OpenMed/multicare-articles huggingface dataset:
The Effects of Fecal Donors with Different Feeding Patterns on Diarrhea in a Patient Undergoing Hematopoietic Stem Cell Transplantation
Authors: Jianping Zhang, Guangxu Ren, Minghua Li, Peihua Lu, Suqin Yi
Journal: Case Rep Hematol (2019)
MeSH terms: Case Reports

Almost 90% of patients undergoing hematopoietic stem cell transplantation (HSCT) experience diarrheal episodes, which represent a severe, often life-threatening complication for these patients. Although fecal microbiota transplantation (FMT) represents an alternative treatment option for infection-related diarrhea, the application of FMT in HSCT patients is greatly restricted for safety reasons. Furthermore, the therapeutic outcomes of FMT as a diarrhea treatment are somewhat related to the choice of the FMT donor. Here, we comprehensively profiled the dynamic changes in the intestinal microbiota after FMT from two donors with different feeding patterns and the same severely diarrheal recipient undergoing HSCT via a 45-day clinical observation. Importantly, no adverse events attributed to FMT were observed. The stool volume and frequency of the patient were reduced when we used feces from donor #1 (mixed feeding), but these changes were not observed after FMT from donor #2 (exclusive breastfeeding). Interestingly, no obvious differences in overall diversity (Shannon) or richness (Chao1) between the two donors were observed. Additionally, Bifidobacterium accounted for 29.9% and 18.1% of OTUs in the stools of donors #1 and #2, respectively. Lactobacillus accounted for 16.3% and 2.9% of the stools of donors #1 and #2, respectively. Furthermore, through longitudinal monitoring of the patient, we identified 6 OTUs that were particularly sensitive to the different FMT complements. Together, we present a case report suggesting that the overall diversity of the intestinal microbiota may not be the only important element in the selection of an effective FMT donor.
Atrioventricular dissociation after electroconvulsive therapy
Authors: Siegfried William Yu, Srikanth Vallurupalli, Jennifer Arnoldi, Richard Holloway
Journal: Cardiol Res Pract (2011)
MeSH terms: Case Reports

Electroconvulsive therapy (ECT) is increasingly used as a treatment for psychiatric disorders. Cardiac effects are the principal cause of medical complications in these patients. We report a case of atrioventricular (AV) dissociation that occurred after ECT that was treated with pacemaker implantation. The mechanisms contributing to the onset of AV dissociation in this patient, and the management and rationale for device therapy, in light of the most recent guidelines, are reviewed.
Development and application of specific cytokine assays in tissue samples from a bottlenose dolphin with hyperinsulinemia
Authors: Kirsten C Eberle, Theresa E Waters, Eric D Jensen, Stephanie K Venn-Watson, Randy E Sacco
Journal: Front Endocrinol (Lausanne) (2013)
Keywords: tursiops truncatus, cytokines, diabetes, hyperinsulinemia, immunohistochemistry, inflammation, real-time pcr

