OpenMed/multicare-articles huggingface dataset:
Paradise -- not without its plagues: overwhelming Blastomycosis pneumonia after visit to lakeside cottages in Northeastern Ontario
Authors: Malvinder S Parmar
Journal: BMC Infect Dis (2005)
MeSH terms: Blastomycosis / diagnosis, Fresh Water, Pneumonia / diagnosis, Pneumonia / microbiology, Travel, Case Reports, Acute Disease, Adult, Blastomycosis / complications, Blastomycosis / pathology, Fatal Outcome, Female, Humans, Male, Obesity / complications, Ontario, Pneumonia / complications, Pneumonia / pathology

Background:
Visiting lakes and cottages is a common leisure activity during summer among most Canadians and paradise for some. Various leisure activities are involved during these visits, including cleaning and 'airing' the cottage after long-winters, activities at the lakes and dock building etc, exposing the Canadians to moist soil and decaying woods -- a source of white or tan mould -- Blastomyces dermatitidis that may cause a flu-like illness to severe pneumonia that often remains a diagnostic challenge and results in delay in diagnosis and appropriate treatment thereby increasing associated morbidity and mortality.
Case presentations:
Five cases of overwhelming acute blastomycosis pneumonia are presented. Four of the five patients presented within few weeks of their visit to the cottages and surrounding lakes and all were initially treated as "community acquired pneumonia" that resulted in delay in diagnosis and poor outcome in the first patient. The first case, however, taught an important lesson that led to high-index of suspicion in the others with early diagnosis and improved outcomes. Interestingly, all patients were obese and had a shorter incubation period and severe clinical course. The possible mechanism for early and severe disease in association with obesity is speculated and literature is reviewed.
Conclusion:
High-index of suspicion is important in the early diagnosis and appropriate management acute blastomycosis pneumonia to improve associated morbidity and mortality.
Case report: Minimally invasive excision of multifocal cardiac papillary fibroelastomas involving right atrium and aortic valve
Authors: Peng Teng, Peng Hu, Shuai Yuan, Liang Ma
Journal: Front Cardiovasc Med (2022)
Keywords: aortic valve, cardiac papillary fibroelastoma, cardiac tumor, minimally invasive, multifocal, right atrium
MeSH terms: Case Reports

Background:
Cardiac papillary fibroelastomas (CPFs) are rare benign cardiac tumors most commonly found on left-sided cardiac valves. Right atrial CPFs are extremely rare, accounting for only 2% of all CPFs. Median sternotomy is a typical approach for surgical excision of CPFs in most cases. Herein, we report an extremely rare case of multifocal CPFs involving the right atrium and aortic valve that were surgically excised via minimally invasive right anterolateral thoracotomy.
Case summary:
A 59-year-old Chinese man was admitted because of an incidental finding of a right atrial mass on transthoracic echocardiography during a routine check-up. The mass was initially diagnosed as a myxoma, and the patient was scheduled for minimally invasive excision via right anterolateral thoracotomy. An additional mass on the non-coronary cusp of the aortic valve was identified using intraoperative transesophageal echocardiography. The patient still underwent complete tumor excision via right anterolateral thoracotomy. Both neoplasms were pathologically diagnosed as CPFs.
Conclusions:
This case highlights the need for a comprehensive cardiac evaluation of cardiac tumors because CPFs can manifest as multifocal lesions. Moreover, minimally invasive surgery is highly feasible as the CPF can be easily excised, and the valve can usually be preserved.
Megalourethra with Y-Type Duplication of Urethra Presented as Perianal Fistula: A Rare Case Report
Authors: Shashi Verma, Goto Gangkak, Sher Singh Yadav, Vinay Tomar
Journal: Case Rep Urol (2015)

Megalourethra with Y-type duplication is an extremely rare anomaly. We report here one such case, diagnosed with retrograde urethrogram, which was done from both penile meatus and perianal opening simultaneously. Patient was successfully treated by laser optical internal urethrotomy (OIU), excision of duplicated urethra, and reduction urethroplasty in a single stage.
Shift to Virtual Self-Management Programs During COVID-19: Ensuring Access and Efficacy for Older Adults
Authors: Pamela Sanchez-Villagomez, Claudia Zurlini, Maggie Wimmer, Linda Roberts, Bertilia Trieu, Bonnie McGrath, Robyn Wiesel, Titilayo Ologhobo, Sandra Goldsmith, Laura Robbins
Journal: Front Public Health (2021)
Keywords: education, exercise, musculoskeletal health, older adults, self-management, virtual
MeSH terms: COVID-19, Self-Management, Aged, Humans, Pandemics, Quarantine, SARS-CoV-2

