OpenMed/multicare-articles huggingface dataset:
Disulfiram-Induced Acute Liver Injury
Authors: Lucas Ramer, Matthieu Tihy, Nicolas Goossens, Jean-Louis Frossard, Laura Rubbia-Brandt, Laurent Spahr
Journal: Case Reports Hepatol (2020)
MeSH terms: Case Reports

Disulfiram is a drug used to treat alcohol dependence since many years. It interferes with the metabolism of alcohol, may be associated with neurological and dermatological symptoms, and can be hepatotoxic. Due to the frequent coexistent liver test alterations due to alcohol, the true incidence of disulfiram-associated liver injury is unclear and severity of injury may vary from mildly elevated liver enzymes to fulminant hepatitis leading to death. There are several reported cases of disulfiram hepatitis in the literature. Liver histology, when available, demonstrates some degree of portal inflammation with eosinophils and hepatocyte necrosis. We present here a well-documented case of acute hepatitis due to disulfiram with typical histological lesions, favorable outcome following drug withdrawal, and a brief steroid course. The risk of hepatotoxicity should be kept in mind when prescribing disulfiram.
Case Report: TEMPI syndrome: Report of three cases and treatment follow-up
Authors: Zhuo-Fan Xu, Jing Ruan, Long Chang, Sijin Wu, Jinkai Lin, Wei Wang, XinXin Cao, Lu Zhang, Jian Li, Daobin Zhou, Wei Zhang
Journal: Front Oncol (2022)
Keywords: tempi syndrome, case report, erythrocytosis, monoclonal gammopathy, plasma cell disorder
MeSH terms: Case Reports

The TEMPI syndrome is a novel and rare disease with five distinct clinical features: Telangiectasis, Erythrocytosis, Monoclonal gammopathy, Perinephric fluids collection, and Intrapulmonary shunting. Here, we report three cases of TEMPI syndrome and their treatment response. The three patients were presented to our department with polycythemia, abdominal distension, and dyspnea. On admission, all patients manifested telangiectasis, erythrocytosis, monoclonal gammopathy, and intrapulmonary shunting. Patient 1 and 2 manifested perinephric fluids collection. In addition, all patients had skin pigmentation, patient 1 and 2 had polyserosal effusion, two symptoms that had not been associated with TEMPI syndrome before. The three patients showed various response to plasma cell-directed therapy. We demonstrated their treatment response by measuring erythropoietin, hemoglobin, and M protein levels throughout therapy. This report suggested that TEMPI syndrome is a rare yet treatable disease. The diagnosis and treatment of it remain challenging.
Painful testicular swelling: an unusual localization of sarcoidosis
Authors: Karima Bouytse, Hanane Haddaoui, Jouda Benamour, Jamal-Eddine Bourkadi
Journal: Pan Afr Med J (2020)
Keywords: sarcoidosis, scrotal mass, testis
MeSH terms: Sarcoidosis / diagnosis, Testicular Diseases / diagnosis, Testicular Neoplasms / diagnosis, Case Reports, Humans, Male, Middle Aged, Pain / etiology, Sarcoidosis / pathology, Testicular Diseases / pathology

Sarcoidosis is a systemic inflammatory disease characterized by non-caseating epitheloid granulomas; whereas it usually involves the lungs and lymph nodes. Testicular sarcoidosis is extremely rare, having been reported to occur in 0.2% of all sarcoidosis patients. We describe a very unusual form of sarcoidosis of the testis, mimicking malignancy at initial presentation.
Disseminated cutaneous histoplasmosis with laryngeal involvement in a setting of immune reconstitution inflammatory syndrome
Authors: Mohamed F Sacoor
Journal: South Afr J HIV Med (2017)
MeSH terms: Case Reports

