases: a case report and literature review
Authors: Sami Dwabe, Warren Chow
Journal: Ther Adv Med Oncol (2024)
Keywords: fgf23, fn1-fgf1 fusion protein, osteomalacia, paraneoplastic syndrome, phosphaturic mesenchymal tumor, tumor induced
MeSH terms: Case Reports

Phosphaturic mesenchymal tumors (PMTs) are rare tumors that can cause tumor-induced osteomalacia (TIO) through overproduction of FGF23, a peptide hormone that causes renal phosphate wasting and reduced osteoblastic activity. The diagnosis of PMTs can be difficult to make as the presenting symptoms are non-specific. Although PMT is a rare entity, most cases are benign in nature, not requiring further intervention after surgery, as resection is typically curative. Here, we present a unique case of malignant PMT with de novo liver metastasis in a female patient who presented with TIO and underwent surgical resection of her primary lesion with subsequent regression of her liver metastasis. Moreover, we analyze a review of literature and discuss the importance of a timely diagnosis of this rare phenomenon. It is encouraged that providers strongly consider a diagnosis of PMT in patients with otherwise unexplained bone pain, fatigue, weakness, especially if accompanied with hypophosphatemia. Further studies are also warranted to identify prognostic factors that predict a PMT's malignant potential as they may help identify possible therapeutic targets.
Incorporating Stud Attachments in the Bar Design for an Implant-Supported Overdenture
Authors: Dimokritos Papalexopoulos, Christos Partalis, Panagiotis Lampropoulos, Ioli-Ioanna Artopoulou, Nikitas Sykaras
Journal: Case Rep Dent (2024)
MeSH terms: Case Reports

Bone resorption following tooth loss might compromise retention, stability, and support of conventional removable prostheses, and for this reason, implant-supported overdentures are suggested as a viable alternative for completely edentulous patients. Bars, telescopic attachments, or stud attachments have been used to provide retention through a different mechanism of action based on specific design characteristics. The purpose of this report is to thoroughly describe the applied protocol for the fabrication of an implant overdenture supported by two bars incorporating stud attachments. A 67-year-old male patient presented to the Postgraduate Clinic of the National and Kapodistrian University in Athens seeking dental rehabilitation. The remaining teeth were characterized with poor prognosis, mainly due to their periodontal status. The proposed treatment plan included the placement of four implants in the maxilla and two implants in the mandible and the fabrication of implant-supported overdentures. The diagnostic stages revealed adequate prosthetic space that would enable the fabrication of a bar substructure for the maxillary overdenture. To combine the benefits of bars and stud attachments, two bars with four attachments were fabricated. Evaluation of the delivered prosthesis revealed adequate retention, support, and stability achieved with minimal palatal coverage. Patient's reported satisfaction and quality of life were increased. Recall appointments at one, six, and twelve months did not reveal any adverse effects or patient's complaints. According to the present case report, different types of attachments may be used after careful study of each case. More studies are needed to report on different aspects of the chosen treatment plan.
Intestinal Fatty Acid Binding Protein as a Predictor of Early Mesenteric Injury Preceding Clinical Presentation: A Case Report
Authors: Annet A M Duivenvoorden, Flores M Metz, Robin Wijenbergh, Hanne C R Verberght, Annemarie A J H M van Bijnen, Steven W M Olde Damink, Robert H Geelkerken, Kaatje Lenaerts, Tim Lubbers
Journal: EJVES Vasc Forum (2024)
Keywords: aortic dissection, case report, diagnosis, intestinal fatty acid binding protein, non-occlusive mesenteric ischaemia
MeSH terms: Case Reports

