OpenMed/multicare-articles huggingface dataset:
Ulcerated Lesion of the Tongue as Manifestation of Systemic Coccidioidomycosis
Authors: Luis A Mendez, Sergio A Flores, Ricardo Martinez, Oslei Paes de Almeida
Journal: Case Rep Med (2017)
MeSH terms: Case Reports

Systemic mycoses and their oral manifestations are very rare. We present a case of a 60-year-old man with an ulcerated lesion on the lateral border of the tongue. Histologic studies revealed a granulomatous fungal infection by Coccidioides immitis. After pharmacological treatment, the lesion resolved. Recently, northern Mexico has been reported to be an endemic zone of C. immitis infections; therefore it should be considered in the differential diagnosis of mouth lesions. A comprehensive clinical history, physical exploration, and complementary studies are essential for an accurate diagnosis.
Isolated Testicular Metastasis Diagnosed More than a Decade and a Half Post Primary Treatment for Prostate Cancer
Authors: Nassib F Abou Heidar, Gerges Bustros, Jose M El-Asmar, Bassel Zein Sabatto, Jad A Degheili
Journal: Case Rep Oncol Med (2019)
MeSH terms: Case Reports

Prostate cancer is the most common visceral malignancy among men. It rarely metastasizes to the testicles. We herein present the case of a male patient who underwent a radical prostatectomy for a grade group 3 Gleason score 7 (4 + 3) prostate adenocarcinoma followed by adjuvant radiation therapy and continuous androgen deprivation therapy after his first biochemical recurrence. Despite optimal management, prostate-specific antigen (PSA) levels rose back up, upon which a PET/CT 68Gallium scan demonstrated an isolated left testicular lesion that turned out to be of prostatic origin following orchiectomy. Testicular metastases from prostate cancer are of unknown prognosis, and the current treatment modality favors an orchiectomy.
Case Report: Functional Outcome of COVID-19 Subjects With Myasthenia Gravis and Critical Illness Polyneuropathy
Authors: Domenico Intiso, Antonello Marco Centra, Luigi Amoruso, Michele Gravina, Filomena Di Rienzo
Journal: Front Neurol (2022)
Keywords: covid-19, icuaw, myasthenia gravis, neurology, neurorehabilitation, outcome
MeSH terms: Case Reports

Background:
The COVID-19 disease can affect subjects suffering from myasthenia gravis (MG) and worsen its clinical course, leading to intensive care unit (ICU) admission. Critically ill subjects can develop a neuromuscular complication called ICU-acquired weakness (ICUAW). This disorder has also been detected in ICU subjects with COVID-19, but the association between MG and ICUAW has never been described in critically ill patients. We describe the case and functional outcome of a COVID-19 patient suffering from MG who developed critical illness polyneuropathy (CIP).
Case presentation:
A 66-year-old man with a history of hypertension and ocular MG had COVID-19 and required ICU admission. The patient underwent mechanical ventilation and tracheotomy and was treated with remdesivir and corticosteroids. Fifteen days after admission, he complained of tetraparesis without the ocular involvement that remained unchanged despite the increase in anticholinesterase therapy. The length of stay (LOS) in ICU was 35 days. On day 2 of admission, the patient underwent a frontal muscle jitter study that confirmed the MG, and electroneurography (ENG) and electromyography (EMG) that showed overlapping ICUAW with electrophysiological signs characteristic of CIP. The cerebrospinal fluid (CSF) showed normal pressure, cell count, and protein levels (<45 mg/dl) without albumin-cytologic disassociation. The CSF/serum glucose ratio was normal. The CSF culture for possible organisms, laboratory tests for autoimmune disorders, the panel of antiganglioside antibodies, and the paraneoplastic syndrome were negative. Strength and functional outcomes were tested with the MRC scale, the DRS, Barthel scale, and the Functional Independence Measure (FIM) at admission, discharge, and follow-up. Muscular strength improved progressively, and the MRC scale sum-score was 50 at discharge. Anticholinesterase therapy with pyridostigmine at a dosage of 30 mg 3 times daily, which the patient was taking before COVID-19, was resumed. His motor abilities recovered, and functional evaluations showed full recovery at follow-up.
Conclusion:
In the described subject, the coexistence of both neuromuscular disorders did not affect the clinical course and recovery, but the question remains about generalization to all patients with MG. The rehabilitation interventions might have facilitated the outcome.
Successful palliative approach with high-intensity focused ultrasound in a patient with metastatic anaplastic pancreatic carcinoma: a case report
Authors: Antonio Ungaro, Franco Orsi, Chiara Casadio, Salvatore Galdy, Francesca Spada, Chiara Alessandra Cella, Clementina Di Tonno, Guido Bonomo, Paolo Della Vigna, Sabina Murgioni, Anna Maria Frezza, Nicola Fazio
Journal: Ecancermedicalscience (2016)
Keywords: hifu, abscopal effect, anaplastic pancreatic carcinoma, palliative treatment
MeSH terms: Case Reports

