OpenMed/multicare-articles huggingface dataset:
A Case of Adult-Onset Still's Disease With Hypocomplementemia
Authors: Yoichi Kurosawa, Sayuri Takamura, Ayako Wakamatsu, Daisuke Kobayashi, Ichiei Narita
Journal: Cureus (2024)
Keywords: adult-onset still’s disease, cytokine storm, ferritin, hyperferritinemic syndrome, hypocomplementemia
MeSH terms: Case Reports

Adult-onset Still's disease (AOSD) causes fever, rash, pharyngalgia, and arthralgia through autoinflammation. Its complement titer has not previously received attention because this usually increases during the inflammatory process. Our female patient in her 60s was admitted to the hospital with fever, rash, arthralgia, and pharyngalgia. Her white blood cell count was 19,130/μL, hemoglobin was 11.0 g/dL, platelet count was 26.0 × 104/μL, and ferritin titer was 6,175 ng/mL. Anti-nuclear antibodies and anti-neutrophil cytoplasmic antibodies were negative. The presence of infectious diseases and malignancies was excluded. She was diagnosed with hypocomplementemia at the onset of AOSD because of her low complement component 4 (C4) titer (<5.0 mg/dL). Her complement component 3 (C3) titer was 104.5 mg/dL, which was within normal limits. There was no sign of thrombotic microangiopathy (TMA) or hemophagocytosis. She was treated with high-dose corticosteroids, including pulse methylprednisolone therapy, cyclosporine, methotrexate, and intravenous immunoglobulin, but was resistant to these, and her disease repeatedly flared up. Treatment with intravenous cyclophosphamide eventually led to remission. Post-treatment, her C4 titer increased to within the normal range. Although hypocomplementemia with TMA or hemophagocytosis has been reported in AOSD patients, our patient showed no sign of either at disease onset. Hypocomplementemia of AOSD may be a sign of high disease activity and could be a predictive marker for resistance to standard therapy.
Case report: Response to everolimus in a patient with platinum resistant, high grade serous ovarian carcinoma with biallelic TSC2 inactivation
Authors: Mariko Peterson, David L Kolin, Panagiotis A Konstantinopoulos
Journal: Front Oncol (2024)
Keywords: tsc1 and tsc2 mutations, everolimus, letrozole, mtor inhibitor, platinum resistant ovarian cancer
MeSH terms: Case Reports

Background:
Patients with platinum-resistant recurrent high grade serous ovarian carcinoma have poor outcomes and limited treatment options.
Case presentation:
We present a case of a 48-year-old woman with platinum-resistant high grade serous ovarian carcinoma harboring the pathogenic TSC2 R611Q variant with concomitant single copy loss of TSC2 (suggesting biallelic TSC2 inactivation) identified in targeted tumor sequencing. The patient was treated with the mTOR inhibitor everolimus, with an excellent response by imaging and a marked decrease in CA125; she remained on everolimus for 19 months until she developed progressive disease.
Conclusions:
While mTOR inhibition is frequently used in tumors associated with tuberous sclerosis complex (TSC), such as lymphangioleiomyomatosis and malignant perivascular epithelioid cell tumors, this is the first case of a patient with ovarian cancer harboring TSC1/2 mutations who responded to mTOR inhibition. This case highlights the utility of targeted DNA sequencing in the management of ovarian carcinoma and demonstrates the value of tumor-agnostic targeted therapies.
White Fibrous Papulosis of the Neck in a 70-Year-Old Female: A Case Report
Authors: Maryam Alzaabi, Rawan Almutairi, Amal Alrushood, Humoud Al-Sabah
Journal: Cureus (2024)
Keywords: collagen thickening, decrease in elastic fibers, dermatopathology, fibroelastic papulosis of the neck, rare skin disease, skin lesion biopsy, white fibrous papulosis of the neck
MeSH terms: Case Reports

