OpenMed/multicare-articles huggingface dataset:
A Case Report of Nonvasculitic Autoimmune Inflammatory Meningoencephalitis with Sensory Ganglionopathy: A Rare Presentation of Sjögren Syndrome
Authors: João Peres, Simão Cruz, Rita Oliveira, Luís Santos, Ana Valverde
Journal: Case Rep Neurol Med (2017)
MeSH terms: Case Reports

A 68-year-old Caucasian female was admitted to the emergency department with a progressive history of behavioural symptoms and anxiety followed by visual and auditory hallucinations, forgetfulness, and impaired gait in the previous 3 months. On examination she was psychotic and had a postural and rest tremor of the upper limbs, cogwheel rigidity of the four limbs, retropulsion on standing position, and inability to walk. During the following 2 weeks she developed xerostomia and unilateral parotiditis that improved with steroids. A simultaneous improvement of the cognitive abilities allowed for the detection of sensory ataxia of the lower limbs. Sensory ganglionopathy was then detected with electrophysiological studies. A diagnosis of Sjögren syndrome was suspected and confirmed by salivary gland scintigraphy, Schirmer's test, and submaxillary gland biopsy. We report a case of Sjögren syndrome associated with central and peripheral nervous system involvement, without sicca symptoms preceding the neurological clinical picture. The coexistence of ganglionopathy and a favourable response to immunosuppression are key features that can lead to the correct diagnosis in cases with atypical CNS symptoms, mimicking a rapidly progressive dementia.
Septic Pulmonary Embolism Secondary to Klebsiella pneumoniae Epididymitis: Case Report and Literature Review
Authors: Juan Sebastián Alonso Ojeda Gómez, Jorge Alberto Carrillo Bayona, Laura Cristina Morales Cifuentes
Journal: Case Rep Radiol (2019)
MeSH terms: Case Reports

Background:
Septic pulmonary embolism (SPE) is defined as the occurrence of septic thrombi in the pulmonary circulation. We report a case of SPE secondary to K. pneumoniae epididymitis.
Case presentation:
A 74-year-old male with a history of diabetes mellitus experienced SPE secondary to epididymitis, with isolation of K. pneumoniae in blood and presence of lung nodules, with a chest computed tomography showing the halo and reversed halo signs.
Discussion:
SPE is characterized by the presence of septic thrombi in the pulmonary circulation coming from an extrapulmonary infective focus. SPE secondary to K. pneumoniae epididymitis is an uncommon condition that is characterized by the presence of multiple bilateral nodules of peripheral distribution.
Conclusion:
SPE is an unusual complication of acute epididymitis. Suspicion of SPE should be considered in patients with a diagnosis of epididymitis, respiratory symptoms, and multiple nodules in chest imaging assessments.
Fatal Overdose due to Confusion of an Transdermal Fentanyl Delivery System
Authors: Ingo Voigt
Journal: Case Rep Crit Care (2013)

Background. The use of transdermal fentanyl systems has increased over recent years, especially in patients with chronic pain. Large misuse potential and fatal outcomes have been described. Case Presentation. A 58-year-old patient presenting with clinical signs of opioid poisoning (hypoventilation, bradycardia, hypotension, and miosis) was admitted to our ICU. The first body check revealed a 75 mcg per hour fentanyl patch at the patient's right scapula. Some months ago, patient's aunt died after suffering from an oncological disease. During breaking up of her household, the patches were saved by the patient. Not knowing the risk of this drug, he mistook it as a heat plaster. Investigations. Laboratory test showed an impaired renal function and metabolic acidosis. Urine drug test was negative at admittance and 12 h later. CCT scan presented a global hypoxic brain disease. Treatment and Outcome. The patient was discharged 30 days after admittance in a hemodynamic stable condition but a vegetative state and transferred to a rehabilitation center. Learning Points. With the ongoing increase in fentanyl patch prescriptions for therapeutic reasons, it is likely that misuse cases will become more relevant. Conventional urine drug screening tests are not able to exclude the diagnosis fentanyl intoxication. History taking should include family member's drug prescriptions.
Case report: A proposed role for cardiopulmonary exercise testing in detecting cardiac dysfunction in asymptomatic at-risk adolescents
Authors: Timothy Edwards, Emir Tas, Kenneth Leclerc, Elisabet Børsheim
Journal: Front Pediatr (2023)
Keywords: adolescents, cardiac dysfunction, cardiopulmonary exercise testing (cpet), case report, family history
MeSH terms: Case Reports

