OpenMed/multicare-articles huggingface dataset:
Retroperitoneal Necrotizing Fasciitis from Fournier's Gangrene in an Immunocompromised Patient
Authors: Samuel B Weimer, Marc R Matthews, Daniel M Caruso, Kevin N Foster
Journal: Case Rep Surg (2017)
MeSH terms: Case Reports

Introduction:
Necrotizing fasciitis (NF) is a devastating soft tissue disease causing fulminant clinical deterioration, and extension into the retroperitoneum has a high mortality rate. This disease process demands a strong clinical suspicion for early identification which must be coupled with frequent wide surgical debridements and intravenous antibiotics for improved outcomes. Various clinical risk factors may render a weakness in the patient's immune status including diabetes mellitus, chronic renal failure, obesity, and autoimmune disorders, such as a human immunodeficiency virus (HIV) infection.
Case report:
A 55-year-old male presented with hypotension requiring a large intravenous fluid resuscitation and vasopressors. He was diagnosed with the human immunodeficiency virus upon presentation. A computerized tomographic scan revealed air and fluid in the perineum and pelvis, ascending into the retroperitoneum. Multiple surgical debridements to his perineum, deep pelvic structures, and retroperitoneum were completed. After colostomy placement, antibiotic administration, and wound care, he was closed using split-thickness skin grafting.
Conclusion:
NF is a sinister and fulminant disease requiring prompt diagnosis and surgical intervention. The best chance for survival occurs with emergent surgical debridement and appropriate intravenous antibiotics. While retroperitoneal NF is consistent with uniformly poor outcomes, patients are best treated in an American Burn Association-verified burn center.
Trichobezoar: Ravenous for Hair
Authors: Akshay Prasad, Atul Jain, Akash Gupta, Aman Kamra
Journal: Euroasian J Hepatogastroenterol (2018)
Keywords: bezoar, rapunzel syndrome, trichobezoars, trichophagia
MeSH terms: Case Reports

Trichophagia is the habit of chewing hair. On an average, only 1% patients with trichophagia develop trichobezoar. They are usually symptomless until they reach a large size. It is common in young females usually with an underlying psychiatric disorder. The gold standard for diagnosis is upper gastrointestinal endoscopy (UGIE). Here we present a case of trichobezoar in an 11-year-old girl who presented in the emergency with complaint of pain abdomen and symptoms of obstruction.
Key messages:
A high index of suspicion among physician can lead to early diagnosis and management in these cases (trichobezoar).How to cite this article: Prasad A, Jain A, Gupta A, Kamra A. Trichobezoar: Ravenous for Hair. Euroasian J Hepato-Gastroenterol 2018;8(1):97-98.
Malignant trigeminal nerve sheath tumor and anaplastic astrocytoma collision tumor with high proliferative activity and tumor suppressor p53 expression
Authors: Maher Kurdi, Hosam Al-Ardati, Saleh S Baeesa
Journal: Case Rep Pathol (2014)

Background. The synchronous development of two primary brain tumors of distinct cell of origin in close proximity or in contact with each other is extremely rare. We present the first case of collision tumor with two histological distinct tumors. Case Presentation. A 54-year-old woman presented with progressive atypical left facial pain and numbness for 8 months. MRI of the brain showed left middle cranial fossa heterogeneous mass extending into the infratemporal fossa. At surgery, a distinct but intermingled intra- and extradural tumor was demonstrated which was completely removed through left orbitozygomatic-temporal craniotomy. Histopathological examination showed that the tumor had two distinct components: malignant nerve sheath tumor of the trigeminal nerve and temporal lobe anaplastic astrocytoma. Proliferative activity and expressed tumor protein 53 (TP53) gene mutations were demonstrated in both tumors. Conclusions. We describe the first case of malignant trigeminal nerve sheath tumor (MTNST) and anaplastic astrocytoma in collision and discuss the possible hypothesis of this rare occurrence. We propose that MTNST, with TP53 mutation, have participated in the formation of anaplastic astrocytoma, or vice versa.
A Rare Case of Steroid Cell Tumor, Not Otherwise Specified (NOS), of the Ovary in a Young Woman
Authors: Eek Chaw Tan, Chit Chong Khong, Kazila Bhutia
Journal: Case Rep Obstet Gynecol (2019)
MeSH terms: Case Reports

