OpenMed/multicare-articles huggingface dataset:
Pulmonary Nocardiosis: Review of Cases and an Update
Authors: Malini Shariff, Jayanthi Gunasekaran
Journal: Can Respir J (2016)
MeSH terms: Anti-Bacterial Agents / therapeutic use, Immunocompromised Host, Nocardia Infections / drug therapy, Pneumonia, Bacterial / drug therapy, Case Reports, Adult, Aged, Amikacin / therapeutic use, Cough / etiology, Diabetes Mellitus / immunology, Dyspnea / etiology, Female, Humans, Imipenem / therapeutic use, India, Male, Meropenem, Middle Aged, Nocardia Infections / complications, Nocardia Infections / immunology, Pneumonia, Bacterial / complications, Pneumonia, Bacterial / immunology, Pulmonary Disease, Chronic Obstructive / complications, Pulmonary Disease, Chronic Obstructive / immunology, Thienamycins / therapeutic use, Trimethoprim, Sulfamethoxazole Drug Combination / therapeutic use, Tuberculosis, Pulmonary / complications, Tuberculosis, Pulmonary / immunology, Anti-Bacterial Agents, Thienamycins, Imipenem, Trimethoprim, Sulfamethoxazole Drug Combination, Amikacin, Meropenem

Nocardia, a branching, filamentous bacteria, is widely distributed in the environment and can cause human infection in immune-compromised hosts. Inhalation of Nocardia leads to pulmonary disease. Microbiology laboratory processed the clinical samples from patients with respiratory infections. Smears were prepared from the samples and were stained and cultured. Five cases were positive for Nocardia. They were treated with the trimethoprim-sulfamethoxazole combination. The disease was cured in three patients, and two died due to other comorbid conditions leading to complications. Nocardiosis is encountered in parts of the world even where it is not endemic due to increased world travel. So physicians and laboratory staff should be aware of this and try to diagnose it. Early detection can lead to the prompt initiation of treatment and reduced mortality in these patients. Patients with disseminated or severe nocardiosis should be treated with combination therapy with two or more active agents.
Single-cell RNA-seq analysis identifies distinct myeloid cells in a case with encephalitis temporally associated with COVID-19 vaccination
Authors: Masakazu Ishikawa, Yuki Shimada, Tatsuhiko Ozono, Hisatake Matsumoto, Hiroshi Ogura, Keigo Kihara, Hideki Mochizuki, Tatsusada Okuno, Shuhei Sakakibara, Makoto Kinoshita, Daisuke Okuzaki
Journal: Front Immunol (2023)
Keywords: covid-19, encephalitis, myeloid cells, single-cell rna-seq, vaccination
MeSH terms: COVID-19, Encephalitis, Case Reports, Research Support, Non-U.S. Gov't, COVID-19 Vaccines, Humans, Leukocytes, Mononuclear, Myeloid Cells, Single-Cell Gene Expression Analysis, Vaccination, COVID-19 Vaccines

Recently accumulating evidence has highlighted the rare occurrence of COVID-19 vaccination-induced inflammation in the central nervous system. However, the precise information on immune dysregulation related to the COVID-19 vaccination-associated autoimmunity remains elusive. Here we report a case of encephalitis temporally associated with COVID-19 vaccination, where single-cell RNA sequencing (scRNA-seq) analysis was applied to elucidate the distinct immune signature in the peripheral immune system. Peripheral blood mononuclear cells (PBMCs) were analyzed using scRNA-seq to clarify the cellular components of the patients in the acute and remission phases of the disease. The data obtained were compared to those acquired from a healthy cohort. The scRNA-seq analysis identified a distinct myeloid cell population in PBMCs during the acute phase of encephalitis. This specific myeloid population was detected neither in the remission phase of the disease nor in the healthy cohort. Our findings illustrate induction of a unique myeloid subset in encephalitis temporally associated with COVID-19 vaccination. Further research into the dysregulated immune signature of COVID-19 vaccination-associated autoimmunity including the cerebrospinal fluid (CSF) cells of central nervous system (CNS) is warranted to clarify the pathogenic role of the myeloid subset observed in our study.
Efficacy of cardiac magnetic resonance imaging in a sub-aortic aneurysm case
Authors: Ruchika Meel, Richard Nethononda, Ferande Peters, Mohammed Essop
Journal: Cardiovasc J Afr (2017)
MeSH terms: Aortic Valve Insufficiency / diagnostic imaging, Heart Aneurysm / diagnostic imaging, Heart Atria / diagnostic imaging, Magnetic Resonance Imaging, Case Reports, Adult, Aortic Valve Insufficiency / etiology, Aortic Valve Insufficiency / physiopathology, Echocardiography, Doppler, Color, Echocardiography, Transesophageal, Female, Heart Aneurysm / complications, Heart Aneurysm / physiopathology, Heart Atria / physiopathology, Hemodynamics, Humans, Predictive Value of Tests