We report a case of a 74-year-old man with a metastatic anaplastic pancreatic carcinoma (APC). After an early tumour progression on first-line chemotherapy with cisplatin and gemcitabine, even though it was badly tolerated, he was treated with a combination of systemic modified FOLFIRI and high-intensity focused ultrasound (HIFU) on the pancreatic mass. A tumour showing partial response with a clinical benefit was obtained. HIFU was preferred to radiotherapy because of its shorter course and minimal side effects, in order to improve the patient's clinical conditions. The patient is currently on chemotherapy, asymptomatic with a good performance status. In referral centres, with specific expertise, HIFU could be safely and successfully combined with systemic chemotherapy for treatment of metastatic pancreatic carcinoma.
Serial murder of four victims, of both genders and different ethnicities, by an ordained baptist minister
Authors: James A Reavis
Journal: Case Rep Psychiatry (2011)
MeSH terms: Case Reports

A case of a 61-year-old African-American male who sexually assaulted and murdered four individuals, of different ethnicities and both genders, is reported. The subject additionally engaged in sexual activity with each victim postmortem. Each murder is reviewed in detail, and the subjective state of the offender during the murders is commented upon. Psychological test data are reviewed. The subject met criteria for several Axis I disorders, including Bipolar I Disorder, Pedophilia, and Sexual Sadism, and met criteria for Axis II diagnoses of Narcissistic and Antisocial Personality disorder. He was additionally classified as a Psychopath, which, in combination with his Sexual Sadism, general psychiatric state, and exquisite sensitivity to humiliation, led to his decision to murder.
Partial nephrectomy in a patient with a left ventricular assist device
Authors: Jules P Manger, John A Kern, Tracey L Krupski
Journal: Case Rep Urol (2011)
MeSH terms: Case Reports

Left ventricular assist device (LVAD) use has increased as a bridge to heart transplant as well as destination therapy in patients with severe heart failure. Presence of LVAD is not a contraindication to noncardiac surgery but does present special challenges to the surgical, anesthesia, and cardiac teams. We present the case of a 40-year-old woman with idiopathic cardiomyopathy necessitating LVAD who underwent left partial nephrectomy for a renal mass. She had undergone three nondiagnostic percutaneous image-guided biopsies. Left partial nephrectomy was performed. Perioperative care was without incident due to careful oversight by a multidisciplinary team. Pathology revealed high-grade clear cell renal cell carcinoma (RCC) with negative margins. Polytetrafluoroethylene (PTFE) bolsters were misidentified six months postoperatively on computed tomography (CT) at an outside institution as a retained laparotomy sponge. This is, to our knowledge, the first report of a partial nephrectomy performed in a patient with LVAD.
A novel mutation in the RPE65 gene causing Leber congenital amaurosis and its transcriptional expression in vitro
Authors: Guoyan Mo, Qin Ding, Zhongshan Chen, Yunbo Li, Ming Yan, Lijing Bu, Yanping Song, Guohua Yin
Journal: PLoS One (2014)
MeSH terms: Asian People / genetics, Leber Congenital Amaurosis / genetics, Leber Congenital Amaurosis / pathology, Polymorphism, Single Nucleotide, cis-trans-Isomerases / genetics, Case Reports, Research Support, U.S. Gov't, Non-P.H.S., Child, China, Female, Genetic Association Studies, HEK293 Cells, Humans, In Vitro Techniques, Male, Pedigree, RNA, Messenger / metabolism, Sequence Analysis, DNA, RNA, Messenger, retinoid isomerohydrolase, cis-trans-Isomerases

