OpenMed/multicare-articles huggingface dataset:
Case Report: Very Late, Atypical Extra-Medullary Relapse in a Patient With Acute Promyelocytic Leukemia (APL) Rescued With a Transplant-Free Approach
Authors: Matteo Molica, Carla Mazzone, Tiziana Ottone, Pasquale Niscola, Elisabetta Abruzzese, Stefano Fratoni, Maria Teresa Voso, Paolo de Fabritiis
Journal: Front Oncol (2021)
Keywords: acute promyelocitic leukemia, all-trans retinoic acid and arsenic trioxide combination treatment, bcr3 variant, transplant free approach, very late relapse
MeSH terms: Case Reports

Relapses of acute promyelocytic leukemia (APL) beyond 7 years from the first molecular remission are exceptional, and it is unclear whether these relapses represent a new, therapy-related leukemia rather than a delayed relapse of the original leukemic clone. The increase extra-medullary relapses (ER) in the era of all-trans retinoic acid (ATRA) therapy suggests a potential correlation between ATRA therapy and ER, and several potential explanations have been proposed. The gold standard post-remission approach, particularly for patients in late relapse, has not yet been established. The benefit of a transplant approach has been questioned in this setting because continuing ATRA-arsenic trioxide (ATO) might be curative. Here we report on the case of an APL patient who relapsed 9 years after achieving her first molecular complete remission (mCR) and who showed an atypical isolated localization at nodal sites, including the into- and peri-parotid glands. Genomic PML/RARa breakpoint analysis detected the same bcr3 PML/RARa hybrid gene in DNA purified from bone marrow and lymph nodes, suggesting that the relapse was because of the reemergence of the initial clone. This case shows that APL, treated with ATRA and cytotoxic drugs, may still emerge in extra-medullary sites even after a very prolonged mCR and could be salvaged with an ATO-based protocol, not including a transplant approach.
Revascularization in Immature Permanent Teeth with Necrotic Pulp and Apical Pathology: Case Series
Authors: López Carmen, Mendoza Asunción, Solano Beatriz, Yáñez-Vico Rosa
Journal: Case Rep Dent (2017)
MeSH terms: Case Reports

Introduction:
To present and discuss the results of five clinical cases treated using the revascularization protocol, showing clinical and radiographic monitoring. Necrotic immature teeth with periapical pathology present a challenge to dentists because the techniques used in apexification leave the tooth susceptible to fracture, since the root does not continue to grow in length and the canal walls are thin. Revascularization has emerged as an alternative to resolve these deficiencies, enabling apical closure, continued development of the roots, and thickening of the dentinal walls.
Case series:
Five clinically and radiographically diagnosed necrotic immature permanent teeth were treated using revascularization treatment. The therapeutic protocol involved accessing the pulp chamber; irrigating copiously with NaOCl; applying a triple antibiotic paste as intracanal dressing; then provisionally sealing it. After 3 weeks, the canal was cleaned and the apex irritated with a size 15 K-file to induce blood that would serve as a scaffold for pulp revascularization. MTA was used to seal the chamber before final obturation (composite or metallic crown).
Conclusion:
The discussion of the results leads to debate about different restorative materials and other published protocols.
Ischemia Possibly Associated with High Degree Atrioventricular Block
Authors: Dimitrios Siamkouris, Elmar Offers, Marc Schloesser, Gjoko Ilieski, Stergios Tzikas
Journal: Case Rep Cardiol (2023)
MeSH terms: Case Reports

Conduction restoration in second- and third-degree atrioventricular (AV) block after revascularization in acute coronary syndrome (ACS) setting is well established, however this is not the case in non-ACS setting. We present a case of a patient referred for permanent pacemaker implantation, due to high degree AV block (HAVB), who restored his conduction possibly due to targeted revascularization. Thus, this case sheds insight in the reversibility potential of HAVB after revascularization in non-ACS patients, which although signified in current literature, is still far from being a recommendation, due to lack of robust scientific confirmation.
Nonsurgical Management of Apical Root Perforation Using Mineral Trioxide Aggregate
Authors: Omar Alzahrani, Faisal Alghamdi
Journal: Case Rep Dent (2021)
MeSH terms: Case Reports

