OpenMed/multicare-articles huggingface dataset:
Acute Hepatitis Induced by Intravesical BCG Therapy: A Rare but Serious Complication
Authors: Hakima Abid, Mouna Figuigui, Sidi Adil Ibrahimi, Mohamed El Abkari, Mohamed Mzyiene, Soufiane Ennaciri, Ouima Justin Ziba, Mohamed Jamal El Fassi, Layla Tahiri Elousrouti, Laila Chbani
Journal: Case Reports Hepatol (2021)
MeSH terms: Case Reports

Bacillus Calmette and Guérin (BCG), widely used as a vaccination to prevent tuberculosis, is also used as immunotherapy, by intrabladder instillation, to treat superficial bladder cancers and prevent recurrence. Complications following instillation of BCG are most often localized reactions, such as cystitis or hematuria. They can more rarely be generalized and potentially severe such as hepatitis, pneumopathies, aortitis, and localization to hematopoietic tissue. We have reported the observation of a 47-year-old patient followed up for a bladder tumor operated for transurethral resection of the bladder, then having benefited from an instillation of BCG therapy complicated by occurrence a week later of an acute hepatitis. The diagnostic time was 2 days, and the outcome was favorable with corticosteroid therapy.
Late Relapse of Henoch-Schönlein Purpura in an Adolescent Presenting as Severe Gastroduodenitis
Authors: Chiara Rubino, Monica Paci, Massimo Resti, Paolo Lionetti, Sandra Trapani
Journal: Front Pediatr (2018)
Keywords: henoch-schönlein purpura, atypical presentation, duodeno-jejunitis, endoscopy, relapse
MeSH terms: Case Reports

Henoch-Schönlein purpura is a systemic vasculitis, commonly affecting children. Gastrointestinal manifestations are observed in 50-75% of patients; it is well known they may occur before skin lesions in about 20% of cases during the first vasculitic episode. Relapses occur in about one third of patients, typically within 4 months from the initial presentation and with milder symptoms. We report the case of a 17-year old girl with an atypical relapse of Henoch-Schönlein purpura, presenting with acute abdominal symptoms 5 years after the first episode. Esophagogastroduodenoscopy showed duodenal multiple hyperemic and hemorrhagic lesions. To our knowledge this is the first case of hemorrhagic-erosive duodenitis representing a relapse of Henoch-Schönlein purpura occurring several years after the initial episode. Duodenojejunal inflammation should be considered as primary manifestation of Henoch-Schönlein purpura, not only during the first episode, but also in relapses. Endoscopy can be helpful for differential diagnosis, especially in patients with atypical manifestations. Further studies are needed to evaluate risk factors for Henoch-Schönlein purpura recurrence and the possible role of fecal calprotectin as an early marker for gastrointestinal involvement.
Endometriosis-Related Pleural Effusion: A Case Report and a PRISMA-Compliant Systematic Review
Authors: Ping Wang, Zhilan Meng, Yakun Li, Zuojun Xu
Journal: Front Med (Lausanne) (2021)
Keywords: clinical features, diagnosis, endometriosis-related pleural effusion, hemorrhagic pleural effusion, thoracic endometriosis syndrome, treatment
MeSH terms: Systematic Review

Background: Endometriosis-related pleural effusion (PE) is a relatively rare but treatable cause of bloody PE. The clinical characteristics and outcome of patients with endometriosis-related PE remain unknown. Objectives: We present a case of endometriosis-related PE diagnosed on pleural fluid cytology. A systematic review of all endometriosis-related PE cases in literature was conducted to elucidate the clinical characteristics, explore the diagnostic yield of pathological examinations, and to summarize the outcomes of therapeutic approaches in this disease. Methods: A case of endometriosis-related PE diagnosed in study hospital was reported. PubMed, Web of Science, and EMBASE were searched for publications pertaining to cases of endometriosis-related PE using predefined search terms. This case and those identified from PubMed, Web of Science, and EMBASE were analyzed. Results: A total of 67 patients were included. Catamential symptoms were presented in 30 (44.8%) patients. Dyspnea was presented in 50 patients (74.6%), followed by right chest/shoulder pain in 34 (50.7%) and cough in 18 (26.9%). 82.8% of the patients had concomitant pelvic endometriosis and 76.7% was infertile or nulliparous. The diagnostic yield of pleural fluid cytological examination, percutaneous pleural biopsy, and surgical biopsy was 9.0, 45.5, and 78.7%, respectively. The patients who received surgery-based therapy had a significantly longer time to relapse than those who received progestational agents or GnRH analogs alone (P = 0.025) or hysterectomy and bilateral salpingoophorectomy (HBSO) (P = 0.040). Conclusions: High clinical awareness of pleural endometriosis is essential in all female with hemorrhagic PE, especially in young females who have infertility and/or pelvic endometriosis. Plerual fluid cytology might be a simple minimally invasive and cost-effective modality in the diagnosis of endometriosis-related PE. Treatment is challenging due to high recurrence and the optimal management of endometriosis-related PE needs further evaluation. The combined approach by surgery and hormonal therapy may achieve the best relapse-free survival.
Peripheral ischaemic retinopathy and neovascularisation in a patient with subacute streptococcus mitis-induced bacterial endocarditis
Authors: Laura S Leysen, Elke O Kreps, Ilse De Schryver, Kristien P Hoornaert, Vanessa Smith, Julie De Zaeytijd
Journal: GMS Ophthalmol Cases (2017)
Keywords: retinal diseases, retinal neovascularisation, subacute bacterial endocarditis
MeSH terms: Case Reports