Background: The COVID-19 pandemic resulted in significant uncertainty and disruption to many aspects of daily living, including physical activity, socialization opportunities, and access to healthcare services. Under these conditions, at-risk older adults are even more likely to be inactive and isolated, leading to potential exacerbation of musculoskeletal and chronic conditions and emotional distress. This case study provides an overview of our experience and best practices developed during our shift from onsite programming to virtual. Methodology: HSS utilized varied online approaches, including phone/video conference classes, webinars, on-demand videos and email campaigns to successfully transition programs. Due to this shift, HSS changed its evaluation to an online approach, using a mixed method to adequately assess the impact of programs. Results: Between April and August 2020, our virtual programs reached 428,766 participants, resulting in a 10,807% increase in program reach. Most participants assessed were 60 years or older (72%) and reported knowledge (85%) and self-management skills (83%) gained as well as high program satisfaction (90%). Analyses of program data did not show any statistical significant difference in self-reported health outcomes. However, qualitative results showed virtual programming helped to foster social connectivity during COVID-19, helped to build a daily routine, and positively impacted mental and physical health. Conclusion: Shifting to virtual programming in the face of the pandemic enabled us to deliver effective programs affording our community the opportunity to stay physically active and socially connected despite the quarantine orders.
Urinary tract infection caused by a small colony variant form of capnophilic Escherichia coli leading to misidentification and non-reactions in antimicrobial susceptibility tests
Authors: Yu Jin Park, Nguyen Le Phuong, Naina Adren Pinto, Mi Jeong Kwon, Roshan D'Souza, Jung-Hyun Byun, Heungsup Sung, Dongeun Yong
Journal: Antimicrob Resist Infect Control (2018)
Keywords: capnophilic, escherichia coli, misidentification, small colony variant
MeSH terms: Escherichia coli / drug effects, Escherichia coli / growth & development, Escherichia coli Infections / microbiology, Urinary Tract Infections / microbiology, Case Reports, Aged, 80 and over, Anti-Bacterial Agents / pharmacology, Escherichia coli / genetics, Escherichia coli / isolation & purification, Female, Genome, Bacterial / genetics, Humans, Microbial Sensitivity Tests, Phenotype, RNA, Ribosomal, 16S / genetics, Urinalysis, Anti-Bacterial Agents, RNA, Ribosomal, 16S

Background:
Small colony and capnophilic variant cases have been separately reported, but there has been no reports of their simultaneous presence in one isolate. We report a case of Escherichia coli with coexpressed small colony and capnophilic phenotypes causing misidentification in automated biochemical kits and non-reactions in antimicrobial susceptibility test cards.
Case presentation:
An 86-year-old woman developed urinary tract infection from a strain of Escherichia coli with SCV and capnophilic phenotypes in co-existence. This strain did not grow without the presence of CO2, and therefore proper identification from automated system was not possible. 16 s rRNA sequencing and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry was able to identify the bacteria.
Conclusion:
As these strains do not grow on culture parameters defined by CLSI or on automated systems, proper identification using alternative methods are necessary.
Impact of hyperprolactinemia in a patient with polyautoimmunity
Authors: Manuel Rojas, Yhojan Rodríguez, Carolina Ramírez-Santana, Juan-Manuel Anaya
Journal: Clin Case Rep (2018)
Keywords: sjögren's syndrome, hyperprolactinemia, prolactin, systemic lupus erythematosus
MeSH terms: Case Reports

Hyperprolactinemia has been proposed as a triggering factor for autoimmune diseases. The increased levels of prolactin could induce an abnormal immune response. Herein, we present a patient with hyperprolactinemia who developed polyautoimmunity. Patient's symptoms were associated with slightly raised levels of prolactin (20-40 ng/mL) and administration of dopaminergic agonists.
A Case Report of Isolated Cuboid Nutcracker Fracture
Authors: Takaaki Ohmori, Shinichi Katsuo, Chiaki Sunayama, Katsunori Mizuno, Tomohiro Ojima, Kotaro Yamakado, Tomonari Ando, Shin Watanabe, Seigaku Hayashi, Hiroyuki Tsuchiya
Journal: Case Rep Orthop (2016)