Noninvasive cardiopulmonary exercise testing (CPET) provides the valuable capacity to analyze pulmonary gas exchange and cardiovascular responses that can be used to differentiate normal cardiopulmonary responses from abnormal. This case report highlights a proposed role for CPET in identifying potential cardiac pathologies in at-risk adolescents. An abnormal CPET response in an asymptomatic adolescent revealed a family history of early-age CAD. The significance of the abnormal CPET response was further supported by the presence of an elevated concentration of circulating high sensitivity C-reactive protein (hs-CRP). These findings emphasize the importance of a thorough clinical evaluation in at-risk adolescents, as CPET can aid in the early detection and management of cardiac pathologies, especially when combined with other relevant biomarkers such as plasma hs-CRP concentration, which can further suggest underlying pathology. Management considerations using serial CPET evaluations are recommended. Thus, CPET abnormalities combined with elevated hs-CRP should be taken seriously and provide justification for further evaluation and monitoring in adolescents at risk for cardiovascular disease.
Inadvertent apical extrusion of sodium hypochlorite with evaluation by dental volumetric tomography
Authors: Elif Delve Başer Can, Meriç Karapınar Kazandağ, Rabia Figen Kaptan
Journal: Case Rep Dent (2015)

This case report describes the tissue injury caused by inadvertently extruded NaOCl through the apical constriction. A 56-year-old female patient with complaints of pain, swelling, and ecchymosis on the left side of her face was referred to our clinic. The symptoms had emerged following root canal treatment of the maxillary left first premolar, and a soft tissue complication due to apical extrusion of NaOCl was diagnosed. Antibiotics and analgesics were prescribed. DVT images revealed that the buccal root apex had perforated the maxillary bone. The patient was followed up every other day and became asymptomatic on the 10th day. Endodontic therapy was completed with routine procedures. Determining working length precisely and following irrigation protocols meticulously are indispensable to prevent this type of complication. 3D visualization of the affected area may reveal the cause of the incident.
Primary retroperitoneal nodal endometrioid carcinoma associated with Lynch syndrome: A case report
Authors: Daniela Fischerova, Umberto Scovazzi, Natacha Sousa, Tatevik Hovhannisyan, Andrea Burgetova, Pavel Dundr, Kristýna Němejcová, Rosalie Bennett, Michal Vočka, Filip Frühauf, Roman Kocian, Tereza Indrielle-Kelly, David Cibula
Journal: Front Oncol (2023)
Keywords: lynch syndrome, adenocarcinoma, biopsy, genetic testing, hereditary nonpolyposis, immunohistochemistry, lymph nodes, ultrasonography
MeSH terms: Case Reports

