OpenMed/multicare-articles huggingface dataset:
Case report: Myelitis and ganglionitis, an atypical presentation of Hansen's disease
Authors: Clarissa Neves Spitz, Izabela Jardim R Pitta, Ligia Andrade, Larissa Bittencourt de Carvalho, Diogo Matheus Terrana de Carvalho, Felipe da Rocha Schmidt, Ana Caroline Siquara de Sousa, Silvana Machado Mendonça, Euzenir Nunes Sarno, Anna Maria Sales, Roberta Olmo Pinheiro, Marcia Rodrigues Jardim
Journal: Front Med (Lausanne) (2024)
Keywords: hansen’s disease, atypical, central nervous system, resonance magnetic images, ulnar nerve, ultrasound imaging
MeSH terms: Case Reports

Hansen's disease, or leprosy, is a disease characterized by dermatological and neurological disorders. A neural form also exists, in which peripheral neuropathy occurs in the absence of skin lesions. However, cases of leprosy that involve the central nervous system and proximal nerves are rare in the literature. We describe the case of an oligosymptomatic patient diagnosed with the neural form of leprosy with involvement of peripheral nerves, dorsal root ganglion, and cervical spinal cord in an atypical presentation of the disease. Through complementary examinations and nerve biopsies, the bacillus was identified, and treatment was subsequently initiated. This case highlights the importance of investigating the suspicion of leprosy, even in cases with atypical manifestations, as early diagnosis and treatment can reduce neurological damage and deformities.
Allopurinol-Induced Toxic Epidermal Necrolysis
Authors: Sofia Perdigão, Ana Sofia Alves, Mariana Nunes, Cristiana Sousa, Nelson Barros
Journal: Cureus (2024)
Keywords: allopurinol, allopurinol hypersensitivity, stevens-johnson syndrome (sjs), toxic epidermal necrolysis (ten), toxicity
MeSH terms: Case Reports

Toxic epidermal necrolysis (TEN) is a rare and life-threatening cutaneous disease, frequently triggered by drugs. Allopurinol is one of the most frequent drugs associated with TEN, which implies detachment of a significant amount of the body surface area (BSA) and has a high morbidity and mortality associated with it. We present the case of a 68-year-old female with a recent diagnosis of hyperuricemia who started treatment with allopurinol. A week later, she presented to the emergency department with an extensive maculopapular exanthema with blisters and skin detachment. After the exclusion of other etiologies, the diagnosis of allopurinol-induced TEN was made, with 35% of BSA involvement. Due to the severity of the clinical condition, she was admitted to intensive care and treated with corticoids that had no response. So, she was started on immunoglobulins and transferred to a burn unit. She developed sepsis with multiorgan failure and required supportive treatment. She was discharged after a month, and physical rehabilitation was needed. This clinical case highlights the severity of allopurinol hypersensitivity that may happen and the importance of an accurate diagnosis and treatment for this rare disease.
Hypersensitivity pneumonitis with Paecilomyces as suspected inciting antigen
Authors: Masayuki Watanabe, Ryo Okuda, Yuriko Ishida, Shinobu Sagawa, Tatsuya Muraoka, Satoshi Ikeda, Tomoe Sawazumi, Tamiko Takemura, Eri Hagiwara, Takashi Ogura
Journal: Respir Med Case Rep (2024)
Keywords: acute hypersensitivity pneumonitis/ antigen avoidance test, fungi/ mold/ paecilomyces/ persistent cough
MeSH terms: Case Reports

A 73-year-old man visited our hospital for persistent cough. Chest high-resolution CT (HRCT) showed infiltration shadows in lower lobes and diffuse ground glass opacities in the upper lobes. Blood tests showed elevated white blood cell, C-reactive protein, surfactant protein D, and Krebs von den Lungen-6 levels. After an antigen avoidance test, his HRCT and blood test findings improved; we diagnosed him with hypersensitivity pneumonitis (HP). A culture of the rotting interior walls within his home revealed Paecilomyces, which we believe caused his HP. Given the few patients with Paecilomyces-induced HP, systematic approach was important to identify the inciting antigen.
Anterior-Segment Optical Coherence Tomography Unlocks Novel Perspectives: Lacking Iris Anterior Limiting Layer Signal in Uveitis
Authors: Joobin Khadamy
Journal: Cureus (2024)
Keywords: anterior-segment oct, as-oct findings, chronic uveitis, intraocular inflammation, iris abnormalities and koeppe nodule, neurosarcoidosis, ocular imaging, ophthalmic diagnostics, uveitic changes, uveitis
MeSH terms: Case Reports

