OpenMed/multicare-articles huggingface dataset:
Case Report: Paradoxical Inflammatory Response Syndrome in a Previously Healthy, HIV-Negative, Pediatric Patient With Cryptococcus gatii Meningitis
Authors: Jessica H Cheng, Ritu Cheema, Peter R Williamson, Victoria R Dimitriades
Journal: Front Pediatr (2021)
Keywords: il-6, cryptococcal meningitis, immunocompetent, pediatrics, post-infectious inflammatory response syndrome
MeSH terms: Case Reports

The immunological response of patients with cryptococcal meningitis (CM), particularly those not known to be immunocompromised, has generated an increased interest recently. Although CM is an infection with significant rates of morbidity and mortality, its sequelae may also include a post-infectious inflammatory response syndrome (PIIRS) in patients who have already achieved microbiological control. PIIRS can cause substantial immune-mediated damage to the central nervous system resulting in long-term neurological disability or even death. Steroids have been used successfully in the management of PIIRS in adults. In this report, we present the case of a previously healthy adolescent male with Cryptococcus gattii meningitis who experienced neurological deterioration due to PIIRS after the initiation of antifungal therapy. Immunological workup did not demonstrate any frank underlying immunodeficiencies, and genetic primary immunodeficiency screening was unremarkable. He was treated with steroids and recovered clinically; however, intermittent inflammatory episodes needed to be managed through several flares of symptoms. In the setting of the current literature, we discuss the management and monitoring of PIIRS in a pediatric patient, along with considerations of targeted future therapies.
An Unexpected Reaction to Topical Garlic Medicament - A Case Report of Irritant Contact Dermatitis Successfully Managed in Primary Care
Authors: Jazlan Jamaluddin, Siti Nuradliah Jamil
Journal: Cureus (2023)
Keywords: complementary and alternative medicines, contact dermatitis, garlic, irritant, primary care
MeSH terms: Case Reports

Irritant contact dermatitis (ICD) is a common skin condition in primary care. The frequent cause of ICD includes hair dye, nail polish, paints, cleaners, soap, and detergent. We present a case of ICD caused by topical garlic medicament, successfully identified and managed in primary care. A 20-year-old woman presented with a sudden onset of multiple painful localized blisters on the right antecubital fossa. She reported applying raw garlic paste to the area one day before the clinic visit to treat mild itchiness. She had no known allergies or medical illnesses. Otherwise, there were no rashes elsewhere or oral and genital ulcers. She was not on any regular medication or taking traditional medication. Examination revealed multiple bullae on the antecubital fossa with perilesional erythema. The lesion was sharply bordered within the contact areas, was asymmetric, and did not spread elsewhere. The clinical history of immediate bullae formation after direct contact with garlic was consistent with ICD due to garlic medicament. The lesions were managed with regular dressings. At one week follow-up, the lesions had healed well. She was advised to avoid further application of topical garlic medicines. Although Allium sativum (garlic) has been used either topical or orally as a medicinal treatment worldwide for thousands of years to treat various conditions, it still has the potential to cause irritant dermatitis when applied to skin and mucosa. Patients and healthcare providers should be cautious of the potential side effects, such as ICD, when using garlic for medicinal purposes.
Case Report: Fulminant Celiac Disease With Combination Immune Checkpoint Therapy
Authors: Ayo S Falade, Kerry L Reynolds, Leyre Zubiri, Vikram Deshpande, Florian J Fintelmann, Michael Dougan, Meghan J Mooradian
Journal: Front Immunol (2022)
Keywords: celiac disease, immune checkpoint inhibitors, immune-related adverse effects, immune-related celiac disease, immunotherapy
MeSH terms: Celiac Disease / diagnosis, Melanoma / drug therapy, Case Reports, Research Support, Non-U.S. Gov't, Aged, Combined Modality Therapy, Humans, Ipilimumab / adverse effects, Male, Nivolumab / adverse effects, Ipilimumab, Nivolumab