Chronic inflammation has been associated with insulin resistance and type 2 diabetes (T2D) in humans. Postmortem hepatic and splenic tissue from a 46-year-old geriatric male bottlenose dolphin (Tursiops truncatus) with insulin resistance (chronic hyperinsulinemia with hyperglycemia), chronic inflammation (white blood cell count greater than 12,000 cells/μL), and mild fatty liver disease was evaluated for elevated pro-inflammatory mediators. Cytokine mRNA expression in postmortem hepatic and splenic tissue, as determined by real-time PCR, included an array of cytokines: TGF-β, TNF-α, IFN-γ, IL-2, IL-4, IL-10, IL-12p40, IL-13, and IL-18. Values from this dolphin were compared to a younger reference dolphin with no known chronic metabolic perturbations or inflammation. Levels of TGF-β, TNF-α, and IL-4 were higher in the case dolphin's liver compared to that of the reference dolphin. In the case dolphin's spleen, IL-10 and IFN-γ mRNA was upregulated while IL-4 was less than the reference dolphin. IL-18 and IL-13 were upregulated in both tissues. Fluorescent immunohistochemistry (IHC) utilized the following antibodies: anti-porcine IL-6, anti-bovine IFN-γ, IL-4, and IL-10, anti-human TGF-β, anti-ovine IL-1β, and anti-dolphin IL-8. Fluorescent IHC in spleen from the case dolphin revealed staining of IL-4, IL-6, IL-8, and TGF-β throughout the tissue. IL-10 and IFN-γ were seen to predominate in areas surrounding the follicles of splenic tissue. This is the first characterization of cytokine levels in dolphin hepatic and splenic tissue. While there are limitations to a case study, this report of inflammatory biomarkers in tissues of a dolphin with insulin resistance and fatty liver disease are similar to those observed in human patients.
An Unusual Presentation of Pediatric Conjunctival Mucosa-Associated Lymphoid Tissue Lymphoma
Authors: Samantha Bobba, Christopher Go, Amanda Charlton, James Smith, Maciek Kuzniarz, Subhashini Kadappu
Journal: Case Rep Ophthalmol Med (2019)
MeSH terms: Case Reports

Ocular adnexal mucosa-associated lymphoid tissue (MALT) lymphoma is uncommon in the pediatric population. Initial misdiagnosis is common and there is lacking consensus regarding the optimal approach to treatment. Herein, we report an atypical presentation of pediatric conjunctival MALT lymphoma and review the presentation and management of this rare condition.
Cardiotoxicity associated with CTLA4 and PD1 blocking immunotherapy
Authors: Lucie Heinzerling, Patrick A Ott, F Stephen Hodi, Aliya N Husain, Azadeh Tajmir-Riahi, Hussein Tawbi, Matthias Pauschinger, Thomas F Gajewski, Evan J Lipson, Jason J Luke
Journal: J Immunother Cancer (2016)
Keywords: cardiomyopathy, checkpoint inhibitor, immune-related adverse events, immunotherapy, ipilimumab, melanoma, myocarditis, nivolumab, pembrolizumab

Immune-checkpoint blocking antibodies have demonstrated objective antitumor responses in multiple tumor types including melanoma, non-small cell lung cancer (NSCLC), and renal cell cancer (RCC). In melanoma, an increase in overall survival has been demonstrated with anti-CTLA-4 and PD-1 inhibition. However, a plethora of immune-mediated adverse events has been reported with these agents. Immune-mediated cardiotoxicity induced by checkpoint inhibitors has been reported in single cases with variable presentation, including myocarditis and pericarditis. Among six clinical cancer centers with substantial experience in the administration of immune-checkpoint blocking antibodies, eight cases of immune-related cardiotoxicity after ipilimumab and/or nivolumab/pembrolizumab were identified. Diagnostic findings, treatment and follow-up are reported. A large variety of cardiotoxic events with manifestations such as heart failure, cardiomyopathy, heart block, myocardial fibrosis and myocarditis was documented. This is the largest case series to date describing cardiotoxicity of immune-checkpoint blocking antibodies. Awareness, monitoring of patients with pre-existing cardiac disorders and prompt evaluation by the treatment team is essential. Treatment including application of steroids is critical for patient safety.
Successful pregnancy in a cystic fibrosis patient with a severe impairment of lung function receiving Elexacaftor-Tezacaftor-Ivacaftor
Authors: Zisis Balmpouzis, Annabelle Faure van Rossum, David Baud, Alice Panchaud, Georgia Mitropoulou, Jesica Mazza Stalder, Angela Koutsokera
Journal: Respir Med Case Rep (2022)
Keywords: cystic fibrosis, elexacaftor-tezacaftor-ivacaftor, impaired lung function, pregnancy
MeSH terms: Case Reports

