OpenMed/multicare-articles huggingface dataset:
Case report: Azithromycin-meropenem combination therapy as a low-cost approach to combat PDR gram-negative infections of war wounds in Ukraine
Authors: Vadym Kryzhevskyi, Viktor Strokous, Yurii Lifshyts, Yurii Rybianets, Artem Oberniak, Alexey Krikunov, Olga Iungin, Viktoria Potochilova, Kateryna Rudnieva, Pavlo Petakh, Aleksandr Kamyshnyi, Olena Moshynets
Journal: Front Med (Lausanne) (2023)
Keywords: mdr, pdr, russian-ukrainian war, xdr gram-negative infections, hospital infection, low-cost therapy, pandrug resistance, war wounds
MeSH terms: Case Reports

Antimicrobial resistance recognised as a major global health problem and it poses a significant challenge in conflict zones, such as the Russia-Ukraine war. This case study focuses on a 32-year-old soldier who sustained combat-related injuries, including extensive wound infections caused by multidrug-resistant and pan-resistant bacteria and was successfully treated with azithromycin-meropenem combination therapy. The emergence of pan-resistant bacteria, particularly a pandrug-resistant strain of Pseudomonas aeruginosa, highlights the severity of the problem and the limited treatment options available. Additionally, the financial burden posed by reserve antibiotics further complicates the management of these infections. The case study demonstrates the effectiveness of including azithromycin-meropenem combination therapy in the treatment regimen, which resulted in improvements in the patient's condition and the eradication of the resistant strains. The findings underscore the need for effective antimicrobial stewardship, infection control measures, and alternative treatment strategies to combat antimicrobial resistance in conflict zones.
Pseudoaneurysm of the Gastroduodenal Artery: A Rare Complication of Bile Duct Surgery
Authors: Tariq Bouhout, Ayoub Kharkhach, Abdelbassir Ramdani, Abdelhakim Harouachi, Badr Serji
Journal: Cureus (2024)
Keywords: common bile duct, digestive hemorrhage, gastroduodenal artery aneurysms, open surgery, vascular ligation
MeSH terms: Case Reports

Pseudoaneurysm of the gastroduodenal artery (GDA) is an exceptional complication of common bile duct (CBD) resection. We present the case of a 60-year-old woman with a history of cholecystectomy. The patient was admitted to our hospital for surgical management of the cystic dilatation of the CBD. The patient presented on postoperative day 21 with hemodynamic instability related to a pseudoaneurysm of the GDA. An urgent open surgery was performed with dissection and ligation of the GDA.
Case report: Predictability of clinical response and rejection risk after immune checkpoint inhibition in liver transplantation
Authors: Jordi Yang Zhou, Dominik Eder, Florian Weber, Philipp Heumann, Katharina Kronenberg, Jens M Werner, Edward K Geissler, Hans J Schlitt, James A Hutchinson, Florian Bitterer
Journal: Front Transplant (2023)
Keywords: biomarker, clinical response, hepatocellular carcinoma, immune checkpoint inhibition, immune monitoring, liver transplantation, rejection risk
MeSH terms: Case Reports

Background:
The approval of Atezolizumab / Bevacizumab therapy (Atezo/Bev) in 2020 opened up a promising new treatment option for patients with end-stage hepatocellular carcinoma (HCC). However, liver transplant (LTx) patients with HCC are still denied this therapy owing to concerns about ICI-induced organ rejection and lack of regulatory approval.
Methods:
A prospective observational study at a tertiary liver transplant centre monitored the compassionate, off-label use of Atezo/Bev in a single, stable LTx recipient with non-resectable HCC recurrence. Close clinical, laboratory and immunological monitoring of the patient was performed throughout a four-cycle Atezo/Bev treatment. Measured parameters were selected after a systematic review of the literature on predictive markers for clinical response and risk of graft rejection caused by ICI therapy.
Results:
19 articles describing 20 unique predictive biomarkers were identified. The most promising negative prognostic factors were the baseline values and dynamic course of IL-6, alpha-fetoprotein (AFP) and the AFP/CRP ratio. The frequency of regulatory T cells (Treg) reportedly correlates with the success of ICI therapy. PD-L1 and CD28 expression level with the allograft, peripheral blood CD4+ T cell numbers and Torque Teno Virus (TTV) titre may predict risk of LTx rejection following ICI therapy. No relevant side effects or acute rejection occurred during Atezo/Bev therapy; however, treatment did not prevent tumor progression. Absence of PD-L1 expression in pre-treatment liver biopsies, as well as a progressive downregulation of CD28 expression by CD4+ T cells during therapy, correctly predicted absence of rejection. Furthermore, increased IL-6 and AFP levels after starting therapy, as well as a reduction in blood Treg frequency, correctly anticipated a lack of therapeutic response.
Conclusion:
Atezo/Bev therapy for unresectable HCC in stable LTx patients remains a controversial strategy because it carries a high-risk of rejection and therapeutic response rates are poorly defined. Although previously described biomarkers of rejection risk and therapeutic response agreed with clinical outcomes in the described case, these immunological parameters are difficult to reliably interpret. Clearly, there is an important unmet need for standardized assays and clinically validated cut-offs before we use these biomarkers to guide treatment decisions for our patients.
An Unusual Encounter: Aeromonas veronii Infection in a Case of Ulcerative Colitis
Authors: Reshmi Adupa, Harika Dadigiri, Toufiq Imtiaz
Journal: Cureus (2024)
Keywords: aeromonas infection, aeromonas veronii, antibiotic therapy, bloody stool, ulcerative colitis
MeSH terms: Case Reports