Since the first approval of immune checkpoint inhibitors (ICIs) in 2011, these agents have rapidly become an integral treatment option across tumor types. However, with the increased adoption of ICIs, the incidence of immune-related adverse events (irAEs) continues to rise, and rare toxicity continues to be reported. Here, we present a case of a 70-year-old male patient with widespread metastatic melanoma who developed rapid onset anasarca and transaminitis after initiation of dual anti-PD-1/CTLA-4 inhibition with nivolumab and ipilimumab. An extensive workup was performed with serologies returning positive for anti-tissue transglutaminase immunoglobulin (tTG-IgA) and endoscopy revealing duodenal mucosal atrophy with duodenal biopsies confirming celiac disease. All symptoms resolved after initiation of a gluten-free diet without the addition of immunosuppression. This case highlights the importance of considering celiac disease in patients with suspected protein-losing enteropathy on ICI, the fulminant nature this uncommon irAE can present with, and underscores the broad differential clinicians must maintain when managing presumed irAEs.
A case of prenatal diagnosis of 18p deletion syndrome following noninvasive prenatal testing
Authors: Ganye Zhao, Peng Dai, Shanshan Gao, Xuechao Zhao, Conghui Wang, Lina Liu, Xiangdong Kong
Journal: Mol Cytogenet (2019)
Keywords: 18p deletion syndrome, cnv-seq, karyotype, nipt, prenatal diagnosis
MeSH terms: Case Reports

Background:
Chromosome 18p deletion syndrome is a disease caused by the complete or partial deletion of the short arm of chromosome 18, there were few cases reported about the prenatal diagnosis of 18p deletion syndrome. Noninvasive prenatal testing (NIPT) is widely used in the screening of common fetal chromosome aneuploidy. However, the segmental deletions and duplications should also be concerned. Except that some cases had increased nuchal translucency or holoprosencephaly, most of the fetal phenotype of 18p deletion syndrome may not be evident during the pregnancy, 18p deletion syndrome was always accidentally discovered during the prenatal examination.
Case presentations:
In our case, we found a pure partial monosomy 18p deletion during the confirmation of the result of NIPT by copy number variation sequencing (CNV-Seq). The result of NIPT suggested that there was a partial or complete deletion of X chromosome. The amniotic fluid karyotype was normal, but result of CNV-Seq indicated a 7.56 Mb deletion on the short arm of chromosome 18 but not in the couple, which means the deletion was de novo deletion. Finally, the parents chose to terminate the pregnancy.
Conclusions:
To our knowledge, this is the first case of prenatal diagnosis of 18p deletion syndrome following NIPT.NIPT combined with ultrasound may be a relatively efficient method to screen chromosome microdeletions especially for the 18p deletion syndrome.
Evaluation of an educational intervention (edworkcases) involving clinical cases and Nursing students: a cross-sectional observational study
Authors: María Isabel Guzmán-Almagro, Cristina Oter-Quintana, Carmen Clara Martín-Salinas, María Luisa Cid-Galán, Elena Carrillo-Camacho, María Victoria Navarta-Sánchez, Oscar Castedo-Martínez, María Teresa Alcolea-Cosín, Luciana Mara Monti Fonseca, Ana Isabel Parro-Moreno
Journal: Rev Lat Am Enfermagem (2022)
MeSH terms: Education, Nursing, Baccalaureate, Students, Nursing, Observational Study, Adult, Attitude of Health Personnel, Cross-Sectional Studies, Female, Humans, Male, Surveys and Questionnaires, Young Adult

Objective:
to evaluate the impact of the (edworkcases) educational intervention on students' evaluation outcomes in their clinical practices, their attitudes towards Nursing diagnoses, and their satisfaction.
Method:
this study used a cross-sectional observational design. The participants were 69 third-year Nursing students from a public university in Madrid, Spain. The data analysed in the study were the grades obtained by students for their clinical practices, as well as pre-post intervention scores on the Positions on Nursing Diagnosis Scale and a satisfaction survey. A means comparison by participation in the project (yes/no) was carried out using Student's t-test. A means comparison by professor was conducted using Kruskal-Wallis tests.
Results:
participation rate: 72.4%; 92% of the participants were women; median age = 21 years old. Statistically significant differences were found between participants and non-participants in terms of mean score in the Overall Evaluation and in the Case Study Evaluation, with higher scores found among the group of participants. The mean score for attitudes towards Nursing diagnoses was 99.9 (SD=2.8) before the intervention and 111.1 (SD=2.9) after the intervention [95% CI: 3.3-19.2].
Conclusion:
the use of (edworkcases) as part of the practical training was considered satisfactory, enabling theory and practice to be combined and improving students' attitudes towards Nursing diagnoses.
Xanthomatous Hypophysitis: A Case Report and Comprehensive Literature Review
Authors: Jianyu Zhu, Zhicheng Wang, Wenze Wang, Jinghua Fan, Yi Zhang, Xiaoxu Li, Jie Liu, Shenzhong Jiang, Kan Deng, Lian Duan, Yong Yao, Huijuan Zhu
Journal: Front Endocrinol (Lausanne) (2021)
Keywords: clinical characteristics, pathological examination, recurrence, surgery, xanthomatous hypophysitis
MeSH terms: Hypophysitis / diagnosis, Pituitary Gland / diagnostic imaging, Xanthomatosis / diagnosis, Case Reports, Research Support, Non-U.S. Gov't, Systematic Review, Adolescent, Adrenocorticotropic Hormone / blood, Adult, Aged, Child, Female, Follicle Stimulating Hormone / blood, Human Growth Hormone / blood, Humans, Hypophysitis / blood, Hypophysitis / diagnostic imaging, Insulin-Like Growth Factor I / metabolism, Luteinizing Hormone / blood, Male, Middle Aged, Thyrotropin / blood, Xanthomatosis / blood, Xanthomatosis / diagnostic imaging, Young Adult, Human Growth Hormone, Insulin-Like Growth Factor I, Adrenocorticotropic Hormone, Luteinizing Hormone, Follicle Stimulating Hormone, Thyrotropin

