OpenMed/multicare-articles huggingface dataset:
Sensory-Motor Polyneuropathy and Digital Ischemia: A Rare Presentation of Granulomatosis with Polyangiitis
Authors: Wasundara Wathurapatha, B G A Rathnamali, Upul Dissanayake
Journal: Case Rep Rheumatol (2021)
MeSH terms: Case Reports

Granulomatosis with polyangiitis (GPA) typically presents with upper or lower respiratory tract symptoms and/or with renal involvement. Although it can affect the peripheral nervous system frequently, with mononeuritis multiplex being the most common pattern, the occurrence of peripheral sensory-motor polyneuropathy as a presenting manifestation is distinctly rare. Prevalence of digital gangrene is also extremely rare in GPA. We describe a 46-year-old woman presenting with severe peripheral sensorimotor polyneuropathy affecting bilateral lower limbs preceded by a purpuric skin rash and multiple painful ulcers confined to the lower limbs. She had evidence of digital ischemia affecting multiple toes and dry gangrene of the left 4th toe. Diagnosis of GPA was made based on skin biopsy, positive ANCA serology, and clinical criteria. She made a good recovery following aggressive immunosuppressive treatment with methylprednisolone and cyclophosphamide and was maintained on prednisolone and azathioprine. This case highlights the importance of suspecting GPA in a patient presenting with sensorimotor polyneuropathy and/or digital ischemia even in the absence of more classic presenting features and underlies the necessity of accurate differential diagnosis in evaluating a case of peripheral neuropathy.
An Atypical Cause of an Epiglottic Abscess
Authors: Muneera Rabeea, Hasan Al Ansari, Amal Al Abdulla
Journal: Case Rep Infect Dis (2019)
MeSH terms: Case Reports

An epiglottic abscess is a rare complication of acute epiglottitis and is life threatening. We describe a case report of a diabetic adult male, who presented with an epiglottic abscess. Culture results showed Aeromonas hydrophila, an organism rarely reported as a cause of acute epiglottitis. Early recognition can be lifesaving.
Huge plastic bezoar: a rare cause of gastrointestinal obstruction
Authors: Mbarek Yaka, Abdelkader Ehirchiou, Tariq Tajdin Sifeddine Alkandry, Khalid Sair
Journal: Pan Afr Med J (2015)
Keywords: bowel obstruction, huge abdominal lump, plastic bezoars
MeSH terms: Bezoars / complications, Intestinal Obstruction / etiology, Stomach / pathology, Case Reports, Adolescent, Female, Humans, Intestinal Obstruction / diagnosis, Plastics, Plastics

Bezoars are rare causes of gastrointestinal obstruction. Basically, they are of four types: trichobezoars, phytobezoars, pharmacobezoars, and lactobezoars. Some rare types of bezoars are also known. In this article a unique case of plastic bezoars is presented. We describe a girl aged 14 years who ingested large amounts of plastic material used for knitting chairs and charpoys. The conglomerate of plastic threads, entrapped food material and other debris, formed a huge mass occupying the whole stomach and extended into small bowel.
First documented cure of a suggestive exogenous reinfection in polymyositis with same but multidrug resistant M. tuberculosis
Authors: Chiranjoy Mukhopadhyay, Ankita Garg, Archana Ayyagari
Journal: BMC Infect Dis (2004)
MeSH terms: Antitubercular Agents / pharmacology, Immunocompromised Host / drug effects, Immunosuppressive Agents / adverse effects, Mycobacterium tuberculosis / drug effects, Polymyositis / complications, Tuberculosis, Miliary / complications, Case Reports, Abscess / drug therapy, Abscess / microbiology, Adult, Antitubercular Agents / administration & dosage, Bacterial Proteins / genetics, DNA Primers / chemistry, Drug Resistance, Multiple, Bacterial / drug effects, Humans, Immunosuppressive Agents / therapeutic use, Male, Microbial Sensitivity Tests / methods, Mycobacterium tuberculosis / classification, Mycobacterium tuberculosis / genetics, Mycobacterium tuberculosis / isolation & purification, Polymerase Chain Reaction / methods, Polymorphism, Restriction Fragment Length, Polymyositis / drug therapy, Polymyositis / immunology, Recurrence, Skin Diseases, Bacterial / drug therapy, Skin Diseases, Bacterial / microbiology, Transcription Factors / genetics, Treatment Outcome, Tuberculosis, Miliary / drug therapy, Antitubercular Agents, Bacterial Proteins, DNA Primers, DevR protein, Nostoc, Immunosuppressive Agents, Transcription Factors

