OpenMed/multicare-articles huggingface dataset:
Tractography-based DBS lead repositioning improves outcome in refractory OCD and depression
Authors: Genevieve Basich-Pease, Natalya Slepneva, Adam C Frank, Tenzin Norbu, Melanie A Morrison, Leo P Sugrue, Paul S Larson, Philip A Starr, A Moses Lee
Journal: Front Hum Neurosci (2024)
Keywords: ocd, anterior limb of the internal capsule, deep brain stimulation, diffusion imaging, fmri, tractography
MeSH terms: Case Reports

Deep brain stimulation (DBS) of the anterior limb of the internal capsule (ALIC) has been used to treat refractory obsessive-compulsive disorder (OCD) and depression, but outcomes are variable, with some patients not responding to this form of invasive neuromodulation. A lack of benefit in some patients may be due to suboptimal positioning of DBS leads. Recently, studies have suggested that specific white matter tracts within the ALIC are associated with improved outcomes. Here, we present the case of a patient who initially had a modest improvement in OCD and depressive symptoms after receiving DBS within the ALIC. Subsequently, he underwent unilateral DBS lead repositioning informed by tractography targeting the ventrolateral and medial prefrontal cortex's connection with the mediodorsal thalamus. In this patient, we also conducted post-implant and post-repositioning diffusion imaging and found that we could successfully perform tractography even with DBS leads in place. Following lead repositioning into tracts predictive of benefit, the patient reached responder criteria for his OCD, and his depression was remitted. This case illustrates that tractography can potentially be used in the evaluation and planning of lead repositioning to achieve therapeutic outcomes.
Ataxia and Seizures despite Phenytoin: A Case Report Highlighting the Importance of TDM and Genetic Influences
Authors: Rachel Manoj, Arpita Meher, Jefry Winner G
Journal: Case Rep Neurol Med (2024)
MeSH terms: Case Reports

Adverse drug reactions to commonly prescribed medications such as phenytoin, used for seizures, often go undetected due to various factors. This case report highlights a 52-year-old male diagnosed with late-onset epilepsy who was prescribed phenytoin. Despite the standard dosage, the patient experienced toxicity symptoms and a seizure, prompting admission for assessment. Laboratory tests and imaging were inconclusive, leading to a therapeutic drug monitoring (TDM) consultation, which revealed elevated phenytoin levels. Genetic testing for CYP2C9 polymorphisms was not feasible but noted as significant, especially in populations with higher prevalence. Phenytoin was tapered, leading to the patient's gradual recovery upon discontinuation and transition to valproate. The Naranjo scale predicted potential adverse drug responses (ADRs). This case underscores the significance of TDM, genetic considerations in drug metabolism, and the need to be vigilant in treating epilepsy to prevent such adverse events.
Human Herpes Virus-6 (HHV-6) infectious encephalitis in an immunocompetent adult
Authors: Lisle Blackbourn, Sharjeel Ahmad, K'la Yuan, Manjari Uppu, Bassil Kherallah
Journal: IDCases (2024)
Keywords: encephalitis, hhv-6, herpes virus 6
MeSH terms: Case Reports

Human herpesvirus 6 (HHV-6) is one of the most prevalent childhood viruses. HHV-6 reactivation in allogeneic hematopoietic cell transplant recipients and solid organ transplant recipients is well described in medical literature. We present a case of HHV-6 reactivation causing encephalitis, which is rare in immunocompetent adults.
Clozapine Serum Concentrations Are Disrupted by SARS-CoV-2 Vaccinations
Authors: Xenia A K Kersting, Nicoletta Momtahen, Klaus Lieb
Journal: Case Rep Psychiatry (2023)
MeSH terms: Case Reports

This paper reports the case of a 27-year-old man with paranoid schizophrenia who was finally stabilized on clozapine medication. After vaccination against severe acute respiratory syndrome coronavirus 2, serum levels of clozapine increased. It is well established that immune responses can trigger cytokine cascades affecting drug metabolism, which, in the case of clozapine treatment, can lead to severe intoxication.
Case Report: Bacterial meningitis due to cerebrospinal fluid leakage following unilateral biportal endoscopic spinal surgery: a cautionary tale
Authors: Haoyu Wang, Yunhui Wang, Zhensong Jiang, Wen Zhang
Journal: Front Surg (2024)
Keywords: klebsiella pneumoniae, bacterial meningitis, cerebrospinal fluid, lumbar drainage, unilateral biportal endoscopic spinal surgery
MeSH terms: Case Reports

