OpenMed/multicare-articles huggingface dataset:
Isomorphic (Koebner) Phenomenon Induced by Insulin Analogue Injections in Psoriasis
Authors: Saartje Thijs, Eric Balti, Corinne Degraeve, Peter Coremans
Journal: JCEM Case Rep (2022)
Keywords: diabetes mellitus, injection sites, insulin therapy, koebnerization, psoriasis
MeSH terms: Case Reports

Koebner phenomenon is an uncommon skin-related complication of subcutaneous insulin injection in patients with diabetes mellitus. This reaction, also referred as isomorphic phenomenon, has previously been described in various conditions including vitiligo, lichen planus, and psoriasis. We report a 56-year-old woman insulin-treated patient with type 2 diabetes mellitus who developed new-onset, sharply well-demarcated erythematous scaly plaques at the insulin injection sites consistent with Koebner phenomenon. These lesions occurred after withdrawal of methotrexate initiated for the treatment of psoriasis. The lesions responded well to guselkumab, an interleukin-23 targeting agent but not ciclosporin. Of note, unlike previously reported cases, our patient developed isomorphic response under treatment with insulin analogues and during psoriasis flare-up. This case highlights the paramount role of thorough and cautious examination of injection and insertion sites in patients at risk undergoing subcutaneous continuous glucose monitoring or treated with continuous transdermal/subcutaneous insulin injections.
Regenerative Surgical Management of an Endodontic Periodontic Lesion of the Mandibular Molar Combined With External Inflammation Root Resorption
Authors: Henytaria Fajrianti, Fauziah Karimah, Safitri Kusuma Dewi, Diatri Nari Ratih, Nungky Devitaningtyas, Vincensia Maria Karina, Silviana Farrah Diba
Journal: Case Rep Dent (2024)
Keywords: biodentine, demineralized freeze-dried bone allograft, endodontics, endo–perio lesion, furcation involvement, periodontology
MeSH terms: Case Reports

Endo-perio lesions are lesions involving pulp tissue with periodontal tissue. The bacterial infection of the pulp can spread to the furcation area through the accessory canal, causing damage to the furcation area. Regeneration therapy has good success when performed with flap surgery and is performed in cases of Grades I and II furcation involvement. Demineralized freeze-dried bone allograft (DFDBA) is a regenerating material that has osteoinductive and osteoconductive abilities. It has the advantage of successful treatment of bone defects. Biodentine is an agent used for direct pulp capping, root perforation and furcation repair, and apexification. It can bind and enter the dentinal tubules and create interlocking crystals with dentin. This case report presents the treatment of furcation involvement Grade II originating from endo-perio lesions by using DFDBA and Biodentine as regeneration materials with 6 months of follow-up.
Amoxicillin-induced bullous erythema multiforme: a case report
Authors: Seema Sitaula, Bikash K Shah, Sanjeev Kharel, Alisha Yadav, Nahakul Poudel, Bhusan Shrestha
Journal: Ann Med Surg (Lond) (2023)
Keywords: amoxicillin, ayurvedic, bullous erythema multiforme
MeSH terms: Case Reports

Introduction:
Bullous erythema multiforme (BEM), an immune-mediated, acute condition, frequently includes erosion affecting the oral, genital, and/or ocular mucosa in addition to discrete target-like lesions on the skin. BEM has been linked to various factors, including infections, medications, malignancy, autoimmune disease, immunization, and radiation.
Case presentation:
Here, we report a case of a 38-year-old married woman who presented with symptoms of reddish-raised, fluid-filled and painful, nonpruritic lesions along with the swelling of bilateral hand and feet. This patient had a history of taking some unrecorded ayurvedic medication for bloating and abdominal pain in a background of antibiotic use before exhibiting the dermatological symptoms of BEM 2 days later. She was successfully managed with ampicillin and cloxacillin, acyclovir and prednisolone.
Clinical discussion:
A few incidence of BEM after the administration of amoxicillin has been reported, which precipitated only after consuming ayurvedic medication. BEM has a clinical diagnosis with biopsy rarely required. Here, the hypersensitivity reaction induced by the antibiotic itself or by altering the immune response to the concomitant consumed herbal medicine could explain the BEM.
Conclusion:
Physicians should note that amoxicillin can trigger BEM, regardless of its use with ayurvedic drugs. Antibiotics should be used with caution, especially in patients with a history of BEM.
Intraoral Extranodal Natural Killer Cell/T-Cell Lymphoma of the Hard Palate
Authors: Fatemeh Ahmadi-Motamayel, Fereshteh Najar-Karimi, Fatemeh Abbasi, Arash Dehghan
Journal: Case Rep Dent (2023)
MeSH terms: Case Reports

