OpenMed/multicare-articles huggingface dataset:
Generalized Pruritus and Gradual Loss of Vision as the Presenting Complaints of Acute HIV Infection: Management Challenges during COVID-19 Pandemic
Authors: Shrebash Paul, S M Mahbubur Rahman, Rajibur Rahman, Mahbubur Rahman, Quazi Mamtaz Uddin Ahmed, Rafiqul Alam, Fazle Rabbi Chowdhury
Journal: Case Rep Infect Dis (2021)
MeSH terms: Case Reports

Background:
Although the prevalence of HIV is low in Bangladesh, there is a potential for an increased number of cases. This is because of high cross-border mobility (India and Myanmar) of people and increased injection drug abusers amongst youth in the cities and rural areas, HIV can present in many ways, from asymptomatic to advanced disease, including various atypical (generalized itching) and advanced (loss of vision) manifestations. A high degree of suspicion is required to diagnose HIV in a country like Bangladesh. Early diagnosis and prompt treatment are essential to have a better outcome.
Methods:
Here, we report two thought-provoking cases where patients were suffering from generalized itchy lesions (pruritic papular eruption) throughout the body for a long time and gradual loss of vision in another case.
Results:
Due to lack of suspicion, initially, HIV screening was not done. Both patients visited several health centres, but no diagnosis was made. Moreover, COVID-19 pandemic worsens the situation. Finally, they were diagnosed with HIV; unfortunately, one of them lost her vision due to CMV retinitis and another patient died of other complications.
Conclusion:
Ongoing COVID-19 pandemic put many challenges to ensure optimum care, especially for patients with long-sufferings like HIV. Clinicians have to have a very high degree of suspicion while dealing with patients presented with rare manifestations, particularly in a low endemic clinical setting.
Traumatic Rupture of an Intermediate Tendon in a Patient with Patellar Duplication
Authors: Stéphane Pelet, Mathieu Hébert, Amerigo Balatri, Pierre-Alexandre LeBlanc
Journal: Case Rep Orthop (2017)
MeSH terms: Case Reports

Patellar duplication is a rare asymptomatic condition. The diagnosis is often made following a traumatic event associated with an injury to the knee extensor mechanism. The treatment is often surgical and consists in removal of the smaller part of the patella with tendon reinsertion. The presence and rupture of an intermediate tendon between the two parts of the patella have not been reported in the modern literature. We present a traumatic rupture of an intermediate tendon in a patient with horizontal patellar duplication. The surgical management consisted of tenorrhaphy protected with a figure-of-eight tension band wire approximating the two parts of the patella. The patient recovered full knee range of motion and quadriceps strength at the last 8-month follow-up.
Case Report: Two Distinct Focal Congenital Hyperinsulinism Lesions Resulting From Separate Genetic Events
Authors: Elizabeth Rosenfeld, Lauren Mitteer, Kara Boodhansingh, Susan A Becker, Heather McKnight, Linda Boyajian, Amanda M Ackermann, Jennifer M Kalish, Tricia R Bhatti, Lisa J States, N Scott Adzick, Katherine Lord, Diva D De León
Journal: Front Pediatr (2021)
Keywords: katp channel, beta cells, case report, hypoglycemia, islets, pancreas
MeSH terms: Case Reports

