OpenMed/multicare-articles huggingface dataset:
Accurate diagnosis of bronchopulmonary Talaromyces marneffei infection in an anti-IFN-γ autoantibodies positive patient assisted by endobronchial ultrasound-guided TBNA and mNGS: a case report
Authors: Guirong Chen, Nan Ma, Donglan Zhu, Huaihai Zhou, Qiumei Liang, Jianfeng Meng, Yin Shen, Hang Liu, Liu Liu, Zhiyi He, Zhiqiang Qin
Journal: Front Cell Infect Microbiol (2023)
Keywords: talaromyces marneffei, anti-interferon-gamma autoantibodies, endobronchial ultrasound, lung, mediastinal lymph node, metagenomic next-generation sequencing
MeSH terms: Cough / pathology, Mycoses / diagnosis, Case Reports, Autoantibodies / blood, Autoantibodies / immunology, Humans, Interferon-gamma, Lymph Nodes / pathology, Male, Middle Aged, Ultrasonography, Interventional, Autoantibodies, Interferon-gamma, talaromycosis

Rationale:

T. marneffei is opportunistic and dimorphic fungus, which can cause systemic mycosis in human beings. It's being difficult to obtain histopathological or microbiological evidence in T. marneffei infection. We reported a rare non-HIV case of T. marneffei infection of bronchopulmonary and mediastinal lymph nodes which was diagnosed by EBUS-TBNA combined with mNGS. The high titer of anti-IFN-γ autoantibodies in serum was probably the cause of T. marneffei infection,which has yet to be fully known.
Patient concerns:
A 56-year-old Chinese man presented with a 5-month history of intermittent low or high fever and dry cough, followed by fatigue, night sweating, and chest pain when coughing. A large hilar lesion in the left lung and multiple mediastinal lymph node enlargements were found on his chest CT scan.
Diagnoses:
The patient received EBUS-TBNA of hilar tissue and lymph node biopsy for mNGS at the second Ultrasonic bronchoscopy. No fungal hyphae or spores were found in the histopathology. There were high sequencing reads of T. marneffei in samples of lymph node fluid and bronchogenesis tissue detected by mNGS. His plasma anti-IFN-γ autoantibodies level was positive with a high titer at 1:2500↑.
Intervention:
The patient went through atrial fibrillation at the first dose of amphotericin B liposomes and treated with voriconazole later.
Outcomes:
His fever, cough and dyspnea quickly disappeared since the fourth day of treatment. After six months, there was not any focus in his chest CT scans. But his plasma anti-IFN-γ autoantibodies remained unchanged.
Lessons:
Complementing the traditional laboratory and bronchoscopy, mNGS combined with EBUS-TBNA facilitate rapid and precise diagnosis of bronchopulmonary mediastinal lymph nodes T. marneffei infection. Clinicians should be aware of anti-INF-γ autoantibodies in opportunistic infections of non-HIV patients.
A Leaky False Pouch: Left Ventricle Pseudoaneurysm with Active Hemopericardium Detected on Cardiac Computed Tomography Angiography
Authors: Shiva Barforoshi, Chandana Shekar, Zoe Yu, Eugene Liu, Venkat Manubolu, Matthew J Budoff, Sion K Roy
Journal: Clin Med Insights Cardiol (2024)
Keywords: pseudoaneurysm, cardiac computed tomography angiography, hemopericardium, left ventricle pseudoaneurysm, myocardial infarction
MeSH terms: Case Reports

