OpenMed/multicare-articles huggingface dataset:
Rapid onset avascular necrosis secondary to misuse of appetite stimulant
Authors: Hilary Stevenson, Salome Cockern, Elizabeth Secord
Journal: J Eat Disord (2019)
Keywords: antiretroviral, appetite stimulants, avascular necrosis, hiv, megestrol
MeSH terms: Case Reports

Background:
HIV patients often fear disclosure of their status and consequently are fearful that their appearance may lead people to believe they have HIV. Excessive attention to weight is one result.
Case presentation:
We present a case of bilateral avascular necrosis (AVN) of the femoral heads secondary to megestrol misuse. Multiple providers with non-communicating electronic medical records contributed to this event, especially in our patient who was a guarded historian. Because of altered body image and fear of HIV disclosure, our patient who was already prescribed an antiretroviral associated with decreased bone density, sought an appetite stimulant and used far more than the prescribed dose leading to rapid onset AVN.
Conclusions:
Use of appetite stimulants in HIV should be carefully monitored and utilized only when weight loss is excessive and documented, and steroid based appetite stimulants should be avoided.
Syphilitic orchitis mimicking a testicular tumor in a clinically occult HIV-infected young man: a case report with emphasis on a challenging pathological diagnosis
Authors: Chia-Ying Chu, Wei-Yu Chen, Shauh-Der Yeh, Huey-Min Yeh, Chia-Lang Fang
Journal: Diagn Pathol (2016)
MeSH terms: AIDS-Related Opportunistic Infections / pathology, Diagnostic Errors, HIV Infections / immunology, Immunocompromised Host, Orchitis / pathology, Syphilis / pathology, Testicular Neoplasms / pathology, Treponema pallidum / isolation & purification, Case Reports, AIDS-Related Opportunistic Infections / immunology, AIDS-Related Opportunistic Infections / microbiology, AIDS-Related Opportunistic Infections / surgery, Adult, Bacteriological Techniques, Diagnosis, Differential, HIV Infections / diagnosis, Humans, Immunohistochemistry, Male, Orchiectomy, Orchitis / immunology, Orchitis / microbiology, Orchitis / surgery, Predictive Value of Tests, Syphilis / immunology, Syphilis / microbiology, Syphilis / surgery, Tomography, X-Ray Computed, Syphilis, tertiary

Background:
Syphilitic orchitis is a rare manifestation of gumma in tertiary syphilis, microscopically typically characterized by multiple discrete granulomas with central necrosis and peripheral fibrosis. We report a case of syphilitic orchitis mimicking a testicular tumor with atypical histological features.
Case presentation:
A 33-year-old clinically occult HIV-infected man had a testicular tumor. A radical orchiectomy was performed, and a histological examination showed an acute and chronic interstitial inflammatory lesion as well as spindle cell proliferation, without typical gumma formation, necessitating the differential diagnosis having to be made from a panel of etiological factors. Syphilitic orchitis was confirmed by both an immunohistochemical study and PCR testing for the Treponema pallidum DNA polymerase I gene using paraffin-embedded tissues. However, serology tests, including both the Venereal Disease Research Laboratory (VDRL) test and Treponema pallidum partical agglutination (TTPA), demonstrated false-negative results.
Conclusion:
Syphilitic orchitis may present atypical and unusual histological features, and should be included in the differential diagnoses of nonspecific interstitial inflammatory lesions of the testes by pathologists, especially in immunocompromised patients.
A case of angiomyolipoma arising in the tongue
Authors: Shinya Yura, Shintaro Terahata, Shun Sugiguchi
Journal: Case Rep Pathol (2011)
MeSH terms: Case Reports

A 61-year-old woman was referred to our hospital with a mass in the left proglossis. The lesion was excised with a provisional diagnosis of hemangioma. The mass was well-demarcated and easily dissected with an ultrasonic surgical aspirator. The histopathologic diagnosis was angiomyolipoma arising in the tongue. There were no signs of recurrence at followup at 18 months.
Endemic gastrointestinal anthrax in 1960s Lebanon: clinical manifestations and surgical findings
Authors: Zeina A Kanafani, Antoine Ghossain, Ala I Sharara, Joseph M Hatem, Souha S Kanj
Journal: Emerg Infect Dis (2003)
MeSH terms: Anthrax / diagnosis, Anthrax / epidemiology, Gastrointestinal Diseases / epidemiology, Gastrointestinal Diseases / microbiology, Case Reports, Adolescent, Adult, Anthrax / drug therapy, Anthrax / surgery, Anti-Bacterial Agents / therapeutic use, Bacillus anthracis / isolation & purification, Child, Disease Outbreaks, Female, Gastrointestinal Diseases / drug therapy, Gastrointestinal Diseases / surgery, Humans, Intestines / microbiology, Intestines / pathology, Lebanon / epidemiology, Lymph Nodes / microbiology, Lymph Nodes / pathology, Male, Anti-Bacterial Agents

