OpenMed/multicare-articles huggingface dataset:
Image-Guided Intensity-Modulated Radiation Therapy for IgG4-Related Ophthalmic Disease
Authors: Rachel A Sabol, Virginia Bubenzer, Krzysztof Moroz, Shams Halat, Audrey Dang, Keith Ferdinand, Angela Traylor, Carol Boyd, Kendra Harris
Journal: Case Rep Ophthalmol Med (2020)
MeSH terms: Case Reports

Background:
IgG4-related ophthalmic disease is a rare, newly recognized entity with high failure rates on first-line therapy of systemic corticosteroids and no other proven management options. Case Presentation. Here, we present the clinical course of a patient with IgG4 ophthalmic disease who achieved a favorable response from radiotherapy. Our patient initially presented with a history of recurrent painful flares of orbital inflammation, a pathologic diagnosis follicular lymphoid hyperplasia from a right lacrimal gland biopsy, and MRI imaging noting expansion of the lateral rectus muscle of the right eye. Initial treatment with dacryoadenectomy and multiple courses of corticosteroids failed to keep his symptoms at bay. Further evaluation revealed florid IgG4 staining. In this context, he was evaluated for image-guided intensity-modulated radiotherapy (IG-IMRT) to the orbit to 20 Gy in 10 fractions. His ophthalmic symptoms resolved.
Conclusions:
This treatment experience suggests radiotherapy may be a favorable option for symptom relief in patients with IgG4-related ophthalmic disease not controlled by corticosteroids.
A nutritional intervention for moderate altitude endurance preparation: A case report
Authors: Juan J Guerrero-Pinzón, Juan M A Alcantara, Gustavo García-Buendia, Sol Mochón-Benguigui, Mauricio Ramírez-Maldonado, Jonatan R Ruiz, Lucas Jurado-Fasoli
Journal: J Int Soc Sports Nutr (2022)
Keywords: altitude, dietary supplements, ergogenic aids, mountain, nutritional intervention, ski, trail running
MeSH terms: Altitude, Sports / physiology, Case Reports, Acclimatization, Athletes, Humans, Male, Nutritional Status

Background:
Moderate altitudes carry physiological and metabolic changes that can dampen exercise performance. Fortunately, these changes can be modulated by an optimal nutritional intervention. This case study represents the first nutritional intervention of a moderate altitude athlete. These results may help to establish well-designed nutritional guidelines for moderate altitude sports athletes.
Case presentation:
This case study examined the effects of a 11-week nutritional intervention on body composition, muscle strength, cardiorespiratory fitness, resting and exercise nutrient oxidation, and subjective sleep quality, in a male high-level moderate altitude athlete with a very light non-exercise activity thermogenesis. During the 11-week of nutritional intervention, 2800-3500 kcal/day, 6.8-8.9 g/kg/day of carbohydrates, 1.2-1.7 g/kg/day of protein, and 1-2.5 g/kg/day of fat were prescribed. Different specific considerations were also included, such as: iron supplementation, antioxidants increment in different phases, and ergogenic aids (i.e. creatine and beta-alanine). Our results demonstrated a decrease in adiposity and an increase in fat-free mass. In parallel, the athlete improved muscle strength, and therefore endurance adaptations after a maximal effort test (i.e. enhancement of the heart rate recovery). After the intervention, the athlete not only increased the carbohydrate oxidation during exercise and resting conditions but also improved his subjective sleep quality.
Conclusions:
Our results suggest that a nutritional intervention based on the endurance nutritional recommendations and adapted to the altitude physiological peculiarities can induce body re-composition, improve physiological adaptations to effort, and upgrade the substrate oxidation in a moderate altitude high-level athletes.
Clinical characteristics of the primary hepatic malignant fibrous histiocytoma in China: case report and review of the literature
Authors: Dianbo Yao, Chaoliu Dai
Journal: World J Surg Oncol (2012)
MeSH terms: Histiocytoma, Malignant Fibrous / pathology, Liver / pathology, Case Reports, Review, China, Female, Follow-Up Studies, Histiocytoma, Malignant Fibrous / diagnostic imaging, Histiocytoma, Malignant Fibrous / surgery, Humans, Liver / diagnostic imaging, Liver / surgery, Male, Middle Aged, Prognosis, Retrospective Studies, Review Literature as Topic, Tomography, X-Ray Computed