We report a rare case of primary nodal, poorly differentiated endometrioid carcinoma associated with Lynch syndrome. A 29-year-old female patient was referred by her general gynecologist for further imaging with suspected right-sided ovarian endometrioid cyst. Ultrasound examination by an expert gynecological sonographer at tertiary center revealed unremarkable findings in the abdomen and pelvis apart from three iliac lymph nodes showing signs of malignant infiltration in the right obturator fossa and two lesions in the 4b segment of the liver. During the same appointment ultrasound guided tru-cut biopsy was performed to differentiate hematological malignancy from carcinomatous lymph node infiltration. Based on the histological findings of endometrioid carcinoma from lymph node biopsy, primary debulking surgery including hysterectomy and salpingo-oophorectomy was performed. Endometrioid carcinoma was confirmed only in the three lymph nodes suspected on the expert scan and primary nodal origin of endometroid carcinoma developed from ectopic Müllerian tissue was considered. As a part of the pathological examination immunohistochemistry analysis for mismatch repair protein (MMR) expression was done. The findings of deficient mismatch repair proteins (dMMR) led to additional genetic testing, which revealed deletion of the entire EPCAM gene up to exon 1-8 of the MSH2 gene. This was unexpected considering her insignificant family history of cancer. We discuss the diagnostic work-up for patients presenting with metastatic lymph node infiltration by cancer of unknown primary and possible reasons for malignant lymph node transformation associated with Lynch syndrome.
One year refractive outcomes of Femtosecond-LASIK in mild, moderate and high myopia
Authors: Bogdana Tabacaru, Horia Tudor Stanca
Journal: Rom J Ophthalmol (2017)
Keywords: femtolasik, femtosecond-lasik, myopia, refractive surgery
MeSH terms: Keratomileusis, Laser In Situ / methods, Lasers, Excimer / therapeutic use, Myopia, Degenerative / surgery, Refraction, Ocular / physiology, Visual Acuity / physiology, Case Reports, Adult, Corneal Pachymetry, Corneal Topography, Female, Humans, Male, Middle Aged, Myopia, Degenerative / classification, Myopia, Degenerative / physiopathology, Postoperative Complications, Surgical Flaps, Treatment Outcome, Young Adult

Purpose: To evaluate the safety, efficacy, predictability and stability for a cohort of myopic eyes treated by Femtosecond-LASIK procedure. Methods: 60 eyes (36 patients) with different degrees of myopia that underwent refractive surgery by using the Femtosecond-LASIK technique were prospectively evaluated for 12 months. The mean preoperative spherical equivalent value was -3.827 ± 1.410 diopters (D) (range: -8.125 to -1.375 D). VisuMax® femtosecond laser was used for cutting the corneal flap and then the Mel80® excimer laser for the stromal ablation. Results: Mean age was 30.80 ± 5.745 years (range: 21 to 46 years) with 75% female patients. Postoperative spherical equivalent at 12 months was within ±0.25 D of emmetropia in 90% of the eyes and within ±0.50 D of emmetropia in 100% of the eyes. All the eyes achieved an uncorrected distance visual acuity (UDVA) of 1.0 (decimal scale). No eye lost lines of preoperative corrected distance visual acuity (CDVA). No major intraoperative or postoperative complications were encountered. Conclusions: Femtosecond-LASIK seems to be a suitable option for the correction of mild, moderate, and high myopia, as the procedure showed to be safe, effective, and predictable for the treatment of myopic refractive errors.
Ruptured heterotopic pregnancy in a natural conception cycle: a case report at the Yaounde central Hospital (Cameroon)
Authors: Jeanne Hortence Fouedjio, Florent Ymele Fouelifack, Jovanny Tsuala Fouogue, Zacharie Sando
Journal: Pan Afr Med J (2013)
Keywords: cameroon, ectopic, hemoperitoneum, heterotopic, pregnancy
MeSH terms: Pregnancy Outcome, Pregnancy, Heterotopic / diagnosis, Pregnancy, Tubal / diagnosis, Case Reports, Adult, Cameroon, Female, Humans, Laparotomy, Pregnancy, Pregnancy, Heterotopic / diagnostic imaging, Pregnancy, Heterotopic / pathology, Pregnancy, Tubal / diagnostic imaging, Pregnancy, Tubal / pathology, Rupture, Spontaneous, Salpingectomy / methods, Ultrasonography, Prenatal / methods

