OpenMed/multicare-articles huggingface dataset:
Case report: Early onset de novo FSGS in a child after kidney transplantation-a successful treatment
Authors: Karla Carvajal Abreu, Sebastian Loos, Lutz Fischer, Lars Pape, Thorsten Wiech, Markus J Kemper, Burkhard Tönshoff, Jun Oh, Raphael Schild
Journal: Front Pediatr (2023)
Keywords: de novo focal segmental glomerulosclerosis, kidney transplant, pediatric donor, plasmapharesis, proteinuria
MeSH terms: Case Reports

Background:
Early onset de novo focal segmental glomerular sclerosis (FSGS) in the kidney allograft in patients without FSGS in the native kidney is a rare disorder in children. It usually occurs mostly beyond the first year after kidney transplantation and often leads to graft loss. Standardized treatment protocols have not yet been established.
Case description:
We describe a boy with early onset de novo FSGS in the transplanted kidney and non-selective glomerular proteinuria (maximum albumin-to-creatinine ratio of 3.8 g/g; normal range, ≤0.03 g/g creatinine). Manifestation occurred at 30 days posttransplant and was accompanied by a significant graft dysfunction (eGFR 61 ml/min per 1.73 m2). Treatment with 25 sessions of plasmapheresis over 14 weeks and three consecutive days of methylprednisolone pulse therapy (10 mg/kg per day) followed by oral prednisolone as rejection prophylaxis (3.73 mg/m2 per day) led to sustained remission of proteinuria (albumin-to-creatinine ratio of 0.028 g/g) and normalization of graft function (eGFR 92 ml/min per 1.73 m2) after 14 weeks. The follow-up period was 36 months.
Conclusions:
This case underlines the efficacy of immunosuppressive and antibody eliminating therapy in early onset de novo FSGS after kidney transplantation.
Case report: Atypical case of autoimmune glial fibrillary acidic protein astrocytopathy following COVID-19 vaccination refractory to immunosuppressive treatments
Authors: Yuto Morishima, Takanori Hata, Sho Nakajima, Kazumasa Shindo, Mai Tsuchiya, Tsubasa Watanabe, Ippei Tahara, Tetsuo Kondo, Akio Kimura, Takayoshi Shimohata, Yuji Ueno
Journal: Front Immunol (2024)
Keywords: covid-19 vaccination, gfap-astrocytopathy, anti-gfap antibody, autoimmune encephalitis, immunosuppressive treatments
MeSH terms: COVID-19 / immunology, Glial Fibrillary Acidic Protein / immunology, SARS-CoV-2 / immunology, Case Reports, Research Support, Non-U.S. Gov't, Astrocytes / immunology, Astrocytes / pathology, Autoantibodies / blood, Autoantibodies / immunology, Brain / diagnostic imaging, Brain / pathology, COVID-19 Vaccines / adverse effects, COVID-19 Vaccines / immunology, Humans, Immunosuppressive Agents / adverse effects, Immunosuppressive Agents / therapeutic use, Male, Middle Aged, Vaccination / adverse effects, Glial Fibrillary Acidic Protein, GFAP protein, human, Immunosuppressive Agents, COVID-19 Vaccines, Autoantibodies