Introduction:
Histoplasmosis is a systemic mycosis caused by the dimorphic fungus Histoplasma capsulatum. We report a case of disseminated cutaneous histoplasmosis with mucocutaneous involvement in an AIDS patient paradigmatic of the multifaceted nature of the disease, which is an expression of the immune reconstitution inflammatory syndrome (IRIS).
Patient presentation:
A 39-year-old man presented with a three month history of asymptomatic papules and nodules with necrotic centres involving the centrofacial region. The patient was diagnosed as being HIV-positive a month earlier and was commenced on antiretroviral treatment. Two weeks after the development of skin lesions, the patient complained of a sore throat and hoarseness of his voice. A fibre-optic laryngoscopy and biopsies of the skin, larynx and liver were performed.
Management and outcome:
The CD4 counts increased from 2 cells/µL to 124 cells/µL, whereas the viral load decreased from one million to less than 20 copies/mL. A fibre-optic laryngoscopy revealed a supraglottitis with ulceration on the epiglottis. Histology of the liver, larynx and sections of the skin demonstrated pandermal necrotising granulomatous inflammation. Grocott-Gomori methenamine silver and Periodic acid-Schiff (PAS) stains revealed a relative paucity of intracellular, narrow-neck budding fungal organisms. Culture findings confirmed the diagnosis of histoplasmosis. The patient was treated with intravenous amphotericin B for two weeks followed by oral itraconazole 100 mg twice a day, with an excellent response to treatment.
Conclusion:
We present this case to remind clinicians that disseminated histoplasmosis in AIDS patients may occur as an expression of IRIS. A sudden onset of hoarseness with cutaneous lesions in a patient with disseminated disease should alert one to possible laryngeal histoplasmosis. Prompt recognition and treatment will avert the potential fatal complications of this disease.
A Patient with Chronic Lymphocytic Leukemia with Pancreatic Involvement
Authors: Rajesh Essrani, Matthew J Sullivan, Hiral Shah
Journal: Case Rep Hematol (2019)
MeSH terms: Case Reports

A 78-year-old female with a past medical history of hypertension, type 2 diabetes mellitus, and chronic lymphocytic leukemia was hospitalized for poor appetite, weight loss, and night sweats. On physical exam, there was no palpable lymphadenopathy, and her abdomen was soft and nondistended. Laboratory results showed a hemoglobin count of 13.3 g/dl, hematocrit 41.3%, white blood cell 68.4 × 103 μL with lymphocytes 92.0%, total bilirubin 0.4 mg/dL, aspartate transaminase 14 U/L, and alanine transaminase 15 U/L. CT of the chest, abdomen, and pelvis showed hypodense lesions within the pancreatic body (1.4 × 1.4 cm) and medial aspect of the pancreatic head (1.2 cm) as well as mild splenomegaly (13 cm craniocaudally). She subsequently underwent endoscopic ultrasound (EUS) with fine needle aspiration (FNA) of the pancreatic mass. Flow cytometry revealed expression of CD5 and CD23, consistent with chronic lymphocytic leukemia.
Effective use of polymyxin B hemoperfusion in septic shock complicated by urosepsis
Authors: P Malleshappa, R Ranganath, A P Chaudhari, P Singhai, M Aghariya, A B Shah
Journal: Indian J Nephrol (2011)
Keywords: gram-negative infection, pmx-dhp, septic shock, urosepsis
MeSH terms: Case Reports

Direct hemoperfusion using polymyxin B-immobilized fiber (PMX-DHP) is an established treatment method for septic shock caused by Gram-negative infections. Here we report one instance in which PMX-DHP therapy has been used successfully in a patient with septic shock from urosepsis. After antibiotic therapy, direct hemoperfusion using polymyxin B helped in cardiovascular stability. The patient recovered from the shock within a few days after treatment with polymyxin-B hemoperfusion. As far as we are aware, this is the first reported case of effective treatment of urosepsis complicated by septic shock using PMX-DHP therapy in India.
Differential diagnosis and laparoscopic resection of an adrenal pseudocyst: A case report
Authors: Yuichiro Yokoyama, Yusuke Tajima, Izuru Matsuda, Kentaro Kamada, Takashi Ikehara, Toshimasa Uekusa, Hirokazu Momose, Satomi Yoneyama, Hiroki Sakata, Akio Hidemura, Hiroyuki Suzuki, Masahiro Ishimaru
Journal: Int J Surg Case Rep (2020)
Keywords: adrenal cyst, laparoscopic resection, pancreatic cyst
MeSH terms: Case Reports

