OpenMed/multicare-articles huggingface dataset:
Listeria monocytogenes Brain Abscess: Controversial Issues for the Treatment-Two Cases and Literature Review
Authors: Beatrice Tiri, Giulia Priante, Lavinia Maria Saraca, Lucia Assunta Martella, Stefano Cappanera, Daniela Francisci
Journal: Case Rep Infect Dis (2018)
MeSH terms: Case Reports

Listeria monocytogenes (LM) is an opportunistic pathogen, and the most common central nervous system manifestation is meningitis while listerial brain abscesses are rare. We describe 2 cases of brain abscess due to LM and a literature review. Only 73 cases were reported in the literature from 1968 to 2017. The mean age was 51.9, and the mortality rate was 27.3%. In 19% of cases, no risk factors for neurolisteriosis were identified. Blood cultures were positive in 79.5% while CSF or brain abscess biopsy material was positive in 50.8%. In 40% was started a monotherapy regimen while in 60% a combination therapy without substantial differences in mortality. Fifty-two percent underwent neurosurgery while 45.3% has been treated only with medical therapy. The mortality rates were, respectively, 13% and 38.2%. Only 25% of patients who were treated for ≤6 weeks underwent neurosurgery, while 80% of those who were treated for ≥8 weeks were operated. The mortality rates were, respectively, 12.5% and 0%, suggesting that a combined approach of surgery and prolonged medical therapy would have an impact on mortality. We believe that it is essential to carry out this review as brain abscesses are rare, and there are no definitive indications on the optimal management, type, and duration of therapy.
Case Report: Low Hematocrit Leading to Tacrolimus Toxicity
Authors: Alexandre Piletta-Zanin, Aurélie De Mul, Nathalie Rock, Pierre Lescuyer, Caroline F Samer, Frédérique Rodieux
Journal: Front Pharmacol (2021)
Keywords: abcb1, hematocrit, monitoring, pharmacogenetic, pharmacokinetic, subtherapeutic, tacrolimus, toxicity
MeSH terms: Case Reports

Tacrolimus is a calcineurin inhibitor characterized by a narrow therapeutic index and high intra- and inter-individual pharmacokinetic variability. Therapeutic drug monitoring in whole-blood is the standard monitoring procedure. However, tacrolimus extensively binds to erythrocytes, and tacrolimus whole-blood distribution and whole-blood trough concentrations are strongly affected by hematocrit. High whole-blood tacrolimus concentrations at low hematocrit may result in high unbound plasma concentrations and increased toxicity. We present the case of a 16-year-old girl with kidney and liver transplant in whom low concentrations of tacrolimus in the context of low hematocrit led to significant increase in the dosage of tacrolimus and participate, along with a genetic polymorphism of ABCB1, in nephrotoxicity.
Coexistence of anomalous muscle, persistent median artery, bifid median nerve causing carpal tunnel syndrome: A case report and literature review
Authors: Jun Qin, Xia-Xian Tan, Ming-Qiang Xue, Jing-Wei Wang, Jin-Min Zhao, Ke Sha
Journal: Front Pediatr (2023)
Keywords: abnormal lumbrical muscle, bifid median nerves, case report, juvenile carpal tunnel syndrome, persistent median artery, treatment
MeSH terms: Case Reports

Carpal tunnel syndrome (CTS) is an upper extremity median nerve entrapment disorder that is rare in children and adolescents. Anatomical variations of the wrist, such as anomalous muscles, persistent median artery (PMA), and bifid median nerves (BMN), are rare etiology of CTS. Coexistence of all three variants combined with CTS in adolescents has been rarely reported. Case description: A 16-year-old right-hand dominant male presented to our clinic with several years of bilateral thenar muscle atrophy and weakness but no paresthesia or pain in his both hands. Ultrasonography showed that the right median nerve become significantly thinner, and the left median nerve was split into two branches by PMA. Magnetic resonance imaging (MRI) revealed that anomalous muscles in the bilateral wrist extending to the carpal tunnel, causing compression of the median nerve. Considering the possibility of CTS clinically, the patient underwent bilateral open carpal tunnel release without resection of anomalous muscles and PMA. The patient has no discomfort after 2 years. This suggests that anatomical variations of the carpal tunnel may contribute to CTS, which can be confirmed by preoperative ultrasonography and MRI, and the possibility of carpal tunnel anatomical variations should be considered when CTS occurs in adolescents. Open carpal tunnel release is an effective treatment for juvenile CTS without the need to resect abnormal muscle and PMA during the operation.
Wide Resection and Iliac Crest Arthrodesis for Multiply Recurrent Giant Cell Tumor of First Metatarsal
Authors: Andrew Golz, Michael Murphy, Lukas Nystrom, Adam Schiff
Journal: Case Rep Orthop (2018)
MeSH terms: Case Reports

