OpenMed/multicare-articles huggingface dataset:
What have we learned from a case of convalescent plasma treatment in a two-time kidney transplant recipient COVID-19 patient? A case report from the perspective of viral load evolution and immune response
Authors: Fabian Aldunate, Alvaro Fajardo, Natalia Ibañez, Florencia Rammauro, Hellen Daghero, Rodrigo Arce, Diego Ferla, Marianoel Pereira-Gomez, Cecilia Salazar, Gregorio Iraola, Otto Pritsch, Javier Hurtado, Jordan Tenzi, Mariela Bollati-Fogolín, Sergio Bianchi, Nicolas Nin, Gonzalo Moratorio, Pilar Moreno
Journal: Front Nephrol (2023)
Keywords: covid-19, sars-cov-2, convalescent plasma therapy, kidney transplant, molecular diagnosis
MeSH terms: Case Reports

Coronavirus disease 2019 (COVID-19), an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, can have a wide range of clinical manifestations, ranging from asymptomatic disease to potentially life-threatening complications. Convalescent plasma therapy has been proposed as an effective alternative for the treatment of severe cases. The aim of this study was to follow a two-time renal transplant patient with severe COVID-19 treated with convalescent plasma over time from an immunologic and virologic perspective. A 42-year-old female patient, who was a two-time kidney transplant recipient, was hospitalized with COVID-19. Due to worsening respiratory symptoms, she was admitted to the intensive care unit, where she received two doses of convalescent plasma. We analyzed the dynamics of viral load in nasopharyngeal swab, saliva, and tracheal aspirate samples, before and after convalescent plasma transfusion. The levels of pro-inflammatory cytokines and antibody titers were also measured in serum samples. A significant decrease in viral load was observed after treatment in the saliva and nasopharyngeal swab samples, and a slight decrease was observed in tracheal aspirate samples. In addition, we found evidence of an increase in antibody titers after transfusion, accompanied by a decrease in the levels of several cytokines responsible for cytokine storm.
Manganese Neurotoxicity as a Complication of Chronic Total Parenteral Nutrition
Authors: Alisha Khan, Jonathan Hingre, Amit S Dhamoon
Journal: Case Rep Neurol Med (2020)
MeSH terms: Case Reports

Manganese accumulation in the central nervous system creates clinical symptoms of cognitive dysfunction, behavioral changes, and movement disorders resembling Parkinson's disease. Radiographic features of this rare clinical entity include symmetric T1 hyperintensities in the bilateral globus pallidi, with corresponding hypointensities on T2-weighted images. Total parenteral nutrition (TPN) is an increasingly used potentially lifesaving therapy for patients who cannot tolerate enteral nutrition. However, when used over a period of several weeks to months, its associated risks and complications carry significant morbidity and mortality. One of the more rare complications of TPN use is manganese toxicity. We provided care for a 38-year-old female on chronic TPN who presented to the hospital with Parkinsonian features, confusion, falls, and lethargy. MRI brain showed T1 hyperintensities in the bilateral globus pallidi, which were attributed to manganese toxicity from chronic TPN use. Supporting evidence for this rare entity included decreased signal intensity in the bilateral globus pallidi on T2-weighted images and T1 hyperintensities in the substantia nigra. With antifungal treatment and permanent cessation of TPN, her mentation and neurological symptoms began to improve within a week. Repeat MRI brain performed one month after discontinuation of TPN revealed improvement of the T1 hyperintensities in the bilateral globus pallidi. Our objective in presenting this case is to highlight manganese neurotoxicity as a rare complication of TPN in a patient without known hepatic dysfunction and to emphasize the importance of routinely monitoring patients for the possible adverse effects of chronic TPN. Our case is among the handful of published cases in which a patient without known liver dysfunction, which is the primary organ responsible for manganese elimination from the body, developed manganese neurotoxicity.
Clonal hypereosinophilic syndrome: two cases report in black men from sub-saharan Africa and literature reviews
Authors: Kodjovi Messie, Ahoefa Vovor, Irenee Messanh Kueviakoe, Levi Kankoe Sallah, Kossi Agbetiafa, Akuete Yvon Segbena
Journal: ISRN Hematol (2011)
MeSH terms: Case Reports