Pseudoaneurysm is a rare but fatal complication of myocardial infarction (MI). With the advances in cardiovascular disease detection and treatments, fatal structural complications post-MI are now rare. When they occur, advanced diagnostic modalities can be used for early diagnosis, aiding surgical planning, and improving prognosis. In our case, post-MI left ventricle pseudoaneurysm complicated by hemopericardium was diagnosed using cardiac computed tomography angiography (CCTA). Use of attenuation measurement on CCTA helped diagnose active extravasation into the hemopericardium. This case highlights the high index of suspicion needed for rare but fatal complications post-MI and the utility of CCTA in their management.
Hepatitis A Leading to Severe Vitamin A Deficiency and Bitot's Spots in a Three-Year-Old Male Child: A Case Report
Authors: Nagaraju Nimmanagoti, Ashish Varma, Amar Taksande, Revat J Meshram
Journal: Cureus (2024)
Keywords: abdominal distension, bitot's spots, hepatitis, pediatric patient, tertiary care center, vitamin a deficiency
MeSH terms: Case Reports

This case presentation details the clinical journey of a three-year-old male child presenting with fever, abdominal distention, and loose stools. The child's symptoms, unresponsive to initial treatment at two hospitals, led to the discovery of elevated liver enzymes and subsequent referral to a tertiary care center. Clinical examination revealed hepatomegaly, abdominal distension, and non-palpable spleen. Laboratory findings confirmed acute hepatitis, prompting further investigation into the child's dietary history and revealing a potential foodborne infection. The child was diagnosed with hepatitis-associated severe vitamin A deficiency, manifested by Bitot's spots on ophthalmic examination. Prompt initiation of antiviral therapy, nutritional supplementation, and supportive care resulted in a positive clinical response, with resolution of symptoms and normalization of liver enzymes. This case underscores the importance of recognizing nutritional deficiencies in the context of infectious diseases, emphasizing the need for a comprehensive approach to patient care. The successful management of this complex case highlights the significance of interdisciplinary collaboration in ensuring optimal outcomes in pediatric patients with overlapping infectious and nutritional etiologies.
Case Report: Successful conversion and salvage resection of huge hepatocellular carcinoma with portal vein tumor thrombosis and intrahepatic metastasis via sequential hepatic arterial infusion chemotherapy, lenvatinib plus PD-1 antibody followed by simultaneous transcatheter arterial chemoembolization, and portal vein embolization
Authors: Xin Luo, Rui-Zhi Chang, Dong Kuang, Mingming Yuan, Gan-Xun Li, Bixiang Zhang, Yan-Jun Wang, Wan-Guang Zhang, Ze-Yang Ding
Journal: Front Immunol (2023)
Keywords: conversion therapy, hepatic arterial infusion chemotherapy, hepatocellular carcinoma, immune therapy, portal vein embolization
MeSH terms: Carcinoma, Hepatocellular / complications, Carcinoma, Hepatocellular / pathology, Carcinoma, Hepatocellular / therapy, Chemoembolization, Therapeutic / methods, Liver Neoplasms / pathology, Venous Thrombosis / etiology, Venous Thrombosis / therapy, Case Reports, Research Support, Non-U.S. Gov't, Antibodies / therapeutic use, Combined Modality Therapy, Humans, Male, Middle Aged, Neoplasm Recurrence, Local / pathology, Portal Vein / pathology, Programmed Cell Death 1 Receptor, lenvatinib, Programmed Cell Death 1 Receptor, Antibodies

