OpenMed/multicare-articles huggingface dataset:
Case report: Daratumumab for treatment of refractory late or chronic active antibody-mediated rejection in renal allograft recipients with high levels of de novo donor-specific antibodies
Authors: Lan Zhu, Zhiliang Guo, Daqiang Zhao, Rula Sa, Guangyuan Zhao, Hui Guo, Gang Chen
Journal: Front Immunol (2023)
Keywords: hla-dq, case report, chronic active antibody-mediated rejection, daratumumab, donor specific antibodies, kidney transplantation
MeSH terms: Kidney Transplantation / adverse effects, Case Reports, Research Support, Non-U.S. Gov't, Allografts, Antibodies, Monoclonal / therapeutic use, Graft Rejection, Humans, Immunoglobulins, Intravenous, Isoantibodies, Kidney / physiology, daratumumab, Immunoglobulins, Intravenous, Isoantibodies, Antibodies, Monoclonal

Background:
Late or chronic active antibody-mediated rejection (AMR) associated with de novo donor-specific antibodies (dnDSA) after renal transplantation is a great clinical challenge because it is often resistant to conventional therapies. Daratumumab, an anti-CD38 monoclonal antibody that can deplete plasma cells, may be effective for the treatment of late or chronic active AMR.
Methods:
We designed a novel regimen that included early intensive therapy with daratumumab plus plasmapheresis (PP)/intravenous immunoglobulins (IVIG) and later maintenance therapy with daratumumab alone, and used this regimen to treat late or chronic active AMR in two kidney transplant recipients with extremely high levels of anti-DQ7 dnDSA.
Results:
Both patients had a limited clinical response to the early treatment with rituximab and PP/IVIG (with or without splenic irradiation); however, they had a remarkable decrease in anti-DQ7 DSA (MFI value from ~20,000 to ~5,000) after 2-3 months of intensive therapy with daratumumab plus PP/IVIG. Over 20 months of follow-up, patient 1 maintained a low DSA (as low as 1,572) and normal renal function on daratumumab maintenance therapy. Patient 2 retained a low DSA and improved renal function and pathological lesions within one year after treatment but then deteriorated because of acute T cell-mediated rejection.
Conclusions:
Our daratumumab-based regimen has shown promising results in the treatment of refractory late active or chronic active AMR in renal transplant recipients with high-level dnDSA. This may provide a reference for better use of daratumumab in the treatment of late or chronic active AMR.
Incidental Finding of Nocardia: A Case Series from a Tertiary Care Centre in Uttarakhand
Authors: Aroop Mohanty, Suneeta Meena, Subodh Pandey Kumar, Puneet Kumar Gupta, Neelam Kaistha, Pratima Gupta, Mithilesh Kumar Jha, Sasi Rekha
Journal: Case Rep Infect Dis (2020)
MeSH terms: Case Reports

Nocardiosis is a rare bacterial infection that may lead to a severe disease. These infections are rare among normal population and are showing an increasing trend worldwide attributable to the increase in the immunosuppressed population. Most of these patients present with nonspecific clinical features such as fever, productive cough, and exertional dyspnoea as seen in our series of patients which makes it difficult to be diagnosed. Pulmonary nocardiosis is rarely clinically suspected and often diagnosed very late in the course of disease resulting in high mortality. A similar observation was made in one of our cases where the patient was being treated on the lines of pneumonia, and in the end she was diagnosed with pulmonary nocardiosis. In view of the limited literature available, we report here a case series of pulmonary nocardiosis in immunosuppressed patients diagnosed incidentally by fungal KOH mount. The most common conditions causing immunosuppression were type II DM, COPD, and pulmonary tuberculosis.
Nontyphoidal Salmonella Gastroenteritis in a Tertiary Children's Hospital in Southern China: Characteristics and Dietary Considerations
Authors: Lu Ren, Min Yang, Lanlan Geng, Peiyu Chen, Huan Chen, Sitang Gong, Ding-You Li
Journal: Gastroenterol Res Pract (2018)

