OpenMed/multicare-articles huggingface dataset:
Neonatal Purpura Fulminans in a Patient With Arterial Thrombosis and Congenital Renal Agenesis
Authors: Mawada M Abbaker, Srujan Edupuganti, Sheimaa T Elmukashfi, Taha Ahmed E Elsheikh
Journal: Cureus (2024)
Keywords: high index suspicion, neonatal purpura fulminans, protein c deficiency, protein s deficiency, sudan
MeSH terms: Case Reports

Neonatal purpura fulminans (PF) is an uncommon skin disorder characterized by acute disseminated intravascular coagulation, tissue necrosis, and small vessel thrombosis. Here, we present a case of a seven-day-old male who was admitted to the Neonatal Intensive Care (NICU) Unit at Gaafar Ibn Auf Tertiary Hospital, in January 2023. He presented with black bullous lesions on the plantar surface of the left foot, deep bluish discoloration over the right buttock and right lower abdomen, and gangrenous changes in the right foot with clear demarcation. Birth history was not significant other than mild pallor and icterus. His blood workup was consistent with severe anemia, thrombocytopenia, elevated prothrombin time, and partial thromboplastin time with decreased protein C and S levels; blood culture yielded no growth. A Doppler ultrasound scan of lower extremities confirmed distal occlusion of the right dorsalis pedis artery. The abdominal ultrasound revealed a free left renal bed and left-sided renal agenesis. We came to a diagnosis of neonatal PF and started administering blood and fresh frozen plasma and subcutaneous heparin injections, but unfortunately, the patient eventually passed away. Hence, we decided to report this case to emphasize the significance of the clinical picture in assisting with early diagnosis, despite limited access to genetic testing. We also want to highlight the importance of a "high index of suspicion" that might be mandatory for better outcomes.
A Case Report Describing Hemophilus parainfluenza Recovered From Pleural Effusion
Authors: Kinnera S Urlapu, Shekhar S Bhatta, Maryam Soliman, Trupti Vakde
Journal: Cureus (2024)
Keywords: atypical presentation, case, hemophilus parainfluenza, pleural effusion, report
MeSH terms: Case Reports

Hemophilus parainfluenza, a less common pathogen typically found in the oropharyngeal flora, has been associated with various clinical conditions. However, its role in pleural effusions remains scarcely documented. We present a unique case of a 42-year-old female with a history of asthma, hypertension, and obesity who presented with epigastric pain and a moderate right-sided pleural effusion. Hemophilus parainfluenza was isolated from the pleural fluid despite an atypical, asymptomatic presentation without pneumonia. Antibiotic treatment led to a positive response, highlighting the importance of recognizing Hemophilus parainfluenza as a potential causative agent in pleural effusion cases.
Gilteritinib Monotherapy as a Transplant Bridging Option for a Patient with FLT3-Mutated Acute Promyelocytic Leukemia Who Developed a Second Relapse after All-Trans Retinoic Acid + Chemotherapy, Arsenic Trioxide, and High-Dose Cytarabine Therapy
Authors: Hirofumi Kobayashi, Hiroki Tsutsumi, Yukiko Misaki, Takashi Maekawa, Naoko Inoshita, Machiko Kawamura, Nobuo Maseki
Journal: Case Rep Hematol (2023)
MeSH terms: Case Reports

We report a case of FLT3-mutated APL who developed disease relapse despite all-trans retinoic acid (ATRA) + chemotherapy, and re-induction chemotherapy with arsenic trioxide (ATO) and high-dose (HD) cytarabine (Ara-C) therapy failed to yield complete remission. Because the leukemic cells were resistant to all the aforementioned therapies, we started the patient on monotherapy with gilteritinib, a selective FLT3-inhibitor, as an alternative re-induction treatment option rather than further intensive chemotherapy. The patient showed complete hematologic remission in response to this therapy. This case serves as supporting evidence for the use of single-agent therapy with gilteritinib as a bridge to transplantation in patients with refractory FLT3-mutated APL.
Case report: Focal heterotopic ossification in paravertebral muscles as a cause of neurogenic lameness in a dog
Authors: Ivo Hajek, Marco Rosati, Kaspar Matiasek, Michal Babinsky, Abby Caine, Viktor Palus
Journal: Front Vet Sci (2024)
Keywords: mri, canine, dogs, heterotopic, mononeuropathies, ossification
MeSH terms: Case Reports