Aeromonas veronii-associated ulcerative colitis flare is sparsely reported in the literature but is a treatable condition with antibiotics including trimethoprim/sulfamethoxazole (TMP-SMX), fluoroquinolones, and second/third-generation cephalosporins. We report a case of a patient with long-standing ulcerative colitis (UC), who presented with bloody stools, fatigue, and oliguria that did not respond to standard regimen including steroids. The lab finding was significant for leukocytosis and anemia. A. veronii was cultured in the stool specimens. The patient was started on ciprofloxacin with marked improvement of symptoms on the second day of initiation of the antibiotic. Although rare, a possible Aeromonas infection should be suspected in patients presenting with a flare of ulcerative colitis. A prompt initiation of treatment can provide rapid improvement in clinical status of these patients.
Testicular Torsion with Intact Blood Flow: A Point of Care Ultrasound Case-Series
Authors: Eric Scheier
Journal: POCUS J (2024)
Keywords: pocus, partial, testicular torsion, ultrasound
MeSH terms: Case Reports

Studies have demonstrated the high sensitivity and specificity of pediatric emergency department (PED) point of care ultrasound (POCUS) in the evaluation of testicular torsion. Rarely, testicular torsion may present with intact blood flow. Here, we present a case series of four children with testicular torsion confirmed intraoperatively, who had intact blood flow on POCUS. Markers of testicular torsion can include surrounding hydrocele, heterogenous echotexture, absent venous or high resistance arterial flow, or a torsed cord complex. POCUS practitioners should be familiar with these findings, and the presence of any one or more of these findings should prompt urgent urology consultation to avoid missed torsion.
The Influence of Institutional Logics and Emotions on the Uptake of Cervical Cancer Screening: A Case Study From Xai-Xai, Mozambique
Authors: Gefra Fulane, Maria Major, Cesaltina Lorenzoni, Khatia Munguambe
Journal: Health Serv Insights (2024)
Keywords: institutional theory, mozambique, autonomy, cervical cancer, emotions, institutional logics

This study investigates the role of emotional attachment to competing institutional logics on women's uptake of cervical cancer screening in Mozambique. Through a qualitative study conducted in Xai-Xai, Southern Mozambique, we identify 2 concurrent logics in the context of screening: preservation logic, influenced by social-cultural norms, and the prevention logic, centered around screening. Women, affected by emotions such as shame, fear, and marital subordination, often become attached to the preservation logic, which influences their values and contradicts acceptance of screening. However, some women with marital autonomy may reflect on both logics and gradually detach themselves from the preservation norms and show their intention to adopt life-saving behavior by accepting screening. It is through their emotions that women show their attachment to and detachment from competing logics, reinforcing traditional norms on the one hand, or giving them the means to adopt preventive measures on the other. The study indicates that cultural expectations, shame and the desire to preserve intimacy tie women to the logic of preservation and have a negative impact on participation in cervical cancer screening. Consequently, to improve screening uptake in Mozambique, the authorities need to adapt screening to socio-cultural and emotional factors, empower women, and effectively engage communities.
Heated tobacco product (IQOS) induced pulmonary infiltrates
Authors: Merlin Thomas, Mansoor Hameed, Shaikha Alhadad, Irfan Ul Haq
Journal: Respir Med Case Rep (2024)
Keywords: acute lung injury, eosinophilia, heated tobacco products, iqos, pulmonary infiltrates
MeSH terms: Case Reports