Background:
Nontyphoidal Salmonella infection is a common cause for acute bacterial gastroenteritis in children in China. There have been no reports of the prevalence of lactose intolerance or food allergies in children with nontyphoidal Salmonella infection. The aim of this study was to characterize nontyphoidal Salmonella gastroenteritis in a tertiary children's hospital and evaluate clinical presentation, lactose intolerance, and food allergies in children with prolonged nontyphoidal Salmonella gastroenteritis.
Methods:
A retrospective case-series analysis was carried out in a tertiary children's hospital in Guangzhou, China. We included all infants and children who were diagnosed with nontyphoidal Salmonella gastroenteritis between 1 January 2014 and 31 December 2016. Patients' clinical features, feeding patterns, laboratory tests, and treatment outcomes were reviewed.
Results:
A total of 142 infants and children were diagnosed with nontyphoidal Salmonella gastroenteritis. 52.1% of cases occurred in infants ≤ 12 months of age and the majority (89.4%) in children younger than 3 years old. The most common symptoms were diarrhea (100%), fever (62%), and vomiting (18.3%). Salmonella Typhimurium was the predominant serotype, accounting for 82.4%. 91.5% of patients were treated with antibiotics. Forty-one (28.9%) and 9 (6.3%) children improved with a lactose-free diet and hypoallergenic formula, respectively, when diarrhea persisted for more than a week.
Conclusions:

Salmonella Typhimurium was the predominant serotype. Most patients with nontyphoidal Salmonella gastroenteritis were younger than 3 years old. Lactose intolerance occurred frequently in children with nontyphoidal Salmonella gastroenteritis and dietary modification should be considered when diarrhea is persistent and prolonged.
Case report: Patiromer-induced hypercalcemia
Authors: Michael R Wiederkehr, Ankit N Mehta, Michael Emmett
Journal: Clin Nephrol Case Stud (2019)
Keywords: hypercalcemia, hyperkalemia, patiromer, potassium binding agents
MeSH terms: Case Reports

Patiromer is a novel potassium-binding compound which has recently received FDA approval. This ion exchange resin releases calcium when it binds potassium. We describe the development of hypercalcemia after initiation of patiromer. The calcium levels fell when the drug was stopped but recurred when it was later resumed. Patiromer was again discontinued, and the serum calcium level fell back into the normal range. We believe this patient manifested patiromer-induced hypercalcemia.
A novel pathogenic DNA variation in the OCRL1 gene in Lowe syndrome
Authors: Enver Şimşek, Tülay Şimşek, Yıldız Dallar, Önder Can, Patrick J Willems
Journal: J Clin Res Pediatr Endocrinol (2011)
Keywords: oculocerebrorenal syndrome, novel pathogenic dna variation
MeSH terms: DNA / genetics, Oculocerebrorenal Syndrome / genetics, Phosphoric Monoester Hydrolases / genetics, Point Mutation, Case Reports, Child, Preschool, Humans, Male, Oculocerebrorenal Syndrome / physiopathology, DNA, Phosphoric Monoester Hydrolases, OCRL protein, human

The oculocerebrorenal syndrome of Lowe (OCRL) is an X-linked disorder characterized by congenital cataracts, renal tubular dysfunction, cognitive problems and maladaptive behavior. The syndrome is caused by pathogenic DNA variations in the X-linked OCRL1 gene. A 24-month-old boy was referred to our hospital with delayed motor milestones, hypotonia, involuntary purposeless movements of hands and feet, congenital cataract, severe feeding difficulties, and failure to thrive. Physical examination at the age of 24 months revealed a body weight of 7350 g (-5.1 SDS). Length was 71 cm (-5.1 SDS) and head circumference 45 cm (-3.9 SDS). He had deep-set small eyes, frontal bossing, flat occiput, parietal prominence, bilateral congenital cataract, cryptorchid left testis, joint hypermobility, decreased muscle tone, and hyporeflexia. Biochemical analysis revealed the characteristic findings of renal Fanconi syndrome. Genetic analysis showed a novel pathogenic DNA variation (c.1528C>T) in exon 15 of the OCRL1 gene. Clinical findings and genetic analysis confirmed the diagnosis of OCRL syndrome.
Left upper lobectomy can be a risk factor for thrombosis in the pulmonary vein stump
Authors: Kazuto Ohtaka, Yasuhiro Hida, Kichizo Kaga, Yasuhiro Takahashi, Hiroshi Kawase, Satoshi Hayama, Tatsunosuke Ichimura, Naoto Senmaru, Naotake Honma, Yoshiro Matsui
Journal: J Cardiothorac Surg (2014)
MeSH terms: Pneumonectomy / adverse effects, Pulmonary Veins / surgery, Venous Thrombosis / etiology, Case Reports, Adult, Aged, Aged, 80 and over, Female, Follow-Up Studies, Humans, Male, Middle Aged, Postoperative Complications, Retrospective Studies, Risk Factors, Tomography, X-Ray Computed, Venous Thrombosis / diagnostic imaging