A 54-year-old Japanese man presented with headache and fever the day after SARS-CoV-2 vaccination. He became deeply unconscious within a week. Brain MRI showed periventricular linear enhancements and a few spotty lesions in the cerebral white matter. Cerebrospinal fluid (CSF) testing showed mild pleocytosis. He was treated with intravenous methylprednisolone and plasma exchange. However, the white matter lesions enlarged to involve the brainstem and cerebellum, and long cord spinal lesions appeared. Anti-glial fibrillary acidic protein (GFAP) antibody was positive in the CSF and serum, and he was therefore diagnosed as autoimmune GFAP-astrocytopathy (GFAP-A). In addition, high-dose immunoglobulin therapy was administered twice, but his symptoms did not improve; the white matter lesions enlarged further, and modified Rankin Scale score increased to 5. A brain biopsy specimen showed infiltration of macrophages and CD4 + lymphocytes together with neuron and oligodendrocytic injuries and glial scar. Although GFAP-A generally responds well to steroids, the present case developed GFAP-A following SARS-CoV-2 vaccination, with refractory to intensive immunosuppressive therapy and atypical pathologic findings of infiltration of CD4 + lymphocytes and demyelination.
Giant Ganglioneuroma of the Lumbar Spine: A Rare Cause of Radiculopathy
Authors: Lina Altalhi, Abdulaziz Alayyaf, Mohammed Bin-Mahfooz, Duaa Alhumoudi, Ali Alkhaibary, Fahd AlSufiani, Ali H Alassiri, Saad AlQahatani, Sami Khairy, Ahmed Alkhani
Journal: Case Rep Surg (2024)
MeSH terms: Case Reports

Background:
Ganglioneuroma (GN) is a rare, benign tumor that originates from neural crest cells and can potentially affect any anatomical site within the sympathetic nervous system. Typically, GNs are more frequently reported in children and young adults, with a slightly higher prevalence in females. We are reporting a rare case of a giant lumbar spine ganglioneuroma by outlining the clinical presentation, radiological finding, management, and outcome. Case Description. A 37-year-old female presented with low back pain radiating to the right lower limb for few years. Neurological examination revealed bilateral lower limb hyperreflexia (+3). Lumbar spine CT and MRI revealed a right paravertebral soft tissue lesion with heterogeneous signal intensity and enhancement at L1 to L3. The patient underwent complete resection of the lesion via a retroperitoneal approach. The surgery was uneventful. The histopathological sections were suggestive of mature ganglioneuroma. She was discharged in stable condition with follow-up at neurosurgery clinic.
Conclusion:
Giant ganglioneuromas are rare, benign tumors of sympathetic neurons. Complete surgical resection is the most effective therapeutic option for ganglioneuroma to avoid recurrence. Given the benign nature of ganglioneuroma, chemotherapy and radiotherapy tend to have a limited role following surgical resection.
The Implications of Double Human Chorionic Gonadotropin (hCG) Trigger on a Pseudo-Empty Follicle Syndrome Patient Seeking Infertility Treatment Through Assisted Reproductive Technology (ART)
Authors: Ritesh Jadhav, Akash More, Shilpa Dutta, Namrata Anjankar, Jarul Shrivastava
Journal: Cureus (2024)
Keywords: double hcg trigger, empty follicle syndrome, in vitro fertilization, infertility treatment, oocyte retrieval
MeSH terms: Case Reports

In the field of assisted reproductive technology (ART), empty follicle syndrome (EFS) is a known condition in which no oocytes are found despite adequate follicular development, which leads to a troublesome situation for patients seeking infertility treatment. In this case study, an EFS patient seeking treatment for infertility at an in vitro fertilization (IVF) clinic was examined to determine the effects of employing a double human chorionic gonadotropin (hCG) trigger. The final oocyte maturation and retrieval are induced by using the double hCG trigger, which includes giving two doses of hCG. In this particular patient, the study looks at the results of follicular development, oocyte retrieval, fertilization rates, embryo quality, and pregnancy rates. The conclusion provides information on how well the double hCG trigger affects treatment outcomes for EFS patients. According to the results of this case study, the two-stage hCG trigger procedure is suggested to enhance the results of oocyte retrieval in the uncategorized EFS patient. In all cycles after the procedural change, the double trigger's application led to effective oocyte maturation and retrieval. The study also showed that the double hCG trigger procedure had no negative consequences on patient safety or ovarian response. There were also no signs of ovarian hyperstimulation syndrome (OHSS) or any other problems. Due to the higher likelihood of oocyte retrieval, the patient also reported better emotional health and less anxiety during subsequent treatment cycles. The positive result of this case study demonstrates the potential advantages of a double hCG trigger procedure in pseudo-EFS patients receiving IVF treatment. When handling EFS cases, this modified strategy may be used as a potential answer by infertility clinics. The effectiveness and safety of the double hCG trigger procedure still need to be confirmed by doing randomized controlled trials on larger populations in order to validate the result.
Case Report: Omadacycline in the treatment of macrolide-unresponsive Mycoplasma pneumoniae pneumonia in an adolescent patient
Authors: Limin Xu, Changquan Fang
Journal: Front Cell Infect Microbiol (2023)
Keywords: mycoplasma pneumoniae pneumonia, bronchoalveolar lavage fluid, macrolide, metagenomic next-generation sequencing, omadacycline
MeSH terms: Community-Acquired Infections / drug therapy, Community-Acquired Infections / microbiology, Pneumonia, Mycoplasma / drug therapy, Case Reports, Adolescent, Adult, Anti-Bacterial Agents / adverse effects, Child, Drug Resistance, Bacterial, Humans, Macrolides, Mycoplasma pneumoniae, Tetracyclines / pharmacology, Tetracyclines / therapeutic use, Macrolides, omadacycline, Anti-Bacterial Agents, Tetracyclines