The first case is about a man of 60 years old suffering of hypereosinophilic syndrome (HES) developed since 1998. He presented chronic cough, insomnia, and negative parasitical test. We observed hypereosinophilia and fibroblastic hyperplasia at the bone marrow biopsy. Initially, hydroxyurea and α-interferon treatment failed. We proposed to him imatinib mesylate in May 2003. The FIP1L1-PDGFRA gene was detected. The second case is about a man of 34 years old seen in March 2002. First investigation concluded to CML. Progressively, eosinophil cells increased, and complications occurred as oedema syndrome, dyspnoea, and parietal chronic endocarditic fibrosis associated with pericarditis. In addition, a bowel obstruction happened and was cured by surgery. Bcr-abl fusion was negative, and FIP1L1-PDGFRA gene was detected after and imatinib mesylate was given. Actually, endocarditic fibrosis decreased. The two patients are in haematological and cytogenetic remission. We concluded that clonal HES is present in Africa, and imatinib mesylate is effective.
Acute Peripheral Facial Paralysis Masquerading as Bell's Palsy Is the First Presentation of COVID-19 Infection
Authors: Tabtim Chongsuvivatwong, Panitta Mueanchoo, Praewchompoo Sathirapanya, Pornchai Sathirapanya
Journal: Case Rep Neurol Med (2023)
MeSH terms: Case Reports

Although Bell's palsy is a common diagnosis of acute isolated peripheral facial palsy (PFP), acute isolated PFP can be the first presentation of various illnesses, including COVID-19 disease. A female with a known history of well-controlled diabetes mellitus presented initially with acute isolated PFP mimicking Bell's palsy. A course of oral prednisolone was given to treat acute PFP. Severe fifth cervical radicular pain, which is unusual for Bell's palsy followed 3 days later. The COVID-19 infection was finally diagnosed by a real-time polymerase chain reaction (RT-PCR) test 15 days after facial paralysis when typical pulmonary infection symptoms developed. Oral favipiravir was given for the treatment of COVID-19 infection, to which the symptoms completely responded. The COVID-19 infection as a cause of acute isolated PFP should be added to the differential diagnosis of acute isolated PFP, albeit without typical pulmonary infection symptoms, particularly during the global pandemic of the infection.
Case report: A primary calcified cardiac mass in right atrium partially obstructs the tricuspid valve in a patient on hemodialysis
Authors: Hongduan Liu, Xiaokang Tu, Hao Zhang, Chengming Fan, Haoyu Tan, Long Song, Qin Wu, Liming Liu
Journal: Front Cardiovasc Med (2022)
Keywords: calcified cardiac tumor, cardiac surgery, chronic kidney disease, hemodialysis, tricuspid valve
MeSH terms: Case Reports

Primary cardiac calcification is a rare benign mass in patients with end-stage renal disease. A few cases have been reported in the literatures. In this case study, during a routine checkup for hemodialysis, a transthoracic echocardiography on a 19-year-old male showed a cardiac mass in the right atrium that was partially obstructing the tricuspid valve. Cardiac magnetic resonance imaging showed a well-circumscribed, homogeneous "shadow" in the right atrium; it measured 29 × 27 mm, had equal T1- and T2-weighted signal intensities, and was adjacent to the tricuspid valve. According to 18F-fluorodeoxyglucose positron emission tomography combined with computed tomography, there was a dense circular shadow in the right atrium abutting the tricuspid valve, but there was no increase in glucose metabolism. Median sternotomy was performed for the surgical resection of the mass, and a cardiopulmonary bypass was completed. The mass was completely removed. The patient recovered well and was discharged 10 days after the surgery. Histological examination showed that the mass contained multiple calcified nodules. No mass recurrence was found by echocardiography during the 12th-month follow-up.
A Novel Missense Mutation, E1623G, in the Human Factor VIII Gene Associated With Moderate Haemophilia A
Authors: Habib Onsori, Mohammad Ali Hosseinpour Feizi, Abbas Ali Hosseinpour Feizi
Journal: Iran Red Crescent Med J (2014)
Keywords: f8 protein, human, hemophilia a, mutation, missense
MeSH terms: Case Reports

Introduction:
Haemophilia A is the most common inherited X-linked recessive bleeding disorder. The severity of the resultant bleeding diathesis depends on the FVIII levels associated with the mutation. Analysis of carrier state can be made indirectly by DNA linkage analysis or directly by identifying the mutation that leads to the disease. The aim of this study was to identification of the causal mutation of the FVIII gene in a haemophilic patient.
Case report:
Our case is a 16-year-old male haemophilia A patient with some symptoms such as recurrent hemarthrosis in left knee. In this study, we used single-stranded conformational polymorphism (SSCP) and conformational sensitive gel electrophoresis (CSGE) methods and direct sequencing to identify the mutation responsible for haemophilia A in our patient.
Conclusions:
We reported a novel missense mutation (GAA→GGA), E1623G, in exon 14 of FVIII gene that is associated with moderate haemophilia A. This new mutation was recorded in GenBank (NCBI) with accession number JF916726.1. This study showed that the use of PCR-CSGE and PCR-SSCP may be useful in detecting most of genetic defects such as point mutations of FVIII gene in haemophilic patients.
Magnetic resonance cholangiopancreatography in the diagnosis of haemobilia
Authors: Ines Casazza, Mara Angela Guglietta, Giuseppe Argento
Journal: Case Rep Radiol (2013)