Anthrax is an ancient disease caused by the gram-positive Bacillus anthracis; recently, it has gained much attention because of its potential use in biologic warfare. Anthrax infection occurs in three forms: cutaneous, inhalational, and gastrointestinal. The last type results from ingestion of poorly cooked contaminated meat. Intestinal anthrax was widely known in Lebanon in the 1960s, when a series of >100 cases were observed in the Bekaa Valley. We describe some of these cases, introduce the concept of the surgical management of advanced intestinal anthrax, and describe some of the approaches for treatment.
Acute headache at emergency department: reversible cerebral vasoconstriction syndrome complicated by subarachnoid haemorrhage and cerebral infarction
Authors: M Yger, C Zavanone, L Abdennour, W Koubaa, F Clarençon, S Dupont, Y Samson
Journal: Case Rep Emerg Med (2015)

Introduction. Reversible cerebral vasoconstriction syndrome is becoming widely accepted as a rare cause of both ischemic and haemorrhagic stroke and should be evocated in case of thunderclap headaches associated with stroke. We present the case of a patient with ischemic stroke associated with cortical subarachnoid haemorrhage (cSAH) and reversible diffuse arteries narrowing, leading to the diagnosis of reversible vasoconstriction syndrome. Case Report. A 48-year-old woman came to the emergency department because of an unusual thunderclap headache. The computed tomography of the brain completed by CT-angiography was unremarkable. Eleven days later, she was readmitted because of a left hemianopsia. One day after her admission, she developed a sudden left hemiparesis. The brain MRI showed ischemic lesions in the right frontal and occipital lobe and diffuse cSAH. The angiography showed vasoconstriction of the right anterior cerebral artery and stenosis of both middle cerebral arteries. Nimodipine treatment was initiated and vasoconstriction completely regressed on day 16 after the first headache. Conclusion. Our case shows a severe reversible cerebral vasoconstriction syndrome where both haemorrhagic and ischemic complications were present at the same time. The history we reported shows that reversible cerebral vasoconstriction syndrome is still underrecognized, in particular in general emergency departments.
Massive Pulmonary Hemorrhage from Bronchial Varix
Authors: Michael Agustin, Scott Shay, Jose Gonzalez, Pei Liu, Nancy Lentz, Anna Shapiro, Nat Dumrongmongcolgul, Michael Torres, Vasin Jungtrakoolchai
Journal: Case Rep Pulmonol (2020)
MeSH terms: Case Reports

Bronchial varix is a rare pulmonary disorder which may lead to life-threatening hemorrhage. Diagnosis is difficult because of the subtle abnormalities on radiographic and bronchoscopic examination. We present a case of massive hemoptysis from a bleeding bronchial varix. In the absence of immediate complex endobronchial therapy in the island of Guam, this case was initially managed with nebulized and intravenous tranexamic acid. This was followed by endobronchial blockade of the bleeding airway with endobronchial epinephrine instillation. Selective bronchial artery embolization alleviated the acute-phase bleeding. Prone positioning was initiated due to severe hypoxia after blood clots compromised the patency of bilateral bronchial airways. Prone ventilation was employed for 17 hours for 2 consecutive days with intermittent bronchoscopic forceps extraction of airway blood clots while in the prone position. These maneuvers resulted to improved lung ventilation and oxygenation. The patient underwent bronchial sleeve resection surgery for definitive management.
A chromosome-level phased genome enabling allele-level studies in sweet orange: a case study on citrus Huanglongbing tolerance
Authors: Bo Wu, Qibin Yu, Zhanao Deng, Yongping Duan, Feng Luo, Frederick Gmitter Jr
Journal: Hortic Res (2022)