Background:
Adrenal pseudocysts are infrequent entities and definite preoperative diagnosis is difficult. We present a case of left adrenal pseudocyst, which was intraoperatively identified as having an adrenal origin and was resected using a laparoscopic approach.
Presentation of case:
A 41-year-old female was referred to our hospital for examination and treatment of a cystic lesion in the pancreatic tail. Preoperative diagnostic imaging studies showed a cystic lesion with intramural nodular structure, measuring 39 mm in the largest diameter and located between the pancreatic tail and the left adrenal gland. However, the origin of the cystic lesion remained unclear, and a definite preoperative diagnosis was not established. The cystic lesion was intraoperatively identified as having an adrenal origin after the division of the loose connective tissue layer around the lesion under the laparoscopic magnified view. Laparoscopic left adrenalectomy was performed as radical treatment and the histopathological diagnosis confirmed the presence of an adrenal pseudocyst.
Discussion:
We could not ascertain the origin of the cystic lesion from the left adrenal gland and establish a definite diagnosis based on the findings of the preoperative diagnostic imaging modalities. Laparoscopic surgery could be more advantageous than the conventional open approach as not only a minimally invasive treatment option but also as an intraoperative diagnostic tool for cystic lesions in the pancreatic tail.
Conclusion:
This case report suggests that laparoscopic surgery could be clinically useful as not only a minimally invasive treatment but also an intraoperative diagnostic tool for cystic lesions in the pancreatic tail region.
Breast Cancer Development in a Transgender Male Receiving Testosterone Therapy
Authors: Nadia Barghouthi, Jennifer Turner, Jessica Perini
Journal: Case Rep Endocrinol (2018)
MeSH terms: Case Reports

Context:
To describe a case of invasive ductal carcinoma of the breast in a transgender male receiving testosterone therapy for gender-affirming treatment.
Case description:
A 28-year-old transgender male receiving intramuscular testosterone was found to have a breast mass on ultrasound after self-exam revealed a palpable breast lump. Ultrasound-guided breast biopsy revealed estrogen receptor/progesterone receptor (ER/PR) negative, human epidermal growth factor receptor-2 (HER-2) positive, invasive ductal carcinoma of the left breast. He underwent neoadjuvant and adjuvant chemotherapy along with bilateral mastectomy. At patient request, his testosterone injections were permanently discontinued.
Conclusion:
Fewer than 20 cases of breast cancer in transgender male patients have been reported in medical literature. While studies have shown increased risk of breast cancer in postmenopausal women with higher testosterone levels, data regarding premenopausal women is conflicting and little is known about breast cancer risk in transgender individuals receiving gender-affirming hormone therapy (GAHT), with inconclusive results regarding correlation between testosterone therapy and breast cancer. More research is required to evaluate whether a possible increased risk of breast cancer exists for transgender men receiving gender-affirming therapy.
Hashimoto's thyroiditis and acute chest syndrome revealing sickle cell anemia in a 32 years female patient
Authors: Marielle Igala, Daniela Nsame, Jennie Dorothée Guelongo Okouango Ova, Siham Cherkaoui, Bouchra Oukkach, Asmae Quessar
Journal: Pan Afr Med J (2015)
Keywords: hashimoto′s thyroitidis, acute, sickle cell anemia
MeSH terms: Acute Chest Syndrome / diagnosis, Anemia, Sickle Cell / diagnosis, Hashimoto Disease / diagnosis, Case Reports, Adult, Anemia, Hemolytic / diagnosis, Chest Pain / etiology, Female, Humans, Thyroid Function Tests

Sickle cell anemia results from a single amino acid substitution in the gene encoding the β-globin subunit. Polymerization of deoxygenated sickle hemoglobin leads to decreased deformability of red blood cells. Hashimoto's thyroiditis is a common thyroid disease now recognized as an auto-immune thyroid disorder, it is usually thought to be haemolytic autoimmune anemia. We report the case of a 32 years old women admitted for chest pain and haemolysis anemia in which Hashimoto's thyroiditis and sickle cell anemia were found. In our observation the patient is a young woman whose examination did not show signs of goitre but the analysis of thyroid function tests performed before an auto-immune hemolytic anemia (confirmed by a high level of unconjugated bilirubin and a Coombs test positive for IgG) has found thyroid stimulating hormone (TSH) and positive thyroid antibody at rates in excess of 4.5 times their normal value. In the same period, as the hemolytic anemia, and before the atypical chest pain and anguish they generated in the patient, the search for hemoglobinopathies was made despite the absence of a family history of haematological disease or painful attacks in childhood. Patient electrophoresis's led to research similar cases in the family. The mother was the first to be analyzed with ultimately diagnosed with sickle cell trait have previously been ignored. This case would be a form with few symptoms because the patient does not describe painful crises in childhood or adolescence.
Stent Thrombosis Patients with Hyporesponsiveness to Clopidogrel, Prasugrel, and Ticagrelor: A Case Series Using Short Thromboelastography
Authors: Bartosz Olechowski, Alexander Ashby, Nalyaka Sambu, Michael Mahmoudi, Nick Curzen
Journal: Case Rep Med (2016)

