OpenMed/multicare-articles huggingface dataset:
Cytomegalovirus Pulmonary Involvement in an Immunocompetent Adult
Authors: Helena Luís, Carolina Barros, Mariana Gomes, José Luís Andrade, Nancy Faria
Journal: Case Rep Infect Dis (2021)
MeSH terms: Case Reports

Introduction:
Cytomegalovirus (CMV) is a linear double-stranded DNA virus that may cause severe and potentially fatal infection in immunocompromised hosts. In immunocompetent individuals, the infection is typically mild or asymptomatic. However, in the last years, some cases of severe cytomegalovirus infection in immunocompetent individuals have been described. Clinical Presentation. The authors present a male patient aged 42 years, without specific medical history, who presented a 15-day history of fever, headache, night sweats, odynophagia, and bilateral otalgia, without improvement after four days of therapy with amoxicillin/clavulanic acid. Blood count and biochemistry were performed with liver cytolysis pattern. Chest teleradiography showed diffuse interstitial infiltrate. Thoracic CT scan revealed areas in a ground glass with a cross-linking component in the left and right upper lung lobes compatible with an inflammatory/infectious process. Blood serology was positive for CMV IgG and IgM. The detection on blood and bronchoalveolar lavage of CMV DNA by polymerase chain reaction (PCR) was also positive. Ganciclovir was started based on the clinical features and the result of CMV serology. After 48 hours, there was a significant clinical improvement, with remission of fever, and he was discharged on the 13th day of hospitalization with oral valganciclovir, completing a 21-day antiviral course at home.
Conclusion:
With this clinical case, the authors highlight the importance of considering CMV infection in evaluating patients with pneumonia, even in immunocompetent ones, particularly in those with no clinical improvement with antibiotics instituted for bacterial pneumonia, and when other causes have been ruled out.
Benzocaine-Induced Methemoglobinemia in a Postoperative Bariatric Patient following Esophagogastroduodenoscopy
Authors: Khuram Khan, Irwin White-Gittens, Saqib Saeed, Leaque Ahmed
Journal: Case Rep Crit Care (2019)
MeSH terms: Case Reports

Methemoglobinemia is a rare complication in clinical practice. It is most commonly seen in patients undergoing endoscopic procedures, including EGDs, laryngoscopies, bronchoscopies, and nasogastric tube insertions. This is thought to be a disease seen almost exclusively in patients with genetic predispositions to develop it; the increasing use of topical anesthetics during procedures has made methemoglobinemia a disease entity that every clinical provider should be able to recognize and treat. Clinically, patients become cyanotic with mild oxygen derangements on pulse oximetry, in the range of 84 to 90%. Paradoxically, these patients demonstrate normal to supranormal oxygen levels in the blood on blood gas analysis. We report a case of 34-year-old female postoperative Roux-en-Y gastric bypass patient who developed hypoxia and cyanosis after a routine EGD procedure to relieve a food impaction. Differentials of aspiration and pulmonary embolism were plausible; stat blood gas analysis clinched the diagnosis and managed with intravenous methylene blue.
Non-referral of potential organ donors in South Africa: insights, challenges and ethical dilemmas
Authors: Poobalan Naidoo, Harriet Rosanne Etheredge, Virendra Rambiritch, Akira Singh, Scott Mahoney, Vanesha Naidu
Journal: Pan Afr Med J (2018)
Keywords: organ donation, ethics, organ transplantation
MeSH terms: Organ Transplantation / ethics, Tissue Donors / supply & distribution, Tissue and Organ Procurement / ethics, Case Reports, Adolescent, Humans, Male, Referral and Consultation / ethics, South Africa, Tissue Donors / ethics

Traditionally, minimal potential organ donor referrals emanate from general medicine departments. We use a clinical vignette to draw attention to challenges related to referral of potential organ donors from general internal medicine departments. In addition, we provide potential solutions to overcome challenges and reflect on the ethical issues of non-referral of potential organ donors. It is hoped that this paper will increase the awareness of organ donation in the medical fraternity in Africa and thus mitigate critical shortages of organs for transplantation.
Tropheryma whipplei-induced plastic bronchitis in children: a case report
Authors: Xuefeng Jin, Caiyun Zhang, Chao Chen, Xiaoning Wang, Jing Dong, Yuanyuan He, Peng Zhang
Journal: Front Pediatr (2023)
Keywords: children, neat-generation sequencing, piperacillin-tazobactam, plastic bronchitis, tropheryma whipplei
MeSH terms: Case Reports