Background:
Advanced hepatocellular carcinoma (HCC) shows poor prognosis. Combined hepatic artery infusion chemotherapy (HAIC) and lenvatinib and PD-1 antibody therapy show promising effects in treating advanced HCC, and salvage hepatectomy further promotes the overall survival in patients who were successfully converted after combined therapy. However, salvage major hepatectomy is not always amenable due to insufficient future liver remnant volume (FLV).
Case presentation:
We report the case of a 59-year-old man with a huge HCC as well as multiple intrahepatic foci and portal vein tumor thrombosis at his right hemi-liver. Genomic and pathologic analyses of HCC tissue revealed a TMB-high, TPS, and CPS-high cancer, with mutated DNA damage repair gene FANCC. These results suggested that this patient may benefit from chemotherapy and immunotherapy. Thus, he received combined HAIC, lenvatinib, and PD-1 antibody treatment and showed a quick and durable response. After successful downstaging, this patient was evaluated as not suitable for salvage hepatectomy due to the low FLV. He then received simultaneous transcatheter arterial chemoembolization (TACE) and portal vein embolization (PVE). The FLV increased to meet the criteria of salvage hepatectomy. Finally, this patient underwent right hemi-hepatectomy without any severe perioperative complications. In addition, no tumor recurrence occurred during the 9-month follow-up period after surgery.
Conclusion:
Combined HAIC, lenvatinib, and PD-1 antibody therapy, followed by simultaneous TACE and PVE, is a safe and effective conversion therapy that promotes tumor necrosis and increase FLV in patients with advanced HCC.
Infantile Rosai-Dorfman Disease With Isolated Brain Lesions Disseminated to the Parenchyma and Intraventricular Ependyma, Alteration of Leukocytes as a Promotion Factor in Immune Defense, and New Proposals: A Case Report and Literature Review
Authors: Nasser Kamalian, Shahmir Kamalian, Mohammad Vasei
Journal: Cureus (2024)
Keywords: brain, brain parenchyma, infantile, intraventricular ependyma, rosai-dorfman disease
MeSH terms: Case Reports

The patient is a one-year-old girl referred to the hospital for an enlarged head after a 1.5-month history of two falls, followed by polydipsia, polyuria, and slow movement and growth. Three subsequent magnetic resonance imaging (MRI) examinations of the brain revealed nodular lesions disseminated in the brain parenchyma and intraventricular ependyma, resulting in obstructive hydrocephalus. Thoracic and abdominopelvic sonography showed no additional lesions. The preliminary diagnosis was a primary or metastatic neoplasm or infection. A biopsy of a lesion in the right frontal lobe was taken. The histological examination revealed features of Rosai-Dorfman disease (RDD), consisting of limited perivascular lymphoplasma cell infiltration with intervening sheets of proliferated histiocytes, with some of the histiocytes showing endocytosis of a single intact lymphocyte (emperipolesis).
The first case report of complement component 7 deficiency in Qatar and a 10-year follow-up
Authors: Sally Mahgoub Khalil, Sami Aqel, Dalal Sideeg Mudawi, Hassan Mobayed, Maryam Ali Al-Nesf
Journal: Front Immunol (2023)
Keywords: c7 deficiency, neisseria meningitidis, complement 7, complement membrane attack complex (mac), primary immunodeficiency diseases
MeSH terms: Meningitis, Neisseria meningitidis, Case Reports, Adult, Complement C7 / genetics, Follow-Up Studies, Humans, Male, Qatar, Complement C7, Complement Component 7 Deficiency

Introduction:

Neisseria meningitidis is a significant cause of bacterial meningitis and septicemia worldwide. Recurrent Neisseria meningitidis is frequently associated with terminal complement protein deficiency, including Complement component 7. This report discusses the first case of C7 deficiency in Qatar.
Case report:
A 30-year-old Qatari man presented with a meningococcal infection, which was verified by a blood culture. He experienced two episodes of meningitis caused by an undetermined organism. His blood tests revealed low levels of CH50 and C7. His C7 gene testing revealed a homozygous mutation in exon 10 (c.1135G>C p.Gly379Arg), a mutation that has not been previously documented in Qatar. However, it has been observed in 1% of Moroccan-origin Israeli Jews who also exhibit C7 deficiency. Regular prophylactic quadrivalent vaccinations against types A, C, Y, and W-135 with azithromycin tabs were administered. Over the last 10 years of follow-up, he remained in good health, with no further meningitis episodes.
Conclusion:
To our knowledge, this is the first confirmed case of C7 deficiency reported in the Arabian Gulf countries. Such rare diseases should be a public health priority. Awareness among medical practitioners and the community should help with early detection of C7 deficiency and the prevention of its consequences.
Case Report: Left atrial dissection after mitral valve replacement: intraoperative management under TEE guidance
Authors: Mengyan Wang, Fucheng Ji, Jinfeng Zhou
Journal: Front Cardiovasc Med (2024)
Keywords: tee, atrial dissection, left atrioventricular groove, mitral valve replacement, surgical intervention
MeSH terms: Case Reports

