OpenMed/multicare-articles huggingface dataset:
Lupus-Induced Accelerated Heart Failure in a Young African American Female: Cardiovascular and Systemic Complications of Noncompliance to Maintenance Therapy and the Social Determinants of Cardiovascular Disease
Authors: Ikpechukwu J Okorie, Edmund Appiah-Kubi, Philipa Owusu-Antwi, Evans Takyi, Derek Ugwendum, Annmarie Fernando, Muhammed Atere, Jay Nfonoyim
Journal: Cureus (2024)
Keywords: cardiomyopathy, heart failure, hydroxychloroquine, left ventricular hypertrophy (lvh), social determinants of health (sdoh), systemic lupus erythema
MeSH terms: Case Reports

Systemic lupus erythematosus (SLE) is an autoimmune inflammatory disorder characterized by dysregulations of the immune system with intermittent and remitting symptoms. SLE affects multiple organs and systems, including the cardiovascular system. This condition is associated with an increased risk of cardiovascular disease, particularly in younger patients. Our case report describes a patient who rapidly developed structural, functional, and electrophysiological cardiac abnormalities due to lupus-induced cardiomyopathy. The accelerating cardiac events were the result of medication noncompliance. Myocarditis and other potentially fatal cardiac complications associated with SLE have been the subject of numerous studies. This presentation appears to be the first to emphasize the rarity of lupus-induced cardiomyopathy, the importance of treatment adherence, the adverse cardiac effects of targeted therapeutic interventions, and the influence of social determinants of cardiovascular health on a patient's prognosis.
Dorsal Lytic Lesions: Cancer or Infection?
Authors: Carolina Carreiro, Catarina Gonçalves, Maria Pires, Alexandra Wahnon, Marisa Silva
Journal: Cureus (2024)
Keywords: bone lytic lesions, dorsal pain, image-guided biopsy, spondylodiscitis, vertebral lesions
MeSH terms: Case Reports

Infectious spondylodiscitis is a rare disease and typically presents with an insidious progression characterized by spinal pain that usually starts gradually and progressively worsens over several weeks to months. It occurs through three main mechanisms: direct contamination in cases of trauma or surgery, hematogenous dissemination, or through contiguity. We report the case of a 63-year-old male, admitted due to a history of dorsolumbar pain after falling from a height of 1.5 meters, with four months of evolution, without other accompanying symptoms, and refractory to anti-inflammatory and analgesic therapy. Initial laboratory evaluation revealed normocytic and normochromic anemia and a slight elevation in C-reactive protein. Computed tomography of the spine showed pathological fractures of T7-T9. A percutaneous biopsy was performed, positive for methicillin-sensitive Staphylococcus aureus, and the patient underwent 12 weeks of targeted antibiotic therapy. A surgical procedure with percutaneous posterior arthrodesis from T4 to T12 was performed. With this case, the authors aim to emphasize the importance of biopsy as a complementary diagnostic method to imaging studies in the diagnosis of spondylodiscitis, with the possibility of identifying the causative agent.
Cocaine-Induced Lung Damage and Uncommon Involvement of the Basal Ganglia
Authors: Hamid Ziani, Siham Nasri, Imane Kamaoui, Imane Skiker
Journal: Cureus (2024)
Keywords: basal ganglia, cocaine-induced intoxication, ct, lung, mri
MeSH terms: Case Reports

Cocaine use is responsible for multiorgan damage, including the brain and lungs. Bilateral and symmetrical involvement of the basal ganglia may be due to toxic, metabolic, vascular, inflammatory, infectious, or tumoral causes. Cocaine-related encephalopathy mainly affects the white matter, while basal ganglia involvement is an uncommon finding. Cocaine-induced lung damage varies clinically and even radiologically, with signs that lack specificity. The diagnosis of cocaine-induced lung or brain injury is based on suggestive radiological signs in the context of cocaine consumption and after the elimination of other etiologies likely to present the same patterns. The context of cocaine use is often not spontaneously declared, making diagnosis more complicated. We report the case of a 28-year-old male patient, with a history of freebase cocaine use, admitted to the emergency room in severe coma with respiratory distress. Brain MRI showed bilateral and symmetrical abnormalities of the basal ganglia. A chest CT scan revealed interstitial lung damage dominated by the ground-glass pattern. The urine toxicology test was positive for cocaine. Cocaine-related lesions can be reversible, and therapeutic management is essentially based on supportive care.
Case report: Autoimmune encephalomyelitis following cytomegalovirus infection after allogeneic hematopoietic stem cell transplantation
Authors: Min Yang, Yu Cai, Liping Wan, Linhua Ji, Xian M Song
Journal: Front Med (Lausanne) (2024)
Keywords: allogeneic hematopoietic stem cell transplantation, autoimmune encephalomyelitis, high-dose steroids, human cytomegalovirus, intravenous immunoglobulins
MeSH terms: Case Reports