Sub-aortic (SA) aneurysms are a rare entity of variable aetiology. We report the first case of a SA aneurysm assessed using cardiac magnetic resonance imaging (MRI). A 33-year-old female with human immunodeficiency virus and on highly active antiretroviral treatment presented with syncope and dyspnoea. Clinical examination suggested moderate to severe aortic regurgitation (AR) confirmed by transthoracic and transoesophageal echocardiograms. However, echocardiography was suboptimal in defining the precise mechanism and severity of AR. A cardiac MRI was done to elucidate the aetiology, severity and mechanism of regurgitation. It confirmed the presence of a SA aneurysm below the left coronary cusp and its retraction, resulting in an eccentric AR jet. An assessment of moderate AR, based on regurgitant volume, was made. Furthermore, the anatomical relationships of the aneurysm were clearly defined. Cardiac MRI allowed comprehensive assessment of this SA aneurysm.
An unusual case of spontaneous bladder perforation with associated autodialysis of the ensuing urinary ascites
Authors: A Aber, S A Hyder, V Arumuham
Journal: Case Rep Med (2011)
MeSH terms: Case Reports

Spontaneous rupture of the urinary bladder is a rare occurrence, and when encountered it is a diagnostic challenge. We present an unusual case of urinary bladder rupture in a patient with severe cerebral palsy who initially presented with localized abdominal pain and during admission developed generalized peritonitis caused by bladder rupture. In this case, the patient had none of risk factors associated with urinary bladder.
Cuticular drusen associated with aneurysmal type 1 neovascularization (polypoidal choroidal vasculopathy)
Authors: Serena Fragiotta, Talia R Kaden, K Bailey Freund
Journal: Int J Retina Vitreous (2018)
Keywords: aneurysmal type 1 neovascularization, cuticular drusen, fluorescein angiography, indocyanine green angiography, optical coherence tomography angiography, polypoidal choroidal vasculopathy
MeSH terms: Case Reports

Background:
Aneurysmal type 1 neovascularization (AT1) is a term recently introduced to better describe the aneurysmal dilatation that may arise from neovascular lesions, more commonly known as polypoidal choroidal vasculopathy. The proposed term, AT1, includes an expanded clinical spectrum of aneurysmal (polypoidal) lesions observed in both different ethnicities and associated with varied clinical phenotypes.
Case presentation:
A 61-year-old woman of European descent was referred for a new, asymptomatic retinal hemorrhage found on routine examination. Ophthalmoscopy revealed cuticular drusen in both eyes best appreciated on fundus autofluorescence, and a hemorrhagic retinal pigment epithelium detachment above the superior arcade in the right eye. In the fellow eye, a reddish appearing pigment epithelial detachment was noted nasal to the optic nerve. Indocyanine green angiography showed findings of AT1 in both eyes. Optical coherence tomography angiography showed intrinsic flow signal within the aneurysmal lesions.
Conclusions:
Eyes with cuticular drusen may develop AT1 which, to our knowledge, has not been described. This is an important observation because the documented coexistence of AT1 in the setting of a variant of age-related macular degeneration lends supports to this new understanding of AT1 as a growth pattern of neovascular tissue proliferating between the RPE and Bruch membrane, rather than as a distinct disease entity.
Case report: Chronic neutrophilic leukemia associated with monoclonal gammopathies. A case series and review of genetic characteristics and practical management
Authors: Gaël Vermeersch, Michel Delforge, Violaine Havelange, Carlos Graux, Lucienne Michaux, Timothy Devos
Journal: Front Oncol (2022)
Keywords: chronic neutrophilic leukemia, monoclonal gammopathy, multiple myeloma, myeloid malignancy, myeloproliferative disorders, myeloproliferative neoplasm
MeSH terms: Case Reports

