OpenMed/multicare-articles huggingface dataset:
PD-1 combined with lenvatinib and TACE for the transformational treatment of hepatocellular carcinoma combined with portal vein tumor thrombus: a case report and literature review
Authors: Sheng Liu, Rui Xiong, Chuanyi Duan, Jiang Tang, Tao Yin, Sisi Dai
Journal: Front Oncol (2023)
Keywords: pd-1, tace, hepatocellular carcinoma, lenvatinib, portal vein tumor thrombus
MeSH terms: Case Reports

Background:
The prognosis of hepatocellular carcinoma combined with portal vein tumor thrombus is poor, with a median survival of only 3-6 months. PD-1 combined with targeted therapy may provide an opportunity for patients with BCLC C stage hepatocellular carcinoma combined with portal vein tumor thrombus to undergo radical surgery, significantly prolonging their survival time.
Case presentation:
A middle-aged 51-year-old male who was diagnosed with hepatocellular carcinoma combined with portal vein main stem tumor thrombus at our center in May 2020, with a BCLC stage of C, liver cirrhosis, HBV infection, and preoperative evaluation as unresectable. The liver function was Child-Pugh A. The initial treatment was lenvatinib combined with PD-1 therapy, followed by one cycle of TACE treatment. The tumor and thrombus volume significantly reduced, followed by continuous TACE combined with immunotherapy and targeted therapy, leading to the appearance of portal vein main stem emboli. After multidisciplinary discussion, surgical resection was performed, and the embolus was removed, achieving a cure. The patient has been tumor-free for over 34 months.
Conclusion:
PD-1 combined with lenvatinib and local TACE create conditions for radical surgery, and it is hoped that more real-world research data can provide better evidence for the transformational treatment of hepatocellular carcinoma combined with portal vein tumor thrombus.
Recurrent retroperitoneal liposarcoma with multiple surgeries: a case report
Authors: Xiao Wang, Xiaobiao Song, Qiang Song, Jijun Wang, Junsheng Chen
Journal: Front Oncol (2024)
Keywords: auxiliary treatment, case report, recurrence, retroperitoneal liposarcoma, surgical treatment
MeSH terms: Case Reports

Retroperitoneal liposarcoma (RPLPS) is a rare malignant tumor that is typically treated with surgical resection. However, RPLPS often has a high rate of local recurrence, making it crucial to explore new treatment options. In this report, we present the case of a middle-aged woman who experienced seven recurrences and underwent seven surgeries following the initial resection. Currently, the patient's condition remains stable after the eighth surgery. Although there have been numerous reports of RPLPS cases both domestically and internationally, instances of repeated recurrence like this are exceptionally rare. Therefore, we have gathered the patient's case data and conducted a retrospective analysis, incorporating relevant literature, to enhance the understanding of this disease among clinical practitioners.
Case Report: Assessment of primary myxofibrosarcoma in the left atrium using multimodal ultrasonography
Authors: Liyan Hu, Zhaohui Wang, Yu Chen, Xiaowei Zhang
Journal: Front Cardiovasc Med (2024)
Keywords: cardiac surgery, cardiac tumor, contrast-enhanced ultrasound (ceus) imaging, multimodal ultrasonography, myxofibrosarcomas
MeSH terms: Case Reports

Primary myxofibrosarcoma of the heart, a rare cardiac malignancy, was diagnosed in a middle-aged female patient exhibiting progressive dyspnea following transthoracic echocardiography and pathological analysis. Postoperatively, the patient underwent chemotherapy and Lenvatinib mesylate therapy, with regular check-ups confirming her survival. After 10 months the patient is still alive and well.
Case Report: A case of thoracoscopic mediastinal tumor resection in a child with ROHHAD syndrome
Authors: Yangwei Ma, Jia Gao, Lianghong Huo, Fang Wang
Journal: Front Pediatr (2024)
Keywords: rohhad syndrome, anesthetic management, case report, hypernatremia, mediastinal tumor, neuroblastoma
MeSH terms: Case Reports

