OpenMed/multicare-articles huggingface dataset:
Guillain-Barré Syndrome Likely due to Relapsing Hepatitis A
Authors: Edgar Blecker, Maryam Ehtsham
Journal: Case Reports Hepatol (2021)
MeSH terms: Case Reports

Guillain-Barré syndrome (GBS) is an immune-mediated disease of the peripheral nervous system that can be caused by various bacterial and virologic agents. The disease is characterized by progressive muscle weakness and paralysis. Rarely, GBS is preceded by an acute infection with hepatitis A. Here, we present the case of a 53-year-old woman who presented with progressively worsening motor weakness in the distal extremities. She reported a preceding gastrointestinal infection with nausea, vomiting, and diarrhea two weeks prior to her presentation to the emergency department. She was noted to have elevated serum transaminase levels and hepatitis A IgM and IgG antibodies signifying likely relapsing hepatitis A. She was later diagnosed with GBS on the basis of clinical findings and albuminocytologic dissociation in the cerebrospinal fluid. She was treated with intravenous immunoglobulin with subsequent improvement in her strength.
Isolated Distal Fibular Stress Fracture after Total Hip Arthroplasty in a Patient with Developmental Dysplasia of the Hip
Authors: Tomofumi Nishino, Fumi Ochiai, Tomohiro Yoshizawa, Hajime Mishima, Masashi Yamazaki
Journal: Case Rep Orthop (2020)
MeSH terms: Case Reports

Stress fractures following total hip arthroplasty in the lower limbs away from the surgical area are very rare. We report a case of stress fracture in the isolated distal fibula that presented five months after total hip arthroplasty in a patient with developmental dysplasia of the hip. A 67-year-old woman diagnosed with coxarthrosis of the right hip joint, classified as Crowe's group 3, underwent total hip arthroplasty with acetabular reconstruction using a bulk bone graft. The surgery successfully treated the preoperative leg length discrepancy and flexion and external rotation contractures. The alignment of the right lower limbs changed from slight varus to valgus knee following surgery. The postoperative process went well; however, she experienced lateral ankle pain on the affected side five months after surgery. No obvious fracture was observed via radiograph; however, she received a subsequent diagnosis of isolated distal fibula stress fracture. Additionally, she was diagnosed with vitamin D deficiency. Valgus alignment change of the knee joint and vitamin D deficiency were considered the main causes of the stress fracture. Stress fractures should be suspected in patients complaining of unexpected pain following total hip arthroplasty, even in distant areas of the affected limb, especially in osteoporotic patients.
Super-late pulmonary recurrence after radical esophagectomy for esophageal squamous cell carcinoma
Authors: Akira Umemura, Yuji Akiyama, Takeshi Iwaya, Keisuke Koeda, Ryo Sugimoto, Tamotsu Sugai, Fumitaka Endo, Shigeaki Baba, Haruka Nikai, Hiroyuki Nitta, Takeshi Takahara, Koki Otuska, Toshimoto Kimura, Hajime Saito, Hiroyuki Deguchi, Makoto Tomoyasu, Akira Sasaki
Journal: Int J Surg Case Rep (2020)
Keywords: esophaegal cancer, late recurrence, oligometastasis, pulmonary metastasis, squamous cell carcinoma
MeSH terms: Case Reports

Introduction:
Pulmonary metastases from esophageal squamous cell carcinoma (ESCC) are often detected bilateral and multiple lesions and are often accompanied by metastases to other sites. The concept of oligometastasis has been developed, and limited distant metastases have been considered as indications for surgical resection for the purpose of extending overall survival. We herein present a long-surviving case of super-late pulmonary recurrence of ESCC, seven years after radical esophagectomy.
Presentation of case:
A 71-year-old woman who underwent radical subtotal esophagectomy with three-field lymph node dissection with a diagnosis of an advanced poorly differentiated ESCC with cT3N1M0 seven years ago visited our hospital. Chest X-ray and computed tomography at the 7-year follow-up revealed a solitary pulmonary tumor, 1.5 cm in diameter, at the right middle lobe without any extrapulmonary metastases; however, we could not diagnose whether primary lung cancer or pulmonary metastasis of ESCC was present. Therefore, we performed thoracoscopic partial resection of the right middle lobe. A histopathological examination including immunohistochemical staining revealed that the tumor was not derived from both alveolar epithelium and neuroendocrine cells and was diagnosed as pulmonary oligometastasis of ESCC. She has been followed for four years without re-recurrence.
Conclusion:
Pulmonary oligometastases of ESCC should be considered as surgical indications if the tumor is detected after a long disease-free interval without any extrapulmonary recurrences.
A case of primary biliary cirrhosis associated with pernicious anemia: a case report
Authors: Elhem Ben Jazia, Mabrouk Khalifa, Atef Ben Abdelkader, Naoufel Kaabia, Neirouz Ghannouchi, Ahlem Braham, Amel Letaief, Fethi Bahri
Journal: Cases J (2010)

