OpenMed/multicare-articles huggingface dataset:
Pelvic actynomyces infection: report of two cases occurred in the Hospital of San José
Authors: Sergio Urbina, Hernando Ruiz, Sofia Parejas
Journal: Infect Dis Obstet Gynecol (2006)
MeSH terms: Actinomyces / isolation & purification, Actinomycosis / diagnosis, Intrauterine Devices / adverse effects, Pelvic Infection / diagnosis, Case Reports, Actinomyces / drug effects, Actinomycosis / drug therapy, Actinomycosis / microbiology, Actinomycosis / surgery, Adult, Anti-Bacterial Agents / administration & dosage, Anti-Bacterial Agents / therapeutic use, Colombia, Female, Hospitals, Urban, Humans, Pelvic Infection / drug therapy, Pelvic Infection / microbiology, Pelvic Infection / surgery, Penicillins / administration & dosage, Penicillins / therapeutic use, Anti-Bacterial Agents, Penicillins

The actynomyces infection is a rare cause of chronic pelvic inflammation, which can be manifested in multiple ways. It is caused by the actynomyces bacteria, usually by the israelii type, which can be a part of the normal flora of the genital tract in patients who use intrauterine device (IUD). There is a discussion about the importance of considering this infection disease as part of the differential diagnosis in patients using the IUD, with atypical manifestations and bizarre presentation of infections of the genital tract, severe pelvic adherent syndromes, tubo-ovarian complexes (abscesses) barely symptomatic, and in the case of intraoperatory suspicion of pelvic carcinomatosis among others.
The Training Effect of Early Intervention with a Hybrid Assistive Limb after Total Knee Arthroplasty
Authors: Takashi Fukaya, Hirotaka Mutsuzaki, Kenichi Yoshikawa, Ayumu Sano, Masafumi Mizukami, Masashi Yamazaki
Journal: Case Rep Orthop (2017)
MeSH terms: Case Reports

After total knee arthroplasty (TKA), it is important for patients to show early improvements in knee joint function and walking to regain independence in performing the activities of daily life. We conducted for 4 weeks an intervention one week after TKA using a hybrid assistive limb (HAL: unilateral leg type) as an exoskeleton robotic device to facilitate knee joint function and walking. The intervention improved the range of knee extension movement safely and without pain compared to preoperation. In addition, we found that training with the HAL improved walking ability, speed, and rate, as well as the time taken to perform the timed up and go (TUG) test compared to preoperation. The strength of the quadriceps muscle did not improve with training; however, the patient was able to induce a knee extensor moment during the initial stance phase, as measured by kinetics and kinematics, and these actions could be performed without pain. HAL training soon after TKA improved knee joint function in a 76-year-old patient who presented with OA of the knee. The improvements in knee extension lag and knee extensor moment allowed the patient to walk without pain and regain ADL in comparison with preoperation.
Index finger pointing posture in a patient with drug-induced foot tremor
Authors: Gohei Yamada, Takanari Toyoda, Eiichi Katada, Noriyuki Matsukawa
Journal: Clin Park Relat Disord (2021)
Keywords: drug-induced movement disorder, index finger pointing posture, paroxetine, serotonin toxicity, tramadol
MeSH terms: Case Reports

A 41-year-old woman who had been taking paroxetine began taking tramadol for bilateral ankle pain. A few days later, the patient presented acutely with both feet tremors. During a mental arithmetic task, index-finger pointing posture briefly appeared on the left side. Co-administration of paroxetine and tramadol increases the risk of serotonin toxicity. This is the first reported case of index-finger pointing posture which was associated with serotonin toxicity.
Bone Status in a Patient with Insulin-Like Growth Factor-1 Receptor Deletion Syndrome: Bone Quality and Structure Evaluation Using Dual-Energy X-Ray Absorptiometry, Peripheral Quantitative Computed Tomography, and Quantitative Ultrasonography
Authors: Paola Pelosi, Elisabetta Lapi, Loredana Cavalli, Alberto Verrotti, Marilena Pantaleo, Maurizio de Martino, Stefano Stagi
Journal: Front Endocrinol (Lausanne) (2017)
Keywords: bone metabolism, insulin-like growth factor-i, insulin-like growth factor-i receptor, peripheral quantitative computed tomography, quantitative ultrasonography
MeSH terms: Case Reports