Purpose:
Xanthomatous hypophysitis (XHP) is an extremely rare form of primary hypophysitis for which there is a lack of clinical experience. A comprehensive understanding of its clinical characteristics, diagnosis and treatment is needed.
Methods:
Here, we report a case study and conduct a systematic review of XHP. Thirty-six cases were included, and their clinical manifestations, endocrine assessment, imaging features, treatment and follow-up data were collected and analyzed.
Results:
The mean age at diagnosis was 39.1 years, and females were predominant (75.0%). The most common symptom was headache (68.6%), and 66.7% of female patients presented menstrual disorders. The most common pituitary dysfunction was growth hormone (GH) deficiency. More than half of patients exhibited central diabetes insipidus (CDI). The majority of patients had an imaging presentation of a cystic lesion with peripheral enhancement. Pituitary stalk thickening was observed in half of the patients. Total lesion resection was achieved in 57.1% of cases. The recurrence rate after partial resection and biopsy was significantly higher than that after total lesion resection (57.1% vs. 0.0%, P = 0.0147). The most common pituitary hormone abnormalities to resolve after surgery were hyperprolactinemia (100.0%) and GH deficiency (91.7%). The typical pathological feature was inflammatory infiltration of foamy histiocytes, which showed positivity for CD68.
Conclusion:
Diagnosis of XHP is difficult when relying on clinical symptoms and imaging features. Therefore, surgical histopathology is necessary. Based on the available evidence, total lesion resection is recommended for treatment. However, the long-term prognosis for this rare disease remains unclear.
Upper Ureteric Stricture Secondary to Celiac Plexus Block Managed by Robotic Ureterocalicostomy
Authors: Deepak Ragoori, Mallikarjuna Chiruvella, Purnachandra Reddy Kondakindi, Mohd Taif Bendigeri, Bhavatej Enganti, Syed Md Ghouse
Journal: J Endourol Case Rep (2018)
Keywords: complications of celiac plexus block, iatrogenic ureteral stricture, robotic ureterocalicostomy
MeSH terms: Case Reports

Introduction: Ureterocalicostomy is a well-established procedure of choice for recurrent pelviureteric junction (PUJ) obstruction refractory to endoscopic management, failed pyeloplasty, completely intrarenal pelvis, and iatrogenic upper ureteral stricture with significant peripelvic fibrosis. Robotic ureterocalicostomy is the procedure of choice in such scenarios where meticulous dissection and accurate anastomotic suturing is required. Case Presentation: We report the case of an 18-year-old male, who underwent celiac plexus block for pain management of chronic calcific pancreatitis and presented with pain in the epigastric region and the right flank. A CT and subsequent nephrostogram revealed an upper ureteral defect (corrosive stricture) of ∼4 cm at the level of PUJ. Robotic ureterocalicostomy was performed. We discuss the clinical presentation, evaluation, and management along with literature review. Conclusion: Iatrogenic ureteral strictures are not uncommon in urological practice, but an upper ureteral stricture secondary to celiac plexus block is a rarity. Adequate evaluation and timely intervention by reconstructive surgery, robotic ureterocalicostomy in this case, yield satisfactory results.
Migrating pleural plaque in a patient with asbestos induced pleural disease: a case report
Authors: Christian Eisenhawer, Michael K Felten, Thomas Hager, Mikhail Gronostayskiy, Philipp Bruners, Andrea Tannapfel, Thomas Kraus
Journal: J Occup Med Toxicol (2017)
Keywords: asbestos, ct-scan, plaques, surveillance, tumour
MeSH terms: Case Reports