Introduction:
Diagnosing non-occlusive mesenteric ischaemia (NOMI) in patients is complicated, due to poor signs and symptoms and non-specific laboratory tests, leading to a high mortality rate. This case study presents the rare case of a patient who developed mesenteric ischaemia after an emergency thoracic endovascular aneurysm repair (TEVAR) for a type B aortic dissection (TBAD) and peri-operative cardiogenic shock. Study outcomes revealed that intestinal fatty acid binding protein (I-FABP) identified early mucosal damage two days before the clinical presentation.
Report:
A 43 year old male patient was admitted to the emergency department with an acute TBAD and a dissection of the superior mesenteric artery (SMA), for which TEVAR was performed with additional stent placement in the SMA. Peri-operatively, the patient went into cardiogenic shock with a sustained period of hypotension. Post-operatively, the plasma I-FABP levels were measured prospectively, revealing an initial increase on post-operative day five (551.1 pg/mL), which continued beyond day six (610.3 pg/mL). On post-operative day seven, the patient developed a fever and demonstrated signs of peritonitis and bowel perforation. He underwent an emergency laparotomy, followed by an ileocaecal resection (<100 cm) with a transverse ileostomy. Pathological analysis confirmed the diagnosis of mesenteric ischaemia.
Discussion:
The diagnosis of NOMI in critically ill patients is often complicated, and the currently available diagnostic markers lack the specificity and sensitivity to detect early intestinal injury. This case report highlights that elevated I-FABP in plasma levels may indicate the presence of early mesenteric injury. Further research needs to be conducted before I-FABP can be applied in daily practice.
Accidental Cushing Syndrome
Authors: Konstantina Kousoula, Oskar Ragnarsson, Penelope Trimpou
Journal: JCEM Case Rep (2024)
Keywords: cushing syndrome, accidental intake, differential diagnosis, exogenous cushing syndrome
MeSH terms: Case Reports

We present a patient with Cushing syndrome secondary to accidental intake of corticosteroid tablets-a 66-year-old woman with a history of well-controlled hypertension, who over the course of a few weeks developed full-blown Cushing syndrome with uncontrolled blood pressure, typical central fat accumulation, and easy bruising. The clinical features further worsened upon increase of the dosage of her antihypertensive medication because of rising blood pressure. Biochemical analyses showed low cortisol and ACTH concentrations. Inspection of the patient's medications revealed that she had accidentally been taking corticosteroids tablets, prescribed for her husband, instead of antihypertensives, ie, dexamethasone 4 mg and then 8 mg, instead of candesartan at the same dose. This case highlights the necessity of a thorough review of the medications taken by patients suspected to have exogenous Cushing syndrome, including inspection of the original packaging, and not just relying on information from the patient and electronic health records. This case also highlights the need of special labeling on the packaging for the easy identification of corticosteroid-containing medications given their widespread availability.
Chemotherapy-induced zosteriform lichen planus following mastectomy: A rare case report
Authors: Zuha Shyma, Ankitha Adiga, Myfanwy Joanne D'Souza, Adarsh V V
Journal: Int J Surg Case Rep (2024)
Keywords: adverse drug reaction, blaschko's line, dermatology, koebner phenomenon
MeSH terms: Case Reports

Introduction:
Zosteriform Lichen Planus represents a relatively uncommon variant of LP. It is characterized by a distinctive distribution following Blaschko's line and involving multiple dermatomes, setting it apart as a unique manifestation. There have been several cases of cutaneous LP reported, but relatively few of them presented as zosteriform LP. To our knowledge, this is the first documented case of zosteriform LP as an adverse drug reaction.
Presentation of case:
A 62-year-old female presented to the dermatology clinic with asymptomatic hyperpigmented patches that exhibited gradual spreading. The patient had a history of breast cancer and underwent a mastectomy procedure, chemotherapy, adjuvant therapy, and radiation treatment. A dermatological examination revealed the presence of multiple hyperpigmented, ill-defined macules arranged linearly on the left flank and inner thigh.
Discussion:
A biopsy confirmed the diagnosis as Lichen Planus. The patient's condition significantly improved following a nine-week topical steroid with dose tapering.
Conclusion:
Zosteriform LP is a rare adverse skin reaction associated with chemotherapeutic drugs. The immunosuppression induced by chemotherapy may trigger T-cell activation, leading to a lichenoid tissue reaction. A thorough patient history assessment is essential for the management of such adverse reactions.
Successful Management of Spontaneous Unilateral Twin Ectopic Pregnancy With Two-Step Dose of Methotrexate
Authors: Lauren A Forbes, Navya Nuthivana, Renee Morales
Journal: Case Rep Obstet Gynecol (2024)
MeSH terms: Case Reports