White fibrous papulosis of the neck (WFPN) manifests through the presence of numerous solid, persistent, and asymptomatic yellowish-white papules, displaying a distinctive asymmetrical distribution primarily localized on the neck and antecubital fossa. This case report describes the clinical presentation of a 70-year-old female diagnosed with WFPN, highlighting the significant finding of collagen fiber thickening upon histopathological analysis. Despite its predilection for specific anatomical sites, the elusive pathogenesis of WFPN adds diagnostic complexity, emphasizing the need for further research in this unique condition that generally follows a benign course.
A Rare Case of Neuroendocrine Prostate Cancer Detected on 68Ga - DOTANOC Positron Emission Tomography/Computed Tomography (PET/CT)
Authors: Abhishek Kumar, Aaditya Prakash, Amitabh Kumar Upadhyay, Bhola Kumar, Sujata Mitra
Journal: Cureus (2024)
Keywords: 68ga - dotanoc, nepc, neuroendocrine tumor, pet/ct, positron emission tomography, prostate cancer
MeSH terms: Case Reports

Prostate cancer is one of the most common malignancies affecting elderly men worldwide and the fifth leading cause of cancer death in men. Prostate cancer includes many histological variants with the prostatic acinar adenocarcinoma variant accounting for the majority of the diagnosed cases. Other less common histological variants are broadly classified as non-acinar carcinomas. One of the non-acinar carcinoma variants is neuroendocrine prostate cancer (NEPC). NEPC can emerge as a mechanism of treatment resistance in castration-resistant conventional prostate cancer and can also rarely be seen as a primary histological form at the time of initial diagnosis. Like other non-acinar carcinoma variants of prostate cancer, NEPC is also an aggressive variant with associated poor prognosis. Neuroendocrine tumors (NETs) are characterized by the expression of somatostatin receptors (SSTRs). Positron emission tomography/computed tomography (PET/CT) using radiolabeled somatostatin analogs like DOTANOC have been used to detect and stage these NETs. These radiolabeled somatostatin analogs also provide the option of treatment of these tumors and have been used in peptide receptor radionuclide therapy of these tumors. NEPC being a neuroendocrine malignancy also expresses SSTRs and hence can be detected with PET/CT radiotracers like 68Gallium-labeled somatostatin analogs. We here report a case of metastatic treatment-emergent NEPC detected on 68Ga - DOTANOC PET/CT.
A longevity level-oriented wellness target area identification method: a case study of Yunnan Province, China
Authors: Yu Wang, Jiaxue Wang, Xiao Wang
Journal: Front Public Health (2024)
Keywords: yunnan province, influencing factor, longevity population, wellness base, wellness target area
MeSH terms: Longevity, Aged, China, Health Promotion, Humans

Background:
Aging, as a global demographic issue, is characterized by its rapid growth, which drives an increase in people's healthcare awareness. The emergence of wellness bases caters to this market demand. Therefore, the identification of potential areas suitable for wellness activities and the construction of wellness bases, referred to as Wellness Target Areas (WTAs), becomes a crucial first step. Currently, commonly used identification methods are mostly based on traditional statistical approaches, which are often complex, cumbersome, and subject to potential risks of subjective assumptions, affecting the reliability of WTAs identification results. Longevity level serves as a comprehensive indicator reflecting the natural and socio-economic environment of a region, making it the most indicative of the regional wellness environment status.
Methods:
This study proposes using longevity level as the benchmark for WTAs identification to simplify the identification process and reduce the impact of subjective bias on the results. The study focuses on 129 county-level units in Yunnan Province. Firstly, the Geodetector (GD) is utilized to explore the complex interaction between the longevity level and the geographical environment to determine regional wellness factors. Secondly, using ArcGIS and geographical weighted regression (GWR), the study investigates the role of different wellness factors, ultimately classifying and grading the WTAs.
Results:
The longevity level in Yunnan Province exhibits a pattern of multi-point clustering, forming three major longevity regions. Factors that significantly influence longevity level include annual average precipitation, sunshine duration, PM2.5 content, per capita disposable income, density of tourist attractions, and distance from residential areas to hospitals. Based on the degree of longevity and the contribution rate of influencing factors, Yunnan Province's WTAs are classified into three levels and two types (natural and comprehensive).
Conclusion:
Our study aims to establish a connection between longevity level and the selection of wellness bases, exploring regional wellness factors through the relationship between longevity phenomena and geographical environment, identifying potential construction areas for wellness bases (i.e., WTAs), providing new insights for the precise selection of wellness bases, effectively enhancing the scientificity of site selection, promoting population health, and contributing to the global aging process with better health.
Giant Retinal Astrocytoma: A Case Report of an Uncommon Presentation of Tuberous Sclerosis in a Young Female
Authors: Keval Thakkar, Fnu Raveena, Aakash Kumar, Doongro Mal, Dileep Kumar, Neha Ahuja, Rahul Mandhan, Aqsa Baig, Manjeet Singh, Heeya Shah, Taha Sajjad, Mansi Singh
Journal: Case Rep Neurol Med (2024)
MeSH terms: Case Reports