Focal hyperinsulinism (HI) comprises nearly 50% of all surgically treated HI cases and is cured if the focal lesion can be completely resected. Pre-operative localization of the lesion is thus critical. Few cases of hyperinsulinism with multiple focal lesions have been reported, and assessment of the molecular mechanisms driving this rare occurrence has been limited. We present two cases of multifocal HI, each resulting from two independent, pancreatic focal lesions. 18Fluoro-dihydroxyphenylalanine positron emission tomography/computed tomography detected both lesions preoperatively in one patient, whereas identification of the second lesion was an incidental finding during surgical exploration in the other. Complete resection of the focal lesions resulted in cure of the HI in both cases. In each patient, genetic testing of the individual focal lesions revealed different regions of loss of heterozygosity for the maternal 11p15 allele, confirming that each lesion arose from independent somatic events in the setting of a paternally inherited germline ABCC8 mutation. These cases highlight the importance of a multidisciplinary and personalized approach to the management of infants with HI.
Primary diffuse large B-cell lymphoma of the right kidney: a case report
Authors: Hamid Nasrollahi, Ali Eslahi, Faisal Ahmed, Bita Geramizadeh, Mansour Ansari
Journal: Pan Afr Med J (2022)
Keywords: diffuse large b-cell lymphoma, case report, primary renal lymphoma
MeSH terms: Carcinoma, Renal Cell / diagnosis, Kidney Neoplasms / drug therapy, Kidney Neoplasms / therapy, Lymphoma, Large B-Cell, Diffuse / drug therapy, Lymphoma, Large B-Cell, Diffuse / therapy, Case Reports, Humans, Kidney / pathology, Male, Middle Aged, Nephrectomy

The existence of primary renal lymphoma (PRL) in the kidney has long been debated due to its extranodal location and lack of lymphatic channels. Primary renal lymphoma is extremely rare, accounting for less than 1%, and is frequently misdiagnosed as renal cell carcinoma (RCC). We present a 50-year-old man presenting with right flank pain in the last week. The computed tomography scan showed a large isodense right renal mass with a small para-aortic lymph node suspected of RCC. The patient underwent right radical nephrectomy and lymphadenectomy with an uneventful postoperative outcome. The histopathology and immunohistochemistry showed diffuse large B-cell lymphoma. Then, the patient received five-cycle chemotherapy and regional radiotherapy. Within five years of follow-up, no symptoms of recurrence. In conclusion, even though PRL is a rare tumor type. An effort should be made to make a preoperative diagnosis because PRL can be treated with systemic chemotherapy instead of other renal tumors requiring nephrectomy.
Acute Rhabdomyolysis in a Child with Multiple Suspicious Gene Variants
Authors: Aiko Murakami, Rhiana L Lau, Robert Wallerstein, Tamara Zagustin, Garett Kuwada, Prashant J Purohit
Journal: Case Rep Pediatr (2022)
MeSH terms: Case Reports

Rhabdomyolysis is diagnosed with creatinine kinase (CK) elevation beyond 1000 U/L or ten times above the normal upper limit. Severe episodes can be fatal from electrolyte imbalance, acute renal failure, and disseminated intravascular coagulation. A 13-month-old child was admitted with a CK of 82,090 U/L in the setting of respiratory tract infection-related hyperthermia of 106.9° farenheit. His medical history was significant for prematurity, dystonia, and recurrent rhabdomyolysis. His home medications clonazepam, clonidine, and baclofen were continued upon admission. He exhibited uncontrolled dystonia despite treatment for dystonia. Therefore, sedative infusions and forced alkaline diuresis were begun to prevent heme pigment-induced renal injury. Despite these interventions, his CK peaked at 145,920 U/L, which is rarely reported in this age group. The patient also developed pulmonary edema despite diuresis and required mechanical ventilation. Sedative infusions were not enough for dystonia management, and he needed the addition of a neuromuscular blocking infusion. He finally responded to these interventions, and the CK normalized after a month. He required a month of mechanical ventilation and two and a half months of hospitalization and extensive rehabilitation. We were able to avert renal replacement therapy despite pulmonary edema and an estimated glomerular filtration rate nadir of 21 mL/min/1.73 m2 based on the bedside Schwartz formula. He made a complete recovery and was discharged home. His growth and development were satisfactory for two years after that event. His extensive diagnostic workup was negative. Unfortunately, he died from septic and cardiogenic shock with mild rhabdomyolysis two years later. Prompt recognition, early institution of appropriate therapies, identification of underlying disease, and triggering events are pivotal in rhabdomyolysis management. Evidence-based guidelines are needed in this context.
Clinicopathological Implications of Proteinuria after Long-Term Isolated Hematuria due to Thin Basement Membrane Nephropathy and Focal Segmental Glomerulosclerosis
Authors: Ryo Togashi, Yoshikazu Nemoto, Kaito Waki, Michito Nagura, Shigeyuki Arai, Yoshifuru Tamura, Yasutoshi Oshima, Fukuo Kondo, Ryuji Ohashi, Shunya Uchida, Shigeru Shibata, Yoshihide Fujigaki
Journal: Case Rep Nephrol (2019)
MeSH terms: Case Reports