Steroid cell tumour is a rare sex cord-stromal tumor of the ovary. It may produce steroids and is associated with testosterone secretion which causes symptoms like hair loss, hirsutism, and oligomenorrhea/amenorrhea due to hormonal activity and virilizing properties of tumor. In this article, we reported a 27-year-old woman who presented with hirsutism, hoarseness of voice, scalp hair fall, and amenorrhea for 8 years. Clinical and diagnostic evaluation revealed a left adnexal mass and elevated serum levels of testosterone and she was diagnosed as having a Sertoli Leydig cell tumour of ovary. She underwent left salpingooophorectomy and both histopathological examination and immunohistochemistry confirmed the diagnosis. Her serum testosterone levels normalized 3 days after the surgery and her menses resumed spontaneously a few months after the operation. In addition, we reviewed the literature on the epidemiology, clinical presentations, imaging and histological findings, and the treatment options on this disease.
SILS Incisional Hernia Repair: Is It Feasible in Giant Hernias? A Report of Three Cases
Authors: Umut Barbaros, Tugrul Demirel, Aziz Sumer, Ugur Deveci, Mustafa Tukenmez, Mehmet Ibrahim Cansunar, Murat Kalayci, Ahmet Dınccag, Ridvan Seven, Selcuk Mercan
Journal: Diagn Ther Endosc (2011)
MeSH terms: Case Reports

Aim. Three incisional ventral abdominal wall hernias were repaired by placing a 20 × 30 cm composite mesh via single incision of 2 cm. Methods. All three cases had previous operations and presented with giant incisional defects clinically. The defects were repaired laparoscopically via single incision with the placement of a composite mesh of 20 × 30 cm. Nonabsorbable sutures were needed to hang and fix the mesh only in the first case. Double-crown technique was used in all of the cases to secure the mesh to the anterior abdominal wall. Results. The mean operation time was 120 minutes. The patients were mobilized and led for oral intake at the first postoperative day. No morbidity occurred. Conclusion. Abdominal incisional hernias can be repaired via single incision with a mesh application in experienced centers.
Rare Development of Primary Parotid Gland Epithelial-Myoepithelial Carcinoma in a Child
Authors: Daniyah Saleh, Doaa Al Ghamdi
Journal: Case Rep Pathol (2020)
MeSH terms: Case Reports

Salivary gland tumors are uncommon in children. They consist of variable histopathological subtypes of benign and malignant tumors. EMC is a discrete entity among the WHO classification of salivary gland tumors since 1991. EMC is considered a low-grade malignant salivary gland tumor arising from intercalated ducts. Typically, it affects an adult female individual. Surgical resection with a negative margin is the mainstay treatment option. EMC has a potential for metastasis with a high rate of recurrence. Based on the available English literature, two cases of EMC diagnosed in a pediatric age group have been reported. Therefore, we describe the third EMC that developed in the left parotid gland of a young child. The diagnosis of EMC was established through histopathological examination of the total parotidectomy specimen and neck lymph node dissection, together with ancillary studies. Later, the patient suffered from cervical lymph node enlargement due to metastasis in which FNAB was taken. Metastasis from the known EMC was suspected with cytomorphological features in smears and cell block. Immunohistochemistry markers for the biphasic components were supportive of EMC. Due to advanced disease, the patient necessitated a concomitant treatment of radiochemotherapy. Besides, there was radiological evidence of bilateral multiple lung metastatic nodules. However, a biopsy was not sent for pathological confirmation.
Silica Desiccant Canister: An Unusual Colonic Foreign Body
Authors: Rajarajeshwari Ramachandran, Vikash Kumar, Giovannie Isaac-Coss, Denzil Etienne
Journal: Case Rep Gastrointest Med (2022)
MeSH terms: Case Reports