Background:
Health surveillance of formerly asbestos exposed individuals focus on early detection of asbestos related diseases, such as lung fibrosis (asbestosis), pleural plaques, mesothelioma and lung cancer in particular. One main concern is the early and clear identification of lesions with a high risk of malignant changes and their undelayed clinical work-up. False positive results may lead to unnecessary and often painful diagnostic interventions, which create high costs when applied to a large cohort and also may discredit the whole program. We describe an unusual presentation of a common lesion among asbestos exposed individuals, which has to our knowledge never been described before. Being aware of this pathological pathway may prevent inadequate clinical decisions with disadvantages for the patient. Underlying implications regarding health surveillance and the reading of CT-scans of the thorax are important for the management of formerly asbestos exposed individuals.
Case presentation:
During follow-up of an asbestos exposed 72 year old former power plant worker with known pleural changes, a nodule located next to the left costophrenic angle was newly discovered on CT-scan. As the previous scan 1 year before did not show any changes in that area, a fast growing tumour was suspected and an immediate biopsy performed. The tissue showed the characteristics of a pleural plaque with no signs of malignancy. After carefully reviewing all previous radiographs a rounded opacity attached to the mediastinal pleura close to the oesophagus and slightly cranial to the position of the removed nodule could be discerned. That nodule had increased in size over several years and was no longer visible on the latest scan. It appeared that the originally slow growing plaque had migrated to the costophrenic angle some time before it was discovered in the latest scan thus imposing as a fast growing tumour.
Conclusions:
We concluded that asbestos related pleural plaques can under special circumstances get separated from the pleura and migrate to another position in the pleural cavity. The case provides new insights in the development and properties of pleural lesions and may offer new options for the management of formerly asbestos exposed patients.
Pedicle Temporalis Fascial Flap with Axial Scalp Flap Obviates Need of Free Flap in Extensive Scalp Wound
Authors: F W Nangole, S O Khainga
Journal: Case Rep Surg (2017)
MeSH terms: Case Reports

Extensive scalp defect with exposed bone is best reconstructed with flaps. Majority of these wounds are now routinely reconstructed with free flaps in many centers. Free flaps however require lengthy operative time and may not be available to all patients, where possible less extensive options should thus be encouraged. A sixty-eight-year-old patient presented to us with a Marjolin's ulcer on the vertex of the scalp. After wide local excision a defect of about 17 cm and 12 cm was left. The defect was successfully covered with a combination of an ipsilateral pedicle temporalis fascial flap and an axial supraorbital scalp flap with good outcome. In conclusion wide defects of the scalp can be fully covered with a combination of local flaps. The axial scalp flap and the pedicle temporalis fascial flap where applicable provide an easy and less demanding option in covering such wounds. These flaps are reliable with good blood supply and have got less donor side morbidity.
A Clinical Case Report of a Potential Acute Allergic Reaction with Titanium Dental Implant
Authors: Ali Robaian Alqahtani, Khalid Gufran, Fred Silva, Mateus Garcia Rocha, Jia Chang
Journal: Case Rep Dent (2021)
MeSH terms: Case Reports

Titanium hypersensitivity is rare, but it may exist among patients who need dental implant treatment. It could contribute to mild or severe peri-implant tissue hypersensitivity reactions and affect patients' oral and general health according to some clinical reports. In extreme cases, it may lead to implant failure or extraction. In this case report, a 64-year-old Caucasian female patient received a titanium implant placement on #5. Right after the implant placement, she reported the symptoms of pain, eczema, and slight extraoral swelling, along with significant burning sensation occurring intra- and extraorally. The symptoms were not released after the systemic intervention of antibiotics for six days. On retrieving her medical history, the patient reported a previous allergic reaction to jewelry-like earrings in her childhood. The diagnosis of titanium hypersensitivity was made based on the rapid onset of symptoms and her metal allergy history. Therefore, the dental implant was removed after diagnosis, and a bone allograft was used to preserve the alveolar bone volume. Immediately after implant extraction, the swelling and burning sensation were receded. A complete recovery was achieved three weeks later. The dimension of the alveolar ridge bone was found well maintained in 10 weeks follow-up visit. Conclusion. Rapid onset of peri-implant gingival swelling may indicate a hypersensitivity to titanium implant in the clinic. For patients with a history of allergy to jewelry, the hypersensitivity tests to titanium alloy such as patch test or lymphocyte transformation test should be recommended as part of the dental implant treatment plan.
Posteriorly displaced salter halter fracture-dislocation at the sternoclavicular joint with associated thoracic outlet syndrome: A case report
Authors: Timothy McAleese, Mark Curtin, Denis Collins
Journal: Int J Surg Case Rep (2020)
Keywords: case report, conservative management, physeal fracture-dislocation, posterior sternoclavicular joint dislocation, salter-harris 2, thoracic outlet syndrome
MeSH terms: Case Reports