Before the arrival of Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) modulators women with CF and impaired lung function were experiencing a high risk of complications and mortality during and the years after pregnancy. The arrival of the highly efficient CFTR modulator, Elexacaftor-Tezacaftor-Ivacaftor (ETI) resulted in an improvement of lung function, quality of life and fertility. Here we report a case of successful pregnancy and uncomplicated delivery for a CF patient with severely impaired lung function receiving ETI prior to conception.
Stress fracture of bilateral tibial metaphysis due to ceremonial march training: a case report
Authors: Mustafa Kurklu, Sener Ozboluk, Erden Kilic, Oner Tatar, Huseyin Ozkan, Mustafa Basbozkurt
Journal: Cases J (2010)

Stress fractures are caused by repetitive microtraumas that occur during unusual or increased activities. Clinical suspicion is essential for the diagnosis. A twenty-years old soldier was presented with bilateral knee pain and restriction of knee movements after a period of training for ceremonial march. Although plain X-rays were normal, scintigraphy and MRI revealed stress fractures at metaphyseal region of both tibias. History of a patient presenting with persisting joint or bone pain after an unusual repetitive activity should be delicately inquired. Typical history, although pain might be localized to unusual sites, should raise the suspicion of a stress fracture.
Non-Hodgkin's Lymphoma presenting as deep venous thrombosis; A case report with literature review
Authors: Okba F Ahmed, Fahmi H Kakamad, Abdulwahid M Salih, Mohammed Q Mustafa, Shvan H Mohammed
Journal: Int J Surg Case Rep (2020)
Keywords: deep venous thrombosis, lymphadenopathy, lymphoma
MeSH terms: Case Reports

Introduction:
Idiopathic deep venous thrombosis is a relatively common clinical finding. The aim of this article is to report and discuss a case of lymphoma presented as DVT in line with SCARE guidelines with brief literature review.
Case report:
A 19-year-old male presented with right lower limb swelling for two week duration. Examination showed pitting leg edema with warm tense calf. Hematological investigations showed lymphopaenia. Duplex ultrasound showed DVT of right common femoral vein with inguinal lymphadenopathy. Computed tomography showed inguinal lymphadenopahthy. Histopathological examination of lymph node specimen confirmed the diagnosis of Non-Hodgkin's Lymphoma (Burkett's type).
Discussion:
Several series have documented a significantly higher risk of malignancy in patients with presumed idiopathic DVT. Among such patients, 7.6% have been noted to have a malignancy during follow-up; the incidence of occult malignancy diagnosed within 6-12 months of an idiopathic DVT is 2.2-5.3 times higher than that expected from general population estimates.
Conclusion:
Idiopathic DVT regardless of age should be approached seriously with a special consideration to malignancy, lymphoma could present only with DVT.
Protein-Losing Enteropathy in the Setting of Severe Iron Deficiency Anemia
Authors: Jessica Lacy Yasuda, Paul A Rufo
Journal: J Investig Med High Impact Case Rep (2018)
Keywords: ple, anasarca, anemia, iron deficiency, protein-losing enteropathy, whole cow milk

A 20-month-old boy presented with a 2-week history of pallor and progressive abdominal distention. Nutritional history revealed long-standing excessive cow milk intake. He was subsequently found to be profoundly iron deficient and hypoproteinemic, with an elevated fecal α-1-antitrypsin level and occult blood positive stool, consistent with protein-losing enteropathy. He was treated with cow milk restriction and oral iron supplements, which resulted in resolution of his edema and laboratory anomalies. While small numbers of previous case reports have described the potential association between excessive cow milk intake and severe iron deficiency and protein-losing enteropathy, this constellation of clinical symptoms is infrequently recognized in clinical practice. As iron deficiency is recognized as the most common nutritional deficiency in the United States, it is important to keep excessive cow milk intake in mind when evaluating young children presenting with severe iron deficiency and protein-losing enteropathy.
Totally tubeless outpatient percutaneous nephrolithotomy: initial case report
Authors: Darren Beiko, Meghana Samant, Thomas B McGregor
Journal: Adv Urol (2009)
MeSH terms: Case Reports