Objective: To describe a patient with peripheral retinal ischaemia and neovascularisation who was diagnosed with streptococcus mitis-induced bacterial endocarditis. Methods: Retrospective analysis of case report. A 57-year-old man presented with a history of a rapidly progressive, bilateral, painless visual loss. He also suffered from pain in the neck and lower back and a weight loss of 10 kg. He underwent a full ophthalmologic work-up, laboratory investigations, and imaging of the spine. Results: BCVA was reduced to 20/40 in the right eye and 20/32 in the left eye. Fundoscopy showed rare intra-retinal haemorrhages including few Roth spots and cotton wool lesions. Fluorescein angiography demonstrated large areas of peripheral retinal ischaemia and neovascularisation. Imaging of the spine showed spondylodiscitis on several levels. Further imaging and blood cultures confirmed bacterial endocarditis of the mitral valve. Streptococcus mitis was subsequently identified as the causative organism. Conclusion: Peripheral retinal ischaemia and neovascularisation were previously unrecognised as a feature of infectious endocarditis. Therefore, their presence, apart from the classic Roth spots, should prompt the consideration of infectious endocarditis in the etiologic work-up.
Pediatric alternating allergic fungal rhinosinusitis: A case report and literature review
Authors: Danah H Althomaly, Ali A AlMomen
Journal: Int J Surg Case Rep (2019)
Keywords: allergic fungal sinusitis, alternating, case report, contralateral, fungal infection, pediatric

Objectives:
to report the alternating nature of allergic fungal rhinosinusitis in children in the Eastern part of Saudi Arabia and to review the experience of King Fahad Specialist Hospital in the diagnosis and management of alternating allergic fungal rhinosinusitis in children. An 8 years old Saudi girl with alternating allergic fungal rhinosinusitis was diagnosed and managed. The patient was diagnosed to have unilateral left allergic fungal rhinosinusitis and underwent endoscopic sinus surgery and cleaning of the left sinuses from polyps, mud and mucin. One year postoperatively the patient developed AFRS in the contralateral right side.
Conclusion:
involvement of the contralateral sinuses in children with AFRS is uncommon. The normal uninvolved sinus should be involved in the routine endoscopic examination and the post-operative treatment in order to minimize the risk of disease recurrence.
Candida Albicans Osteomyelitis after Chest Wall Blunt Trauma: A Case Report
Authors: Fabrizio Minervini, Peter B Kestenholz, Elmar Fritsche, Alberto Franchi
Journal: Case Rep Surg (2021)
MeSH terms: Case Reports

Fungal osteomyelitis is a rare disease that can occur in immunocompromised patients. We report a case of a patient with a primary rib osteomyelitis after a blunt trauma of the chest wall. Aggressive surgical debridement along with antifungal therapy was the cornerstone of the disease management in this patient.
Case report: Anti-CARPVIII autoantibody-associated mixed dementia
Authors: Niels Hansen, Bianca Teegen, Sina Hirschel, Jens Wiltfang, Björn H Schott, Berend Malchow, Bartels Claudia
Journal: Front Psychiatry (2023)
Keywords: anti-carpviii autoantibody, autoimmunity, dementia, mixed dementia, psychiatry
MeSH terms: Case Reports