Haploinsufficiency of the insulin-like growth factor (IGF)-1 receptor (IGF1R) gene is a rare, probably under-diagnosed, cause of short stature. However, the effects of IGF1R haploinsufficiency on glucose metabolism, bone status, and metabolism have rarely been investigated. We report the case of a patient referred to our center at the age of 18 months for short stature, failure to thrive, and Silver-Russell-like phenotype. Genetic analysis did not show hypomethylation of the 11p15.5 region or uniparental disomy of chromosome 7. Growth hormone (GH) stimulation tests revealed GH deficiency, whereas IGF-1 was 248 ng/mL. r-hGH treatment showed only a slight improvement (from -4.4 to -3.5 SDS). At 10 years of age, the child was re-evaluated: CGH-array identified a heterozygous de novo 4.92 Mb deletion in 15q26.2, including the IGF1R gene. Dual-energy X-ray absorptiometry showed a normal bone mineral density z-score, while peripheral quantitative computed tomography revealed reduced cortical and increased trabecular elements. A phalangeal bone quantitative ultrasonography showed significantly reduced amplitude-dependent speed of sound and bone transmission time values. The changes in bone architecture, quality, and metabolism in heterozygous IGF1R deletion patients, support the hypothesis that IGF-1 can be a key factor in bone modeling and accrual.
Osteopetrosis, hypophosphatemia, and phosphaturia in a young man: a case presentation and differential diagnosis
Authors: Zahi Mitri, Vin Tangpricha
Journal: Case Rep Endocrinol (2012)
MeSH terms: Case Reports

We report the case of a 30-year-old African-American male with osteopetrosis and hypophosphatemia, presenting with diffuse myalgias. Laboratory evaluation performed revealed a low serum phosphorus level with urinary phosphate wasting, low calcium, and 25-hydroxyvitamin D concentrations, as well as elevated alkaline phosphatase. Skull and pelvic radiographs revealed high bone density consistent with high bone mass found on bone mineral density reports. PHEX gene mutation analysis was negative. Patient was started on calcium and phosphorus replacement, and he clinically improved. This paper will review the different subtypes of osteopetrosis, and the evaluation of hypophosphatemia.
Identification of a novel de novo mutation associated with PRKAG2 cardiac syndrome and early onset of heart failure
Authors: Yang Liu, Rong Bai, Lin Wang, Cuntai Zhang, Ruifu Zhao, Deli Wan, Xinshan Chen, Gabriel Caceres, Daniel Barr, Hector Barajas-Martinez, Charles Antzelevitch, Dan Hu
Journal: PLoS One (2013)
MeSH terms: AMP-Activated Protein Kinases / genetics, Heart Failure / genetics, Hypertrophy, Left Ventricular / genetics, Mutation, Case Reports, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Adolescent, Adult, Age of Onset, Amino Acid Substitution, Case-Control Studies, Female, Heart Failure / enzymology, Heart Failure / etiology, Heart Failure / pathology, Humans, Hypertrophy, Left Ventricular / complications, Hypertrophy, Left Ventricular / enzymology, Hypertrophy, Left Ventricular / pathology, Male, Protein Conformation, Static Electricity, PRKAG2 protein, human, AMP-Activated Protein Kinases

