OpenMed/multicare-articles huggingface dataset:
Case Report: MRI, Clinical, and Pathological Correlates of Bromethalin Toxicosis in Three Dogs
Authors: Vishal D Murthy, Ehren McLarty, Kevin D Woolard, Rell L Parker, Gregg Kortz, Jamie N King, Robert H Poppenga, Marguerite F Knipe, Peter J Dickinson
Journal: Front Vet Sci (2022)
Keywords: biopsy, bromethalin, canine, corticospinal tract, desmethylbromethalin, leukoencephalopathy, restricted diffusion
MeSH terms: Case Reports

Bromethalin toxicosis is an increasingly common clinical presentation in dogs that may be fatal depending on the extent of intoxication. Antemortem diagnosis of bromethalin toxicosis was achieved in three dogs by demonstration of the active metabolite desmethylbromethalin in fat or serum. Magnetic resonance imaging (MRI) findings were consistent with a diffuse leukoencephalopathy with restricted diffusion and prominent involvement of the corticospinal motor tracts on T2-weighted and diffusion-weighted sequences. Imaging findings were confirmed in one non-surviving dog at necropsy. Resolution of MRI abnormalities was demonstrated in one surviving dog that was consistent with the associated resolution of clinical signs. Initial findings in these dogs support further investigation of specific MRI patterns in cases of leukoencephalopathy to aid differential diagnosis. While antemortem detection of bromethalin and its metabolites confirms exposure, quantitation may be informative as a prognostic biomarker.
Beneficial effect of conversion to belatacept in kidney-transplant patients with a low glomerular-filtration rate
Authors: Julie Belliere, Céline Guilbeau-Frugier, Arnaud Del Bello, Laure Esposito, Caroline Capuani, Isabelle Cardeau-Desangles, Lionel Rostaing, Nassim Kamar
Journal: Case Rep Transplant (2014)

Belatacept has been found to be efficient at preserving good kidney function in maintenance kidney-transplant patients. Herein, we report on the use of belatacept as a rescue therapy for two kidney-transplant patients presenting with severe adverse events after treatment with calcineurin inhibitors (CNIs) and mammalian target-of-rapamycin (mTOR) inhibitors. Two kidney-transplant patients developed severely impaired kidney function after receiving CNIs. The use of everolimus was associated with severe angioedema. Belatacept was then successfully used to improve kidney function in both cases, even though estimated glomerular-filtration rate before conversion was <20 mL/min. These case reports show that belatacept can be used as a rescue therapy, even if kidney function is very low in kidney-transplant patients who cannot tolerate CNIs and/or mTOR inhibitors.
Cryptogenic recurrent spontaneous intracranial epidural hematoma: A case report and literature review
Authors: Min Xu, Ya Xue, Xiaofeng Chao, Zhenglou Chen, Yunjiang Wang, Xuqi Huo, Xiang Ji, Hongshen Wang
Journal: Front Neurol (2023)
Keywords: icp, coagulation, evacuation of epidural hematoma, spontaneous epidural hematoma, treatment
MeSH terms: Case Reports

Background:
Spontaneous epidural hematoma (EDH) has been suggested to be associated with adjacent infective pathologies, dural vascular malformations, extradural metastases, or coagulopathies. Cryptogenic spontaneous EDH is extremely rare.
Case presentation:
The present study reports the case of a cryptogenic spontaneous EDH in a young woman following sexual intercourse. She was diagnosed with consecutive EDH at three different sites within a short time. After three timely operations, a satisfactory outcome was achieved.
Conclusion:
EDH should be investigated when a young patient develops headaches and shows signs of increased ICP after emotional hyperactivity or hyperventilation. If early diagnosis and surgical decompression can be carried out in time, the prognosis would be satisfactory.
Clinical manifestations in a Chinese girl with heterozygous de novo NAA10 variant c. 247C > T, p. (Arg83Cys): a case report
Authors: Kaiyan Wei, Chaochun Zou
Journal: Front Pediatr (2023)
Keywords: naa10, naa10-related syndrome, case report, n-terminal acetylation, ogden syndrome
MeSH terms: Case Reports