Chronic neutrophilic leukemia (CNL) is a rare but potentially aggressive BCR::ABL1 negative myeloproliferative neoplasm, characterized by sustained mature, neutrophilic leukocytosis. The discovery of key driver mutations in the colony-stimulating-factor-3 receptor (CSF3R) gene resulted in the updated World Health Organization (WHO) diagnostic criteria in 2016. A significant number of CNL cases have been associated with plasma cell dyscrasias, predominantly multiple myeloma (MM) and monoclonal gammopathy of unknown significance (MGUS). Compared to pure CNL, mutated CSF3R is infrequently reported in CNL cases associated with monoclonal gammopathies (MG). Until now it remains unclear whether CNL and occurring plasma cell neoplasms are clonally related or CNL is developing secondary to the underlying dyscrasia. Owing to its rarity, currently no standard of care management exists for CNL and MG-associated CNL. In this case series we report the multi-center experience of five MG-associated CNL cases with a median age of diagnosis of 69 years. Three patients (66%) showed predominance of lambda light chain expression. Four (80%) eventually evolved to MM, and one CNL-MGUS patient developed secondary acute myeloid leukemia (AML). Mutated CSF3R was present in the patient who developed AML but was absent in other cases. To assess possible associated genetic aberrations we performed recurrent analysis with next-generation sequencing (NGS). Two patients (40%) deceased with a median time of survival of 8 years after CNL diagnosis. Three (60%) are currently in follow-up with no reoccurring leukocytosis. This case series, followed by a short review, provides a long-term clinical and genetic overview of five CNL cases associated with MG.
The Wire Rendezvous and Chasing Wire Technique in the Bidirectional Approach for the Percutaneous Coronary Intervention for Chronic Total Occlusion with a Single Guiding Catheter
Authors: Keisuke Nakabayashi, Daisuke Sunaga, Nobuhito Kaneko, Akihiro Matsui, Kazuhiko Tanaka, Hiroshi Ando, Minoru Shimizu
Journal: Case Rep Cardiol (2018)
MeSH terms: Case Reports

A bidirectional approach for percutaneous coronary intervention for chronic total occlusion (CTO-PCI) using ipsilateral collaterals with a single guiding catheter limits procedural choices. The CTO of the left circumflex artery with ipsilateral collateral artery was treated by the bidirectional approach using a single guiding catheter. While the retrograde wire directly crossed the CTO lesion, the microcatheter could not pass the CTO lesion despite the conventional strategies. Therefore, we performed the wire rendezvous and chasing wire techniques. The wire rendezvous technique enables deeper retrograde guidewire progression, and the antegrade microcatheter can reach the CTO entry. The chasing wire technique enables the antegrade guidewire to pass the route made by the retrograde guidewire. These techniques might offer a possible solution for bidirectional CTO-PCI using a single guiding catheter. However, this technique should be considered as a last resort because of the risk of rapid reocclusion.
Clonazepam as agonist substitution treatment for benzodiazepine dependence: a case report
Authors: Angelo Giovanni Icro Maremmani, Luca Rovai, Fabio Rugani, Silvia Bacciardi, Matteo Pacini, Liliana Dell'osso, Icro Maremmani
Journal: Case Rep Psychiatry (2013)

Nowadays, the misuse of benzodiazepines (BZDs) is a cause for a serious concern among pharmacologically inexperienced patients, whether treated or untreated, that could lead to significant complications, including tolerance, dependence, and addiction. We present a case report in which an Italian patient affected by anxiety disorder and treated with BZDs presented a severe case of dependence on BZDs. We treated him according to an agonist substitution approach, switching from the abused BZD to a slow-onset, long-acting, high potency agonist (clonazepam), and looking at the methadone treatment model as paradigm. We decided to use clonazepam for its pharmacokinetic properties. The advantage of choosing a slow-onset, long-lasting BZD for the treatment of our patient was that it led us to a remarkable improvement in the clinical situation, including the cessation of craving, absence of withdrawal symptoms, reduced anxiety, improvements in social functioning, and a better cognition level.
Cerebral aspergillosis caused by Neosartorya hiratsukae, Brazil
Authors: Josep Guarro, Esper G Kallas, Patricio Godoy, Anna Karenina, Josepa Gené, Alberto Stchigel, Arnaldo Lopes Colombo
Journal: Emerg Infect Dis (2002)
MeSH terms: Fungi / classification, Fungi / isolation & purification, Mycoses / microbiology, Case Reports, Research Support, Non-U.S. Gov't, Aged, Amphotericin B / therapeutic use, Antifungal Agents / therapeutic use, Aspergillosis, Brazil, Central Nervous System Infections / drug therapy, Central Nervous System Infections / microbiology, Female, Fungi / pathogenicity, Humans, Itraconazole / therapeutic use, Mycoses / drug therapy, Antifungal Agents, Itraconazole, Amphotericin B