Introduction:
Cytomegalovirus (CMV) can cause various end-organ diseases in immunocompromised hosts, including allogeneic hematopoietic cell transplant (allo-HSCT) recipients. Interestingly, CMV viremia has been associated with various complications and poor prognosis in allo-HSCT recipients. Complications involving the central nervous system (CNS) occur in 9-14% of patients following allo-HSCT. However, autoimmune encephalitis (AE) secondary to CMV infection after allo-HSCT has rarely been reported. Here we report a case of possible AE following CMV viremia after allo-HSCT, which was successfully treated with high-dose pulsed methylprednisolone and intravenous immunoglobulins (IVIg).
Case description:
A 53-year-old female underwent allo-HSCT for T-lymphoblastic lymphoma/leukemia. The patient developed CMV viremia on day 36 after transplantation, and serum CMV-DNA remained positive after initiating ganciclovir antiviral therapy, turning negative one month later. Four months later, she started experiencing memory impairment, weakness in the left limbs, cognitive dysfunction, and hallucinations. A magnetic resonance imaging brain scan showed scattered ischemic lesions under the bilateral frontal cortex. Viral detection in cerebral spinal fluid (CSF) by next-generation gene sequencing technology showed no obvious abnormality. Antibodies specific to AE and paraneoplastic diseases in serum and CSF were absent. The oligoclonal bands in the CSF were detected using isoelectric focusing and immunofixation, and the results were negative. However, after extensive investigation regarding infections, autoimmune disorders, and recurrence of the malignancy, possible AE could not be excluded. The patient was treated with high-dose steroids combined with IVIg therapy; the patient's symptoms were significantly improved.
Conclusion:
The mechanisms of AE after allo-HSCT and the relationship with CMV infection should be further studied. Therefore, reporting this and similar cases will improve our awareness and understanding of the underlying disease mechanisms.
Gastric paraganglioma: a case report and review of literature
Authors: Chengyu Hu, Bixian Luo, Bo Hong, Mingqi Zhang, Zelai Wu, Xiuliang Zhu, Fengming Luan, Yi Huang, Weihua Gong
Journal: Front Oncol (2024)
Keywords: case report, catecholamine crisis, diagnostic, gastric paraganglioma, immunohistochemistry
MeSH terms: Case Reports

Paragangliomas (PGLs) are rare neuroendocrine tumors which overproduce catecholamines (CAs). They are extra-adrenal, catecholamine-secreting tumors occurring outside the adrenal glands. Gastric PGLs originating from extra-adrenal paraganglia are exceptionally rare, and their presentation in geriatric patients further adds to the complexity of diagnosis and management. A 72-year-old male patient presented with enduring left upper abdominal pain and anemia persisting for over a year, and hypertension for six months. Physical examination revealed epigastric discomfort and pallor. Computed tomography scans revealed enlarged lymph nodes in the lesser curvature of the stomach and thickening of the gastric antrum wall with concavity. The patient underwent three cycles of neoadjuvant therapy before radical gastrectomy for gastric cancer. These imaging findings were confirmed during surgery and intraoperative blood pressure was in fluctuation. After the successful resection of the tumor, postoperative pathology confirmed paraganglioma. During postoperative examination, it was observed that the patient's CAs and their metabolites had returned to within the normal range. Combined with the existing ten literatures, we retrospective report the clinical and pathological characteristics and treatment strategies of the rare gastric paraganglioma.
IDH2-mutated near ETP-ALL with aggressive leukemia cutis and brisk response to venetoclax and decitabine
Authors: Poorva Vaidya, Huan-You Wang, Michelle D Don, Brian R Hinds, James K Mangan
Journal: Leuk Res Rep (2023)
Keywords: hypomethylating agents, leukemia cutis, t-cell lymphoblastic leukemia, venetoclax
MeSH terms: Case Reports

Near early T-cell precursor acute lymphoblastic leukemia (ETP-ALL) is a rare hematologic malignancy, for which second line therapeutic options are limited. T-cell leukemias are also rarely associated with leukemia cutis, which is more often seen in leukemias of myeloid origin. We present the case of an adult male diagnosed with near ETP-ALL, with IDH2 and DNMT3A mutations, suggestive of a myeloid origin, and leukemia cutis. After the patient progressed on hyper-CVAD and nelarabine, we treated him with the BCL-2 inhibitor venetoclax and the hypomethylating agent decitabine. The regimen induced a rapid bone marrow response and resolution of the leukemia cutis.
A Case of Pulmonary MALToma Camouflaged Within Invasive Pulmonary Aspergillosis
Authors: Gurumurthy Thilagavathy, R K Sasankh, Arul Sekary, Niranjan Prabhu Ss
Journal: Cureus (2024)
Keywords: haemoptysis, invasive aspergillosis, pulmonary maltoma, tuberculosis associated obstructive pulmonary disease, upper lobe lobectomy
MeSH terms: Case Reports