The NAA10 gene encodes the catalytic subunit of the N-terminal acetyltransferase protein complex A (NatA), which is supposed to acetylate approximately 40% of the human proteins. After the advent of next-generation sequencing, more variants in the NAA10 gene and Ogden syndrome (OMIM# 300855) have been reported. Individuals with NAA10-related syndrome have a wide spectrum of clinical manifestations and the genotype-phenotype correlation is still far from being confirmed. Here, we report a three years old Chinese girl carrying a heterozygous de novo NAA10 [NM_003491: c. 247C > T, p. (Arg83Cys)] variant (dbSNP# rs387906701) (ClinVar# 208664) (OMIM# 300013.0010). The proband not only has some mild and common clinical manifestations, including dysmorphic features, developmental delay, obstructive hypertrophic cardiomyopathy, and arrhythmia, but also shows some rare clinical features such as exophthalmos, blue sclera, cutaneous capillary malformations, and adenoid hypertrophy. Our attempt is to expand the clinical phenotype associated with NAA10-related syndrome and explore genotype-phenotype correlation with such syndrome.
Negative Diffusion Weighted Imaging on Magnetic Resonance Imaging of the Brain in Creutzfeldt-Jakob Disease
Authors: Elijah Lackey, Deepal P Shah-Zamora, Jodi Hawes, Andy J Liu
Journal: Case Rep Neurol Med (2020)
MeSH terms: Case Reports

A 76-year-old Caucasian woman initially presented to the Duke Memory Disorders clinic with a 9-month history of a rapid decline in cognitive, motor, and neuropsychiatric function. On initial presentation, the patient required assistance with activities of daily living. On neurological examination, she was found to have Gerstmann's syndrome along with appendicular apraxia. A positional tremor was noted without myoclonus or fasciculations. She had a paucity of speech and was unable to write her own name. Snout and grasp reflexes were present. Episodes of inappropriate laughter were noted during the exam. She was admitted to the inpatient neurology service for further evaluation. The Diffusion Weighted Imaging sequence on Magnetic Resonance Imaging of the brain was negative for restricted diffusion. An electroencephalogram was unremarkable. Cerebrospinal fluid analysis for Real-Time Quaking-Induced Conversion assay was positive along with an elevated 14-3-3 and increased total Tau protein levels. There was no family history of Creutzfeldt-Jakob disease. The cerebral spinal fluid results were consistent with a diagnosis of Creutzfeldt-Jakob disease, despite the negative MRI brain findings.
Prolonged Use of a Continuous Peripheral Nerve Block Catheter for Analgesia after Pediatric Foot and Ankle Surgery
Authors: Jake MacDonald, De-An Zhang
Journal: Case Rep Anesthesiol (2021)
MeSH terms: Case Reports

Continuous peripheral nerve blocks (CPNB) have a variety of indications and have been shown to be a safe and effective means of minimizing pain postoperatively. Early studies have indicated duration of catheter use greater than 48 hours as a main contributor to infection risk in CPNBs. Recent studies, though, have suggested that the risk of infection does not increase until 4 days after insertion. In the following case report, we recount our experience in using a continuous popliteal-sciatic peripheral nerve block for postoperative pain control in a pediatric patient following calcaneal and first metatarsal osteotomy. The catheter remained in place for 65 hours postoperatively without signs of local inflammation or infection. The prolonged CPNB use resulted in a significant decrease in postoperative opioid use and pain and increase in patient satisfaction when compared to the same procedure done one year prior on the opposite foot.
The Foot That Broke Both Hips: A Case Report and Literature Review of Tumor-Induced Osteomalacia
Authors: Sara Beygi, Alfred Denio, Tarun S Sharma
Journal: Case Rep Rheumatol (2017)
MeSH terms: Case Reports

Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome characterized by hypophosphatemia and clinical symptoms of osteomalacia. Only discussed as case reports, there is still limited knowledge of this condition as a potentially curable cause of osteomalacia among clinicians and pathologists. In this article, we present a case of tumor-induced osteomalacia in a 59-year-old gentleman followed by an up-to-date review of the existing literature on TIO.
Verbal interaction pattern analysis in clinical psychology
Authors: Jesús Alonso-Vega, Natalia Andrés-López, María Xesús Froxán-Parga
Journal: Front Psychol (2022)
Keywords: clinical psychology, pattern analysis, principle-based therapy, process-based therapy, sequential analysis, verbal interaction

