OpenMed/multicare-articles huggingface dataset:
An unusual case of metaphyseal osteonecrosis of humerus in a post covid patient: a case report
Authors: Ajayakumar Thankappan, Nizaj Nasimudeen, Arun Thomas, Jyothi Karikkanthra, Jojo Pullockara
Journal: Pan Afr Med J (2022)
Keywords: covid-19, case report, metaphysis, osteonecrosis, pathological fracture
MeSH terms: COVID-19 / complications, Fractures, Spontaneous / pathology, Osteonecrosis / etiology, Osteonecrosis / surgery, Case Reports, Aged, Female, Humans, Humerus / pathology, Shoulder / pathology

Osteonecrosis of the metaphysis is often rare as it is a highly vascular region. Here we report an unusual case of non-traumatic osteonecrosis of the humerus predominantly involving the metaphysis in a post covid elderly female. The patient had a pathological fracture of humerus during the post-operative period of intertrochanteric femur fracture surgery. She was evaluated for the causes of pathological fracture and the fracture was managed with hemi replacement of the shoulder because of the extensive bone loss. The pathology here could only be explained as some sequelae of hyper inflammatory state associated with COVID-19 infection. The possible differentials are also discussed here. This case report will help clinicians to consider COVID-19 infection as a cause for non-traumatic osteonecrosis among other reported causes of osteonecrosis.
Case Report: A Rare Case of Severe Coronary Venous Spasm During Radiofrequency Ablation of Premature Ventricular Contraction
Authors: Rina Sha, Bing Rong, Kellina Maduray, Jingquan Zhong
Journal: Front Cardiovasc Med (2022)
Keywords: coronary artery spasm, coronary venous spasm, mechanism, premature ventricular contraction, radiofrequency ablation
MeSH terms: Case Reports

Coronary venous spasm has never been reported during premature ventricular extrasystole ablation. We report a 20-year-old female patient who experienced a severe spasm of the great cardiac vein during radiofrequency ablation for premature ventricular contractions, which were relieved eventually by the administration of intracoronary nitroglycerine. The operation was successfully completed, leading to a long-term resolution of her palpitation symptoms.
Traumatic odontoid process synchondrosis fracture with atlantoaxial instability in a calf: clinical presentation and imaging findings
Authors: Velia-Isabel Hülsmeyer, Katharina Flatz, Katrin Putschbach, Martina Ramona Bechter, Sebastian Weiler, Andrea Fischer, Melanie Feist
Journal: Ir Vet J (2015)
Keywords: atlantoaxial instability, bovine, calf, dens axis, odontoid process, tetraparesis

A 6-week-old female Simmental calf was evaluated for acute non-ambulatory tetraparesis. Physical and laboratory examinations revealed no clinically relevant abnormalities. Neurological findings were consistent with acute, progressive and painful cervical myelopathy. Radiographs displayed a fractured odontoid process (dens axis) and vertebral step misalignment at the fracture site. A traumatic origin was suspected. Advanced diagnostic imaging was considered to allow better planning of potential surgical stabilisation and to exclude any additional lesions of the cervical vertebral column. However, during trailer transportation to the advanced diagnostic imaging and surgery site, the calf deteriorated neurologically and was humanely euthanised. Magnetic resonance imaging (MRI) and computed tomography (CT) were performed immediately post-mortem for scientific reasons. The MRI examination reflected the radiographic findings and confirmed severe spinal cord compression at the fracture site. In addition, a T2W-hyperintense signal change within the paravertebral soft tissue dorsal to the fracture site was indicative of a traumatic event. CT identified the fracture site at the synchondrosis between the odontoid process and the body of the axis, and this finding was confirmed by post-mortem examination. Advanced diagnostic imaging and post-mortem examination did not identify any other cervical lesion. In summary, this calf was diagnosed with a traumatic odontoid process synchondrosis fracture, which has not been reported previously in calves but presents a challenging and well-known fracture type in young children. This case report indicates that the odontoid process synchondrosis is a potential predisposed injury site and that traumatic odontoid process synchondrosis fractures should be considered as a potential differential in calves with acute cervical pain and/or signs of a cervical myelopathy.
Vogt-Koyanagi-Harada disease during prolonged intermittent steroid therapy for chronic obstructive pulmonary disease: a case report
Authors: Shalini Akulwar, Hemant Gupta, Manas Pustake, Tushar Vidhale, Sumeet Lahane, Prafulla Jaya Rohan
Journal: Pan Afr Med J (2021)
Keywords: vogt-koyanagi-harada disease, autoimmune disease, case report, granulomatous autoimmune disease, panuveitis
MeSH terms: Glucocorticoids / administration & dosage, Pulmonary Disease, Chronic Obstructive / drug therapy, Uveomeningoencephalitic Syndrome / diagnosis, Case Reports, Aged, Diagnosis, Differential, Humans, Male, Uveomeningoencephalitic Syndrome / drug therapy, Vision Disorders / etiology, Glucocorticoids