Chronic uveitis, a challenging intraocular inflammatory condition, presents complexities in diagnosis and management due to its diverse etiologies and manifestations. Anterior-segment optical coherence tomography (AS-OCT) has emerged as a pivotal tool in evaluating uveitis, offering high-resolution imaging of anterior segment structures. We present the case of a 49-year-old man diagnosed with neurosarcoidosis and chronic intermediate uveitis, where AS-OCT revealed unique findings. Clinical examination identified a Koeppe nodule. AS-OCT evaluation unveiled hyperreflectivity in the iris stroma and the adjacent nodule. Notably, AS-OCT documented the absence of the hyperreflective anterior limiting layer signal, a novel observation in uveitis assessment. This unprecedented finding underscores the significance of AS-OCT in elucidating uveitis pathophysiology and emphasizes its potential in refining diagnostic and therapeutic strategies for this complex ocular condition.
Case Report: Unresectable pulmonary metastases of a giant cell tumor of bone treated with denosumab: a case report and review of literature
Authors: Shinji Miwa, Norio Yamamoto, Katsuhiro Hayashi, Akihiko Takeuchi, Kentaro Igarashi, Yuta Taniguchi, Sei Morinaga, Yohei Asano, Takayuki Nojima, Hiroyuki Tsuchiya
Journal: Front Oncol (2023)
Keywords: pet, denosumab, giant cell tumor of bone, metastasis, unresectable
MeSH terms: Case Reports

Giant cell tumors of bone (GCTB) sometimes metastasize to distant organs. In this case report, we present pulmonary metastases of GCTB mimicking malignancies. A 49-year-old man underwent two surgical treatments for a GCTB of the right proximal radius. At the time of the second surgery, no lesions were observed on chest radiography. Three years after surgery, the patient presented with cough and dyspnea, and chest radiography and computed tomography (CT) revealed multiple lung nodules. Positron emission tomography/CT revealed a high accumulation of 18F-fluoro-2-deoxy-D-glucose (18F-FDG) in multiple lesions. Based on the rapid growth and accumulation of 18F-FDG, a metastatic malignant tumor was suspected. CT-guided needle biopsy was performed, and the histology showed proliferation of spindle cells and multinuclear giant cells without malignant changes. Denosumab was administered because multiple lung lesions were unresectable. One month after denosumab treatment, CT showed marked shrinkage of the lesions, and the symptoms significantly improved. Eighteen months after the initial treatment with denosumab, the patient had no symptoms or tumor growth. Although its long-term efficacy and safety remain unclear, denosumab may be a treatment option for patients with unresectable pulmonary GCTB.
Acute complicated jejunum diverticulitis: a case report with a short literature review
Authors: Stefan Chiorescu, Mihaela Mocan, Maria Elena Santa, Florin Mihăileanu, Roxana Mihaela Chiorescu
Journal: Front Med (Lausanne) (2024)
Keywords: diverticulitis, intestinal perforation, jejunal diverticulosis, segmental resection, surgical treatment
MeSH terms: Review

Introduction:
Jejunal diverticulosis is a rare condition. Most of the time, it is asymptomatic; but it can cause severe complications such as intestinal perforation, mechanical occlusion, and hemorrhage.
Case presentation:
A patient aged 78 years, with a history of biological aortic valve prosthesis, atrial fibrillation, type 2 diabetes mellitus, and chronic obstructive pulmonary disease, presented in the emergency department for acute abdominal pain in the lower abdominal floor, nausea, and inappetence. Abdominal computed tomography revealed an inflammatory block in the hypogastrium, agglutinated small intestinal loops, fecal stasis, and air inclusions. Pulled mesentery and associated internal hernia are suspected. Exploratory laparotomy was performed, revealing an inflammatory block in the hypogastrium, whose dissection revealed inner purulent collection and the appearance of jejunal diverticulitis, a diagnosis confirmed by histopathological examination. Segmental resection of the jejunum with double-layer terminal-terminal enteroenteric anastomosis, lavage, and drainage was performed. The evolution was favorable.
Conclusion:
Based on our brief review, the diagnosis of complicated jejunal diverticulosis is difficult and sometimes not accurately established, even by high-resolution imaging techniques, with diagnostic laparotomy being necessary for these situations. Surgical treatment should be considered before severe complications develop.
Spinal Accessory Nerve Injury following Spinal Adjustment: Case Report and Literature Review of the Outcome of Accessory Nerve Pathology as Result of Blunt Trauma (Spinal Accessory Nerve Palsy after Spinal Adjustment)
Authors: Sulaiman Alanazi, Areej M Alawfi, Bander S Alrashedan, Reem A Almohaini, Majed M Shogair, Talal A Alshehri
Journal: Case Rep Orthop (2024)
MeSH terms: Case Reports