Recent developments in pattern analysis research have made this methodology suitable for the study of the processes that are set in motion in psychological interventions. Outcome research, based on the comparison between clinical results from treatment and control groups, has leveraged our empirical knowledge about the efficacy of psychological interventions. However, these methods of research are not precise enough for the analysis of these processes. On the contrary, pattern analysis could be a powerful tool to study moment-to-moment interactions typical of psychological interventions. This is methodology is relevant because clinical psychology is experiencing a paradigm shift from a protocol for syndrome perspective to a principle-based and person-centered intervention. This evidence-based, theory-grounded, and process-oriented paradigm of clinical intervention needs new research methods to thrive (i.e., pattern analysis). The analysis of the therapeutic relationship built into the verbal interaction between the clinician and the client is one of the cornerstones of this new era of research. So, the purpose of this article is three-fold: (1) to discuss the role of the verbal interaction pattern analysis in the clinical context to the development of the principle-based clinical psychology, (2) to analyze the patterns of verbal interaction in a clinical case, and (3) to compare the results using two different methods. To reach these purposes, using the observational methodology, we have coded the verbal interaction of 16 clinical sessions with a person diagnosed with a borderline personality disorder. We have analyzed the data using sequential analysis (GSEQ) and pattern recognition algorithms (i.e., T-Pattern detection). We have been able to detect typical patterns during different phases of psychological intervention (i.e., evaluation, explanation, treatment, and consolidation). Finally, the conceptual, methodological, and empirical implications of this study will be discussed within the realms of pattern analysis research and principle-based clinical psychology.
Granulomatosis with Polyangiitis Localized in the Greater Omentum
Authors: Ryuji Komine, Takashi Kobayashi, Hiro Uehara, Keisuke Minamimura, Kazuhiko Mori, Toru Hirata, Atsushi Shimizu, Masaya Mori
Journal: Case Rep Surg (2018)
MeSH terms: Case Reports

Granulomatosis with polyangiitis (GPA) is known as anti-neutrophil cytoplasmic antibody- (ANCA-) associated small vessel vasculitis and typically manifests as pulmonary-renal syndrome, but the disease is not limited to pulmonary or renal systems. The inflammation can involve whole body organs. In addition, the ANCA titer does not always become positive. Here, we describe the case of a 91-year-old man who presented with umbilical pain and fever of unknown origin. Only the increased computed tomography value of the greater omentum suggested intra-abdominal inflammation; however, serological examinations, including the ANCA level, could not reveal the focus or cause of symptoms. Finally, the histopathological examination of specimens surgically excised from the greater omentum demonstrated GPA limited to the greater omentum. This report reminds physicians to consider GPA in the differential diagnosis of acute abdominal pain or fever of unknown origin.
PiggyBac-Generated CAR19-T Cells Plus Lenalidomide Cause Durable Complete Remission of Triple-Hit Refractory/Relapsed DLBCL: A Case Report
Authors: Chenggong Li, Yan Sun, Jing Wang, Lu Tang, Huiwen Jiang, Tao Guo, Lin Liu, Yaohui Wu, Lisha Ai, Linghui Xia, Jianjun Wu, Zhicai Lin, Qijun Qian, Yu Hu, Heng Mei
Journal: Front Immunol (2021)
Keywords: piggybac transposon system, chimeric antigen receptor-t cell therapy, diffuse large b cell lymphoma, lenalidomide maintenance, relapsed/refractory, triple-hit lymphoma
MeSH terms: Immunotherapy, Adoptive, Lenalidomide / administration & dosage, Lymphoma, Large B-Cell, Diffuse / therapy, Remission Induction, Case Reports, Clinical Trial, Phase I, Research Support, Non-U.S. Gov't, Humans, Lymphoma, Large B-Cell, Diffuse / immunology, Lymphoma, Large B-Cell, Diffuse / pathology, Male, Middle Aged, Recurrence, Lenalidomide

MYC/BCL2/BCL6 triple-hit lymphoma (THL) is an uncommon subset of high-grade B-cell lymphoma with aggressive clinical behavior and poor prognosis. TP53 mutation is an independently poor progonistic indicator in patients with THL, hence novel therapeutic strategies are needed for these patients. CD19-directed chimeric antigen receptor(CAR19)-T cell therapy has shown promising efficacy for relapsed/refractory diffuse large B cell lymphoma (RR DLBCL), but the majority of CAR19-T cell products to date have been manufactured using viral vectors. PiggyBac transposon system, with an inclination to memory T cells, offers a more convenient and economical alternative for transgene delivery. We herein report the first case of triple-hit RR DLBCL with TP53 mutation who was treated with piggyBac-generated CAR19-T cells and accompanied by grade 2 cytokine release syndrome. The patient obtained a complete remission (CR) in the 2nd month post-infusion and demanded maintenance therapy. Whether maintenance therapy is favorable and how to administrate it after CAR-T cell infusion remain controversial. Preclinical studies demonstrated that lenalidomide could enhance antitumor activity of CAR19-T cells. Therefore, we pioneered oral lenalidomide after CAR19-T therapy in the patient from the 4th month, and he discontinued after one cycle due to side effects. The patient has still kept sustained CR for over 24 months. Our case have firstly demonstrated the feasibility, preliminary safety and efficacy of piggyBac-produced CAR19-T cell therapy in triple-hit lymphoma. The innovative combination with lenalidomide warrants further investigation. Our findings shed new light on the possible solutions to improve short-term relapse after CAR19-T cell therapy in RR DLBCL. ChiCTR, number ChiCTR1800018111.
Piloting the Update: The Use of Therapeutic Relationship for Change - A Free Energy Account
Authors: Gernot Hauke, Christina Lohr
Journal: Front Psychol (2022)
Keywords: active inference, cognitive behavioral therapy, embodied cognition, emotional survival, exploration-exploitation-dilemma, free energy, safety regulation, therapeutic relationship