Case:
Giant cell tumor of bone is a benign, aggressive neoplasm commonly arising in the femur, tibia, and distal radius and less commonly in the hands and feet. We describe a 22-year-old woman who underwent wide resection of multiply recurrent first metatarsal giant cell tumor and reconstruction with iliac crest arthrodesis.
Conclusion:
To our knowledge, there have been no previous reports of managing multiply recurrent giant cell tumor of the first metatarsal. The patient was without pain and exercising without difficulty 18 months following surgery. This method appears useful for reconstructing the foot following multiply recurrent giant cell tumor of the metatarsal.
Case report: Laryngospasm following ethanol ablation of a parathyroid nodule in a dog with primary hyperparathyroidism
Authors: Kaitlyn Rank, Alex M Lynch, Randolph Green, Leslie Reed-Jones, Karyn Harrell, Yu Ueda
Journal: Front Vet Sci (2023)
Keywords: ethanol ablation, hyperparathyroidism, hypocalcemia, iatrogenic, laryngospasm
MeSH terms: Case Reports

A 12-year-old female spayed dachshund was presented for emergency assessment of respiratory distress, characterized by inspiratory dyspnea with stridor. Percutaneous ultrasound-guided ethanol ablation of a functional parathyroid tumor was performed 72-h earlier for management of primary hyperparathyroidism. The dog was hypocalcemic (ionized calcium 0.7 mmol/L, reference interval: 0.9-1.3 mmol/L) at the time of presentation and had evidence of laryngospasm on a sedated oral exam. The dog was managed conservatively with supplemental oxygen, anxiolysis, and parenteral calcium administration. These interventions were associated with rapid and sustained improvement in clinical signs. The dog did not demonstrate any recurrence of signs afterwards. To the authors' knowledge, this is the first description of laryngospasm following ethanol ablation of a parathyroid nodule in a dog that developed hypocalcemia.
Intussusception Related to Small Intestinal Lipomas: A Case Report and Review of the Literature
Authors: Qiang Hu, Jinfeng Wu, Yuanshui Sun
Journal: Front Surg (2022)
Keywords: abdominal pain, case report, intussusception, small intestinal lipoma, surgery
MeSH terms: Case Reports

Introduction:
Adult intussusception is a rare disease that is difficult to diagnose and treat and is even rarer when it is caused by a lipoma of the small intestine. We reported a case of a small intestine lipoma combined with intussusception, which can guide people in future clinical work.
Case presentation:
A 51-year-old female was admitted to the hospital with "abdominal pain for 1 month." Enhanced computed tomography (CT) of the abdomen suggested a lipoma in the left lower quadrant and a proximal intussusception. After excluding surgical contraindications, laparoscopic exploration was performed on the second day of admission, which showed a small amount of ascites in the abdominal cavity, a small intestine-small intestine-type intussusception about 20 cm from the ileocecal area and about 140 cm from the ileocecal area, and a mass of about 2×4 cm that was palpable by laparoscopic intestinal forceps, which was protruded into the intestinal cavity with a soft texture and sound mobility. A 5 cm-long incision was made above the mass to dissect into the abdomen layer by layer, and the diseased intestine was dislodged outside the abdominal cavity with oval forceps. The intestine was reduced by hand and observed for half an hour after reduction, and the blood circulation and peristalsis of the intestine were observed to be still sound. The intestine was dissected at 2 cm from the upper and lower margins of the mass using linear anastomosis to operate small intestine side-to-side anastomosis. The intestine was opened concurrently and closed with a linear anastomosis, using 3-0 absorbable thread to reinforce anastomosis intermittently. The procedure went smoothly, and the patient was discharged on the 5th postoperative day.
Conclusion:
A small intestinal lipoma combined with small intestinal intussusception is rare in clinical practice and needs to be diagnosed by asking history detailedly, physical examination, and relevant ancillary tests such as abdominal CT. Laparoscopic-assisted small incision surgery for adult intussusception combines the advantages of laparoscopic surgery and laparotomy, operating simply and easily.
Palpable Abdominal Mass is a Renal Oncocytoma: Not All Large Renal Masses are Malignant
Authors: Sumi Dey, Sabrina L Noyes, Ghayas Uddin, Brian R Lane
Journal: Case Rep Urol (2019)
MeSH terms: Case Reports