Haemobilia is a rare cause of unrecognized gastrointestinal bleeding and is hard to diagnose. Through the present case report we aim to corroborate magnetic resonance relevance in the evaluation of biliary system and bile features, investigating on its role in patients with acute biliary diseases. We report a case of a Caucasian 48-year-old man who was admitted due to abdominal pain and fever. After an ultrasonography exam we detected multiple cysts in the hepatic left lobe: imaging features, laboratory findings, and patient past work experience (woodcutter) suggested a diagnosis of hepatic Echinococcosis. Once surgery decision was taken, patient underwent an intervention of cystopericystectomy. On the 8th postoperative day, the procedure was complicated by black stool, jaundice, and severe anaemia. Acomputed tomography revealed an inhomogeneous collection with some air bubbles in the area of previous surgical intervention, but it was not able to solve the diagnosis question. At this stage a magnetic resonance study was mandatory. On T2-weighted images we observed an expanse gallbladder with hypointense intraluminal material and a considerable intrahepatic biliary system dilatation due to bloody material. On the basis of these examination results, we supposed haemobilia arising from previous surgical intervention. A therapeutic endoscopic retrograde cholangiopancreatography procedure led to decompression of biliary system through a major papilla sphincterotomy with spillage of bile mixed with blood clots.
Imaging appearance of isolated diffuse neurofibroma of nipple areolar area: a case report
Authors: Siham Nasri, Youssef Benmoussa, Widad Abbou, Houda Mirali, Narjiss Aichouni, Imane Skiker
Journal: Pan Afr Med J (2021)
Keywords: nipple areolar area, case report, mammography, neurofibroma
MeSH terms: Neurofibroma / diagnostic imaging, Neurofibromatoses / diagnostic imaging, Nipples / diagnostic imaging, Case Reports, Adult, Female, Humans, Magnetic Resonance Imaging, Mammography, Neurofibroma / pathology, Neurofibromatoses / pathology, Nipples / pathology

Sporadic neurofibromas of the nipple-areolar complexes are exceptional even in patients with neurofibromatosis. Diffuse neurofibroma is an uncommon subtype of neurofibroma that has received little attention in the imaging literature. As are most superficial lesions, it is often evaluated clinically and if biopsy is needed, it is usually performed without imaging. However the imaging data is quite characteristic with the aim of evaluating the extension in depth and detecting an underlying cancer. We report a case of women without a history of neurofibromatosis presenting a skin thickening disfiguring her left breast, related to diffuse neurofibroma of the nipple-areolar complexes confirmed histologically. We study echo-mammography and breast magnetic resonance imaging (MRI) findings in order to highlight its radiographics features.
Successful Detection of Unrecognized Rickettsia typhi in Pregnancy Using Cell-Free Next-Generation Sequencing
Authors: Irene A Stafford, Fernando H Centeno, Mayar Al Mohajer, George Parkerson, Laila Woc-Colburn, Angelica Janice Burgos-Lee, Martha Rac, James Dunn, Kenneth Muldrew
Journal: Case Rep Obstet Gynecol (2020)
MeSH terms: Case Reports

Flea-borne (murine) typhus is caused by Rickettsia typhi. Infection in pregnant women can lead to adverse outcomes when diagnosis and treatment is delayed. We describe how next-generation sequencing (NGS) using the Karius® test was used to rapidly diagnose murine typhus in two pregnant women admitted to a large tertiary care center in Houston, Texas, when all initial testing was nondiagnostic.
Detachable Lip and Cheek Plumper for Rehabilitation of Facial Disfigurement
Authors: Nada Fathalla Abdelbagi, Ibrahim Ahmed Ismail, Fadia Awadalkreem, Mohammed Nasser Alhajj
Journal: Case Rep Dent (2021)
MeSH terms: Case Reports