Isolated cuboid fractures are very rare, since they typically occur in combination with midfoot fractures or dislocations. A 61-year-old man presented at our hospital with pain and swelling on the outside of his right foot. The lateral column of his right foot was shortened by approximately 6.5 mm on X-ray. CT showed displacement of the joint surface between the cuboid and the fourth metatarsal, with a 3.5 mm depression. An MRI revealed no other injuries. Based on these findings, we diagnosed the patient with an isolated nutcracker fracture of the cuboid. Using a 1.9 mm arthroscope, we examined the Lisfranc joint. Then the depressed fragments were elevated until the regular joint line was restored. A bone biopsy needle was then used to fill in the large defect with artificial bone. In this case, we did not plate the fracture. Six months after surgery, patient could walk without pain. We report a very rare case of isolated nutcracker fracture of the cuboid. In addition, we suggest our new treatment plan of this fracture.
Ocular symptomatology, management, and clinical outcome of a giant intracranial aneurysm
Authors: Chryssa Terzidou, Georgios Dalianis, Fani Zacharaki
Journal: Case Rep Med (2012)
MeSH terms: Case Reports

Giant aneurysms of the anterior intracranial circulation are rare, slowly progressive vascular abnormalities, often presenting with neuro-ophthalmological symptoms before they rupture. This is a case of a 55-year-old woman with a double aneurysm of the anterior intracranial circulation, part of which was giant, diagnosed exclusively on the basis of ocular manifestations. We also describe successful management of the case throughout a long follow-up period.
Ketosis prone diabetes presenting as fulminant type 1 diabetes
Authors: Katerina Krompa, Ines Barka, Stéphanie Malard, Sopio Tatulashvili, Camille Baudry, Hélène Bihan, Marinos Fysekidis
Journal: Pan Afr Med J (2018)
Keywords: ketosis prone diabetes, diabetes classification, fulminant diabetes
MeSH terms: Diabetes Mellitus, Type 1 / diagnosis, Diabetic Ketoacidosis / diagnosis, Ketosis / diagnosis, Case Reports, Diabetes Mellitus, Type 1 / physiopathology, Diabetic Ketoacidosis / physiopathology, Glycated Hemoglobin / metabolism, Humans, Insulin Secretion, Ketosis / physiopathology, Male, Middle Aged, Glycated Hemoglobin A

Patients with ketosis prone diabetes have been reported primarily in Africans and African Americans. At presentation, both insulin secretion and insulin action are impaired in ketosis prone diabetes patients. Fulminant diabetes is a subtype of type 1 diabetes reported mainly in the Asian populations characterized by diabetic ketosis or ketoacidosis occurring soon after the onset of hyperglycemic symptoms with inappropriately low HbA1c (< 8.5%). We report here the first case of a ketosis prone diabetes presenting as fulminant diabetes.
Intrauterine extremity gangrene and cerebral infarction at term: a case report
Authors: M Tanvig, J S Jørgensen, M Nybo, G Zachariassen
Journal: Case Rep Pediatr (2011)
MeSH terms: Case Reports

Intrauterine extremity gangrene in combination with cerebral infarction is a serious and rare event. We present a case with a healthy mother who gave birth to a child with this condition. At term, the mother presented at the antenatal clinic with decreased fetal movements. Cardiotocography (CTG) showed signs of fetal distress and a caesarean section was performed. The left arm of the newborn was found gangrenous. Amputation of the arm was necessary and the child was subsequently treated with anticoagulant therapy due to thrombosis and cerebral infarction in the left hemisphere found by magnetic resonance imaging (MRI). At one year of age the boy was doing well and had prosthesis as a left arm. He had no signs of further complications. Despite thorough examination of the parents and the child, the reason for the thrombosis is still unknown.
Blast crisis Ph+ chronic myeloid leukemia with NUP98/HOXA13 up-regulating MSI2
Authors: Danika Di Giacomo, Valentina Pierini, Gianluca Barba, Veronica Ceccarelli, Alba Vecchini, Cristina Mecucci
Journal: Mol Cytogenet (2014)
Keywords: blast crisis cml, fusion transcript, hoxa genes, msi2
MeSH terms: Case Reports