Omadacycline is a novel tetracycline antibiotic that exhibits good in vitro antibacterial activity against atypical pathogens such as Mycoplasma pneumoniae. It is approved for the treatment of adults with community-acquired bacterial pneumonia. However, the safety and efficacy of omadacycline in pediatric patients under 18 years of age have not yet been established. In the present paper, we report a case of pediatric community-acquired pneumonia in which initial empirical anti-infective therapy had failed. The patient received empirical anti-infective therapy with azithromycin and other antimicrobial agents upon admission but showed a poor clinical response and developed secondary tinnitus and liver dysfunction. After the confirmation of M. pneumoniae infection through metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid, an antibiotic switch to omadacycline was made. Thereafter, the patient's condition improved, and no adverse reactions were observed. These findings demonstrate that mNGS enables the identification of infection-causing pathogens in patients with unresponsive pneumonia. Omadacycline can be considered as an alternative option for anti-infective therapy in pediatric M. pneumoniae pneumonia, especially when the presence of bacterial resistance, adverse drug reactions, or organ failure are taken into consideration.
Case Report: Mepolizumab in the treatment of idiopathic chronic eosinophilic pneumonia
Authors: Selsabil Daboussi, Samia Essebaa, Samira Mhamdi, Chiraz Aichaouia, Ghedira Hela, Aida Ayadi, Moetemri Zied
Journal: F1000Res (2023)
Keywords: corticosteroid, idiopathic chronic eosinophilic pneumonia, mepolizumab, treatment
MeSH terms: Drug-Related Side Effects and Adverse Reactions, Pulmonary Eosinophilia / drug therapy, Case Reports, Adult, Antibodies, Monoclonal, Humanized / therapeutic use, Humans, Young Adult, mepolizumab, Antibodies, Monoclonal, Humanized, Carrington syndrome

Idiopathic chronic eosinophilic pneumonia (ICEP) is a rare interstitial lung disease of unknown cause. It usually responds well to systemic corticosteroid therapy, but relapses are frequent. We describe two cases of 21- and 27-year-old patients, presenting with dyspnea. The diagnosis of steroid-relapsing and steroid-dependent ICEP was made respectively. Mepolizumab was prescribed to both patients. This treatment resulted in successful long-term disease management with much fewer side effects than a traditional corticosteroid therapy.
Acral lentiginous melanoma with multiple bone metastasis: case report
Authors: Pei Ting Chen, Kapilkumar Manvar, Rashid Chaudhry, Richard Wu, Jen Chin Wang
Journal: Pan Afr Med J (2023)
Keywords: acral lentiginous melanoma, bone metastasis, case report, cutaneous melanoma
MeSH terms: Bone Neoplasms / diagnosis, Bone Neoplasms / pathology, Melanoma / pathology, Skin Neoplasms / pathology, Case Reports, Aged, 80 and over, Foot / pathology, Humans, Male, Melanoma, Cutaneous Malignant, Skin / pathology