Background:
Thrombosis in the left upper pulmonary vein stump after left upper lobectomy is a very rare but important complication because it occurs in the systemic circulation system. We previously made the first ever report on the frequency and risk factors of thrombosis in the pulmonary vein stump after lobectomy. In this study, we conducted an investigation in a different hospital to determine whether this was a common complication.
Methods:
From 2008 to 2012, 151 patients who underwent lobectomy and following enhanced CT within 2 years after the operation were studied. Postoperative contrast-enhanced CT imaging was retrospectively checked.
Results:
We found thrombosis in the pulmonary vein stump in 5 of the 151 patients (3.3%). All 5 patients underwent left upper lobectomy (17.9% of the patients who underwent left upper lobectomy). These 5 patients did not have infarction of any vital organ. The thrombus was disappeared several months later on contrast-enhanced CT in 3 patients and followed in 2 patients. On univariate analysis, there was a significant difference only in the operative procedure (p<0.001).
Conclusions:
Thrombosis in the pulmonary vein stump occurred with high frequency in patients who underwent left upper lobectomy. Because the frequency of thrombosis in this study was the same as in our previous report, this might be a common complication.
Successful mechanical thrombectomy and stent exclusion of sacral chordoma tumor thrombus
Authors: Valeria Gioioso, David Duncan, Jeet Minocha, Jonas Redmond
Journal: Radiol Case Rep (2022)
Keywords: deep venous thrombosis, interventional radiology, mechanical thrombectomy, sacral chordoma, tumor thrombus, venous stenting
MeSH terms: Case Reports

A 77-year-old man with history of sacral chordoma and pulmonary embolism presented to the emergency room with a 1-day history of diffuse left flank and lower extremity swelling. The patient was found to have thrombus in the left common and external iliac veins. The patient was brought to Interventional Radiology for mechanical thrombectomy using the Inari ClotTriever and a sample of extracted thrombus was sent to pathology. Analysis on the sample was positive for sacral chordoma, consistent with tumor thrombus. The patient returned after 6 weeks with similar symptoms and repeat mechanical thrombectomy was performed with the Inari ClotTriever and stent placement through the left common and external iliac vein with an Ovation iX stent graft. The patient remained asymptomatic following the second procedure at repeat follow-up at 6 weeks.
Lymphangioma of the heart as a rare tumor: A case report
Authors: Nádia Junqueira, Ricardo Ferreira, João Gonçalves, Ângelo Nobre
Journal: Int J Surg Case Rep (2018)
Keywords: case report, heart tumour, lymphangiomas, rare tumour

Introduction:
Tumors of the heart are uncommon, and lymphangiomas are among the rarest of this group, with very few cases reported. These tumors consist of a benign slow-flow vascular malformation.
Presentation of case:
We report a case of a man diagnosed incidentally with a pericardial mass and our surgical approach for its treatment.
Discussion:
The pericardial mass of our case had no cleavage plane between the myocardium and the tumor. Because of this, rather than a total resection, with very high operative risk, a biopsy was preferred. The pathology specimen showed a benign tumor and the patient was referred to the cardiologist for regular follow-up.
Conclusion:
There is no specific investigation for diagnosing cardiac lymphangiomas, and though benign, they should be considered in the differential diagnosis of other malignant diseases of the mediastinum and definitive pathologic diagnosis is mandatory. Given the increased risk of uncontrolled bleeding related to percutaneous biopsy, the definite diagnosis is usually obtained with open surgical biopsy.
Experiences of families of adolescents with gender incongruence in the light of the Calgary Models for Families
Authors: Paula Fernanda Lopes, Luciana de Lione Melo, Circéa Amália Ribeiro, Vanessa Pellegrino Toledo
Journal: Rev Esc Enferm USP (2022)
MeSH terms: Family / psychology, Adolescent, Child, Humans, Infant, Newborn, Qualitative Research

Objective:
to know the experiences of family members of adolescents with gender incongruence.
Method:
this is a qualitative case study, supported by the Calgary Family Assessment and Intervention Models theoretical-methodological framework. Data collection took place through semi-structured interviews, participant observation in family groups and document analysis, with eight family members. Data analysis was performed following the precepts of content analysis.
Results:
with family assessment, two categories emerged: "Challenges in the face of gender transition", which highlighted the problems related to the expectations created at birth, new names, pronouns and gender fluidity and the fear of prejudice, and "Supporting aspects in the face of the possibility of gender transition", which revealed family support as a strong point.
Conclusion:
knowing the experiences allowed us to understand the challenges that family members face when facing physical and emotional aspects of their children's gender transition. It was noticed that the act of seeking help and offering support is important for a healthy transition. The findings provided a better understanding of family issues and provided suggestions on how nursing can develop care for this population.
Acute kidney injury in patients with paraquat intoxication; a case report and review of the literature
Authors: Afshin Safaei Asl, Peyman Dadashzadeh
Journal: J Renal Inj Prev (2016)
Keywords: acute kidney injury, paraquat, poisoning, suicide
MeSH terms: Case Reports