We are reporting a case of incidental identification and removal of two silica desiccant canisters from the cecum in a patient undergoing screening colonoscopy.
Acute psychotic episode inaugurating a primary hyperaldosteronism: a case report
Authors: Wiame El Bouchalli, Kaouthar El Mir, Salah-Eddine El Jabiry, Mohammed Berrimi
Journal: Pan Afr Med J (2022)
Keywords: acute psychotic episode, conn’s adenoma, case report, primary hyperaldosteronism
MeSH terms: Adrenal Gland Neoplasms / surgery, Hyperaldosteronism / diagnosis, Hyperaldosteronism / etiology, Hypertension / complications, Hypokalemia / etiology, Case Reports, Adrenalectomy, Aldosterone, Humans, Aldosterone

Psychiatrist manifestations-especially acute psychotic episode-of primary hyperaldosteronism is not very common in the scientific literature. The main symptoms are high blood pressure and hypokalemia, the diagnosis seems to be based on the determination of aldosterone and plasma renin activity, also the treatment includes majorly adrenalectomy. The take-away lesson from this case is to think of organic cause in front of acute psychotic episode.
Long-Lasting Unruptured Large Intracranial Aneurysm in Bilateral Moyamoya Disease: Case Report
Authors: Eunyoung Chae, Soomin Jeong, Chan-Hyuk Lee
Journal: Case Rep Neurol Med (2022)
MeSH terms: Case Reports

Introduction:
The rupture risk of intracranial aneurysms in patients with moyamoya disease is higher than that in the general population. We report a confirmed case of moyamoya disease with bilateral middle cerebral artery (MCA) occlusion with a large and long-lasting aneurysm.
Case:
A 71-year-old woman visited the clinic with a large intracranial aneurysm. The patient was diagnosed with an ischemic stroke 2 months ago. She exhibited weakness in the left upper and lower extremities and dysarthria and was taking aspirin. The brain magnetic resonance imaging showed complete occlusion in the bilateral MCA proximal (M1) and a large 11 × 11 mm nonruptured cerebral aneurysm in the A3 segment of the left anterior cerebral artery. On transfemoral cerebral angiography, the patient was diagnosed with Suzuki grade VI moyamoya disease with bilateral MCA occlusion. After 7 years, the cerebral aneurysm size further increased, but it remained unruptured.
Conclusions:
Here, the patient had moyamoya disease with a large aneurysm, but aneurysmal rupture did not occur even after 7 years. Our case report might help in understanding the mechanisms of cerebral aneurysm occurrence and rupture in moyamoya patients.
AIDS Cholangiopathy in an Asymptomatic, Previously Undiagnosed Late-Stage HIV-Positive Patient from Kenya
Authors: Yiming Gao, Kathryn Chin, Yehia Y Mishriki
Journal: Int J Hepatol (2011)
MeSH terms: Case Reports

