OpenMed/multicare-articles huggingface dataset:
An Unusual Cause of Spontaneous Pneumomediastinum: The Mounier-Kuhn Syndrome
Authors: Salim Naciri, Rachida Zahraoui, Mouna Soualhi, Jamal-Eddine Bourkadi
Journal: Case Rep Pulmonol (2019)
MeSH terms: Case Reports

Mounier-Kuhn syndrome is a rare clinical and radiologic condition. It is characterized by tracheal and bronchial dilation. Diagnosis is made by computed tomography and bronchoscopy. An 81-year-old man presenting with an acute chest pain was referred to the pulmonology department. His chest computed tomographic scan showed a tracheobronchomegaly with an increase in the diameter of both the trachea and right and left main bronchi, associated with pneumomediastinum and fibrosis. Fiberoptic bronchoscopy revealed enlarged trachea and both main bronchi. These findings are consistent with a diagnosis of Mounier-Kuhn syndrome. Besides considering this long-neglected "orphan disease" when diagnosing spontaneous pneumomediastinum, clinicians should also be aware of an underlying Mounier-Kuhn syndrome in patients with recurrent respiratory infections, in order to avoid complications associated with the disease.
Arteriovenous malformations of the colon: A report of two cases and review of the literature
Authors: Ghodratollah Maddah, Abbas Abdollahi, Omid Rouhbakhshfar, Shirin Taraz Jamshidi, Masoumeh Hassanpour
Journal: Caspian J Intern Med (2017)
Keywords: arteriovenous malformations, cavernous, gastrointestinal hemorrhage, hemangioma
MeSH terms: Case Reports

Background:
Arteriovenous malformations are one of the most common vascular disorders of the colon. Vascular disorders present as painless, high-volume rectal bleeding.
Case presentation:
This study elucidates two rare cases of vascular disorders that are diagnosed as angiodysplasia of the left colon and cavernous hemangioma of the colon and rectum. The chief complaint in two patients was rectorrhagia. The patients who were diagnosed of ulcerative colitis were treated with sulfadiazine and prednisone. Due to continuous bleeding, the patients were referred to the surgery department for operation. The patients underwent total proctocolectomy.
Conclusion:
We discuss the faults in the diagnosis and management of vascular disorders of the intestine.
Treatment of Recurrent Undifferentiated Pleomorphic Sarcoma of Infratemporal Fossa by Surgery Combined With Carbon Ion Radiotherapy: One Case Report
Authors: Zaixing Wang, Zhiyuan Tang, Hailiang Zhao, Xianhai Zeng, Xiaodong Han, Qiuhang Zhang
Journal: Front Surg (2021)
Keywords: infratemporal fossa, operation combined with carbon-ion radiotherapy, otolaryngology head and neck surgery, recurrent, undifferentiated pleomorphic sarcoma

We retrospectively analyzed the diagnosis and treatment process of one patient with recurrent undifferentiated pleomorphic sarcoma (UPS) of infratemporal fossa and made a definite diagnosis by combining the imaging and pathological examination results. After treatment failure with 2 cycles of chemotherapy and several surgeries, UPS was eventually treated by surgery + carbon ion radiotherapy, and MRI reexamination showed no relapse. Head and neck UPS is located deeply, easily recurs after operation, and difficult to be resected completely by surgery, with a gradually shortened interval of relapse over the number of surgeries, which becomes a treatment challenge. After the last surgery, the patient received carbon ion radiotherapy, with a good therapeutic effect, and no sign of relapse just before sending this article. Based on the above advantages, we have concluded that surgery + carbon ion radiotherapy is a new effective pathway to treat head and neck UPS.
Adrenal cancer in neurofibromatosis type 1: case report and DNA analysis
Authors: Ravi Kumar Menon, Francesco Ferrau, Tom R Kurzawinski, Gill Rumsby, Alexander Freeman, Zahir Amin, Márta Korbonits, Teng-Teng L L Chung
Journal: Endocrinol Diabetes Metab Case Rep (2014)