The incidence of unilateral tubal twin pregnancy is 1/20,000-1/250,000 with about 100 reported cases. Four of the six cases that were medically managed were successful. A 24-year-old female presented to the emergency department (ED) with vaginal bleeding and abdominal cramping. She was hemodynamically stable without signs of an acute abdomen. Laboratory evaluation revealed she was pregnant with a serum beta-human chorionic gonadotropin (b-hCG) of 798 mIU/mL. Transvaginal ultrasound (TVUS) revealed a single left tubal pregnancy with a yolk sac. The patient elected medical management with body surface area (BSA)-based intramuscular (IM) methotrexate (MTX). On Day 4, the patient returned to the ED; her b-hCG was 727 mIU/mL. TVUS revealed twin left tubal pregnancies with yolk sacs and fetal poles without cardiac activity. The patient elected to continue medical management with a second dose of BSA-based IM MTX. On Day 6, the patient returned to the ED with abdominal and rectal pain. She was hemodynamically stable without signs of an acute abdomen. Her b-hCG was 533 mIU/mL. TVUS showed persistent twin left tubal pregnancies-one at 5 weeks gestational age and the other at 6 weeks gestational age-without evidence of rupture. The patient continued serial b-hCGs. Thirty-one days after the first dose of MTX, her b-hCG was < 1 mIU/mL. TVUS showed resolution of tubal pregnancies. The patient consented to the publication of this case report. This case documents the successful treatment of spontaneous, unilateral tubal twin pregnancies with two-step dosing of IM MTX.
Airway Management for Massive Anterior Mediastinal Tumor Resection in an Infant: A Strategy Involving Spontaneous Breathing-Preserving Endotracheal Intubation under Intravenous Anesthesia
Authors: Hiromi Matsuda, Ei Ito, Akiko Katsuike, Hirotsugu Okamoto
Journal: Case Rep Pediatr (2024)
MeSH terms: Case Reports

Tracheal intubation under sedation in uncooperative infants is challenging. The case of a 4-month-old infant with a massive anterior mediastinal tumor and upper respiratory tract symptoms, for whom effective preoxygenation was provided with a high-flow nasal cannula (HFNC), allowing for safe tracheal intubation in combination with a supraglottic device and local anesthetic, is reported. With careful planning of anesthesia and creative problem solving, airway management for anterior mediastinal tumors can be performed safely with the selection of an appropriate airway device. This may be a good airway management strategy for infants with mediastinal tumors or who may be expected to have ventilation difficulties.
Stafne's Bone Defect Correlated with Submandibular Glands: A Case Report and CBCT and MRI Analysis
Authors: Antoine Berberi
Journal: Case Rep Dent (2024)
MeSH terms: Case Reports

Stafne's bone defect is a developmental anatomic bone defect in the lingual side of the mandible in the area of the mandibular angle that is filled with proliferation or translocation of adjacent structures such as salivary gland tissue. The etiology is still undefined, and two hypotheses are proposed: one is the glandular related to the submandibular or sublingual glands and the second is ischemic that affects the vascularization of the mandibular lingual. Usually, Stafne's bone defect is accidentally detected on panoramic radiographs during dental treatments as a well-limited radiolucency image with a clear peripheral regular condensation border, located below the mandibular canal. The differential diagnosis includes traumatic bone cyst, odontogenic and nonodontogenic cystic lesions, nonossifying fibroma, focal osteoporotic bone marrow defect, and other lesions. A case of Stafne's bone defect on a 60-year-old male patient extending in the lingual posterior part of the mandibular region was presented. The panoramic radiograph revealed a well-limited radiolucency image with a clear peripheral regular condensation border, located below the mandibular canal. The lesion was discovered in a routine radiographic exam: the cone beam computed tomography gave us more details about the localization, the shape and size, and the relation with the mandibular canal, and the magnetic resonance imaging identifies the nature of the inside soft tissue. The final diagnosis was a Stafne's bone defect resulting of a depression of the lingual cortical plate filled with expansion of the submandibular gland.
Parasitic leiomyoma of the greater omentum: a case report and literature review
Authors: Zhiman Huang, Yongzhou Wang, Hongyan Lei
Journal: J Surg Case Rep (2024)
Keywords: fibroid, parasitic leiomyoma, the greater omentum
MeSH terms: Case Reports