Sweet orange originated from the introgressive hybridizations of pummelo and mandarin resulting in a highly heterozygous genome. How alleles from the two species cooperate in shaping sweet orange phenotypes under distinct circumstances is unknown. Here, we assembled a chromosome-level phased diploid Valencia sweet orange (DVS) genome with over 99.999% base accuracy and 99.2% gene annotation BUSCO completeness. DVS enables allele-level studies for sweet orange and other hybrids between pummelo and mandarin. We first configured an allele-aware transcriptomic profiling pipeline and applied it to 740 sweet orange transcriptomes. On average, 32.5% of genes have a significantly biased allelic expression in the transcriptomes. Different cultivars, transgenic lineages, tissues, development stages, and disease status all impacted allelic expressions and resulted in diversified allelic expression patterns in sweet orange, but particularly citrus Huanglongbing (HLB) shifted the allelic expression of hundreds of genes in leaves and calyx abscission zones. In addition, we detected allelic structural mutations in an HLB-tolerant mutant (T19) and a more sensitive mutant (T78) through long-read sequencing. The irradiation-induced structural mutations mostly involved double-strand breaks, while most spontaneous structural mutations were transposon insertions. In the mutants, most genes with significant allelic expression ratio alterations (≥1.5-fold) were directly affected by those structural mutations. In T19, alleles located at a translocated segment terminal were upregulated, including CsDnaJ, CsHSP17.4B, and CsCEBPZ. Their upregulation is inferred to keep phloem protein homeostasis under the stress from HLB and enable subsequent stress responses observed in T19. DVS will advance allelic level studies in citrus.
Endoscopic endonasal resection via a transsphenoidal and transpterygoid approach for sphenoid ridge meningioma extending into the sphenoid sinus: A case report and literature review
Authors: Hidenori Yokoi, Satoru Kodama, Keisuke Maruyama, Masachika Fujiwara, Yoshiaki Shiokawa, Koichiro Saito
Journal: Int J Surg Case Rep (2019)
Keywords: sphenoidal ridge meningioma, staged approach

Introduction:
Large sphenoid ridge meningiomas are surgically challenging because of their extension to adjacent structures. Extracranial meningiomas are very rare; most are of the secondary type and have an intracranial origin. Improved surgical methods are required for treatment of this entity.
Presentation of case:
Here, we describe a case of a huge sphenoid ridge meningioma extending into the sphenoid sinus that was resected by staged transcranial and endoscopic endonasal resection via a transsphenoidal and transpterygoid approach. It was possible to excise the tumor from the sphenoid sinus in a minimally invasive manner via this approach.
Discussion and conclusion:
The transsphenoidal and transpterygoid approach was useful for providing a surgical field that allowed adequate visualization for removal of a sphenoid tumor that had expanded well into the lateral fossa of the sphenoid bone.
Uterine Necrosis after Uterine Artery Embolization for Symptomatic Fibroids
Authors: Steve Kyende Mutiso, Felix Mwembi Oindi, Nigel Hacking, Timona Obura
Journal: Case Rep Obstet Gynecol (2018)
MeSH terms: Case Reports

Introduction:
Uterine artery embolization (UAE) is a minimally invasive intervention that is used in the treatment of fibroids. UAE can lead to complications including postembolization syndrome, postprocedure pain, infection, endometrial atrophy leading to secondary amenorrhea, and uterine necrosis. Uterine necrosis after UAE is very rare and hence poses a clinical dilemma for any clinician in its identification and management. We document a case of uterine necrosis after UAE and conduct a literature review on its causation, clinical features, and management principles.
Case:
A patient presented one month after UAE with abdominal pain and abdominal vaginal discharge. Her work-up revealed features of possible uterine necrosis with sepsis and she was scheduled for a laparotomy and a subtotal hysterectomy was performed. She was subsequently managed with broad spectrum antibiotic and recovered well.
Conclusion:
Uterine necrosis after UAE is a rare occurrence and we hope the documentation of this case will add to the body of knowledge around it. Theories that explain its occurrence include the use of small particles at embolization, the use of Contour-SE a spherical poly-vinyl alcohol, and lack of collateral supply to the uterus. Its symptoms may be nonspecific but unremitting abdominal pain is invariably present. Finally although conservative management may be successful at times, surgical management with hysterectomy will be required in some cases. The prognosis is good after diagnosis and surgical management.
Perilymph Fistula as a Complication of Eustachian Tube Dilation and Tympanoplasty
Authors: R Kim, L U Scholtz, R Jadeed, C J Pfeiffer, H Sudhoff, I Todt
Journal: Case Rep Otolaryngol (2022)
MeSH terms: Case Reports