Adrenal cortical carcinoma (ACC) has previously only been reported in eight patients with type 1 neurofibromatosis (NF1). There has not been any clear evidence of a causal association between NF1 gene mutations and adrenocortical malignancy development. We report the case of a 49-year-old female, with no family history of endocrinopathy, who was diagnosed with ACC on the background of NF1, due to a novel germline frame shift mutation (c.5452_5453delAT) in exon 37 of the NF1 gene. A left adrenal mass was detected by ultrasound and characterised by contrast computerised tomography (CT) scan. Biochemical tests showed mild hypercortisolism and androgen excess. A 24-h urinary steroid profile and (18)flouro deoxy glucose PET suggested ACC. An open adrenalectomy was performed and histology confirmed ACC. This is the first reported case with DNA analysis, which demonstrated the loss of heterozygosity (LOH) at the NF1 locus in the adrenal cancer, supporting the hypothesis of an involvement of the NF1 gene in the pathogenesis of ACC. LOH analysis of the tumour suggests that the loss of neurofibromin in the adrenal cells may lead to tumour formation.
Learning points:
ACC is rare but should be considered in a patient with NF1 and adrenal mass when plasma metanephrines are normal.Urinary steroid metabolites and PET/CT are helpful in supporting evidence for ACC.The LOH at the NF1 region of the adrenal tumour supports the role of loss of neurofibromin in the development of ACC.
Case report of a huge lower lip cancer successfully treated with intra-arterial infusion chemotherapy
Authors: Yen Ting Sheen, Yu Yuan Chen, Maw Chang Sheen
Journal: Int J Surg Case Rep (2020)
Keywords: case report, lip cancer, methotrexate, squamous cell carcinoma, surgery
MeSH terms: Case Reports

Introduction:
We present a difficult case of huge squamous cell carcinoma (SCC) of lower lip that was successfully treated by intra-arterial infusion with methotrexate (MTX).
Presentation of case:
This 42-year-old female patient present with a fungating lower lip SCC of approximately 10 × 5 cm in size. MTX 25 mg was infused continuously to each side of external carotid artery every 24 h using two portable pumps. Totally, MTX 300 mg was given over 6 days. After treatment initiation, the tumor shrank dramatically and disappeared completely 2 months after the therapy. The patient was now recurrence-free at the recent follow-up 4 and half years after therapy.
Discussion:
Intra-arterial infusion chemotherapy has the advantage of delivering a high concentration of anticancer drug to the lesion to induce a rapid shrinkage of the tumor and the side effects are limited. Intra-arterial infusion with MTX achieves good tumor response to lower lip cancer with excellent anatomical and functional preservation.
Conclusion:
This therapy may be a treatment option in lower lip cancers with unresectable lesions, or in those patients who are unwilling to undergo resection.
Undiagnosed Abdominal Term Pregnancy with Good Neonatal Outcome
Authors: Phoy Cheng Chun, Ka-Hee Chua, Mohamed Siraj Shahul Hameed, Manisha Mathur, Wai Kheong Ryan Lee
Journal: Case Rep Obstet Gynecol (2019)
MeSH terms: Case Reports

Abdominal pregnancy is a rare occurrence and it represents only 1% of ectopic pregnancy. We report a case of an abdominal pregnancy that resulted in a term live baby. Diagnosis is unsurprisingly difficult in advanced gestation. A high index of suspicion detailed clinical and imaging examinations are needed to make the diagnosis. Multidisciplinary team involvement is crucial in the management of abdominal pregnancy.
Vegan triple-ironman (raw vegetables/fruits)
Authors: Roman Leischik, Norman Spelsberg
Journal: Case Rep Cardiol (2014)

Endurance sport requires a healthy and balanced diet. In this case report we present the findings of an ultra-triathlete (three times Ironman, means 11.4 km swim, 540 km bike, 125 km run in 41:18 h as a whole) living on a raw vegan diet and having finished the competitions under these nutritional conditions. To this end, the vegan ultra triathlete and a control group of 10 Ironman triathletes of similar age living on a mixed diet were investigated, using echocardiography and spiroergometry. In addition, blood samples were taken from the vegan athlete both in the sporting season and in the off-season. The vegan athlete showed no signs of dietary deficiencies or impaired health. In comparison with the control group, the vegan athlete showed a higher oxygen intake at the respiratory compensation point. This case demonstrates that even top-class sporting performance, like that of a three-time Ironman, is possible on a vegan diet. Whether a vegan diet offers advantages or disadvantages for the performance of endurance athletes remains an open question.
Rare Presentation of Hypoglycemia in a Patient with Anaplastic Large-Cell Lymphoma
Authors: Raed Aldahash
Journal: Case Rep Endocrinol (2021)
MeSH terms: Case Reports