Tuberous sclerosis (TS) is a rare multisystem autosomal dominant genetic disorder with characteristic pathognomonic genetic mutations involving the TSC (tuberous sclerosis complex) group of genes. Ocular signs are fairly common and include an achromic patch and retinal astrocytic hamartomas, which usually have a maximum size of between 0.5 and 5 mm. The incidence of tuberous sclerosis is estimated to be 1 in 5000-10,000 individuals, with both familial and sporadic cases reported. The diagnostic criteria for tuberous sclerosis include the presence of major and/or minor clinical features as well as genetic mutations. We present the case of a 15-year-old girl, presented with a history of seizures and blurred vision. Physical examination revealed angiofibroma on the face. Further evaluation, including contrast-enhanced MRI of the brain and ophthalmological consultation, led to the diagnosis of tuberous sclerosis. Additional imaging studies confirmed the presence of subependymal giant cell astrocytoma, retinal astrocytoma, lymphangioleiomyomatosis in the lungs, and renal angiomyolipoma. This case highlights the importance of considering tuberous sclerosis in patients presenting with seizures and ocular symptoms. This case sheds light on early diagnosis and appropriate management which are crucial in preventing complications and improving patient outcomes.
Neurological Manifestations of Scrub Typhus Infection in Pediatric Patient: A Case Report From Tertiary Care Hospital in Central India
Authors: Priyanka Singh, Vishal Shete, Abhijit Choudhary, Neeta Gade, Meena Mishra
Journal: Cureus (2024)
Keywords: rickettsial disease, scrub typhus case report, scrub typhus meningitis, scrub typhus meningitis in children, scrub typhus meningoencephalitis
MeSH terms: Case Reports

Scrub typhus is a neglected tropical bacterial disease endemic in central India which can manifest as meningitis/meningoencephalitis in children. It is difficult to diagnose clinically, especially in the absence of eschar or rash. Scrub typhus is seldom considered the differential diagnosis of meningitis in the Indian subcontinent. Appropriate investigations can lead to early detection of infection and initiation of correct antibiotic treatment leading to better patient prognosis even when features of meningitis supervene. Here, we report a pediatric case of scrub typhus meningitis that could be saved due to timely investigations and initiation of appropriate antimicrobial agents.
Case report: Peri-procedural hydroxyurea helps minimize bleeding in patients with Essential Thrombocythemia associated with acquired von Willebrand syndrome
Authors: Leah Kogan, Russell Price, Rouslan Kotchetkov
Journal: Front Oncol (2024)
Keywords: essential thrombocythemia, bleeding, hemorrhage, hydroxyurea, von willebrand syndrome
MeSH terms: Case Reports