A 59-year-old woman presented with abdominal pain and a palpable abdominal mass. Initial imaging revealed a 14cm solid, enhancing renal mass and suspicion for liver and bone metastases. Family history included a brother with clear cell renal cell carcinoma and mother with glioblastoma multiforme. After liver biopsy was inconclusive, she underwent radical nephrectomy with final pathologic diagnosis of oncocytoma. Renal oncocytoma is the most common benign renal tumor but remains difficult to distinguish clinically and radiographically from renal cell carcinoma. Should urologists use renal mass biopsy even more frequently prior to surgical intervention?
A Unique Case of Melorheostosis Presenting with Two Radiologically Distinct Lesions in the Shoulder
Authors: Ahmed A Elsheikh, Rohan S Pinto, Alpesh Mistry, Simon P Frostick
Journal: Case Rep Orthop (2017)
MeSH terms: Case Reports

Melorheostosis is a rare, nonhereditary, benign, mesenchymal condition of unknown aetiology affecting the bones and surrounding tissues. A male patient complaining of left shoulder pain, swelling, and mildly limited range of motion has an exclusive combination of the classic dripping wax lesion in the scapula and the myositis ossificans-like lesion in the deltoid muscle; this combination is the first to be reported in the shoulder. Both lesions showed typical findings of melorheostosis in radiographs, CT, MRI, and bone scan. This case has a stationary course over the follow-up period, and no specific treatment is needed in due course.
Lymphoid Interstitial Pneumonia in Common Variable Immune Deficiency - Case Report With Disease Monitoring in Various Therapeutic Options: Pleiotropic Effects of Rituximab Regimens
Authors: Przemyslaw Zdziarski, Andrzej Gamian
Journal: Front Pharmacol (2019)
Keywords: foxp3+ regulatory t cells (treg), common variable immune deficiency (cvid), immune dysregulation, lymphoid interstitial pneumonia (lip), lymphoproliferative disease (lpd), natural killer (nk) natural killer t-cells (nkt), rituximab, innate immune response

Lymphoid interstitial pneumonia (LIP) is a rare lymphoproliferative disease. LIP in common variable immunodeficiency (CVID) was observed in a patient during immunomodulatory therapy after progression of the disease (i.e., glucocorticoids, immunoglobulin dose escalation, and finally rituximab). Due to humoral immunodeficiency and serious serum sickness rituximab was used initially at a low dose (150 mg/m2 weekly). It resulted in temporary remission with the decrease of serum paraproteinemia, β2-microglobulin (β2M) and SUV decrease as well as increase of FVC. Owing to the relapse after 6-month remission in the second cycle a standard dose of rituximab was used (375 mg/m2). Therapeutic regimen with 375 mg/m2 of Rtx in optimal schedule (i.e., every 3 weeks) resulted in no longer remission but higher incidence of opportunistic infections. Finally, after another cycle of immunotherapy FVC, paraproteinemia and β2M level normalization were observed as well as the decrease of severe splenomegaly. In laboratory and immunological progress the increase of NK and NKT cells was observed after the initial dose but the standard one caused NK cell increase only. Unfortunately, the decrease of CD19+Bcells was comparable between both doses, as was the decline of FoxP3+ regulatory T cell. On the contrary, after the low dose absolute T cell (both CD4 and CD8) number decreased but after the standard one - it normalized. Rtx (especially in low dose) brought further increase of persistent T cell activation (CD38+ T cells made up 79%). Innate immune response and the decrease of Treg are a compensatory pathways for the decrease of B and T cells. Immunodeficiency requires a different investigative approach to a immunotherapy. Clinical Trial Registration: ClinicalTrials.gov, NCT02789397.
Acquired Hemophilia A Presenting as Intramuscular Hematoma
Authors: Ghassan Al-Shbool, Anusha Vakiti
Journal: J Investig Med High Impact Case Rep (2018)
Keywords: obizur, acquired hemophilia a, bleeding disorder, cyclophosphamide, rituximab
MeSH terms: Factor VIII / therapeutic use, Factor VIIa / therapeutic use, Hematoma / blood, Hemophilia A / blood, Case Reports, Aged, Antibodies, Monoclonal, Murine-Derived / therapeutic use, Cyclophosphamide, Drug Therapy, Combination, Female, Hematoma / complications, Hemophilia A / complications, Hemophilia A / drug therapy, Humans, Partial Thromboplastin Time, Rituximab, Antibodies, Monoclonal, Murine-Derived, Rituximab, Cyclophosphamide, Factor VIII, Factor VIIa, Factor 8 deficiency, acquired