Anaplastic large-cell lymphoma is a rare type of aggressive non-Hodgkin's lymphoma, and arriving at a final diagnosis for this tumor is a challenge for the healthcare providers. Usually, it involves the lymph nodes and extranodal tissues such as the lungs, skin, and other soft tissues. Its presentation by extending into different organs such as the liver, lungs, bones, spleen, and thyroid is rare. Thus, involvement of other organs is very rare as we found in a 54-year-old male patient, a known case of hypertension and end-stage renal disease who was on hemodialysis, who presented to the emergency department with a history of generalized weakness and weight loss of about 20 kg for two months. The tumor cells are positive for CD45, CD30, CD15, MUMi, and Ki-67 (80%) and negative for CD20, PAX-5, CD79a, CD3, CD5, CD10, BCL6, BCL2, EMA, ALK-1, and CD138. The patient was hypoglycemic and hypercalcemic and was managed accordingly. The patient was evaluated, and the third assessment showed that hypoglycemia was resolved due to dexamethasone. The patient's glucose storage was depleted most likely due to liver involvement plus poor general condition. It was asserted that the patient's hypoglycemia could be related to his underlying malignancy. Also, the patient was advised to start tablet diazoxide 45 mg three times a day (3 mg/kg/day TID) in addition to levothyroxine tablet 50 mcg once a day. Tablet diazoxide was stopped, and nutritional support was recommended. This case reveals a rare systematic ALK-1-negative anaplastic large-cell lymphoma that involves multiple organs. The main learning point from this report is that these tumors can present atypically even in adults and can be ALK-1 negative, which is contrary to the typical systematic anaplastic large-cell lymphomas that are positive for ALK.
Atypical Presentation of Acute Coronary Syndrome-Not ST Elevation: A Case Report
Authors: Nicola Vitulano, Graziano Riccioni, Antonio Trivisano, Carlo Palumbo, Linda D'aloia, Elena Ricci Barbini, Nino Leone, Miriam Placentino, Silvia Cappetti, Pierluigi Pellegrino, Rocco Perrella, Vincenzo Ferrara, Gaetano Prencipe, Lorenzo Pellegrino, Matteo Melchionda, Matteo Vitulano
Journal: Case Rep Med (2012)
MeSH terms: Case Reports

We describe the unexpected case of a 70-year-old man, with medical history of ischemic heart disease and surgery for aneurysm of abdominal aorta, who comes to the emergency department complaining of low-back pain without other symptoms or signs of organic failure. After a few hours we see a deterioration of physical conditions with pulmonary oedema, increase of blood pressure, changing in the ECG pattern, and worsening of left ventricular function with progressive increase of biomarkers for myocardial necrosis. So this pain has revealed the premature symptom of an acute coronary syndrome (ACS). After a short time a subsequent cardiac arrest complicates the clinical situation. After resuscitation, the patient undergoes successfully to coronary angiography and performed a percutaneous transluminal coronary angioplasty (PTCA).
Esophageal Rupture Presenting with ST Segment Elevation and Junctional Rhythm Mimicking Acute Myocardial Infarction
Authors: Wytch Rigger, Raymond Mai, P Tim Maddux, Stuart Cavalieri, Joe Calkins
Journal: Case Rep Crit Care (2021)
MeSH terms: Case Reports

Esophageal rupture is a rare but potentially fatal cause of chest pain. The presentation is variable and can mimic other conditions such as aortic dissection, pulmonary embolism, and myocardial infarction (MI). A 71-year-old male with a history of coronary artery disease presented to the ED with complaints of acute chest pain and respiratory distress. Over the next 48 hours, the patient developed dynamic ST segment changes on surface electrocardiogram mimicking an inferolateral ST segment elevation MI accompanied by a junctional rhythm. Curiously, his cardiac enzymes remained negative during this time, but his clinical status continued to deteriorate. A subsequent CT scan demonstrated a lower esophageal rupture, and the patient underwent successful endoscopic stenting. While rare, prompt recognition of esophageal rupture is imperative to improving morbidity and mortality. While esophageal rupture has been noted to cause ST segment elevation before, this appears to be the first case associated with a junctional rhythm.
Case Report: ICIs-induced Guillain-Barré syndrome recovered from mycophenolate mofetil
Authors: Mengge Ding, Chao Deng, Xianling Liu, Shun Jiang, Yuan Gao, Dan Fan, Yiguang Zhou, Jiangbo He, Chaoyuan Liu
Journal: Front Immunol (2023)
Keywords: guillain–barré syndrome, kn046, immune checkpoint inhibitors, immune-related adverse events, mycophenolate mofetil
MeSH terms: Antibodies, Bispecific, Carcinoma, Non-Small-Cell Lung, Guillain-Barre Syndrome / chemically induced, Guillain-Barre Syndrome / diagnosis, Guillain-Barre Syndrome / drug therapy, Lung Neoplasms, Case Reports, Research Support, Non-U.S. Gov't, Humans, Male, Methylprednisolone, Middle Aged, Mycophenolic Acid / adverse effects, Mycophenolic Acid, Antibodies, Bispecific, Methylprednisolone