This case report describes a 17-month-old Pudelpointer with recurring motor impairment localized to the left thoracic limb. A neurological exam highlighted lameness in that limb, accompanied by pre-scapular swelling. Radiographs and magnetic resonance imaging detected an osseous structure in soft tissues close to the fifth cervical vertebra, and subsequent surgery uncovered adjacent cervical spinal nerve impingement. Histology of the bony structure revealed heterotopic ossification in paravertebral muscles. Mild bone re-formation at the operating site was detected after a 2-year period, but the patient was asymptomatic. This article reports the first case of heterotopic ossification with spinal nerve entrapment in a dog and adds a new differential diagnosis to the causes of neurogenic lameness in dogs.
Successful treatment of Giant keloid on the right toes using trepanation combined with superficial radiotherapy (SRT-100): a case report with literature review
Authors: Ying-Hua Song, Hui-Min Zhu, Dan Chen, Zi-Lu Qu, Liang Zhang, Li Wei
Journal: Front Med (Lausanne) (2024)
Keywords: keloids, superficial radiotherapy, surgery, surgical excision, trepanation
MeSH terms: Review

In dermatology, a keloid is one of the most common skin morphological abnormalities caused by excessive proliferation of fibroblasts. Keloids that are large or occur near important joint sites often cause varying degrees of physiological dysfunction in patients, therefore requiring medical treatment. A boy with congenital syndactyly developed huge keloids at the surgical site after undergoing surgical correction treatment. After treatment using trepanation combined with superficial radiotherapy (SRT-100) in our hospital, most of the boy's keloids shrank and flattened. The affected foot returned to its normal appearance, and the boy could wear shoes normally. The boy did not complain of pain, numbness, or any other distinctive discomfort after completing the treatment. This suggested that the combination of trepanation and SRT-100 may be one of the options for treating hypertrophic keloids that cannot be treated by surgical excision.
Case Report: Recalcitrant oral lichen planus involving bilaterally buccal mucosae treated with a combination of photodynamic and photobiomodulation therapies
Authors: Juthamast Trakarnboonkij, Suwat Tanya, Wilairat Sarideechaigul, Ajiravudh Subarnbhesaj, Peera Tabbon, Sajee Sattayut
Journal: F1000Res (2024)
Keywords: burning sensation, low-intensity laser therapy, oral lichen planus, photosensitizer
MeSH terms: Lichen Planus, Oral / drug therapy, Lichen Planus, Oral / pathology, Lichen Planus, Oral / radiotherapy, Lichen Planus, Oral / therapy, Low-Level Light Therapy / methods, Mouth Mucosa / pathology, Photochemotherapy / methods, Case Reports, Adult, Aminolevulinic Acid / analogs & derivatives, Aminolevulinic Acid / therapeutic use, Combined Modality Therapy, Humans, Male, Aminolevulinic Acid