Rapid-onset obesity with hypoventilation, hypothalamic dysfunction, and autonomic dysregulation (ROHHAD) is an exceptionally rare condition. This case report highlights a child diagnosed with ROHHAD syndrome, presenting with a mediastinal tumor. ROHHAD syndrome is characterized by early onset obesity, hypothalamic dysfunction, autonomic dysfunction, inadequate ventilation, suspected seizures, and abnormal behavior. The presence of a mediastinal tumor necessitated surgical intervention. Key considerations during surgery included hypernatremia due to hypothalamic dysfunction, potential airway challenges, preoperative anemia, and hemodynamic fluctuations during the removal of the sizable mediastinal tumor. Comprehensive preparations ensured a safe operation. Notably, some children with this syndrome may exhibit symptoms such as decreased gastrointestinal function, polyuria, and thermoregulatory disturbances. Vigilance is essential during anesthesia assessment in these patients. Anesthesiologists should enhance their knowledge of this condition and tailor their management strategies based on individual clinical presentations and the specific planned surgical procedures.
Case report: First treatment of acute ischaemic stroke in a patient on active rivaroxaban therapy using andexanet alfa and rtPA combined with early complete recovery
Authors: Bartosz Karaszewski, Sebastian Szczyrba, Bartosz Jabłoński, Dariusz Gąsecki, Piotr Kraszewski, Adam Wyszomirski, Robert Kowalski, Wioletta Kaliszan, Małgorzata Dąbrowska
Journal: Front Neurol (2023)
Keywords: andexanet alfa, anticoagulation, case report, intravenous thrombolysis, stroke
MeSH terms: Case Reports

Patients with non-large vessel occlusion acute ischemic stroke (NL-AIS) on oral anticoagulants (OAC) constitute the biggest portion among those who cannot receive any potential-reperfusion treatment even if they appear early in the hospital. We present the first case of therapy for NL-AIS in a patient with active anti-Xa anticoagulation, combining andexanet alfa and rtPA, who was recruited for STRoke On AntiCoagulants for Thrombolysis (acronym: STROACT), an ongoing therapeutic trial for non-LVO ischemic stroke on a DOAC. This is also the first report of the use of andexanet alfa-rtPA for AIS in a patient on rivaroxaban, which is the most frequently used non-vitamin K antagonist oral anticoagulant. The patient received the intravenous bolus of 800 mg of andexanet (contralateral arm), followed by a bolus of rtPA (10% of the calculated dose; ipsilateral arm), then a continuous infusion of andexanet at 8 mg/min for 120 min (contralateral arm), and rtPA (90% of the calculated dose; ipsilateral arm)-both stopped after completion of 38.9 and 74% of infusion dose, respectively, due to the severe adverse event related to the administration of rtPA. In this schema, both infusions are ongoing concurrently for approximately 60 min, and then andexanet is administered alone until the completion of the dose (altogether lasting approximately 3 h). The therapy was spectacularly effective, with early and complete improvement in NIHSS from 8 to 0 points in 70 min from the initiation of the therapy; mRS = 0. Obviously, a single case cannot drive any standard therapeutic decisions, but the experience we share in this article may help manage selected special clinical problems, especially when a patient's expected outcome is poor and there is no other way to help than experimentally. Additionally, it seems a valuable addition to recent meta-data on thrombolysis in anticoagulated patients.
Trial registration:
https://www.clinicaltrialsregister.eu. Identifier: 2020-004898-41. Date of registration: March 31, 2021.
Hypersensitivity to intravenous succinate corticosteroids in patients with nonsteroidal anti-inflammatory drug-exacerbated respiratory disease
Authors: Masami Taniguchi, Atsuhiko Sato, Haruhisa Mita
Journal: Front Allergy (2023)
Keywords: aerd (aspirin-exacerbated respiratory disease), n-erd, corticosteroids, hypersensitivity, succinate