This article reports a case of a 7-year-old child with severe pneumonia whose chest CT showed pulmonary consolidation, and bronchoscopy revealed plastic bronchitis. The metagenomic Next-Generation Sequencing (NGS) of the pulmonary lavage fluid suggested the infection of Tropheryma whipplei (T whipplei). The patient was treated with bronchial lavage to remove sputum plugs, intravenous azithromycin, and piperacillin-tazobactam and was discharged after eight days of hospitalization without any recurrence during follow-up. This article aims to raise clinical awareness of T whipplei infection and suggests that NGS for rare pathogens should be performed early for unexplained plastic bronchitis.
Operative management and outcomes in patients with myxomas: A single-center experience
Authors: Ahmed Abdulfattah Alhasso, Okba F Ahmed, Dana H Mohammed-Saeed, Fahmi H Kakamad, Saif S Almodhaffer, Zaid A Zaid, Hiwa O Abdullah, Razhan K Ali, Suhaib H Kakamad, Diyar A Omar, Berun A Abdalla, Shvan H Mohammed, Mohammed Q Mustafa
Journal: Front Surg (2023)
Keywords: cardiac myxoma, cardiac surgery, cardiac tumor, case series, myxomas

Background:
Cardiac myxoma is a rare cardiac tumor that may be asymptomatic or can cause embolization or intracardiac obstruction, leading to heart failure, sudden cardiac death, and arrhythmia. This study aims to report an 11-year experience of a single center in the management of cardiac myxoma.
Method:
This study is a single-center retrospective case series. Eighty cases of cardiac myxoma were collected in Ibn Albitar's specialized center for cardiac surgery. Transthoracic echocardiography was used to make the preoperative diagnosis in all patients. The surgeries were undertaken through the standard approach of a median sternotomy. All four cardiac chambers were thoroughly explored for additional myxomas. The major objective of the operations was complete tumor resection.
Result:
The mean age of the patients was 46.3 years. Females (67.5%) were predominant over males (32.5%). Shortness of breath was the most common symptom (86.25%). The left atrium was the most affected site (83.75%), followed by the right atrium (13.75%). Coronary artery bypass grafting was required as the secondary or associated intervention in 19 (23.75%) cases. The recurrence rate was 11.25%, with a mortality rate of 3.75%.
Conclusion:
Recurrence and tumor embolism are risks of surgical intervention for myxoma. Good preparation using transthoracic echocardiography as a diagnostic tool and standard median sternotomy to complete resection of the tumors can decrease the rate of recurrence, embolism, and even mortality.
A rare case of giant hepatic angiomyolipoma with subcapsular rupture
Authors: Cuiting Wu, Yang Yang, Feng Tian, Yuan Xu, Qiang Qu
Journal: Front Surg (2023)
Keywords: case report, hepatic angiomyolipoma (haml), laparoscopic—laparotomy, left liver, subcapsular rupture

Hepatic angiomyolipoma (HAML) is a rare mesenchymal neoplasm that predominantly affects middle-aged women. In this study, we present a case of a 49-year-old woman with a giant HAML accompanied by spontaneous subcapsular rupture. The patient initially experienced nausea and abdominal distention, followed by an enlargement of the upper abdominal circumference. Laboratory examination revealed decreased serum hemoglobin, while tumor biomarkers were within normal ranges. Imaging studies, such as abdominal ultrasound and contrast-enhanced computed tomography (CT), demonstrated a large upper abdominal mass with heterogeneous density and hypervascularity. The tumor appeared to have invaded the left liver, raising concerns about possible malignancy. Subsequent positron-emission tomography/CT confirmed increased fluorodeoxyglucose uptake in the mass. Laparoscopic exploration revealed a protruding, well-encapsulated tumor from the left liver, exhibiting subcapsular hemorrhage. Surgical resection of the tumor and the left liver was performed, leading to a successful outcome.
Sudden death associated with lipoma of the cerebellopontine angle
Authors: Stefano Tambuzzi, Guendalina Gentile, Michele Boracchi, Arnaldo Migliorini
Journal: Autops Case Rep (2022)
Keywords: autopsy, brain neoplasm, forensic pathology
MeSH terms: Case Reports