Background:
Managing recalcitrant oral lichen planus (OLP) can be challenging. Laser therapy has been suggested as an alternative to corticosteroids for treatment. Photodynamic therapy (PDT) is a non-invasive technique that enables the removal of lesions without surgery. Photobiomodulation therapy (PBMT) can promote healing and recovery of the lesions.
Case presentation:
The objective was to treat unresponsive bilateral OLP of the whole buccal mucosae with a combination of PDT and PBMT.
Results:
A 43-year-old Thai male presented with the severe painful reticular type of OLP of bilateral buccal mucosae involving upper and lower vestibular areas. The lesions were not remitted with either prednisolone systemic steroids or fluocinolone topical corticosteroids. After undergoing ten sessions of PDT with 10% 5-Aminolevulinic acid (5-ALA) in the form of thermoplastic gel and a 635 nm diode laser at 100 to 400 mW with an energy density of 20 to 30 J/cm 2 in continuous wave mode, combined with five interim-sessions of PBMT using a 635 nm diode laser at 200 to 300 mW with an energy density of 6 to 10 J/cm 2 in continuous wave, the patient reported relief of burning sensation beside remission of lesions without any complications.
Conclusion:
The wide-spreading recalcitrant OLP with burning sensation can be managed by combining PDT and PBMT.
Homemade pericardial bifurcated graft for Q fever-infected abdominal aortic aneurysm open repair: a case report
Authors: A Mouche, J Baron, C Toquet, T Le Corvec, B Maurel, A Benichou, J Mougin
Journal: Front Cardiovasc Med (2024)
Keywords: coxiella burnetii, q fever, abdominal aortic aneurysm, inflammatory aortic disease, vascular surgery
MeSH terms: Case Reports

Q fever is a zoonotic infection caused by Coxiella burnetii. In rare cases, it can lead to vascular complications, including infected aneurysms. Successful treatment involves surgery and antibiotics, but there is no established consensus or clear recommendation for the choice of material graft. We report a case of abdominal aortic aneurysm infected by C. burnetii treated by open surgery with complete resection of the aneurysm and homemade bovine pericardial bifurcated graft reconstruction and long-term antibiotherapy using doxycycline. One year postoperatively, the patient had no sign of persistent infection or vascular complication. Moreover, C. burnetii immunoglobulins titers decreased 6 months postoperatively.
Adult-Onset Still's Disease After an mRNA COVID-19 Vaccine in an Older Woman
Authors: Hiroaki Nishioka, Shogo Shirota
Journal: Cureus (2024)
Keywords: adult-onset still’s disease, cytokine storm, immune-mediated adverse events, mrna covid-19 vaccine, older individual
MeSH terms: Case Reports

Adult-onset Still's disease (AOSD) is an uncommon autoinflammatory disorder without a clear etiology that primarily affects young adults. New-onset disease at > 80 years of age is uncommon. We present the case of an 82-year-old woman with AOSD which developed after receiving a messenger ribonucleic acid (mRNA) coronavirus disease 2019 (COVID-19) vaccine. COVID-19 vaccines are known to cause overproduction of cytokines, systemic inflammation, and some immune-mediated adverse events, such as rheumatoid arthritis, systemic lupus erythematosus, dermatomyositis, vasculitis, and polymyalgia rheumatica after the vaccination has been reported. A handful of cases of AOSD after the vaccination have also been reported and the median age was 40s. However, AOSD related to COVID-19 vaccination can develop even in older individuals.
Low-grade mucoepidermoid carcinoma mimicking benign cystic lesions in the salivary gland: A diagnostic dilemma
Authors: Wangpan Shi, Timothy Law, Kevin Thomas Brumund, Jennifer Chang, Charmi Patel, Grace Lin, Jingjing Hu
Journal: Rare Tumors (2024)
Keywords: salivary gland tumor, acinic cell carcinoma, cystic degeneration, low grade mucoepidermoid carcinoma, rare tumors
MeSH terms: Case Reports