AIDS-associated cholangiopathy is a form of biliary tract inflammation with stricture formation seen in AIDS patients who are severely immunosuppressed. It is no longer common in countries in which HAART therapy is widely employed but is still seen in underdeveloped countries. The majority of patients are symptomatic at the time of presentation. Herein, we describe a seventy-four-year-old woman who presented with unilateral leg swelling after a prolonged airplane flight. She was otherwise entirely asymptomatic. Routine laboratory testing was notable for a hypochromic microcytic anemia, slight leukopenia, and mild hypoalbuminemia. Liver enzymes were all elevated. Deep venous thrombosis was confirmed, and a CT scan of the chest disclosed no pulmonary emboli. However, the visualized portion of the abdomen showed dilatation of the common bile and pancreatic ducts. This was confirmed on ultrasonography and MRCP, and no obstructive lesions were noted. An ERCP revealed a dilated common bile duct without filling defects or strictures. A balloon occlusion cholangiogram showed strictures and beading of the intrahepatic ducts. Shortly thereafter, serology for HIV returned positive along with a depressed CD4 cell count, and the patient was diagnosed with AIDS-associated cholangiography.
Checkpoint Inhibition May Trigger the Rare Variant of Anti-LAD-1 IgG-Positive, Anti-BP180 NC16A IgG-Negative Bullous Pemphigoid
Authors: Christian D Sadik, Ewan A Langan, Victoria Grätz, Detlef Zillikens, Patrick Terheyden
Journal: Front Immunol (2019)
Keywords: lad-1, bullous pemphigoid, checkpoint inhibitors, melanoma, nivolumab, skin inflammation
MeSH terms: Antineoplastic Agents, Immunological / adverse effects, Autoantigens / genetics, Autoantigens / immunology, Immunoglobulin G / immunology, Non-Fibrillar Collagens / genetics, Non-Fibrillar Collagens / immunology, Pemphigoid, Bullous / diagnosis, Pemphigoid, Bullous / etiology, Case Reports, Aged, Antineoplastic Agents, Immunological / therapeutic use, Autoantibodies / immunology, Enzyme-Linked Immunosorbent Assay, Female, Fluorescent Antibody Technique, Humans, Immunoglobulin G / blood, Immunosuppressive Agents / therapeutic use, Melanoma / complications, Melanoma / drug therapy, Non-Fibrillar Collagens / antagonists & inhibitors, Pemphigoid, Bullous / drug therapy, Skin / immunology, Skin / pathology, Treatment Outcome, Antineoplastic Agents, Immunological, Autoantibodies, Autoantigens, Immunoglobulin G, Immunosuppressive Agents, Non-Fibrillar Collagens, collagen type XVII

Bullous pemphigoid (BP) is an autoimmune blistering skin disease characterized by an autoimmune response to type XVII collagen (BP180). The generation of anti-BP180-NC16A IgG autoantibodies is considered to be central to the pathogenesis of BP, in part due to the close correlation between serum concentration and disease activity. However, ~60% of BP patients also generate IgG autoantibodies against LAD-1, the soluble 120 kDa ectodomain of BP180. Whilst the pathogenic significance of anti-LAD-1 IgG remains unclear, it may be sufficient to precipitate the development of BP, even in the absence of anti-BP180-NC16A IgG, based on several case reports in Japanese patients. There is increasing recognition that immune-checkpoint inhibitors may trigger and/or exacerbate BP as an immune-related adverse event (irAE). Until now, all of these cases have been associated with the induction of anti-BP180-NC16A IgG. Here, we report the case of a female Caucasian patient who developed BP during treatment with the programmed cell death protein 1 (PD-1) inhibitor nivolumab. Intriguingly, the patient exclusively generated anti-LAD-1 IgG, suggesting that anti-LAD-1 IgG was responsible for the development of her autoimmune blistering dermatosis. This is the first such case documented in a non-Japanese patient, thus, lending further support to the pathogenic relevance of anti-LAD-1 IgG in BP.
Case Report: Dural Dissection With Ventral Spinal Fluid-Filled Collection in Superficial Siderosis: Insights Into the Pathology From Anterior-Approached Surgical Cases
Authors: Toshitaka Yoshii, Takashi Hirai, Satoru Egawa, Motonori Hashimoto, Yu Matsukura, Hiroyuki Inose, Nobuo Sanjo, Takanori Yokota, Atsushi Okawa
Journal: Front Neurol (2022)
Keywords: anterior approach, dural closure, dural dissection, fluid-filled collection, inner layer dural dissection in superficial siderosis 2, superficial siderosis
MeSH terms: Case Reports