Acral lentiginous melanoma (ALM) is a type of melanoma that is traditionally seen on the soles of the feet, palms of the hand, and under the fingernails or toenails. It is the least frequently diagnosed melanoma among the four histologic subtypes of cutaneous melanoma, accounting for less than 5% of all cases. ALM is frequently diagnosed at late stages and has higher incidences in non-white populations in relation to the other forms of cutaneous malignant melanoma. The most common sites of metastases in melanoma are the skin and subcutaneous tissue followed by lung, liver, brain, and bone. Bone metastases from malignant melanoma usually occur in patients who already have widespread metastases. We present this paper as a unique case study of ALM lesion in an 84-year-old African American male presenting originally in the base of right fifth toe plantar aspect then found multiple bone metastases without any other organ involved.
A novel homozygous variant in SLC25A46 gene associated with pontocerebellar hypoplasia type 1E: a case report
Authors: Adrien Guillaume, Vojtech Stejskal, Guillaume Smits, Dorottya Kelen
Journal: Front Pediatr (2024)
Keywords: slc25a46, clinical diagnosis, neonatal encephalopathy, pontocerebellar hypoplasia type 1e, therapeutic strategies
MeSH terms: Case Reports

Neonatal encephalopathy (NE) is a complex clinical condition with diverse etiologies. Hypoxic-ischemic encephalopathy (HIE) is a major contributor to NE cases. However, distinguishing NE subtypes, such as pontocerebellar hypoplasia type 1E (PCH1E), from HIE can be challenging due to overlapping clinical features. Here, we present a case of PCH1E in a neonate with a homozygous mutation c.72delT p. (Phe24LeufsTer20) in the SLC25A46 gene. The severity of PCH1E associated NE highlighted the significance of early recognition to guide appropriate clinical management.
Thoracic Erector Spinae Plane (T-ESP) Block Together With Intertransverse Process (ITP) Block for Laparoscopic Abdominal Surgery: A Case Report
Authors: Carmine Pullano, Francesco Marrone, Saverio Paventi, Lorenzo Forasassi, Roberto Starnari
Journal: Cureus (2024)
Keywords: intertransverse process block, laparoscopic surgery, superior costotransverse ligament, thoracic erector spinae block, thoracic paravertebral space block, truncal blocks
MeSH terms: Case Reports

Laparoscopy has become a milestone with reduced surgical stress and postoperative pain. Evidence promotes erector spinae block for laparoscopic abdominal surgery, in particular for cholecystectomy. The thoracic paravertebral space block is the administration of local anesthetic into a wedge-shaped space on the antero-lateral thoracic spine and provides abdominal analgesia. We hypothesized that a combination of two paravertebral by proxy blocks (erector spinae and intertransverse process (ITP)) with multi-dermatomeric coverage and visceral pain control, with evidence for intra- and postoperative analgesia in thoracic and abdominal surgeries, may be a surgical anesthesia option for laparoscopy. A 42-year-old patient with gastroesophageal reflux disease (GERD) was scheduled for a laparoscopic Nissen fundoplication. He was 173 cm in height and weighed 90 kg (BMI 30 kg.m-2) and was classified in the American Society of Anesthesiologists Physical Status Classification System (ASA-PS) as 2. He had a history of difficult airway and refused general anesthesia. With the patient's informed written consent, we performed a bilateral thoracic erector spinae plane (T-ESP)/ITP blocks at the T4-8 level. Surgery was performed with the patient spontaneously breathing under sedation without complications. Hence, the combination of ESP-ITP blocks was a good anesthesia option for the planned surgery without side effects and optimal postoperative pain control.
Effects of inhaled beclomethasone dipropionate/formoterol fumarate/glycopyrronium on diaphragmatic workload and lung function in uncontrolled asthma: a case report
Authors: Antonio Maiorano, Chiara Lupia, Nicola Montenegro, Giuseppe Neri, Andrea Bruni, Eugenio Garofalo, Federico Longhini, Claudia Crimi, Angelantonio Maglio, Alessandro Vatrella, Girolamo Pelaia, Corrado Pelaia
Journal: Front Med (Lausanne) (2024)
Keywords: acq-5, asthma, diaphragmatic ultrasound, thickening fraction, triple inhaled therapy
MeSH terms: Case Reports