Paraquat and diquat are classified as bipyridyl compounds not only leads to acute organ damage, but also to a variety of complications. Patients with severe paraquat-induced poisoning may succumb to multiple organ failure involving the circulatory and respiratory systems. Deliberate self-poisoning with paraquat continues to be a major public health concern in many developing countries. At present there is no specific antidote to paraquat poisoning, hence the need to more focus on prevention and in cases of poisoning aggressive decontamination to prevent further absorption. This article presented a 12-year-old male with acute kidney injury following the ingestion of paraquat in suicidal attempt and serves to explore the complications associated with paraquat poisoning and current recommended treatment.
Miltefosine Rescue Treatment for Visceral Leishmaniasis Relapse Patient
Authors: Anup Bastola, Mitesh Shrestha, Bimal Sharma Chalise, Abhdesh Kumar Mishra, Lina Devkota
Journal: Case Rep Infect Dis (2019)
MeSH terms: Case Reports

We report the first case of miltefosine rescue treatment carried out for visceral leishmaniasis (VL) relapse patient. Despite undergoing treatment regimens of liposomal amphotericin B (LAMB) 5 mg/kg (standard: 10 mg/kg) daily for 3 days during the first episode followed by LAMB 5 mg/kg stat and paromomycin 15 mg/kg IM for 10 days against the second episode, the patient suffered from a third relapse and was eventually treated with miltefosine 50 mg BID directly observed treatment for 28 days. Prior to treatment, the patient had a history of intermittent fever and vague abdominal pain for one week and epistaxis for 4 days. He had massive splenomegaly, tested positive for the rK39 test, and showed LD bodies in bone marrow aspirate. The patient tested negative for malaria and HIV. Upon treatment completion with miltefosine, the patient had clinically improved and showed no LD bodies in bone marrow.
Severe colchicine poisoning treated successfully with kidney replacement therapy and plasmapheresis: a case report
Authors: D H Schaffer, D L Overbeek, T B Erickson, E W Boyer, C Goldfine, S A Muhsin, P R Chai
Journal: Toxicol Commun (2022)
Keywords: colchicine, case report, overdose, plasmapharesis

Colchicine is commonly prescribed for treatment of inflammatory conditions but has a narrow therapeutic window and dangerous toxicity profile. Here we describe a case of survival after massive unintentional colchicine overdose treated with plasmapheresis and renal replacement therapy. A 37 year old male with history of pericarditis presented to the Emergency Department with a chief complaint of nausea, vomiting, and diarrhea after unintentionally ingesting 36 mg of colchicine 17 h prior to arrival. An initial colchicine concentration resulted at 5.1 ng/mL (30 h post-ingestion) and peaked at 12 ng/mL (40 h post-ingestion). He was treated with continuous kidney replacement therapy (CKRT) beginning on his first day of hospitalization and with plasmapheresis on hospital days two through four. The patient's course was complicated by multiorgan failure including coagulopathy, respiratory failure, neuropathy, renal failure, pancytopenia, and heart failure. He was discharged to inpatient rehabilitation on hospital day 24. On clinical follow up four months after discharge the patient was found to have no significant persistent morbidity related to colchicine overdose.
FDG-PET Lacks Sufficient Sensitivity to Detect Myxoid Liposarcoma Spinal Metastases Detected by MRI
Authors: Joseph H Schwab, John H Healey
Journal: Sarcoma (2007)
MeSH terms: Case Reports

Purpose. To document a case of myxoid liposarcoma in which PET scan was less sensitive than MRI in detecting spinal metastasis. Materials and Methods. The case of a 65-year-old female with a history of myxoid liposarcoma (MLS) of the thigh resected 5 years previously and now presenting with low back pain is presented. Her medical oncologist ordered an FDG-PET scan to evaluate distant recurrence. Subsequently, an MRI of her spine was obtained by her surgeon. Results. The FDG-PET scan was obtained 1 week prior to the MRI, and it did not show increased glucose uptake in the spine. Her MRI did show increased signal intensity in her lumbar spine. CT needle biopsy confirmed the lesion to be metastatic MLS. Conclusion. FDG-PET scans are utilized to detect distant recurrence of cancerous lesions. Myxoid liposarcoma has a unique propensity to metastasize to the spine. Previous reports have documented the unreliability of bone scintigraphy to diagnose these metastases. Our report demonstrates that FDG-PET may also lack the sensitivity needed to detect these lesions. We advocate total spine MRI when screening for metastases in this population when they present with back pain.
Sudden Vision Loss Secondary to Optic Nerve Infiltration as a Presenting Symptom of Metastatic Lung Adenocarcinoma
Authors: M M Shamim, M Whaley, H Rana, S K Jeffus, S Bhatti, A B Sallam
Journal: Case Rep Ophthalmol Med (2022)
MeSH terms: Case Reports