Left atrial dissection (LatD) is a very rare complication of cardiac surgery, but it is relatively more common in mitral valve surgery. Transesophageal echocardiography (TEE) plays an important role in timely detection of LatD and accurate assessment of the condition, which are key factors in determining the patient's prognosis. There are two different treatment options for patients with or without circulatory crisis caused by dissection hematoma, namely surgical management and conservative treatment. In this report, we used TEE to quickly detect the cause and severity of LatD, which assisted the surgeon in making appropriate surgical decisions. The patient was successfully surgically treated for LatD.
Efficacy of dupilumab in the treatment of severe vulvar pruritus associated with lichen sclerosus et atrophicus: a case report
Authors: Na Du, Qiuyu Mao, Jingyi Yang, Yiwen Zhang, Xinyan Lyu, Yueyue Li, Wei Min, Jing Xu
Journal: Front Med (Lausanne) (2024)
Keywords: biologicals, dupilumab, lichen sclerosus et atrophicus, pruritus, treatment
MeSH terms: Case Reports

Lichen sclerosus et atrophicus (LSA) is a chronic inflammatory skin lesion with an undefined cause. It is more commonly found in the genital area, particularly in adolescents, premenopausal women and postmenopausal women. LSA is difficult to treat and often recurs. The primary treatment for LSA involves the administration of potent topical corticosteroids. Dupilumab is increasingly being used for the treatment of itching in non-atopic dermatitis patients but there are few reports on its use for the treatment of LSA. Here, we present a case of LSA in a 61-year-old woman with extensive vulvar itching. Over four months of dupilumab therapy, significant therapeutic effects were observed, including vulvar skin thinning and pruritus relief without adverse reactions.
Case Report: Bradycardia in neonatal lupus: differential diagnosis between atrioventricular block and premature atrial contractions with block
Authors: Wei-Li Liu, Ying-Hsuan Peng
Journal: Front Pediatr (2024)
Keywords: atrial tachycardia, bradycardia, high-degree atrioventricular block, neonatal lupus, premature atrial contraction with block
MeSH terms: Case Reports

Neonatal lupus may be associated with severe cardiac conduction problems, including high-degree or complete atrioventricular (AV) block, necessitating immediate pacemaker implantation during the neonatal period. However, cardiac manifestations of neonatal lupus may extend beyond AV block. Our case was a full-term female neonate, who presented with fetal arrhythmia and bradycardia with a heart rate of approximately 70-75 beats per minute after birth. Neonatal lupus was diagnosed later due to positive maternal and neonatal anti-SSA/Ro antibody. High-degree AV block was considered initially but bigeminy premature atrial contractions (PACs) with block was confirmed through a detailed evaluation of an electrocardiogram, which demonstrated unfixed PP intervals and fixed RR intervals. Atrial tachycardia (AT) developed when the neonate was 23 days old. The key point that differentiates high-degree AV block from PACs with block is the PP interval. The PP interval is fixed in high-degree AV block and unfixed in PACs with block. Careful differential diagnosis is required in neonates with bradycardia because it may lead to very different management. Our case presents a good illustration of why these arrhythmias need to be differentiated. Furthermore, our case may be the first of neonatal lupus with AT.
Detection of Hanseniaspora opuntiae in anovaginal samples of pregnant women in Rio de Janeiro, Brazil-a case report
Authors: Tatiane Nobre Pinto, Laura M A Oliveira, Gisela L da Costa, Natália Silva Costa, Elaine Cristina Francisco, Tatiana C A Pinto, Manoel M E Oliveira
Journal: Front Cell Infect Microbiol (2024)
Keywords: hanseniaspora, maldi-tof ms, streptococcus agalactiae, apiculate yeasts, opportunistic pathogens
MeSH terms: Pregnancy Complications, Infectious / diagnosis, Pregnancy Complications, Infectious / microbiology, Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization, Adult, Brazil, DNA, Ribosomal / genetics, Diabetes, Gestational / diagnosis, Diabetes, Gestational / microbiology, Female, Humans, Pregnancy, Sequence Analysis, DNA, Streptococcus agalactiae / classification, Streptococcus agalactiae / genetics, Streptococcus agalactiae / isolation & purification, Vagina / microbiology, Young Adult, DNA, Ribosomal