Beclomethasone dipropionate/formoterol fumarate/glycopyrronium (BDP/FF/G) single inhaler extrafine triple therapy is effective for the treatment of uncontrolled asthma. Nevertheless, there is a lack of data about the use of diaphragmatic ultrasonography to monitor adult asthmatics while they are receiving inhaled treatment. We took into consideration a 78-year-old woman complaining of asthma, treated with inhaled corticosteroid/long-acting β2-adrenergic agonist (ICS/LABA), characterized by an asthma control questionnaire-5 (ACQ-5) score and a lung function test suggestive of uncontrolled asthma. Moreover, a diaphragmatic ultrasound showed signs of high diaphragm workload. Because of these findings, we proposed to our patient a shift toward triple inhaled therapy with BDP/FF/G, and she underwent a second evaluation after 7 days of treatment. Improvements in the diaphragmatic ultrasound parameters, lung function test, and ACQ-5 score were found. In particular, we detected a reduction of thickening fraction (TF), and a normalization of the other diaphragmatic measures, indicative of a decrease in diaphragmatic workload. To our knowledge, this is the first literature report showing concomitant improvements of both lung function tests and diaphragmatic ultrasonography parameters, observed in an adult patient with uncontrolled asthma after short-term treatment with the single inhaler triple therapy BDP/FF/G.
Case report: Unilateral papilledema in a dog with a large suprasellar mass and suspected intracranial hypertension: insights from funduscopy, optical coherence tomography, and magnetic resonance imaging
Authors: Heejong Cho, Mihyun Choi, Sukjong Yoo, Manbok Jeong, Shin Ae Park
Journal: Front Vet Sci (2024)
Keywords: bruch’s membrane, brain tumors, canine, optic disk edema, optic nerve head, sellar mass
MeSH terms: Case Reports

A spayed, 8-year-old female Poodle, weighing 5.7 kg, was presented with the chief complaint of vision impairment. Vision assessment, including pupillary light reflexes, menace response, dazzle reflex, and maze navigation in photopic and scotopic circumstances, revealed a negative response in both eyes except for positive direct pupillary light reflex in the right eye and positive consensual pupillary light reflex from the right eye to the left eye. Systemic evaluation, including neurologic status, blood profile, and thoracic radiographs, did not reveal any abnormalities. Complete ophthalmic examinations, ocular ultrasonography, and electroretinography did not identify a cause of blindness. Upon funduscopy, the left eye exhibited an increased optic disk diameter, blurred optic disk borders, and loss of the physiologic pit, as well as an increase in vascular tortuosity. In the right eye, there were multifocal depigmented areas in the non-tapetal fundus and several pigmented spots surrounded by a region of dull tapetal reflection in the tapetal fundus. The optical coherence tomography revealed severe anterior deformation of the optic nerve head and Bruch's membrane in the peripapillary region of the left eye. Magnetic resonance imaging revealed an irregular, broad-based suprasellar mass, with features suggestive of intracranial hypertension, including dorsal displacement of third ventricles, a rightward shift of the falx cerebri, trans-tentorial herniation, perilesional edema, flattening/protrusion of the posterior sclera, and lager optic nerve sheath diameter in left side than right side. This is the first comprehensive report that describes unilateral papilledema in a dog with a brain tumor, using advanced ophthalmic and neuro-imaging modalities.
A Rare Case of Spontaneous Pneumothorax Leading to Cerebral Air Embolism
Authors: Zakaria Alagha, Amro Al-Astal
Journal: Cureus (2024)
Keywords: cerebral air emboli, paradoxical cerebral embolism, patent foramen ovale (pfo), pneumothorax ptx, transient ischemic attack, usual interstitial pneumonia (uip)
MeSH terms: Case Reports

