OpenMed/multicare-articles huggingface dataset:
Case report: Inflammatory sternoclavicular joint arthritis induced by an immune checkpoint inhibitor with remarkable responsiveness to infliximab
Authors: Shion Kachi, Shuji Sumitomo, Hideki Oka, Akito Hata, Koichiro Ohmura
Journal: Front Immunol (2024)
Keywords: durvalumab, immune checkpoint inhibitor (ici), infliximab, irae, programmed-death ligand 1 (pd-l1), small cell lung carcinoma (sclc), sternoclavicular arthritis
MeSH terms: Arthritis / chemically induced, Arthritis / drug therapy, Arthritis / etiology, Immune Checkpoint Inhibitors / adverse effects, Immune Checkpoint Inhibitors / therapeutic use, Infliximab / adverse effects, Infliximab / therapeutic use, Sternoclavicular Joint, Case Reports, Antibodies, Monoclonal, Antirheumatic Agents / adverse effects, Antirheumatic Agents / therapeutic use, Female, Humans, Lung Neoplasms / drug therapy, Lung Neoplasms / immunology, Middle Aged, Small Cell Lung Carcinoma / drug therapy, Small Cell Lung Carcinoma / immunology, Treatment Outcome, Infliximab, Immune Checkpoint Inhibitors, Antirheumatic Agents, durvalumab, Antibodies, Monoclonal

This report describes the case of a 48-year-old woman who presented with sternoclavicular joint arthritis after administration of an immune checkpoint inhibitor (ICI), durvalumab, for small cell lung carcinoma. The onset of arthritis transpired 18 months after the commencement of the ICI therapeutic regimen and demonstrated resilience to glucocorticoid treatment. After excluding infectious aetiologies and metastatic involvement, the patient was diagnosed with ICI-induced arthritis (ICI-IA). Considering the articular implications akin to the SAPHO syndrome, the patient was treated with infliximab, resulting in complete resolution. This finding implies that biological DMARDs can serve as effective interventions for ICI-induced sternoclavicular joint arthritis. Given the heterogeneous nature of its pathogenesis, the selection of therapeutic agents may require customization based on the distinct clinical presentation of each individual case.
Urinary tract infection associated with bacteremia caused by vancomycin-resistant enterococcus following continent urinary diversion
Authors: Kai Morishita, Soichiro Kashiwabara, Yuki Matsumoto, Atsuhiro Mizushima, Kaori Hara, Toshihiko Agatsuma, Yuji Mimura, Hideyoshi Matsumura, Hiroya Mizusawa
Journal: Clin Case Rep (2023)
Keywords: continent reservoir, in‐hospital outbreak, multidrug‐resistant bacterium, postoperative complication, pyelonephritis
MeSH terms: Case Reports

Key clinical message:
Even in a country where vancomycin-resistant enterococcus is rare, multidrug-resistant organism precautions are necessary when admitting patients with a history of medical exposure in other countries. On admission, screening is necessary and if infection is confirmed, a multidisciplinary approach involving different specialists is required.
Abstract:
The patient was a 49-year-old Japanese female living in the United States. Total pelvic exenteration for cervical carcinoma, Miami pouch formation, and ileostomy had been performed in the United States. She returned to Japan to undergo postoperative adjuvant chemotherapy. Fever and abdominal pain occurred 42 days after surgery. She consulted the fever outpatient clinic, and a diagnosis of urinary retention-associated acute renal failure and pyelonephritis was made. We detected vancomycin-resistant enterococcus on urine/blood culture 5 days after admission. Infection control measures were implemented, and the ward was closed for 3 days. We administered linezolid, which was effective for pyelonephritis and bacteremia.
Good Syndrome in a Young Woman: An Unusual Presentation
Authors: Sandra D Rebelo, Tiago Ferreira, Teresa Pacheco, Susana L Silva, Ana Tornada
Journal: Cureus (2024)
Keywords: good syndrome, hypogammaglobulinemia, immunodeficiency, recurrent infections, thymoma
MeSH terms: Case Reports