A 45-year-old obese man presented with persistent hematuria for 21 years. At the age of 37, he developed hypertension and proteinuria which later increased up to 1.6 g/g creatinine. Kidney biopsy revealed thin basement membrane nephropathy (TBMN) and focal segmental glomerulosclerosis (FSGS), which explained his urinary abnormalities. Although a subgroup of TBMN can be complicated by FSGS, his FSGS was associated with obesity because of its histological features. Reduction of body weight and increasing a dose of angiotensin-receptor blocker could transiently reduce the amount of proteinuria. Clinicopathological implications of proteinuria after long-term hematuria by TBMN and FSGS were further discussed.
Duodenal perforation in a 12-month old child with severe malaria
Authors: Nina Goldman, Damien Punguyire, Kingsley Osei-Kwakye, Frank Baiden
Journal: Pan Afr Med J (2012)
Keywords: peptic ulcer disease, children, intestinal perforation, malaria
MeSH terms: Duodenal Ulcer / complications, Malaria / complications, Peptic Ulcer Perforation / complications, Case Reports, Humans, Infant, Male, Severity of Illness Index

Peptic ulcer disease (PUD) in children remains rare and difficult to diagnose before the onset of complications. We report on a case of a 12-month child with perforated duodenal ulcer, association with malaria. The severity of the febrile presentation and the positive laboratory confirmation of malaria delayed the diagnosis of PUD. Surgical intervention was successful and without significant sequelae. An awareness of the possibility, and a lower threshold for considering PUD in children may help prevent complications.
Case report: Sarcomatoid urothelial carcinoma of the renal pelvis masquerading as a renal abscess
Authors: Yaru Chu, Hao Ning, Ke Yin, Tong Chen, Haihu Wu, Delin Wang, Feifan Liu, Zhenlin Zhao, Jiaju Lv
Journal: Front Oncol (2023)
Keywords: misdiagnosis, rare disease, renal abscess, renal pelvis, sarcomatoid urothelial carcinoma
MeSH terms: Case Reports

Sarcomatoid urothelial carcinoma (SUC), a rare tumor of the urinary tract epithelium, exhibits a high degree of malignancy and therefore a poor prognosis. Due to the absence of specific clinical presentations and imaging findings, SUC of the renal pelvis masquerades as a renal abscess is frequently under-recognized or misdiagnosed as benign inflammatory disease, resulting in delayed or erroneous treatment. Here, we report a patient with SUC of the renal pelvis who presented with a renal abscess. Repeated anti-inflammatory treatment was ineffective. Unexpectedly, cancerous cells were detected in subsequent exfoliative cytology of nephrostomy drainage fluid. In accordance with this, radical surgery and postoperative chemotherapy were conducted. Fortunately, neither recurrence nor metastasis occurred during a one-year follow-up.
A Rare Case of Metastatic Primary Peritoneal Ependymoma: A Case Report and Literature Review
Authors: Ben Man Fei Cheung, Johnny Kin Sang Lau, Anthony W I Lo, Mai-Yee Luk, Kwok Keung Yuen
Journal: Case Rep Oncol Med (2020)
MeSH terms: Case Reports