Acquired hemophilia A poses a clinical and diagnostic challenge. Although rare, it is still the most common acquired factor deficiency. We present a case of acquired hemophilia A diagnosed in a 71-year-old female who presented with a right thigh hematoma of acute onset. The diagnosis was established based on the coagulation profile along with factor VIII levels, mixing studies, and inhibitor levels. The patient received multiple lines of therapy including steroids, factor VIIa, Obizur (porcine-derived recombinant factor VIII), followed by multiple cycles of chemotherapy including cyclophosphamide and rituximab.
Rectovaginal Fistula as a Complication of Fecal Management System
Authors: Emily Butts, Sandeep Anand Padala, Anusha Vakiti, Vamsi Kota
Journal: J Investig Med High Impact Case Rep (2019)
Keywords: fecal incontinence, fecal management system, intrarectal catheter, rectovaginal fistula, veno-occlusive disease
MeSH terms: Catheters / adverse effects, Rectovaginal Fistula / etiology, Rectum, Case Reports, Adolescent, Catheterization / adverse effects, Fatal Outcome, Female, Graft Rejection / complications, Hematopoietic Stem Cell Transplantation / adverse effects, Humans, Multiple Organ Failure / etiology, Multiple Organ Failure / therapy, Precursor T-Cell Lymphoblastic Leukemia-Lymphoma / complications, Precursor T-Cell Lymphoblastic Leukemia-Lymphoma / therapy

We report a rare complication of the use of an intrarectal catheter. An 18-year-old female with T-cell acute lymphoblastic leukemia post-matched unrelated donor allogeneic stem cell transplantation (auto-SCT) developed hepatic encephalopathy secondary to hepatic sinusoidal obstructive disease. A fecal management system was used to contain and divert fecal matter in this immobilized patient. Approximately 1 month after placement of an intrarectal catheter, stool was noted in the vaginal vault. Speculum examination confirmed development of a rectovaginal fistula.
A complex presentation of an uncommon disease: Gas-forming pyogenic liver abscess complicated by septic pulmonary emboli and muscle abscesses, a case report and review of the literature
Authors: Aseel H Alzibdeh, Ans A Alamami, Mohammad Adam, Muna Almaslamani, Hamad Abdel Hadi
Journal: IDCases (2022)
Keywords: alt, alanine aminotransferase, ast, aspartate transaminase, ctpa, computed tomography pulmonary angiogram, dm, gfpla, gas-forming pyogenic liver abscess, gas forming, hiv, human immunodeficiency virus, hba1c, glycated hemoglobin, klebsiella, liver abscess, pla, pyogenic liver abscess, septic emboli
MeSH terms: Case Reports

Background:
Pyogenic liver abscess (PLA) is the most common type of visceral abscess. Its variable clinical presentation depends on patient demography, underlying conditions, causative pathogens as well as the size of the abscess. Most cases are secondary to enteric pathogens that cause focal liver disease. Gas-forming pyogenic liver abscess (GFPLA) is a rare subgroup of PLA characterized by the presence of gas within the abscess. The disease is associated with diabetes mellitus (DM) while Klebsiella penumoniae is the most frequently isolated pathogen. Despite appropriate evaluation and management, secondary complications are common with significant morbidity and mortality that necessitate prompt recognition and management.
Case presentation:
We present a case of a 46-year-old gentleman from Bangladesh who presented to the emergency department with fever, chills, and right upper quadrant abdominal discomfort. Evaluation revealed elevated inflammatory markers with high blood glucose and a subdiaphragmatic lucency on a plain chest radiograph. The suspected underlying visceral infection was confirmed by abdominal ultrasonography and computed tomography which demonstrated an emphysematous abscess of 8 cm in diameter in the right liver lobe.Because of clinical instability, the patient was admitted to the medical intensive care unit (MICU) where he received appropriate supportive management with antimicrobials and percutaneous drainage of the abscess. Cultures collected from blood, the abscess, and urine grew a sensitive strain of Klebsiella pneumoniae. During his stay in the MICU, he complained of dyspnea. A CT pulmonary angiography was suggestive of septic emboli. A few days later, the patient started to complain of left gluteal pain and an US revealed a deep left gluteal abscess which required drainage. Cultures of the pus grew the same sensitive strain of Klebsiella pneumoniae. After receiving 6 weeks of parenteral antimicrobial therapy a repeated US revealed complete resolution of the abscess in the liver. Outpatient follow up showed favorable recovery.
Conclusion:
Gas-forming pyogenic liver abscess (GFPLA) is a rare manifestation of pyogenic liver abscess that usually occurs in patients with poorly controlled DM. Despite appropriate evaluation, morbidity remains high therefore timely recognition and anticipation of complications is important.
Unusual Case of Malignant Struma Ovarii and Cervical Thyroid Cancer Preceded by Ovarian Teratoma: Case Report and Review of the Literature
Authors: Elias G Tzelepis, Elena Barengolts, Steven Garzon, Joseph Shulan, Yuval Eisenberg
Journal: Case Rep Endocrinol (2019)
MeSH terms: Case Reports