Vogt-Koyanagi-Harada Disease (VKHD) is a rare systemic granulomatous autoimmune condition that affects melanocyte-rich organs including the eyes, inner ears, meninges, skin, and hair. VKHD causes chronic uveal inflammation and a loss in visual acuity in some patients. Patients generally respond well to steroid therapy. In our patient, we evidenced VKHD in the chronic recurrent stage at the time of presentation while the patient was on intermittent systemic steroid therapy. To date, no cases of VKHD have been reported in patients who were taking immunosuppressive medications. This study sheds light on the possibility that, in addition to the complex multisystem autoimmune phenomenon, other variable factors may also be implicated in the etiopathogenesis of this disease. Also, if a patient presents with subacute vision loss and an acute onset headache and encephalopathy, this differential diagnosis should be kept in mind, and the patient should be treated as soon as possible if the diagnosis is confirmed.
The ectopic vesical pheochromocytoma a diagnostic and therapeutic challenge case report and literature review
Authors: Issam Jandou, Amine Moataz, Mohammed Hicham Mouqtassid, Mohammed Dakir, Adil Debbagh, Rachid Aboutaieb
Journal: Int J Surg Case Rep (2020)
Keywords: bladder pheochromocytoma, ectopic pheochromocytoma, methoxylated derivative, partial cystectomy
MeSH terms: Case Reports

Introduction:
Extra-adrenal localization of pheochromocytoma is rare. Its clinical revelation is paroxysmal but maybe in the form of permanent hypertension resistant to treatment. The main problem with these tumors is to affirm their benignity or malignancy, ectopic pheochromocytomas have a malignant development once in two.
Case presentation:
We report the observation of a 39-year-old woman hypertensive on Amlodipine. She presents for sweating, headache, and palpation. The dosage of urinary metabolites revealed a marked increase in metanephrine and normetanephrine. Imagery had shown, at the expense of the left lateral wall of the bladder, a budding tissue formation with irregular contours which was significantly enhanced after injection of PDC. The diagnosis of an ectopic pheochromocytoma was accepted. The patient underwent a partial cystectomy, the postoperative consequences of which were unremarkable.
Discussion:
Threatening secretory syndromes are rare medical situations that require urgent management. Pheochromocytoma can be seen at any age from childhood to old age. The treatment of pheochromocytoma is surgical, once the stages of positive and topographic diagnosis have been carried out, the patient must be immediately entrusted to a team of trained surgeons and anesthetists. The prognosis remains unpredictable, hence the interest in prolonged monitoring.
Conclusion:
Pheochromocytoma is a tumor developed at the expense of chromaffin tissues, extra-adrenal localizations exist, but remain rare. It is a pathology that presents a diagnostic and therapeutic dilemma in which patients require regular and prolonged postoperative monitoring to detect a possible metastasis or recurrence.
Case report: Incomplete penetrance of autosomal dominant myotonia congenita caused by a rare CLCN1 variant c.1667T>A (p.I556N) in a Malaysian family
Authors: Nurul Huda Musa, Karuppiah Thilakavathy, Nur Afiqah Mohamad, Marina L Kennerson, Liyana Najwa Inche Mat, Wei Chao Loh, Anna Misyail Abdul Rashid, Janudin Baharin, Azliza Ibrahim, Wan Aliaa Wan Sulaiman, Fan Kee Hoo, Hamidon Basri, Abdul Hanif Khan Yusof Khan
Journal: Front Genet (2023)
Keywords: clcn1, thomsen disease, autosomal dominant, case report, chloride channel, myotonia congenita
MeSH terms: Case Reports