Background:
Musashi2(Msi2)-Numb pathway de-regulation is a molecular mechanism underlying the transition of chronic phase Ph + CML to deadly blast crisis, particularly in cases with a NUP98/HOXA9 fusion from a t(7;11)(p15;p15). This study provides new insights on the mechanisms cooperating in driving MSI2 over-expression and progression of Ph-positive CML.
Results:
Herein we describe a t(7;11)(p15;p15) originating a NUP98 fusion with HOXA13, at 7p15, in a 39 year-old man in blast crisis of Ph-positive CML. Both MSI2 and HOXA9 were evaluated by quantitative RT-PCR in our patient and in a series of haematological malignancies. Up-regulation of both genes emerged only in the presence of NUP98/HOXA13 gene fusion. However, over-expression of MSI2, but not HOXA9, was found in 2 cases of Ph + blast crisis with additional chromosome aberrations other than t(7;11). To determine the mechanisms underlying MSI2 over-expression in our patient we performed Chromatin Immunoprecipitation and found that NUP98/HOXA13 fusion protein deregulates MSI2 gene by binding its promoter.
Conclusions:
To the best of our knowledge, this is the first molecular characterization of NUP98/HOXA13 fusion in blast crisis of Ph + CML. Our findings suggest cooperative mechanisms of MSI2 over-expression driven by HOXA proteins and strongly supports MSI2 as a prognostic marker and a candidate in target treatment of CML.
Case report: A choroidal fissure pial arteriovenous malformation inducing venous congestive edema of the medulla oblongata and cervicothoracic spinal cord presented with proximal arm predominant weakness
Authors: Yun Jiang, Ying Zhou, Ximeng Yang, Aizhen Sheng, Jun Lu
Journal: Front Neurol (2023)
Keywords: choroidal fissure, interventional treatment, intracranial arteriovenous malformation, intracranial dural arteriovenous fistula, myelopathy
MeSH terms: Case Reports

Intracranial dural arteriovenous fistula (DAVF) can induce remote myelopathy via spinal perimedullary venous drainage. In the present study, we report a rare case of intracranial pial arteriovenous malformation (AVM)-related myelopathy. A 52-year-old man presented with progressive, predominantly proximal weakness and muscle atrophy in bilateral upper limbs, urinary retention, and hyperreflexia in bilateral upper and lower limbs. Brain and cervicothoracic MRI showed longitudinal myelopathy extending from the medulla oblongata to the T6 level, with perimedullary enlarged veins from the C1 to T12 level, and remarkable enhancement in bilateral anterior horns from the C2 to C7 level. Cerebral angiography revealed a choroidal fissure AVM, which was supplied by the left anterior choroidal artery and drained exclusively by an inferior ventricular vein descending toward the spinal perimedullary veins. After endovascular embolization of the feeding pedicle, nidus, and proximal segment of the draining vein, the patient's neurological deficits rapidly improved, and a significant recovery was achieved 3 months after the procedure. This rare case indicates that intracranial pial AVM can also cause extensive congestive myelopathy with similar mechanisms underlying intracranial and craniocervical DAVF cases, and gray matter in the spinal cord might be more susceptible to ischemia induced by intraspinal venous hypertension.
Cefepime-Induced Nonconvulsive Status Epilepticus in a Pediatric Patient with Normal Renal Function
Authors: Clever Nguyen, Taylor Clegg, Ashutosh Kumar, Sita Paudel
Journal: Child Neurol Open (2022)
Keywords: eeg, cefepime, neurotoxicity, nonconvulsive status epilepticus, pediatric
MeSH terms: Case Reports

Introduction: Cefepime, a fourth-generation cephalosporin, is known to risk the induction of neurotoxic impairment from confusion to nonconvulsive status epilepticus (NCSE). Neurotoxic effects of cefepime are most commonly evident in the setting of impaired renal function in adults; however, are rarely present in those with normal renal excretion function or in the pediatric population. Case: We present a case of a 16-year-old female with a complicated past medical history but no accounts of impaired renal function yet, after starting cefepime, presented with encephalopathy, intermittent stimulus-induced posturing, and was found to have NCSE. Discontinuation of cefepime and administration of additional antiepileptics provided significant improvement in EEG and allowed the patient to return to baseline within two days. Conclusion: Cefepime-induced nonconvulsive status epilepticus should be considered in any patient with or without impaired renal function that shows acute changes in mental status, and/or reduced consciousness, after initiating cefepime treatment.
A Severe Case of Ipilimumab-Induced Ileocolitis Refractory to Glucocorticosteroids and Infliximab
Authors: Behdod Poushanchi, Hiren Vallabh, Gorman Joel Reynolds
Journal: Case Rep Gastrointest Med (2018)
MeSH terms: Case Reports

