OpenMed/multicare-articles huggingface dataset:
Solitary contralateral adrenal metastasis of renal cell carcinoma 15 years following radical nephrectomy: A case report and review of literature
Authors: Hthayyim Khalid Ahmed, Rawa Bapir, Goran Fryad Abdula, Karzan Mohammed Salih Hassan, Rawa Muhsin Ali, Mahabad Abdalaziz Salih
Journal: Int J Surg Case Rep (2019)
Keywords: adrenal gland, adrenal metastasis, adrenalectomy, case report, renal cell carcinoma

Introduction:
Renal cell carcinoma (RCC) is known to metastasize to almost every organ. A well-recognized phenomenon in RCC is late metastatic recurrence after nephrectomy which is arbitrarily defined as more than 10 years. The incidence of solitary ipsilateral and contralateral adrenal metastasis is 3% and 0.7% respectively in patients who have underwent radical nephrectomy.
Case report:
A57-year-old female presented with an incidental ultrasonic finding of a right adrenal mass 15 years after radical nephrectomy for left side renal cell carcinoma. Further evaluation with abdominal contrast enhanced CT scan revealed a right adrenal mass suggestive of metastatic lesion. The results of laboratory examinations showed the mass to be nonfunctional. Open right adrenalectomy was performed. She was discharged home on 4th postoperative day. Pathological examination revealed morphological and immunohistochemical findings in line with metastatic renal cell carcinoma of the left kidney. During the last 2 years she has being on regular follow up, neither local recurrence nor distant metastasis anywhere have been detected by whole body Positron Emission Tomography(PET) scan.
Discussion:
Late metastatic contralateral adrenal recurrence from RCC is very rare and to the best of our knowledge, 5 similar cases have been reported 10 years after radical nephrectomy. Early diagnosis of adrenal metastasis is challenging because they are usually silent both anatomically and functionally.
Conclusion:
Solitary contralateral adrenal metastatic recurrence of RCC is extremely rare event. Surgical removal is a wise option in these cases that may improve survival.
New findings useful for clinical practice using swept-source optical coherence tomography angiography in the follow-up of active ocular toxoplasmosis
Authors: João Rafael de Oliveira Dias, Camila Campelo, Eduardo Amorim Novais, Gabriel Costa de Andrade, Paula Marinho, Yusláy Fernández Zamora, Luciana Finamor Peixoto, Maurício Maia, Heloísa Nascimento, Rubens Belfort Jr
Journal: Int J Retina Vitreous (2020)
Keywords: ocular toxoplasmosis, optical coherence tomography angiography, toxoplasmic retinochoroiditis

Background:
Ocular toxoplasmosis is one of the most common causes of intraocular inflammation and posterior uveitis in immunocompetent patients. This paper aims to investigate swept-source optical coherence tomography angiography (SS-OCTA) findings in eyes with active toxoplasmic retinochoroiditis.
Methods:
This case series was conducted from November 2017 through October 2019 in two Brazilian centers. 15 eyes of 15 patients with active toxoplasmic retinochoroiditis were included, and were imaged at baseline and after at least 4 weeks of follow-up. All patients underwent ophthalmic examinations and multimodal imaging including SS-OCT and SS-OCTA before and after treatment of ocular toxoplasmosis. The differential diagnoses included toxoplasmosis, syphilis, and human immunodeficiency virus, which were eliminated through serologic and clinical evaluations.
Results:
All 15 patients presented with positive anti-Toxoplasma gondii immunoglobulin G titers and three also presented with positive anti-T. gondii immunoglobulin M titers. The mean age at examination was 32.4 years ± 12.7 years (range 15-59 years). Sixty percent of the patients were female. In all eyes, the inner retinal layers were abnormally hyperreflective with full-thickness disorganization of the retinal reflective layers at the site of the active toxoplasmic retinochoroiditis. At baseline, 80% of eyes had focal choroidal thickening beneath the retinitis area, and all eyes had a choroidal hyporeflective signal. Before treatment, SS-OCTA showed no OCTA decorrelation signal next to the lesion site in all eyes, and flow signal improvement was noticed after treatment. Three eyes presented with intraretinal vascular abnormalities during follow-up. SS-OCTA showed retinal neovascularization in one patient and a presumed subclinical choroidal neovascular membrane in another patient.
Conclusions:
SS-OCT and SS-OCTA are useful for assessing unexpected structural and vascular retinal and choroidal changes in active and post-treatment toxoplasmic retinochoroiditis and these findings are useful for clinical practice.
Case report: Minimal manifestations of mucous membrane pemphigoid in a young adult
Authors: Franziska Schauer, Federica Casetti, Dimitra Kiritsi
Journal: Front Med (Lausanne) (2022)
Keywords: bp230, autoimmune disease, blistering disorder, hemidesmosome, skin fragility, urethral erosion
MeSH terms: Case Reports