Intracranial lipomas are rare benign tumors considered exceptional when localized in the cerebellopontine angle (CPA), with an incidence of 0.1% of the total number of expansive processes located in this area. We present a case of the sudden death of a 26-year-old young woman in which an unencapsulated neoformation of 0.8 cm was documented at the right cerebellopontine angle and was histologically characterized as intracranial lipoma. The cause of death was then identified as a cardiocirculatory failure secondary to supratentorial (uncal right) herniation caused by the lipoma of the pontocerebellar angle with high-grade diffuse cerebral edema.
Persistence of SARS-CoV-2 Infection in Severely Immunocompromised Patients With Complete Remission B-Cell Lymphoma and Anti-CD20 Monoclonal Antibody Therapy: A Case Report of Two Cases
Authors: Carlos Martínez-Chinchilla, Lucía Vazquez-Montero, Natalia Palazón-Carrión, Isabel M Fernández-Román, José López-Barba, Luis de la Cruz-Merino, Jesús Rodríguez-Baño, Zaira R Palacios-Baena
Journal: Front Immunol (2022)
Keywords: covid-19, sars-cov-2, anti-cd20, case report, immunocompromised, lymphoma, rituximab
MeSH terms: COVID-19 Drug Treatment, Lymphoma, B-Cell / drug therapy, Case Reports, Randomized Controlled Trial, Research Support, Non-U.S. Gov't, Antibodies, Monoclonal, Humans, Immunocompromised Host, Immunosuppressive Agents, Rituximab / therapeutic use, SARS-CoV-2, Antibodies, Monoclonal, Immunosuppressive Agents, Rituximab

Immunosuppressant conditions such as hematological malignancies increase the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. It has been described in the literature that patients on anti-CD20 maintenance therapies for lymphoid malignancies are susceptible to having recurrent flares together with viral replication or reinfections, although these cases are scarce. These patients are not well represented in randomized controlled trials, and as a consequence, the evidence for the use of certain treatments in this scenario is lacking. We present two cases of patients with B-cell lymphoma on remission and treated with rituximab on maintenance. They developed at least 1 flare of coronavirus disease 2019 (COVID-19) after acute infection and always after receiving rituximab. RT-PCR was positive in the nasopharyngeal swab and also in plasma. Patients were treated during flares with remdesivir, hyperimmune plasma, and corticosteroids. These two cases showed the unresolved problem of COVID-19 in immunosuppressant patients and showed that despite the vast amount of information available on SARS-CoV-2, information in this subgroup of patients is lacking.
Sudden Onset, Rapidly Expansile, Cervical Cystic Hygroma in an Adult: A Rare Case with Unusual Presentation and Extensive Review of the Literature
Authors: Vivek Dokania, Anagha Rajguru, Harmanjot Kaur, Ketan Agarwal, Sujata Kanetkar, Prajakta Thakur, Femina Patel, Dhirajkumar Shukla
Journal: Case Rep Otolaryngol (2017)
MeSH terms: Case Reports

Cystic hygroma (CH) is a benign infiltrative malformation of the lymphatic channels. We report a case of a 28-year-old Indian female who presented with rapidly enlarging right sided neck swelling over the posterior triangle since 5 days. Complete resection of CH is sometimes not amenable because of its infiltrative nature and involvement of surrounding vital structures. However, in our patient successful complete surgical resection was undertaken. The MRI findings of our patient were consistent with brachial cleft cyst; this posed a challenge in the diagnosis of CH. The histopathological analysis of the resected mass confirmed CH. CH is rare in adults and such an acute presentation is exceptionally atypical. History of prior trauma and infection are known etiological factors for adult CH; these were conspicuously absent in our patient. CH should be considered in the differentials of rapidly enlarging cystic swelling of posterior region of neck in adults. Optimal and timely management is necessary to achieve a favorable prognosis. Therefore, we report a case of rapidly enlarging cervical CH in an adult along with extensive literature review to have a better understanding regarding epidemiology, etiopathogenesis, clinical presentation, optimal management, and prognosis of such a rare entity in adults.
Evidence from a rare case study for Hebbian-like changes in structural connectivity induced by long-term deep brain stimulation
Authors: Tim J van Hartevelt, Joana Cabral, Arne Møller, James J FitzGerald, Alexander L Green, Tipu Z Aziz, Gustavo Deco, Morten L Kringelbach
Journal: Front Behav Neurosci (2015)
Keywords: dti, hebbian-like learning, parkinson’s disease, deep brain stimulation, subthalamic nucleus