A 59-year-old non-smoking male, with a known case of COPD (chronic obstructive pulmonary disease), treated pulmonary tuberculosis with Category 1 antitubercular drugs (six-month regimen) and was admitted with repeated bouts of moderate haemoptysis (~60 mL/day) for three days. The patient had a history of self-limiting occasional mild haemoptysis (~20 mL) over three years. An HRCT chest revealed a left upper lobe fibro-cavitary lesion with an intracavitary mass (air crescent sign), adjacent pleural thickening and fibrosis. Bronchoalveolar lavage (BAL) was positive for galactomannan and negative for Mycobacterium tuberculosis GeneXpert®. With the above clinical factors, host factors, and microbiological factors, the case was diagnosed as 'probable' invasive pulmonary aspergillosis and was treated with voriconazole. However, given relapsing haemoptysis despite adequate antifungal treatment, a left upper lobectomy was done. The resected left upper lobe specimen culture demonstrated Aspergillus fumigatus with histopathology confirming hyphae invading lung tissues confirming 'proven' invasive aspergillosis. Resected tissue also showed florid lymphoid tissue hyperplasia with Immunohistochemistry confirming the presence of a peculiar malignancy; MALT lymphoma/MALToma in the resected lobe. The association of a rare malignancy such as MALToma with invasive pulmonary aspergilloma (IPA) has been identified and reported for the first time. This could be because of a chronic inflammatory reaction elicited by the Aspergillus antigen. Long-standing fibro-cavitary disease and aspergillosis are partners in crime, augmenting the damages inflicted by one another. In such a scenario, early surgical intervention may be warranted if haemoptysis is moderate to severe or relapsing, following conservative medical management. Surgical resection may lead to the identification of unexpected diseases as in our case.
Frontotemporal Dementia-Parkinsonism Due to MAPT Gene Variant Presenting with Rest and Action Tremor
Authors: Shakya Bhattacharjee, Christopher Kobylecki
Journal: Tremor Other Hyperkinet Mov (N Y) (2023)
Keywords: ftd, mapt, dementia, mutation, rest tremor
MeSH terms: Frontotemporal Dementia / diagnostic imaging, Frontotemporal Dementia / genetics, Frontotemporal Dementia / pathology, Parkinsonian Disorders / diagnostic imaging, Parkinsonian Disorders / genetics, Case Reports, Humans, Male, Middle Aged, Mutation / genetics, Tremor / diagnostic imaging, Tremor / genetics, tau Proteins / genetics, tau Proteins, MAPT protein, human

A 50-year-old male presented with a four-year history of gradually progressive rest tremor in the distal right lower limb and then spreading to the left lower limb in last 10-12 months. He developed right arm rest and action tremor two years later. Magnetic resonance imaging scans showed progressive frontotemporal and asymmetrical mesial temporal atrophy. Genetic testing revealed a heterozygous c.915+16C>T pathogenic variant in intron 9 of the MAPT gene. Presentation with rest tremor should not exclude frontotemporal dementia-parkinsonism due to a MAPT variant as a differential diagnosis though rest tremor is a rare presentation.
When Blood Is Thicker Than Water: A Case of Acute Pancreatitis Secondary to Familial Hypertriglyceridemia
Authors: Krishna Patel, Nitya Devireddy, Calista Long, Annika Daya, John Cherneskie, Kaleigh Krill
Journal: Cureus (2024)
Keywords: acute pancreatitis, familial hypercholesterolemia, familial lipid disorders, hypertriglyceridemia, hypertriglyceridemia-induced pancreatitis, hypertriglyceridemic pancreatitis
MeSH terms: Case Reports