We report the first case of infection by Neosartorya hiratsukae, an ascomycete in which the conidial state resembles Aspergillus fumigatus. The fungus caused a brain infection in a Brazilian woman, who died despite itraconazole treatment. Diagnosis was established by direct microscopic examination, computed tomographic scan, and magnetic resonance imaging of the brain, and repeated cultures from the lesions. The in vitro antifungal susceptibility of the isolate is provided.
Intracerebral Hemorrhage with Intraventricular Extension-Getting the Prognosis Right Early
Authors: Christoph Stretz, Catherine Gao, David M Greer, Caitlin Loomis, Emily J Gilmore, Adam J Kundishora, Charles C Matouk, David Y Hwang
Journal: Front Neurol (2017)
Keywords: intracerebral hemorrhage, intraventricular hemorrhage, outcome, prognosis, self-fulfilling prophesy
MeSH terms: Case Reports

Background:
Early accurate outcome prognostication for patients with intracerebral hemorrhage (ICH) and accompanying intraventricular hemorrhage (IVH) is often challenging (1). Acute hydrocephalus often contributes to a poor clinical exam (2) and can portend significant morbidity and mortality (3). Accordingly, the inpatient neurologist may feel inclined to recommend limitations of care for an ICH patient admitted with a large IVH burden and poor exam.
Case presentation:
We present a patient with significant IVH and minimal ICH who deteriorated rapidly to coma after presentation. Despite this exam, an initially non-functioning diversion of cerebrospinal fluid (CSF) and temporary halt of further attempts of CSF diversion in the setting of an early "do not resuscitate order," our patient gradually improved and, with supportive ICU care and rehabilitation, was able to communicate and ambulate with assistance at 12 weeks.
Conclusion:
Patients with ICH with IVH do have the capacity to improve dramatically even with relatively conservative management. Unless previous limitations of care exist, we recommend that early judgments of prognosis for patients with ICH and/or IVH should be delayed for at least 72 h until the patient's clinical trajectory over time is better understood.
Identical wave forms of vena cava and pulmonary artery during pulmonary artery catheter insertion due to kinking: a case report of a rare complication
Authors: Masayuki Oshima, Tatsuki Onishi, Hitomi Iwata, Kazuyoshi Aoyama
Journal: Springerplus (2016)
Keywords: fluoroscopic guidance, kinking, knotting, pulmonary artery catheter

Background:
We experienced a rare malposition of a pulmonary artery catheter due to kinking in a 63-year-old male who was scheduled for an off-pump coronary artery by-pass graft.
Findings:
Given the difficulty to obtain stable pulmonary artery waveform, we discovered that the two waveforms of the distal and proximal ports of the pulmonary artery catheter were completely identical. Subsequent fluoroscopy revealed that because the catheter had formed a kink around the apex of the right ventricle, the distal port faced the proximal port of the catheter.
Conclusions:
We recommend that both ports of the pulmonary artery catheter need to be monitored simultaneously in case neither portable fluoroscopy nor transesophageal echo is available.
Chronic Widespread Pain and Fibromyalgia Syndrome: Life-Course Risk Markers in Young People
Authors: Aidan C Tan, Tiina Jaaniste, David Champion
Journal: Pain Res Manag (2019)
MeSH terms: Chronic Pain / etiology, Chronic Pain / psychology, Fibromyalgia / etiology, Fibromyalgia / psychology, Case Reports, Review, Adolescent, Adult, Child, Female, Humans, Risk Factors

Although the life-course concept of risk markers as potential etiological influences is well established in epidemiology, it has not featured in academic publications or clinical practice in the context of chronic widespread pain (CWP) and fibromyalgia syndrome (FMS). Studies of risk markers are required considerations for evaluation of patients and for research because there is no single cause, pathological feature, laboratory finding, or biomarker for CWP or FMS. The early-life risk markers identified by extensive literature review with best evidence for potential causal influence on the development and progression of CWP and FMS include genetic factors, premature birth, female sex, early childhood adversity, cognitive and psychosocial influences, impaired sleep, primary pain disorders, multiregional pain, physical trauma, infectious illness, obesity and inactivity, hypermobility of joints, iron deficiency, and small-fiber polyneuropathy. The case history illustrates the potential etiological influence of multiple risk markers offset by personal resilience.
Mirror-image Artifact of a Cephalhematoma Mimicking an Epidural Hematoma in a Newborn
Authors: Elyn Van Snick, Bjorn Valgaeren, Bart Claikens
Journal: J Belg Soc Radiol (2022)
Keywords: cephalhematoma, epidural hematoma, mirror-image artifact, neonate, ultrasound
MeSH terms: Case Reports

Teaching Point: When performing ultrasound examination of a cephalhematoma, the occurrence of a mirror-image artifact can mimic the presence of an epidural hematoma.
Primary Clear Cell Microcystic Adenoma of the Sinonasal Cavity: Pathological or Fortuitous Association?
Authors: Rosalin Cooper, Hannah Markham, Jeffery Theaker, Adrian Bateman, David Bunyan, Matthew Sommerlad, Gillian Crawford, Diana Eccles
Journal: Case Rep Pathol (2017)
MeSH terms: Case Reports