In this study, we report the first isolation of Hanseniaspora opuntiae obtained from four pregnant women in Brazil. Clinical isolates were obtained from four samples taken between 35 and 37 gestational weeks, as part of the routine antenatal care for maternal colonization screening for Streptococcus agalactiae group B. The patients were immunocompetent, with two of them diagnosed with gestational diabetes mellitus. Species identification was performed by MALDI-TOF MS and rDNA sequencing. While Hanseniaspora species have not traditionally been considered a typical opportunist pathogen, our findings emphasize the importance of investigating and screening for Hanseniaspora in pregnant populations, highlighting H. opuntiae as a potential agent of human infections.
Pulmonary Mucormycosis: Beyond Classic COVID-19-Associated Fungal Infections
Authors: Rita Pereira, Sara Neves, Maria Ruão, Celina Gonçalves, Carla Teixeira
Journal: Cureus (2024)
Keywords: covid 19, covid-19, covid-19-associated mucormycosis, mucor, pulmonary mucormycosis, rhizopus
MeSH terms: Case Reports

Coronavirus disease 2019 (COVID-19) is often linked to a broad range of opportunistic bacterial and fungal infections. The second wave of the COVID-19 pandemic has witnessed an unprecedented surge in mucormycosis cases, predominantly in India, while the disease remained relatively rare in Europe. The authors describe the case of a 62-year-old female patient admitted to the hospital for consolidation therapy with chemotherapy as a part of the treatment protocol for acute myeloid leukemia. During hospitalization, she was diagnosed with nosocomial COVID-19, which later progressed to respiratory deterioration. COVID-19 with bacterial superinfection was presumed, leading to the initiation of empirical antibiotic therapy. A bronchoscopy was performed several days later due to a lack of improvement, revealing an infection by the Rhizopus microsporus complex. Despite antifungal treatment, the patient experienced an unfavorable clinical course and ultimately died. Given the high index of suspicion required to diagnose pulmonary mucormycosis, which can lead to delays in appropriate treatment and increase the burden of disease, the authors are aiming to enhance its awareness.
Case report: Pulse cyclophosphamide for treatment of multi-agent-refractory hepatic graft-versus-host disease
Authors: Yijun Cai, Amir Ali, Elan Filler, Rua Bayati, Tanjia Toma, Omar Zaki, George Yaghmour, Abdullah Ladha, Karrune Woan, Eric Tam, Preet M Chaudhary
Journal: Front Oncol (2024)
Keywords: allogeneic hematopoietic stem cell transplantation, case report, graft-versus-host disease, hepatic variant, pulse cyclophosphamide, ruxolitinib, steroid-refractory
MeSH terms: Case Reports