Background:
Primary peritoneal ependymoma is an exceedingly rare tumour with only four cases reported in the literature. It typically follows an indolent disease course. We describe a rare case of metastatic primary peritoneal ependymoma which was treated with chemotherapy and radiotherapy resulting in prolonged survival to date for 10 years. Case Presentation. The patient was a 23-year-old female on presentation. She presented with right upper quadrant pain associated with an abdominal mass. Computed tomography demonstrated a large mass displacing the liver. Debulking surgery was done revealing a tumour arising from the peritoneum as well as multiple metastatic pleural and peritoneal nodules. Pathology was consistent with primary peritoneal ependymoma. The patient was then treated with multiple lines of chemotherapy containing etoposide as the backbone. She also received palliative radiotherapy to the thoracic metastases with good and durable response.
Conclusion:
We reported a rare case of metastatic primary peritoneal ependymoma. Etoposide containing the chemotherapy regimen is effective in the treatment of peritoneal ependymoma. Radiotherapy is also effective for palliation of local symptoms with durable response.
Barium aspiration in an infant: a case report and review of management
Authors: M Jackson, N Kapur, V Goyal, K Choo, A Sarikwal, I B Masters, Alan F Isles
Journal: Front Pediatr (2014)
Keywords: aspiration, barium, tracheo-esophageal cleft, tracheo-esophageal fistula
MeSH terms: Review

We describe a case of bilateral inhalation of barium in an infant following a barium swallow for investigation of dusky spells associated with feeds. A bronchoscopy subsequently revealed the presence of a mid-tracheal tracheo-esophageal cleft. To date, little has been reported on barium aspiration in children and there is no consensus for management. We review the literature on barium aspiration, its consequences, and make recommendations for management.
Contralateral hyperinflation: Computed tomography demonstration of an unusual complication of unrecognized endobronchial intubation
Authors: Jyotindu Debnath, Rajesh Kumar, R Bala Murali Krishna, Ankit Mathur
Journal: Indian J Crit Care Med (2011)
Keywords: contralateral hyperinflation, computed tomography, endobronchial intubation
MeSH terms: Case Reports

Endobronchial intubation (EBI) is an important complication of endotracheal intubation. In a case of unrecognized EBI, usually, the intubated lung gets hyperinflated while the contralateral lung collapses. We report a case of unrecognized right main stem EBI with ipsilateral normal aeration and contralateral hyperinflation detected during computed tomography scan of the chest for trauma work up in a case of severe head injury.
Long-Term Outcomes of Cultivated Limbal Epithelial Transplantation: Evaluation and Comparison of Results in Children and Adults
Authors: Anita Ganger, M Vanathi, Sujata Mohanty, Radhika Tandon
Journal: Biomed Res Int (2015)
MeSH terms: Cornea / surgery, Corneal Diseases / surgery, Corneal Transplantation, Epithelial Cells / transplantation, Stem Cells, Research Support, Non-U.S. Gov't, Adolescent, Adult, Child, Child, Preschool, Cornea / pathology, Corneal Diseases / pathology, Epithelium, Corneal / pathology, Epithelium, Corneal / transplantation, Female, Graft Survival, Humans, Male, Treatment Outcome, Visual Acuity / physiology

Purpose:
To compare the long-term clinical outcomes of cultivated limbal epithelial transplantation (CLET) in children and adults with limbal stem cell deficiency.
Design:
Retrospective case series.
Methods:
Case records of patients with limbal stem cell deficiency (LSCD) who underwent CLET from April 2004 to December 2014 were studied. Outcome measures were compared in terms of anatomical success and visual improvement. Parameters for total anatomical success were avascular, epithelized, and clinically stable corneal surface without conjunctivalization, whereas partial anatomical success was considered when mild vascularization (sparing centre of cornea) and mild conjunctivalization were noted along with complete epithelization.
Results:
A total of 62 cases underwent the CLET procedure: 38 (61.3%) were children and 24 (38.7%) were adults. Patients with unilateral LSCD (33 children and 21 adults) had autografts and those with bilateral LSCD (5 children and 3 adults) had allografts. Amongst the 54 autografts partial and total anatomical success were noted in 21.2% and 66.6% children, respectively, and 19.0% and 80.9% in adults, respectively (p value 0.23). Visual improvement of 1 line and ≥2 lines was seen in 57.5% and 21.2% children, respectively, and 38% and 38% in adults, respectively (p value 0.31).
Conclusion:
Cultivated limbal epithelial transplantation gives good long-term results in patients with LSCD and the outcomes are comparable in children and adults.
Case series: Cariprazine in early-onset schizophrenia
Authors: Elena Ivanova, Desislava Maslinkova, Nadia Polnareva, Vihra Milanova
Journal: Front Psychiatry (2023)
Keywords: cariprazine, early-onset/adolescent schizophrenia, general and social functioning, negative symptoms, novel atypical antipsychotics, tolerability
MeSH terms: Case Reports