Background:
Heated tobacco products (HTPs) have been marketed as safer alternatives to conventional cigarettes, but emerging evidence suggests potential respiratory risks. We present a case of pulmonary complications associated with IQOS, a popular HTP, contributing to the growing understanding of these risks.
Case description:
A 40-year-old chronic smoker switched to IQOS, consuming 1.5 packs per day. He presented with incidental chest radiographic abnormalities and peripheral eosinophilia. Computed tomography of chest revealed pulmonary nodules and ground glass opacities. Bronchoscopy indicated mild eosinophilia. After ruling out other causes, a lung biopsy was recommended but declined. Discontinuation of IQOS led to symptom resolution and radiographic improvement. This case adds to a limited literature on HTP-induced lung injury, with a unique presentation and favorable response to cessation.
Conclusions:
The case highlights potential pulmonary complications and the first describing an organizing pattern of lung injury associated with IQOS use, emphasizing the importance of recognizing and discontinuing HTPs in patients with respiratory symptoms or radiographic abnormalities. Further research is needed to elucidate the mechanisms underlying the harmful effects of HTPs and inform public health policies. This case underscores the importance of monitoring and educating individuals about the potential risks of HTPs to respiratory health, especially in the context of smokers switching to these products.
Cerebellar Compression by Giant Extracanalicular Osteoma with Central Cholesterol Granuloma
Authors: Caroline F Smith, Conner J Massey, Scott E Mann
Journal: Case Rep Otolaryngol (2023)
MeSH terms: Case Reports

Temporal bone osteomas comprise 0.1-1% of benign tumors involving the skull, the majority of which arise in the external auditory canal. More rarely, they can arise from the mastoid portion of the temporal bone. These generally present as a slow growing skull base lesion that can cause cosmetic deformity, headache, and/or hearing loss. Here, we report a case of extracanalicular mastoid osteoma uniquely presenting with posterior fossa and cerebellar compression with associated dizziness and imbalance.
Community-acquired methicillin-resistant Staphylococcus aureus invasive infections: a case series from Central-South Chile
Authors: Alejandro Aguayo-Reyes, Felipe Morales-León, Mario Quezada-Aguiluz, Martha Quezada, Sergio Mella, Gisela Riedel, Néstor Herrera-Chávez, Yohana Espine, Gerardo González-Rocha, Andrés Opazo-Capurro
Journal: Front Med (Lausanne) (2024)
Keywords: chile, mrsa, st8, community-acquired infections, molecular epidemiology
MeSH terms: Case Reports

The emergence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections at the end of the 20th century represents a significant shift in the epidemiology of staphylococcal infections and, consequently, their clinical management. There are diverse CA-MRSA clones that are widely spread worldwide, showing differences in their regional dissemination, which has been dynamically changing over time. Although the first CA-MRSA description occurred about 30 years ago, its epidemiology in certain regions, such as South America, has been poorly explored, resulting in a gap in the understanding of the epidemiology of CA-MRSA in under-represented countries/regions. This report describes the first four clinical cases of invasive infections caused by CA-MRSA in a tertiary hospital in the central-southern region of Chile. It also associates the clinical characteristics of the infections with the microbiological and molecular features of the isolates. The four S. aureus isolates belong to sequence type 8, which has been widely described as a cause of community-acquired infections. All of them presented a wide resistome and virulome. Additionally, in two of them, it was possible to reconstruct the COMER genetic element, present in the USA300-Latin American variant clone. Considering these findings, it is crucial to prepare for a potential increase in invasive CA-MRSA infections in Chile. This would involve enhancing current surveillance systems and maintaining a low threshold of suspicion for these infections among clinicians.
Gilteritinib as Bridging and Posttransplant Maintenance for Relapsed Acute Myeloid Leukemia with FLT3-ITD Mutation Accompanied by Extramedullary Disease in Elderly
Authors: Masuho Saburi, Masanori Sakata, Rika Maruyama, Yosuke Kodama, Hiroyuki Takata, Yasuhiko Miyazaki, Katsuya Kawano, Junpei Wada, Shogo Urabe, Eiichi Ohtsuka
Journal: Case Rep Hematol (2023)
MeSH terms: Case Reports