Parasitic leiomyomas (PL), also known as free leiomyomas, which occur outside the uterus and rarely happen in clinical practice. They are usually reported in women of reproductive age who underwent hysterectomy or myomectomy and frequently present with symptoms such as abdominal pain and distention. In fact, it is hard to determine the nature of the mass according to the imaging examination and clinical manifestation. At present, the most common treatment involves an abdominal or laparoscopic surgery in order to remove the mass and perform the next step of treatment based on the histological diagnosis. In this case report, we describe a 35-year-old woman with a 12.4 × 9.3 × 9.8 cm3 PL with blood supply from the greater omentum. Considering the prolonged menstruation of the patient, she underwent the hysteroscopic and laparotomy exploration. The mass was confirmed as smooth leiomyoma with necrosis by the immunohistochemical examination. The patient had a good recovery and being discharged seven days after the surgery. The patient is still in the follow-up.
Pulmonary nocardiosis following COVID-19 in a patient with idiopathic pulmonary fibrosis and lung transplantation: a case report
Authors: Liming Cao, Yilan Sun, Fei Chen
Journal: Front Med (Lausanne) (2023)
Keywords: covid-19, idiopathic pulmonary fibrosis, immunosuppression, lung transplantation, pulmonary nocardiosis
MeSH terms: Case Reports

Background:
Nocardiosis is an opportunistic infection that primarily affects immunocompromised patients. Pulmonary nocardiosis is the most prevalent form, but can also spread to other organs. Potential causes contributing to opportunistic infection may include immunosuppression and disruption of tight junctions, both of which can result from COVID-19.
Case presentation:
We reported a case of a 68-year-old male patient who presented with a 10-day history of fever, cough, and productive sputum. Upon physical examination, velcro rales were detected in the right lung, while breath sounds in the left lung were clear. The patient had previously undergone left lung transplantation due to idiopathic pulmonary fibrosis four years ago. He was initially hospitalized and treated for COVID-19 but was readmitted due to worsening symptoms. Subsequently, pulmonary nocardiosis was diagnosed utilizing metagenomic next-generation sequencing of bronchoalveolar lavage fluid. The above-mentioned condition was improved following treatment with cancidas and linezolid. Now, he is under regular follow-up.
Conclusion:
This case highlights the complexity of COVID-19 and the occurrence of secondary opportunistic infections, which require further investigation.
The "appearing" and "disappearing" ascites in the treatment of colorectal cancer: a case report
Authors: Hong-Ming Cui, Xin-Peng Shu, Zheng-Qiang Wei, Xing-Ye Wu
Journal: Front Oncol (2024)
Keywords: ascites, case report, chemotherapy, colorectal cancer, oxaliplatin
MeSH terms: Case Reports

Background:
Colorectal cancer (CRC) is one of the most common cancers worldwide. In the treatment of patients with CRC, oxaliplatin plays a pivotal role, with moderate side effects. Neurotoxicity, myelosuppression, ototoxicity, delayed hypersensitivity reactions, and rhabdomyolysis induced by oxaliplatin have been reported individually. However, the occurrence of oxaliplatin-induced ascites has not been reported previously. The objectives of this case report were to elaborate on the rare occurrence of ascites in a patient with CRC after oxaliplatin therapy and to explore its characteristics and causes.
Case description:
We report on a case of upper rectal cancer seen in a 65-year-old man who underwent robotic-assisted laparoscopic anterior rectal resection. The patient developed ascites during postoperative adjuvant therapy with oxaliplatin and capecitabine. We ruled out tumor recurrence by laparoscopy, intraoperative biopsy, and biochemistry of the ascites. The patient did not experience a recurrence of ascites after discontinuation of chemotherapy.
Conclusion:
This case suggests that chemotherapy with oxaliplatin might cause ascites. The mechanism of the oxaliplatin-induced liver injury was further discussed, which might have been the cause of ascite formation. When patients with CRC who underwent chemotherapy with oxaliplatin develop ascites, surgeons should actively determine whether this is a side effect of chemotherapy or is due to tumor recurrence in order to avoid unnecessary surgery.
Pneumothorax, Pneumomediastinum, and Cervical and Facial Massive Emphysema Secondary to Colonoscopy: A Rare Complication of Colonoscopy
Authors: Ruben Daniel Perez Lopez, Julian Vargas Flores, Lenin de Jesus Orbe Garibay, Hugo Fernando Narvaez Gonzalez
Journal: Case Rep Gastrointest Med (2024)
MeSH terms: Case Reports