Introduction:
Negative symptoms are part of the clinical manifestations of schizophrenia and their presence is associated with a poorer prognosis, significantly limited vocational opportunities, impaired quality of life and social functioning. In the clinical practice, treatment of negative symptoms in patients with schizophrenia, is a challenge. Cariprazine is a novel partial agonist of D3 and D2 receptors, and shows a high affinity for D3, with good tolerability, good response to schizophrenic symptoms and limited side effects. We present two cases of young patients with predominantly negative symptoms during treatment with an atypical antipsychotic, administered in a stable dose and therapeutic range, and for at least 4 weeks prior to the Cariprazine switch.
Methods:
Two patients (men aged 21 and 22) with schizophrenia, exhibiting predominantly negative symptoms, are presented. Their diagnosis was based on, DSM-5 criteria (295.10).Patients were treated with Cariprazine at a daily dose of 4.5 mg. They were followed for a period of 18 months and assessed with Positive and Negative Syndrome Scale (PANSS), Global Assessment of Functioning (GAF) and Clinical Global Impression-Severity (CGI-S), at the fourth week of initiation of treatment with Cariprazine, at 6 months, at 12 months and at 18 months. Their mean initial value was 75.5 on PANSS, 4.0 on CGI-S, and 52.5 on GAF. Both patients were treated with stable doses of atypical antipsychotic-Risperidone at a daily dose of 4,5 mg. Cross-titration to Cariprazine was initiated, from 1.5 mg daily dose up to 4,5 mg daily dose, during a period of 2 weeks.
Results:
After 18 months of treatment with Cariprazine at a daily dose of 4.5 mg, the following results were reported: mean value was 57.5 on PANSS, 3.0 on CGI-S, and 74.5 on GAF. The overall PANSS mean score decreased by 23.8%, the CGI-S mean score improved by 25% and the mean GAF score increased by 29.5%. The positive PANSS subscale score decreased minimally, from 20 to 16, while for the negative subscale the improvement was 29.8%.Cariprazine was well tolerated by patients and no side effects were observed from it during therapy.
Discussion:
After 18 months Cariprazine succeeded in improving negative symptoms, global functioning, and global clinical impression. In young schizophrenic patients with a predominance of negative symptoms, the cariprazine may be a successful alternative.
Syncope associated with subthalamic nucleus deep brain stimulation in a patient with Parkinson's disease
Authors: Dursun Aygun, Ersoy Kocabicak, Onur Yildiz, Musa Kazim Onar, Hatice Guz, Omer Boke, Murat Kurt, Yasin Temel
Journal: Case Rep Neurol Med (2013)