Introduction:
Posterior sternoclavicular joint fracture-dislocations are a rare and often missed diagnosis. They represent <1% of shoulder girdle injuries and are nine times less common than anterior dislocations. These injuries can be associated with life-threatening complications such as compression of the superior mediastinal structures including the great vessels and brachial plexus.
Presentation of case:
This case describes a 23-year-old woman who was initially discharged from the emergency department but represented 8 days later with symptoms of venous and neurogenic thoracic outlet syndrome as a result of posterior displacement of a Salter 2 fracture-dislocation at the sternoclavicular joint. Multidisciplinary consensus and patient preference resulted in the conservative management of her injuries with intensive rehabilitation and close outpatient follow-up.
Discussion:
The evidence regarding this rare injury is evolving. It currently suggests all posteriorly displaced fracture-dislocations at the sternoclavicular joint are reduced. Closed reduction is often unsuccessful and open reduction is high risk and must be undertaken in the presence of a cardiothoracic surgeon which may not always be appropriate or in line with patient preferences. There are limited reports of successful conservative management of these injuries and none in the setting of thoracic outlet syndrome.
Conclusion:
This unique case report is the first to describe outcomes of a conservatively managed, posteriorly displaced fracture-dislocation at the sternoclavicular joint with associated venous and neurogenic thoracic outlet syndrome. This information will benefit select patients.
Real-World Long-Term Experience on Endoxifen in Bipolar Disorder with Psychotic Symptoms
Authors: Vikas Thanvi
Journal: Case Rep Psychiatry (2022)
MeSH terms: Case Reports

Evidence suggests that inhibition of protein kinase C (PKC) signalling may have a contributing role in the treatment of bipolar affective disorder (BPAD). Endoxifen, an active metabolite of tamoxifen, is a potent direct PKC inhibitor. This report presents a severe case of a BPAD patient with a baseline Young Mania Rating Scale (YMRS) score of 49, associated family history and addiction to psychostimulants, with no improvement by the first and second-generation antipsychotics. Treatment with endoxifen 8 mg once a day showed improvement in manic symptoms with a YMRS score of 4 and a reduction in the use of psychostimulants as well as other antipsychotic concomitant medications. No adverse effects were noted up to 8-month follow-up. Long-term treatment with endoxifen is safe and effective in severe BPAD.
Fatal Multiorgan Failure Syndrome in a Strongyloides-HTLV-1 Coinfected Patient, after Treatment with Ivermectin
Authors: Emmanuelle Guérin, Paule Poirier, Marine Nervo, Christophe Le Terrier
Journal: Case Rep Crit Care (2021)
MeSH terms: Case Reports

Because of its characteristic features of autoinfection, the parasitic nematode Strongyloides stercoralis can infect patients for years. An acceleration of its autoinfective cycle can be triggered by human T-lymphotropic virus-1 (HTLV-1) infection, mainly by the deviation of the protective Th2- to Th1-type immune response and can lead to severe disease by dissemination of Strongyloides stercoralis larvae carrying intestinal bacteria to multiple organs. Meningitis caused by enteric Gram-negative bacteria is a potentially fatal complication of disseminated strongyloidiasis. Herein, we present the case of a Strongyloides-HTLV-1 coinfected patient, admitted for E. coli meningitis. One day after initiation of ivermectin, the patient developed significant S. stercoralis dissemination, complicated by multiorgan failure syndrome, and died from neurological failure. While the initial clinical scenario of our case has already been well described in the literature, its course after antihelminthic treatment initiation remains unclear and needs to be discussed.