Unilateral biportal endoscopic spinal surgery (UBE) is a rapidly growing surgical method and has attracted much interest recently. The most common complication of this technique is cerebrospinal fluid (CSF) leakage due to intraoperative dural tears. There have been no reports of bacterial meningitis due to dural tears in UBE surgery and its treatment and prevention. We reported a 47 year-old man with CSF due to an intraoperative dural tear. A drainage tube was routinely placed and removed on the fourth day after surgery, resulting in fever and headache on the fifith postoperative day. Blood and CSF cultures showed Klebsiella pneumoniae infection, and with lumbar drainage and appropriate antibiotics based on sensitivity tests, the patient's fever and headache were effectively relieved. This case report suggests the importance of prolonged drainage tube placement, adequate drainage, careful intraoperative separation to avoid dural tears, and effective sensitive antibiotic therapy.
First-Trimester Pregnancy Loss Due to Condyloma Acuminata: A Twisted Tale of Gravidity
Authors: Saloni, Jyotsna Potdar, Apoorva Dave, Swati M Dahiphale
Journal: Cureus (2024)
Keywords: genital warts, human papilloma virus, pregnancy, sexually transmitted diseases in pregnancy, spontaneous abortion
MeSH terms: Case Reports

The human papillomavirus can induce condyloma acuminata, a benign papillomatous squamous growth with a fibrovascular core that arises in the vaginal canal. These illnesses typically afflict women who are fertile and are frequently encountered during pregnancy, manifesting with a variety of symptoms. The influences of hormones and vaginal secretions cause the lesion to expand quickly during pregnancy. Viral infections are known to be one risk factor for threatening abortions. Infection with human papillomavirus (HPV) during pregnancy has been associated with a risk for spontaneous abortion, preterm delivery, and abnormalities in the placenta. There are many therapeutic approaches available to address the disease; however, it is still unclear which one is the most successful. Additionally, organogenesis is crucial throughout the first trimester, and treatment during this period may elevate the risk of spontaneous abortion. Here, we describe the case of a young woman who experienced vaginal lesions during the first trimester of her pregnancy.
Rhodococcus equi and Brucella pulmonary mass in immunocompetent: A case report and literature review
Authors: Pengfei Li, Lifang Zhang, Xicheng Li, Xuejuan Zhang
Journal: Open Life Sci (2024)
Keywords: brucella, brucellar spondylitis, rhodococcus equi, pulmonary occupancy
MeSH terms: Case Reports

Rhodococcus equi, predominantly recognized as an opportunistic pathogen affecting immunocompromised hosts, and Brucella, a widespread zoonotic bacterium, infrequently co-infect immunocompetent adults, thereby posing a distinctive diagnostic challenge. Here, we describe a case involving a 53-year-old male with a history of goat farming, who presented with persistent chest tightness, cough, and notable weight loss, absent fever. Radiological and bronchoscopic assessments showed a right hilar mass, extensive vertebral destruction, and bronchial lesions, deviating from the typical symptoms associated with either pathogen. Laboratory analyses confirmed a co-infection involving R. equi and Brucella. Initial therapy with levofloxacin and vancomycin proved ineffective; however, a subsequent treatment regimen comprising azithromycin, etimicin, minocycline, and moxifloxacin resulted in substantial clinical improvement. This case accentuates the intricacies involved in diagnosing and managing atypical co-infections in immunocompetent individuals and underscores the importance of careful microbiological testing to inform effective therapeutic strategies.
Clinical Features and Follow-Up of the First Two Cases of Mpox From Trinidad and Tobago
Authors: Robert Jeffrey Edwards, Jonathan Edwards, Gregory G Boyce
Journal: Cureus (2024)
Keywords: genital lesions, mpox, msm, stigma, trinidad
MeSH terms: Case Reports