Although there are many case reports of asthma exacerbations with intravenous corticosteroids, especially hydrocortisone succinate, in nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (N-ERD), the frequency and mechanism remain unclear. We hypothesized that N-ERD patients are potentially hypersensitive to succinates, especially succinate corticosteroids, based on the results of previous provocation studies and considered specific mechanisms. The objective of this study was to determine the frequency and mechanism of succinate corticosteroids hypersensitivity in patients with N-ERD. Eleven patients with stable, moderate to severe N-ERD were tested with hydrocortisone sodium succinate (HCs), hydrocortisone sodium phosphate (HCp), methylprednisolone sodium succinate (MPSLs), prednisolone sodium succinate (PSLs), and chloramphenicol sodium succinate (CPs, without a steroidal chemical structure) at doses below the normal dose through intravenous administration using a single-blind test. As a comparison, seven patients with aspirin-tolerant asthma (ATA) also underwent an intravenous provocation test of HCs. The positive intravenous provocation test rates of HCs 100-500 mg, HCp 500 mg, MPSLs 80 mg, PSLs 20 mg, and CPs 500 mg in N-ERD patients were 82% (9/11), 9% (1/11), 50% (5/10), 33% (1/3), and 86% (6/7), respectively. Most positive reactions began with a severe cough within 5 min of intravenous injection. The course of these hypersensitivity symptoms differed from those seen with the usual aspirin challenge test. The HCs 100-500 mg intravenous test was negative in all seven patients with ATA. In conclusion, patients with N-ERD have high rates of potential hypersensitivity to the succinate ester structure, which is not linked to the corticosteroid structure, but to the succinate ester structure. We hypothesized that the mechanism of hypersensitivity observed during rapid intravenous administration of succinate corticosteroids is mast cell activation via succinate receptor stimulation, rather than due to the corticosteroid itself.
Haloperidol-induced painless legs and moving toe syndrome in a schizophrenia patient: a case report
Authors: Mugundan U Maheshwari, Natarajan Shanmugasundaram, Karthik Sankar, Mahendran Sekar, Ling S Wong, Sarvesh Sabarathinam, M Yasmin Begum, Srikanth Jeyabalan
Journal: Future Sci OA (2024)
Keywords: haloperidol, painless legs, tardive dyskinesia
MeSH terms: Case Reports

Painless legs and moving toe syndrome (PoLMT) is a rare syndrome characterized by involuntary movements of the toe without pain. The exact etiology of the patient's PoLMT is unknown. We present a case of PoLMT in 45-year-old woman with a history of haloperidol intake for 10 months. Haloperidol was discontinued, and aripiprazole (15 mg) was initiated. After this switch, a reduction in movement was observed in the third and fourth toes; however, the second toe showed no discernible change.
Euglycemic Diabetic Ketoacidosis Presenting as Hypoglycemia in a Patient With Type 2 Diabetes and Von Gierke's Disease
Authors: Emmanuel Tito, Akshaya Ramaswami, Ron Milbocker, Darwin Edmond
Journal: Cureus (2024)
Keywords: diabetes mellitus, diabetic ketoacidosis (dka), empaglifozin, hypoglycemia, von gierke disease
MeSH terms: Case Reports

Von Gierke's disease (VGD) is rarely associated with type 2 diabetes mellitus (DM2). We present a case of VGD with DM2 that presented with hypoglycemia in the setting of diabetic ketoacidosis (DKA) in a young male with VGD using the sodium-glucose co-transporter 2 (SGLT2) inhibitor empagliflozin. The patient required resuscitation with fluids containing glucose prior to the administration of insulin for DKA protocol with significant clinical improvement. This case demonstrates a rare presentation of DKA with hypoglycemia.
Denosumab combined with chemotherapy followed by anlotinib in the treatment of multiple metastases of malignant peripheral nerve sheath tumor: a case report and literature review
Authors: Qian Chen, Haocheng Cui, Kai Zheng, Ming Xu, Xiuchun Yu
Journal: Front Oncol (2024)
Keywords: adjuvant chemotherapy, anlotinib, case report, denosumab, malignant peripheral nerve sheath tumor
MeSH terms: Case Reports

Primary intraosseous malignant peripheral nerve sheath tumors (MPNSTs) are rare yet highly aggressive neoplasms originating from peripheral nerves. Typically manifesting as soft tissue masses accompanied by pain or functional impairment, these tumors pose significant challenges in management. Surgical intervention remains the cornerstone of treatment for patients with MPNST lacking distant metastasis, with generally modest success rates. In cases of recurrence and metastasis, the pursuit of effective systemic therapies has been a focus of clinical investigation. Herein, we present a case study involving an elderly female patient with refractory MPNST. In light of surgical limitations, a multimodal therapeutic approach combining chemotherapy, denosumab, and subsequent administration of anlotinib was pursued following collaborative consultation. This regimen yielded noteworthy clinical benefits, exemplifying a promising avenue in the management of challenging MPNST cases.
Dolichocephaly, Arachnodactyly, Diplopia, and Distal Myopathy - Novel Phenotype of MICU1 Variant c.553C>T
Authors: Josef Finsterer, Awini Barwari
Journal: Cureus (2024)
Keywords: ataxia, cognitive impairment, micu1, mutation, myopathy
MeSH terms: Case Reports