Background:
MDR Mycobacterium tuberculosis is the major cause of treatment failure in tuberculosis patients, especially in immunosuppressed. We described a young polymyositis patient on immunosuppressive therapy who was started with antituberculosis therapy as a susceptible strain of M. tuberculosis was isolated from a single cutaneous abscess in his neck and from regional lymph nodes.
Case presentation:
He had non-reactive miliary tuberculosis and multiple cutaneous abscesses 6 months later with the same strain, which was resistant this time to 9 antituberculosis drugs. We described clinical presentation, radiological and laboratory work-up, treatment and follow-up as the patient was cured after 1.5 years with 6 antituberculosis drugs.
Conclusion:
To our knowledge, this is the first reported case where an immunosuppressed patient with suggestive exogenous reinfection within 6 months with the same but MDR strain of M. tuberculosis was cured. Intense management and regular follow up were important since the patient was a potent source of MDR M. tuberculosis infection and there was limited choice for therapy.
Case report: Low dose dexmedetomidine infusion for the management of hypoglycemia in a dog with an insulinoma
Authors: Randolph Green, Sarah E Musulin, Alexie Jade Baja, Bernie D Hansen
Journal: Front Vet Sci (2023)
Keywords: alpha-2 agonists, dexmedetomidine infusion, hypoglycemia, insulinoma, pancreatic tumor
MeSH terms: Case Reports

Objective:
To describe the use of a low dose dexmedetomidine infusion as preoperative treatment for hypoglycemia secondary to a functional pancreatic tumor in a dog.
Case summary:
An 8.7-year-old castrated male Hungarian Vizsla presented for further evaluation of persistent hypoglycemia after the referring veterinarian established a tentative diagnosis of insulinoma based on paired insulin and glucose measurements. Abdominal ultrasound and computed tomography demonstrated evidence of a pancreatic mass with possible hepatic metastases. Attempts to aspirate the lesions under ultrasound guidance were unsuccessful, and the dog was hospitalized overnight for planned surgical resection of the presumed pancreatic tumor and biopsy of the hepatic lesions the following day. In response to a progressive increase in patient anxiety and agitation trazodone was prescribed ~5 mg/kg orally every 8 h and gabapentin at ~7 mg/kg every 8 h. As the dog continued to remain anxious dexmedetomidine at a dose of 1 mcg/kg was administered intravenously immediately followed with an infusion of dexmedetomidine at 1 mcg/kg/h. The anxious behaviors were successfully controlled with minimal cardiovascular side effects. Serial blood glucose measurements obtained during this time demonstrated euglycemia. The dog remained euglycemic while receiving dexmedetomidine for the remainder of the pre-operative period and for duration of hospitalization following surgical resection and biopsy.
New or unique information provided:
This case report demonstrates a possible role for dexmedetomidine to counteract hypoglycemia in dogs with insulinomas.
Changes in Resting-State Connectivity following Melody-Based Therapy in a Patient with Aphasia
Authors: Tali Bitan, Tijana Simic, Cristina Saverino, Cheryl Jones, Joanna Glazer, Brenda Collela, Catherine Wiseman-Hakes, Robin Green, Elizabeth Rochon
Journal: Neural Plast (2018)
MeSH terms: Aphasia / physiopathology, Aphasia / therapy, Brain / physiopathology, Brain Injuries / complications, Language Therapy / methods, Music Therapy, Neuronal Plasticity, Case Reports, Aphasia / etiology, Brain Mapping, Female, Functional Laterality, Humans, Magnetic Resonance Imaging, Middle Aged, Neural Pathways / physiopathology, Neuropsychological Tests, Treatment Outcome

Melody-based treatments for patients with aphasia rely on the notion of preserved musical abilities in the RH, following left hemisphere damage. However, despite evidence for their effectiveness, the role of the RH is still an open question. We measured changes in resting-state functional connectivity following melody-based intervention, to identify lateralization of treatment-related changes. A patient with aphasia due to left frontal and temporal hemorrhages following traumatic brain injuries (TBI) more than three years earlier received 48 sessions of melody-based intervention. Behavioral measures improved and were maintained at the 8-week posttreatment follow-up. Resting-state fMRI data collected before and after treatment showed an increase in connectivity between motor speech control areas (bilateral supplementary motor areas and insulae) and RH language areas (inferior frontal gyrus pars triangularis and pars opercularis). This change, which was specific for the RH, was greater than changes in a baseline interval measured before treatment. No changes in RH connectivity were found in a matched control TBI patient scanned at the same intervals. These results are compatible with a compensatory role for RH language areas following melody-based intervention. They further suggest that this therapy intervenes at the level of the interface between language areas and speech motor control areas necessary for language production.
Case report: A vertebral bone spur as an etiology for spinal cord herniation: case presentation, surgical technique, and review of the literature
Authors: S Hunziker, A Örgel, M Tatagiba, S D Adib
Journal: Front Surg (2023)
Keywords: brown-sequard syndrome, isch, bone spur, dural patch, osteophyte, spinal cord herniation
MeSH terms: Case Reports