A 69-year-old woman was diagnosed with acute myeloid leukemia (AML) with an FMS-like tyrosine kinase 3-internal tandem duplication (FLT3-ITD) mutation. Complete remission (CR) was achieved after induction therapy, but AML resulted in a hematological relapse two months after the consolidation chemotherapy. Relapse was accompanied by multiple skin lesions that demonstrated leukemic cell infiltration as well as a drooping right eyelid with extroversion of the eye due to right oculomotor palsy. Gilteritinib was started as salvage therapy, and bone marrow blasts decreased to 0.8% after one month. Two months later, the eye symptoms improved, and the patient underwent cord blood transplantation (CBT). The skin lesions disappeared after the conditioning regimen, and the patient achieved CR status with complete donor chimerism at day 28. Gilteritinib was restarted as posttransplant maintenance therapy on day 53 of CBT. No adverse events other than mild hepatotoxicity were observed, and the patient was alive and in CR status, while continuing gilteritinib at one year and seven months after CBT. Bridging and posttransplant maintenance therapy with gilteritinib may be a promising therapeutic option for relapsed AML with the FLT3-ITD mutation in elderly patients.
Sellar xanthogranuloma as a diagnostic challenge: a report on five cases
Authors: Silvia Carolina Fernández, María Celina Bernhardt, Ezequiel Grondona, Ana Clara Venier, María Lorena Bertolino, Mauro José Pautasso, Emilio Mezzano, Roxana Analía Damilano, Claudia Susana Sala, Enrique José Herrera, Favio Nicolás Pesaola, Cristina Alicia Maldonado, Amado Alfredo Quintar, Ana Lucía De Paul
Journal: Front Neurosci (2023)
Keywords: mri, rathke’s cleft cyst, chronic inflammation, electron microscopy, pituitary adenoma, sellar region, xanthogranuloma
MeSH terms: Case Reports

Xanthogranulomas are considered rare tumors, with their sellar and non-sellar frequency ranging from 1.6 to 7% among intracranial lesions, and described as a separate entity by the World Health Organization in 2000. The diagnosis of sellar xanthogranulomas is challenging, given their uncertain origin and clinical course. In addition, the limited reporting of sellar xanthogranuloma cases and the absence of characteristic images make these entities difficult to distinguish from other cystic lesions of the sellar region, such as adamantinomatous craniopharyngiomas, Rathke's cleft cysts, pituitary tumors, arachnoid cysts, epidermoid cysts, and dermoid cysts. Here, we describe the clinical presentation, radiological findings, immunohistochemical/histopathological analysis, and the ultrastructural examination by transmission electron microscopy of five sellar xanthogranulomas cases reported in two care centers in Cordoba, Argentina. Two males and three females between 37 and 73 years of age (average 51.8 years) presented with persistent headaches, generalized endocrine defects, and visual problems. MRI revealed cystic formations in the sellar region, which usually projected into adjacent tissues such as the suprasellar region or cavernous sinuses, and compressed other structures such as the optic chiasm, pituitary gland, and cranial nerves. All patients underwent surgical intervention to remove the tumor tissue. The histopathological analysis of the samples showed cellular tissue with a xanthogranulomatous appearance, inflammatory cellular infiltrate (mainly lymphocytes and macrophages), fibroblasts, abundant collagen fibers, and hemorrhages. An ultrastructural analysis helped to identify cellular infiltrates and granules resulting from tumor cell activity. The data support the hypothesis that sellar xanthogranulomas could occur as an inflammatory reaction secondary to the rupture and hemorrhage of a previous cystic process, thereby generating an expansion of the tumor body toward adjacent tissues. The information obtained from these cases contributes to the current knowledge about this disease's origin and clinical and histological evolution. However, the scarcity of patients and the observed phenotypic heterogeneity make its diagnosis still challenging. Undoubtedly, more investigations are needed to provide additional information in order to be able to achieve a more accurate diagnosis and effective treatment of this rare disease.
Case Report: Flurbiprofen-induced Type I Kounis syndrome
Authors: Chao Tang, Yuqi Chen, Xiaosong Gu
Journal: Front Cardiovasc Med (2023)
Keywords: kounis syndrome, acute myocardial infarction, allergy, case, flurbiprofen
MeSH terms: Case Reports