Patients after percutaneous coronary intervention (PCI) with stent implantation and functional hyporesponsiveness to P2Y12 inhibitors are at higher risk of ischaemic events, particularly stent thrombosis (ST). It is currently not routine practice to assess the functional response to these agents. However, concern over functional hyporesponsiveness to clopidogrel has led to widespread uptake of prasugrel and ticagrelor as the default P2Y12 inhibitor after stent implantation in patients with acute coronary syndrome. Here we report, for the first time, 3 cases in which patients who have had ST exhibit hyporesponsiveness to clopidogrel, prasugrel, and ticagrelor.
Case report: Severe dry cough associated with superior vena cava syndrome-Caused recurrent chylothorax
Authors: Ziming Wan
Journal: Front Cardiovasc Med (2022)
Keywords: case report, chylothorax, dry cough, enhanced computed tomography, superior vena cava syndrome
MeSH terms: Case Reports

Introduction:
Symptomatic pleural effusion is occasionally caused by superior vena cava syndrome. Dyspnea and pleuritic chest pain are common symptoms of pleural effusion. However, the current literature has not reported a causal linkage between chylous pleural effusion and dry cough.
Case presentation:
A patient with uremia suffered from an unexplained severe dry cough, which could be triggered by postural changes. Medical examinations ruled out the possibility of chronic bronchitis, gastroesophageal reflux, chest tumor, tuberculosis, asthma, chronic obstructive pulmonary disease, and allergy history. Examinations showed that the patient had chylous pleural effusion. The cough symptoms were relieved after extraction of the pleural effusion but soon reappeared with the recurrence of chylothorax. Enhanced computed tomography showed that the patient had superior vena cava occlusion. After recanalization of the superior vena cava by percutaneous balloon dilatation, the patient no longer had chylothorax, and the severe cough was eliminated.
Conclusion:
Super vena cava syndrome can cause chylothorax and further stimulate severe dry cough. Cough is not a specific symptom. Chest imaging and pleural fluid analysis can help narrow down the diagnosis.
Sirenomelia: a rare presentation
Authors: K Ramesh Reddy, S Srinivas, Shiva Kumar, Surweshwar Reddy, Hari Prasad, G M Irfan
Journal: J Neonatal Surg (2012)
Keywords: caudal regression syndrome, mermaid syndrome, sirenomelia
MeSH terms: Case Reports

We are presenting two cases of Sirenomelia (Mermaid Syndrome), which is an extreme example of the caudal regression syndrome. It invariably presents with lower limb fusion, sacral and pelvic bony anomalies, absent external genitalia, imperforate anus, and renal agenesis or dysgenesis. There are approximately 300 cases reported in the literature, 15% of which are associated with twinning, most often monozygotic. The syndrome of caudal regression is thought to be the result of injury to the caudal mesoderm early in gestation. One of our cases survived for 12 days after birth. This new born had an unusually high anorectal anomaly in which the colon was ending at the level of mid transverse colon, fused lower limbs and genital anomalies. Ultrasound of the abdomen revealed horseshoe kidney. Colostomy was performed on day 2 of life. The second case encountered was a stillborn baby on whom an autopsy was performed.
Case report: delayed perforation after definitive treatment of focal intestinal perforation with a peritoneal drain
Authors: Brian G A Dalton, Kenneth C Walters, Melvin S Dassinger 3rd
Journal: Case Rep Surg (2012)

Focal intestinal perforation (FIP) has long been described in the pediatric literature. Peritoneal drainage (PD) is widely used as treatment for focal intestinal perforation. Here we report a premature infant that underwent PD on day of life 9 for a FIP. The infant recovered well from this episode and was discharged home without known sequelae. Subsequently, the same patient presented 16 months later with peritonitis. A perforation was discovered at laparotomy without evidence of surrounding necrosis. Given this finding, we believe this second episode of perforation was at the same site as the initial episode of FIP. The finding of FIP has been described without findings of surrounding necrosis. However, we believe this to be the first report of delayed perforation greater than 1 year from initial presentation after FIP treated definitively with peritoneal drain.
Case Report: Long-Acting Oral Cariprazine
Authors: Emanuela Dyrmishi, Marco De Pieri, Marco Ferrari, Rafael Traber, Matteo Preve, Luca De Peri, Emilio Bolla
Journal: Front Psychiatry (2022)
Keywords: adherence–compliance–persistence, cariprazine, long acting antipsychotics, personalized medicine, therapeutic alliance
MeSH terms: Case Reports