Objective:
The pathophysiology of idiopathic spinal cord herniation remains unknown. However, several different factors have been postulated, such as congenital causes (ventral dura mater duplication, preexisting pseudomeningocele, or other congenital dural defects), inflammation, remote spinal trauma, or thoracic disc herniation. Herein, the diagnosis and surgical treatment of a patient with spinal cord herniation caused by an intraspinal bone spur is presented along with a relevant literature review.
Case presentation:
A 56-year-old male patient presented with a non-traumatic Brown-Sequard syndrome persisting for over 1 year. A magnetic resonance imaging of the spinal axis revealed a ventral spinal cord displacement in the level of T 6/7. A supplementary thin-sliced computed tomography of the spine revealed a bone spur at the same level. For neurosurgical intervention, T 6 and T 7 laminectomy was performed. The cranial and caudal end of the right paramedian ventral dural defect was visualized and enlarged. Following extradural spinal cord mobilization by denticulate ligament transection, the spinal cord was finally released. The spinal cord was rotated and the ventral closure of the dural defect was performed by continuous suture. The patient recovered from surgery without additional deficits. The patient's postoperative gait, sensory, and motor function deficits improved, and further neurological deterioration was prevented.
Conclusion:
Since the first description of spinal cord herniation by Wortzman et al. in 1974, approximately 260 cases have been reported in the literature. In addition to other causes, intraspinal bone spur is a possible cause of spinal cord herniation.
Carcinoma in situ of true vocal cord in a nonsmoker adolescent female
Authors: Dodul Mondal, Sayan Kundu, Subrata Chattopadhyay, Sumitava De, A Ghosh Dastidar, Amitabha Roy
Journal: Indian J Med Paediatr Oncol (2009)
Keywords: carcinoma in situ, adolescent, non smoker female, true vocal cord
MeSH terms: Case Reports

Carcinoma in situ (precancerous lesion) of true vocal cord in a nonsmoker adolescent female without any history of prior neck irradiation is rare. A 16-year-old female patient without any of the known risk factors presented with history of gradual-onset hoarseness of voice unrelieved by symptomatic treatments for 1 year. Contrast-enhanced CT scan of neck and laryngoscopy and histopathology of the tissue from irregular lesions along the medial margin of the left vocal cord diagnosed it as a case of carcinoma in situ of vocal cord. Absence of known risk factors and very young age of the patient made this case a rarity and hence the case is being reported.
A Case Report on Oral Subcutaneous Dirofilariasis
Authors: R D Jayasinghe, S R Gunawardane, M A M Sitheeque, S Wickramasinghe
Journal: Case Rep Infect Dis (2015)

Dirofilariasis is an uncommon zoonotic parasitic infection affecting human. The natural hosts for this nematode are animals such as dogs, cats, foxes, jackals, and raccoons. This disease is endemic in South Eastern United States, Australia, Europe, and Central and Southern Asia. Dirofilaria immitis and D. repens are the common mosquito borne filarial nematodes that cause infection. Several species of mosquitos including Mansonia uniformis, M. annulifera, and Aedes aegypti are the potential vectors for this disease in Sri Lanka. Two rare cases of dirofilariasis presenting as facial and intraoral lumps are presented.
SAPHO Syndrome Complicated by Ankylosing Spondylitis Successfully Treated With Tofacitinib: A Case Report
Authors: Fangfang Yuan, Jing Luo, Qiong Yang
Journal: Front Immunol (2022)
Keywords: sapho syndrome, adalimumab, ankylosing spondylitis, case report, tofacitinib
MeSH terms: Acquired Hyperostosis Syndrome / complications, Acquired Hyperostosis Syndrome / diagnosis, Acquired Hyperostosis Syndrome / drug therapy, Janus Kinase Inhibitors / therapeutic use, Spondylitis, Ankylosing / complications, Spondylitis, Ankylosing / drug therapy, Case Reports, Adult, Humans, Male, Piperidines / therapeutic use, Pyrimidines / therapeutic use, Janus Kinase Inhibitors, Piperidines, Pyrimidines, tofacitinib

Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome, a type of chronic inflammatory disease, is rare and difficult to treat. Osteoarthropathy with skin involvement is the primary clinical manifestation of SAPHO syndrome. The unknown pathogenesis of SAPHO syndrome is speculated to be related to individual genetic differences, immune levels, microorganisms, and environmental factors. Tofacitinib, a novel small-molecule Janus kinase (JAK) inhibitor, has been used to treat rheumatoid arthritis. However, it also has great potential for the treatment of other immune diseases, including SAPHO syndrome. A 36-year-old man with chest and back pain for more than two months was admitted to our hospital. After admission, the patient developed a pustular rash and enteritis. SAPHO syndrome was diagnosed based on the above clinical manifestations, computed tomography (CT), and bone scintigraphy findings. Notably, the patient also had ankylosing spondylitis. Tofacitinib significantly improved the patient's skin symptoms while preventing worsening of chest and back pain when adalimumab was discontinued. We report the first case of ankylosing spondylitis with SAPHO syndrome. In addition, it is also the first successful treatment thereof with tofacitinib. We hope to provide valuable information regarding the pathogenesis and treatment of SAPHO syndrome in this case.
Non-Hodgkin lymphoma affecting the tongue: unusual intra-oral location
Authors: Francesco Inchingolo, Marco Tatullo, Fabio M Abenavoli, Massimo Marrelli, Alessio D Inchingolo, Angelo M Inchingolo, Gianna Dipalma
Journal: Head Neck Oncol (2011)
MeSH terms: Lymphoma, Non-Hodgkin / diagnosis, Mouth / pathology, Tongue Neoplasms / diagnosis, Case Reports, Aged, Dyspnea / diagnosis, Dyspnea / pathology, Humans, Lymphoma, Non-Hodgkin / pathology, Male, Tongue Neoplasms / pathology

Introduction:
The expression non Hodgkin lymphoma is used to cover a wide group of lymphoid neoplasias unrelated to Hodgkin's disease, due to the huge histological variety and the tendency to affect organs and tissues that does not physiologically contain lymphoid cells.The intraoral location is not frequent (3 - 5 percent of cases) and the initial manifestations of the disease rarely take place here.
Case presentation:
We describe the case of a 73 years old Italian caucasian male who came to our attention with a tongue lesion. The clinical manifestation was macroglossia and bleeding, probably deriving from the tongue-bite injuries. The patient had been complaining of dyspnea for 48 hours.
Conclusion:
A tongue affected by non-Hodgkin's lymphoma rarely occurs. In spite of this, this possibility should always be considered for the differential diagnosis of benign and malignant lesions affecting such area.A rapid diagnostic assessment, together with an adequate histopathologic verification, are indeed essential to improve the management and the prognosis of this disease.
Case Report: Distinctive EEG Patterns in SCARB-2 Related Progressive Myoclonus Epilepsy
Authors: Mostafa Hotait, Maya Dirani, Tarek El Halabi, Ahmad Beydoun
Journal: Front Genet (2020)
Keywords: eeg, scarb2, action myoclonus with renal failure (amrf), fixation-off phenomenon, progressive myoclonus epilepsy
MeSH terms: Case Reports

Action myoclonus-renal failure syndrome (AMRF) is a rare, recessively inherited form of progressive myoclonus epilepsy (PME) caused by mutations in the SCARB2 gene and associated with end-stage renal failure. In addition to severe progressive myoclonus, the neurological manifestations of this syndrome are characterized by progressive ataxia and dysarthria with preserved intellectual capacity. Since its original description, an increasing number of "AMRF-like" cases without renal failure have been reported. We describe the case of a 29-year-old woman with progressive disabling myoclonus associated with dysarthria and ataxia who was found to have a novel homozygous frameshift mutation in the SCARB2 gene. In addition, this report emphasizes the presence of two EEG patterns, fixation-off phenomenon, and bursts of parasagittal spikes exclusively seen during REM sleep that appear to be characteristic of this condition.
Multimodal Treatment With ECT for Identity Integration in a Patient With Dissociative Identity Disorder, Complex Post-traumatic Stress Disorder, and Major Depressive Disorder: A Rare Case Report
Authors: Kyle D Webster, Susan Michalowski, Thomas E Hranilovich
Journal: Front Psychiatry (2018)
Keywords: dissociative identity disorder, electroconvulsive therapy, major depressive disorder, personality integration, post-traumatic stress disorder, suicidal ideation
MeSH terms: Case Reports