Myotonia congenita (MC) is a rare neuromuscular disease caused by mutations within the CLCN1 gene encoding skeletal muscle chloride channels. MC is characterized by delayed muscle relaxation during contraction, resulting in muscle stiffness. There is a lack of MC case reports and data on the prevalence among Malaysians. We report a clinical case of a 50-year-old woman presents with muscle stiffness and cramp episodes that started in early childhood. She had difficulty initiating muscle movement and presented with transient muscle weakness after rest, which usually improved after repeated contraction (warm-up phenomenon). She was diagnosed with MC after myotonic discharge on electromyography (EMG). Her brother had similar symptoms; however, no additional family members showed MC symptoms. Serum creatine kinase levels were elevated in both the proband and her brother with 447 U/L and 228 U/L recorded, respectively. Genetic analysis by whole-exome sequencing (WES) revealed a previously reported pathogenic CLCN1 gene variant c.1667T>A (p.I556N). Genetic screening of all family members revealed that the same variant was observed in the children of both the proband and her brother; however, the children did not present with either clinical or electrophysiological MC symptoms. The multiplex ligation-dependent probe amplification (MLPA) analysis conducted identified neither exon deletion nor duplication in CLCN1. In conclusion, this report describes the first case of MC in Malaysia in which incomplete penetrance observed in this family is caused by a known pathogenic CLCN1 variant.
A Rare Benign Tumor in a 14-Year-Old Girl
Authors: Meral Hassan Abualjadayel, Osama Y Safdar, Maysaa Adnan Banjari, Sherif El Desoky, Ghadeer A Mokhtar, Raed A Azhar
Journal: Case Rep Nephrol (2018)
MeSH terms: Case Reports

Background:
Oncocytomas are the second most common benign renal neoplasm but, unfortunately, they are difficult to differentiate from renal cell carcinoma. Renal oncocytomas are rare and have mostly been reported in adults. To our knowledge, this is only the sixth pediatric reported case of renal oncocytoma worldwide.
Case presentation:
A 14-year-old Yemeni girl with a recurrent history of urinary tract infections came to our clinic complaining of left flank pain with a frontal headache. Ultrasound showed a 3 cm, well-defined echogenic lesion with mild vascularity. This lesion increased in size on her subsequent follow-ups. Computed tomography showed no intralesional fat, vessels invasion, or enlarged lymph nodes. The patient underwent laparoscopic radical nephrectomy, and a pathology report confirmed the diagnosis of renal oncocytoma.
Conclusion and recommendations:
We present the rare occurrence of renal oncocytoma in a pediatric patient and highlight the importance of considering oncocytomas in the diagnosis of a renal mass.
Travel Planning Ability in Right Brain-Damaged Patients: Two Case Reports
Authors: Alessia Bocchi, Massimiliano Palmiero, Maddalena Boccia, Antonella Di Vita, Cecilia Guariglia, Laura Piccardi
Journal: Front Hum Neurosci (2020)
Keywords: navigational impairments, navigational planning, planning, right brain lesions, spatial navigation, topographical orientation, travel planning