Eustachian tube dilation (ETD) is an established, minimally invasive therapeutic approach for chronic eustachian tube dysfunction. The complications associated with performing a ETD are rare. A 22-year-old female patient presented with chronic otitis media on the right side and chronic obstructive tube dilation disorder on both sides. A type I tympanoplasty was performed on the right side because of a tympanic membrane perforation after a ETD on both sides without apparent complications. On the 5th postoperative day, she presented with headache, dizziness and hearing loss on the right side. There was a decrease of hearing threshold on the right side in the pure-tone audiogram and vHIT, cVEMP, and SVV were irregular. The β-2-transferrin test was positive. Since a right-sided perilymph fistula was suspected, an emergency tympanotomy was performed with a round window membrane cover with fascia on the right side. Intraoperatively, a regular, intact ossicular chain was found with a slightly moist middle ear mucosa. The round window membrane was covered by the promontorial lip. Under these measures, the patient's dizziness regressed. The right ear pure-tone threshold vHIT, cVEMP, and SVV normalized.
The Utility of the Knotless Suture Fixation for Bilateral Second Toe Transplantation in Traumatic Multiple-Digit Amputation
Authors: Yasuhiro Yamamoto, Satoshi Ichihara, Akira Hara, Toshiya Kudo, Yuichiro Maruyama, Hajime Kajihara, Kazuo Kaneko
Journal: Case Rep Orthop (2018)
MeSH terms: Case Reports

Toe-to-hand transfer is a useful reconstruction method after finger amputation. We report a case of multiple-digit amputation, reconstructed with bilateral second-toe transfer. In this study, we used a knotless suture fixation system (ZipTight™; Arthrex Inc., FL, USA) which effectively closed the wound and reduce the amount of dead space. Both second-toe transplantations survived. The feet were asymptomatic with good cosmetic outcomes. Although the reconstructed digits had limited range of motion, the patient was able to return to work. Knotless suture fixation system may be one of the effective methods for closing the donor site wound in second-toe transplantations.
Psychological Aspects of Androgen Insensitivity Syndrome: Two Cases Illustrating Therapeutical Challenges
Authors: Filippa Pritsini, Georgios A Kanakis, Ioannis Kyrgios, Eleni P Kotanidou, Eleni Litou, Konstantina Mouzaki, Aggeliki Kleisarchaki, Dimitrios G Goulis, Assimina Galli-Tsinopoulou
Journal: Case Rep Endocrinol (2017)
MeSH terms: Case Reports

Androgen Insensitivity Syndrome (AIS) and its heterogeneous phenotypes comprise the pieces of a challenging clinical problem. The lack of standardized guidelines results in controversies regarding the proper diagnostic and therapeutic approach, including the time and type of intervention. Due to its variable phenotype, AIS is not diagnosed at the proper age that would allow optimal psychological and medical support to the patient. Therapeutic approaches are not established, mainly due to the rarity of the disease. In addition, various social and ethical consequences may emerge. The aim of this double case report is to outline the difficulties that may rise during diagnostic, therapeutic, and psychological approach of AIS, especially concerning the handling of the relatives' reaction.
Ulcerative colitis after SARS-CoV-2 infection
Authors: Sofia Kartsoli, Spyridon Vrakas, Dimitrios Kalomoiris, Kassiani Manoloudaki, Vasileios Xourgias
Journal: Autops Case Rep (2022)
Keywords: covid-19, sars-cov-2, ulcerative colitis
MeSH terms: Case Reports

Although severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) affects mainly the respiratory system, the gastrointestinal tract is also considered a site of viral activity. We hereby present the case of a 74-year-old male patient with the diagnosis of new-onset ulcerative colitis. One month earlier, the patient presented fever, running nose, and diarrhea and was tested positive for SARS-CoV-2. Studies with COVID-19 patients revealed significant changes in gut microbiota composition and alterations in immune responses that could lead to chronic inflammation and manifestations of inflammatory bowel disease. We review additional cases of ulcerative colitis presented after SARS-CoV-2 infection and summarize the possible mechanisms that underlie the gastrointestinal abnormalities in COVID-19 patients.
"The Immune Conundrum": Acquired Hemophilia A, Immune Thrombocytopenia, and Neutropenia in a Patient with Pancreatic Cancer
Authors: Praveen Ramakrishnan Geethakumari, Ashwin Sama, Jaime G Caro, Charles J Yeo, Srikanth Nagalla
Journal: Case Rep Pancreat Cancer (2016)
Keywords: acquired hemophilia a, immune thrombocytopenia, neutropenia, pancreatic cancer, paraneoplastic syndromes
MeSH terms: Case Reports