Background:
Colonoscopy is a resource used for the diagnosis, treatment, and monitoring of benign and malignant colorectal pathologies. The incidence of perforation is 0.03%-0.65% in diagnostic colonoscopy; however, the incidence can be up to 10 times higher in therapeutic interventions, such as polypectomies, increasing the risk of complications up to 0.07-2.1%. Materials and methods. Case report of a 71-year-old female who presents a rare complication due to a perforation in the sigmoid which developed pneumoperitoneum, pneumomediastinum, pneumothorax, and massive subcutaneous emphysema as a complication of a diagnostic colonoscopy where a biopsy of a friable lesion was performed.
Results:
A 71-year-old female that went to the emergency room due to acute generalized abdominal colic spasm pain with a duration of 7 hours, associated with significant abdominal distension, malaise, diaphoresis, progressive dyspnea, and massive subcutaneous emphysema that developed after performing panendoscopy and colonoscopy for diverticulosis follow-up. An abdominal CT scan with double contrast was performed, reporting suggestive data of hollow viscus perforation, pneumoperitoneum, pneumomediastinum, pneumothorax, and massive subcutaneous emphysema in the thorax, neck, and skull base. She underwent an exploratory laparotomy finding a perforation in the sigmoid for which sigmoidectomy was performed, and for the pneumothorax and pneumomediastinum, endopleural tubes were placed in both hemithoraxes. The massive subcutaneous emphysema subsided with observation and oxygen.
Conclusion:
A rare complication of the use of colonoscopy as a diagnostic and therapeutic method is presented. The purpose of presenting this case is for the doctor who performs these interventions to suspect this complication in a timely manner, not delaying the diagnosis and carrying out an urgent therapeutic approach as in this case with exploratory laparotomy, finding the perforation site and carrying out the corresponding surgical management. We demonstrated that massive subcutaneous emphysema can be managed with observation if there is no other alarm data evident that required another surgical approach.
Case report: Carnivore-ketogenic diet for the treatment of inflammatory bowel disease: a case series of 10 patients
Authors: Nicholas G Norwitz, Adrian Soto-Mota
Journal: Front Nutr (2024)
Keywords: crohn’s disease, carnivore diet, inflammatory bowel disease, ketogenic diet, ulcerative colitis
MeSH terms: Case Reports

Background:
Very-low-carbohydrate diets, including ketogenic and carnivore diets, are gaining popularity for the experimental treatment of a wide range of disorders, including inflammatory bowel disease (IBD).
Methods:
Participants were recruited through a social media survey. Final inclusion required a histologically confirmed diagnosis of ulcerative colitis (UC) or Crohn's disease that was responsive to treatment with a ketogenic or carnivore diet without medication or with successful medication cessation on the diet. Clinical improvement was measured with the Inflammatory Bowel Disease Questionnaire (IBDQ).
Results:
We report on 10 cases of IBD responsive to ketogenic, mostly carnivore, diets. Clinical presentations were diverse, including six cases of UC and four of Crohn's disease. Clinical improvements were universal, with clinical improvement scores ranging between 72 and 165 points on the IBDQ. Patients' diets comprised mostly meat, eggs, and animal fats. Patients report their diets are pleasurable, sustainable, and unequivocally enhance their quality of life.
Conclusion:
Ketogenic and carnivore diets hold promise for the treatment of IBD, including UC and Crohn's disease. These cases are consistent with clinical literature that shows an inverse association between intestinal ketone levels and IBD activity, as well as the therapeutic effects of low residue elimination diets on colonic microbiota metabolism.
A Case Report of Erythema Multiforme Secondary to Atorvastatin Use
Authors: Ann M Chacko, Giselle Carrero, Shweta Akhouri
Journal: Cureus (2024)
Keywords: cutaneous rash, erythema multiforme (em), erythema multiforme minor, medication side effects, statin induced, statin safety, statin side effects, targetoid lesion
MeSH terms: Case Reports

Erythema multiforme (EM) is a rare and typically self-limited mucocutaneous reaction known to present secondary to various triggers, with the most common being from an infectious etiology. Medications account for a small percentage of EM cases. Here, we report a case of a 55-year-old female who presented to her primary care physician with a circular rash on the palm of her right hand, which she noticed five days after being started on atorvastatin due to right branch retinal artery occlusion. The rash was identified as case of non-photoinduced EM associated with atorvastatin use presenting solely on the palmar aspect of the patient's hand and resolving four days after discontinuation of the medication. Current literature only describes photoinduced cases of EM secondary to statin use making this case unique, and it provides important insights about considering alternative lipid-lowering treatment options for patients with recurrent or persistent cases.