Spinal accessory nerve palsy (SANP) is rare and is commonly presented following iatrogenic injury. Their diagnosis is often missed on initial presentation. Injury following blunt trauma is rare, with few cases reported in literature describing blunt-associated SANP and their treatment and recovery. We present and discuss a case of SANP following an aggressive soft tissue adjustment by an uncertified individual that has been responsive to nonsurgical measures over 18 months. We also reviewed the related literature on similar cases that were presented as result of direct pressure on the nerve from soft tissue manipulation or heavy lifting and their outcome following treatment. Chiropractic is generally a safe complimentary medicine and must only be practiced by trained personnel. We found that blunt-caused SANP injuries should initially be treated conservatively as they are likely to respond and recover unlike when presented following invasive trauma accordingly to what we found in literature.
Spontaneous Stoma Closure: A Case Report and Review of the Literature
Authors: Mahdi Albandar, Jumana A Fatani
Journal: Cureus (2024)
Keywords: cancer, colon, enterocutaneous fistula, retraction, stoma
MeSH terms: Case Reports

Stomas serve various purposes, and surgical closure of temporary stomas is typically performed once the underlying reason for their creation has been resolved. However, spontaneous closure of a stoma without surgical intervention is exceptionally rare. Here, we present a case of spontaneous stoma closure. A 67-year-old female presented with symptoms indicative of partial bowel obstruction. A computed tomography (CT) scan revealed circumferential wall thickening involving the transverse, splenic flexure, and proximal descending colon, along with a dilated proximal colon. Urgent intervention led to a total colectomy with ileorectal anastomosis and the creation of a diverting loop ileostomy. Six months later, she was then booked for stoma closure but found that the stoma was already closed, and the patient reported a history of pushing the stoma inside by herself. Spontaneous closure of a stoma is extremely rare. The mechanism behind spontaneous closure is not fully understood. Stoma retraction or the healing process of an enterocutaneous (EC) fistula can be attributable factors. Only six cases of spontaneous stoma closure have been reported in the literature. The technique that has been described by the patient of pushing the stoma inside has not been discussed before. Gradual retraction of the stoma and the healing process of EC fistula are the most common acceptable factors. The technique of pushing the stoma inside could be a helpful factor in spontaneous stoma closure. Long-term follow-up can help in understanding the unclear mechanism of this condition.
Multifocal tuberculosis revealed by a sternal swelling in an immunocompetent child
Authors: Ghizlane Chehrastane, Elmostafa Benaissa, Abdelilah Radi, Amal El Hassani, Mostafa Elouennass
Journal: Access Microbiol (2024)
Keywords: multifocal tuberculosis, real-time pcr, sternal swelling
MeSH terms: Case Reports

Tuberculosis (TB) is one of the most common pathogens of bacterial lung infections, especially in underdeveloped nations like Morocco, where the incidence of TB was 97 cases per 100 000 persons in 2019. Thanks to its national TB prevention and control plan, Morocco was able to achieve remarkable progress in the management of TB with an 80% reduction in the total number of patients diagnosed with TB between 1980 and 2018. The national plan also allowed us to reach and maintain a therapeutic rate above 86% since 2002. Sternal TB is a rare clinical condition accounting for 1% of all musculoskeletal TB cases. Due to its rarity and the lack of awareness of clinical presentations, the diagnosis of sternal TB can be quite complex. We describe the case of a 14-year-old Moroccan patient consulting in the Military Hospital Mohammed V-Rabat with central chest pain for 4 months which was not associated with breathing, physical exercise or eating. The patient also had a history of asthenia, fever and weight loss. A computed tomography scan of the chest showed a destructive lesion of the sternum. Afterward, a chirurgical biopsy was performed and enabled to confirm the microbiological diagnosis of TB with the realization of the real-time PCR. The antitubercular therapy was given to the patient who had complete resolution of symptoms. This condition should be included in the differential diagnosis of chronic chest pain that mimics costochondritis particularly in patients from endemic areas.
Case report: prolonged durable clinical benefit and low toxicity from combination endocrine therapy in a patient with recurrent endometrial carcinoma
Authors: Joyce M Cheng, Stephanie Gaillard, Anna L Beavis, Tullia Rushton, Amanda N Fader
Journal: Front Oncol (2023)
Keywords: progestational agent, endocrine therapy, endometrial carcinoma, endometrioid, recurrence, tamoxifen
MeSH terms: Case Reports