Primary biliary cirrhosis is often associated with autoimmune diseases. However, its association with pernicious anemia has rarely been reported.We report a case of a 68-year-old woman who presented jaundice and pruritus. Mildly elevated serum levels of alkaline phosphatase and gamma-glutamyl transpeptidase were detected. The titer of anti-mitochondrial M(2 )anti-body was elevated. Histology of liver biopsy showed features of primary biliary cirrhosis. In addition, aregenerative macrocytic anemia was found in the full blood count. The diagnosis of pernicious anemia was established by megaloblastosis in bone marrow, atrophic gastritis without Helicobacter pylori, low level of vitamin B(12 )and good response to treatment regimen of vitamin B(12). The association of primary biliary cirrhosis and pernicious anemia is unlikely to be casual and may be explained by autoimmune mechanism commonly shared by the diseases.
Brucellosis - laboratory workers' nightmare come true: A case study
Authors: Lebogang Skosana, Farzana Ismail, Nontombi Mbelle, Mohamed Said
Journal: Afr J Lab Med (2020)
Keywords: brucellosis, laboratory exposure, microbiology, prophylaxis, public health
MeSH terms: Case Reports

Introduction:

Brucella spp. are rarely encountered organisms in the medical microbiology laboratory and, when encountered, can cause concern in laboratory workers. Laboratory personnel may in fact develop serious disease as a result of this exposure. This case highlights shortcomings in recognition of Brucella spp. from a patient presenting atypically as well as the follow-up and management of an infected patient.
Case presentation:
The patient was an 8-year-old boy from a rural area of South Africa who presented to an academic hospital with a bladder mass and history of enuresis in September 2016. Brucella melitensis was isolated from a blood culture submitted to the laboratory. The child was subsequently treated for brucellosis in November 2016.
Management and outcome:
The source of infection in the patient was traced to consumption of unpasteurised milk from a local farmer. The patient was treated with doxycycline 100 mg twice daily and rifampicin 600 mg daily for 6 weeks and completed treatment, however he was not followed up at our hospital. The laboratory personnel, however, did not handle the specimen as a Biosafety Level 3 pathogen as this organism is not commonly encountered; they were provided with prophylaxis for brucellosis (rifampicin and doxycycline).
Conclusion:

Brucella spp. is a dangerous pathogen, easily capable of causing significant exposure in an unsuspecting and unprepared laboratory. The case discusses the management of brucellosis in the infected patient as well as the management of laboratory exposure to Brucella spp. Our case also describes the public health response to a case of brucellosis.
Surgical Treatment of Iatrogenic Rectourinary Fistula-York-Mason Technique-a Case Report
Authors: Pedro Bargão Santos, Fernando Ferrito, Rocha Pires
Journal: ISRN Urol (2011)
MeSH terms: Case Reports

Introduction. Recto-urinary fistulas resulting from trauma or surgery are a serious and debilitating complication. They represent a challenge not only because of the difficulty on choosing the best technique to solve them but also because of the risk of recurrence. Spontaneous cure is rare. Materials and Methods. We describe the case of a 61-years-old man that on the 9th postoperative day of a laparoscopic radical prostatectomy (LRP) started with fecaluria and liquid faeces. Recto-urinary fistula was confirmed at the 10th postoperative day by CT scan and contrast enema. Discussion. We chose the York-Mason technique, because it is simple to perform, effective and has minimal morbidity. This is a posterior, transrectal, and transsphincteric approach, carried out on healthy tissues without previous scarring phenomena. Results. The postoperative period progressed without complications, and the patient discharged on the 4th day. The closure of the fistula was confirmed radiologically by retrograde cystography after 4 weeks allowing the removal of drainage catheter. The reconstruction of intestinal transit was carried out 2 months later. Conclusion. The York-Mason technique, a transrectal and transsphincteric approach with minimal morbidity, proved to be effective on the resolution of the recto-urinary fistula, a rare complication of the radical prostatectomy.
Pallister-Hall Syndrome Presenting in Adolescence
Authors: Aria Mahtabfar, Niall Buckley, Susan Murphy, Shabbar Danish, Ian Marshall
Journal: Case Rep Genet (2019)
MeSH terms: Case Reports