Mucoepidermoid carcinoma (MEC) is a common malignancy arising in the parotid gland. The diagnosis of MEC is typically based on its morphological features alone, characteristically containing mucocytes, intermediate cells and epidermoid cells. However, when cystic degeneration is diffuse, it is challenging to distinguish MEC from other benign cystic tumors. This is a case report of a 58-year-old Caucasian man who presented with a parotid mass. H&E sections of the mass reveal multiloculated cysts lined by bland-looking epithelium with only rare papillary architectures. The papillary proliferation contains mucocytes, and epidermoid cells highlighted by the p63 immunohistochemistry study. The diagnosis was confirmed by FISH result of positive MAML2 (11q21) rearrangement. Patient underwent parotidectomy and is disease-free 6 months post-surgery. MEC with cystic degeneration is a common diagnostic pitfall which can mimic many benign lesions in the salivary gland. We present a rare case with MEC with extensive cystic change, its molecular and pathologic findings and review the diagnostic features of MEC, its benign mimickers and useful tools for distinguishing these entities.
Case report: A collision tumor of clear cell renal cell carcinoma and clear cell papillary renal cell tumor
Authors: Yingsheng Lin, Jinan Guo, Zaishang Li, Zengqin Liu, Jing Xie, Junxu Liu, Hongtao Jin, Kefeng Xiao
Journal: Front Oncol (2024)
Keywords: case report, clear cell papillary renal cell tumor, clear cell renal cell carcinoma, collision tumor, specimens
MeSH terms: Case Reports

We report the case of a 51-year-old woman who was initially hospitalized in the respiratory department with cough and fever. Urinary computed tomography (CT) showed two different incidental masses in the right kidney. The patient underwent a radical right nephrectomy without lymph node dissection and postoperative adjuvant treatment. The pathological examination of the surgical specimens showed a collision tumor composed of a clear cell renal cell carcinoma (CCRCC) and a clear cell papillary renal cell tumor (CCPRCT). To the best of our knowledge, this is the first such case reported to date. No recurrence of local or distant metastasis was found during routine follow-up 14 months after the operation.
MYRF-related mild encephalopathy with reversible myelin vacuolization: a case report and literature review
Authors: Shumei Yao, Xiufeng Mo, Changjiang Luo, Chuanqiang Qu
Journal: Front Genet (2023)
Keywords: myrf-related mild encephalopathy with reversible myelin vacuolization, corpus callosum demyelination, genetic analysis, infection, seizures
MeSH terms: Case Reports

Background: MYRF-related mild encephalopathy with reversible myelin vacuolization (MMERV) is an inherited neurological disorder characterized by dysfunction in the central nervous system and widespread reversible leukoencephalopathy. This paper presents a confirmed case of familial MMERV and summarizes pertinent features to offer guidance for future diagnosis and treatment of MMERV. Case Introduction: We have diagnosed a case of MMERV based on a history of seizures during early childhood and recurrent speech fluency issues in adulthood, reversible abnormal intensities in bilateral white matter in the centrum semiovale and corpus callosum, and the identification of myelin regulatory factor (MYRF) heterozygous variants. Conclusion: MYRF-related mild encephalopathy with reversible myelin vacuolization is a rare autosomal dominant genetic disease, with early clinical manifestations often being seizures. The definitive diagnosis of MMERV can be confirmed through genetic analysis. Minimizing infections can help reduce disease recurrence. However, future research should explore the impact of MYRF heterozygous variants in the wider MMERV population.
Hemophagocytic Lymphohistiocytosis in a Remote Kidney Transplant Recipient Triggered by HSV Infection With Complete Recovery: An Educational Case Report
Authors: Anjana Gopal, S Joseph Kim
Journal: Can J Kidney Health Dis (2024)
Keywords: hemophagocytic lymphohistiocytosis, herpes simplex virus, kidney transplant
MeSH terms: Case Reports