Good Syndrome is a rare disease that comprises the presence of a thymoma, immunodeficiency, and recurrent opportunistic infections. We report the case of a young woman who was diagnosed with Good Syndrome, who had a long-term history of recurrent infections, often due to atypical agents, and who also had a previous history of immunodeficiency and a B1 thymoma invading the large vessels, lung, and pericardium (Masaoka stage IV). She underwent surgical resection of the mediastinal mass, requiring vena cava superior reconstruction due to the extent of invasion, followed by adjuvant radiotherapy and immunoglobulin G supplementation. Despite relative stability in the subsequent years, without serious infections, after three years she had a thymoma recurrence requiring a new therapeutic approach. This case highlights the importance of a thorough investigation of the underlying causes of recurrent infections, which may be the result of an immunodeficiency secondary to malignancy. In young patients, early diagnosis is crucial to avoid disease progression and to reduce mortality rates. To achieve such outcomes, a multidisciplinary team and a comprehensive therapeutic strategy are necessary.
Return of the Living Dead Gut - A Case Report of Ischemic Colitis Identified on Point of Care Ultrasound
Authors: Kandria Ledesma, Joseph Kim, Allison Cohen, Nicholas Bielawa, Mathew Nelson
Journal: POCUS J (2024)
Keywords: abdominal point of care ultrasound, bowel ultrasound, case report, emergency medicine, ischemic colitis
MeSH terms: Case Reports

Ischemic colitis is the most common form of gastrointestinal ischemia 1. The diagnosis of ischemic colitis is made by clinical data and computed tomography (CT) imaging of the abdomen and pelvis 1. While colonoscopy is considered the gold standard for diagnosis, this is not performed in the emergency department (ED) 2. Few studies have been performed to describe the sonographic findings of ischemic colitis using point of care ultrasound (POCUS). We report a case that highlights the sonographic findings of ischemic colitis in a patient who had two separate visits to the ED, showcasing the utility of POCUS in making this diagnosis. POCUS can be used as a diagnostic tool for early detection of ischemic colitis leading to prompt treatment with antibiotics, CT imaging, and surgical consultation.
Colovesical Fistula due to Sigmoid Diverticulitis
Authors: Christos K Stefanou, Spiridon Gkogkos, Stefanos Flindris, Apostolis K Paxinos, Thomas Tsiantis, Polyxeni Oikonomou, Kostas Tepelenis, Stefanos K Stefanou
Journal: Case Rep Surg (2023)
MeSH terms: Case Reports

Introduction:
The incidence of colonic diverticulosis has risen significantly. Diverticular disease is the most frequent cause of colovesical fistulas, which are uncommon complications of diverticulitis. Clinical signs, such as fecaluria and pneumaturia, are typically required to confirm its presence. Finding the cause of the disease so that the proper therapy can be started is the primary goal of a diagnostic workup rather than observing the fistula tract itself. Case Presentation. We present a 43-year-old man complaining of frequent urinary tract infections for six months. On CT abdomen and pelvis, a colovesical fistula was diagnosed. Surgery was performed, and after the division between the sigmoid colon and the bladder, a sigmoidectomy and an end-to-end colorectal anastomosis were performed. During the surgery, the fistula tract was not detected. The patient was discharged in excellent condition on day six, and the catheter was removed on day 10.
Conclusion:
In conclusion, as in our case, any patient with a urinary tract infection should be suspected of having this condition, especially if he has persistent symptoms that have not responded to standard medical care. Patients who present with fecaluria, pneumaturia, and other specific symptoms of a colovesicular fistula do not necessarily need a barium enema or cystography to confirm the presence of the fistula.
Duodenogastric Intussusception in a 14-Week-Old Infant with Donohue Syndrome: Case Study
Authors: Corina Ramona Nicolescu, Clara Cremillieux, Jean-Louis Stephan
Journal: Case Rep Pediatr (2023)
MeSH terms: Case Reports

Donohue syndrome (DS) is a rare recessively inherited disorder characterized by severe insulin resistance caused by genetic defects affecting the insulin receptor. The classical clinical characteristics include severe intrauterine growth restriction, craniofacial dysmorphic features, body and skin features, and soft tissue overgrowth. Postnatal growth retardation, cardiac, gastrointestinal, and renal complications, and infection susceptibility develop within the first few months of life, leading to a short life expectancy (<2 years). The classical metabolic abnormalities vary from fasting hypoglycemia to postprandial hyperglycemia with severe hyperinsulinemia. We present the case of a 14-week-old infant with DS who developed cardiac, renal, hepatic, pancreatic, and gastrointestinal features, all of them previously reported in infants with DS. The gastrointestinal features started during the first week of life and included abdominal distension, feeding difficulties, intermittent vomiting, and two episodes of intestinal obstruction. The diagnosis of duodenogastric intussusception was made, and this previously unreported complication tragically resulted in mortality. We discuss how basic mechanisms of cross-talk between insulin and insulin-growth factor 1 receptors could be linked to hyperinsulinemia and its associated comorbidities.
Methylmalonic aciduria as a biochemical marker for mitochondrial DNA depletion syndrome in patients with developmental delay and movement disorders: a case series
Authors: Montaha Almudhry, Arushi Gahlot Saini, Mohammed A Al-Omari, Yashu Sharma, Maryam Nabavi Nouri, C Anthony Rupar, Chitra Prasad, Andrea C Yu, Savita Verma Attri, Asuri Narayan Prasad
Journal: Front Neurol (2023)
Keywords: sucla2, suclg1, dystonia, methylmalonic acid, mitochondrial dna depletion syndrome, mitochondrial disorder, movement disorder