Background:
A malignant fibrous histiocytoma is a soft tissue tumor that most commonly occurs in the extremities, but rarely involves the liver. The clinical characteristics and therapeutic experiences of primary hepatic malignant fibrous histiocytoma are still limited.
Methods:
Two cases of primary hepatic malignant fibrous histiocytoma were analyzed retrospectively, and all the literature concerning primary hepatic malignant fibrous histiocytoma was analyzed.
Results:
In China, a total of 76 cases had been reported, among which 50 were men, with a male to female ratio of 1.9:1. Mean age of the patients was 51.0 years old, and more than 85 percent were older than 40 years. 82.9 percent (63/76) of hepatic MFH were solitary lesions, with tumor size ranging from 2.5 to 23.5 cm (average 10.3 cm). Major clinical presentation (78.4%) was abdominal pain or discomfort, accompanied with some other non-specific symptoms such as malaise, anorexia, weight loss, jaundice and fever, and small cases (14.9%) were asymptomatic. Computed tomography and ultrasound usually revealed the location of lesions. The rate of pre-operative misdiagnosis was extremely high, and 14.9 percent of patients were even misdiagnosed as a benign liver cyst, liver abscess or hematoma. Integrated resection was performed among the most cases (49/68), among which only a few ones (12 cases) were introduced to have no recurrence or metastasis or be still alive with no detail information provided, while among the cases with palliative operation or only a biopsy, the cases that were followed-up all died.
Conclusions:
Hepatic malignant fibrous histiocytoma is a rare malignant mesenchymal tumor. The variable features of clinical presentations and images make the diagnosis difficult. Though the prognosis of primary hepatic malignant fibrous histiocytoma was rather poor, integrated resection might provide a few cases a good opportunity for surviving, suggesting that surgery might be an effective treatment.
Carotid Dissection and Isolated Paralysis of Ipsilateral Half Tongue: Clinical Cases
Authors: Komi Igneza Agbotsou, Damelan Kombate, Christopher Mehri, Kossivi Apetse, Kpalma Duga Bakpatina-Batako, Olivier Guerrier, Albert Beschet, Karine Blanc Lasserre, Ludovic Breynaert, Victor Chan
Journal: Case Rep Neurol Med (2020)
MeSH terms: Case Reports

Objective:
We report two cases of carotid dissection revealed by isolated paralysis of the ipsilateral half tongue. Observations. First patient, 52 years old, with no particular medical or surgical history, presented with isolated paralysis of the left half tongue preceded by two weeks of moderate-intensity cervicalgia and having been the subject to cervical manipulation. MRI revealed dissection of the left internal carotid artery in its prepetrous portion. The evolution after 6 weeks of platelet aggregating inhibitors treatment was favorable. The second patient, 74 years old, with no particular medical or chirurgical history, presented with a sudden onset of paralysis of the left half tongue preceded by unusual headaches associated with neck pain. Brain MRI showed aneurysmal ectasia of the left internal carotid with parietal irregularity suggestive of carotid dissection. The evolution after four weeks of treatment with anticoagulant was favorable.
Conclusion:
Carotid dissection revealed by isolated paralysis of the half tongue is rare. It is generally of good prognosis. However, in paralysis of half tongue, it must be urgently sought and treated to reduce the risk of a transient or constituted ischemic accident.
Legionnaires' Disease Complicated with Rhabdomyolysis and Acute Kidney Injury in an AIDS Patient
Authors: Karan Seegobin, Satish Maharaj, Cherisse Baldeo, Julio Perez Downes, Pramod Reddy
Journal: Case Rep Infect Dis (2017)
MeSH terms: Case Reports

Objective:
To present a case of an uncommon triad of Legionella pneumonia, rhabdomyolysis, and renal failure, with review of the relevant literature.
Case:
A 51-year-old with a history of human immunodeficiency virus (HIV), chronic obstructive pulmonary disease (COPD), and hypertension presented with fever, cough, and shortness of breath over four days. Chest X-ray showed consolidation in left lower lung field; urine was positive for Legionella antigen and myoglobin; creatine kinase was 51092U/L; creatine was 6.9 mg/dL, and his CD4 count was 41 cells/ul. He was managed with azithromycin and levofloxacin and further required dialysis and ventilatory support in the intensive care unit due to renal failure and respiratory failure. He responded well to the treatment and made a complete recovery. Legionella pneumophila infection is a recognized but rare cause of rhabdomyolysis with high morbidity and mortality when there is extrapulmonary involvement. Early diagnosis and appropriate treatment is essential to improve outcomes.
Conclusion:
Physicians should consider Legionella pneumonia in patients with rhabdomyolysis, renal failure, and respiratory symptoms. Early diagnosis and treatment have been shown to have good clinical response. Timely intensive care management, together with early and judicious use of dialysis in patients complicated with rhabdomyolysis and renal failure, may lead to good outcomes.
Ventricular metastasis resulting in disseminated intravascular coagulation
Authors: Thomas John, Ian D Davis
Journal: World J Surg Oncol (2005)