Background:
Anti-carbonic anhydrase-related protein VIII (CARPVIII) is reported to be associated with paraneoplastic cerebellar degeneration. Our case extends the spectrum of anti-CARPVIII-associated disease to severe cognitive impairment.
Methods:
We present the case of a 75-year-old woman who presented to our Department of Psychiatry and Psychotherapy with a dementia syndrome. The diagnostic approach included magnetic resonance imaging (MRI), cerebrospinal fluid analysis (CSF) analysis involving autoantibody determination, and neuropsychological examination.
Results:
Neuropsychological examination revealed severe cognitive impairment meeting the criteria for dementia. MRI showed evidence of moderate cerebral microangiopathy. CSF analysis revealed mild pleocytosis, and serum analysis revealed anti-CARPVIII autoantibodies. Based on the dementia syndrome entailing signs of CNS inflammation such as pleocytosis and the repeated detection of anti-CARPVIII autoantibodies in serum, we diagnosed autoimmune dementia as a component of mixed dementia with additional vascular dementia components.
Conclusion:
Our finding adds severe cognitive impairment to the spectrum of anti-CARPVIII-associated disease. However, detecting anti-CARPVIII antibodies may also be an incidental finding in conjunction with typical mixed dementia. Further studies are needed to evaluate the relevance of these clinical findings.
Unexpected Liver Embryonal Sarcoma in the Adult: Diagnosis and Treatment
Authors: Maurizio Pinamonti, Federico Vittone, Francesco Ghiglione, Andrea Borasi, Stefano Silvestri, Sergio Coverlizza
Journal: Case Rep Surg (2018)
MeSH terms: Case Reports

Undifferentiated embryonal sarcoma of the liver is a malignancy with poor prognosis observed more frequently in children between 6 and 10 years old and very rarely found in adults. We present a case of embryonal sarcoma of the liver in a 60-year-old woman without significant medical history who presented to our attention with constitutional symptoms. Preoperative assessments did not show alterations in blood chemistry or tumor markers. Imaging studies showed a huge mass lying in the right abdominal quadrants, strictly adherent to the liver. The tumor was partially cystic with a thickened wall, sporadic contrast enhancement, and solid component. The patient underwent excision of the mass with associated liver bisegmentectomy S5-S6. Postoperative course was uneventful. The definitive histological diagnosis revealed the presence of embryonal sarcoma of the liver. We describe the clinical, histopathological, and therapeutic options adopted in the multimodal treatment of this disease.
Case Report: Clinicopathological Analysis of Minute Pulmonary Meningothelial-Like Nodules: Report of 7 Cases
Authors: Ying-Xia Wang, Zi Lei, Man Yang, Zhi-Yuan Wang, Xuan Zhang, Guo-Qing Pan
Journal: Front Oncol (2022)
Keywords: benign lesions, immunophenotype, minute pulmonary meningothelial-like nodules, pathological features, radiographic manifestations
MeSH terms: Case Reports

Objective:
To investigate the clinical manifestations, radiologic features, pathological features, and immunophenotype of minute pulmonary meningothelial-like nodules (MPMNs).
Method:
This is a retrospective observational study. We collected the clinical data of 7 cases of MPMNs, and performed comprehensive characterization using a combination of clinical, morphological, radiologic and immunohistochemical assessments.
Results:
Of the 7 cases of MPMNs, 6 were female and 1 was male. The median age was 55 years. All MPMNs were multiple in lung with the size from 0,01 to 0,5cm. Chest CT examination showed ground-glass attenuation or solid nodules. Four cases were concomitant with carcinoma and/or pneumonia, and 3 cases occurred alone. Four of the 7 patients had no obvious symptoms; 3 patients had chest pain or cough or shortness of breath or hemoptysis. Multiple white nodules were found macroscopically, and the diseased cells grew along the alveolar septum, with relatively normal morphology, rich cytoplasm, unclear cell boundary, and uniform nucleus with delicate chromatin and without atypia; and the diseased cells showed nest or whorls distribution. EMA, PR, CD56 and vimentin were positive in all cases by immunohistochemistry.
Conclusions:
MPMNs are rare benign lesions in the lung, often multiple, usually less than 0.5cm in diameter, most of which have no obvious clinical symptoms. MPMNs are often found by chest CT, and occur independently or concomitant with other lesions. The positive immunohistochemical staining of EMA, PR, CD56, vimentin supports the diagnosis.
The efficacy and safety of lenvatinib plus transarterial chemoembolization in combination with PD-1 antibody in treatment of unresectable recurrent hepatocellular carcinoma: a case series report
Authors: Chunyang Mu, Junyi Shen, Xinrui Zhu, Wei Peng, Xiaoyun Zhang, Tianfu Wen
Journal: Front Oncol (2023)
Keywords: combination therapy, lenvatinib, programmed death-1 antibody, recurrent hepatocellular carcinoma, trans-arterial chemoembolization