Background:
Mitochondrial DNA (mtDNA) depletion syndromes (MDDS) are genetically and clinically variable disorders resulting from a reduction in mtDNA content in the cells, tissues, and organ systems, leading to symptoms related to energy deficits. Deficiency of the mitochondrial succinyl-CoA ligase/synthetase enzyme secondary to pathogenic variations in the SUCLG1 and SUCLA2 genes is a subtype of MDDS that presents with neurological manifestations and a specific biochemical profile.
Methods:
This cross-sectional series describes five patients with MDDS secondary to pathogenic variations in the SUCLG1 and SUCLA2 genes from two tertiary care centers in Canada and India. Clinical data concerning the course, investigations, and outcome were gathered through chart reviews.
Results:
All subjects presented in early infancy with neurological manifestations, including movement disorder, psychomotor regression, developmental delay, hearing loss, behavioral issues, or a combination thereof. Elevated methylmalonic acid metabolites, an abnormal acylcarnitine profile, and lactic acidemia were noted in the biochemical profile of each patient (n = 5/5, 100%). Molecular genetic testing disclosed the presence of pathogenic homozygous mutations in four subjects and compound heterozygosity in one subject.
Conclusion:
MDDS associated with SUCLG1 and SUCLA2 genes can be detected biochemically by the presence of methylmalonic aciduria besides the elevation of lactate, C3, C4DC, and C5-OH acylcarnitine. Conducting metabolic workups including MMA and acylcarnitine profiles in patients with heterogeneity of clinical symptoms associated with the presence of this biochemical marker may potentially reduce the time to diagnosis and management.
Case report: Ultrasonographic and computed tomographic imaging features of hemochromatosis in a dog
Authors: Mihyun Choi, Namsoon Lee
Journal: Front Vet Sci (2024)
Keywords: canine, hemochromatosis, iron-overload disorder, portal hypertension, pre-contrast ct
MeSH terms: Case Reports

A castrated male mixed-breed dog weighing 7 kg presented with elevated liver enzymes and anorexia. Abdominal radiography revealed hepatomegaly with heterogeneous hepatic opacification, and abdominal ultrasonography showed a fine echotexture and heterogeneous parenchyma concurrent with a suspected acquired portosystemic shunt. Pre-contrast computed tomography (CT) showed marked hepatomegaly with homogeneous increased liver density and multiple enlarged abdominal lymph nodes with markedly increased parenchymal density. Histopathology of the hepatic and lymph node biopsy revealed accumulated abundant hemosiderin, and the Prussian Blue stain confirmed marked iron accumulation within the hepatocytes. Based on our review of the literature, this is the first case report describing the imaging diagnosis of hemochromatosis in a dog.
Have one's view of the important overshadowed by the trivial: chronic progressive external ophthalmoplegia combined with unilateral facial nerve injury: a case report and literature review
Authors: Ziyang Feng, Rui Lai, Jia Wei, Xuan Liu, Xueqin Chen, Yangsicheng Liu, Wenxin Qin, Xiude Qin, Fanxin Kong
Journal: Front Neurol (2024)
Keywords: case report, chronic progressive external ophthalmoplegia, genetic testing, misdiagnosis, muscle biopsy
MeSH terms: Case Reports