The emergence of immune checkpoint inhibitors (ICIs) has significantly prolonged the survival time of cancer patients. However, it may also lead to various immune-related adverse events (irAEs), including Guillain-Barré syndrome (GBS), a rare type of irAE. Most GBS patients can recover spontaneously due to the self-limited nature of the disease, but severe cases can result in respiratory failure or even death. Here we report a rare case of GBS occurring in a 58-year-old male patient with non-small cell lung cancer (NSCLC) who developed muscle weakness and numbness of the extremities during chemotherapy combined with KN046, a PD-L1/CTLA-4 bispecific antibody. Despite receiving methylprednisolone and γ-globulin, the patient's symptoms did not improve. However, there was significant improvement after treatment with mycophenolate mofetil (MM) capsules, which is not a routine regimen for GBS. To the best of our knowledge, this is the first reported case of ICIs-induced GBS that responded well to mycophenolate mofetil instead of methylprednisolone or γ-globulin. Thus, it provides a new treatment option for patients with ICIs-induced GBS.
Case report: Open-heart removal for a cement embolism formed 10 years ago in the right ventricle and pulmonary artery
Authors: XinPei Liu, PeiShan Chu, Qi Miao
Journal: Front Cardiovasc Med (2023)
Keywords: case report, cement embolism, pulmonary artery, right ventricle, surgery
MeSH terms: Case Reports

Bone cement embolism is a known complication after a kyphoplasty operation. Cement embolisms without immediate fatal complication such as cardiac perforation or hypoxemia were often stable during observation. We report a case of a large volume bone cement embolism involving the right ventricle and the pulmonary artery system. The patient developed mild exertional shortness of breath and chest pain after a percutaneous kyphoplasty (PKP) operation 10 years ago. However, her mild symptoms were attributed to multiple myeloma, and no chest imaging was taken until the symptoms exacerbated after a COVID-19 infection 6 months ago. A large, tree-branch-shaped embolus was found, causing severe obstruction of the ascending and middle-lobe branch of the right pulmonary artery. The pulmonary perfusion scintigraphy demonstrated an impaired perfusion of the right upper and middle lobe. An open-heart removal was performed, and the symptoms were relieved afterward. We report this case to highlight the importance of routine chest imaging after a PKP operation and to claim that open-heart removal for chronic cement pulmonary embolism is technically feasible and safe.
Pituitary Metastasis of Lung Neuroendocrine Carcinoma Mimicking Pituitary Adenoma:Case Report and Literature Review
Authors: Xiaohai Liu, Renzhi Wang, Mingchu Li, Ge Chen
Journal: Front Endocrinol (Lausanne) (2021)
Keywords: case report, diabetes insipidus, lung neuroendocrine carcinoma, pituitary adenoma, pituitary metastasis
MeSH terms: Adenoma / diagnostic imaging, Carcinoma, Neuroendocrine / diagnostic imaging, Lung Neoplasms / diagnostic imaging, Pituitary Neoplasms / diagnostic imaging, Case Reports, Research Support, Non-U.S. Gov't, Review, Aged, Carcinoma, Neuroendocrine / secondary, Diagnosis, Differential, Humans, Lung Neoplasms / pathology, Magnetic Resonance Imaging, Male, Pituitary Neoplasms / secondary

Pituitary metastasis is an unusual situation in clinical practice, while the incidence is increasing with age. Breast cancer for women and lung cancer for men were the most frequent primary origins of pituitary metastasis. Diagnosing asymptomatic patients with unknown primary malignant origin is difficult, thus pituitary metastasis may be diagnosed as primary pituitary adenoma. Here, we report a case of a 65-year-old patient with visual changes and diabetes insipidus, showing an extensive mass in the sellar region which was initially thought to be a primary pituitary adenoma. Patient corticotropic deficits were corrected, and transnasal transsphenoidal surgery was adopted, leading to total tumor resection. Tumor texture during surgical procedure was similar to that of pituitary adenoma. However, the histopathological and immunohistochemistry results suggested it as a pituitary metastasis from lung neuroendocrine tumor. Postoperative chest CT scan confirmed a pulmonary mass consistent with primary neoplasm. Abdominal CT further detected multiple metastases in liver, pancreas, and colon. Despite intensive treatment, the patient continued to show decreased level of consciousness due to cachexia, resulting in death 1 week after surgery. This case highlights the importance of differential diagnosis of invasive lesions of the sellar region, especially in individuals over 60 years of age with diabetes insipidus.
Trapezoid Fracture Associated with Scaphoid Fracture in a Football Goalkeeper
Authors: Tetsuya Yamamoto, Takehiko Matsushita, Kenjiro Ito, Shinji Matsushima, Kazuya Yoshida, Ryosuke Kuroda
Journal: Case Rep Orthop (2019)
MeSH terms: Case Reports