Superficial siderosis (SS) of the central nervous system is a rare disease caused by chronic and repeated hemorrhages in the subarachnoid space. Recently, attention has been paid on the association of SS and dural defect with ventral fluid-filled collection in the spinal canal (VFCC). The pathophysiology of hemosiderin deposition in patients with SS and dural defects is still unclear. However, previous studies have suggested the possible mechanism: cerebrospinal fluid (CSF) leaks into the epidural space through the ventral dural defect, and repetitive bleeding occurs from the epidural vessels that circulate back to the subarachnoid space through the dural defect, leading to hemosiderin deposition on the surface of the brain, the central nerves, and the spinal cord. Previously, the surgical closure of dural defect via the posterior approach has been reported to be effective in arresting the continued subarachnoid bleeding and disease progression. Herein, we describe SS cases whose dural defects were repaired via the anterior approach. From the direct anterior approach to the ventral dural defect findings, we confirmed that the outer fibrous dura layer is intact, and the defect is localized in the inner thin layer. From the findings of this study, our proposed theory is that dural tear at the inner dural layer causes "dural dissection," which is likely to occur between the outer fibrous layer and inner dural border cellular layer. Bleeding from the vessels between the inner and outer Line 39-40 dural layers seems to be the pathology of SS with dural defect.
Multiple myeloma with intracranial and spinal intradural metastasis: A case report
Authors: Wei-Lin Hsu, Jeng-Hung Guo, Ying-Ying Hung, Der-Yang Cho, Der-Cherng Chen
Journal: Biomedicine (Taipei) (2020)
Keywords: hydrocephalus, intracranial, intradural, multiple myeloma, spine
MeSH terms: Case Reports

Multiple myeloma is a hematopoietic cancer that is multicentric and most commonly involves the spine. Multiple myeloma with extraosseous and intradural involvement is an extremely rare condition. Here we present a rare case of spinal multiple myeloma with intracranial and spinal intradural metastasis causing lumbar spinal nerve compression. We present a 60-year-old woman with progressive weakness of the lower limbs for several weeks. Spinal magnetic resonance imaging (MRI) showed a leptomeningeal tumor with nodularity spreading within the cauda equina. Examination of the brain using MRI showed a lytic skull bone lesion and leptomeningeal enhancement. The patient underwent L3-5 laminectomy. Immunohistological staining confirmed a diagnosis of multiple myeloma of the IgA kappa subtype. After surgery, the patient underwent chemotherapy and rehabilitation exercises. Multiple myeloma has a median survival of 2.5 years, while 75% of patients with spinal involvement die within 1 year of diagnosis. Unfortunately, our patient died 3 months after the diagnosis of multiple myeloma with spinal and intracranial involvement. Intracranial and spinal intradural multiple myeloma invasions are quitely rare. Spine biopsies and cerebrospinal fluid cytology can aid in the diagnosis. Early surgical decompression is necessary, especially when neurological deficits occur.
Invasive Aspergillus niger Is the Sole Etiological Agent for CSOM : A Clinical Case from Nepal
Authors: Ajay Kumar Chaurasiya, Rabindra Bhakta Pradhananga, Niranjan Prasad Sah, Basista Prasad Rijal, Bharat Mani Pokhrel, Santosh Dulal
Journal: Case Rep Infect Dis (2021)
MeSH terms: Case Reports