It is unclear whether Hebbian-like learning occurs at the level of long-range white matter connections in humans, i.e., where measurable changes in structural connectivity (SC) are correlated with changes in functional connectivity. However, the behavioral changes observed after deep brain stimulation (DBS) suggest the existence of such Hebbian-like mechanisms occurring at the structural level with functional consequences. In this rare case study, we obtained the full network of white matter connections of one patient with Parkinson's disease (PD) before and after long-term DBS and combined it with a computational model of ongoing activity to investigate the effects of DBS-induced long-term structural changes. The results show that the long-term effects of DBS on resting-state functional connectivity is best obtained in the computational model by changing the structural weights from the subthalamic nucleus (STN) to the putamen and the thalamus in a Hebbian-like manner. Moreover, long-term DBS also significantly changed the SC towards normality in terms of model-based measures of segregation and integration of information processing, two key concepts of brain organization. This novel approach using computational models to model the effects of Hebbian-like changes in SC allowed us to causally identify the possible underlying neural mechanisms of long-term DBS using rare case study data. In time, this could help predict the efficacy of individual DBS targeting and identify novel DBS targets.
The "lasso sign": an early sonographic sign of posterior meningocele
Authors: Alina Weissmann-Brenner, Zeev Feldman, Yaron Zalel
Journal: ISRN Obstet Gynecol (2011)
MeSH terms: Case Reports

Posterior meningocele is an uncommon form of spina bifida. We present a case of unique posterior meningocele diagnosed at the early second trimester anatomical scan using 2D and 3D ultrasound. The sonographic appearance resembled "lasso". The prenatal follow-up was uneventful, with no demonstration of tethered cord. Clinical, neurological and radiological examinations following delivery and at the age of four months were unremarkable.
Use of Continuous Intravenous Anakinra Infusion in Multisystem Inflammatory Syndrome in Children
Authors: Abdulaziz Alolayan, Abdullah S Aldamegh, Azzah Alkhayrat
Journal: Case Rep Crit Care (2023)
MeSH terms: Case Reports

Coronavirus disease (COVID-19) is an emergency pandemic with a high mortality rate worldwide. One of its complications in children is developing multisystemic inflammatory syndrome related to cytokine storm. Anakinra is a recombinant human interleukin-1 (IL-1) receptor antagonist used to suppress the exaggerated inflammatory response in such conditions, and it is potentially lifesaving in a cytokine storm. We present the case of a patient with critical COVID-19 associated with multisystem inflammatory syndrome in children (MIS-C) successfully treated with anakinra intravenous (IV) infusion.
Elevated middle cerebral artery peak systolic velocity in a nonanemic fetus with alpha-thalassemia trait
Authors: Kent Heyborne
Journal: Obstet Gynecol Int (2009)
MeSH terms: Case Reports

Background. Elevated middle cerebral artery peak systolic velocity (MCA-PSV) has been reported in nonanemic fetuses following fetal transfusion, and has been attributed to a major population of red blood cells (RBCs) with an adult mean corpuscular volume (MCV) in the fetal circulation. Reported here is an analogous case of elevated MCA-PSV with a normal fetal hematocrit and relative fetal microcytosis due to fetal alpha-thalassemia trait. Case. Ultrasound findings concerning for early hydrops prompted measurement of MCA-PSV, which was elevated. Cordocentesis revealed fetal microcytosis with a normal hematocrit which proved to be due to fetal alpha-thalassemia trait inherited from the mother. Conclusion. This case provides another example of elevated MCA-PSV with normal hematocrit and microcytosis, here due to fetal alpha-thalassemia trait. This finding provides support for the observation that MCA-PSV may be influenced by hematological indices other than the fetal hematocrit.
Vitreous Hemorrhage as Presenting Sign of Retinal Arteriovenous Malformation
Authors: Geraldine P B M Accou, Fanny Nerinckx, Bart P Leroy, Julie De Zaeytijd
Journal: Case Rep Ophthalmol Med (2020)
MeSH terms: Case Reports

Objective:
To describe a patient with vitreous hemorrhage and peripheral retinal ischemia, eventually diagnosed with an underlying retinal arteriovenous malformation.
Methods:
A 15-year-old girl presented with sudden-onset, painless visual loss in the right eye. She underwent a full ophthalmological work-up.
Results:
BCVA was less than 20/400 in the right eye and 20/20 in the left eye. Intraocular pressure and anterior segment examination were unremarkable. Fundoscopy was impossible due to an opaque vitreous hemorrhage in the right eye. The left eye was completely unremarkable. Examination during a 23-gauge pars plana vitrectomy showed dilated, tortuous arteriovenous vessels extending from the optic disc and silver wiring of the enlarged vessels. A clinical diagnosis of retinal arteriovenous malformation was made. During surgery, a peripheral retinal photocoagulation was executed to avoid rebleeding. Postoperatively, fluorescein angiography demonstrated additional macular microangiopathy and diffuse retinal nonperfusion in the periphery. The MRI brain revealed neither cerebral nor orbital vascular anomaly, confirming a group 2 retinal arteriovenous malformation.
Conclusion:
Retinal arteriovenous malformations are generally considered stable over time. However, complications due to retinal ischemia can occur. Hence, regular observation is warranted. In so doing, timely treatment can be offered to avoid complications.
Treatment of Knee Osteochondral Lesions Using a Novel Clot of Autologous Plasma Rich in Growth Factors Mixed with Healthy Hyaline Cartilage Chips and Intra-Articular Injection of PRGF
Authors: Ramón Cugat, Eduard Alentorn-Geli, Gilbert Steinbacher, Pedro Álvarez-Díaz, Xavier Cuscó, Roberto Seijas, David Barastegui, Jordi Navarro, Patricia Laiz, Montserrat García-Balletbó
Journal: Case Rep Orthop (2017)
MeSH terms: Case Reports