BACKGROUND: Disseminated Intravascular Coagulation (DIC) complicates up to 7% of malignancies, the commonest solid organ association being adenocarcinoma. Transitional Cell Carcinoma (TCC) has rarely been associated with DIC. CASE PRESENTATION: A 74-year-old woman with TCC bladder and DIC was found to have a cardiac lesion suspicious for metastatic disease. The DIC improved with infusion of plasma and administration of Vitamin K, however the cardiac lesion was deemed inoperable and chemotherapy inappropriate; given the patients functional status. We postulate that direct activation of the coagulation cascade by the intraventricular metastasis probably triggered the coagulopathy in this patient. CONCLUSION: Cardiac metastases should be considered in cancer patients with otherwise unexplained DIC. This may influence treatment choices.
Primary ameloblastic carcinoma of the maxilla: A case report and literature review
Authors: Narikazu Uzawa, Miho Suzuki, Chika Miura, Nobuyoshi Tomomatsu, Toshiyuki Izumo, Kiyoshi Harada
Journal: Oncol Lett (2015)
Keywords: ameloblastic carcinoma, maxilla, odontogenic, primary

Ameloblastic carcinoma (AC) is a rare malignant odontogenic neoplasm that tends to occur in the mandible rather than in the maxilla. This malignancy is classified as a tumor that combines the morphological features of ameloblastoma and carcinoma, regardless of the presence or absence of metastasis. In addition, AC has been classified into two types, primary and secondary. The former develops de novo and the latter develops by malignant transformation of a pre-existing benign ameloblastoma. The present study describes the case of a 22-year-old patient with primary AC of the maxilla. A review of the literature focusing on the clinical details, treatment results and histopathological and phenotypic information available for ameloblastic carcinoma of the maxilla from a 60-year period was also performed. As a result, it was found that primary AC is dominant in the maxilla and does not exhibit an aggressive phenotype compared with secondary AC. In addition, the presence of recurrence was found to correlate with mortality, indicating that early, aggressive and complete removal of the tumor is the best treatment for survival.
Post-thoracotomy paraplegia after oxidized cellulose spinal compression
Authors: Da Jun Than, Vinodh Vayara Perumall, Syamim Johan, Xin Leh Lee, Khasnizal Abd Karim, Firdaus Hayati
Journal: Einstein (Sao Paulo) (2023)
MeSH terms: Cellulose, Oxidized, Spinal Cord Compression / diagnostic imaging, Spinal Cord Compression / etiology, Spinal Cord Compression / surgery, Case Reports, Female, Humans, Laminectomy / adverse effects, Laminectomy / methods, Middle Aged, Paraplegia / complications, Paraplegia / surgery, Thoracotomy / adverse effects, Cellulose, Oxidized

Post-thoracotomy paraplegia after non-aortic surgery is an extremely uncommon complication. A 56-year-old woman presented with a 1-year history of progressive shortness of breath. Computed tomography revealed a locally advanced posterior mediastinal mass involving the ribs and the left neural foramina. Tumor excision with a left pneumonectomy was performed. Post-resection, bleeding was noted in the vicinity of the T4-T5 vertebral body, and the bleeding point was packed with oxidized cellulose gauze (Surgicel®). Postoperatively, the patient complained of bilateral leg numbness extending up to the T5 level, with bilateral paraplegia. An urgent laminectomy was performed, and we noted that the spinal cord was compressed by two masses of Surgicel® with blood clots measuring 1.5 × 1.5cm at T4 and T5 levels. The paraplegia did not improve despite the removal of the mass, sufficient decompression, and aggressive postoperative physiotherapy. Surgeons operating in fields close to the intervertebral foramen should be aware of the possible threat to the adjacent spinal canal as helpful hemostatic agents can become a preventable threat.
Prolonged SARS-CoV-2 infection during autologous hematopoietic stem cell transplantation from Hodgkin's lymphoma: a case report
Authors: Ouadii Abakarim, Fatima Ezzahra Lahlimi, Oumaima Maghnouj, Illias Tazi
Journal: Pan Afr Med J (2023)
Keywords: hodgkin’s lymphoma, sars-cov-2, autologous hematopoietic stem cell transplantation, case report, chemotherapy
MeSH terms: COVID-19 / therapy, Hematopoietic Stem Cell Transplantation, Hodgkin Disease / pathology, Hodgkin Disease / therapy, Case Reports, Humans, Male, SARS-CoV-2, Transplantation, Autologous