Purpose:
To report a rare case of left-sided metastatic optic nerve infiltration and right-sided choroidal mass with exudative retinal detachment caused by EGFR exon 19 deletion positive non-small-cell lung adenocarcinoma that responded to targeted therapy with osimertinib (EGFR-TKI). Our patient demonstrated an excellent response with reduced size of the metastatic choroidal mass of the right orbit and improved visual acuity, in addition to systemic disease control.
Case:
A 66-year-old male patient with a history of diabetes mellitus, hypertension, and tobacco use presented with sudden vision loss in the left eye secondary to optic nerve infiltration and subacute vision loss in the right eye secondary to exudative retinal detachment from a choroidal metastasis. He was found to have a right lung mass, multiple metastatic pulmonary nodules, and liver and bone metastases. Biopsy from a mediastinal lymph node confirmed the diagnosis of metastatic lung adenocarcinoma. He was found to have exon 19 deletion on next-generation sequencing. We treated him with local radiation therapy to the left eye and systemic osimertinib (EGFR-TKI).
Conclusion:
To our knowledge, our case is the first report of a patient who initially presented with acute vision loss and was found to have metastatic retrobulbar optic nerve infiltration in one eye and metastatic choroidal lesion with exudative retinal detachment in the fellow eye secondary to lung adenocarcinoma. Due to the rarity of this condition, literature regarding effective treatment is scarce. Our patient demonstrated significant improvement in visual acuity and resolution of exudative retinal detachment in the right eye following osimertinib treatment and radiation therapy to the left eye. Further investigation into the role of tyrosine kinase inhibitors and radiation therapy in treating intraocular metastasis involving the optic nerve is needed.
Posaconazole-Induced Adrenal Insufficiency in a Case of Chronic Myelomonocytic Leukemia
Authors: Ann Miller, Lauren K Brooks, Silpa Poola-Kella, Rana Malek
Journal: Case Rep Endocrinol (2018)
MeSH terms: Case Reports

Introduction:
Posaconazole is an azole used in treatment and prophylaxis of a broad spectrum of fungal infections. Antifungals such as ketoconazole have been shown to cause primary adrenal insufficiency (AI) as a result of direct inhibition on the steroidogenesis pathway. There is only one reported case of primary AI induced by posaconazole in a patient with mucormycosis. We report a case of posaconazole-related primary AI.
Case:
A 63-year-old man with chronic myelomonocytic leukemia was admitted for fatigue and intermittent nausea and vomiting. He had recently discontinued prophylactic posaconazole 300 mg daily. He was assessed for AI with a morning cortisol of 1.9 mcg/dL followed by a failed cosyntropin stimulation (CS) test. Adrenocorticotropic hormone (ACTH) level was 154.6 pg/mL with negative 21-hydroxylase antibodies. The patient's symptoms improved with initiation of hydrocortisone and fludrocortisone. One year after discontinuation of posaconazole, he underwent a repeat CS test which showed normal adrenal function with normal ACTH at 34.1 pg/mL.
Conclusion:
In this case, we demonstrate that prolonged use of posaconazole is associated with primary AI. As use of posaconazole increases, knowledge of the potential risk of AI is important and must be included in the differential diagnosis when these patients present with hypotension, hypoglycemia, and failure to thrive.
Eyebrow tattoo-associated sarcoidosis: A case report
Authors: Shu Nie, Ke Li, Chuang Gao, Na Yin, Zile Chen, Zhouwei Wu
Journal: Front Med (Lausanne) (2022)
Keywords: eyebrow, granulomas, permanent makeup, sarcoidosis, tattoo
MeSH terms: Case Reports

Cutaneous sarcoidosis can manifest after doing a permanent makeup (PMU), such as tattooed eyebrows. A 41-year-old Chinese woman, with a tattoo in the eyebrows, developed yellow-brown plaques in her eyebrows for several months. A dermatopathological examination revealed non-caseating granulomas consistent with cutaneous sarcoidosis. For months, topical corticosteroids were applied, which showed little effect. Furthermore, a physical evaluation of the patient revealed no apparent involvement of other body organs except bilateral hilar lymphadenopathy with few diffuse reticulonodular opacities. On the basis of fully informed consent, the patient agreed to a 6-month initial follow-up to avoid unnecessary PMU.