We report the first case of totally tubeless outpatient percutaneous nephrolithotomy (PCNL). Our patient was discharged home safely less than 4 hours following uncomplicated PCNL with no nephrostomy tube, ureteral stent, or urethral catheter. Follow-up the next day in clinic confirmed that the procedure was successful, as the patient was clinically well and stone free. To our knowledge, this is the first case report of totally tubeless (no nephrostomy, no ureteral stent) PCNL performed on a truly outpatient basis.
In Vivo Resistance to Ceftolozane/Tazobactam in Pseudomonas aeruginosa Arising by AmpC- and Non-AmpC-Mediated Pathways
Authors: Erik Skoglund, Henrietta Abodakpi, Rafael Rios, Lorena Diaz, Elsa De La Cadena, An Q Dinh, Javier Ardila, William R Miller, Jose M Munita, Cesar A Arias, Vincent H Tam, Truc T Tran
Journal: Case Rep Infect Dis (2018)
MeSH terms: Case Reports

Two pairs of ceftolozane/tazobactam susceptible/resistant P. aeruginosa were isolated from 2 patients after exposure to β-lactams. The genetic basis of ceftolozane/tazobactam resistance was evaluated, and β-lactam-resistant mechanisms were assessed by phenotypic assays. Whole genome sequencing identified mutations in AmpC including the mutation (V213A) and a deletion of 7 amino acids (P210-G216) in the Ω-loop. Phenotypic assays showed that ceftolozane/tazobactam resistance in the strain with AmpCV213A variant was associated with increased β-lactamase hydrolysis activity. On the other hand, the deletion of 7 amino acids in the Ω-loop of AmpC did not display enhanced β-lactamase activity. Resistance to ceftolozane/tazobactam in P. aeruginosa is associated with changes in AmpC; however, the apparent loss of β-lactamase activity in AmpC∆7 suggests that non-AmpC mechanisms could play an important role in resistance to β-lactam/β-lactamase inhibitor combinations.
Uterine Sarcoma Presenting with Sepsis from Clostridium perfringens Endometritis in a Postmenopausal Woman
Authors: Mary J Kao, Madhuchhanda Roy, Josephine Harter, Ryan J Spencer
Journal: Case Rep Obstet Gynecol (2018)
MeSH terms: Case Reports

Clostridium perfringens is an anaerobic gram positive rod that is found in normal vaginal and cervical flora in 1-10% of healthy women. Uterine infection with Clostridium perfringens is seen rarely but is often related to underlying uterine pathology and can progress quickly to sepsis. Early recognition of sepsis, prompt treatment with antibiotics, and source control with surgical management allow for optimal chance of recovery. We present a case of a postmenopausal woman who presented with sepsis, vaginal bleeding, and back pain who was found to have Clostridium perfringens infection in the setting of undifferentiated uterine sarcoma.
Intraocular ossification. Case report
Authors: Ciprian Maftei, Horia Tudor Stanca
Journal: Rom J Ophthalmol (2017)
Keywords: bone formation, intraocular ossification, osseous metaplasia
MeSH terms: Ossification, Heterotopic / etiology, Osteogenesis, Retinal Diseases / etiology, Case Reports, Adult, Eye Evisceration, Female, Humans, Metaplasia, Orbital Implants, Ossification, Heterotopic / diagnosis, Ossification, Heterotopic / surgery, Retinal Detachment / etiology, Retinal Detachment / surgery, Retinal Diseases / diagnosis, Retinal Diseases / surgery