Planning ability is fundamental for goal-directed spatial navigation. Preliminary findings from patients and healthy individuals suggest that travel planning (TP)-namely, navigational planning-can be considered a distinct process from visuospatial planning (VP) ability. To shed light on this distinction, two right brain-damaged patients without hemineglect were compared with a control group on two tasks aimed at testing VP (i.e., Tower of London-16, ToL-16) and TP (i.e., Minefield Task, MFT). The former requires planning the moves to reach the right configuration of three colored beads on three pegs, whereas the latter was opportunely developed to assess TP in the navigational environment when obstacles are present. Specifically, the MFT requires participants to plan a route on a large carpet avoiding some hidden obstacles previously observed. Patient 1 showed lesions encompassing the temporoparietal region and the insula; she performed poorer than the control group on the ToL-16 but showed no deficit on the MFT. Conversely, Patient 2 showed lesions mainly located in the occipitoparietal network of spatial navigation; she performed worse than the control group on the MFT but not on the ToL-16. In both cases performances satisfied the criteria for a classical dissociation, meeting criteria for a double dissociation. These results support the idea that TP is a distinct ability and that it is dissociated from VP skills.
Multimodal imaging of retinal metastasis masquerading as an acute retinal necrosis
Authors: Fukutaro Mano, Stephen A LoBue, Kuo-Chung Chang, Tomiya Mano
Journal: Int J Retina Vitreous (2018)
Keywords: acute retinal necrosis, blood–brain barrier, cisplatin, fluorouracil, metastasis, retina, vitrectomy
MeSH terms: Case Reports

Background:
To report the multimodal imaging and histology of a case of metastatic esophageal cancer with vitreoretinal involvement resembling acute retinal necrosis (ARN) in a patient receiving systemic chemotherapy.
Case presentation:
A 69-year-old Japanese man with a history of stage 4 esophageal carcinoma, treated with three cycles of 5-fluorouracil (5-FU) and cisplatin (CDDP) chemotherapy as well as 30 sessions of radiation therapy, presented with new onset of blurry vision in the right eye (OD). Visual acuity was 20/200 OD. Fundus examination OD revealed 2+ nuclear cataract, veil-like vitreous opacity, a tractional retinal detachment, and white retinal lesions in the macula and periphery masquerading as an ARN. Due to the poor view and uncertainty regarding diagnosis, combined cataract extraction and 25 gauge pars plana vitrectomy was performed. Polymerase chain reaction and cytologic analysis were performed on the vitreous samples, which was negative for all infectious entities but positive for poorly differentiated malignant cells. The vitreous biopsy was consistent with the primary endoscopic esophageal biopsy. Ultra-wide view fundus imaging revealed multifocal white intraretinal lesions in the macula and periphery. Optical coherence tomography through these white opacities displayed hyper-reflective inner retinal lesions with no choroidal involvement, suggestive of retinal metastasis. Observation and palliative support was continued until the patient passed away 3 months after diagnosis.
Conclusion:
Retinal metastasis may mimic infectious syndromes such as ARN and are associated with a very poor prognosis. Outside of the retina, no further central nervous system metastasis was found. 5-FU is known to cross the blood-brain-barrier but may be inadequate in preventing retinal metastasis.
Case Report: Durable Clinical Response to Third-Line Pyrotinib After Resistance to Trastuzumab in a Gastric Cancer Patient
Authors: Junyi Wu, Lei Li, Jun Qin, Zhengqing Yan, Shiqing Chen, Tao Jin, Junming Xu
Journal: Front Oncol (2022)
Keywords: her2, gastric cancer, pyrotinib, resistance, trastuzumab
MeSH terms: Case Reports