Purpose:
To explore the safety and efficacy of lenvatinib in combination with trans-arterial chemoembolization (TACE) and programmed death receptor 1 (PD-1) antibody in the treatment of unresectable recurrent hepatocellular carcinoma (urHCC).
Patients and methods:
The clinical data of 16 patients with unresectable recurrent hepatocellular carcinoma admitted to the Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, and received the conversion therapy of lenvatinib + TACE + PD-1 antibody between January 2019 and January 2022 were retrospectively analyzed.
Results:
There were 25% (4/16) patients suffering from grade 3 adverse events and no patients suffering from grade 4 or higher adverse events. After 4 months of treatment of 16 patients, according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST), two, five, three, and six cases were in complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD), respectively, and the objective response rate (ORR) was 43.8% (7/16). The 1-year overall survival (OS) rate and 1-year progression-free survival (PFS) rate were 86.2% and 46.9%, respectively. In our subgroup analysis, the ORR of patients with multiple lesions reached up to 60%, which was higher than that of patients with single lesions.
Conclusions:
Lenvatinib in combination with TACE and PD-1 antibody is safe and effective in the treatment of unresectable recurrent hepatocellular carcinoma.
Metachronous occurrence of triple malignancies of kidneys, prostate, and breast. A case report and review of the literature
Authors: Mohammad Ali Zargar-Shoshtari, Hossein Saffari, Mohammad Kazem Moslemi
Journal: Case Rep Urol (2013)

Multiple consecutive cancers involving different organs in a male individual are presented. Case Presentation. Herein, we present a rare case of primary right renal cell carcinoma (RCC), in which two different organ malignancies of prostate and breast were occurred consecutively. After proper treatment of each organ tumor, the patient experienced metachronous occurrence of its final tumor in his remained left kidney as left side RCC. Discussions. Multiple primary cancers are defined as occurrence of two or more malignancies, synchronous or metachronous, in different organs without any relation to each other. For primary and secondary tumors of the male genitourinary system, the most common occurrence was tumors of bladder and prostate followed by tumors of the kidney. Our case was a rare presentation of consecutive occurrence of multiple organ tumors: right side RCC, adenocarcinoma of prostate, and ductal cell carcinoma of the left breast, followed by left side RCC. Conclusions. In any case of primary malignancy of any organ, not only primary tumor recurrence but also tumoral growth of other nonrelated organs should be evaluated, especially in high risk patients or patients with positive familial history.
Secondary hemophagocytic syndrome: the importance of clinical suspicion
Authors: Cristina Oliveira, Sérgio Chacim, Isabel Ferreira, Nelson Domingues, José Mário Mariz
Journal: Case Rep Hematol (2014)

Hemophagocytic syndrome is a rare and potentially fatal disorder characterized by pathological immune activation associated with a primary familial disorder, genetic mutations, or occurring as a sporadic condition. The latter can be secondary to infections, malignancies, or autoimmune diseases. Clinically, patients present signs of severe inflammation, with unremitting fever, cytopenias, spleen enlargement, phagocytosis of bone marrow elements, hypertriglyceridemia, and hypofibrinogenemia. Increased suspicion is determinant to timely initiate treatment in an attempt to alter the natural history. The authors present three clinical cases of this syndrome, with a brief review of the diagnostic criteria and treatment.
Examining the Utility of Resective Epilepsy Surgery in Children With Electrical Status Epilepticus in Sleep: Long Term Clinical and Electrophysiological Outcomes
Authors: Ahmad Marashly, Jennifer Koop, Michelle Loman, Yu-Wen Lee, Sean M Lew
Journal: Front Neurol (2020)
Keywords: cognitive outcome, electrical status epilepticus in sleep, epilepsy surgery, hemispherotomy, seizure outcome