Autologous hematopoietic stem cell transplantation (HSCT) for relapsed Hodgkin's lymphoma increases the risk of infection by using intensive chemotherapy. This risk is obviously ongoing given the increased virulence of severe COVID-19. We report a case of a young man with Hodgkin's lymphoma who received conditioning chemotherapy followed by autologous HSCT and tested positive for SARS-CoV-2 by polymerase chain reaction (PCR) during the early phase of aplasia with persistence of COVID-19 beyond 30 days with favorable follow-up and clinical improvement on treatment. For this type of patient with hematologic malignancy, viral infection can be fatal and strict medical precautions with isolation rules must be maintained, especially for SARS-CoV-2.
Use of CAD/CAM in esthetic restoration of badly decayed tooth
Authors: Satheesh B Haralur, Ali Hassan Al-Faifi
Journal: Case Rep Dent (2012)

Proper, intelligent use of materials and technology should be utilized for the benefit of the patient. This case report presents a patient with a badly broken premolar tooth demanding high esthetic all-ceramic restoration. Following multiple procedure tooth was restored with zirconia all ceramic restoration. Multiple procedures to save a tooth are a really worthy, in the interest of patients. Use of zirconia and CAD-CAM will help in saving many compromised tooth even in high-stress regions. This provides the patient a chance to have restorations, which are biomechanically superior in addition to being pleasing esthetically.
A Skeptical Approach to the Management of Persistent Oral Ulceration in a Child
Authors: Ibrahim Kartal, Ayhan Dağdemir, Murat Elli, Levent Yıldız, Ayşegül Yılmaz
Journal: Case Rep Pediatr (2018)
MeSH terms: Case Reports

The diagnosis of oral lesions is sometimes difficult due to both the clinician's limited experience with the conditions that may cause the lesions and their similar appearances, especially in children. Correctly establishing a definitive diagnosis is of major importance to clinicians who manage patients with oral mucosal diseases. In patients with Fanconi anaemia (FA), oral ulcers occur frequently, which are quite variable, and may lead to a misdiagnosis or failure to diagnose. Here, we report the case of a 15-year-old boy who was examined for squamous cell cancer of the tongue and diagnosed as having FA without any haematological manifestations. While surgery could not be done, both radiotherapy and chemotherapy had to be decreased. He died of progressive disease 6 months after the diagnosis. Unexplained ulcers in a child with a duration longer than 2 weeks should be further evaluated, especially for FA, even without the presence of anaemia.
Acute Hemiparesis in a Healthy Elderly Woman: Where and What Is the Lesion?
Authors: Ji Hoon Lee, Sung Hyuk Heo, Jin San Lee, Dae-Il Chang, Ki-Ho Park, Ji-Youn Sung, Il Ki Hong, Myeong Hee Kim, Bong Jin Park, Woo Suk Choi
Journal: Front Neurol (2017)
Keywords: propionibacterium acnes, cerebritis, clinical pathology, hemiparesis, myelitis
MeSH terms: Case Reports

Hemiparesis may be the result of lesions in the contralateral pyramidal tract in the brain or, less frequently, in the ipsilateral pyramidal tract in the upper cervical spinal cord. However, although rare, multiple lesions that simultaneously occur in both of these regions may be the cause of acute hemiparesis, and the clinical symptoms can often be misdiagnosed as a stroke. In addition, the correct diagnosis of these multiple central nervous system (CNS) lesions is very challenging if they are caused by infection from an unexpected microorganism. We evaluated an elderly healthy woman who presented with acute hemiparesis and multiple brain and spinal cord lesions that were confirmed to occur from an infection with Propionibacterium acnes. In this report, the differential diagnosis and histopathological findings are discussed for these multiple CNS lesions in this healthy woman.
Anti-PD-1 Immunotherapy and Radiotherapy for Stage IV Intrahepatic Cholangiocarcinoma: A Case Report
Authors: Ze-Long Liu, Xin Liu, Hong Peng, Zhen-Wei Peng, Jian-Ting Long, Di Tang, Sui Peng, Yong Bao, Ming Kuang
Journal: Front Med (Lausanne) (2020)
Keywords: biomarkers, combination therapy, immunotherapy, intrahepatic cholangiocarcinoma, radiotherapy
MeSH terms: Case Reports