Introduction:
The major structure elements of the AMP-activated protein kinase (AMPK) are α, β, and γ sunbunits. Mutations in γ2 subunit (PRKAG2) have been associated with a cardiac syndrome including inherited ventricular preexcitation, conduction disorder and hypertrophy mimicking hypertrophic cardiomyopathy. The aim of the present study was to identify PRKAG2 syndrome among patients presenting with left ventricular hypertrophy (LVH).
Methods and results:
Nineteen unrelated subjects with unexplained LVH were clinically and genetically evaluated. Among 4 patients with bradycardia, manifestations of preexcitation were only found in a 19 year old male who also developed congestive heart failure 3 years later. Electrophysiological study of this case identified the coexistence of an AV accessory pathway and AV conduction defect. Histological analysis of his ventricular tissue isolated by biopsy confirmed excessive glycogen accumulation, prominent myofibrillar disarray and interstitial fibrosis. Direct sequencing of his DNA revealed a heterozygous mutation in PRKAG2 consisting of an A-to-G transition at nucleotide 1453 (c.1453A>G), predicting a substitution of a glutamic acid for lysine at highly-conserved residue 485 (p.Lys485Glu, K485E), which was absent in his unaffected family members and in 215 healthy controls. To assess the role of K485 in the structure and function of the protein, computational modeling calculations and conservation analyses were performed. Electrostatic calculations indicate that K485 forms a salt bridge with the conserved D248 residue in the AMPK β subunit, which is critical for proper regulation of the enzyme, and the K485E mutant disrupts the connection.
Conclusions:
Our study identifies a novel de novo PRKAG2 mutation in a young, in which progression of the disease warrants close medical attention. It also underlines the importance of molecular screening of PRKAG2 gene in patients with unexplained LVH, ventricular preexcitation, conduction defect, and/or early onset of heart failure.
Case Report: Depression × dementia with Lewy bodies in the elderly: The importance of differential diagnosis
Authors: Alexandre M Valença, Cláudia Cristina Studart Leal, Gustavo C Oliveira, Talvane M de Moraes, Antonio E Nardi, Mauro V Mendlowicz
Journal: Front Psychiatry (2022)
Keywords: lewy bodies (lbd), dementia, depression, diagnosis, legal medicine assessment
MeSH terms: Case Reports

Background:
Dementia is a clinical syndrome which is more common in elderly people. Dementia with Lewy bodies (LBD) is not so rare in elderly people, with cognitive impairment in about 30% over age 65. The clinical picture is characterized by fluctuation in cognitive functions, recurrent, well-formed, detailed visual hallucinations, and Parkinsonism, with rigidity, tremor, bradykinesia, and slurred speech.
Case presentation:
We present a case report of LBD in a 73-year-old retired teacher, which a initial wrong diagnosis of refractory depression for at least 3 years. We also conduct a review of recent works on theme.
Conclusion:
LBD diagnosis can be neglected for years, with a legal and clinical issues to patients and their families. Detailed medical research, including differential diagnosis, are very necessary on those cases, specially when they are called refractory. We encourage new research and adequate clinical training to prevent damage.
A penetrating stab wound of the perianal area causing a combined rectal and bladder injury: one case report
Authors: Mohammed Fadl Tazi, Abdelhak Khallouk, Youness Ahallal, Omar Riyach, Jalal Eddine El Ammari, Mohammed Jamal El Fassi, Moulay Hassan Farih
Journal: Case Rep Urol (2012)

Although the management of either isolated rectal or bladder injury is no more controversial, their combined effect and their optimal management has been seldom reported in the English literature. From a case report of a 45-year-old male who was found to have a combined bladder and rectal injury secondary to a stab wound of the perianal area, the authors develop a diagnostic and therapeutic algorithm for the management of this uncommon trauma.
Successful use of extracorporeal membrane oxygenation in a human immunodeficiency virus infected patient with severe acute respiratory distress syndrome
Authors: Robertas Samalavicius, Mindaugas Serpytis, Donata Ringaitiene, Daiva Grazulyte, Ruta Bertasiute, Bernardas Rimkus, Raimonda Matulionyte, Ruta Ambrazaitiene, Jurate Sipylaite, Tomas Kacergius, Laimonas Griskevicius
Journal: AIDS Res Ther (2014)
Keywords: ards, hiv, vap, multidrug resistant bacteria, veno-venous ecmo