The retinal pigment epithelium-specific 65 kDa protein is an isomerase encoded by the RPE65 gene (MIM 180069) that is responsible for an essential enzymatic step required for the function of the visual cycle. Mutations in the RPE65 gene cause not only subtype II of Leber congenital amaurosis (LCA) but also early-onset severe retinal dystrophy (EOSRD). This study aims to investigate a Chinese case diagnosed as EOSRD and to characterize the polymorphisms of the RPE65 gene. A seven-year-old girl with clinical symptoms of EOSRD and her parents were recruited into this study. Ophthalmologic examinations, including best-corrected visual acuity, slit-lamp, Optical coherence tomography (OCT), and fundus examination with dilated pupils, were performed to determine the clinical characteristics of the whole family. We amplified and sequenced the entire coding region and adjacent intronic sequences of the coding regions of the RPE65 gene for the whole family to explore the possible mutation. Our results demonstrate that the patient exhibited the typical clinically features of EOSRD. Her bilateral decimal visual acuity was 0.3 and 0.4 in the left and right eyes, respectively. Spectral-domain optical coherence tomography (SD-OCT) was used to assess the retinal stratification for the whole family. All together, we identified four mutations within the RPE65 gene (c.1056G>A, c.1243+2T>A, c.1338+20A>C and c.1590C>A) in the patient. Among the four mutations, c.1056G>A and c.1338+20A>C had been reported previously and another two were found for the first time in this study. Her mother also carried the novel mutation (c.1243+2T>A). Either a single or a compound heterozygous or a homozygous one mutation is expected to cause EOSRD because mutations of RPE65 gene usually cause an autosomal recessive disease. Therefore, we speculate that the c.1590C>A mutation together with the c.1243+2T>A mutation may cause the patient's phenotype.
Case report: a robotic-vaginal approach for total vaginectomy and hysterectomy with pelvic sentinel lymph node dissection in primary vaginal melanoma: a 10-step technique and literature review
Authors: Philippe Van Trappen, Ines Lebbe, Eveline De Cuypere, Nele Claes
Journal: Front Surg (2023)
Keywords: hysterectomy, melanoma, robotic, sentinel, vaginal, vaginal melanoma, vaginectomy
MeSH terms: Case Reports

Introduction:
Primary vaginal melanoma is extremely rare, has a poor prognosis, and occurs mostly in elderly women. The diagnosis is based on histology and immunohistochemistry of a biopsy. Given the rarity of vaginal melanoma, no standardized treatment guidelines are established; however, surgery is the primary treatment modality in the absence of metastatic disease. Most reports in the literature are retrospective single cases, case series, and population-based studies. The open surgical approach is the main modality reported. Here, we report for the first time a 10-step combined robotic-vaginal technique, with en bloc resection of the uterus and total vagina, for treating clinically early-stage primary vaginal melanoma. In addition, the patient in our case underwent a robotic pelvic bilateral sentinel lymph node dissection. The literature on the surgical approach for vaginal melanoma is reviewed.
Case presentation:
A 73-year-old woman was referred to our tertiary cancer center and was clinically staged according to the 2009 International Federation of Gynaecology and Obstetrics (FIGO) staging for vaginal cancer as FIGO-stage I (cT1bN0M0) and according to the American Joint Committee on Cancer (AJCC) for (cutaneous) Melanoma Staging as clinical stage IB. Preoperative imaging with magnetic resonance imaging, FDG-positron emission tomography-computed tomography, and ultrasound of the groins did not reveal any adenopathy nor metastases. The patient was planned for a combined vaginal and robotic en bloc total vaginectomy and hysterectomy, as well as a pelvic bilateral sentinel lymph node dissection.
Results:
The surgical procedure was performed in 10 steps described in this case report. The pathology revealed free surgical margins and negative test results for all sentinel lymph nodes. The postoperative recovery process was uneventful, and the patient was discharged on day 5.
Conclusion:
The main surgical approach reported for primary early-stage vaginal melanoma is open surgery. A minimally invasive surgical approach, described here as a combined vaginal-robotic en bloc total vaginectomy and hysterectomy, for the surgical treatment of early-stage vaginal melanoma enables precise dissection, low surgical morbidity, and fast recovery for the patient.
Role of carbamazepine in the symptomatic treatment of subacute sclerosing panencephalitis: a case report and review of the literature
Authors: Sandhya Ravikumar, John Ross Crawford
Journal: Case Rep Neurol Med (2013)