This study illustrates a conservative approach to nonsurgical management of apical root perforation in maxillary first molars. A patient was referred for retreatment of a maxillary left first molar. Her chief complaint was dull pain while biting in her maxillary left first molar. Periapical radiography showed radiolucency related to the mesiobuccal root and overextended gutta-percha through a perforation in the apical part of the distobuccal root. A CBCT scan was acquired and revealed the location and size of the apical perforation. The clinical examination showed that the tooth has been endodontically treated and the canals were filled, tender to percussion and palpation. Thus, the nonsurgical root canal retreatment was done and the perforation site was repaired by using mineral trioxide aggregate (MTA). At the one-year follow-up, after the management of apical root perforation, we observed periapical tissue healing and no pain due to percussion and palpation, without any clinical/radiological signs or symptoms. The prognosis of this case has a higher success rate with the development of new materials such as MTA. The MTA not only can seal the site of the perforation but also has the ability to induce calcification. Many factors can contribute to the success rate of perforated cases, including time, size, and location of the perforation. With the use of this material and good tools like a microscope, there are those with having higher chances of repair and eventually higher success rates.
Rare case of gallbladder mucocele causing gastric outlet obstruction treated with cholecystectomy
Authors: Wei-Liang Loh, Nick Zhi Peng Ng, Tousif Kabir, Chung Yip Chan
Journal: Int J Surg Case Rep (2019)
Keywords: case report, cholecystectomy, gallbladder mucocele, gastric outlet obstruction

Introduction:
Gallstone(s) impacted at the distal small bowel causing intestinal obstruction as a result of cholecystoenteric fistula is a well-known, albeit uncommon surgical condition. The rare Bouveret's Syndrome, which refers to the proximal impaction of gallstone(s) in the duodenum or pylorus resulting in the gastric outlet obstruction (GOO), has also been described in the literature. However, gallbladder mucocele with extrinsic compression of the duodenum and/or pylorus causing GOO is a separate entity that is extremely rare.
Presentation of case:
A patient who presented with loss of appetite and weight, with intermittent vomiting over a course of eight months was found to have GOO secondary to extrinsic duodenal compression from a large gallbladder mucocele. Surgical intervention in the form of cholecystectomy was performed, and the patient's symptoms resolved post-operatively.
Discussion:
We describe an extremely rare case of GOO, which can be easily corrected with cholecystectomy. Removal of the gallbladder removes the root cause of the issue, and should be first line therapy unless the patient is unfit for surgery.
Conclusion:
This extremely rare cause of GOO should be recognized, and treated promptly with surgery if possible.
Complete response in advanced breast cancer patient treated with a combination of capecitabine, oral vinorelbine and dasatinib
Authors: V Sgroi, M Bassanelli, M Roberto, E Iannicelli, R Porrini, P Pellegrini, A Tafuri, P Marchetti
Journal: Exp Hematol Oncol (2018)
Keywords: advanced breast cancer, capecitabine, chronic myeloid leukemia, dasatinib, vinorelbine
MeSH terms: Case Reports

Background:
Currently, there are no data available on the best choice of treatment in heavily pretreated patients with advanced breast cancer. However, the combination of oral vinorelbine and capecitabine has been demonstrated to be effective and safe in patients with advanced breast cancer pretreated with anthracycline. Furthermore, some studies assessed the activity of dasatinib, an oral tyrosine kinase inhibitor that inhibits five oncogenic tyrosine kinase families, alone or in combination with different chemotherapy in patients affected with advanced breast cancer.
Case presentation:
A patient with metastatic breast cancer, hormone receptor positive and human epidermal grow factor receptor 2 negative, pretreated with epirubicine, taxanes and nab-paclitaxel, was submitted to third line chemotherapy with vinorelbine 60 mg/m2 on day 1, 8 plus capecitabine 1000 mg/m2 twice daily from day 1 to day 14 every 21 days. The patient was taking also dasatinib 100 mg once daily for chronic myeloid leukemia. The treatment was well tolerated and, after 15 months, computed tomography scan showed a complete response of liver metastases and bone stable disease. After another 28 months, a 18-fluorodeoxyglucose positron emission tomography scan showed a metabolic response of bone metastases without other site of disease.
Conclusions:
This is the first case in literature about activity of dasatinib in combination with a chemotherapy schedule of oral vinorelbine and capecitabine in advanced breast cancer. This treatment showed both good tolerability and great activity with a long progression free survival of 54 months.
Left-Sided Upper Partial Anomalous Pulmonary Venous Return through a Curved Vein Joining the Left Brachiocephalic Vein
Authors: Eleonora Tricarico, Francesco Tricarico, Carlo Florio
Journal: Case Rep Radiol (2016)