Primary clear cell microcystic adenoma of the sinonasal cavity is rare. It has previously been described only as a VHL-associated tumour. Von Hippel-Lindau (VHL) syndrome is an inherited cancer syndrome characterised by an elevated risk of neoplasia including clear cell renal cell carcinoma (ccRCC), haemangioblastoma, and phaeochromocytoma. We describe the second reported case of a primary clear cell microcystic adenoma of the sinonasal cavity. The 39-year-old patient with VHL syndrome had previously undergone resection and ablation of ccRCC. He presented with epistaxis. Imaging demonstrated a mass in the ethmoid sinus. Initial clinical suspicion was of metastatic ccRCC. However, tumour morphology and immunoprofile were distinct from the previous ccRCC and supported a diagnosis of primary microcystic adenoma. Analysis of DNA extracted from sinonasal tumour tissue did not show loss of the wild-type allele at the VHL locus. Although this did not support tumour association with VHL disease, it was not possible to look for a loss-of-function mutation. The association of primary microcystic adenoma of the sinonasal cavity with VHL disease remains speculative. These lesions are benign but are likely to require regular surveillance. Such tumours may require repeated surgical excision.
A Case of Macrolide-Refractory Mycoplasma pneumoniae Pneumonia in Pregnancy Treated with Garenoxacin
Authors: Yoko Matsuda, Yoshitsugu Chigusa, Eiji Kondoh, Isao Ito, Yusuke Ueda, Masaki Mandai
Journal: Case Rep Obstet Gynecol (2017)
MeSH terms: Case Reports

Pneumonia in pregnancy is associated with adverse maternal and foetal outcomes, and intensive treatment with appropriate antibiotics is essential. However, cases caused by pathogens that are resistant to antibiotics suitable for the developing foetus are challenging. We herein report a case of macrolide-refractory Mycoplasma pneumoniae pneumonia in pregnancy. A 40-year-old multigravida with twin pregnancy complained of cough and fever at 13 weeks of gestation and was diagnosed with pneumonia. Even though empiric treatment with ceftriaxone and oral azithromycin was started, her condition deteriorated rapidly. The findings of chest computed tomography suggested Mycoplasma pneumoniae pneumonia. Since azithromycin did not work, this strain was considered to be macrolide-refractory. Garenoxacin, an oral quinolone, was selected and was dramatically effective. The use of quinolone could be justified with the emergence of drug-resistant bacterial/atypical pneumonia and in the maternal life-threatening condition.
Small gastrointestinal stromal tumour of the duodenum causing a life-threatening bleeding - A case report and review of the literature
Authors: Milena Taskovska, Mirko Omejc, Jan Grosek
Journal: Int J Surg Case Rep (2019)
Keywords: bleeding, case report, duodenum, gastrointestinal stromal tumor, surgery

Introduction:
Duodenal gastrointestinal stromal tumors (DGISTs) are mesenchymal tumors. Main presenting symptoms are gastrointestinal bleeding and non-specific abdominal pain. Surgical treatment is golden standard for treatment of DGISTs. Tumour location and size determine the surgical strategy. Recurrence rate depends on tumour location and completeness on removal.
Presentation of case:
75 years old male fell ill with hematemesis, hemohesia and dizziness. Oesophagogastroduodenoscopy (EGD) did not reveal the source of bleeding. Upon admission, a second EGD was performed due to loss of consciousness and anaemia, which revealed only approximate source of bleeding in the third portion of the duodenum. The exact bleeding spot could not be reached and bleeding could not be controlled endoscopically. Patient was transferred to the operating room for an emergency explorative laparotomy. After extensive mobilisation of the duodenum a 2 × 2 cm intraluminal tumour with central bleeding ulceration was found in D3. The diseased part of the duodenum was excised and the duodenotomy was closed with interrupted sutures. Final pathohistological report confirmed gastrointestinal stromal tumour, pT1. Postoperative period was uneventful.
Discussion:
Gastrointestinal stromal tumours are most common in males aged 60-65 years. Surgical treatment is a golden standard. Surgical approach depends upon tumor location and size. In case of major bleeding surgical procedure is lifesaving and diagnostics for staging purposes are omitted.
Conclusion:
Gastrointestinal stromal tumors are a potential source of life-threatening bleeding. In such cases an emergency operation is often indicated with aim to remove the tumour en bloc and achieve hemostasis as soon as possible.