Introduction:
We report a case of an adult patient with human immunodeficiency virus (HIV), acute respiratory distress syndrome (ARDS) and ventilator associated pneumonia (VAP) caused by multidrug resistant (MDR) bacteria that was successfully managed with veno-venous extracorporeal membrane oxygenation (ECMO).
Case report:
A 25 year old male with no significant past medical history had been admitted to a local hospital due to dyspnea and fever. His pulmonary function subsequently failed necessitating mechanical ventilation (MV) and introduction of ECMO support. The patient was transported for 300 km by road on ECMO to a tertiary medical center. The diagnosis of ARDS, HIV infection and MDR bacterial and fungal VAP was made. Patient was successfully treated with antiretroviral therapy (ART), anti-infective agents and 58 days of veno-venous ECMO support, with complete resolution of the respiratory symptoms.
Conclusion:
HIV infected patients with ARDS and MDR bacterial VAP whose HIV replication is controlled by ART could be successfully managed with ECMO.
Myasthenia gravis in pregnancy: a case report
Authors: Sebastian Berlit, Benjamin Tuschy, Saskia Spaich, Marc Sütterlin, Regine Schaffelder
Journal: Case Rep Obstet Gynecol (2012)
MeSH terms: Case Reports

Objective. To present a case of maternal myasthenia gravis in pregnancy and give a systematic review of the literature. Case. We report the case of a 38-year-old parturient with a life-threatening complication of immune-mediated myasthenia gravis shortly after an elective cesarean section on patient's request under spinal anesthesia at 35 + 3 weeks of gestation. The newborn was transferred to the pediatric unit for surveillance and did not show any signs of muscular weakness in the course of time. The mother developed a respiratory insufficiency on the second day postpartum. The myasthenic crisis led to a progressive dyspnoea within minutes, which exacerbated in a secondary generalized seizure with cardiac-circulatory arrest. After successful cardiopulmonary resuscitation, the patient was transferred to intensive care. The interdisciplinary therapeutic approach included ventilatory assistance via endotracheal intubation, parenteral pyridostigmine, azathioprine, and steroids. By interdisciplinary measures, a stable state was regained. Conclusion. Myasthenia gravis especially when associated with pregnancy is a high-risk disease. As this disease predominantly occurs in women of reproductive age, it is important to be aware of this condition in obstetrics and its interdisciplinary diagnostic and therapeutic management.
Primary breast angiosarcoma: avoiding a common trap
Authors: Christine Desbiens, Jean-Charles Hogue, Yves Lévesque
Journal: Case Rep Oncol Med (2011)
MeSH terms: Case Reports

Background. Primary breast angiosarcoma is a rare entity. Case. Initial diagnosis was a benign hemangioma at core biopsy. Wide local excision was performed, with positive margins. Pathology after surgery reported a moderately differentiated angiosarcoma. Tumor was finally treated using mastectomy and radiations. She developed a second angiosarcoma in contralateral breast, with an initial diagnosis on core biopsy of an atypical vascular lesion and was again treated using mastectomy and radiations. She developed bones and lung metastases. Conclusion. Primary breast angiosarcoma is a rare entity often difficult to diagnose on core biopsy, and a benign differential diagnosis is frequent. A highly vascular breast mass should always be considered malignant until proven otherwise. Surgical treatment seems to be the best course of action. There is a lack of data proving efficacy of adjuvant chemotherapy and radiation therapy.
Median Arcuate Ligament Syndrome Revealed by Splenic Infarcts
Authors: Olaia Chalh, Nabil Moatassim Billah, Ittimad Nassar
Journal: J Belg Soc Radiol (2022)
Keywords: celiac artery compression, median arcuate ligament syndrome, splenic infarcts
MeSH terms: Case Reports