Objective:
To present a rare case of malignant struma ovarii (MSO) and synchronous thyroid cancer, review the medical literature, and present the latest trends in management.
Methods:
The case of a woman with MSO and concomitant thyroid cancer is presented, including clinical presentation, treatment, and follow-up care. A search of the English-language literature was conducted using MEDLINE and Google Scholar data bases.
Results:
We found 10 publications (one abstract) describing 10 patients with MSO and concomitant thyroid cancer. Six additional patients were reported by a study that analyzed the SEER (cancer registry) database. The median age of women was 42 years, with the majority of them presenting with abdominal symptoms. Histologically, most tumors were papillary carcinomas in both organs. In 5 patients, there was extrathyroidal tumor extension at time of surgery.
Conclusion:
MSO can occasionally coexist with highly aggressive eutopic thyroid cancer. Although this concurrence is even rarer than MSO, clinicians should routinely investigate for possible synchronous thyroid cancer in all cases of MSO and also consider aggressive postoperative treatment including thyroidectomy and radioiodine ablation therapy in cases of MSO.
Lenalidomide-Associated Immune Thrombocytopenia: A Case Report and Review of the Literature
Authors: William Forehand Iii, Germame Ajebo, Michael Toscano, Anand Jillella, Paul Dainer
Journal: Case Rep Hematol (2020)
MeSH terms: Case Reports

Lenalidomide is indicated in the front-line management of multiple myeloma. More recently, it has been introduced for use in treating other hematologic malignancies. Although the drug is known to cause myelosuppression, there have been rare reports of lenalidomide-associated immune thrombocytopenia (ITP). Here, we review the literature on lenalidomide-associated ITP and report upon a 59-year-old man who was administered lenalidomide due to concern of progressive multiple myeloma more than a year following his having undergone an autologous hematopoietic stem cell transplant. His platelet count precipitously declined and lead to his hospitalization. Despite our withholding of the drug, he did not respond to platelet transfusions or administration of corticosteroids. He was successfully managed with intermittent immune globulin for several months before definitive treatment with splenectomy, which resulted in the complete resolution of his thrombocytopenia. A literature search identified a total of six additional cases of lenalidomide-associated ITP. Similarly, many of the reported cases were associated with persistent thrombocytopenia after discontinuation of the drug. Furthermore, these patients were generally managed successfully with standard ITP therapies, such as corticosteroids or intravenous immune globulin.
Neuroblastoma of the lumbosacral canal in an adult: a case report and literature review
Authors: Qingyu Jiang, Haihao Gao, Gan Gao, Yang Li, Haofeng Cheng, Guoliang Shi, Aijia Shang
Journal: Front Neurol (2023)
Keywords: lumbosacral canal, neuroblastoma, neurological deficits, surgery, tumor
MeSH terms: Case Reports

Neuroblastoma (NB) is a leading cause of death in children. It usually occurs in the adrenal gland and rarely in the spinal canal. Here, we report the case of a 48-year-old male patient with abnormal thickening of the cauda equina nerve as revealed by lumbosacral magnetic resonance imaging. The patient's main clinical manifestations were numbness and pain in both lower limbs. The patient underwent surgical treatment; however, intraoperatively, an unclear border was observed between the cauda equina nerve and the tumor; therefore, the tumor was not forcibly excised. The postoperative pathological results were reported as NB. The disease known as NB, which is extremely rare. We believe that a pathological biopsy is extremely vital for diagnosing NB, and aggressive post-operative radio-chemotherapy could potentially prolong the patient's survival time.
Melioidosis with Septic Shock and Disseminated Infection in a Neutropenic Patient Receiving Chemotherapy
Authors: Sitthi Sukauichai, Chantana Pattarowas
Journal: Case Rep Infect Dis (2020)
MeSH terms: Case Reports

Melioidosis is a bacterial infection, caused by Gram-negative bacillus, Burkholderia pseudomallei, widespread in Southeast Asia and the northern part of Australia, resulting in a high mortality rate in severe infection. However, it has rarely been reported in patients with chemotherapy-induced neutropenia. The authors described a case of melioidosis in a neutropenic patient presenting with septic shock after receiving chemotherapy. Blood and urine cultures were positive for Burkholderia pseudomallei, and CT scan showed multiple pulmonary nodules and hepatosplenic abscesses. The patient was successfully treated with antibiotics for the infection and with combined modalities for a malignancy.