Pallister-Hall syndrome (PHS) is an extremely rare syndrome of unknown prevalence with autosomal dominant inheritance due to GLI3 gene mutations classically characterized by the presence of a hypothalamic hamartoma and polydactyly. Additional diagnostic criteria include bifid epiglottis, imperforate anus, small nails, hypopituitarism, growth hormone deficiency, and genital hypoplasia. It is typically diagnosed in infancy and early childhood, presenting with seizures and/or precocious puberty due to the hypothalamic hamartoma, and with limb anomalies due to central polydactyly. Our patient had presented with polysyndactyly at birth. However, as this is not uncommon in infants and is usually as part of the sporadic, isolated form of polydactyly, no further work up was done. He then presented at age 16 years with a headache and subjective visual changes, with brain imaging revealing a hypothalamic hamartoma. He did not have a history of seizures or central precocious puberty. Genotyping revealed a pathogenic variant affecting the GLI3 gene. We encourage all clinicians to consider PHS or an associated syndrome with a clinical finding of polydactyly. Further, as the natural history continues to reveal itself, this patient's presentation provides important new data to the broad phenotypic spectrum of PHS.
A 75-year-old woman with a hemispheric stroke
Authors: Stavros K Kakkos, George Geroulakos
Journal: PLoS Med (2005)
MeSH terms: Carotid Stenosis / diagnosis, Endarterectomy, Carotid, Stroke / diagnosis, Case Reports, Aged, Brain Ischemia / etiology, Carotid Stenosis / complications, Carotid Stenosis / surgery, Diagnosis, Differential, Female, Humans, Recurrence, Stroke / etiology

What are the causes, investigation, and management of hemispheric stroke? Find out in this case-based article
Primary Cecal Squamous Cell Carcinoma: A Case Report of a Rare Tumor with Poor Prognosis
Authors: Mohamed Bouzroud, Mustapha Azzakhmam, Aboulfeth El Mehdi, Bouchentouf Sidi Mohammed, El Kaoui Hakim, Oukabli Mohaned, Bounaim Ahmed
Journal: Case Rep Oncol Med (2021)
MeSH terms: Case Reports

Squamous cell carcinoma of the colon is a rare tumor and primary cecal localization is unusual. This malignant condition is marked by a worst prognosis due to early local invasion. We report a case of a 46-year-old female patient admitted to the emergency department with symptoms of peritonitis. CT scan showed a cecal tumor perforated in the retroperitoneal space. The patient underwent right hemicolectomy with D2 lymphadenectomy without intestinal anastomosis. The diagnosis of squamous cell carcinoma was confirmed by histopathological examination. Squamous cell carcinoma is a malignant tumor with poor prognosis, hence, the interest of early diagnosis and management.
Fatal heat stroke in a schizophrenic patient
Authors: María Jesús Gómez Ramos, Francisco Miguel González Valverde, Carmen Sánchez Álvarez, Lisa Ortin Katnich, Francisco Pastor Quirante
Journal: Case Rep Crit Care (2012)

Objective. The case of a patient who developed a fatal post-exertional heat stroke is reported. Case Report. A 20-year-old man with a history of morbid obesity, hypertension, and schizophrenia was admitted to our intensive care unit because of multiorgan failure due to severe heat stroke. He had been working under the sun. Treatment included aggressive body cooling but, in spite of the best supportive care, the patient succumbed in a few hours. We concluded that the adverse event was possibly associated with his obesity and the use of antipsychotics. Histological evaluation revealed lesions consistent with severe hyperthermia and shock. Conclusions. Heat stroke is an uncommon clinical entity characterized by systemic heat and loss of the body's normal mechanisms for dealing with heat stress, such as sweating and temperature control. When heat stroke is diagnosed early and supportive care begins promptly the prognosis is optimal but it becomes a life-threatening disease when treatment is delayed. Lack of physical acclimatization and the use of certain medications that interfere with salt and water balance can impair thermoregulation under conditions of high environmental temperature. Health professionals must be adequately prepared to prevent, recognise, and treat them urgently.
Extensive Cutaneous T-Cell Lymphoma of the Feet Treated with High-Dose-Rate Brachytherapy and External Beam Radiation
Authors: Joy Tao, Courtney Hentz, Michael L Mysz, Issra Rashed, David Eilers, James Swan, Rebecca Tung, Bahman Emami
Journal: Case Rep Dermatol Med (2018)
MeSH terms: Case Reports