Objective: To report a case of intraocular ossification, describe its particularities and review some of the pathogenesis theories. Methods: We described the case of a 31-year-old woman with a history of perforating trauma ten years before, who presented in our clinic for right eye pain. The patient wanted a cosmetic improvement so an evisceration was proposed. An intraocular hard yellowish mass, which had a histopathological examination, was found intraoperatively. Results: We diagnosed the case as an intraocular ossification, based on the medical history and histopathological specimen examination, which proved to be an ossified structure. Conclusions: In spite of a rare occurrence, our case emphasized the theory that trauma and subsequent neurogenic inflammation could lead to osseous metaplasia.
Ruptured Emphysematous Prostatic Abscess Caused by K1-ST23 Hypervirulent Klebsiella pneumoniae Presenting as Brain Abscesses: A Case Report and Literature Review
Authors: Kensuke Konagaya, Hiroyuki Yamamoto, Tomoyuki Suda, Yusuke Tsuda, Jun Isogai, Hiroyuki Murayama, Yoshichika Arakawa, Hidemitsu Ogino
Journal: Front Med (Lausanne) (2022)
Keywords: epa, k1-st23, klebsiella pneumoniae, ngs, brain abscess, hypervirulent
MeSH terms: Case Reports

Emphysematous prostatic abscess (EPA) is an extremely rare but potentially fatal urinary tract infection (UTI). Here, we describe a case (a 69-year-old male with prediabetes) of ruptured EPA caused by a hypervirulent Klebsiella pneumoniae (hvKp) K1-ST23 strain, presenting as motor aphasia. Our patient presented with ruptured EPA concurrent with various severe systemic pyogenic complications (e.g., urethro-prostatic fistula, ascending UTIs, epididymal and scrotal abscesses, and liver, lung, and brain abscesses). Whole-body computed tomography (CT) and next-generation sequencing (NGS) were useful for the detection of ruptured EPA and its systemic complications, and for identification of K1-ST23 hvKp strains, respectively. Subsequently, the infections were successfully treated with aggressive antimicrobial therapy and multiple surgical procedures. This case highlights the significance of awareness of this rare entity, the clinical importance of CT for the early diagnosis of EPA and the detection of its systemic complications in view of hvKp being an important causative organism of severe community-acquired UTI, and the usefulness of NGS to identify hvKp strains.
Memokath for treating ureteric stricture post cryoablation of renal mass: A case report of rare complication and proposed alternative management
Authors: Ibrahim A Khalil, Nagy Younes, Khalid Awad, Maya Aldeeb, Omar M Aboumarzouk, Khalid Al-Rumaihi, Abdulla Al-Ansari
Journal: Radiol Case Rep (2022)
Keywords: case report, cryoablation, iatrogenic stricture, memokath, small renal mass, ureteral stricture
MeSH terms: Case Reports

The use of cryoablation in the management of small renal masses is widely acceptable. Although rare but ureteral injury during the procedure with subsequent stricture formation can result in devastating effects on renal function. On the other hand, the management of such strictures requires reconstructive surgery as gold standard. Unfortunately, in some cases the reconstructive surgery might not be feasible, and the treatment usually is ureteral stent insertion that need to be changed regularly. Here we present a case of a 53-year-old gentleman who developed an upper ureteric iatrogenic stricture post cryoablation in which the reconstructive surgery was not feasible due to high procedural risk. We used metallic ureteral stent (Memokath) instead of regular ureteral double J stent. We found that if the reconstructive surgery is not possible the usage of Memokath in treating iatrogenic ureteral strictures is associated with better quality of life, lower costs and a similar functional outcome when compared to ureteral double J stent that needs regular frequent changes.
Seronegative Arthritis and Whipple Disease: Risk of Misdiagnosis in the Era of Biologic Agents
Authors: Luca Quartuccio, Ivan Giovannini, Stefano Pizzolitto, Maurizio Scarpa, Salvatore De Vita
Journal: Case Rep Rheumatol (2019)
MeSH terms: Case Reports