The legitimacy and etiology of Dissociative Identity Disorder (DID) remains a controversial topic within Psychiatry. The two schools of thought are the Post-Traumatic Model (PTM) and the Socio-Cognitive Model (SCM). This case highlights the validity of PTM in an individual who suffered severe and prolonged physical, psychological, and sexual abuse from 2 years old through adulthood. The reported abuse was corroborated and proven on two separate occasions via medical professionals/rape kit and the police. This resulted in the incarceration of one of her abusers. The only way for the patient to cope with the trauma she suffered was to dissociate, which resulted in the development of four full identity alters. In addition to being diagnosed with DID, the patient has been diagnosed with Major Depressive Disorder (MDD), Post-Traumatic Stress Disorder (PTSD), and chronic suicidality. Unable to manage the suicidal ideations and MDD after nearly 10 years of therapy and psychiatric medications, the patient was referred for Electroconvulsive Therapy (ECT). Upon receiving ECT weekly for 2 years, the patient reported having "lost the others." As ECT progressed she went from having four alters to no alters and at the time of this report only being able to vaguely hear alter #4. With the integration of these alters she had access to the memories and pain that the alters had protected her from. Prior to losing the alters, her long-term memory was impaired by dissociative processes. Her long-term memory was also impaired because when one of the alters was in control of consciousness only that alter remembered what had happened during that time, unless that alter shared what had happened with one or more of the others. It is unclear if frequent ECT was the catalyst that lead to the integration of her alters however, integration finally began following prolonged ECT. This case highlights the importance of the PTM as an etiological description for DID and the importance of mental health providers further studying and researching the effects of ECT on patients with chronic MDD, PTSD, and suicidal intent, especially if these are comorbid with DID.
Lung cancer presenting as acrometastasis to the finger: a case report
Authors: Lawrence Stephen Long, Leslea Brickner, Lisa Helfend, Tony Wong, Derek Kubota
Journal: Case Rep Med (2010)
MeSH terms: Case Reports

Lung cancer is the commonest cause of acrometastatic disease to the fingers. Here we describe a case of occult lung cancer presenting as unrelenting finger pain and swelling from a metastatic phalangeal fracture. The patient's management was largely palliative and he died soon after discovery of the primary tumor. Digital acrometastatic disease rarely becomes symptomatic before the primary lung cancer is diagnosed and, as observed in this case, carries a very poor prognosis. Clinicians should be cognizant of the strong association between digital acrometastases and bronchogenic carcinoma and vigilant in screening high-risk patients with importunate finger symptoms.
Seasonal influenza A (H1N1) infection in early pregnancy and second trimester fetal demise
Authors: Richard W Lieberman, Natasha Bagdasarian, Dafydd Thomas, Cosmas Van De Ven
Journal: Emerg Infect Dis (2011)
MeSH terms: Fetal Death / etiology, Fetal Diseases / diagnosis, Influenza A Virus, H1N1 Subtype / isolation & purification, Influenza, Human / complications, Influenza, Human / virology, Pregnancy Complications, Infectious / diagnosis, Pregnancy Trimester, Second, Case Reports, Research Support, Non-U.S. Gov't, Female, Fetal Diseases / virology, Humans, Influenza A Virus, H1N1 Subtype / genetics, Influenza A Virus, H1N1 Subtype / immunology, Influenza, Human / diagnosis, Maternal-Fetal Exchange, Pregnancy, Pregnancy Complications, Infectious / virology, Seasons

A second trimester fetal demise followed influenza-like illness in early pregnancy. Influenza A virus (H1N1) was identified in maternal and fetal tissue, confirming transplacental passage. These findings suggested a causal relationship between early exposure and fetal demise. Management of future influenza outbreaks should include evaluation of products of conception associated with fetal loss.
Isotretinoin-Induced Delusional Disorder, Somatic Subtype
Authors: Katharine V Jensen, Adam Abba-Aji
Journal: Case Rep Dermatol Med (2020)
MeSH terms: Case Reports

Isotretinoin, an active form of vitamin A, is the drug of last resort for the treatment of severe acne. Depression, suicidal ideation, and psychosis are among the most well-documented psychiatric side effects. Here, we report a case of isotretinoin-induced psychosis, which was diagnosed as delusional disorder somatic subtype, in a young male in the absence of any prodromal symptoms, previous psychiatric history, or family history of mental illness. The onset of psychosis was in the context of a dosage increase from 40 mg/day to 80 mg/day. Isotretinoin was discontinued, and the patient showed improvement on low-dose quetiapine.