Background:
Kounis syndrome is a specific type of acute coronary syndrome caused by allergic or hypersensitivity response. Clinical knowledge about this syndrome is insufficient. We report a case in which intravenous administration of flurbiprofen resulted in Type I Kounis syndrome.
Case summary:
A 60-year-old female patient with no history of coronary artery disease developed limb erythema, hypotension, and chest tightness after receiving intravenous flurbiprofen. Electrocardiogram showed ST segment elevation in leads II, III, and aVF. Emergency coronary angiography revealed no significant stenosis or thrombus in the coronary arteries. Subsequent echocardiography showed no apparent abnormalities. Levels of troponin T were elevated. The diagnosis was flurbiprofen-induced Type I Kounis syndrome, presenting as acute ST segment elevation myocardial infarction.
Conclusions:
Patients with Kounis syndrome can exhibit severe clinical symptoms, and their condition may even be life-threatening. It is important for clinicians to have a thorough understanding of this syndrome in order to develop comprehensive treatment plans.
Case Report: A successful outcome of nadroparin calcium therapy for cerebral venous sinus thrombosis in a child with acute lymphoblastic leukemia
Authors: Lichun Xie, Ye Xu, Guichi Zhou, Fen Chen, Changgang Li, Lian Ma, Feiqiu Wen
Journal: Front Pediatr (2024)
Keywords: anticoagulation, cerebral venous sinus thrombosis, childhood acute lymphoblastic leukemia, nadroparin calcium, pegylated-asparaginase
MeSH terms: Case Reports

Background:
The appearance of cerebral venous sinus thrombosis (CVST) in childhood acute lymphocytic leukemia (ALL) is a rare life-threatening disease that can cause significant morbidity, neurological sequelae, and potentially poor outcomes.
Case presentation:
We present the case of a 13-year-old boy with ALL who developed CVST and intrinsic hemorrhage approximately 30 days after receiving chemotherapy with vincristine, dexamethasone, daunorubicin, and pegylated-asparaginase (PEG-Asp). He complained of a severe headache and then developed a generalized seizure at night. T1- and T2-weighted magnetic resonance imaging (MRI) and cerebral magnetic resonance venography sequences revealed superior sagittal sinus thrombosis and intrinsic hemorrhagic changes in the bilateral frontoparietal lobes. He received nadroparin calcium as the anticoagulant treatment and was switched to Erwinia asparaginase (Erwinia Asp) rather than PEG-Asp. Oxcarbazepine and clonazepam were started with good seizure control. Intrathecal treatment was delayed until 1 month later. Anticoagulation treatment was stopped for 24 h before and 6 h after lumbar puncture. Platelet transfusion was administered to ensure the platelet count remained at >50 × 109/L. Oral acetazolamide (500-1,000 mg, daily) was administered to relieve headache and reduce intracranial pressure. Three months later, brain MRI showed a complete resolution of or significant improvement in the filling defect. Nadroparin calcium was administered for 1 week after switching to Erwinia Asp to prevent clot recurrence. He completed the 6-month chemotherapy and is doing well with no neurological sequelae and no recurrence of bleeding or thrombosis.
Conclusions:
Nadroparin calcium therapy appears to be safe and effective for pediatric CVST with ALL. The reintroduction of Erwinia Asp should be accompanied by anticoagulant therapy with nadroparin calcium.
Case report: Rare case of a preoperatively diagnosed spermatic cord paraganglioma and literature review
Authors: Yining Hao, Xiuci Li, Jing Xie, Wei He, Chenghe Wang, Fukang Sun
Journal: Front Oncol (2024)
Keywords: neuroendocrine tumors (net), paraganglioma, preoperative diagnose, spermatic cord mass, urogenital system
MeSH terms: Case Reports

Paraganglioma (PGL) is rare, and PGL that arises from the urogenital system is even rarer. Here we report a case of PGL in spermatic cord and review the relevant literatures. We encountered a 15-year-old boy with a history of hypertension for almost 2 years, accompanied with headache and palpitations. His serum and urine catecholamines were elevated, but no adrenal lesions were detected, suggesting the existence of PGL. Upon physical examination, a painless nodule adherent to the spermatic cord in the right scrotum was found. A systemic Ga68 DOTATATE PET-CT was then performed, and it revealed a mass with high DOTATATE uptake in the right scrotum. The CT, MRI, and ultrasound images showed the abundant blood supply to the tumor. Based on the above-mentioned imaging and biochemical information, a diagnosis of PGL was made prior to surgery. After 2 weeks of preparation with Cardura, an open surgery was performed to remove the tumor together with the right testis and right epididymis. The blood pressure increased to 180/100 mmHg when the tumor was touched intraoperatively and decreased to 90/55 mmHg after the tumor was removed. Post-operative pathology confirmed our diagnosis of PGL originating from the spermatic cord. Immunohistochemical (IHC) staining showed SDHB (+), CgA (+), synaptophysin (+), GATA3 (+), CD56 (+), sertoli cells S-100 (+), and Ki67 (5%). Genetic testing revealed a missense mutation in the SDHA gene. Only 16 cases of spermatic cord PGL have been reported to date. Although it is easy to diagnose by histology and IHC examinations, preoperative diagnosis is quite important as it can actually reduce intraoperative complications.