Background:
Trastuzumab plus chemotherapy remains the standard first-line treatment strategy for HER2-positive gastric cancer (GC). Trastuzumab resistance, on the other hand, remains a significant issue. There are a few effective anti-HER2 agents for patients who develop resistance to trastuzumab.
Case presentation:
A 49-year-old female was diagnosed with stage IV GC with liver and lung metastasis in July 2017. She underwent gastrostomy, and the immunohistochemistry (IHC) result of postoperative tissue demonstrated HER2 (3+). She received first-line treatment of trastuzumab (440 mg), oxaliplatin (200 mg), and S-1 (40 mg). After treatment for 6 months, the patient achieved complete response (CR) with PFS up to 21 months. After progression, she subsequently received trastuzumab (440 mg) plus oxaliplatin (200 mg) as second-line treatment. However, the patient developed resistance to trastuzumab after 12 months of treatment. She started to receive third-line treatment of irinotecan (200 mg d1) and capecitabine (60 mg bid) plus pyrotinib (400 mg/day). After 2 months of treatment, the tumor is evaluated as partial response with PFS of 12 months.
Conclusions:
We presented a patient with HER2-positive GC who benefited from the pyrotinib-based treatment after two lines of trastuzumab-based therapies failed. Further research is required to validate such conclusions.
Langerhans cell histiocytosis: another cause of a fluid-fluid level within an appendicular bony lesion
Authors: Venkata Rama Krishna Varanasi, May Ying Leong, Ah Moy Tan, Wen Quan Derrick Lian, Eu Leong Harvey James Teo
Journal: BJR Case Rep (2016)
MeSH terms: Case Reports

We report a case of Langerhans cell histiocytosis (LCH) occurring in the pelvis of a 2-year 11-month-old female with fluid-fluid level seen on MRI. Aspiration of the fluid during biopsy showed it to be blood with a few inflammatory cells and eosinophils. Tissue obtained during the biopsy confirmed the diagnosis to be LCH. While fluid-fluid levels have been infrequently encountered in skull lesions due to LCH, they have yet to be reported in lesions of the appendicular skeleton. The aim of this report is to familiarize radiologists with the fact that fluid-fluid levels can occur in LCH of the appendicular skeleton in children.
KRAS Gene Copy Number as a Negative Predictive Biomarker for the Treatment of Metastatic Rectal Cancer With Cetuximab: A Case Report
Authors: Qunli Xiong, Zhu Zeng, Yang Yang, Ya Wang, Yongfeng Xu, Ying Zhou, Jinlu Liu, Zhiwei Zhang, Meng Qiu, Qing Zhu
Journal: Front Oncol (2022)
Keywords: kirsten rat sarcoma viral oncogene homolog (kras), anti-egfr monoclonal antibody, biomarker, cetuximab, colorectal cancer, gene copy number
MeSH terms: Case Reports

Background:
Close to one third of colorectal cancer (CRC) patients are diagnosed with metastatic CRC (mCRC). Patients with wild-type RAS and BRAF usually receive anti-EGFR monoclonal antibody therapy containing cetuximab. Overall, 30-50% of mCRC patients are reported to harbor RAS mutations, and RAS mutation status should be assessed when considering EGFR inhibitor treatment according to mCRC biomarker guidelines. Of note, 0.67-2% of patients with CRC harbored a KRAS amplification. Here we reported a case of advanced rectal cancer with wild-type RAS and BRAF in a male patient who harbored a KRAS amplification during anti-EGFR treatment.
Case presentation:
A 46-year-old man was diagnosed with rectal adenocarcinoma with liver metastases (cT3NxM1a, stage IVA). After receiving first-line irinotecan- fluorouracil chemotherapy (FOLFIRI) plus cetuximab, second-line capecitabine- oxaliplatin chemotherapy (XELOX) plus bevacizumab, and third-line regorafenib, he rechallenged FOLFIRI and cetuximab for seven cycles, achieving a prolonged survival of at least 5 months. The KRAS copy number of circulating tumor DNA (ctDNA) was assessed during treatment. Notably, apart from serum carbohydrate antigen 199 (CA199) and carcinoembryonic antigen (CEA), the change of plasm Kirsten Rat Sarcoma Viral Oncogene Homolog (KRAS) copy number appeared to strongly correlate with treatment response.
Conclusion:
Our findings suggest that the dynamic change of KRAS copy number on ctDNA during treatment might be a negative predictive biomarker. Additionally, RAS and BRAF wild-type mCRC patients who are resistant to first-line FOLFIRI plus cetuximab therapy may respond well to the FOLFIRI plus cetuximab "rechallenged" strategy.
Bilateral Chylothorax as a Unique Presentation of Pancreaticobiliary or Upper Gastrointestinal Cancer
Authors: Nooraldin Merza, John Lung, Mazin Saadaldin, Tarek Naguib
Journal: Case Rep Pulmonol (2019)
MeSH terms: Case Reports