Ipilimumab is a monoclonal antibody that works as an immunotherapeutic agent through selective targeting of T cells to strengthen the response to metastatic melanoma. It is well known that this pharmaceutical agent can cause the adverse effect of colitis. We report a rare presentation of ileocolitis refractory to both glucocorticosteroids and infliximab with a resultant pneumatosis and perforation requiring subtotal colectomy and end ileostomy.
HIDEA syndrome: A new case report highlighting similarities with ROHHAD syndrome
Authors: J Harvengt, A Lumaka, C Fasquelle, J H Caberg, M Mastouri, A Janssen, L Palmeira, V Bours
Journal: Front Genet (2023)
Keywords: hidea syndrome, p4htm, rohhad, central hypoventilation, childhood obesity, hypothalamic dysfunction and autonomic dysregulation, rapid-onset obesity with hypoventilation
MeSH terms: Case Reports

Context: ROHHAD syndrome presents a significant resemblance to HIDEA syndrome. The latter is caused by biallelic loss-of-function variants in the P4HTM gene and encompasses hypotonia, intellectual disabilities, eye abnormalities, hypoventilation, and dysautonomia. We report the first patient identified with HIDEA syndrome from our ROHHAD cohort. Clinical case: Our patient was a 21-month-old girl who had a history of severe respiratory infections requiring intensive care, hypotonia, abnormal eye movements, and rapid weight gain. Polysomnography identified severe central hypoventilation. During her follow-up, a significant psychomotor delay and the absence of language were gradually observed. The prolactin levels were initially increased. Hypothermia was reported at 4 years. Exome sequencing identified a new homozygous truncating P4HTM variant. Discussion: Our patient met the diagnosis criteria for ROHHAD, which included rapid weight gain, central hypoventilation appearing after 1.5 years of age, hyperprolactinemia suggesting hypothalamic dysfunction, and autonomic dysfunction manifesting as strabismus and hypothermia. However, she also presented with severe neurodevelopmental delay, which is not a classic feature of ROHHAD syndrome. HIDEA syndrome presents similarities with ROHHAD, including hypoventilation, obesity, and dysautonomia. To date, only 14% of endocrinological disturbances have been reported in HIDEA patients. Better delineation of both syndromes is required to investigate the eventual involvement of P4HTM, a regulator of calcium dynamics and gliotransmission, in ROHHAD patients. Conclusion: In the case of clinical evidence of ROHHAD in a child with abnormal neurological development or eye abnormalities, we suggest that the P4HTM gene be systematically interrogated in addition to the analysis of the PHOX2B gene. A better delineation of the natural history of HIDEA is required to allow further comparisons between features of HIDEA and ROHHAD. The clinical similarities could potentially orient some molecular hypotheses in the field of ROHHAD research.
Tetralogy of Fallot With Right Aortic Arch and Retro-Aortic Innominate Vein
Authors: Zhia N Lim, Bryan J W Chew, Sanfui Yong, Antonio F Corno
Journal: Front Pediatr (2018)
Keywords: congenital heart disease, congenital heart surgery, retro-aortic innominate vein, right aortic arch, tetralogy of fallot, vascular ring
MeSH terms: Case Reports

Right aortic arch (RAA) and retro-aortic innominate vein are rare vascular anomalies. Diagnosis of these anatomical variations can be achieved using fetal echocardiography, post-natal echocardiography, and computed tomography scan. RAA can form a vascular ring when associated with other vascular anomalies which may compress the trachea and/or esophagus. On the other hand, the existence of retro-aortic innominate vein can influence the clinical decision-making and surgical strategy. We report a rare occurrence of both RAA and retro-aortic innominate vein in a 3 months old girl with a prenatal diagnosis of tetralogy of Fallot and include details of her presentation and successful management.
Medial migration of the tympanostomy tube: what is the optimal management option?
Authors: Ilias Benchafai, Mohamed Moumni, Saloua Ouraini, Noureddine Errami, Bouchaib Hemmaoui, Fouad Benariba
Journal: Pan Afr Med J (2019)
Keywords: medial migration, etiology, optimal treatment, tympanostomy tube
MeSH terms: Foreign-Body Migration / diagnosis, Middle Ear Ventilation / adverse effects, Otitis Media with Effusion / surgery, Case Reports, Review, Child, Humans, Male, Prosthesis Failure

The tympanostomy tube insertion is the gold standard of treatment for secretory otitis media. Complications are associated with this surgery in 17% of cases. One of the rare but real complications is the medial migration of the tympanostomy tube. To our knowledge, this is the 14th case reported in childhood. Considering this rarity, there is no consensus for the management of this phenomenon. Some authors propose a surgical removal, while others prefer to observe whether the patient is asymptomatic. We reported a case of migration of the tympanostomy tube and described the detailed clinical features and management options. This case report and mini-review will broaden readers the knowledge of medial migration of the tympanostomy tube and may guide the relative treatment of this complication in the future.