Mpox is a viral zoonotic disease that is endemic in Central and West Africa and belongs to the Orthopoxvirus genus. A global outbreak of mpox began in May 2022, mainly due to the transmission of the clade 11b virus through person-to-person contact with the lesions or scabs of a person infected with mpox. The data on mpox infection in the Caribbean is sparse. Here we report the clinical features and follow-up of the first two confirmed cases of mpox in Trinidad and Tobago (T&T). Both patients were men who have sex with men (MSM) who presented with genital lesions and expressed concern about increased stigma towards their already marginalized community.
Case report: From sequence to solution: tailoring treatment for transformed follicular lymphoma (DLBCL) through next generation sequencing study
Authors: Antonin Bouroumeau, Sarah Perdikis-Prati, Noémie Lang
Journal: Front Oncol (2024)
Keywords: ngs - next generation sequencing, pd-1 inhibitor, aggressive transformation, follicular lymphoma, tumor mutational burden (tmb)
MeSH terms: Case Reports

Immune checkpoint blockade (ICB) has indeed transformed the outlook for many advanced-stage solid tumors, yet its effectiveness in hematological malignancies has been particularly limited, with success predominantly demonstrated in classical Hodgkin lymphoma (cHL) and immune-privilege subtypes of non-Hodgkin lymphoma (NHL). In this report, we present an impactful case of a 71-year-old man grappling with refractory follicular lymphoma (rFL) that had progressed to a high-grade lymphoma, leaving no conventional treatment options on the table. Notably, the histological examination of the tumor tissue revealed a markedly elevated PD-L1 expression, illuminating the potential for immunotherapy to be effective. Additionally, comprehensive gene sequencing unveiled a moderate tumor mutational burden (TMB), deepening our understanding of the tumor's molecular intricacies. As his health declined with no access to cell therapies or clinical trials at that time, a combination treatment of PD-1 ICB and an anti-CD20 drug surprisingly led to a significant improvement in his condition and long-term remission. While PD-1 ICB therapy has historically shown limited responses in non-Hodgkin lymphomas (NHLs), this case serves as a beacon of optimism, underscoring the promise of combining immunotherapy modalities and the potential of comprehensive molecular assessments in charting innovative treatments for extensively treated NHL patients. The quest for predictive biomarkers to gauge treatment response remains a formidable challenge. This report serves as a testament to the ever-evolving landscape of cancer treatment, where precision medicine and immunotherapy continue to unlock new possibilities for those confronting the most challenging malignancies.
A rare case report of panuveitis with retinochoroidal involvement, retinitis, and retinal vasculitis due to extensive tinea corporis
Authors: Vinaya Kumar Konana, Kalpana Babu
Journal: Front Ophthalmol (Lausanne) (2023)
Keywords: itraconazole, panuveitis, retinal vasculitis, retinitis, skin, tinea corporis
MeSH terms: Case Reports

A 40-year-old Asian Indian woman, diagnosed as having idiopathic panuveitis (elsewhere) 3 years earlier and being treated with oral steroids (20 mg/day) and methotrexate (25 mg/week), presented to us with worsening vision in both eyes. Her best corrected visual acuity (BCVA) was perception of light in her right eye and counting fingers close to face in her left eye. A slit lamp examination showed an anterior chamber (AC) reaction (1+) in both eyes with posterior synechia, a total cataract in her right eye, and pseudophakia in her left eye. The left fundus showed vitritis, vitreous membranes, chorioretinitis, multifocal areas of retinitis, and retinal vascular sheathing. A systemic examination showed extensive multifocal areas of tinea corporis on the hands and torso. Owing to the leukocytosis (22,000 cells/mm3), diagnostic vitrectomy was initially deferred and 100 mg of oral itraconazole was given twice a day for 3 months. The vitritis improved a little and her total white blood cell (WBC) count improved with treatment of the skin infection. Following a diagnostic vitrectomy later in her left eye, resolving areas of retinitis were seen. Complete resolution of eye inflammation was seen at the end of 6 weeks. At the 6-month follow-up, her BCVA was 6/18 in left eye and she was off oral steroids and methotrexate, with no recurrence of inflammation. We speculate a probable association between the ocular inflammation and extensive tinea corporis based on the therapeutic response to itraconazole.
Post operative abdominal wall mucormycosis infection after laparotomy for bowel perforation
Authors: Neha Kumta, Lawrence Huang, Gururaj Nagaraj, Lindsey Papacostas, Shradha Subedi
Journal: IDCases (2024)
Keywords: infectious diseases and parasitology, intensive care, pathology, surgery
MeSH terms: Case Reports