In advanced Parkinson's disease (PD), deep brain stimulation (DBS) may be an alternative option for the treatment of motor symptoms. Side effects associated with subthalamic nucleus (STN) DBS in patients with PD are emerging as the most frequent sensory and motor symptoms. DBS-related syncope is reported as extremely rare. We wanted to discuss the mechanisms of syncope associated with STN DBS in a patient with Parkinson's disease. Case report. Sixty-three-year-old female patient is followed up with diagnosis of idiopathic Parkinson's disease for 6 years in our clinic. The patient has undergone STN DBS due to painful dystonia and drug resistant tremor. During the operation, when the left STN was stimulated at 5 milliampere (mAmp), the patient developed presyncopal symptoms. However, when the stimulation was stopped symptoms improved. During the early period after the operation, when the right STN was stimulated at 1.3 millivolts (mV), she developed the pre-yncopal symptoms and then syncope. Our case shows that STN DBS may lead to directly autonomic symptoms resulting in syncope during stimulation-on (stim-on).
Exercise-induced hypoglycemic hemiplegia in a child with type 1 diabetes: a rare find with multiple potential causative mechanisms
Authors: M Constantine Samaan, Abeer Alassaf, Jonathan Dellavedova, Trisha Murthy
Journal: Case Rep Med (2011)
MeSH terms: Case Reports

A 10-year-old boy known to have type 1 diabetes presented to the emergency department with history of sudden onset of right-sided hemiplegia after exercise. He did not respond to oral glucose administration, but had an almost immediate resolution of symptoms with intravenous bolus of dextrose. Hemiplegic hypoglycemia is a rare complication in diabetic children, mostly affects the right side of the body, and is rarely recurrent. Children have normal brain imaging and angiography testing, and electroencephalogram may show slow-wave activity. The recovery takes place within 24 hours, and the prognosis is excellent with no focal neurological deficits noted. Our patient responded within minutes to intravenous dextrose, which is unusual and has not been reported previously. The mechanisms leading to development of hypoglycemic hemiplegia are unclear, but may involve effects of hypoglycemia on intracellular signaling pathways or molecules on motor neurons, as recent studies have shown normal brain cell glucose uptake and metabolism in hypoglycemia. While hypoglycemic hemiplegia is rare, it is a frightening experience to caregivers, and efforts should concentrate on its prevention by preventing hypoglycemia.
Mandibular Reconstruction With the Contralateral Vascularized Iliac Flap Using Individual Design: Iliac Crest Used to Reconstruct the Ramus and the Anterior Border of the Iliac Wing Used to Reconstruct the Inferior Border: A Case Report
Authors: Guangcai Xu, Ju Jia, Xuepeng Xiong, Liwei Peng, Lin-Lin Bu, Xiqian Wang
Journal: Front Surg (2022)
Keywords: 3d printing, individual, mandibular, reconstruction, vascularized iliac flap
MeSH terms: Case Reports

Mandible defects resulting from resection of benign or malignant lesions, trauma, or radionecrosis are commonly encountered in the oral and maxillofacial department. Vascularized bone flaps, in general, provide the best functional and aesthetic outcome. The iliac crest provides a large piece of curved cortico-cancellous bone, measuring 6-16 cm in length. It has a natural curvature that complements the curve of the lateral and sometimes anterior mandible and can be placed accordingly to fill defects. In the paper, we report a mandibular reconstruction with a vascularized iliac flap using individual virtual preoperative planning and 3D printing technology. We want to offer a new design idea for mandibular defect reconstruction.
Cerebral venous sinus thrombosis in HIV-infected patients: report of 2 cases
Authors: Julius Chacha Mwita, Kgomotso Baliki, Ludo Tema
Journal: Pan Afr Med J (2013)
Keywords: cerebral venous sinus thrombosis, hiv, cerebrovascular diseases, stroke
MeSH terms: HIV Infections / complications, Sinus Thrombosis, Intracranial / complications, Case Reports, Adolescent, Adult, Female, HIV-1, Headache / diagnosis, Headache / etiology, Humans, Seizures / diagnosis, Seizures / etiology, Sinus Thrombosis, Intracranial / diagnosis

Infection with the human immunodeficiency virus (HIV) is associated with increased risk of cerebrovascular disease; however Cerebral Venous Sinus Thrombosis (CVST) is rarely associated with HIV-related cerebrovascular events. We describe two cases of HIV-positive patients who, at the same time, presented to our hospital with deep cerebral venous thrombosis and stroke.