Chylothorax presents as exudate with lymphocytic predominance and high triglyceride-low LDH levels, usually due to a traumatic disruption of the thoracic duct, possibly iatrogenic. Other causes include malignancy, sarcoidosis, goiter, AIDS, or tuberculosis. Here we present a case of a 66-year-old male who came in with cough and shortness of breath for few weeks. A week earlier, at an ED visit, he was diagnosed with pneumonia based on CT angiogram of the chest without contrast that showed bilateral pleural effusion and bilateral pulmonary infiltrates. The CT-guided placement of bilateral chest tube drained 1160 cc of creamy yellow fluid on the right and 1200 cc of creamy yellow fluid on the left. CT chest/abdomen/pelvis showed bilateral ground-glass opacities within the lungs and possible bony metastasis. A whole-body bone scan showed multiple bony metastatic lesions throughout the skeleton. IR guided bone biopsy suggested upper GI or pancreaticobiliary cancer. Venous ultrasound with Doppler of left upper extremity showed findings suggestive of a nonocclusive DVT of proximal/mid left subclavian vein which is difficult to compress. Eventually, malignancy-related DVT of the left subclavian/brachiocephalic vein was identified as the possible etiology for the bilateral chylothorax.
Headache in a Child with Pseudohypoparathyroidism: An Alarming Symptom Not to Miss
Authors: Sarah Wing-Yiu Poon, Brian Hon-Yin Chung, Anita Man-Ching Tsang, Grace Wing-Kit Poon
Journal: Case Rep Endocrinol (2020)
MeSH terms: Case Reports

Background:
While the endocrine manifestations of pseudohypoparathyroidism are well known, less is known about the associated brain and spine abnormalities. These abnormalities may present with nonspecific symptoms in the paediatric population, and lack of awareness to these uncommon manifestations of the disease may result in a delay in necessary intervention. Case Presentation. We herein present a case of known pseudohypoparathyroidism type 1a who presented initially with minor head injury. She later developed progressive worsening headache, increased irritability, and vomiting. Repeated imaging showed hydrocephalus and Chiari malformation type 1 necessitating emergency craniectomy.
Conclusion:
Growth hormone deficiency, a common manifestation of pseudohypoparathyroidism type 1a, results in underdevelopment of the posterior cranial fossa and may account for the higher incidence of Chiari malformation in this group of patients. Other associated neurological features reported in pseudohypoparathyroidism type 1a include spinal stenosis, syringomyelia, and craniosynostosis. While less commonly seen, awareness to these associations is important in order to optimize the multidisciplinary care to this group of patients.
Primary Renal Carcinoid with Bilateral Multiple Clear Cell Papillary Renal Cell Carcinomas
Authors: Daniel A Anderson, Maria S Tretiakova
Journal: Case Rep Pathol (2017)
MeSH terms: Case Reports

Clear cell papillary renal cell carcinoma (CCPRCC) is a newly recognized entity in the 2016 WHO classification and usually presents as a small, circumscribed, solitary mass of indolent nature. CCPRCCs could seldom occur in conjunction with other synchronous or metachronous kidney tumors and even less frequently as bilateral masses. To our knowledge, multiple bilateral CCPRCCs have never been described with the existence of a synchronous well-differentiated neuroendocrine tumor of the kidney and hence reported here as a unique case. This case report highlights the importance in considering this entity and its unusual presentation in the differential diagnosis as a possible mimicker of Von Hippel-Lindau syndrome.