Mucormycosis is a devastating disease with a high mortality rate, typically affecting immunosuppressed individuals. Postoperative surgical site infections due to mucromycosis are rare, with only a handful of cases reported in the literature. Here, we describe a fatal case of post operative abdominal wound infection caused by mucormycosis in an immunocompetent man in his 70 s, who developed the infection following a laparotomy for bowel perforation. Initially, the growth of fungal species from a superficial wound swab was not considered significant until the patient exhibited signs of worsening sepsis. Limited operative debridement was performed for prognostication, in accordance with the family's wishes. There was evidence of extensive significant invasive fungal infection, marked by necrosis extending into the abdominal wall fat and muscle. The patient was then transitioned to comfort measures and subsequently died. This case emphasizes the importance of maintaining a high level of clinical suspicion for mucormycosis, even in patients with minimal risk factors, and highlights the importance of prompt and aggressive treatment.
Case report: Urachal perivascular epithelioid cell tumor
Authors: Mengru Liu, Pan Liang, Dongbo Lyu, Bingbing Zhu, Jianbo Gao
Journal: Front Oncol (2024)
Keywords: pecoma, case report, imaging features, urachal tumor, urachus
MeSH terms: Case Reports

Background:
Urachal tumors are rare in clinical practice, among which urachal adenocarcinoma is the most common. In this study, we report a rare case of urachal perivascular epithelioid cell tumor to improve our understanding of the disease.
Case presentation:
A 26-year-old male patient was hospitalized for lower abdominal pain. The US showed a hypoechoic mass measuring 26mm × 18mm in the superior aspect of the bladder. MRI showed an irregular mass located anterior to the bladder roof, near the midline. The tumor exhibited hypointense on T1WI and heterogeneous hyperintense on T2WI. Additionally, contrast-enhanced T1-weighted imaging revealed obvious ring enhancement of the tumor. The patient underwent surgical resection of the urachal tumor, with subsequent pathological examination revealing a diagnosis of urachal PEComa. Following surgery, the patient underwent regular follow-up assessments, with no evidence of recurrence or metastasis observed after three and a half years.
Conclusions:
Urachal PEComa is a rare mesenchymal tumor that presents challenges in diagnosis through imaging and clinical symptoms. Definitive diagnosis relies on pathological and immunohistochemical analysis. Due to the rarity of urachal PEComa, prognosis assessment necessitates long-term follow-up and evaluation of more cases.
Sintilimab-induced myocarditis suspected in a patient with esophageal cancer and followed septic shock: case report and literature review
Authors: Qihao Zhou, Zhiquan Qin, Guoqing Wu, Peiyuan Yan, Qunjiang Wang, Jing Qu, Jiahong Jiang, Da Ye
Journal: Front Oncol (2024)
Keywords: case report, immune-related adverse events, methylprednisolone, myocarditis, septic shock, sintilimab
MeSH terms: Case Reports

Background:
Immune checkpoint inhibitors (ICIs) have become a prevalent tool in anti-tumor therapy in recent years. They may cause immune-related adverse events (irAEs) including potentially life-threatening cardiovascular toxicities such as myocarditis.
Case presentation:
In this report, we describe a 69-year-old man with recurrent esophageal cancer who developed myocarditis after receiving three cycles of sintilimab combined with nab-paclitaxel. Despite a rising cardiac troponin I (cTnI), he initially reported no discomfort. He was later suspected of having with sintilimab-induced myocarditis. Although treatment with methylprednisolone reduced his cTnI levels, he still experienced significant discomfort. Moreover, he developed pneumonia and septic shock.
Conclusion:
In our literature search to identify all reported cases of sintilimab-associated adverse events involving myocarditis, we found 14 patients, including those with esophageal cancer, thymoma, lung cancer, gastric cancer, hepatobiliary carcinoma, and chordoma. The primary treatment for ICI-induced cardiotoxicity is methylprednisolone. However, the long-term or high-dose use of steroids can also induce side effects, which have not been the focus of these case reports. This is the first reported case of asymptomatic immune-mediated myocarditis occurring during the treatment of esophageal cancer with sintilimab. It is also the first to address the side effects of methylprednisolone used in the treatment of sintilimab-related myocarditis. To facilitate an early diagnosis, regular monitoring is required during sintilimab treatment. We should also focus on the prevention and management of adverse effects related to steroid use.
Treatment of complex limb fractures with 3D printing technology combined with personalized plates: a retrospective study of case series and literature review
Authors: Hairui Liang, Beibei Chen, Siyu Duan, Lei Yang, Rongda Xu, He Zhang, Ming Sun, Xueting Zhou, Hanfei Liu, Hang Wen, Zhencun Cai
Journal: Front Surg (2024)
Keywords: 3d printing technology, case series, limb fractures, literature review, personalized custom steel plates, preoperative planning