Background: Malignancy-associated bleeding can pose diagnostic dilemmas. We report a unique case of paraneoplastic acquired hemophilia A (AHA), immune thrombocytopenia (ITP), and immune neutropenia in a patient with pancreatic adenocarcinoma. Case Presentation: A 66-year-old male with newly diagnosed pancreatic cancer and normal preoperative hematological evaluation was taken to the operating room for pancreaticoduodenectomy. The operation was aborted due to empyema of the gall bladder, cholangitis, and local extent of disease. Postoperatively, the patient developed bleeding diatheses with mucocutaneous and intra-abdominal bleeding and a prolonged activated partial thromboplastin time. Evaluation revealed high-titer factor VIII inhibitor confirming AHA. Management with bypassing agents such as recombinant activated factor VII, factor VIII inhibitor bypassing activity, and immunosuppression with steroids, cyclophosphamide, and rituximab achieved remission in 2 months. ITP developed after achieving normal factor VIII levels, which was managed with intravenous immunoglobulin. Neutropenia was detected before initiation of chemotherapy and was managed with granulocyte-colony stimulating factor. Conclusion: These unique challenges posed by paraneoplastic hematological syndromes warrant the need for astute clinical judgment and multidisciplinary collaboration for effective management.
"At-Home" Photobiomodulation: A New Approach for Bell's Palsy Treatment
Authors: Carlo Fornaini, Zhao Meng, Elisabetta Merigo, Jean-Paul Rocca
Journal: Case Rep Neurol Med (2021)
MeSH terms: Case Reports

Objective:
This report is the first one to describe the possibility to use "self-administered" photobiomodulation (PBM) for Bell's palsy (BP) treatment.
Background:
BP is a peripheral disorder of the facial nerve causing sudden paralysis of unilateral facial muscles, and PBM has been successfully suggested for its treatment without any side effect. This is the first case report where a laser device was successfully used at home by the patient herself to treat BP opening new perspectives on the therapy of this disease.
Methods:
This report describes the "at-home PBM" treatment performed on a 15-year-old girl who presented BP consisting of acute pain on the right side of her face, difficulty in biting and dripping saliva from the right side of her lips. The treatment was performed twice a day by cutaneous applications, each of 15 minutes (total fluence 48 J/cm2) in an area corresponding to the parotid gland by a device emitting at 808 nm at 250 mW output power.
Results:
Two weeks after PBM treatment, performed at home twice a day by the patient herself without any kind of pharmacological therapy, the complete disappearing of the disease was noticed with no side effects.
Conclusion:
With the limitations due to a single case report and with the need of further clinical trials to confirm it, "at-home PBM" seems to represent a good and safe approach to the treatment of BP.
The Dilemma Behind Negative Troponin: A Case Report
Authors: Nava R Sharma, Bharosa Sharma, Madalasa Pokhrel, Sudarshan Gautam, Saral Lamichhane
Journal: Cureus (2023)
Keywords: acute coronary syndrome (acs) and stemi, cardiac troponin, false negative troponin, st-elevation myocardial infarction (stemi), ventricular thrombus
MeSH terms: Case Reports

Acute coronary syndrome remains the primary cause of mortality and morbidity in the United States. Cardiac ischemia is a consequence of an imbalance between oxygen demand and supply. The sensitivity of troponin is above 99% in diagnosing cardiac injury; rare exceptions can occur, however. We present a case of acute coronary syndrome with a negative troponin level, even on repeated testing using different methods at two different centers.
Palpable purpura with an unexpected outcome
Authors: Anne Friesgaard Christensen, Ole Clemmensen, Peter Junker
Journal: Case Rep Rheumatol (2013)

Scurvy is a potentially lethal condition caused by inadequate vitamin C intake. Hypovitaminosis of vitamin C causes vessel fragility and follicular hyperkeratosis that can lead to palpable purpuric skin lesions. In this case report, we aim to remind readers that scurvy still occurs in Western countries and that the clinical presentation may resemble vasculitis.
A Case of HELLP Syndrome in a Patient with Immune Thrombocytopenic Purpura
Authors: Sebastián Ben, Fabián Rodríguez, Carlos Severo, Natalia Debat
Journal: Obstet Gynecol Int (2010)
MeSH terms: Case Reports

We will describe the clinical case of a pregnant patient with chronic Immune Thrombocytopenic Purpura who develops preeclampsia syndrome with HELLP syndrome. These concomitant and independent conditions become complex, resulting in thrombocytopenia which creates diagnostic, prognostic and therapeutic inconveniences.