We describe the clinical presentation and clinical course of subacute sclerosing panencephalitis in a 13-year-old previously healthy boy who recently immigrated to the United States from Iraq. He presented with macular retinopathy, followed by progressive myoclonus and encephalopathy. After extensive workup, a diagnosis of subacute sclerosing panencephalitis was suspected by the presence of period epileptiform discharges on electroencephalogram and confirmed by elevated measles titers in the cerebrospinal fluid. Combination immunomodulatory therapy with isoprinosine, ribavirin, and intra-Ommaya interferon alpha did not result in clinical improvement. Within days following the administration of carbamazepine, there was remarkable improvement in the myoclonus and he was able to ambulate independently for a period of 4 months at which time he unfortunately progressed to a vegetative state. This case highlights the importance of carbamazepine as a potential first line symptomatic treatment of subacute sclerosing panencephalitis and provides a review of the literature on the subject.
A 3-piece penile prosthesis salvage in the presence of late-onset infected hematoma: Clinical, radiological and intraoperative findings-A case report
Authors: Moayid Fallatah, Manerh Bin Mosa, Ahmed Aljuhayman, Naif Alhathal
Journal: Int J Surg Case Rep (2019)
Keywords: case report, complications, hematoma, infection, penile implant, salvage

Introduction:
Erectile dysfunction (ED) is a common health problem affecting 30% of young men worldwide. Despite the availability of non-invasive lines of management, penile prosthesis insertion is considered as a definite solution for ED. Despite strict perioperative measures, infection still complicates around 3% of penile prosthesis surgeries.
Presentation of case:
This is a case of a 36-year-old male who had an infected scrotal hematoma that led to prosthesis malfunction due to the inability to locate the pump to activate and deactivate the device. Intraoperatively, the prosthesis was salvaged after hematoma evacuation and ensuring a good device functionality.
Discussion and conclusion:
Infected penile prostheses are usually either removed completely with a new device insertion a few months later or exchanged at the same setting with vigorous wound washout. We suggest salvaging penile implants which are surrounded by infected hematomas in selected patients who don't manifest systemic signs of infection. This approach will help in cost reduction and avoiding further intraoperative complications.
Case report: marfan syndrome (MFS) mimicking cutaneous vasculitis
Authors: Fiona Price-Kuehne, Ebun Omoyinmi, Maha Younes, Matthew Edwards, Despina Eleftheriou, Paul Brogan
Journal: Front Pediatr (2023)
Keywords: fbn1 gene, aortic dilatation, marfan syndrome, skin rash, vasculitis
MeSH terms: Case Reports

Marfan syndrome (MFS) is an autosomal dominant connective tissue disorder caused by variants in the extracellular microfibril fibrillin (FBN1) gene. Here we report an FBN1 variant in a child with an unusual skin rash mimicking cutaneous vasculitis, and mild aortic root dilatation. The case was complicated by lack of typical skeletal MFS phenotype; and severe needle phobia preventing any blood testing for workup of suspected vasculitis. Therefore inflammatory markers, autoantibody profile and general hematology/biochemistry results were unknown. Diagnosis of MFS was made via genetic testing of a saliva sample alone using a next-generation sequencing (NGS) targeted gene panel designed to screen for monogenic forms of vasculitis and noninflammatory vasculopathic mimics. This revealed the patient was heterozygous for a pathogenic frameshift variant in FBN1; NM_000138, c.1211delC, p.(Pro404Hisfs*44), predicted to cause premature protein truncation leading to loss of function. The variant has not been detected in control populations and has previously been detected in individuals with MFS. This rapid diagnosis significantly impacted the patient management: avoidance of invasive investigations; avoidance of unnecessary immunosuppression; facilitating genetic counselling of the index case and family; and directly informing lifelong monitoring and ongoing treatment for aortic root involvement from MFS. This case further emphasizes the diagnostic utility of NGS early in the diagnostic workup of paediatric patients referred with suspected vasculitis, and we emphasize that MFS can present with cutaneous vasculitic-like features in the absence of the typical Marfanoid skeletal phenotype.
Realtime Remote Programming in Patients Carrying Cardiac Implantable Electronic Devices Requiring Emergent Reprogramming
Authors: Shiqiang Xiong, Jin Li, Lin Tong, Jun Hou, Siqi Yang, Lingyao Qi, Xu Chen, Yan Luo, Zhen Zhang, Hanxiong Liu, Lin Cai
Journal: Front Cardiovasc Med (2022)
Keywords: covid-19, cardiac implantable electronic device, emergent programming, follow-up, in-office evaluation, remote programming, telemedicine