Background:
Endometrial carcinoma is the most common gynecologic cancer, with increasing incidence and mortality. Combination endocrine therapy comprised of tamoxifen and progestational agents has demonstrated promising results in treating recurrent disease. This case report describes the prolonged clinical benefit of treatment with tamoxifen and megestrol acetate in a woman with recurrent, metastatic endometrial endometrioid carcinoma positive for estrogen (ER) and progesterone receptors (PR).
Case:
A 71-year-old gravida 1 para 1 woman presented with postmenopausal bleeding and vaginal discharge. Pelvic ultrasound and magnetic resonance imaging confirmed a 4.7 cm endometrial mass. The patient underwent a total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy, and cystoscopy; pathology revealed a FIGO stage IA grade 1 ER/PR-positive endometroid endometrial adenocarcinoma. She continued under active surveillance for approximately 42 months until she experienced bone metastases in her pelvis, for which she received radiation therapy. Five months later, pulmonary metastases were detected, and she received six cycles of carboplatin and paclitaxel. She then started megestrol acetate and tamoxifen and has remained clinically stable with minimal side effects and reasonable quality of life for approximately 57 months.
Conclusion:
Our case suggests that combination endocrine therapy has the potential to provide substantial long-term clinical benefit in women with recurrent endometrial cancer and bone metastases, despite multiple prior treatments, allowing patients to experience stable disease and quality of life. In patients with recurrent endometrioid, ER/PR-positive disease, endocrine therapy alone or in combination with other targeted therapies are regimens that may be considered due to their low overall toxicity.
Case report: The histopathological analyses of two myelin oligodendrocyte glycoprotein antibody-associated diseases with a distinctive linear radiating gadolinium enhancement on MRI
Authors: Mikito Shimizu, Goichi Beck, Shigeo Murayama, Taku Hoshi, Hiroyuki Sumikura, Kyoko Higashida, Isao Fukasaka, Yuki Shimada, Nozomi Nagashima, Tomohiro Fujioka, Naoki Hatayama, Tatsusada Okuno, Hideki Mochizuki, Manabu Sakaguchi
Journal: Front Immunol (2024)
Keywords: mri, axonal damage, brain atrophy, histopathology, myelin oligodendrocyte glycoprotein antibody-associated disease, the radial linear periventricular enhancement pattern
MeSH terms: Autoantibodies / immunology, Gadolinium, Magnetic Resonance Imaging, Myelin-Oligodendrocyte Glycoprotein / immunology, Case Reports, Adult, Biopsy, Brain / diagnostic imaging, Brain / pathology, Encephalomyelitis, Acute Disseminated / diagnostic imaging, Encephalomyelitis, Acute Disseminated / immunology, Encephalomyelitis, Acute Disseminated / pathology, Female, Humans, Male, Middle Aged, Myelin-Oligodendrocyte Glycoprotein, Gadolinium, Autoantibodies, MOG protein, human

Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) has highly heterogeneous clinical presentations, in which encephalitis is an important phenotype. Moreover, MOGAD has been reported to exhibit diverse imaging findings. However, there have been no previous reports of cases with perivascular radial gadolinium enhancement in periventricular regions, commonly reported in autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy. In this paper, we present two cases of MOGAD with this MRI feature, both of which underwent brain biopsy for the lesions. Brain biopsies revealed perivenous demyelination and inflammation consistent with acute disseminated encephalomyelitis (ADEM), with pronounced axonal damage in Case 1 and minimal axonal involvement in Case 2. Case 1 exhibited more severe cerebral atrophy than Case 2, correlating with the extent of axonal damage. Through these cases, we highlight the heterogeneity of radiological manifestations of MOGAD, expanding the spectrum beyond previously defined MRI patterns. Furthermore, histopathological analysis revealed distinct axonal involvement as a potential prognostic marker of brain atrophy. These observations emphasize the importance of considering MOGAD in the differential diagnosis, even in cases with atypical imaging findings, and highlight the significance of brain biopsy in guiding both diagnosis and prognosis.
A Case of Circumscribed Choroidal Hemangioma Treated With Proton Beam Therapy and Followed Up for 15 Years
Authors: Daichi Takizawa, Toshiyuki Okumura, Masashi Mizumoto, Kei Nakai, Hideyuki Sakurai
Journal: Cureus (2024)
Keywords: benign tumors, choroidal haemangioma, long term follow up, proton beam radiotherapy, retinal detachment (rd)
MeSH terms: Case Reports