Chronic progressive external ophthalmoplegia (CPEO) is a mitochondrial encephalomyopathy that is characterized by progressive ptosis and impaired ocular motility. Owing to its nonspecific clinical manifestations, CPEO is often misdiagnosed as other conditions. Herein, we present the case of a 34-year-old woman who primarily presented with incomplete left eyelid closure and limited bilateral eye movements. During the 6-year disease course, she was diagnosed with myasthenia gravis and cranial polyneuritis. Finally, skeletal muscle tissue biopsy confirmed the diagnosis. Biopsy revealed pathological changes in mitochondrial myopathy. Furthermore, mitochondrial gene testing of the skeletal muscle revealed a single chrmM:8469-13447 deletion. In addition, we summarized the findings of 26 patients with CPEO/Kearns-Sayre syndrome who were misdiagnosed with other diseases owing to ocular symptoms. In conclusion, we reported a rare clinical case and emphasized the symptomatic diversity of CPEO. Furthermore, we provided a brief review of the diagnosis and differential diagnosis of the disease.
Impetigo Surgical Site Infection Following Open Reduction and Internal Fixation of a Patella Fracture
Authors: Westin M Yu, Tristan M Palmer, Drew Miller, Shawn Storm
Journal: Cureus (2024)
Keywords: impetigo, open reduction and internal fixation with a plate (orif with plate), patella fracture, staph aures, surgical fixation of patella fracture, surgical site infection(ssi)
MeSH terms: Case Reports

Impetigo is a pediatric skin infection characterized by the presence of pathognomonic "honey-crusted" lesions caused by either Staphylococcus aureus or Streptococcus pyogenes. The diagnosis of impetigo is largely based on clinical judgment, confirmatory skin cultures, and Gram staining. Surgical site infections following patellar surgery are a relatively uncommon occurrence, with the most common causative organisms being Staphylococcus aureus, Streptococcus pyogenes, Pseudomonas aeruginosa, and other gram-negative bacilli. Surgical site infections have a range of risk factors that largely depend on patient characteristics and surgical logistics. We report the first documented case in the literature of a surgical impetigo infection with diagnostic skin lesions following open reduction and internal fixation of a patellar fracture in a 24-year-old female.
Sequential severe immune-related adverse events induced by PD-1 inhibitor: a case report and literature review
Authors: Jinxiong Xia, Yingmei Wen, Mengxia Xiao, Dafu Ye, Yanjun Gao, Dongling Tang, Xiuyun Zhang, Jinling Chen, Qingqing Li, Yi Yao
Journal: Front Oncol (2024)
Keywords: advanced lung adenocarcinoma, case report, immune hepatitis, immune myocarditis, immune pneumonia, immune-related adverse events, sintilimab
MeSH terms: Case Reports

In a variety of cancers, immune checkpoint inhibitors (ICIs) have demonstrated substantial survival advantages. Nevertheless, the widespread use of ICIs in the clinic has resulted in a growing interest in immune-related adverse events (irAEs) and their treatment methods. This paper reports a case in which a patient with three sequential severe irAEs was successfully treated. After undergoing two regimens of sintilimab in conjunction with chemotherapy for advanced lung cancer, the patient developed myocarditis combined with hepatitis. Subsequently, the patient developed pneumonia following remission from treatment. We also discuss the mechanism of irAEs, principles of treatment, and progress in the study of biomarkers for early prediction of irAEs by reviewing the literature.
Anesthesia Approach to Managing Severe Hemorrhagic Shock and Anemia With Non-transfusion Alternatives in a Practicing Jehovah's Witness: A Case Report
Authors: Colin Kirsch, Romain Rabany, Matthew Pon, Julia Shabanian, Anand Narayanappa
Journal: Cureus (2024)
Keywords: blood transfusion, hemorrhagic shock, jehovah's witness, medical ethics, non-transfusion therapy, patient autonomy, patient-centered care, severe anemia, shared decision-making, trauma
MeSH terms: Case Reports

Traumatic hemorrhagic shock is a common yet life-threatening occurrence across the United States and is typically managed with blood transfusions as the standard of care. However, providers caring for a Jehovah's Witness patient who refuses transfusions due to religious reasons face unique ethical challenges in upholding evidence-based shock resuscitation protocols while respecting the patient's autonomy and faith-based stance that strictly prohibits blood products. We present a complex clinical case of a 46-year-old Jehovah's Witness who developed severe hemorrhagic shock, partial amputation, and critical anemia after a traumatic 40-mile-per-hour motorcycle collision resulting in comminuted fractures and arterial disruption. Despite receiving emergent blood transfusions initially, further transfusions were declined once his identity as a practicing Jehovah's Witness was disclosed. His hemoglobin plunged to dangerously low levels of 4.6 g/dL before stabilizing to 5.3 g/dL with pharmaceutical alternatives including intravenous iron, high-dose erythropoietin, and phlebotomy minimization. Respecting patient convictions while delivering effective evidence-based shock management created significant ethical conflicts given the proven efficacy of blood transfusions. However, this complex case demonstrates that through meticulous medical and surgical care coordinated by a multi-disciplinary team applying customized non-transfusion techniques, traumatic hemorrhagic shock and life-threatening anemia can still achieve favorable outcomes without relying on transfusions when respecting faith-based refusal of blood products.
Parkinsonism-Hyperpyrexia Syndrome in a patient undergoing upper gastrointestinal surgery: A case report
Authors: Nissar Shaikh, Adnan Saadeddin
Journal: Qatar Med J (2024)
Keywords: parkinson’s disease, antiparkinsonian medications, neuroleptic malignant syndrome, parkinsonism-hyperpyrexia syndrome, perioperative management
MeSH terms: Case Reports