Heterotopic pregnancy is very rare under natural circumstances. We report the case of a 28 year old Gravida2 Para1001 woman at 9 weeks of pregnancy who consulted in emergency for acute pelvic pain following metrorrhagia. Physical exam revealed hemoperitoneum without shock. An emergency ultrasonography revealed two gestational sacs, one intra-uterine and the other extra-uterine. Laparotomy was done and the findings were: a ruptured right tubal pregnancy with 1,300 milliliters of hemoperitoneum, type B left utero-adnexal adhesions and an increased uterus consistent with a 9 weeks pregnancy. Right total salpingectomy was done and the patient did well postoperatively. That intrauterine pregnancy evolved normally under progesterone supply and the woman delivered a termed live female baby weighing 3.1 kilogrammes. In our context where ultrasound is not always available, practitioners carrying out salpingectomy for ruptured ectopic pregnancies should bear in mind the plausibleness of heterotopic pregnancy in order to properly handle the uterus.
A case of metastatic cancer with markedly elevated PSA level that was not detected by repeat prostate biopsy
Authors: Hiromichi Iwamura, Shingo Hatakeyama, Yoshimi Tanaka, Toshikazu Tanaka, Noriko Tokui, Hayato Yamamoto, Atsushi Imai, Takahiro Yoneyama, Yasuhiro Hashimoto, Takuya Koie, Kazuaki Yoshikawa, Chikara Ohyama
Journal: BMC Res Notes (2014)
MeSH terms: Adenocarcinoma / secondary, Biopsy, Needle, Bone Neoplasms / secondary, Neoplasms, Hormone-Dependent / secondary, Neoplasms, Unknown Primary, Prostate-Specific Antigen / blood, Prostatic Neoplasms / diagnosis, Case Reports, Research Support, Non-U.S. Gov't, Adenocarcinoma / blood, Adenocarcinoma / diagnosis, Adenocarcinoma / drug therapy, Adenocarcinoma / pathology, Androgen Antagonists / therapeutic use, Antineoplastic Agents, Hormonal / therapeutic use, Antineoplastic Combined Chemotherapy Protocols / therapeutic use, Back Pain / etiology, Bone Neoplasms / blood, Bone Neoplasms / diagnosis, Bone Neoplasms / drug therapy, Bone Neoplasms / pathology, Diagnostic Imaging, Disseminated Intravascular Coagulation / etiology, Docetaxel, Drug Resistance, Neoplasm, False Negative Reactions, Fatal Outcome, Humans, Male, Middle Aged, Neoplasms, Hormone-Dependent / blood, Neoplasms, Hormone-Dependent / diagnosis, Neoplasms, Hormone-Dependent / pathology, Prostatic Neoplasms / blood, Prostatic Neoplasms / pathology, Prostatic Neoplasms / surgery, Taxoids / administration & dosage, Transurethral Resection of Prostate, Androgen Antagonists, Antineoplastic Agents, Hormonal, Taxoids, Docetaxel, Prostate-Specific Antigen

Background:
Prostate-specific antigen (PSA) is a widely used specific tumor marker for prostate cancer. We experienced a case of metastatic prostate cancer that was difficult to detect by repeat prostate biopsy despite a markedly elevated serum PSA level.
Case presentation:
A 64-year-old man was referred to our hospital with lumbar back pain and an elevated serum PSA level of 2036 ng/mL. Computed tomography, bone scintigraphy, and magnetic resonance imaging showed systemic lymph node and osteoblastic bone metastases. Digital rectal examination revealed a small, soft prostate without nodules. Ten-core transrectal prostate biopsy yielded negative results. Androgen deprivation therapy (ADT) was started because of the patient's severe symptoms. Twelve-core repeat transrectal prostate biopsy performed 2 months later, and transurethral resection biopsy performed 5 months later, both yielded negative results. The patient refused further cancer screening because ADT effectively relieved his symptoms. His PSA level initially decreased to 4.8 ng/mL, but he developed castration-resistant prostate cancer 7 months after starting ADT. He died 21 months after the initial prostate biopsy from disseminated intravascular coagulation.
Conclusion:
CUP remains a considerable challenge in clinical oncology. Biopsies of metastatic lesions and multimodal approaches were helpful in this case.
Intranasal esketamine as therapeutic option: a case report of an adolescent with treatment resistant depression
Authors: Katrin Skala, Kamer Doganay, Harald Eder, Dunja Mairhofer, Katrin Neubacher, Paul L Plener
Journal: Front Psychiatry (2023)
Keywords: adolescents, intranasal, ketamine, off-label, treatment resistant depression
MeSH terms: Case Reports