Cerebral arterial air embolism (CAE), a rare subtype of air embolism, carries a 21% mortality rate. We present a unique case involving a 69-year-old female with a history of usual interstitial pneumonia (UIP) who suffered a transient ischemic attack (TIA) due to CAE. Unlike typical cases, CAE in this instance resulted from spontaneous pneumothorax, not the more common iatrogenic causes. Adding complexity, an unexpected discovery emerged during evaluation: a patent foramen ovale, contributing to paradoxical embolism. This underscores the vital need to consider CAE as a differential diagnosis in UIP patients with neurological symptoms, highlighting its rarity and diagnostic challenges.
Immediate full-arch fixed rehabilitation of a narrow mandible with newly conceived connection system implants: A case report
Authors: Gerardo Pellegrino, Zoran Zaccheroni, Giuseppe Lizio
Journal: J Adv Periodontol Implant Dent (2024)
Keywords: alveolar bone loss, case report, dental implant, dental prosthesis retention, immediate dental implant loading, metal-on-metal joint prostheses
MeSH terms: Case Reports

Rehabilitating thin jaws without reconstructive surgery entails using narrow implants. The proposed treatment adopted an innovative implant system, allowing the mini-screws to be parallel and immediately loaded. A mandible, wearing an overdenture, was functionalized contextually to the residual dental extraction and the placement of six 2.4-mm thick one-piece implants. Low-profile intermediate abutments, the LEMs, able to rotate over the spherical heads of the fixtures, were connected after suturing, oriented, and blocked in a mutual parallel position. The copings, engaging with a tapered juncture of the LEMs, resulted in their alignment to be intraorally wedged together. The provisional superstructure enclosed the copings and was immediately connected to the implants, and the definitive prosthesis was delivered after three months. No clinical signs of peri-implantitis or radiographically evident bone loss were recorded after a two-year follow-up without any prosthetic complication. No cases have been published regarding mini-implants bearing fixed prosthesis rehabilitation.
Drug-Resistant TB, HIV and COVID-19 Co-Infection: Case Reviews from Kwa-Zulu Natal, South Africa
Authors: Razia Hassan-Moosa, Kegaugetswe Wilhemina Motsomi, Radhamoney Narasimmulu, Aida Sivro, Kevindra K Naidu, Ayesha B M Kharsany, Natasha Samsunder, Rubeshan Perumal, Kogieleum Naidoo
Journal: Infect Drug Resist (2023)
Keywords: covid-19, dr-tb, hiv, case reviews, screening, transmission
MeSH terms: Case Reports

Background:
Coronavirus disease (COVID-19) potentially exacerbates drug-resistant tuberculosis (DR-TB). We describe the clinical presentation and outcomes of three patients with human immunodeficiency virus (HIV), DR-TB and COVID-19.
Case one:
A virologically suppressed 31-year-old man on antiretroviral therapy (ART) and multidrug-resistant (MDR)-TB treatment presented with mild COVID-19 and was hospitalised for 10 days of clinical monitoring, despite being clinically stable with normal baseline inflammatory markers. Severe acute respiratory syndrome coronavirus polymerase chain reaction (SARS-CoV-2 PCR) positivity persisted at Day 28.
Case two:
A virologically suppressed 37-year-old woman on ART and MDR-TB treatment presented with moderate COVID-19. Baseline inflammatory markers were raised, and dexamethasone and azithromycin were initiated with good clinical improvement. SARS-CoV-2 PCR positivity persisted at Day 28.
Case three:
A viraemic 24-year-old woman on second-line ART and MDR-TB treatment, presented with mild COVID-19 disease, normal oxygenation and normal inflammatory markers, and remained clinically stable with negative SARS-CoV-2 PCR at Days 14 and 28.
Conclusion:
Screening for SARS-CoV-2 infection is advised for DR-TB patients with new or worsening respiratory symptoms.