A male patient presented to our department at the age of 23 suffering from recurrent painful erosions in the urethral outlet area. In closer clinical examination gingival erosions, primarily around the teeth were identified as well. Indirect immunofluorescence on salt split skin with epidermal IgG deposition and positive anti-BP230 IgG ELISA diagnostics hinted toward the presence of mucous membrane pemphigoid (MMP). Direct immunofluorescence from oral mucosa confirmed the diagnosis. MMP in young adulthood is an underdiagnosed disease and latency of diagnosis was around 4 years in our case. Treatment with systemic glucocorticosteroids and dapsone led to clinical remission, prohibiting the development of MMP manifestations in further organs and complications associated with the disease, e.g., scar formation and miction problems.
Relapsed Brucellosis Manifested as Endocarditis with Vegetation on the Implantable Cardioverter Defibrillator Lead
Authors: Bisher Sawaf, Wael Kanjo, Yasir Alabbas, Ahmad Hatim, Unus K Bedardeen, Wafer A Dabdoob
Journal: Case Rep Cardiol (2021)
MeSH terms: Case Reports

Implantable cardioverter defibrillator lead endocarditis due to Brucella melitensis is a rare and life-threatening complication of brucellosis. Successful management requires a combination of medical treatment and device extraction. We present a case of relapsing brucellosis manifested as infective endocarditis colonizing the lead of the implantable cardioverter defibrillator with formation of vegetation on the lead. A 63-year-old male presented to the rehabilitation unit with hypotension. No other signs of infection were noted. The patient had a history of drinking unpasteurized milk since childhood and a previous episode of Brucella infective endocarditis. A transthoracic echocardiography showed an oscillating vegetation on the lead of the tip of the right atrial ICD, and the blood cultures were positive for Brucella melitensis. Surgical removal of the device was infeasible, and medical management was the only feasible option in this case.
Psammomatoid juvenile ossifying fibroma of frontal sinus - surgical and reconstructive approach
Authors: Jefferson Rocha Tenório, Paulo Roberto de Alencar Bártholo, Mário José Romañach, Aline Corrêa Abrahão, Michelle Agostini, Bruno Augusto Benevenuto de Andrade
Journal: Autops Case Rep (2022)
Keywords: fibroma, ossifying, neoplasms, bone tissue, reconstructive surgical procedures, rehabilitation
MeSH terms: Case Reports

Psammomatoid juvenile ossifying fibroma (PJOF) is a benign fibro-osseous lesion that mainly affects the paranasal sinuses and periorbital bones. It may cause significant esthetic and functional impairment. Herein, we describe the diagnosis and surgical approach of an extensive PJOF arising in the frontal sinus of a young male. After complete lesion removal and histopathological confirmation, the bone defect was repaired with a customized polymethylmethacrylate implant. PJOF may present aggressive clinical behavior. The excision of extensive PJOF in the orbitofrontal area can result in significant esthetic defects. Polymethacrylate implants restore functionally and esthetically the involved area.
Auditory Hallucinations as a Rare Presentation of Occipital Infarcts
Authors: Firas Ido, Reina Badran, Brandon Dmytruk, Zain Kulairi
Journal: Case Rep Neurol Med (2018)
MeSH terms: Case Reports