Knee cartilage or osteochondral lesions are common and challenging injuries. To date, most symptomatic lesions warrant surgical treatment. We present two cases of patients with knee osteochondral defects treated with a one-step surgical procedure consisting of an autologous-based matrix composed of healthy hyaline cartilage chips, mixed plasma poor-rich in platelets clot, and plasma rich in growth factors (PRGF). Both patients returned to playing soccer at the preinjury activity level and demonstrated excellent defect filling in both magnetic resonance imaging and second-look arthroscopy (in one of them). The use of a clot of autologous plasma poor in platelets with healthy hyaline cartilage chips and intra-articular injection of plasma rich in platelets is an effective, easy, and cheap option to treat knee cartilage injuries in young and athletic patients.
Cutaneous polyarteritis nodosa successfully treated with topical diflucortolone valerate: a case report & review of the literature
Authors: Ruby Haviv, Maya Capua, Jacob Amir, Liora Harel
Journal: Pediatr Rheumatol Online J (2014)
Keywords: cpan, corticosteroid, cutaneous polyarteritis nodosa, diflucortolone valerate, periarteritis, topical treatment
MeSH terms: Anti-Inflammatory Agents / therapeutic use, Diflucortolone / analogs & derivatives, Polyarteritis Nodosa / drug therapy, Skin Diseases / drug therapy, Case Reports, Review, Administration, Topical, Adolescent, Anti-Inflammatory Agents / administration & dosage, Anti-Inflammatory Agents / pharmacology, Biopsy, Diflucortolone / administration & dosage, Diflucortolone / pharmacology, Diflucortolone / therapeutic use, Humans, Male, Polyarteritis Nodosa / pathology, Skin / drug effects, Skin / pathology, Skin Diseases / pathology, Treatment Outcome, Anti-Inflammatory Agents, diflucortolone valerate, Diflucortolone

Cutaneous Polyarteritis Nodosa (cPAN) was first described in 1931. cPAN is considered a rare disease, its true incidence is unknown. The age of onset is diverse. Most studies have shown no significant gender predominance. cPAN presents with distinct skin findings, such as a maculopapular rash, subcutaneous nodules, livedoid vasculitis, panniculitis, ischemic finger lesions, or erythematous patchy rash. Etiology is unclear. It is still believed to be an immune complex-mediated disease, although a possible mechanism recently proposed relates a familial form of the disease to impaired activity of Adenosine Deaminase 2. cPAN may reflect an underlying disease, infection or medical treatment. There is no consensus as to initial treatment, dosage and length of treatment. Patients with constitutional symptoms, visceral involvement, a more severe course of the disease, or high acute phase reactants, were treated mainly with systemic corticosteroids and/or cytotoxic agents for varying durations. However, persistence of cutaneous lesions has been documented. We describe a 14 year old male suffering from persistent cPAN, with no constitutional symptoms or involvement of internal organs. The patient was treated with a local corticosteroid-based ointment during exacerbations, until complete remission. Although reported in only one study, treatment with topical corticosteroid compound may result in significant improvement or complete regression of skin lesions in cPAN patients.
A large uterine leiomyoma leading to non-puerperal uterine inversion: A case report
Authors: Batool Teimoori, Arezoo Esmailzadeh
Journal: Int J Reprod Biomed (2017)
Keywords: haultain’s procedure, laparotomy, leiomyoma, uterine inversion
MeSH terms: Case Reports

Background:
Although leiomyomas are the most common gynecologic disorders, non-puerperal uterine inversion due to leiomyoma is considered as a rare clinical problem. This condition can occur as a complication of a large sub-mucous leiomyoma that leads to dilate cervix and protrude into vagina. The patient may have several symptoms such as heavy vaginal bleeding, pelvic pain and intermittent acute urinary retention.
Case:
We presented a 32-year-old nulliparous woman with 17 years of unexplained infertility and diagnosis of a large vaginal prolapsed non-pedunculated leiomyoma.
Conclusion:
Haultain's procedure was used to reposition uterine inversion and remove leiomyoma through a posterior incision, using laparotomy.