We apply the Free Energy Principle (FEP) to cognitive behavioral therapy (CBT). FEP describes the basic functioning of the brain as a predictive organ and states that any self-organizing system that is in equilibrium with its environment must minimize its free energy. Based on an internal model of the world and the self, predictions-so-called priors-are created, which are matched with the information input. The sum of prediction errors corresponds to the Free Energy, which must be minimized. Internal models can be identified with the cognitive-affective schemas of the individual that has become dysfunctional in patients. The role of CBT in this picture is to help the patient update her/his priors. They have evolved in learning history and no longer provide adaptive predictions. We discuss the process of updating in terms of the exploration-exploitation dilemma. This consists of the extent to which one relies on what one already has, i.e., whether one continues to maintain and "exploit" one's previous priors ("better safe than sorry") or whether one does explore new data that lead to an update of priors. Questioning previous priors triggers stress, which is associated with increases in Free Energy in short term. The role of therapeutic relationship is to buffer this increase in Free Energy, thereby increasing the level of perceived safety. The therapeutic relationship is represented in a dual model of affective alliance and goal attainment alliance and is aligned with FEP. Both forms of alliance support exploration and updating of priors. All aspects are illustrated with the help of a clinical case example.
Giant Conjunctival Nevus in a 12-Year-Old Child
Authors: Edit Tóth-Molnár, Eszter Vizvári, Ákos Skribek, András Vörös
Journal: Case Rep Ophthalmol Med (2017)
MeSH terms: Case Reports

We describe a case of a giant conjunctival nevus presented in a 12-year-old girl with suspicious clinicomorphological appearance. The lesion was noticed by the parents at the age of 3 years as a "fleshy spot" on the bulbar conjunctiva. The lesion remained unchanged until approx. 6 months before recent admission. On slit-lamp examination, a large conjunctival lesion with variegate pigmentation and indistinct margins was detected on the superonasal part of the bulbar conjunctiva of the left eye. Intralesional cysts and vessels were detected with AS-OCT examination. Wide excision and cryotherapy to the scleral bed were performed and amniotic membrane graft was used to restore the ocular surface. Histopathological examination revealed compound type conjunctival nevus and disclosed any sign of malignancy. Although giant conjunctival nevus is a rare entity, precise diagnosis and adequate management are very important as it can be confused with malignant melanoma.
A Rare Case of Demodicosis Following Treatment With Oral Fluconazole
Authors: Joshua A Bezecny, Emily Bolton, Matthew H Taylor, Elizabeth G Berry
Journal: Cureus (2023)
Keywords: antifungal, blepharitis, demodex, demodicosis, fluconazole, fungal microbiome, ivermectin, permethrin
MeSH terms: Case Reports

Demodex folliculorum and Demodex brevis are commensal human ectoparasites that reside within or near hair follicles and have been highly associated with rosacea-like papulopustular skin eruptions. We present an interesting case of recurrent, iatrogenic demodicosis in a 56-year-old man. We suspect this to have been triggered by antifungal therapy given it occurred twice closely following azole treatment. We propose that oral antifungals in the setting of immunosuppression can alter the skin microbiome, facilitating Demodex proliferation.
Massive Intestinal Bleeding in an Adult with IgA Vasculitis Treated with Intravenous Immunoglobulin
Authors: Ibrahim Nassereddin, Ariel Kenig, Yuval Ishay, Hillel Lehmann, Noa Hurvitz, Narmine Elkhateeb, Ram Gelman, Yael Ratz, Inon Sarig, Ido Burstain, Stephanie Benshushan, Fadi Kharouf
Journal: Case Rep Rheumatol (2022)
MeSH terms: Case Reports