Background:
In recent years, 3D printing technology has made significant strides in the medical field. With the advancement of orthopedics, there is an increasing pursuit of high surgical quality and optimal functional recovery. 3D printing enables the creation of precise physical models of fractures, and customized personalized steel plates can better realign and more comprehensively and securely fix fractures. These technologies improve preoperative diagnosis, simulation, and planning for complex limb fractures, providing patients with better treatment options.
Patients and methods:
Five typical cases were selected from a pool of numerous patients treated with 3D printing technology combined with personalized custom steel plates at our hospital. These cases were chosen to demonstrate the entire process of printing 3D models and customizing individualized steel plates, including details of the patients' surgeries and treatment procedures. Literature reviews were conducted, with a focus on highlighting the application of 3D printing technology combined with personalized custom steel plates in the treatment of complex limb fractures.
Results:
3D printing technology can produce accurate physical models of fractures, and personalized custom plates can achieve better fracture realignment and more comprehensive and robust fixation. These technologies provide patients with better treatment options.
Conclusion:
The use of 3D printing models and personalized custom steel plates can improve preoperative diagnosis, simulation, and planning for complex limb fractures, realizing personalized medicine. This approach helps reduce surgical time, minimize trauma, enhance treatment outcomes, and improve patient functional recovery.
Delirious Mania in an Elderly, Challenges in Diagnosis and Treatment
Authors: Omkar Dhungel, Najina Shrestha, Pawan Sharma, Pankaj Pathak, Nidesh Sapkota
Journal: Case Rep Psychiatry (2023)
MeSH terms: Case Reports

Delirious mania is an acute neurobehavioral syndrome which can have the features of mania, delirium, psychosis and catatonia. There are no diagnostic and treatment guidelines of delirious mania which can lead to delayed treatment, increasing morbidity and mortality. The primary goal of this report is to raise awareness among healthcare professionals and improve patient outcomes for this potentially life-threatening condition. In this case report, we present an octogenarian female, a case of bipolar disorder, current episode manic, who had impaired orientation, delusion of persecution, and altered sleep-wake cycle. She was treated with a combination of mood stabilizer and antipsychotic and discharged after 24 days of admission.
Peritoneal Dialysis-Related Peritonitis Caused by Lysinibacillus sphaericus
Authors: Teerawat Thanachayanont, Pailin Mahaparn, Tanyarat Teerapornlertratt, Teerachai Chantarojanasiri, Kriang Tungsanga
Journal: Case Rep Nephrol (2024)
MeSH terms: Case Reports

Peritonitis is the major complication of peritoneal dialysis (PD) patients. Staphylococcus is the leading causative organism of PD-related peritonitis. However, there were more reports of unusual organisms causing peritonitis. Clinical features, management, and outcome of peritonitis from unusual organisms are important information. We reported herein a 72-year-old female patient who presented with fever, abdominal pain, and cloudy dialysate for 3 days. Upon admission, ceftazidime and vancomycin were given intraperitoneally. A preliminary report of blood and PD fluid culture showed the presence of Gram-positive bacilli. Her clinical status improved 48 hours after the commencement of the antibiotics. Subsequently, culture reports of blood and PD fluid showed Lysinibacillus sphaericus which was susceptible to vancomycin at a minimal inhibitory concentration of less than 0.25 μg/mL. The patient was given intraperitoneal vancomycin for a total of 14 days. Then, the PD effluent was clear, and its cell count was below 100 cells/mm3 in 3 days. The patient did not have a recurrence of peritonitis after antibiotic discontinuation. The possibility of this organism infection is environmental contamination related to the patient's gardening activities.