Rationale:
Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening disease characterized by excessive immune activation. It is more commonly seen in children but increasingly recognized in adults. Primary HLH relies on a genetic predisposition, whereas secondary HLH develops in the context of infections, malignancies, or autoimmune diseases. Hemophagocytic lymphohistiocytosis has been rarely described in patients on immunosuppressive therapy after kidney transplant. Here, we describe a case of HLH in a patient with a remote history of kidney transplant, triggered by a viral infection.
Presenting concerns:
A 45-year-old female, with a kidney transplant in 2009 for IgA nephropathy, presented with fever, vomiting, and back pain of 1-week duration. She was on triple immunosuppression consisting of daily doses of prednisone 5 mg, azathioprine 100 mg, and tacrolimus extended release 1 mg, and a baseline creatinine of 130 µmol/L.
Diagnosis:
Initial investigations showed anemia, leukopenia, elevated serum creatinine, transaminitis, and markedly increased ferritin of 67 600 µg/L which prompted a bone marrow biopsy to rule out HLH. The bone marrow showed an increased proportion of CD68+ cells (macrophages) with more than 5 in 1000 hemophagocytic macrophages. Her soluble IL-2 receptor (CD25) level was 3406 pg/mL (606-2299 pg/mL) which was mildly elevated. She fulfilled 4 of the 8 criteria for HLH and with an H score was 223 which suggested a diagnosis of HLH with 96.9% probability. An extensive secondary workup for possible triggers for HLH led to a swab from genital ulcers that was positive for herpes simplex virus (HSV) type 2. The polymerase chain reaction (PCR) in the blood for HSV type 2 was also positive.
Interventions:
Given the diagnosis of HSV type 2 as the putative trigger for HLH, she was started on parenteral acyclovir for 2 weeks followed by oral valacyclovir for 2 more weeks. In the context of infection, the azathioprine was stopped while low-dose steroid and tacrolimus were continued.
Outcomes:
With the initiation of treatment for HSV infection, leukopenia, creatinine, and transaminases improved along with ferritin levels. At her 6-month follow-up, her blood counts and liver enzymes had normalized, and ferritin was 566 µg/L.
Teaching points:
Hemophagocytic lymphohistiocytosis is a rare disease in kidney transplant recipients with a high mortality rate. It can occur even in remote kidney transplant recipients so a high degree of suspicion is necessary to lead to a prompt diagnosis. Infections are common triggers for secondary HLH. Early identification and treatment of the triggering infection may improve outcomes.
Cervical Manipulation and Koren Specific Technique Emotions Protocol in the Improvement of Intensive Nocturnal Dry Cough: A Case Report
Authors: Hsuan Pin Chang
Journal: Cureus (2024)
Keywords: chiropractic, chronic cough, depression, koren specific technique, kst emotions protocol, neurogenic cough, nocturnal dry cough, spinal manipulation, upper cervical spine, vagus nerve
MeSH terms: Case Reports

This report describes a 42-year-old female patient who presented with an intensive nocturnal dry cough persisting for over six months. Subsequent to the prolonged cough, she developed shoulder and neck discomfort, leading her to seek chiropractic care. The patient received cervical chiropractic adjustments combined with the Koren Specific Technique (KST) emotions protocol. The patient was mainly treated for her musculoskeletal complaint. However, after two treatment sessions, the patient's chronic cough showed significant improvement. Two weeks later, the cough had completely ceased, and her shoulder and neck discomfort had also improved. The cough symptoms did not reappear during the six-month follow-up. The mechanism of cough improvement remains unclear, whether it is due to spinal adjustments, the KST emotions protocol, their combined effects, or merely a placebo response. This report discusses the potential underlying mechanisms of the case improvement, suggesting a non-pharmacological adjunctive therapeutic approach that could be investigated further in future research.
Posterior Cervical Glomus Tumor Mimicking Neurogenic Occipital Pain
Authors: Diogo Luz, Carlos Casimiro, Cátia Gradil
Journal: Cureus (2024)
Keywords: glomus tumor, neurogenic pain, neurosurgery, pain management, rare tumors
MeSH terms: Case Reports