Natural killer cell/T-cell lymphoma (NK/TL) is a rare subtype of non-Hodgkin's lymphoma (NHL) associated with the Epstein-Barr virus (EBV) and requires early detection, which can be very challenging. NK/TL often arises in the nasal cavity and can then spread to the oral cavity, but the case presented here is an unusual presentation of NK/TL in a 66-year-old edentulous male patient who initially presented an intraoral exophytic lesion in the palate that appeared within 3 months. We report the present case to highlight the challenges of reaching an accurate diagnosis given the diverse clinical manifestations of NK/TL.
Fifteen-Centimeter Giant Tamoxifen-Associated Endometrial Polyp Presenting With Constipation: A Case Report and Review of the Literature
Authors: Sompon Apornvirat, Komsun Suwannarurk
Journal: Case Rep Obstet Gynecol (2024)
Keywords: constipation, endometrial polyp, pressure symptom, tamoxifen
MeSH terms: Case Reports

Endometrial polyps are benign disorganized growth of endometrial glands and stroma in the uterine cavity. They are associated with subfertility, abnormal uterine bleeding, and tamoxifen use. While most polyps are smaller than 2 cm in size, rare giant polyps can cause concerns over malignancy. We report a case of a 15 cm giant endometrial polyp in a 58-year-old woman with a history of tamoxifen use who presented with an uncommon complaint of constipation. Additionally, a literature review of giant endometrial polyp cases is presented. This case represents the largest reported endometrial polyp to date.
Successful Endovascular Management of Recurrent Hemoptysis due to Multiple Rasmussen Aneurysms in a Case of Pulmonary Tuberculosis: A Rare Case Scenario
Authors: Shritik Devkota, Harish Bhujade, Abhiman Baloji, Nidhi Prabhakar, Atul Saroch, Ujjwal Gorsi
Journal: Acta Med Litu (2024)
Keywords: rasmussen aneurysm, coil embolization, pulmonary artery pseudoaneurysm, pulmonary tuberculosis
MeSH terms: Case Reports

Background:
Hemoptysis is defined as coughing out of blood. Pulmonary tuberculosis is the most common cause of hemoptysis in tuberculosis-endemic countries like India. Rasmussen aneurysm is a pseudoaneurysm arising from the pulmonary artery adjacent to or within a tuberculous cavity. Chest radiographs, chest computed tomography angiography (CTA), and digital subtraction angiography (DSA) are the imaging tools for evaluating a case of hemoptysis.
Case:
A 32-year-old man with a history of pulmonary tuberculosis presented with complaints of recurrent hemoptysis. On imaging evaluation, multiple pulmonary artery pseudoaneurysms were seen in the left lung. The patient was shifted to the DSA lab and the pseudoaneurysms were subsequently treated by endovascular coil embolization. Hemoptysis resolved following the procedure and the patient was again started on anti-tubercular therapy.
Conclusion:
Endovascular coiling is minimally invasive, safe, and effective management of multiple Rasmussen aneurysms for preventing possible torrential blood loss and unfortunate death.
Sepsis as the Grand Mimic of Secondary Hemophagocytic Lymphohistiocytosis: Serratia marcescens Bacteremia with Concomitant Decompensated Cirrhotic Liver Disease
Authors: Anthony M Lim, Jonathan R Ghazaleh, Robert M Cacdac, Julia K Oberndorf, Marrey Ruby L Quizon, Justin M Thomas
Journal: Case Rep Crit Care (2023)
MeSH terms: Case Reports

Secondary hemophagocytic lymphohistiocytosis (HLH) is an elusive entity with sequelae that may be confused with sepsis. We discuss a 45-year-old man with decompensated liver cirrhosis with sepsis treated with broad-spectrum intravenous antibiotics. Further work-up initially supported sepsis-HLH overlap syndrome (SHLHOS) and corticosteroids were added. Ongoing refractory hypotension ensued, and the patient passed within 31 hours of presentation. Based on the patient's overwhelming immune activation and clinical course likely unsalvageable by cytotoxic immunosuppressive agents, the patient was diagnosed with sepsis with acute end organ dysfunction. This case report illustrates both the diagnostic challenge of sepsis versus HLH, which both require very different treatments, and the potential for rapid clinical decline without swift recognition and management of the true pathology.
Area of Focus in 3D Volumetry and Botulinum Toxin A Injection for Giant Diaphragmatic Hernia with Loss of Domain: A Case Report with Video Illustration
Authors: Sylvie Nachtergaele, Haitham Khalil, Paul Martre, Jean-Marc Baste, Edouard Roussel
Journal: J Abdom Wall Surg (2024)
Keywords: 3d volumetry, botulinum toxin a, case report, diaphragmatic hernia, loss of domain
MeSH terms: Case Reports