Circumscribed choroidal hemangiomas are rare and benign tumors but often have a progressive course and are complicated by retinal detachment and glaucoma. The effectiveness of external radiation for large tumors that are difficult to treat with photodynamic therapy was recently reported; however, few studies have conducted long-term follow-ups. We encountered a case of localized choroidal hemangioma that was treated with proton beam therapy and followed up for 15 years. A 37-year-old man was diagnosed with a 10 × 4 mm circumscribed choroidal hemangioma involving the macular area with retinal detachment. Proton beam therapy was performed at 26.4 Gy relative biological effectiveness (RBE) in 8 fractions. The choroidal hemangioma gradually shrank over three years, and the retinal detachment also improved. A cataract developed on the affected side 11 years after irradiation, and eye coordination issues developed 15 years after irradiation. Glaucoma was not observed during the follow-up period; however, visual acuity did not recover, and the patient developed light perception. Although vision was not preserved, proton beam therapy effectively shrank the tumor and maintained quality of life.
Case report: dose-dependent interaction between dexamethasone and voriconazole in severely ill patients with non-Hodgkin's lymphoma being treated for invasive pulmonary aspergillosis
Authors: Jingjing Huang, Yang Chen, Ming Zhong, Ruoming Tan
Journal: Front Pharmacol (2024)
Keywords: aspergillosis, case report, dexamethasone dose, drug interaction, hematological malignancies, therapeutic drug monitoring, voriconazole trough concentration
MeSH terms: Case Reports

Background:
Voriconazole is primarily metabolized by CYP2C19 and CYP3A4. Drug interactions that affect this pathway can alter its plasma exposures, resulting in untargeted voriconazole concentrations.
Case summary:
In this case report, we describe the case of a 64-year-old man who was treated for non-Hodgkin's lymphoma with continuous glucocorticoids co-administrated with voriconazole against invasive pulmonary aspergillosis. A decrease in trough concentration (Cmin) of voriconazole was observed and related with co-administration of dexamethasone in the patient carrying the CYP2C19 *1*2 genotype: voriconazole Cmin/dose ratios of 0.018 (0.1 mg L-1/5.7 mg kg-1 day-1), 0.18 (1 mg L-1/5.7 mg kg-1 day-1), and 0.23 (2 mg L-1/8.6 mg kg-1 day-1) at dexamethasone doses of 20, 12.5, and 2.5 mg, respectively. Sub-therapeutic voriconazole Cmin was associated with high- and moderate-dose dexamethasone (20 and 12.5 mg), leading to failure of antifungal treatment.
Conclusion:
The extent of voriconazole-dexamethasone interaction was determined by the dose of dexamethasone and associated with the CYP2C19 *1*2 genotype. Therapeutic drug monitoring of voriconazole is necessary to avoid clinically relevant interactions for optimal antifungal therapy.
Vertebral osteomyelitis with Campylobacter jejuni - a case report and review of the literature of a very rare disease
Authors: Simone Greminger, Carol Strahm, Julia Notter, Benjamin Martens, Seth Florian Helfenstein, Jürgen Den Hollander, Manuel Frischknecht
Journal: J Bone Jt Infect (2024)
MeSH terms: Case Reports

Infections with Campylobacter species mainly cause gastrointestinal disease and are usually self-limiting. Systemic complications such as bacteremia and osteoarticular infections are rare. Here we report a very rare case of a vertebral osteomyelitis due to C. jejuni, and we reviewed the literature for similar cases, identifying six other cases. Therapy should be guided on resistance testing if available due to emerging resistance rates, especially to fluoroquinolones. Azithromycin may be a treatment option for C. jejuni spondylodiscitis.
A natural history of untreated chronic osteomyelitis of the tibia over 20 years, with evolving squamous cell carcinoma: a case report
Authors: Asanka Wijendra, Alex Ramsden, Martin McNally
Journal: J Bone Jt Infect (2023)
MeSH terms: Case Reports

Squamous cell carcinoma (SCC) is a rare but potentially life-threatening complication of chronic osteomyelitis. Whilst there have been over 100 cases of chronic osteomyelitis with malignant transformation reported in the literature between 1999 and 2020, this is the first case report to document transformation with 20 years of concordant imaging and clinical review.