Background:
Parkinsonism-hyperpyrexia syndrome (PHS) is a potentially life-threatening condition that occurs due to the abrupt withdrawal or significant dose reduction of antiparkinsonian medications. It presents similarly to neuroleptic malignant syndrome (NMS) and is characterized by severe rigidity, fever, autonomic instability, and altered mental status.
Case:
A 62-year-old male with a 10-year history of Parkinson's disease (PD) underwent laparoscopic mesh repair for a left-sided diaphragmatic and large hiatus hernia. His antiparkinsonian medications included levodopa/carbidopa, amantadine, pramipexole, and benzhexol. Medications were withheld as part of the nil per os (NPO) status. Postoperatively, he developed withdrawal features, including tremors, difficulty speaking, tachycardia, hypertension, fever, and sweating. PHS, resulting from the withdrawal of antiparkinsonian medications, was diagnosed. The patient was transferred to the intensive care unit (ICU), intubated, and his antiparkinsonian medications were reintroduced. The patient's condition improved gradually, and he was discharged home on the 15th postoperative day.
Discussion:
The abrupt discontinuation of antiparkinsonian medications precipitated PHS in our patient. Recognizing the clinical picture of PHS and differentiating it from other possible conditions, such as neuroleptic malignant syndrome and malignant hyperthermia, is pivotal. Management involves resuming medications and providing supportive care. Early recognition and prompt reintroduction of the antiparkinsonian medications are essential for the patient's recovery.
Conclusion:
PHS is a rare but potentially life-threatening condition that occurs due to the withdrawal of antiparkinsonian medications, leading to an acute hypodopaminergic state. Our case emphasizes the importance of careful perioperative management of antiparkinsonian medications and early recognition and management of withdrawal symptoms in patients with Parkinson's disease undergoing surgery.
Case report and literature analysis: pancreatic hepatoid carcinoma with multiple lymph node metastases progressing to liver metastasis after pancreaticoduodenectomy
Authors: Xiaorui Huang, Xinyi Guo, Yahong Yu
Journal: Front Oncol (2024)
Keywords: case report, immunotherapy, literature analysis, pancreatic hepatoid carcinoma, postoperative liver metastases
MeSH terms: Case Reports

Hepatoid carcinoma is an extrahepatic primary tumor displaying characteristics reminiscent of hepatocellular carcinoma differentiation, which is found in various organs, such as the stomach, ovaries, gallbladder, and pancreas. Reports of pancreatic hepatoid carcinoma remain scarce. Consequently, understanding of this disease remains a priority, with no established consensus on its diagnosis and management. Here, we reported the case of a 45-year-old woman diagnosed with hepatoid carcinoma located in the pancreatic head, accompanied by multiple lymph node metastases. Following pancreaticoduodenectomy, the patient developed liver metastases within 3 months. Subsequently, she underwent adjuvant therapy consisting of Teysuno and Durvalumab following microwave ablation for the liver metastases. Remarkably, the patient has survived for one year without significant disease progression. This case underscores the potential efficacy of immunotherapy as a promising treatment option for pancreatic hepatoid carcinoma. Further research and clinical trials are warranted to explore the optimal management strategies for this rare and challenging malignancy.
Ineffective ventilation in a very low birth weight infant with H-type Tracheoesophageal Fistula with bilateral chemical pneumonitis. A lesson learned
Authors: Faraz Ahmad, Sana Niaz, Naveed Durrani, Vikram Kumar
Journal: Pak J Med Sci (2024)
Keywords: chemical pneumonitis, h-type tracheoesophageal fistula, ineffective ventilation, ventilation corrective strategies
MeSH terms: Case Reports

Tracheoesophageal fistula (TEF) with or without associated esophageal atresia (EA) in the neonate is challenging to diagnose and manage its complications like aspiration, respiratory distress, and other associated anomalies. To stabilize, ventilate and prepare for surgical correction, understanding the H-nature of disease and anticipation of problems and their management will improve survival. We present a newborn with tracheoesophageal fistula without atresia from resource-limited settings and lessons we learned from the case.