Background:
Chronic giant diaphragmatic hernia is a severe disease with challenging diagnosis and treatment. Given the risk of loss of domain, the use of botulinum toxin A is an option but has been minimally studied in diaphragmatic hernia surgery.
Case report:
We present a case of a giant diaphragmatic hernia in a 66-years-old patient who showed a 12-year history of progressive chronic respiratory insufficiency. There were not notion of traumatic injuries. The CT-scan showed a giant diaphragmatic hernia with herniation of small bowel, right liver, omentum and transverse colon.
Method:
We assessed the risk of loss of domain using a 3D volumetry based on the Sabbagh score and decided to use Botox injection before laparoscopic reduction of the hernia due to the high risk of complications related to the loss of domain. A computed tomography was performed 24 months after surgery and showed no evidence of recurrence. The patient presented an excellent functional result with a normal physical activity.
Conclusion:
This report is among the first to highlight the utility of 3D reconstruction in assessing the risk associated with loss of domain and in preparing the abdominal wall with botulinum toxin A for diaphragmatic hernia repair.
Long-term follow-up of an attenuated presentation of NAXE-related disease, a potentially actionable neurometabolic disease: a case report
Authors: Montaha Almudhry, Chitra Prasad, C Anthony Rupar, Keng Yeow Tay, Asuri N Prasad
Journal: Front Neurol (2024)
Keywords: nad(p)hx epimerase, naxe gene, pebel1, cerebellar ataxia, niacin
MeSH terms: Case Reports

Background:
Early-onset progressive encephalopathy with brain edema and/or leukoencephalopathy (PEBEL-1) is an autosomal recessive disorder whereby a fluctuating clinical course is exacerbated by febrile illnesses. Pathogenic NAD(P)HX epimerase (NAXE) gene mutations underpin this disorder. This mutation damages the metabolite repair system involved in regenerating crucial redox carriers. Longer survival has rarely been reported in this potentially actionable entity.
Objectives:
This case study aims to report a milder phenotype of a patient with NAXE gene mutation and his longitudinal follow-up of more than 20 years.
Case report:
A 24-year-old man first became symptomatic in infancy with frequent initial neurological decompensations in the setting of infections with subsequent clinical improvement followed by stability with residual cerebellar dysfunction. Clinical features noted over the years include chronic ataxia, nystagmus, ptosis, mild spasticity of lower limbs, and neuropsychiatric symptoms. Cerebellar and spinal cord atrophy were noted in cranial and spinal MR imaging. Biallelic homozygous variants in the NAXE gene (c.733 A>C) were identified on whole exome sequencing. Symptom management included the initiation of a mitochondrial cocktail with carnitine, coenzyme Q, and thiamine. Subsequently, niacin (Vitamin B3), which is involved in the cellular biosynthesis of NAD+, was added, given its potentially beneficial therapeutic impact.
Conclusion:
A missense homozygous variant in the NAXE gene is described in this patient with a milder clinical phenotype of the disease. Supplementation with niacin in addition to a mitochondrial cocktail presents a potential supportive therapeutic option to reduce disease progression.
Multiple autoimmune disorders refractory to glucocorticoids after allogeneic hematopoietic stem cell transplantation: a case report and review of the literature
Authors: Linjun Xie, Jingjing Xu, Huiping Xu, Beibei Zhang, Wuqiang Lin, Ting Yang
Journal: Front Immunol (2024)
Keywords: allogeneic hematopoietic stem cell transplantation, autoimmune hemolytic anemia, autoimmune hepatitis, multiple autoimmune syndrome, rituximab
MeSH terms: Autoimmune Diseases / etiology, Autoimmune Diseases / therapy, Glucocorticoids / therapeutic use, Hematopoietic Stem Cell Transplantation / adverse effects, Transplantation, Homologous, Case Reports, Review, Research Support, Non-U.S. Gov't, Anemia, Hemolytic, Autoimmune / drug therapy, Anemia, Hemolytic, Autoimmune / etiology, Anemia, Hemolytic, Autoimmune / therapy, Drug Resistance, Humans, Male, Middle Aged, Rituximab / therapeutic use, Glucocorticoids, Rituximab