The evaluation of pulmonary veins during cross-sectional imaging of the chest and the knowledge of their embryology and anatomy are useful for detecting congenital conditions that may be clinically significant. Moreover, with the spread of cross-sectional imaging it is very frequent to find anatomical variants; therefore the radiologist should easily recognize their appearances. This case report shows a left-side upper partial anomalous pulmonary venous return (PAPVR) through a "curved" vein that joins the left brachiocephalic vein, in a female patient who underwent whole-body computed tomography (CT) for staging endometrial cancer. This was an incidental finding, not related to any symptoms; however, we explain the anatomical aspects of this abnormality within the congenital condition of PAPVR and its possible clinical relevance.
Case report: Systemic muscle involvement as the primary clinical manifestation of chronic active Epstein-Barr virus infection: A case-based review
Authors: Shanfen Shi, Liangda Li, Cuiping Pan, Yandi Yang, Gun Chen, Yongping He
Journal: Front Immunol (2022)
Keywords: caebv, chronic active epstein–barr virus infection, generalized myositis, lymphoma, polymyositis
MeSH terms: Epstein-Barr Virus Infections / complications, Epstein-Barr Virus Infections / diagnosis, Myositis / diagnosis, Polymyositis, Case Reports, Research Support, Non-U.S. Gov't, Chronic Disease, Herpesvirus 4, Human, Humans, Muscles / pathology, Persistent Infection

Chronic active Epstein-Barr virus infection (CAEBV) is common in Asian countries and characterized by recurrent or persistent infectious mononucleosis-like symptoms. Here, we describe a rare case of CAEBV-associated generalized myositis with extranodal NK/T-cell lymphoma, who initially presented with swelling and muscle soreness in the extremities and was diagnosed as polymyositis at the initial stage. CAEBV-associated generalized myositis is different from polymyositis and other types of myositis. Furthermore, it is prone to lymphoma with poor prognosis.
Primary Peritoneal Carcinosarcoma: A Case Report
Authors: Logan Erz, Brandon Smith, Brandon Larson, Truong Ma
Journal: Front Surg (2021)
Keywords: mullerian tumor, carcinosarcoma, multiple mullerian tumor, peritoneal carcinoma, peritoneal carcinosarcoma
MeSH terms: Case Reports

Introduction: Carcinosarcoma, also known as malignant mixed Mullerian tumor (MMMT) is a malignant biphasic neoplasm consisting of carcinomatous and malignant non-epithelial components of mesenchymal origin. MMMTs typically arise from the female genital tract in patients over 40 years old. Primary extragenital MMMTs are extremely rare with published literature totaling 40 reported cases. The primary peritoneal carcinosarcoma is an aggressive tumor as patients with this tumor have an average survival of 7.6 months. Surgical debulking is the mainstay of treatment for these tumors and systemic chemotherapy is advised in all cases. Case: A 48-year-old Amish female presented with 5 day history of bloating and abdominal pain superimposed on a 1 year history of worsening fatigue and intermittent bloody bowel movements. She was found to have a pelvic mass on physical exam. Computed tomography scan of the abdomen and pelvis that demonstrated stricturing of the sigmoid colon, and a large multi-cystic mass in the midline pelvis measuring 12.5 × 9.9 × 11.7 cm. Colonoscopy showed stenosis due to external compression without intraluminal lesion. CEA and CA 125 levels were elevated and CA 19-9 was normal. Exploratory laparotomy was performed with en-bloc resection of a 15 cm mass originating from the sigmoid colon mesentery with several other small tumor deposits throughout the mesentery. Pathology diagnosed primary peritoneal carcinosarcoma Mullerian-type with three positive lymph nodes. Conclusion: Malignant mixed Mullerian tumor (carcinosarcoma) caries a universally grim prognosis. Herein, we report a unique case of primary peritoneal carcinosarcoma and discuss the work-up and surgical management of this rare tumor.
Eustachian Valve Endocarditis: Echocardiographic Diagnosis in a Critical Care Patient
Authors: Mariana Alves, Rita Faria, António Messias, Carlos Meneses-Oliveira
Journal: Case Rep Crit Care (2018)
MeSH terms: Case Reports

Eustachian valve endocarditis is rare. A literature review revealed that only 29 cases have been reported and, among them, there is only one mention of an intensive care unit (ICU) admission. We present an 82-year-old man without previous medical records who presented with septic shock with multiple organ dysfunction. The patient was admitted to the ICU and deteriorated with combined shock (septic + cardiogenic). A second ultrasound screen detected a prominent Eustachian valve with mobile multilobulated vegetation attached. Transesophageal echocardiography confirmed a 12 mm oscillating mass attached to a visible Eustachian valve.
Imaging of retroperitoneal haemorrhage revealing median arcuate ligament syndrome
Authors: Younes El Hassani, Meriem Haloua, Badreeddine Alami, Meryem Boubbou, Mustapha Maaroufi, Moulay Youssef Alaoui Lamrani
Journal: SA J Radiol (2021)
Keywords: epigastric pain, haematoma, median arcuate ligament syndrome, pancreaticoduodenal aneurysm, retroperitoneal haemorrhage