Background:
Hemimaxillectomy of acquired palatal defects may predispose the patient to hypernasal speech, leakage of fluids into the nasal cavity, impaired masticatory function, and swallowing difficulties leading to a detrimental impact on the quality of life. Sequentially, it can also affect individual character and trust in social life, leading to social phobia and anxiety. This article presents prosthodontic management of a young male patient with deformation of the entire right half of the face due to surgical removal of odontogenic myxoma. It describes a method where the clinician utilized a simple, noninvasive, and cost-effective technique to cut the weight of the obturator and to attain aesthetics, utilizing a detachable lip and cheek plumper. Case Presentation. A 19-year-old male attended the Prosthodontic Clinics at Faculty of Dentistry, the University of Khartoum, eight months after the surgical removal of a tumor. The chief complaint was difficulty eating or drinking. Furthermore, he dropped out of school because of his facial deformity and his indistinct voice. Medical and dental history revealed surgical resection of the entire right half of the maxillary alveolar bone due to myxoma. Intraoral examination revealed a well-healed surgical defect in the maxillary right buccal vestibule creating an oroantral communication. A treatment plan was formulated, keeping the patient's demand in mind. The decision was made to treat the patient with a maxillary obturator that would gain its support from the remaining teeth and tissues with a detachable cheek and lip plumper. The use of dental magnets as a means of attachment was elected.
Conclusion:
This article has described a simple, noninvasive, and cost-effective method to improve facial appearance in patients with hollow faces. The plumper prosthesis successfully improved the patient's appearance to the extent that comfort and function would permit and encourage self-esteem.
Case report: Intrapericardial thrombus aspiration in early stage of pericardial thrombosis for cardiac tamponade complicating percutaneous left atrial appendage closure
Authors: Bin-Feng Mo, Cheng-Qiang Wu, Qun-Shan Wang, Yi-Gang Li
Journal: Front Cardiovasc Med (2022)
Keywords: cardiac tamponade, case report, left atrial appendage closure, pericardial thrombosis, thrombus aspiration
MeSH terms: Case Reports

Introduction:
Pericardial thrombosis that complicates pericardial bleeding is a life-threatening emergency in interventional cardiology, and surgery remains the only definitive treatment option. We report the first case of successful intrapericardial thrombus aspiration using a dedicated thrombus aspiration catheter in the early stage of pericardial thrombosis.
Case report:
A 76-year-old woman with non-valve atrial fibrillation underwent percutaneous left atrial appendage (LAA) closure for secondary prevention of stroke. A 24-mm Watchman device was deployed under fluoroscopic guidance. Post-deployment angiography revealed LAA perforation, which led to the rapid onset of cardiac tamponade. Emergency pericardiocentesis was performed and the deep-seated device was redeployed at a more proximal position to seal the distal perforation. Pericardial bleeding was controlled after the drainage of 400 ml of blood. However, the patient re-developed cardiac tamponade following a period of stability. The patient was diagnosed with early-stage pericardial thrombosis based on echocardiographic findings of a hypoechoic effusion in the pericardial space. Thrombus aspiration using a pigtail catheter and long sheath failed; however, we performed successful intrapericardial thrombus aspiration using a dedicated thrombus aspiration catheter. We drained 120 ml of sludge-like blood, and the patient underwent successful conservative management without surgical intervention.
Conclusion:
This case report highlights the potential usefulness of a percutaneous intrapericardial thrombus aspiration technique using a dedicated thrombus aspiration catheter in selected patients with early-stage pericardial thrombosis, as a less invasive alternative to cardiac surgery.
Bleeding duodenal ulcer after Roux-en-Y gastric bypass surgery: the value of laparoscopic gastroduodenoscopy
Authors: Hussain Issa, Osama Al-Saif, Sami Al-Momen, Bahaa Bseiso, Ahmed Al-Salem
Journal: Ann Saudi Med (2010)
MeSH terms: Duodenal Ulcer / etiology, Duodenoscopy, Duodenum / injuries, Gastric Bypass / adverse effects, Gastroscopy, Peptic Ulcer Hemorrhage / etiology, Case Reports, Adult, Duodenal Ulcer / diagnosis, Duodenal Ulcer / surgery, Duodenum / surgery, Humans, Male, Obesity, Morbid / surgery, Peptic Ulcer Hemorrhage / diagnosis, Peptic Ulcer Hemorrhage / surgery