We report here the case of a 50-year-old man who was first diagnosed with myelodysplastic syndrome with excess blasts-2 (MDS-EB-2) and underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) in 2019, resulting in complete remission. However, he was diagnosed in 2021 with several autoimmune disorders, including autoimmune hepatitis (AIH), Hashimoto's thyroiditis (HT), and autoimmune hemolytic anemia (AIHA). This is referred as multiple autoimmune syndrome (MAS), which is a rare occurrence after allo-HSCT, as previously noted in the literature. Despite being treated with glucocorticoids, cyclosporine A, and other medications, the patient did not fully recover. To address the glucocorticoid-refractory MAS, a four-week course of rituximab (RTX) at a weekly dose of 100mg was administered, which significantly improved the patient's condition. Thus, this case report underscores the importance of implementing alternative treatments in patients with post-transplant autoimmune diseases, who are glucocorticoid-refractory or glucocorticoid-dependent, and highlights the effectiveness of RTX as second-line therapy.
Case report: Klinefelter syndrome may protect against the development of spinal and bulbar muscular atrophy
Authors: Haruna Akanuma, Suguru Kadowaki, Kazuaki Kanai
Journal: Front Neurol (2024)
Keywords: klinefelter syndrome, androgen replacement therapy, leuprorelin, spinal and bulbar muscular atrophy, testosterone
MeSH terms: Case Reports

Spinal and bulbar muscular atrophy (SBMA) is an X-linked recessive motor neuron disease caused by the expansion of cytosine-adenine-guanine (CAG) repeats in the androgen receptor (AR) gene. It is thought that the nuclear translocation of abnormal AR proteins following binding to testosterone triggers the onset of the disease. We report the case of a patient who had SBMA coincident with Klinefelter syndrome. He developed SBMA symptoms rapidly after receiving androgen replacement therapy for Klinefelter syndrome. No cases of coincident SBMA and Klinefelter syndrome have been reported, and if confirmed by further patients in future, that androgen hormones are strongly associated with the development and progression of SBMA in fact in humans.
Case report: Hypertrophic lichen planus initially misdiagnosed as squamous cell carcinoma
Authors: Nidhi Kuchimanchi, Lydia A Luu, Preeya T Shah, Jennifer DeSimone
Journal: Front Med (Lausanne) (2024)
Keywords: jak inhibitors, clinicopathological correlation, cutaneous squamous cell carcinoma, hypertrophic lichen planus, misdiagnosis, oral retinoids, topical corticosteroids
MeSH terms: Case Reports

Fewer than 26 case reports describe hypertrophic lichen planus (HLP) misdiagnosed as cutaneous squamous cell carcinoma (cSCC). It can be difficult to distinguish between HLP and cSCC, as these two conditions share many clinical and histopathological characteristics. Patients who are misdiagnosed with cSCC often undergo unnecessary medical and/or surgical interventions before receiving a diagnosis of HLP and improving on HLP-directed therapy. This case series highlights the course of three female patients, referred to a single tertiary institution between 2018 and 2022, who were initially misdiagnosed with cSCC before receiving a diagnosis of HLP. We have emphasized the clinical and histopathological distinguishing features between HLP and cSCC, the pathogenesis of HLP, and current and new HLP-directed therapy. We hope that this case series serves as a reminder to dermatologists, dermatologic surgeons, and dermatopathologists to be aware of this diagnostic challenge.
Myocardial infarction due to septic thromboembolism in chronic rheumatic heart disease
Authors: Suneel Rachagiri, Aravind Sekar, Saurabh Mehrotra, Uma Nahar Saikia
Journal: Autops Case Rep (2023)
Keywords: aortic valve, embolism, endocarditis
MeSH terms: Case Reports

Chronic rheumatic heart disease (RHD) is the most troublesome complication of rheumatic fever. Extensive valvular scarring and ventricular remodeling due to pressure and volume overload occur in chronic RHD. Deformed valves are at potential risk for developing infective endocarditis (IE) with further systemic embolism. We hereby describe a case of a patient diagnosed with chronic rheumatic heart disease and severe ventricular dysfunction, planned for aortic valve replacement. The patient developed septic shock during a hospital stay. The autopsy revealed infective endocarditis in the aortic valve with septic thromboembolism in the peripheral branches of the coronary artery and early multifocal myocardial infarction changes.
Management of a Unique Subcarinal Bronchogenic Cyst with Robotic-Assisted Thoracic Surgery
Authors: Sandra Francis, Deepa Treesa Francis, Ishaan Thassu, Mohammad Ahsan Anwaar, Jhanvi Kothari, Rupert Chima, Malavika Jayan
Journal: Cureus (2024)
Keywords: bronchogenic cysts, computed tomography, posterior mediastinal mass, robotic thoracoscopic surgery, subcarinal
MeSH terms: Case Reports