Cutaneous T-cell lymphoma (CTCL) is a chronic, debilitating disease that has a severe impact on quality of life. We present a patient with multiple CTCL lesions on the bilateral feet, which impaired his ability to ambulate. His lesions on both feet were successfully treated with a total of 8 Gy in two fractions via high-dose-rate surface brachytherapy using the Freiburg Flap applicator. The deeper aspects of the bulkier lesions on the left foot were boosted with electron beam therapy. The radiation therapy was well tolerated, and the patient was able to regain his mobility after completing radiation therapy. To our knowledge, there are few reports utilizing brachytherapy in treating CTCL. Our case describes treatment of larger, more extensive CTCL lesions than previously reported.
Case report: A Chinese patient with glutathione synthetase deficiency and a novel glutathione synthase mutation
Authors: Xiaojiao Wu, Jiancheng Jiao, Yaofang Xia, Xiaotong Yan, Zehao Liu, Yanyan Cao, Li Ma
Journal: Front Pediatr (2023)
Keywords: 5-oxoprolinuria, case report, glutathione synthetase deficiency, glutathione synthetase gene variation, inherited metabolic disease, newborn
MeSH terms: Case Reports

Glutathione synthetase deficiency (GSSD) is an autosomal-recessive metabolic disorder caused by glutathione synthetase (GSS) gene mutations. No more than 90 cases of GSSD have been reported worldwide; thus, the spectrum of GSS mutations and the genotype-phenotype association remain unclear. Here, we present a severely affected infant carrying a compound heterozygous GSS variation, c.491G > A, and a novel variant of c.1343_1348delTACTTC. We also summarize the clinical manifestations, treatment protocol, prognosis, and genetic characteristics of previously reported GSSD cases in China. In this case study, our patient presented with tachypnea, jaundice, intractable metabolic acidosis, and hemolytic anemia. Urinary-organic acid analysis revealed elevated 5-oxoproline levels. Further, this patient showed improved outcomes owing to early diagnosis and the timely administration of vitamins C and E. Therefore, our study indicates that in clinical cases of unexplained hemolytic anemia and metabolic acidosis, GSSD should be considered. Additionally, genetic testing and antioxidant application might help identify GSSD and improve the prognosis.
Paraneoplastic internal jugular vein thrombosis leading to diagnosis of bilateral ovarian ependymoma
Authors: Irappa Madabhavi, Apurva Patel, Mukesh Choudhary, Asha Anand
Journal: Case Rep Obstet Gynecol (2014)

Ovarian ependymomas are extremely rare tumors of the ovary. We present a case of a 67-year-old lady presented to us with swelling in the right side of neck for 2 months followed by pelvic pain, lower abdominal distention, and weight loss for 1 month. Her coagulation profile, blood chemistry, lipid profile, and tumor markers were within normal limits. Neck Doppler ultrasonography revealed thrombus in the right internal jugular vein and CT scan of the abdomen showed bilateral ovarian masses. Patient was subjected to debulking surgery for suspected ovarian cancer and microscopy revealed a highly cellular tumor composed of small cells with hyperchromatic, round-to-oval nuclei with scanty cytoplasm, and perivascular pseudorosettes. Diagnosis was confirmed by immunophenotype showing strong positivity to glial fibrillary acidic protein, estrogen receptors, and progesterone receptors. Patient was successfully managed with anticoagulants, adjuvant chemotherapy with BEP regimen, and letrozole. After ruling out other common conditions for thrombosis in this age group, this seems to be a paraneoplastic presentation of ovarian malignancy that preceded the diagnosis of ependymoma by 2 months. To the best of our knowledge this is the first case report in the world literature as "paraneoplastic internal jugular vein thrombosis leading to diagnosis of bilateral ovarian ependymoma."
Case Report: Successful Staged Ureteroscopic Treatment of a 5 cm Staghorn Renal Calculus
Authors: Joseph M Ciccone, J Clinton McCabe, Robert C Eyre
Journal: Case Rep Urol (2012)
MeSH terms: Case Reports

It is widely accepted that percutaneous nephrostolithotorny (PCNL) is the standard of choice for the removal of large staghorn renal calculi. Although data exists supporting a stagad ureteroscopic as an alternate treatment for stones up to 3 cm in select patients, little data exists to support a ureteroscopic approach for stones as large as 5 cm. We present a case of a 68 year old female with a 5 cm staghorn renal calculus managed successfully with a staged ureteroscopic approach. A staged ureteroscopic approach can be effective in treating stones as large as 5 cm.
Durable effect of imatinib and metronomic chemotherapy with capecitabine in pancreatic carcinoma
Authors: Sana Al-Sukhun, Karim Khalidi
Journal: Ecancermedicalscience (2023)
Keywords: kit amplification, metronomic chemotherapy, molecular profiling, pancreatic cancer
MeSH terms: Case Reports