Hypertriglyceridemia is one of the major causes of acute pancreatitis in addition to gallstones and alcohol use. These etiologies are often associated with underlying comorbidities. Acute pancreatitis secondary to hypertriglyceridemia is associated with an increase in clinical severity and further complications. We present a case of a 56-year-old man with a past medical history of hypertension, diabetes mellitus, and familial hypertriglyceridemia who was diagnosed with acute pancreatitis secondary to hypertriglyceridemia. The patient presented with 9/10 pressure across the abdomen radiating to the sternum. Labs revealed elevated triglyceride count > 8000 mg/dL and cholesterol > 705 mg/dL. Abdominal CT showed fat stranding along the anterior aspect of the pancreatic head. The patient was managed with IV fluids, nil per os (NPO), and statin management for hypertriglyceridemia. Seven days later, triglycerides decreased to 658 mg/dL, and abdominal pain resolved. This case highlights an unusual presentation of acute pancreatitis and demonstrates the importance of understanding the spectrum of etiologies for this condition.
Cryptogenic Epidural Cervicothoracic Abscess: A Case Report and Literature Review
Authors: Harvey Misael Aguilar Mora, Julio Cesar Soto Barraza
Journal: Cureus (2024)
Keywords: cervical spinal, spinal epidural abscess, subdural empyema, thoracic spinal, transverse myelitis
MeSH terms: Case Reports

A spinal epidural abscess (SEA) is a rare infection characterized by pus formation in the spinal epidural space, associated with various degrees of motor, sensory, or combined deficits. It is linked to several risk factors and predominantly impacts middle-aged men. This report discusses an atypical case of a patient without any predisposing factors who developed a cervicothoracic SEA associated with significant transverse myelitis. A targeted literature search was conducted on PubMed, Scopus, and SpringerLink, employing terms such as "spinal epidural abscess, subdural empyema, and transverse myelitis." While there are numerous studies on this topic with a multidisciplinary approach, reports of cryptogenic SEA associated with the extensive involvement of cervical and thoracic spinal segments are rare. SEA is a very uncommon condition. Hence, a comprehensive understanding of its clinical presentation is crucial for adopting an appropriate diagnostic approach and delivering timely treatment.
Emerging infection: streptococcal toxic shock-like syndrome caused by group B Streptococcus (GBS), Streptococcus agalactiae
Authors: Fareed Rajack, Shawn Medford, Ali Ramadan, Tammey Naab
Journal: Autops Case Rep (2024)
Keywords: amputation, surgical, bacteremia, fasciitis, necrotizing, shock, septic, virulence factors
MeSH terms: Case Reports

Streptococcus agalactiae or Group B Streptococcus (GBS) infections are commonly associated with infections in neonates and pregnant women. However, there has been a rising incidence in nonpregnant adults. The risk of GBS infection in nonpregnant adults is increased for patients of advanced age and those with underlying medical conditions such as diabetes mellitus and cancer. We present a 77-year-old female with type-2 diabetes mellitus, hypertension, and bilateral foot ulcers that presented in probable septic shock with necrotic foot ulcers and necrotizing fasciitis and underwent bilateral lower limb amputations. The patient fulfilled the Streptococcal Toxic Shock Syndrome (STSS) criteria as defined by The Working Group on Severe Streptococcal Infections. These criteria were created for group A Streptococcus (Streptococcus pyogenes). Our patient fulfilled the Working Group's criteria, except that the blood culture was positive for group B Streptococcus (Streptococcus agalactiae). Numerous studies demonstrate the importance of early detection and antibiotic treatment for GBS infections in general and early surgical management for necrotizing soft tissue infections (NSTIs) such as necrotizing fasciitis.
Case report: Immune response characterization of a pseudoprogression in a PD-L1-negative, TMB-low, KEAP1/STK11 co-mutated metastatic NSCLC
Authors: Nicolas Roussot, Marion Thibaudin, Jean-David Fumet, Susy Daumoine, Léa Hampe, Cédric Rébé, Emeric Limagne, Aurélie Lagrange, Victor Herreros, Julie Lecuelle, Hugo Mananet, Alis Ilie, David Rageot, Romain Boidot, Vincent Goussot, Anthony Comte, Pierre Jacob, Françoise Beltjens, Anthony Bergeron, Céline Charon-Barra, Laurent Arnould, Valentin Derangère, Sylvain Ladoire, Caroline Truntzer, François Ghiringhelli
Journal: Front Immunol (2024)
Keywords: nsclc, case report, chemoimmunotherapy, cold tumor, metastatic nsclc, neoantigen, pseudoprogression, tumor neoantigen
MeSH terms: B7-H1 Antigen / genetics, Carcinoma, Non-Small-Cell Lung / genetics, Carcinoma, Non-Small-Cell Lung / immunology, Carcinoma, Non-Small-Cell Lung / therapy, Disease Progression, Kelch-Like ECH-Associated Protein 1 / genetics, Kelch-Like ECH-Associated Protein 1 / metabolism, Lung Neoplasms / genetics, Lung Neoplasms / immunology, Lung Neoplasms / pathology, Lung Neoplasms / therapy, Mutation, Case Reports, Biomarkers, Tumor, Female, Humans, Middle Aged, Kelch-Like ECH-Associated Protein 1, B7-H1 Antigen, KEAP1 protein, human, CD274 protein, human, Biomarkers, Tumor