Pathogenic variants in mitochondrial calcium uptake 1 (MICU1) manifest phenotypically heterogeneously but most frequently in the brain and skeletal muscle. Dolichocephaly, arachnodactyly, diplopia, and distal myopathy have not been reported in carriers of a pathogenic MICU1 variant. The patient is a 23-year-old female with consanguineous parents (first cousins) who was a carrier of the homozygous MICU1 variant c.553C>T, phenotypically presenting with developmental delay, intellectual disability, ataxia, dysmorphia (dolichocephaly, arachnodactyly, clinodactyly, hypertelorism, wide nasal bridge), myopathy (ptosis, double vision, strabismus, distal limb weakness, diffuse wasting, hypotonia), hyperextensible joints and hyperkyphosis. Features not previously described were dolichocephaly, arachnodactyly, broad nasal bridge, double vision, and distal myopathy. She was treated with physical therapy, speech therapy, and occupational therapy and received escitalopram and mirtazapine for concomitant depression, anxiety disorder, and insomnia. The presented case shows that the phenotypic heterogeneity of pathogenic MICU1 variants is even greater than previously assumed. Treatment of MICU1-related phenotypes is symptomatic, but these patients benefit from physical therapy, behavioral therapy, speech therapy, and antidepressant treatment.
Liver Pseudotumor Due to Aberrant Left Gastric Vein: A Case Report
Authors: Serhat Deger, Ahmet Bozer
Journal: J Belg Soc Radiol (2023)
Keywords: aberrant left gastric vein (algv), focal fatty sparing, liver, pseudotumor, third inflow
MeSH terms: Case Reports

Liver pseudotumors (pseudolesions) pose diagnostic challenges in imaging, often linked to anomalous venous drainage. Notably, aberrant left gastric vein (ALGV) plays a role in segment 2 and 3 pseudolesions. A liver parenchymal pseudolesion due to abnormal venous drainage involving ALGV is highlighted. Understanding hepatic vascular dynamics, exemplified by ALGV-related pseudolesions, aids diagnosis and guides decisions. Further investigating intricate mechanisms underlying these anomalies is crucial.
Teaching point:
The recognition of third inflow pathways such as ALGV holds significance in distinguishing hepatic pseudolesions from true lesions.
Schwannoma at an Unusual Site: Case Report and Surgical Technique Discussion for Nasal Dorsum
Authors: Sultan K Kadasah, Abdulrazaq M Alshammari, Nader S Alharbi, Ibtihal S Alshehri, Raghad Y Alasiri, Saud A Aldhabaan, Ghalib X Alsayed, Adnan Q Almalki
Journal: Case Rep Otolaryngol (2024)
MeSH terms: Case Reports

Peripheral nerve sheath tumors (PNSTs), while uncommon, can have a significant impact on appearance and quality of life, especially when they form in prominent areas such as the nose dorsum. We discuss a case of a 29-year-old woman who developed a benign PNST on the right side of her nasal ala. This tumor gradually grew, impairing her face appearance. Diagnostic tests, such as computed tomography (CT) and magnetic resonance imaging (MRI), revealed the tumor as a slowly growing, well-defined mass. The tumor was removed via open rhinoplasty under general anesthesia, and pathological investigation verified its benign nature. After surgery, the patient's quality of life improved significantly, and there were no evidence of tumor recurrence after eight months. This case emphasizes the need of including PNST in the differential diagnosis of nasal tumors.
Symptomatic Hypocalcemia due to Nutritional Vitamin D Deficiency in Three Adolescents during the COVID-19 Pandemic
Authors: Sabitha Sasidharan Pillai, Lisa Swartz Topor
Journal: Case Rep Pediatr (2023)
MeSH terms: Case Reports