Teaching Points: Splenic infarction is an extremely rare presentation of median arcuate ligament syndrome that requires a good analysis of celiac axis on computed tomography angiography in other to make a proper diagnosis and management.
Septic Shock and Spontaneous Gangrenous Gas Necrosis of the Spleen Secondary to Clostridium perfringens: The Importance of Source Control
Authors: Morgan Oskutis, Matthew Reaven
Journal: Case Rep Crit Care (2021)
MeSH terms: Case Reports

Clostridium perfringens is a rare cause of septic shock, occurring most frequently in immunocompromised patients. An uncommon cause of Clostridium perfringen septicemia is spontaneous gangrenous gas necrosis of the spleen, where the primary treatment is splenectomy. We present a case of septic shock caused by spontaneous gangrenous gas necrosis of the spleen secondary to Clostridium perfringens in a patient whose profound pancytopenia made obtaining definitive source control extremely difficult.
Recovery of Dysphagia in lateral medullary stroke
Authors: Hitesh Gupta, Alakananda Banerjee
Journal: Case Rep Neurol Med (2014)

Lateral medullary stroke is typically associated with increased likelihood of occurrence of dysphagia and exhibits the most severe and persistent form. Worldwide little research exists on dysphagia in brainstem stroke. An estimated 15% of all patients admitted to stroke rehabilitation units experience a brainstem stroke out of which about 47% suffer from dysphagia. In India, a study showed that 22.3% of posterior circulation stroke patients develop dysphagia. Dearth of literature on dysphagia and its outcome in brainstem stroke particularly lateral medullary stroke motivated the author to present an actual case study of a patient who had dysphagia following a lateral medullary infarct. This paper documents the severity and management approach of dysphagia in brainstem stroke, with traditional dysphagia therapy and VitalStim therapy. Despite being diagnosed with a severe form of dysphagia followed by late treatment intervention, the patient had complete recovery of the swallowing function.
Splenic lymphangioma
Authors: Thiam Ousmane, Faye Papa Mamadou, Sarr Ibrahima Sitor, Niasse Abdou, Dieng Madieng
Journal: Int J Surg Case Rep (2019)
Keywords: lymphangioma, rare, splenic

Introduction:
Abdominal localization of cyst lymphangioma is rare. The splenic involvement is exceptional.
Case presentation:
A 63-year-old woman, who was followed for martial anemia evolving associated with abdominal pain in the past 12 months. On clinical examination, she had pallor conjunctival mucosa, with a normal abdominal and lymph node examination. The abdominal ultrasound showed multiple splenic cysts. The abdominal CT scan showed a normal-sized spleen with multiples hypodense cystic lesions. At the laparotomy exploration a multinodular spleen was found which measured 18 cm*15 cm*6 cm. The histological exam results showed concluded to a splenic cavernous lymphangioma without malignity signs. The follow-up after 12 months was normal.
Conclusion:
splenic lymphangioma is rare and benign tumor. Total splenectomy under laparotomy or laparoscopy is the appropriate treatment.
The "frosted liver" appearance in hepatic tuberculosis: a rare presentation
Authors: Neeraj Jain, Harmeet Kaur Rissam, Sunil Kumar Puri, Udit Chauhan
Journal: BJR Case Rep (2016)
MeSH terms: Case Reports

Tuberculosis is a major re-emerging global health concern. The disease may involve any body system and is a great mimicker of various pathologies owing to its non-specific imaging findings. Herein we report an extremely rare case of atypical tuberculosis of the liver in a young female with complaints of abdominal pain and haematemesis for 10 weeks. Isolated hepatic tuberculosis is a rare entity with < 100 cases reported in the literature. It is therefore important to have a high index of suspicion and be familiar with the atypical imaging findings of abdominal tuberculosis. This discussion highlights the clinical presentation, imaging findings and types of hepatic involvement in tuberculosis.
Treatment of Shiga-Toxin Hus with Severe Neurologic Features with Eculizumab
Authors: Jacob H Umscheid, Collin Nevil, Rhythm Vasudeva, Mohammed Farhan Ali, Nisha Agasthya
Journal: Case Rep Pediatr (2021)
MeSH terms: Case Reports