Background:
Pancreatic ductal carcinoma (PDC) is a challenging diagnosis with a particularly poor prognosis, even after curative surgery (median survival: <30 months). The prognosis of borderline resectable pancreatic cancer (BR-PDC) is even worse. We describe a patient with BR-PDC who achieved stable disease with metronomic chemotherapy after refusing surgery.
Case presentation:
A 75-year-old woman was presented with jaundice and epigastric pain. Imaging confirmed a mass in the pancreatic head encasing the superior mesenteric vein, with obstruction of the pancreatic and bile ducts. After stenting to relieve the obstruction, Fine needle aspiration (FNA) confirmed the diagnosis of PDC. The patient refused surgery and radiation therapy but agreed for chemotherapy. After the second cycle of mFOLFIRINOX - complicated by febrile neutropenia - she refused further IV therapy. Genomic profiling revealed KIT amplification. Therefore, she was started on imatinib with dramatic improvement both clinically and biochemically reflected in carbohydrate antigen 19-9 drop. However, that response was short-lived at 3 months. Therefore, capecitabine was added at a low dose of 1 g bid on an alternate weekly basis. The patient did well and she is currently alive with a stable disease as of 2 years after diagnosis.
Conclusion:
Metronomic chemotherapy, especially capecitabine added to the targeted therapy, imatinib, is a potentially useful treatment for PDC where no other options are available, especially those harbouring no mutation in the dominant four genes. Indeed, the absence of mutation with KIT amplification could be a potential marker for improved outcomes with targeted and metronomic therapy, which deserves further evaluation in a clinical trial setting.
Case report and review of the literature: rare fetus-in-fetu presenting as oropharyngeal epignathus
Authors: Daniel Runggaldier, Michael Reinehr, Hergen Friedrich, Georg Henze, Dominic Good, Claudine Gysin
Journal: Front Surg (2023)
Keywords: asymmetric twin, epignathus, fetus in fetu (fif), heteropagus, neonate airway
MeSH terms: Case Reports

An epignathus is caused by a continuous spectrum of masses of the oral cavity or oropharynx ranging in its entity from mature teratoma to the exceedingly rare fetus-in-fetu. Due to its location, regardless of the entity, the occurrence of an epignathus is frequently associated with life threatening airway obstruction. Here we demonstrate a case of a fetus-in-fetu presenting as an epignatus. We describe its successful management and review the available literature. Early diagnosis and knowledge of the preoperative workup are essential to enable a multidisciplinary management. Once the airway is secured, surgical excision is the treatment of choice often resulting in a good clinical outcome and prognosis.
Diarrhea due to SARS-CoV-2-Related Exocrine Pancreatic Insufficiency
Authors: Harish K Patel, Jasbir Makker, Ahemd Alemam, Sridhar Chilimuri
Journal: Case Rep Gastrointest Med (2021)
MeSH terms: Case Reports

Gastrointestinal symptoms, especially diarrhea, are common with novel coronavirus SARS-CoV-2 infection. Angiotensin-converting enzyme-2 (ACE-2) receptors are heavily expressed in enterocytes and serve as entry receptors for SARS-CoV-2. ACE-2 receptors may also be responsible for pancreatic injury in patients infected with SARS-CoV-2. Diarrhea associated with SARS-CoV-2 is usually believed to be due to viral invasion of enterocytes. However, exocrine pancreatic insufficiency resulting from SARS-CoV-2 is another plausible mechanism leading to diarrhea in such patients. We present a case series of three SARS-CoV-2-infected patients with predominant respiratory symptoms at presentation who developed diarrhea, and further fecal analysis revealed exocrine pancreatic insufficiency as the underlying mechanism.
Importance of Oral Hygiene Habits in Mentally Disabled Children
Authors: Usha Mohan Das, Beena Jp, Divya Reddy
Journal: Int J Clin Pediatr Dent (2010)
Keywords: mentally disabled, gingival hyperplasia, oral hygiene
MeSH terms: Case Reports

Background:
The main factor related to gingival/periodontal problems in disabled individuals is the inadequacy of the plaque removal from the teeth. Motor coordination problems and muscular limitation in neuromuscularly disabled individuals along with the difficulty in understanding the importance of oral hygiene in mentally disabled individuals have resulted in the progression of inflammatory diseases.
Case report:
This report describes a case of cerebral palsy child who developed gingival hyperplasia due to poor oral hygiene practices which remarkably improved by proper motivation and adaptation of oral hygiene measures.
Conclusion:
It is important that the caretakers especially mother is informed about the importance of maintaining proper oral hygiene and the harmful effects of not doing so. It forms our duty to guide them towards maintaining good oral hygiene and thereby help in improving overall health of these children.