Background:
Symptomatic hypocalcemia secondary to vitamin D deficiency (VDD) is rare among adolescents without underlying medical disorders, but its prevalence is higher in known risk populations. We report on three adolescent males with low nutritional intake of vitamin D and calcium and limited sun exposure who presented with hypocalcemic tetany and muscle cramps due to VDD during the COVID-19 pandemic. Case Reports. Three adolescent males (age range 14 to 16 years) presented with symptomatic hypocalcemia: paresthesia, carpopedal spasms, and muscle cramps. All reported limited dairy intake and sun exposure. Laboratory studies showed mean ionized calcium (iCa) 2.73 mg/dl (range 2.69-2.8), mean phosphorus 4.17 mg/dl (range, 3-5.4), mean parathyroid hormone (PTH) 431.67 pg/mL (range, 320-527), and mean 25-hydroxyvitamin D (25(OH)D) 7.37 ng/mL (range 5.3-10.8). All the patients presented during the COVID-19 pandemic, and one had COVID-19 infection. All were treated with oral calcium and high dose ergocalciferol. Patients 2 and 3 were also treated with intravenous calcium gluconate infusion and oral calcitriol.
Conclusion:
Severe VDD with symptomatic hypocalcemia can occur among adolescents without underlying medical diagnoses due to dietary and behavioral habits that limit nutritional intake and sun exposure. Risk factors of the patients may have been potentiated by pandemic-related behaviors such as more time indoors at home related to social distancing, as well as diets with limited nutrient intake. Adolescents presenting with nonspecific musculoskeletal symptoms should be screened for VDD and hypocalcemia. Appropriate treatment and preventive measures can stop immediate and long-term complications.
Colitis in a patient with familial Mediterranean fever: Is it Crohn's disease or ulcerative colitis?
Authors: Ayano Hoshi, Yuichi Shimodate, Tatsuhiro Gotoda, Rio Takezawa, Naoyuki Nishimura, Hirokazu Mouri, Kazuhiro Matsueda, Motowo Mizuno, Takayuki Matsumoto
Journal: DEN Open (2024)
Keywords: crohn's disease, colitis, familial mediterranean fever, inflammatory bowel disease, ulcerative colitis
MeSH terms: Case Reports

A 24-year-old woman was referred to our hospital with joint pain, fever, abdominal pain, and diarrhea. A colonoscopy revealed longitudinal ulcers with a cobblestone appearance throughout the entire colon, suggestive of Crohn's disease. However, treatment with 5-aminosalicylic acid, azathioprine, and infliximab failed to achieve clinical remission. A colonoscopy 5 months later revealed a diffusely spreading granular mucosa without visible vasculature, compatible with active ulcerative colitis. Based on these serial changes in colonic lesions, we tested the patient for MEFV gene mutations and found variants E148Q and L110P in exon 2. Administration of colchicine resulted in complete clinical remission. Our experience suggests that drastic changes in the features of colonic inflammation may be a clue to the diagnosis of enterocolitis associated with familial Mediterranean fever.
Blinding Optic Neuropathy Associated With Carboplatin Therapy: A Case Report and Literature Review
Authors: Sammy Shihadeh, Madison M Patrick, Galen Postma, Brenda Trokthi, Charles Maitland
Journal: Cureus (2024)
Keywords: optic coherence tomography, optic nerve atrophy, sudden visual loss, toxic optic neuropathy, visual field defect
MeSH terms: Case Reports

Various forms of cancer and chemotherapeutics are associated with optic neuropathy. Cisplatin is a platinum analogue chemotherapeutic commonly associated with ocular toxicity among many other serious adverse effects. Carboplatin is a more chemically stable platinum analogue that is generally better tolerated with a comparatively favorable side effect profile. There are very few reports of carboplatin precipitating optic neuropathy. This case report describes a rare occurrence of carboplatin-induced blinding optic neuropathy. We treated a patient receiving carboplatin for neuroendocrine bladder cancer who developed rapidly progressive bilateral optic neuropathy over the course of three days. Upon evaluation at our clinic, his visual acuity had declined to light perception only and 20/60 in his left and right eye, respectively. Carboplatin therapy was immediately held and steroids were initiated. Despite the intervention, the patient's visual deficits have not improved at the one-year follow-up. Although the mechanism by which carboplatin causes ocular toxicity remains speculative, arterial ischemia appears to be the likely mechanism given the irreversible nature of visual decline. As demonstrated by our patient's course, irreversible vision loss despite high-dose steroid intervention necessitates expeditious recognition and management of this rare adverse effect. ​​​​​.
Asymptomatic Esophageal Eosinophilia in an 11-Year-Old with Severe Persistent Asthma
Authors: Casey E Hofstaedter, Runa Watkins, Nidhi Kotwal
Journal: Case Rep Pediatr (2023)
MeSH terms: Case Reports

Asymptomatic esophageal eosinophilia (aEE) is a rare presentation, where patients have increased eosinophils in esophageal mucosa but lack any esophagus-related symptoms. Cases of aEE have only been documented in adults, and little is known about its clinical significance and whether treatment is warranted. We report a case of an 11-year-old patient with uncontrolled severe persistent asthma who underwent flexible bronchoscopy and upper endoscopy as a part of complete aerodigestive evaluation. Elevated intraepithelial eosinophils in the esophageal mucosa were noted, suggesting an aEE-like presentation. This case documents a pediatric patient with aEE and highlights the importance of combined aerodigestive assessment with pulmonology and gastroenterology teams for the evaluation of severe asthma.