Graft-versus-host disease (GVHD) is a common complication in patients receiving allogeneic hematopoietic stem cell transplantation (HSCT). GVHD is characterized as either acute or chronic based on symptomatology and histopathological findings. Despite advancements in disease-targeting therapeutics, steroid-refractory GVHD remains a significant contributor to mortality in HSCT recipients, highlighting the gaps in our understanding of its pathophysiology and treatment strategies. We present the case of a 46-year-old woman diagnosed with acute undifferentiated leukemia, who exhibited persistently elevated levels of serum total bilirubin (T.Bili), alkaline phosphatase (ALP), and liver function tests (LFTs) beginning on [day +201] post-haploidentical peripheral blood stem cell (PBSC) transplantation. The patient received fludarabine/total body irradiation (Flu/TBI) as a myeloablative conditioning regimen and post-transplant cyclophosphamide/tacrolimus/mycophenolate mofetil (PTCy/Tac/MMF) as GVHD prophylaxis. A liver biopsy confirmed the diagnosis of GVHD, while other possible etiologies were excluded by corresponding tests. Initial treatment with prednisone and tacrolimus, and the later addition of ruxolitinib, all showed poor response indicated by worsening T.Bili, ALP, and LFTs at the same time. Based on a multidisciplinary comprehensive assessment, we decided to administer 1,000 mg/m2 (1,600 mg) of cyclophosphamide ("pulse Cy"), which resulted in a dramatic improvement in T.Bili and transaminases starting from the very next day. A durable response to pulse cyclophosphamide was observed, as all indicators normalized ("complete response") within 55 days without relapses. The patient remains in good health with no recurrence of hepatic GVHD. To our knowledge, this is the first case in which Grade IV hepatic GVHD, refractory to multiple agents including steroids, tacrolimus, and ruxolitinib, demonstrated a complete response to pulse cyclophosphamide. The success highlights the potential therapeutic role of cyclophosphamide, a potent and cost-effective chemotherapy agent, in treating multi-agent-refractory GVHD. Large-scale clinical trials are warranted to validate its efficacy in this setting.
Pancreaticoduodenectomy performed for a patient with prepancreatic postduodenal portal vein: a case report and literature review
Authors: Bingjun Tang, Sijia Li, Pengfei Wang, Jiming Ma, Fei Yu, Jun Shi, Xuedong Wang
Journal: Front Med (Lausanne) (2023)
Keywords: case report, pancreatic surgery, pancreaticoduodenectomy, portal vein variant, prepancreatic postduodenal portal vein
MeSH terms: Case Reports

Introduction:
Prepancreatic postduodenal portal vein (PPPV) is a rare congenital variation, with only 17 cases reported in the literature and five of them undergoing pancreaticoduodenectomy (PD). Of these, four were L-shaped PPPV with a thin wall that was difficult to isolate, while only one normal-shaped PPPV was reported previously. For patients undergoing PD, recognizing this variation is important to prevent PPPV injury, which could lead to liver ischemia or intraoperative hemorrhage. We here present a case of normal-shaped PPPV who underwent PD.
Case presentation:
A 68-year-old woman underwent PD for bile duct carcinoma at our hospital. Preoperative enhanced CT revealed that the portal vein was located anterior to the pancreas and posterior to the duodenum, and the L-shaped splenic vein was longitudinally located posterior to the pancreatic neck. During surgery, there was a loose tissue area between the PPPV and the pancreatic head, and the PPPV could be isolated safely. The morphology of PPPV was similar to normal portal vein. Due to the presence of the PPPV, a superior mesenteric artery (SMA)-first approach from the anterior was at high risk of vascular injury, and the pancreatic neck could not be dissected at the dorsal face of PV. Therefore, the SMA was revealed by the classic right posterior approach after transection of the pancreatic neck on the dorsal surface of L-shaped spleen vein, and the specimen was successfully resected without significant intraoperative bleeding. The patient was discharged 18 days after surgery without complications. The final pathology was bile duct carcinoma with R0 resection.
Conclusion:
PPPV is a rare variant that can be diagnosed by preoperative imaging. In PD procedure, knowledge of PPPV helps in surgical decision-making, approach selection and avoid major bleeding due to PPPV injury. The origin of normal-shaped and L-shaped PPPV might be different. Normal-shaped PPPV can be safely isolated in this case.