Roux-en-Y gastric bypass is a common surgical procedure used to treat patients with morbid obesity. One of the rare, but potentially fatal complications of gastric bypass is upper gastrointestinal bleeding, which can pose diagnostic and therapeutic dilemmas. This report describes a 39-year-old male with morbid obesity who underwent a Roux-en-Y gastric bypass. Three months postoperatively, he sustained repeated and severe upper attacks of upper gastrointestinal bleeding. He received multiple blood transfusions, and had repeated upper and lower endoscopies with no diagnostic yield. Finally, he underwent laparoscopic endoscopy which revealed a bleeding duodenal ulcer. About 5 ml of saline with adrenaline was injected, followed by electrocoagulation to seal the overlying cleft and blood vessel. He was also treated with a course of a proton pump inhibitor and given treatment for H pylori eradication with no further attacks of bleeding. Taking in consideration the difficulties in accessing the bypassed stomach endoscopically, laparoscopic endoscopy is a feasible and valuable diagnostic and therapeutic procedure in patients who had gastric bypass.
Vague neuroglycopenic complaints camouflage diagnosis of adolescent insulinoma: a case report
Authors: Kelsee Halpin, Ryan McDonough, Patria Alba, Jared Halpin, Vivekanand Singh, Yun Yan
Journal: Int J Pediatr Endocrinol (2016)
Keywords: adolescent, altered mental status, child, epilepsy, hyperinsulinism, hypoglycemia, insulinoma
MeSH terms: Case Reports

Background:
Insulinoma is a rare diagnosis in the general population with estimates of 1 in 250,000 people per year. Reports of these pancreatic islet cell tumors are even more unusual in children and adolescents. Chronic hypoglycemia due to an insulinoma often presents with neuroglycopenic symptoms that can easily be overlooked, especially in adolescents where nonspecific complaints are common. This may result in delayed diagnosis with prolonged periods of untreated hypoglycemia and associated complications. The rarity of pediatric insulinoma, vagueness of presenting symptoms, and challenge of tumor localization make insulinoma a true diagnostic quandary for clinicians.
Case presentation:
In this report, we present a 15-year-old female who visited her primary care provider complaining of intermittent episodes of altered mental status including fatigue, irritability, and poor concentration. Her outpatient management included routine laboratory studies, drug screening, electroencephalogram (EEG), valproic acid initiation, CT scan of the abdomen, and endoscopic ultrasound with documentation of hypoglycemia, but otherwise inconclusive results. The patient was admitted to a tertiary children's hospital with severe refractory hypoglycemia 8 months after the initial evaluation. A serum critical sample was obtained and magnetic resonance imaging (MRI) of the abdomen performed which confirmed the presence of a pancreatic mass ultimately identified as an insulinoma. She went on to have surgical resection of her tumor resulting in complete resolution of her hypoglycemia and associated symptoms.
Conclusion:
Within this report we demonstrate the importance of being vigilant for fasting hypoglycemia secondary to insulinoma even when the patient presents with nonspecific symptoms such as fatigue, irritability, or problems with concentration. If these neuroglycopenic complaints are unnoticed or misdiagnosed, patients with a potentially curable disease are put at risk of neurologic injury, or even death, due to untreated severe hypoglycemia.
Secondary tuberculosis of adjacent segments after anterior cervical discectomy and fusion: A case report
Authors: Chengjiang Liu, Yidong Liu, Boyuan Ma, Mengmeng Zhou, Xinyan Zhao, Xuanhao Fu, Shunli Kan, Wei Hu, Rusen Zhu
Journal: Front Surg (2023)
Keywords: adjacent segment infection, anterior cervical discectomy and fusion, cervical spine, cervical spondylotic myelopathy, tuberculosis
MeSH terms: Case Reports

Introduction:
Anterior cervical discectomy and fusion (ACDF) is a common operation for spinal surgery to treat a variety of cervical diseases. The postoperative infection rate of this procedure is extremely low, and adjacent segments are rarely involved. Tuberculosis (TB) is a common infectious disease that affects the spine in less than 1% of cases and is more common in the thoracolumbar and rarely cervical spine. Herein, for the first time, we report tuberculosis infection in adjacent segments after ACDF.
Case presentation:
We report a 50-year-old patient with cervical spondylotic myelopathy (CSM) who was discharged from the hospital after receiving ACDF at the C3/4 level. Two months later, he was admitted to the hospital with neck pain and found to be infected with tuberculosis in C4/5. After 4 months of anti-tuberculosis treatment, the vertebral body was fused.
Conclusion:
After ACDF, the adjacent cervical vertebrae were infected with TB but the infection was limited. We believe that the special vertebral blood supply and postoperative secondary blood-borne infection may lead to the occurrence of extrapulmonary tuberculosis.