Coeliac artery compression stenosis caused by the median arcuate ligament can lead to aneurysm formation in the pancreatico-duodenal arteries that can eventually result in a spontaneous rupture leading to retroperitoneal haemorrhage. In this case series, we describe the cases of three patients, all presenting with sudden epigastric pain, diagnosed as spontaneous haematoma, complicating a median arcuate ligament syndrome.
Ectomesenchymal chondromyxoid tumor: Review of literature and a report of a rare case
Authors: Mohanty Leeky, Tv Narayan, Sadhana Shenoy, Saleha Jamadar
Journal: J Oral Maxillofac Pathol (2011)
Keywords: benign, chondromyxoid, ectomesenchymal, tongue, tumor
MeSH terms: Case Reports

Ectomesenchymal chondromyxoid tumor (ECMT) is a rare benign intraoral tumor. Clinically, it presents as a slow growing, painless, firm, submucosal sweling exclusively occurring on the anterior dorsum of the tongue. Till date only 40 cases have been reported in literature. Histopathologically the tumor is characterized by a well circumscribed, lobular proliferation of round, polygonal, ovoid or fusiform cells in a net-like pattern in a myxoid to chondromyxoid background. Here, we present a rare case of ECMT occurring in a 7-year-old boy and throw some light on this distinct entity.
Peripartum Cardiomyopathy: Management Strategies for Pregnancy Termination
Authors: Ashley M Darlington, Jonah D Fleisher, Joan E Briller
Journal: Womens Health Rep (New Rochelle) (2020)
Keywords: case reports, perioperative management, peripartum cardiomyopathy, pregnancy termination
MeSH terms: Case Reports

Some women have underlying cardiovascular disease that leads to increased morbidity and mortality with pregnancy. These women may choose to terminate a pregnancy rather than face this increased risk. The optimal approach for pregnancy termination in women with cardiomyopathy is not well defined. We present two women with peripartum cardiomyopathy, both modified World Health Organization (mWHO) class IV and with elevated Cardiac Disease in Pregnancy (CARPREG II) pregnancy risk stratification scores who are at the highest risk for pregnancy continuation. Both underwent induced abortion, although the procedure was performed in very different settings. These cases illustrate factors that influence the mode and setting of pregnancy termination performance.
Gastrointestinal autonomic nerve tumours--report of a case and review of literature
Authors: Manoj H Mulchandani, Dipankar Chattopadhyay, John O Obafunwa, Vickram B Joypaul
Journal: World J Surg Oncol (2005)

Background:
Gastrointestinal autonomic nerve tumours are uncommon stromal tumours of the intestinal tract. They can involve any part of the gastrointestinal system, but are very rarely seen in the rectum.
Case presentation:
We report a unique case of rectal schwannoma with associated synchronous adenocarcinoma of the splenic flexure and adenoma of the descending colon. A 70-year-old patient was admitted with complaint of bleeding per rectum and investigations revealed the presence of a large submucosal rectal lesion in addition to the colonic pathologies. Following panproctocolectomy with permanent spout ileostomy, histopathology and immunohistochemistry confirmed the rectal lesion to be a schwannoma.
Conclusion:
Literature review of the few reported cases has suggested radical surgical excision to be the best approach. Prognosis tends to be favourable after resection.
Atypical and isolated posterior reversible encephalopathy syndrome in postpartum without preeclampsia: a case report
Authors: Houda Moustaide, Karima Aouali, Saad Benkirane
Journal: Pan Afr Med J (2023)
Keywords: pres syndrome, case report, maternal health, preeclampsia, seizure
MeSH terms: Posterior Leukoencephalopathy Syndrome / diagnosis, Posterior Leukoencephalopathy Syndrome / etiology, Pre-Eclampsia / diagnosis, Case Reports, Brain, Female, Humans, Neuroimaging, Postpartum Period, Pregnancy