We report 2 cases of Whipple disease (WD), previously diagnosed as seronegative polyarthritis and treated for several years with immunosuppressive agents, accordingly. Both cases had been treated over years with cDMARDs and bDMARDs. The first patient was a 48-year-old male, who developed a life-threatening disease characterized by fever, significant weight loss, and bloody diarrhoea, supported with RBC transfusions. The second patient was a 55-year-old man, presenting with arthritis, fever, serositis, lymphadenopathy, thoracic rash, and systemic inflammation; at the beginning he was diagnosed as adult onset Still's disease. He was treated with steroids and antitumour necrosis factor agents, but showed no improvement. Both patients were eventually treated with antimicrobial therapy for WD with dramatic improvement and no clinical relapse in 6 months. This paper reviews the literature on WD mimicking chronic inflammatory arthritis. WD may lead to chronic seronegative arthritis that might often be misrecognized. Importantly, patients treated with bDMARDs and glucocorticoids might develop a life-threatening disease. Therefore, WD should be suspected and excluded in patients showing resistance or frequent recurrence of chronic arthritis, if seronegative, under treatment with bDMARDs, especially in the presence of new, unexpected sign and/or symptoms.
Colorectal Choriocarcinoma in a Patient with Probable Lynch Syndrome
Authors: Viktor H Koelzer, Karl Steuer, Ulrike Camenisch Gross, Dieter Zimmermann, Aino Paasinen-Sohns, Kirsten D Mertz, Gieri Cathomas
Journal: Front Oncol (2016)
Keywords: lynch syndrome, ataxia telangiectasia mutated, choriocarcinoma, colorectal cancer, microsatellite instability, molecular pathology, next-generation sequencing, personalized medicine
MeSH terms: Case Reports

Background:
Personalized therapy of colorectal cancer is influenced by morphological, molecular, and host-related factors. Here, we report the comprehensive clinicopathological and molecular analysis of an extra-gestational colorectal choriocarcinoma in a patient with probable Lynch syndrome.
Case presentation:
A 61-year-old female with history of gastric cancer at age 36 presented with a transmurally invasive tumor of the right hemicolon and liver metastasis. A right hemicolectomy was performed. Histopathological analysis showed a mixed trophoblastic and syncytiotrophoblastic differentiation, consistent with choriocarcinoma. Disease progression was rapid under oxaliplatin, capecitabine, irinotecan, and bevacizumab. Molecular phenotyping identified loss of mismatch-repair protein immunostaining for PMS2, microsatellite instability, a lack of MLH1 promoter methylation, and lack of BRAF mutation suggestive of Lynch syndrome. Targeted next-generation sequencing revealed an ataxia telangiectasia mutated (p.P604S) missense mutation. A bleomycin, etoposide, and cisplatin treatment protocol targeting germ cell neoplasia lead to disease remission and prolonged survival of 34 months.
Conclusion:
Comprehensive immunohistochemical and genetic testing is essential to identify uncommon cancers possibly related to Lynch syndrome. For rare tumors, personalized therapeutic approaches should take both molecular and morphological information into account.
Dramatic Response of Lupus Enteritis, Nephritis, and Pancytopenia to Plasmapheresis and Rituximab
Authors: Adan Aftab, Nida Saleem, Syed Farhat Abbas, Zafar Ullah, Muhammad Haneef
Journal: Case Rep Gastrointest Med (2022)
MeSH terms: Case Reports

Background:
Although lupus enteritis is a rare manifestation of systemic lupus erythematosus yet results in significant distress. This disorder contributes to diagnostic and therapeutic dilemma leading to enhanced mortality. Case Description. We report a case history of a 29-year-old female who presented with severe abdominal pain, watery stools, and vomiting, and later on, she developed pancytopenia and renal impairment. On intensive workup, diagnosis of lupus-associated enteritis, nephritis, and pancytopenia was discovered. She improved drastically on initiation of plasmapheresis followed by low-dose intravenous rituximab. One year posttreatment, she remained in complete remission.
Conclusion:
From this case, it can be suggested that in a young female with intractable abdominal pain, the remote possibility of lupus enteritis must be kept in mind. Besides this, plasmapheresis can have a potential role in refractory lupus enteritis. Furthermore, low-dose intravenous rituximab can be a safe and cost-effective treatment option in achieving sustained remission of clinical and laboratory parameters in lupus enteritis.