Aspergillus causing chronic suppurative otitis media (CSOM) is rare in immunocompetent people; however, it can occur as a significant opportunistic pathogen in immunocompromised patients. Here, in our study, a 53-year-old diabetic patient having a history of CSOM visited the Department of Otorhinolaryngology-Head and Neck Surgery (ENT-HNS), Tribhuvan University and Teaching Hospital (TUTH), Nepal, in March 2016. Although he was on medication with an antibacterial ear drop from the last 10 days, his right ear was presented with otorrhea, pruritus, otalgia, aural fullness, hearing impairment, and tinnitus from the last 3-4 months. Preliminarily, otoscopy of the right ear revealed the presence of fungal mass. For further diagnosis, ear discharge was aseptically collected and sent to the laboratory to confirm the etiological agents. Findings of laboratory analysis indicated that Gram staining of aural discharge displayed pus cells with fungal spores but did not exhibit bacteria. Furthermore, potassium hydroxide (KOH) mount revealed the presence of fungal spores and septate hyphae with the characteristic of dichotomous branching. Culture in four different bacterial media (chocolate agar, blood agar, MacConkey agar, and Robertson's cooked meat medium) has unveiled no bacterial growth. However, fungal growth was observed in both bacterial and fungal media. Thereafter, the fungal colony was investigated via a lactophenol cotton blue (LPCB) tease mount which displayed the structure of Aspergillus. Aspergillus niger was microbially conformed by specifically characterizing the specific phenotypic biseriate structure of phialides and the black-coloured conidia. For medication, the patient was treated with Candid Ear Drop with clotrimazole (1% w/v) plus lidocaine (2% w/v) for 4 weeks which successfully improved his condition.
WU polyomavirus in respiratory epithelial cells from lung transplant patient with Job syndrome
Authors: Erica A Siebrasse, Diana V Pastrana, Nang L Nguyen, Annie Wang, Mark J Roth, Steven M Holland, Alexandra F Freeman, John McDyer, Christopher B Buck, David Wang
Journal: Emerg Infect Dis (2015)
MeSH terms: Job Syndrome / virology, Polyomavirus Infections / diagnosis, Respiratory Mucosa / virology, Case Reports, Research Support, N.I.H., Extramural, Research Support, U.S. Gov't, Non-P.H.S., Adult, Female, HEK293 Cells, Humans, Job Syndrome / surgery, Lung Transplantation, Polyomavirus / genetics, Polyomavirus / isolation & purification, Polyomavirus Infections / virology

We detected WU polyomavirus (WUPyV) in a bronchoalveolar lavage sample from lungs transplanted into a recipient with Job syndrome by using immunoassays specific for the WUPyV viral protein 1. Co-staining for an epithelial cell marker identified most WUPyV viral protein 1-positive cells as respiratory epithelial cells.
Macular hole and submacular hemorrhage secondary to retinal arterial macroaneurysm - successfully treated with a novel surgical technique
Authors: Ramin Nourinia, Nazanin Behnaz, Hossein Hassanpour, Zahra Karjoo, Kiana Hassanpour
Journal: GMS Ophthalmol Cases (2020)
Keywords: macular hole, pars plana vitrectomy, recombinant tissue plasminogen activator, submacular hemorrhage
MeSH terms: Case Reports

Purpose: To present a 65-year-old patient with macular hole (MH) and submacular hemorrhage (SMH) secondary to a ruptured retinal arterial macroaneurysm (RAM) which was successfully treated with a novel surgical technique. Patient: A 65-year-old woman presented with a 1-week history of sudden-onset visual loss in her right eye. Her best-corrected visual acuity (BCVA) was hand motion in the right eye. Her fundus examination revealed intraretinal and massive subretinal hemorrhage with macular involvement. An MH with an approximate diameter of 600 microns was also noted. The patient was treated by a standard pars plana vitrectomy (PPV) and internal limiting membrane (ILM) peeling, followed by 10 µg recombinant tissue plasminogen activator injection into the submacular space via the MH with a 25-gauge vitrectomy probe. BCVA of the patient increased to 20/320 and 20/60, one and four weeks after surgery, respectively. Optical coherence tomography (OCT) images confirmed the complete anatomical closure of the MH and the restoration of the outer retinal layers such as the external limiting membrane and the ellipsoid zone. Conclusion: This case report expands our knowledge about the management of MH in combination with SMH after a ruptured RAM. We suggest the use of a vitrectomy probe and MH for subretinal recombinant tissue plasminogen activator (rtPA) injection.