Hemolytic Uremic Syndrome (HUS) is a constellation of microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure. Shiga toxin-producing Escherichia coli- (STEC-) mediated HUS is a common cause of acute renal failure in children and can rarely result in severe neurological complications such as encephalopathy, seizures, cerebrovascular accidents, and coma. Current literature supports use of eculizumab, a monoclonal antibody that blocks complement activation, in atypical HUS (aHUS). However, those with neurologic complications from STEC-HUS have complement activation and deposition of aggregates in microvasculature and may be treated with eculizumab. In this case report, we describe a 3-year-old boy with diarrhea-positive STEC-HUS who developed severe neurologic involvement in addition to acute renal failure requiring renal replacement therapy. He was initiated on eculizumab therapy, with clinical improvement and organ recovery. This case highlights systemic complications of STEC-HUS in a pediatric patient. The current literature is limited but has suggested a role for complement mediation in cases with severe complications. We review the importance of early recognition of complications, use of eculizumab, and current data available.
Chronic Trichuris trichiura Infection Presenting as Ileocecal Valve Swelling Mimicking Malignancy
Authors: Sharifah Emilia Tuan Sharif, Ch'ng Ewe Seng, Nazri Mustaffa, Nurul Azira Mohd Shah, Zeehaida Mohamed
Journal: ISRN Gastroenterol (2011)
MeSH terms: Case Reports

A 46-year-old man presented with a history of passing bright red blood per rectum over the last one month. He also had on and off diarrhea with visible mucus in the stool for two months' duration. Further history was unremarkable, and physical examination revealed hemorrhoids which were subsequently banded. A colonoscopy was arranged in view of the prolonged diarrhea whereby an edematous and swollen ileocecal valve was seen. This was shown to be due to Trichuris trichiura infection, confirmed on histopathological examination of biopsies taken from the site. The patient was started on oral albendazole treatment and has been asymptomatic on latest followup. This case illustrates an accidental finding of T. trichuria infection on colonoscopic examination, which was done to investigate the patient's prolonged diarrhea.
Nizatidine Improves Impaired Salivary Secretion in GERD
Authors: Yoshihisa Urita, Toshiyasu Watanabe, Kazuo Hike, Makie Nanami, Tadashi Maeda, Yosuke Sasaki, Asuka Nakayama, Takamasa Ishii, Kaoru Domon, Susumu Ishihara, Masaki Sanaka, Hitoshi Nakajima, Motonobu Sugimoto
Journal: Clin Med Case Rep (2008)
Keywords: gerd, laryngeal discomfort, nizatidine, salivary scintigraphy
MeSH terms: Case Reports

During esophageal acid clearance, salivation plays an important role in defending the esophageal mucosa. Nizatidine, a histamine H2 receptor antagonist, inhibits acetylcholine esterase, with a resultant increase in acetylcholine. We experienced a patient with gastroesophageal reflux disease (GERD) and impaired salivary secretion who has been successfully treated with nizatidine.
Case report:
A 63-year-old female visited our hospital with complaints of heartburn and continuous laryngeal discomfort. Saliva scintigraphy was performed to evaluate the salivary function. Washout ratio was decreased to be 25%-40% in individual salivary gland. After the treatment with nizatidine, salivary scintigraphy demonstrated the increased washout ratios. The values of both parotid glands increased up to 90%, whereas those of submandibular glands improved to be around a normal range. GERD symptoms disappeared completely after treatment. In conclusion, nizatidine may be one of therapeutic options for low salivary excretion.