We report the case of a 29-year-old adult presenting with severe IgA vasculitis, with cutaneous, urologic, and renal manifestations. The late appearance of severe gastrointestinal bleeding dominated the clinical picture, necessitating the administration of tens of units of packed cells and the augmentation of the immunosuppressive protocol. It was not until therapy with intravenous immunoglobulin (IVIG) was introduced that the massive bleeding was controlled. We herein discuss the patient's presentation, the gastrointestinal manifestations of IgA vasculitis, the recommended treatments, and the existent evidence about IVIG therapy.
p-ANCA-Associated Vasculitis Caused by Levamisole-Adulterated Cocaine: A Case Report
Authors: Michelle R Carter, Sorour Amirhaeri
Journal: Case Rep Emerg Med (2013)

A rare case of a patient with an unusual skin rash after using cocaine is presented. A clinical diagnosis of levamisole-induced vasculitis was made based on initial presentation of purpuric skin lesions involving the ears and positive cocaine on urine toxicology screening. The diagnosis was confirmed after laboratory findings of neutropenia, positive serum levamisole, and a histopathologic test of the skin lesions. The pathophysiology of this condition is discussed. Treatment with methylprednisolone and prednisone led to the resolution of the neutropenia and complete recovery of the skin lesions. With the growing use of levamisole-tainted cocaine, clinicians should be aware of the symptoms of vasculitis and neutropenia induced by this combination of drugs to avoid unnecessary tests and delayed diagnosis.
"Pseudosarcoma" in a pregnant woman
Authors: Amarjit Anand, Eva Maria Tsapakis, Ali A Narvani, Ali Alhakim, Steve R Cannon, Eleftherios Tsiridis
Journal: World J Surg Oncol (2007)
MeSH terms: Fasciitis / pathology, Pregnancy Complications / pathology, Vascular Diseases / pathology, Adult, Fasciitis / surgery, Female, Hand, Humans, Pregnancy, Pregnancy Complications / surgery, Vascular Diseases / surgery, Young Adult

Background:
Intravascular fasciitis (IVF) is a rare benign condition characterised by reactive myofibroblastic proliferation arising from the superficial or deep fascia and involving arteries and/or veins. It is a distinct variant of the more common condition of nodular fasciitis, which possesses similar clinical and histological features to IVF, but lacks vascular invasion. A thorough review of the literature revealed 26 reported cases of IVF.
Case presentation:
We report a case of IVF in a 16-week pregnant lady affecting the hypothenar eminence of the hand associated with the ulnar artery.
Conclusion:
The characteristic involvement of muscular arteries and veins by reactive myofibroblastic proliferation in IVF suggests a malignant component and often leads to an inappropriate diagnosis for this benign condition. We propose that hormone-related changes associated with pregnancy may play an important role in the aetiopathogenesis of this myofibroblastic lesion.
Fatal Brucellosis Infection in a Liver Transplant Patient: A Case Report and Review of the Literature
Authors: Daniela Piedrahita, Alvaro Jose Martinez-Valencia, Olga Lucia Agudelo Rojas, Eric Tafur, Fernanto Rosso
Journal: Case Rep Infect Dis (2021)
MeSH terms: Case Reports

Brucellosis is the most common zoonosis, particularly in developing countries. The true incidence of human brucellosis is unknown. The WHO points out that 500,000 cases of brucellosis are reported each year from around the world. In Colombia, there is currently no regular surveillance of the event in humans and its prevalence is low due a low clinical suspicion. We report a case of a 66-year-old man, an urban merchant, who had received a liver transplant 11 years ago. The patient presented to the emergency department for two months of fatigue, severe myalgia, paresis of the extremities, loss of muscle strength, and progressive deterioration of functional class. In the emergency room, he became disoriented and was transferred to the intensive-care unit. He had a white blood cell count of 18990/uL and creatine phosphokinase 10302 U/L. Routine blood cultures were positive for Brucella melitensis. The patient reported consumption of unpasteurized bovine milk. He was treated with doxycycline and ciprofloxacin. Despite antibiotic management, after one month of hospitalization and in the context of septic shock with multiorgan failure, the patient died. Brucellosis is an unsuspected and underdiagnosed disease. It can occur in people with or without risk factors. Although the mortality is low, immunocompromised patients can develop fatal infections. A presumptive diagnosis can be established through the correlation of patient history and classic laboratory findings, which include transaminitis, anemia, and leukopenia with relative lymphocytosis; however, other findings can help us to guide the diagnosis, such as rhabdomyolysis, which appears as a complication in different infections; however, it had not been described before in brucellosis. A partnership between clinical suspicion laboratory diagnostic tests and improved disease surveillance systems is necessary to fight the disease.