Depression is among the most common mental health disorders worldwide and treatment resistant depression (TRD) represents a major challenge for both patients and clinicians. In recent years ketamine has received attention as an antidepressant agent, demonstrating promising results in TRD in adults. To date, few attempts have been made in treating adolescent TRD with ketamine and none have used intranasal application. This paper discusses a case of a 17-year-old female adolescent suffering from TRD who underwent treatment with intranasal esketamine application (Spravato 28 mg). As symptoms showed clinically insignificant improvement despite modest gains in objective assessments (GAF, CGI, MADRS), treatment was prematurely discontinued. However, the treatment was tolerable and side effects were scarce and mild. Although this case report does not demonstrate clinical effectiveness, ketamine may nonetheless be a promising substance in treating TRD in other adolescents. Questions regarding the safety of ketamine use in the rapidly developing brains of adolescents still remain unanswered. To further explore the potential benefits of this treatment method a short term RCTs for adolescents with TRD is recommended.
Adult ocular toxocariasis mimicking ciliary body malignancy
Authors: Ahmad M Mansour, Bachir Abiad, Fouad I Boulos, Ramzi Alameddine, Fadi C Maalouf, Alaa Bu Ghannam, Rola N Hamam
Journal: Case Rep Med (2014)

Purpose. To discuss an unusual presentation of ocular toxocariasis. Methods. Case report. Results. A 40-year-old woman presented with decreased vision in the left eye with a long history of recurrent red eye from uveitis. Eosinophilia and positive ELISA titers for Toxocara canis favored the diagnosis of ocular toxocariasis. Over 3 months, an anterior scleral mass had a rapid growth raising the possibility of medulloepithelioma, which rarely can mimic uveitic syndromes. Surgical plan changed from local excision to enucleation. Histopathology demonstrated a large homogeneous mass of chronic inflammatory cells with inflammation of the overlying thinned out sclera, medial rectus insertion, and limbal cornea. The triad of peripheral granuloma, eosinophilia, and positive blood serology established the diagnosis of ocular toxocariasis. Conclusions. Ocular toxocariasis can mimic ocular malignancy such as medulloepithelioma in adults and rarely presents as an anterior scleral mass.
Acetabular roof stress fracture: a rare cause of hip pain in children
Authors: Zied Jlalia, Mehdi Bellil, Maher Ben Ghachem
Journal: Pan Afr Med J (2016)
Keywords: stress fracture, acetabulum, magnetic resonance imaging
MeSH terms: Acetabulum / injuries, Fractures, Stress / diagnostic imaging, Hip Joint / pathology, Pain / etiology, Case Reports, Acetabulum / diagnostic imaging, Child, Female, Follow-Up Studies, Fractures, Stress / pathology, Hip Joint / diagnostic imaging, Humans, Magnetic Resonance Imaging / methods

Stress fracture of acetabular roof is an unusual cause of hip pain. It is considered as an underdiagnosed entity. People who are more susceptible to experience this fracture are athletes, soldiers and dancers. We present the case of an 11 year old girl with a roof acetabular stress fracture for which the diagnosis and follow-ups were possible by the means of MRI. The treatment was keeping the child at a complete rest. Failure to abide with this treatment can cause the stress fracture to evaluate into a complete fracture.
Multibacillary Leprosy Presenting as Anetoderma in a Young Teenager
Authors: Niraj Parajuli, Shraddha Shrestha, Laila Lama, Rushma Shrestha, Sumida Tiwari, Anupama Karki
Journal: Case Rep Dermatol Med (2020)
MeSH terms: Case Reports