Introduction:
Cariprazine is a third-generation antipsychotic, approved for the treatment of schizophrenia and bipolar disorder and used off-label for schizoaffective disorder and treatment-resistant depression. Cariprazine is a partial agonist at dopamine receptors D2 and D3 and serotonin receptor 5HT1A and an antagonist at serotonin receptors 5HT2B and 5HT2A. It is metabolized by CYP3A4 in desmetyl-cariprazine and didesmethyl-cariprazine, both active metabolites with a half-life of 1-2 days and 2-3 weeks, respectively.
Case report:
Here we show the cases of 3 outpatients diagnosed with bipolar I disorder (two patients) and schizoaffective disorder (one patients) and characterized by low adherence to treatment, satisfactory cognitive and personal functioning and average disease severity to whom we administered cariprazine as a monotherapy, on a two-times a week schedule (i.e., every 72-96 h). We evaluated response to treatment and disease remission according to conventional definitions, using rating scales BPRS, PANSS and BDI-II. Two-times a week treatment was set either after a disease relapse (one patient), after a sustained remission obtained with daily administration of cariprazine (one patient) or since our first evaluation (one patient). After 4 weeks of treatment all three patients satisfied criteria for response to treatment and remission, a result that was sustained for 8 (in one patients) and 12 months (in other two patients) and still ongoing.
Discussion:
Reported results support our hypothesis that long half-lives of cariprazine and its metabolites provide an adequate therapeutic response with a two-times a week administration. In selected patients, cariprazine administered as a "oral long-acting" seems effective in treating acute episodes of illness and in sustaining remission, combining advantages of oral and long-acting injectable antipsychotics concerning therapeutic alliance.
Lower extremity cutaneous lesions as the initial presentation of metastatic adenocarcinoma of the colon
Authors: Dhyan Rajan, Mitanshu Shah, Pooja Raghavan, Shanza Mujeeb, Sadat Rashid, Aieska Desouza, Paul Mustacchia
Journal: Case Rep Med (2012)
MeSH terms: Case Reports

Cutaneous metastases from colorectal cancers are rare and are usually present on the abdominal wall or previous surgical incision sites. Remote cutaneous lesions have been reported, however, often occur in the setting of widespread metastatic disease including other visceral secondaries. We present a case of lower extremity cutaneous metastases as the first sign of metastatic disease in a patient with adenocarcinoma of the colon. This case illustrates that new skin lesions may be the initial presentation of metastatic disease in a patient with a history of cancer.
Mandibular Involvement in Recurrent Multifocal Osteomyelitis Associated with SAPHO Syndrome
Authors: Igor-Moreira Hazboun, Thiago-Pires Brito, Vanessa-Gonçalves Silva, Carlos-Eduardo-Monteiro Zappelini, Leopoldo-Nizam Pfeilsticker
Journal: Iran J Otorhinolaryngol (2018)
Keywords: mandibular involvement, osteomyelitis, sapho syndrome
MeSH terms: Case Reports

Introduction:
SAPHO syndrome is defined as the association of a group of rare sterile osteoarticular disorders and inflammatory skin diseases whose etiology, although not yet determined, probably involves genetic, immunological and infectious mechanisms. The recurrent multifocal osteomyelitis, an inflammatory disease, can be associated with this syndrome even as a single event.
Case report:
A case of a young female patient, with a definite diagnosis of SAPHO and an inflammatory mandibular atypical disease for which therapeutic options with immunosuppressants were being used, is reported. The adverse evolution of the clinical conditions led to the hypothesis that the patient suffered from associated mandibular odontogenic bacterial osteomyelitis. The extraction of all teeth was recommended. After our evaluation, we recommended a conservative treatment, and after 2 months of treatment with an endovenous antibiotic, the patient showed improvement of clinical and laboratory results.
Conclusion:
Early diagnosis is necessary to avoid successive and unnecessary tooth loss in the treatment of chronic osteomyelitis mandibular.