Background: Electrical Status Epilepticus in Sleep (ESES) is an epileptic encephalopathy syndrome characterized by infrequent clinical seizures and prominent interictal burden during slow wave sleep associated with cognitive deficits and behavioral dysfunction. Medical treatment with anti-epileptic drugs is often unsuccessful. Resective surgery may be a valuable option in carefully selected patients. This case series aims to describe the indications, long term results and utility of resective surgery for ESES. Methods: Information on 14 patients who underwent surgery for epilepsy and ESES at the Children's Hospital of Wisconsin between 2007 and 2017 is included. Clinical, electrographic and neuropsychological features and outcomes are described in detail. Results: The most common pathology was encephalomalacia due to perinatal middle cerebral artery stoke (5/14). Twelve patients had imaging findings of perinatal pathologies; however, two patients had normal magnetic resonance imaging. Surgery was performed to control refractory epilepsy in eight patients. Six patients had no clinical seizures for 1-6 years prior to surgery, one of which had no known clinical seizures at all. All showed cognitive declines (6/14) or impairment (8/14) on neuropsychological assessments, and surgery was suggested to minimize further cognitive declines. The most common surgical procedure was hemispherotomy (10/14). Temporo-parieto-occipital disconnection, frontal lobectomy, parieto-occipital resection, and limited corticectomy were also used, with good outcomes for the first three procedures. Clinical follow up mean was 4.4 years and 12 patients had excellent seizure outcome. Electroencephalography (EEG) follow up mean was 3 years and ESES resolved in 12/14 patients. All patients completed post-surgical neuropsychological evaluation with mean follow-up of 17.46 months. Conclusions: Resective surgery is an effective treatment for selected cases of ESES, producing long term seizure freedom, resolution of ESES and stabilization of cognitive and behavioral functioning in most patients. Our case series is the largest single center cohort description addressing resective surgery for ESES. Outcomes in this sample suggest that good long-term seizure, EEG and cognitive/behavioral outcomes can be achieved in patients with normal brain imaging and in limited lobar or multi-lobar resections. Moreover, patients with ESES and very infrequent clinical seizures can benefit from surgery with stabilization of cognitive and behavioral functioning.
Undervirilized male infant with in utero exposure to maternal use of high dose antifungal therapy
Authors: Jasmine Gujral, Gertrude Costin, Divya Khurana, Mabel Yau, Elizabeth Wallach, Christopher J Romero, Meredith Wilkes, Swathi Sethuram, Robert Rapaport
Journal: Int J Pediatr Endocrinol (2020)
Keywords: adrenal insufficiency, atypical genitalia, endocrine disruptors, undervirilization
MeSH terms: Case Reports

Background:
Antifungals act on fungal sterols structurally similar to human cholesterol. Ketoconazole reversibly suppresses steroidogenesis by inhibiting cytochrome P450 enzymes and interferes with dihydrotestosterone (DHT) activity by binding to the androgen receptor. Hypospadias was reported in infants exposed to nystatin in utero.
Case presentation:
A male infant exposed to antepartum nystatin presented with severe under-undervirilization and transient adrenal corticosteroid abnormalities. He was born in USA at 31 weeks gestation to a mother treated with vaginal Polygynax capsules (nystatin-100,000 international units, neomycin sulphate-35,000 international units and polymyxin B-35,000 international units) for vaginal discharge in the Ivory Coast. She used approximately 60 capsules between the first trimester until delivery. The infant was born with micropenis, chordee, perineo-scrotal hypospadias and bifid scrotum with bilaterally palpable gonads. The karyotype was 46,XY. No Mullerian structures were seen on ultrasound. Serum 17-hydroxyprogesterone (17 OHP) on newborn screening was high (304 ng/ml, normal < 35). Cortisol response to cosyntropin on the 3rd day of life (DOL) was 10 mcg/ml; the subnormal cortisol response may have resulted from prematurity and the predelivery treatment with betamethasone. The elevation of several adrenal corticosteroids was not consistent with any specific enzymatic defect. Hydrocortisone and fludrocortisone were initiated at another hospital for suspected mild glucocorticoid and mineralocorticoid deficiencies. Genetic screening for adrenal and gonadal developmental defects performed when transferred to our care were normal. All medications were gradually discontinued over 5-8 months. Adrenal and testicular responses to cosyntropin and human chorionic gonadotropin (hCG) were normal at 8 months.
Conclusions:
We report severe undervirilization in a 46,XY infant born to a mother treated with prolonged and high dose nystatin during pregnancy. This presentation suggests that prolonged antepartum use of high dose nystatin could lead to severe but transient defects in androgen synthesis and/or action possibly by acting as an endocrine disruptor. Further studies are warranted to confirm this finding. Thus, endocrine disruptors should be considered in male newborns with atypical genitalia not explained by common pathologies.