To protect cardiac implantable electronic device (CIED) patients with arrhythmia or possible device malfunction, it is important for health care professionals to provide emergent device evaluation and reprogramming. This case series illustrated the clinical application of realtime remote programming in CIED patients requiring emergent in-person evaluation and reprogramming (ChiCTR2100046883 chictr.org). All remote sessions were performed safely and efficiently by remote electrophysiologists without being in the physical presence of a patient. The implementation of realtime remote programming not only largely reduces the response time to urgent events but also greatly helps to minimize personnel exposure to COVID-19 infection.
Case report: Endovascular coil embolization of an aneurysm at the origin of the accessory middle cerebral artery from the A1 segment as the collateral artery to twigs
Authors: Lei Zhang, Han Su, Jinlu Yu
Journal: Front Neurol (2023)
Keywords: accessory middle cerebral artery, aneurysm, anterior cerebral artery, embolization, twig-like middle cerebral artery
MeSH terms: Case Reports

An aneurysm at the origin of the accessory middle cerebral artery (AccMCA) from the A1 segment of the anterior cerebral artery (ACA) as the supplying artery of a twig-like MCA is exceptional. In this study, we reported on such a case and presented a review of the relevant literature. A 56-year-old male suffered a subarachnoid hemorrhage. Digital subtraction angiography confirmed a twig-like MCA and a ruptured aneurysm at the origin of the AccMCA. Endovascular coil embolization of the aneurysm was performed. After the microcatheter was positioned in the aneurysm, soft coils were delivered to complete the embolization. Postoperatively, the patient recovered uneventfully. One month later, the patient returned to his job without any neurological deficits. Postoperative computed tomography at the 3-month follow-up showed that the brain tissue was normal. By reporting our case and reviewing the relevant literature, we found that endovascular coil embolization for such aneurysms at the AccMCA origin is feasible in certain cases.
Trapped Between Theological and Medical Notions of Possession: A Case of Possession Trance Disorder With a 3-Year Follow-Up
Authors: Igor J Pietkiewicz, Urszula Kłosińska, Radosław Tomalski
Journal: Front Psychiatry (2022)
Keywords: possession trance disorder, assessment, dissociation, exorcism, religious coping
MeSH terms: Case Reports

Few studies on Possession Trance Disorder (PTD) describe diagnostic and research procedures in detail. This case study presents the clinical picture of a Caucasian Roman-Catholic woman who had been subjected to exorcisms because of her problems with affect regulation, lack of control over unaccepted sexual impulses, and somatoform symptoms accompanied by alterations in consciousness. It uses interpretative phenomenological analysis to explore meaning attributed by her to "possession" as a folk category and a medical diagnosis; how this affected her help-seeking was also explored. This study shows that receiving a PTD diagnosis can reinforce patients' beliefs about supernatural causation of symptoms and discourage professional treatment. Dilemmas and uncertainties about the diagnostic criteria and validity of this disorder are discussed.
Lichen planus with multiple system involvement including the mouth, vagina, urethra, and scalp: a case report
Authors: Lan Mi, Hong Zhang, Dai Zhang, Miao Zhang
Journal: Braz J Med Biol Res (2019)
MeSH terms: Lichen Planus / diagnosis, Scalp Dermatoses / diagnosis, Urethral Diseases / diagnosis, Vaginal Diseases / diagnosis, Case Reports, Adult, Female, Humans, Lichen Planus / pathology, Lichen Planus / therapy, Scalp Dermatoses / pathology, Scalp Dermatoses / therapy, Urethral Diseases / pathology, Urethral Diseases / therapy, Vaginal Diseases / pathology, Vaginal Diseases / therapy

This is a case report of lichen planus (LP) with multiple system involvement. A 35-year-old female patient was admitted in November 2014 with a 5-year history of painful/difficult sexual intercourse and loss of oral mucosa, and an 8-year history of focal hair loss. Earlier, the patient had been unable to adhere to corticosteroid therapy because of severe adverse side effects. In September 2014, labia minora mucosa defects and stricture of the urethral orifice (with dysuria), vaginal orifice, and vagina were identified. Biopsy was performed and a diagnosis of erosive LP was made. The patient was treated with an oral immunosuppressant (cyclosporine A) and urethral/vaginal dilatation. Urine flow rate and sex life were improved after 6 months and she discontinued medication. Four years later, the patient reported a good overall treatment efficacy. LP can involve multiple systems and should be considered in patients with dyspareunia. Immunosuppressive agents can achieve a satisfactory effect in patients with contraindication to corticosteroid.