Background:
Essential Thrombocythemia is a chronic myeloproliferative neoplasm characterized by an isolated excessive production of platelets. Extreme thrombocytosis is defined by having a platelet count greater than or equal to 1,000 x 109/L, which may lead to the development of acquired von Willebrand syndrome and complications of excessive hemorrhage.
Case description:
A 74-year-old female patient was brought in for a bone marrow examination regarding elevated platelet count. She had no history of excessive bleeding. The physical exam was unremarkable with no petechiae or hematomas. Complete blood count showed platelet count 1,491x109/L. Bone marrow aspiration and biopsy were unremarkable, however, the patient developed bleeding from the biopsy site. Local pressure and an ice pack were ineffective, so she received 20 mcg of desmopressin subcutaneously, 1 unit of fresh frozen plasma and was started on tranexamic acid 1,000 mg orally every 8 hours. She was admitted for bleeding control and had another dose of desmopressin. Blood work showed elevated partial thromboplastin time and normal international normalized ratio. Acquired von Willebrand syndrome was suspected and a sample for von Willebrand disease was sent out. The next day her bleeding continued, and her Hb decreased from 145 to 89 g/L, she became symptomatic (tachycardic) and fatigued. The coagulation profile was consistent with acquired von Willebrand syndrome. Since she continued bleeding, she received 1 unit of packed red blood cells. A high dose of hydroxyurea (3g/day) was started urgently; within 24 hours platelet count was halved, and the bleeding resolved. Blood work was repeated 24 hours later and showed normalization of partial thromboplastin time and a normal Von Willebrand profile.
Conclusion:
Patients with extreme thrombocytosis are at high risk of bleeding due to acquired Von Willebrand Syndrome. Initiation of hydroxyurea at the time of bone marrow exam helps to control platelet count and minimizes the risk of peri-procedural hemorrhage in high-risk Essential Thrombocythemia patients with suspected acquired Von Willebrand Syndrome.
Identification of prosthetic joint infection by Candida using metagenomic shotgun sequencing
Authors: Liqiong Lin, Kaiwei Shen, Lili Xiao, Yu Lin, Eryou Feng, Yiyuan Zhang
Journal: Access Microbiol (2023)
Keywords: candida, metagenomic shotgun sequencing, prosthetic joint infection
MeSH terms: Case Reports

Background:
Periprosthetic joint infection (PJI) is a serious complication after total knee arthroplasty. Fungal infections are prone to biofilm formation, which makes it hard to diagnose and clarify the pathogenic species.
Case presentation:
This case study provides evidence of a novel PJI pathogen that is otherwise difficult to detect using conventional methods. A patient was reviewed with persistent postoperative pain, swelling and eventually drainage around the left knee after undergoing a bilateral total knee arthroplasty 2 years previously for progressive osteoarthritis. By using metagenomic shotgun sequencing to analyse both bacterial and fungal agent sequences, we were able to identify fungal strains of Candida tropicalis, a rarely reported and difficult-to-culture PJI pathogen.
Conclusion:
Metagenomic shotgun sequencing enables the detection of difficult-to-detect pathogens and the formulation of treatment recommendations for fungal infections with low positive rates based on gene content analysis.
Moyamoya Disease Causing Stroke in the Setting of Cocaine Use and Uncontrolled Hypertension Due to Primary Hyperaldosteronism
Authors: Nathan DeRon Jr, Francis Fischer, Tara Norris
Journal: Cureus (2024)
Keywords: cocaine, cocaine use disorder, hyperaldosteronism, moyamoya, moyamoya disease, moyamoya syndrome, puff of smoke, stroke
MeSH terms: Case Reports

Moyamoya disease is a cerebrovascular disease characterized by stenosis of large intracranial arteries and the development of smaller collateral vessels. Moyamoya may cause strokes and stroke-like symptoms in young patients. It has also been linked to autoimmune diseases and neuropsychiatric conditions. We present a case of moyamoya disease in a young patient with concomitant hyperaldosteronism, uncontrolled hypertension, and cocaine use disorder, along with features of antisocial personality disorder. This is a unique presentation of an underlying neurological disease causing psychiatric features exacerbated by cocaine use, and it describes a rare clinical presentation that physicians should consider in patients with moyamoya disease.
Online procedure to encourage reading in children with school difficulties and their guardians, during the COVID-19 pandemic
Authors: Giulia Ito Silva, Gabriela Diniz, Patrícia Abreu Pinheiro Crenitte, Aline Roberta Aceituno da Costa
Journal: Codas (2023)
MeSH terms: COVID-19, Case Reports, Child, Female, Humans, Literacy, Mothers, Pandemics, Schools