A patient with a PD-L1-negative, TMB-low, KEAP1/STK11 co-mutated metastatic non-small cell lung cancer (NSCLC) experienced a multisite radiological progression at 3 months after initiation of chemoimmunotherapy as first-line treatment for metastatic disease. After the radiological progression, while she was not undergoing treatment, the patient had spontaneous lesions shrinkage and further achieved a prolonged complete response. Genomic and transcriptomic data collected at baseline and at the time of pseudoprogression allowed us to biologically characterize this rare response pattern. We observed the presence of a tumor-specific T-cell response against tumor-specific neoantigens (TNAs). Endogenous retroviruses (ERVs) expression following chemoimmunotherapy was also observed, concurrent with biological features of an anti-viral-like innate immune response with type I IFN signaling and production of CXCR3-associated chemokines. This is the first biological characterization of a NSCLC pseudoprogression under chemoimmunotherapy followed by a prolonged complete response in a PD-L1-negative, TMB-low, KEAP1/STK11 co-mutated NSCLC. These clinical and biological data underline that even patients with multiple factors of resistance to immune checkpoint inhibitors could trigger a tumor-specific immune response to tumor neoantigen, leading to complete eradication of the tumor and probably a vaccinal immune response.
18F-AlF-NOTA-octreotide PET/CT in the localization of tumor-induced osteomalacia: case series and literature review
Authors: Jing Li
Journal: Front Endocrinol (Lausanne) (2024)
Keywords: 18f-alf-nota-octreotide, pet/ct, hypophosphatemia, phosphaturic mesenchymal tumors, tumor-induced oseteomalacia
MeSH terms: Osteomalacia / diagnostic imaging, Osteomalacia / etiology, Positron Emission Tomography Computed Tomography / methods, Review, Case Reports, Fibroblast Growth Factor-23, Fluorine Radioisotopes, Heterocyclic Compounds, Heterocyclic Compounds, 1-Ring, Humans, Neoplasms, Connective Tissue / diagnostic imaging, Octreotide / analogs & derivatives, Paraneoplastic Syndromes / diagnostic imaging, Radiopharmaceuticals, 1,4,7-triazacyclononane-N,N',N''-triacetic acid, FGF23 protein, human, Fibroblast Growth Factor-23, Fluorine Radioisotopes, Heterocyclic Compounds, Heterocyclic Compounds, 1-Ring, Octreotide, Radiopharmaceuticals, Oncogenic osteomalacia

Introduction:
This study explores tumor-induced osteomalacia (TIO) through a case series and literature review, assessing the diagnostic potential of 18F-AlF-NOTA-octreotide (18F-OC) positron emission tomography/computed tomography (PET/CT).
Methods:
We analyzed TIO patients who underwent 18F-OC PET/CT. Parameters such as tumor dimension, the maximum standardized uptake value (SUVmax), the mean standardized uptake value (SUVmean) and metabolic tumor volume (MTV) were meticulously assessed. Clinical features and imaging characteristics pertinent to TIO were reviewed.
Results:
6 patients with clinical suspicion of TIO exhibited hypophosphatemia (0.25 to 0.64 mmol/L), elevated alkaline phosphatase (ALP) levels (142 to 506 U/L), and increased parathyroid hormone (PTH) levels (92.9 to 281.7 pg/mL). Of these patients, two underwent FGF-23 testing, with results of 3185.00 pg/ml and 17.56 pg/ml, respectively. Conventional imaging modalities depicted widespread osteoporosis, with several cases demonstrating fractures indicative of osteomalacic and associated pathological fractures. Subsequent 18F-OC PET/CT facilitated the accurate localization of causative tumors, with histopathological examination confirming the diagnosis of phosphaturic mesenchymal tumor (PMT). The interval from initial clinical presentation to definitive TIO diagnosis spanned approximately 2.5 years (range: 1 - 4 years), with tumors varying in size (maximum diameter: 7.8 to 40.0 mm), SUVmax (5.47 to 25.69), SUVmean (3.43 to 7.26), and MTV (1.27 to 18.59 cm3).
Conclusion:
The implementation of whole-body 18F-OC PET/CT imaging emerges as a critical tool in the identification of occult tumors causing TIO. Future investigations incorporating a broader cohort are imperative to further delineate the diagnostic and therapeutic implications of 18F-OC PET/CT in managing TIO.