A stroke is a clinical syndrome characterized by a focal neurologic deficit that can be attributed to a vascular territory within the brain. The presenting features of an acute stroke depends on the area of the brain affected. Although unusual, the presenting feature may include psychosis with auditory and/or visual hallucinations. A 56-year-old female was admitted to the psychiatric unit after threatening her husband with a knife. She reported experiencing altered sensorium for one week with suicidal and homicidal command hallucinations. Given the acute onset, brain images were obtained to rule out an organic etiology. A brain MRI revealed an acute right occipital lobe infarct with hemorrhagic transformation. The patient's symptoms were self-limited, resolving without antipsychotic medications. Psychosis with auditory hallucinations is not commonly reported following stroke. Since histologic and functional alterations in the occipital lobe appear to play a significant role in psychosis of schizophrenics, it is likely that ischemia in the same area may cause similar changes. Familiarity with this rare presentation is important, as it prevents a delay in diagnosis, which may negatively impact the outcome.
Idiopathic Multicentric Castleman Disease Presenting With Hypertensive Choroidopathy: A Case Report
Authors: Tamami Mimoto, Noriyasu Hashida, Kohji Nishida
Journal: Cureus (2023)
Keywords: case report, castleman disease, choroid, malignant hypertension, optical coherence tomography
MeSH terms: Case Reports

Castleman disease (CD) is a lymphoproliferative disorder and rarely affects ocular tissue. This study aimed to report a case of hypertensive choroidopathy in a patient with Castleman's disease associated with malignant hypertension. A 39-year-old man visited his local physician with fever, systemic edema, and multiple lymphadenopathies. An inguinal lymph node biopsy indicated CD. One month after the biopsy, the patient noted a blurring of vision. At the time of the initial examination at our hospital, his best-corrected visual acuity (BCVA) was 20/20 in both eyes but there were bilateral multiple Elschnig spots and sprinter hemorrhage at the fundus. Swept-source optical coherence tomography showed intra-retinal fluid, and serous retinal detachment (SRD). Fluorescein angiography revealed multiple punctate hyper fluorescences and indocyanine green angiography showed choroidopathy with increased vascular permeability. A general examination revealed symptoms of cardiac failure and multiple lymphadenopathies. Malignant hypertension with acute glomerulonephritis was diagnosed after a renal biopsy. After antihypertensive treatment, his blood pressure (BP) improved, and the SRD and choroidopathy promptly resolved. Presently, the patient is being followed up without complications. We report a case of hypertensive choroidopathy in a patient with CD associated with malignant hypertension. As a severe elevation in BP can damage choroidal vasculature and lead to vision loss, careful observation and active treatment are necessary.
Extramedullary plasmacytoma of the pancreas: a rare entity
Authors: Alexis Smith, Hassan Hal, Elizabeth Frauenhoffer
Journal: Case Rep Radiol (2012)
MeSH terms: Case Reports

Extramedullary plasmacytomas are plasma cell neoplasms in organs other than the bone marrow. Most are found in the upper respiratory tract. Involvement of the pancreas is rare. We report a case of pancreatic plasmacytoma in association with advanced multiple myeloma.
Fusidic Acid: A Neglected Risk Factor for Statin-Associated Myopathy
Authors: Josefine Rönnqvist, Pär Hallberg, Qun-Ying Yue, Mia Wadelius
Journal: Clin Med Insights Cardiol (2018)
Keywords: adverse drug reactions, cardiovascular drugs, drug safety, drug-induced disorders, dyslipidemia, hypercholesterolemia, hyperlipidemia, myopathy and statins

Background:
Statins are widely used lipid-lowering drugs used for the prevention of cardiovascular disease. Statins are known to cause myopathy, an adverse drug reaction with various clinical features rhabdomyolysis.
Objective:
To describe clinical characteristics of statin-treated individuals who experienced myopathy and identify risk factors of statin-associated myopathy.
Methods:
A retrospective study was conducted on cases of statin-associated myopathy reported to the Swedish Medical Products Agency. Clinical factors were compared between cases and statin-treated controls not diagnosed with myopathy. Statistical methods were univariate and multivariate logistic regression and results were presented as odds ratio (OR) with 95% confidence interval (CI). To correct for multiple comparisons, the cutoff for statistical significance was set to P < .0017.
Results:
In total, 47 cases of statin-associated myopathy were compared with 3871 treated controls. Rhabdomyolysis was diagnosed in 51% of the cases. Markers for cardiovascular disease were more common in cases than controls. Statistical analysis revealed the following independent risk factors for myopathy: high statin dose (OR = 1.54, calculated using the standard deviation 19.82, 95% CI = 1.32-1.80, P < .0001), and concomitant treatment with fusidic acid (OR = 1002, 95% CI = 54.55-18 410, P < .0001), cyclosporine (OR = 34.10, 95% CI = 4.43-262.45, P = .0007), and gemfibrozil (OR = 12.35, 95% CI = 2.38-64.10, P = .0028).
Conclusions:
The risk of myopathy increases with statin dose and cotreatment with cyclosporine and gemfibrozil. Concomitant fusidic acid has previously only been noted in a few case reports. Considering that use of fusidic acid may become more frequent, it is important to remind of this risk factor for statin-associated myopathy.
Metastatic malignant melanoma mimicking benign breast cysts
Authors: Marius Lund-Iversen, Olav Inge Håskjold, Hiep Phuc Dong, Aasmund Berner
Journal: Case Rep Med (2011)
MeSH terms: Case Reports