Anetoderma presents as a circumscribed area of slack skin. It can present as either primary or secondary, if associated with other conditions. Leprosy is one of the causes of secondary anetoderma, but it is not commonly reported, especially in multibacillary leprosy. Here, we report a case of a 16-year-old young girl who presented with fever, joint pain, and only three anetodermic plaques. A slit skin smear from the lesion showed multiple acid-fast bacilli with a bacillary index of 3+, thus confirming the diagnosis of leprosy. This case is unique since multibacillary leprosy presented with only few anetoderma lesions in a young teenager girl from a leprosy-eliminated country.
Sixth Nerve Palsy from Cholesterol Granuloma of the Petrous Apex
Authors: Ségolène Roemer, Philippe Maeder, Roy Thomas Daniel, Aki Kawasaki
Journal: Front Neurol (2017)
Keywords: abducens palsy, cholesterol granuloma, diplopia, esotropia, petrous apex tumor, sixth nerve palsy, skull-base tumor
MeSH terms: Case Reports

Herein, we report a patient who had an isolated sixth nerve palsy due to a petrous apex cholesterol granuloma. The sixth nerve palsy appeared acutely and then spontaneously resolved over several months, initially suggesting a microvascular origin of the palsy. Subsequent recurrences of the palsy indicated a different pathophysiologic etiology and MRI revealed the lesion at the petrous apex. Surgical resection improved the compressive effect of the lesion at Dorello's canal and clinical improvement was observed. A relapsing-remitting sixth nerve palsy is an unusual presentation of this rare lesion.
An Obstructing Small Bowel Phytobezoar in an Elderly Female Nigerian: A Case Report and Literature Review
Authors: O S Balogun, A O Osinowo, M O Afolayan, A A Adesanya
Journal: Case Rep Surg (2017)
MeSH terms: Case Reports

Small bowel obstruction secondary to phytobezoars is an unusual presentation in surgery. We present a case of an elderly female patient with an insidious onset of abdominal pain, abdominal distension, and bilious vomiting diagnosed radiologically to be small bowel obstruction. Exploratory laparotomy revealed a trapped mass of vegetable matter in the distal ileum. She had enterotomy with primary closure for removal of obstructing ileal phytobezoars. Her postoperative recovery was uneventful.
Osteochondrolipoma of the Mandible
Authors: Takeshi Kitazawa, Masato Shiba
Journal: Eplasty (2017)
Keywords: mandible, mesenchymoma, osseous and cartilaginous metaplasia, osteochondrolipoma, pluripotency
MeSH terms: Case Reports

Objective: Lipomas are very common benign tumors located in any part of the body in which fat is normally present, but lipomas containing both osseous and cartilaginous elements are rare. Methods: A case of osteochondrolipoma in a 72-year-old man is reported. The tumor in the mental region was 2×1.5×1.5 cm. Results: After resection of the tumor, there has been no recurrence during the 6-month postoperative follow-up. Histological examination confirmed the definitive diagnosis. Conclusions: Osteochondrolipoma is an extremely unusual lesion that should be kept in mind in the differential diagnosis of soft-tissue tumors.
Caecal Perforation from Primary Intestinal Tuberculosis in Pregnancy
Authors: Soe Lwin, Nina Lau Lee Jing, Haris Suharjono, Mardiana Binti Kipli, Tin Moe Nwe, Myat San Yi, Lucas Luk Tien Wee
Journal: Case Rep Gastrointest Med (2017)
MeSH terms: Case Reports

The incidence of tuberculosis (TB) is rising worldwide, despite the efficacy of the BCG vaccination. Populations at greatest risk of contracting TB are migrant communities, as well as immunocompromised individuals. The diagnosis of extrapulmonary TB (EPTB) can often present as a diagnostic conundrum, due to its nonspecific and varied presentation, often mimicking inflammatory bowel disease or malignancy. We present a case of caecal TB in pregnancy, which resulted in caecal perforation, a right hemicolectomy, and severe preterm delivery. The aim of this case report is to discuss the diagnosis of extrapulmonary TB, as well as its subsequent management in pregnancy.