Posterior reversible encephalopathy syndrome (PRES) is a neurological complication frequently found during brain exploration for severe preeclampsia when it is associated with neurological signs. Being a newly discovered entity, its mechanism of genesis is still based on a hypothesis not yet confirmed. The clinical case that we report highlights an atypical PRES syndrome occurring in postpartum without any signs of preeclampsia. The patient had suffered a state of convulsive dysfunction after delivery without hypertension and the diagnosis of PRES syndrome was confirmed based on the results of the brain computed tomography (CT) scan, she showed signs of clinical improvement on the fifth day of postpartum. Our case report calls into question the association between PRES syndrome and preeclampsia that we find in literature and puts a big question mark on the causal link between the two in pregnant women.
Diagnostic challenge in children with an acquired demyelinating syndrome: an illustrative case report
Authors: Luciana Midaglia, Ana Felipe-Rucián, Ignacio Delgado Alvarez, Xavier Montalban, Mar Tintoré
Journal: Front Neurosci (2023)
Keywords: mog antibody-associated disease (mogad), acquired demyelinating syndrome (ads), multiple sclerosis (ms), myelin oligodendrocyte glycoprotein (mog), neuromyelitis optica spectrum disorder (nmosd), pediatric onset multiple sclerosis (poms)
MeSH terms: Case Reports

The clinical-radiological and biological overlap of the spectrum of pediatric demyelinating disorders makes the diagnostic process of a child with an acquired demyelinating syndrome truly challenging. We present a 9-year-old girl with subacute symptoms of severe decrease in bilateral visual acuity and gait ataxia. An urgent MRI showed inflammatory-demyelinating lesions affecting the periaqueductal gray matter, the cerebellar hemispheres, the area postrema as well as both optic nerves and chiasm. Likewise, multisegmental involvement of the cervical and dorsal spinal cord was found, with short and peripheral lesions. Anti myelin oligodendrocyte glycoprotein (MOG) antibodies (Abs) were positive in cerebrospinal fluid (CSF) and weakly in serum. Oligoclonal bands (OB) were positive in CSF. Based on all this, the diagnosis of MOG antibody disease (MOGAD) with a neuromyelitis optica spectrum disorder (NMOSD)-like picture was made. Given the good clinical and radiological recovery after the acute phase treatment, and that anti MOG Abs became negative, it was decided to keep the patient without specific treatment. However, during follow-up, while the patient was asymptomatic, a control brain MRI showed the appearance of new lesions with morphology and topography suggestive of multiple sclerosis (MS). This, added to the presence of OB, made the diagnosis of pediatric-onset MS (POMS) likely. Immunosuppressive treatment was restarted with a good response since then. Unlike adult-onset MS, children with POMS may usually not have entirely typical clinical and radiological features at presentation. In many cases, the time factor and close clinical and radiological monitoring could be critical to make an accurate diagnosis.
Eosinophilic Colitis and Clostridioides difficile Sepsis With Rapid Remission After Antimicrobial Treatment; A Rare Coincidence and Its Pathogenic Implications
Authors: Simona Alexandra Iacob, Mihaela Cristina Olariu, Diana Gabriela Iacob
Journal: Front Med (Lausanne) (2020)
Keywords: clostridioides difficile, dysbiosis, eosinophilic colitis, hypereosinophilia, intestinal eosinophilic infiltrate, intestinal inflammation, pathogenesis, sepsis
MeSH terms: Case Reports

Eosinophilic colitis is a rare inflammatory disorder of the digestive tract with chronic evolution and unknown pathophysiological mechanisms. The article describes the case of a 64-year old woman with a history of asthma and hypereosinophilia, who presented to a surgical department for persistent abdominal pain in the past 4 months, weight loss and malabsorption. She was diagnosed with eosinophilic colitis based on the colonoscopic result indicating extensive eosinophilic infiltration of the colonic mucosa correlated with the laboratory data and abdominal CT scan results. Following the colonoscopy, the patient developed fever, hypotension and diarrhea and was transferred to an Infectious Diseases Department with a presumptive diagnosis of abdominal sepsis. Treatment with ertapenem was immediately started. Metronidazole was also added due to a PCR positive stool test for Clostridioides difficile toxins encoding-genes. The patient displayed a rapid remission of the fever and of the intestinal complaints following antibiotic therapy and was discharged after 14 days. During a 3 months follow-up, the patient remained asymptomatic with normal values of laboratory parameters except for a persistent hypereosinophilia. The case outlines two distinguishing features: a histopathologic diagnosis of eosinophilic colitis, a rare diagnosis of a patient with chronic abdominal pain and an unexpected and rapid remission of the eosinophilic colitis following the antibiotic treatment and the restoration of the intestinal eubiosis.