Due to the unsatisfactory robustness of current predictive biomarkers in many cases, application of immunotherapy in advanced cancers with limited treatment options, such as stage IV intrahepatic cholangiocarcinoma (ICC), was quite common. Hence, strategies to enhance the therapeutic effect of immunotherapy or to extend the scope of potential beneficial patients were urgently needed. Combination of radiotherapy and anti-programmed death receptor-1 (PD-1) immunotherapy was a promising one, since they were found to have a synergistic anti-tumor effect in animal models and a couple of patients. We here present a 68-years-old male with chemotherapy-intolerable stage IV ICC, whose primary tumor had low PD-L1 expression level, scarce CD8+ cells in tumor microenvironment, high microsatellite instability (MSI), and high tumor mutation burden (TMB). These biomarkers showed a conflicting prediction of the treatment response and clinical benefit of anti-PD-1 immunotherapy. Combination therapy of anti-PD-1 immunotherapy and radiotherapy was adopted as first-line treatment for the patient. After six cycles of immunotherapy, shrinkage of the primary liver tumor and metastatic lymph nodes happened, alongside with new lung metastasis, which indicated a mixed response. Radiotherapy was then administered to both the liver and lung lesions, accompanied with continued immunotherapy. The combined therapy eventually led to a complete response for both the primary tumor and all metastases without treatment-related adverse effects. The patient has survived for 26 months after the combined therapy and remains tumor-free currently. This case demonstrates the high inconsistency between immunotherapy response biomarkers and the synergetic anti-tumor effect of immunotherapy and radiotherapy in ICC.
Cushing's Disease Presenting with Functional Neurological (Conversion) Disorder
Authors: Sahar Ashrafzadeh, Maria Theresa Mariano, Saba Syed
Journal: Case Rep Psychiatry (2023)
MeSH terms: Case Reports

While psychiatric manifestations are common in patients with Cushing's syndrome (CS), to our knowledge, there are no reported cases of CS presenting with functional neurological disorder (FND), a neuropsychiatric condition in which patients experience neurological symptoms, such as motor dysfunctions, sensory symptoms, speech disorders, or nonepileptic seizures, in the absence of neurological disease. Here, we report a case of a complex patient with Cushing's disease who presented with multiple FND symptoms including nonepileptic seizures, bilateral lower extremity paralysis, decreased finger flexion resulting in limited hand function, and stuttering. This case illustrates a rare psychiatric manifestation of CS presenting as multiple neurological complaints. Furthermore, we elucidate how a multidisciplinary treatment approach improved our patient's FND symptoms.
Eosinophilic Myocarditis: An Often-Overlooked Diagnosis in Patients Presenting with Heart Failure
Authors: Young Min Cho, Abdullah Asreb, Riaz Mahmood, Ahmad Moaz, Ugochukwu Egolum
Journal: Case Rep Cardiol (2022)
MeSH terms: Case Reports

Introduction. Hypereosinophilic syndrome (HES) is a rare disease characterized by unexplained peripheral eosinophilia along with evidence of end-organ damage. Cardiac involvement is the most life-threatening consequence and is frequently underreported with a prevalence of around 5%. The gold standard for diagnosis is myocardial biopsy, but less-invasive imaging such as cardiac MR (CMR) has been frequently used to help with the diagnosis. We are presenting a unique case of a patient diagnosed with Eosinophilic myocarditis (EM) supported by CMR with rapid improvement after starting steroid treatment. Case Presentation. A 67-year-old African American female with extensive cardiovascular disease history presenting with chest pain was diagnosed with EM secondary to hypereosinophilic syndrome (HES). Lab workup revealed absolute eosinophils of 4.70 × 103/μL (normal 0-0.75 × 103/μL). Transthoracic echocardiography showed mild reduction in left ventricular function and a large obliterating thrombus in the right ventricular apex. CMR showed increased signal intensity at the left ventricular and right ventricular apex, consistent with myocardial edema. Subsequently, the patient was placed on dexamethasone 10 mg daily with significant symptomatic improvement. Discussion. EM is a rare complication of hypereosinophilic syndrome and can mimic common cardiovascular diseases such as acute exacerbation of heart failure or myocardial infarction. A high index of suspicion is essential especially in the setting of suggestive lab workup. CMR is a promising noninvasive and cost-effective alternative for myocardial biopsy in diagnosis.