Glomus tumors, typically localized in digits, palms, and soles, rarely occur in the posterior cervical region. This case report describes a unique presentation of an epithelioid glomus tumor in a 49-year-old male with a history of progressive occipital headaches. A 49-year-old male, referred with a five-year history of worsening occipital headaches, presented a palpable lesion in the right suboccipital area. MRI identified a 2.3 cm subcutaneous lesion adjacent to the right occipital artery, raising initial suspicion of a schwannoma. Subsequent excisional biopsy unveiled an unexpected diagnosis - an epithelioid glomus tumor. The rarity of glomus tumors in the posterior cervical region, coupled with their potential to mimic neurogenic tumors like schwannomas, underscores the diagnostic complexity. This encounter of a glomus tumor in an uncommon posterior cervical location serves as a pertinent reminder for neurosurgeons to consider atypical differentials. This case underscores the need for heightened clinical vigilance when faced with unusual presentations in neurosurgical practice.
Deciphering the Neuropsychiatric Lupus Enigma: Navigating the Intersection of Acute Inflammatory Demyelinating Polyneuropathy (AIDP), Infection, and Flare
Authors: Jhasaketan Meher, Jivtesh Singh, Saroj Kumar Pati, Vinay R Pandit, Saurabh K Patel, Mallika Kapur, M S Nithin
Journal: Cureus (2024)
Keywords: aidp, cyclophosphamide, mrsa, neuro lupus, pulse steroid therapy, sle
MeSH terms: Case Reports

A 17-year-old male diagnosed with systemic lupus erythematosus (SLE), showing poor compliance with medication, presented to our facility with a 20-day history of fever, polyarthritis, and cough. Additionally, he had experienced a seizure episode, followed by a one-day history of altered mentation. Subsequently, he developed pneumonia, respiratory distress, and shock, necessitating ventilator and inotropic support. Neuropsychiatric lupus (NP-lupus) was suspected, and hence high-dose steroids, hydroxychloroquine, and broad-spectrum antibiotics were initiated. Following successful extubation, he manifested ascending flaccid paralysis. The presence of albumin-cytological dissociation and axonal neuropathy confirmed the diagnosis of acute inflammatory demyelinating polyneuropathy (AIDP). He underwent further management with pulse steroids and plasmapheresis. Upon recovery, he was discharged on a regimen of steroids, cyclophosphamide, and hydroxychloroquine. During follow-up, he maintained ambulatory status with no residual neurological sequelae.
Endogenous Purulent Pericarditis Due to Klebsiella aerogenes in a Patient With Traumatic Chest Injury: A Case Report
Authors: Gi Eun Kim, Soubiya Ansari, Gabriala N Andrews, Sreethish Sasi, Jouhar Kolleri, Tasneem A Abdallah, Ibrahim F Hassan, Muna Al Maslamani
Journal: Cureus (2024)
Keywords: klebsiella aerogenes, meropenem, multidrug resistant, pericardiocentesis, purulent pericarditis
MeSH terms: Case Reports

Purulent pericarditis is a rare but serious medical condition caused by an infection that spreads to the pericardial space surrounding the heart. Gram-positive organisms are the most common pathogens associated with purulent pericarditis. However, there has been a shift in recent years toward gram-negative bacteria. Klebsiella aerogenes is a rare pathogen that has never been linked to purulent pericarditis. In this report, we describe the case of a 40-year-old male patient with chronic bronchiectasis who, two months after suffering an injury, developed purulent pericarditis due to an uncommon organism, K. aerogenes. During his stay in the hospital, the patient developed several infections caused by K. aerogenes. These included bacteremia and ventilator-associated pneumonia (VAP). Beta-lactamase-inducible K. aerogenes was grown in pericardial fluid culture following an emergency pericardiocentesis. The organism was resistant to carbapenems in a sputum culture, even though it was sensitive to meropenem in a blood culture. The patient had hypotension, requiring inotropes, and continued persistent bacteremia due to K. aerogenes. The patient had a heart attack with no pulse or electrical activity and died despite getting the best care possible. In light of this example, it is crucial to think about K. aerogenes and other rare organisms as possible pathogens in purulent pericarditis, especially in people who do not normally have known risk factors for this condition. Multidrug resistance patterns can make treatment more complicated, and aggressive care may be necessary in critically ill patients with chronic bacteremia.