Introduction:
Trapezoid fractures are uncommon in sports. We presented a rare case of a trapezoid fracture associated with a scaphoid fracture caused by punching a ball in a football goalkeeper.
Case presentation:
A 19-year-old male who played as a football goalkeeper visited our hospital with complaints of sustained pain from the right wrist to the hand after punching a ball. Scaphoid fracture was diagnosed on plain radiographs, whereas trapezoid fracture was overlooked. Computed tomography revealed a displaced trapezoid fracture associated with a scaphoid fracture. Both fractures were successfully treated by open reduction and internal fixation using cannulated screws. Almost complete bone union was achieved at 5 months after surgery. The patient returned to play as a football goalkeeper.
Conclusion:
The simultaneous occurrence of trapezoid and scaphoid fractures has never been reported. Trapezoid fractures are rare and can be overlooked on plain radiographs, as what happened in the present case, because the trapezoid is small and overlaps with other carpal bones on plain radiographs. If there is sustained pain in the wrist and hand after punching, combined trapezoid and scaphoid fractures should be considered as the possible injury.
Hypercapnea and Acidemia despite Hyperventilation following Endotracheal Intubation in a Case of Unknown Severe Salicylate Poisoning
Authors: Shannon M Fernando, Valérie Charbonneau, Hans Rosenberg
Journal: Case Rep Crit Care (2017)
MeSH terms: Case Reports

Salicylates are common substances for deliberate self-harm. Acute salicylate toxicity is classically associated with an initial respiratory alkalosis, followed by an anion gap metabolic acidosis. The respiratory alkalosis is achieved through hyperventilation, driven by direct stimulation on the respiratory centers in the medulla and considered as a compensatory mechanism to avoid acidemia. However, in later stages of severe salicylate toxicity, patients become increasingly obtunded, with subsequent loss of airway reflexes, and therefore intubation may be necessary. Mechanical ventilation has been recommended against in acute salicylate poisoning, as it is believed to take away the compensatory hyperpnea and tachypnea. Despite the intuitive physiological basis for this recommendation, there is a paucity of evidence to support it. We describe a case of a 59-year-old male presenting with decreased level of consciousness and no known history of ingestion. He was intubated and experienced profound hypercarbia and acidemia despite mechanical ventilation with high minute ventilation and tidal volumes. This case illustrates the deleterious effects of intubation in severe salicylate toxicity.
Complete Heart Block in a Diabetic Patient with a Preexisting LBBB and Normal Coronaries, Paradoxically Responding to Atropine
Authors: Nikolaos S Ioakeimidis, Dimitrios Valasiadis, Lykourgos Nanis, Pantelis Kligkatsis, Stefanos Papastefanou
Journal: Case Rep Cardiol (2018)
MeSH terms: Case Reports

We present a case of a complete atrioventricular block (AV block) with different aberrancy patterns during sinus rhythm and escape rhythm. A 66-year-old woman visited our emergency department complaining of sudden onset dizziness and fatigue over the past thirty minutes. Her medical history was remarkable for arterial hypertension, type 2 diabetes mellitus, and hypothyroidism. The patient had a known Left Bundle Branch Block (LBBB) on past ECGs. Upon palpation of peripheral pulse, a measurement of 32 beats per minute was obtained. No other sign of hemodynamic instability was present. A 12-Lead ECG revealed a complete heart block with sparse QRS complexes with a Right Bundle Branch Block (RBBB) morphology. Before the insertion of a temporary transvenous pacemaker, atropine was administered intravenously. Shortly after the administration, the patient's heart rhythm was restored to sinus rhythm (SR) with LBBB. The patient remained hemodynamically stable and in sinus rhythm at the cardiac ICU and was scheduled for implantation of a permanent pacemaker at a specialized tertiary center. Before successful implantation, a coronary angiography revealed normal coronary anatomy with no atherosclerotic lesions.