Benign cysts are one of the most common mass-occupying lesions of the breast and are often investigated with triple diagnostic trial (clinical examination, radiology, and cytology). Malignant melanoma is one of medicine's imitators, and metastatic disease can mimic cysts. Thorough investigation of any breast mass is essential to clarify its nature.
Kleine-levin syndrome comorbid with obsessive compulsive disorder and personality disorder: A case report
Authors: Pezhman Hadinezhad, Javad Setareh, Parisa Adimi Naghan
Journal: Caspian J Intern Med (2023)
Keywords: case report, hypersomnia, kleine-levin syndrome, obsessive-compulsive disorder
MeSH terms: Case Reports

Background:
Kleine-Levin syndrome (KLS) is a rare sleep disorder with at least two episodes of hypersomnia coincidence with at least one cognitive, eating, perceptive and disinhibited symptoms and normal inter-episodes. These symptoms are not explained by another sleep, medical, neurological, psychiatric disorders and substance or drug use.
Case presentation:
Here we report a young female with personality disorder and obsessive-compulsive disorder who had KLS. Her symptoms appeared in the past 1.5 years ago, while she had an episode of hypersomnia lasting for 5 days. She had 4 attacks; each one lasted up to 2-7 days. We found that overriding KLS symptoms on underlying main psychiatric or personality disorders complicates diagnosis. All neurological examinations during episode and further investigation were in normal range.
Conclusion:
We suggest that taking a complete history and mental state examination in the episode and inter episode phase helps to diagnosis both KLS and comorbid psychiatric disorders.
A Combination of Tachycardia-Mediated Heart Failure and Coronary Artery Vasospasm-Induced Silent Myocardial Infarction in a Patient with Severe Thyrotoxicosis
Authors: Serena Sert Kim Khoo, Chong Mow Chu, Yin Khet Fung
Journal: Case Rep Cardiol (2018)
MeSH terms: Case Reports

Severe thyrotoxicosis can present with a myriad of cardiovascular complications. It may be mild features such as palpitations, tachycardia, and exertional dyspnea or may progress to life-threatening consequences such as atrial fibrillation, tachyarrhythmias, heart failure, myocardial infarction, and shock. In rare cases, they may present with myocardial ischemia secondary to coronary artery vasospasm. We report a case of a 59-year-old Malay gentleman who presented with fast atrial fibrillation and tachycardia-mediated heart failure that evolved to a silent myocardial infarction secondary to severe coronary artery vasospasm with undiagnosed severe thyrotoxicosis. He had complete resolution of heart failure and no further recurrence of coronary artery vasospasm once treatment for thyrotoxicosis was initiated and euthyroidism achieved. This life-threatening consequence has an excellent prognosis if recognised early and treated promptly.
Management of a Buccal Space Mass: A Clinical Case Report
Authors: Alexander Karatzanis, Stylianos Velegrakis, Georgia Liva, Dionysios Kyrmizakis, Emmanuel Prokopakis
Journal: Case Rep Otolaryngol (2020)
MeSH terms: Case Reports