A bronchogenic cyst (BC), although a rare congenital abnormality, represents the most common cystic lesion in the mediastinum and can present with chest pain and shortness of breath, especially due to compression of adjacent vital structures. The most common diagnostic modalities used are computed tomography (CT) and magnetic resonance imaging (MRI). These cysts may elude even a seasoned clinician unless they become symptomatic. For clinicians attempting to give optimum and prompt management for these cysts, robotic-assisted surgical resection is the recommended treatment of choice. Robotic-assisted thoracic surgery (RATS) offers precision and enhanced visualization, making it a safe and accurate approach for the removal of posterior mediastinal BCs. Our patient is a 65-year-old female who presented with symptomatic posterior mediastinal subcarinal BCs and underwent complete surgical resection with RATS. The diagnosis was confirmed with histopathology. Advancements and the clinical impact of RATS for mediastinal BCs including the Da Vinci robotic surgeries have been demonstrated to be minimally invasive, safe, and feasible especially when in difficult-to-reach areas. RATS has also proven to be advantageous in reducing disease burden and improving patient outcomes.
An Unusual Case of Gynecomastia Associated With Subclinical Hyperthyroidism
Authors: Pedro L Rojas, Rumeysa Ucar, Lutfor Nessa, Maria C Perez, Devi Suravajjala
Journal: Cureus (2024)
Keywords: gynecomastia, hyperthyroidism, male, subclinical, thyroiditis
MeSH terms: Case Reports

Gynecomastia in males is a medical condition that manifests as the abnormal enlargement of male breast tissue and has a variety of potential causes, which mainly classify as physiologic (infancy, puberty, elderly) and pathologic (hyperthyroidism, medications, cirrhosis, chronic kidney disease (CKD), malignancies). Pathologic causes mainly result from hormonal imbalances. While gynecomastia has been documented in cases of Graves' disease, it is rarely the presenting symptom with very few cases reported in the literature. Here we report an uncommon case of a 65-year-old male with bilateral gynecomastia who presented to his primary care physician (PCP) with concern for breast sensitivity and enlargement. Ultrasound of his breasts showed bilateral findings consistent with gynecomastia. Initial lab demonstrated suppressed thyroid-stimulating hormone (TSH) levels high, normal FT4, elevated estradiol level, elevated sex hormone-binding globulin (SHBG), and elevated total testosterone. The patient was seen by an Endocrinologist six months post-symptom onset and reported that his symptoms had resolved spontaneously.
ATAK complex (adrenaline, takotsubo, anaphylaxis, and kounis hypersensitivity-associated coronary syndrome) related to latamoxef administration-a case report
Authors: Sheng Li, Peng Ding, Chunxia Wang, Kunlan Long, Peiyang Gao
Journal: Front Cardiovasc Med (2024)
Keywords: kounis syndrome, adrenaline, allergy, case, latamoxef, stress cardiomyopathy
MeSH terms: Case Reports

Background:
Adrenaline, stress cardiomyopathy, allergic reactions, and Kounis syndrome (Adrenaline, Takotsubo, Anaphylaxis, Kounis Complex, ATAK) constitute a complex clinical syndrome often associated with endogenous or exogenous adrenaline. Due to its rapid onset, severity, and treatment challenges, it warrants significant attention from clinicians. This article reports a case of Type II Kounis syndrome combined with stress cardiomyopathy (ATAK) triggered by a latamoxef-induced allergy.
Case report:
A 67-year-old male patient with an acute exacerbation of chronic obstructive pulmonary disease was admitted to the respiratory department for treatment. The day before discharge, after receiving a latamoxef infusion for 27 min, the patient developed wheezing, dyspnea, chills, profuse sweating, and an elevated body temperature, necessitating transfer to the ICU for monitoring and treatment. The ECG suggested a suspected myocardial infarction, while bedside echocardiography showed a left ventricular ejection fraction of 40%, segmental dysfunction of the left ventricle, and apical rounding. Emergency coronary angiography revealed 50% segmental eccentric stenosis in the mid-segment of the left anterior descending branch and right coronary artery. The final diagnosis was Type II Kounis Syndrome combined with stress cardiomyopathy due to a latamoxef-induced allergy, i.e., ATAK. Despite aggressive treatment, the patient succumbed to severe cardiogenic shock on the third day in the ICU.
Conclusion:
ATAK is a critical condition that progresses rapidly. For patients experiencing severe allergic reactions, monitoring biomarkers such as Troponin and ECG changes is crucial for timely recognition. If a patient is diagnosed with Kounis syndrome, caution should be exercised in using adrenaline to prevent ATAK.