School is the main environment for the formal promotion of literacy and it is the first step to the world of reading. However, with the occurrence of the COVID-19 pandemic, pedagogical activities had to be suspended or adapted to the remote model, causing harm to all students, and notably to those who already had school difficulties, especially those related to reading. Proficiency and the habit of reading are important conditions for academic development. Studies have shown that the application of strategies in the family context and the use of digital platforms, with the purpose of sharing readings, are practices that promote the reading habit. Therefore, the present study aimed to report the experiences of applying an online procedure to encourage reading in children with school difficulties and their respective guardians (six dyads), using a specific digital platform for sharing readings. The results obtained include a behavioral change in the children towards solid reading habits, a change in mothers' daily attitudes in the family environment towards encouraging reading, and mothers' encouraging behaviors when sharing their children's reading. The experiences reported were promising and, to further consolidate the findings, new studies are suggested with a sample size that allows statistical analyses, longitudinal studies and also with a possible face-to-face or hybrid application of the procedure.
Iliopsoas fibrosis after revision of total hip arthroplasty revealed by 68Ga-FAPI PET/CT: a case report
Authors: Yiqun Wang, Yabing Sun, Junlei Song, Xiaojun Zhang, La Li, Zhihui Shen, Jiahe Tian, Yingfang Ao
Journal: Front Med (Lausanne) (2024)
Keywords: 68ga-fapi, pet/ct, tha, fibrosis, skeletal muscle
MeSH terms: Case Reports

Background:
Total hip arthroplasty (THA) is a well-established surgical procedure that has been extensively validated to alleviate pain, enhance joint function, improve the ability to perform daily activities, and enhance overall quality of life. However, this procedure is associated with certain complications, among which skeletal muscle fibrosis is a frequently overlooked but significant complication that can lead to persistent pain. Currently, there is no effective method for diagnosing skeletal muscle fibrosis following total hip arthroplasty.
Case report:
We report a 75-year-old male patient who complained of left groin pain after revision total hip arthroplasty. Serological examinations, X-rays, and bone scan results were all normal. However, during the 68Ga-FAPI PET/CT examination, we observed significant radiotracer uptake along the iliopsoas muscle. This abnormal uptake pattern suggested potential biological activity in this specific area. Combined with physical examination, the patient was diagnosed with iliopsoas fibrosis.
Conclusions:
The presented images indicated that the uptake pattern was an important indicator for diagnosis, and the prospect of fibroblast activation protein in the diagnosis of skeletal muscle fibrosis has shown certain application value.
A Two Stage Open and Interventional Therapeutic Approach for an Inferior Pancreaticoduodenal Artery Aneurysm With Coeliac Artery Occlusion
Authors: Polina Shabes, Waseem Garabet, Peter Minko, Joscha Mulorz, Julian-Dario Rembe, Hubert Schelzig, Markus U Wagenhäuser
Journal: EJVES Vasc Forum (2024)
Keywords: coeliac trunk occlusion, coil embolisation, visceral artery aneurysm, visceral bypass
MeSH terms: Case Reports

Introduction:
Visceral artery aneurysms (VAAs) are rare but have a high mortality rate in cases of rupture, especially for pancreaticoduodenal artery aneurysms (PDAAs). A hybrid approach is presented for a challenging case with inferior PDAA (iPDAA) with concomitant coeliac artery (CA) occlusion and a variant arterial supply to the liver.
Report:
A 61 year old patient complained of postprandial pain associated with elevated liver enzymes and impaired hepatic synthesis capacity. The left hepatic artery (LHA) originated from an occluded CA, whereas the right hepatic artery (RHA) originated directly from the superior mesenteric artery (SMA) proximal to the iPDAA. Due to the anatomical variant, an endovascular only approach via iPDAA embolisation could have posed a critical risk to the arterial supply of the liver. Therefore, the initial plan was to first secure liver perfusion via endovascular revascularisation of the CA, before conducting a coil embolisation of the iPDAA. However, endovascular CA revascularisation failed due to a complete and fixed occlusion. As an alternative therapeutic approach, open surgical aorto-visceral autologous bypass ensured arterial supply of the liver, which now enabled safe exclusion of the iPDAA via interventional coil embolisation. This two stage hybrid strategy resulted in iPDAA exclusion and was followed by symptom relief and normalised hepatic synthesis capacity.
Discussion:
This case demonstrates the continued need for open visceral bypass surgery to ensure organ perfusion, if the latter depends on an aneurysmal artery. In such a situation, visceral bypass surgery can be considered in challenging anatomical scenarios, which demonstrates the relevance of endovascular and open procedures. In conclusion, both procedures can be combined in individualised therapy approaches to maximise patient benefit.