Background:
Buccal space tumors constitute rare pathologies with significant histological diversity. They may pose serious diagnostic and therapeutic challenges for the head and neck surgeon.
Methods:
A case of buccal space tumor diagnosed and treated in a tertiary center is presented. Clinical presentation, imaging, and surgical approach are discussed, followed by review of the literature.
Results:
A 79-year-old male patient with a slowly growing painless mass on the right cheek presented to a head and neck reference center. Imaging revealed a tumor of the right buccal space with nonspecific characteristics. Imaging studies revealed extended infiltration of the masseter muscle as well as the anterior border of the parotid gland. FNA biopsy was performed but was nondiagnostic. The decision of surgical excision with a modified parotidectomy incision was taken. The lesion was completely excised with preservation of neighboring facial nerve branches and ipsilateral Stensen's duct. The postoperative course was uneventful. Histological examination showed CLL/Lymphoma, and the patient was referred to the hematology department for staging and further management.
Conclusion:
Differential diagnosis of buccal space masses is very diverse. Despite challenges in the diagnostic and therapeutic approach, these entities may be managed surgically with minimal morbidity.
An unusual cause of altered mental status in elderly-acute cerebellitis: a case report and review
Authors: Priyank Patel, Supratik Rayamajhi, Hemasri Tokala, Heather Laird-Fick
Journal: Case Rep Med (2013)

Acute cerebellitis is a rare diagnosis found mostly in the pediatric population. The etiology, in most instances, is unknown. We describe the case of a 61-year-old woman who presented with acute mental status changes, signs of cerebellar dysfunction, and MRI findings of acute cerebellitis. A brief review of the existing literature and comparison of our case with previous reports are also presented.
Challenges in Anaesthetic Management in a Case of Facial Plexiform Neurofibromatosis Posted for Debulking Surgery
Authors: Sambit Dash, Neeta Verma, Sheetal Madavi, Jui A Jadhav, Aruna Chandak
Journal: Cureus (2023)
Keywords: anesthesiology, difficult airway management, neurofibromatosis ii, plastic and reconstructive surgery, plexiform neurofibromatosis
MeSH terms: Case Reports

A patient diagnosed with facial plexiform neurofibromatosis type 1 who is 18 years old and is scheduled for tumour resection and debulking surgery of his face is the subject of this study. The purpose of this paper is to describe the anaesthetic treatment that was administered to this patient. In addition, we analyze the relevant literature, with a particular emphasis on the implications of modifying neurofibromatosis to achieve anaesthesia. Our patient was found to have multiple huge tumours all over his face. When he first arrived, he experienced cervical instability as a result of the enormous mass on the back of his head and in the region of his scalp. He also expected to have difficulty maintaining an airway and breathing through a bag and mask. To protect the patient's airway, a video laryngoscopy was performed, and a difficult airway cart was maintained on standby in the event it was required. In conclusion, the purpose of this case study was to demonstrate the relevance of comprehending the one-of-a-kind anaesthetic requirements of persons diagnosed with neurofibromatosis type 1 who are about to undergo surgical procedures. Neurofibromatosis is an extremely uncommon kind of disease that requires the anesthesiologist's undivided attention in surgical settings. Careful pre-operative planning and competent intra-operative treatment are required when dealing with patients who are expected to have difficult airway management.
Case report: splicing effect of a novel heterozygous variant of the NUS1 gene in a child with epilepsy
Authors: Yan Hu, Mingwei Huang, Jialun Wen, Jian Gao, Weiwei Long, Yansheng Shen, Qi Zeng, Yan Chen, Tian Zhang, Jianxiang Liao, Qiuli Liu, Nannan Li, Sufang Lin
Journal: Front Genet (2023)
Keywords: nus1, aberrant splicing, case report, epilepsy, trio-wes
MeSH terms: Case Reports

NUS1 is responsible for encoding of the Nogo-B receptor (NgBR), which is a subunit of cis-prenyltransferase. Over 25 variants in NUS1 have been reported, and these variants have been found to be associated with various phenotypes, such as congenital disorders of glycosylation (CDG) and developmental and epileptic encephalopathy (DEE). We report on the case of a patient who presented with language and motor retardation, epilepsy, and electroencephalogram abnormalities. Upon conducting whole-exome sequencing, we discovered a novel pathogenic variant (chr6:118024873, NM_138459.5: c.791 + 6T>G) in NUS1, which was shown to cause Exon 4 to be skipped, resulting in a loss of 56 amino acids. Our findings strongly suggest that this novel variant of NUS1 is responsible for the development of neurological disorders, including epilepsy. It is believed that the truncation of Nogo-B receptor results in the loss of cis-prenyltransferase activity, which may be the underlying cause of the disease.