OpenMed/multicare-articles huggingface dataset:
Spinal Syphilitic Gumma: A Rare Presentation of an Old Disease
Authors: Dominic Worku, Angela Houston, Catherine Cosgrove, Laura Byrne
Journal: Case Rep Infect Dis (2021)
MeSH terms: Case Reports

Syphilis is an ancient condition which still is of global concern today. Despite better awareness amongst clinicians and improving diagnostics, it remains likely underdiagnosed in part because of its namesake the 'great imitator.' While many patients suffer primary or secondary disease, tertiary syphilis characterised by gumma is rare, especially in the context of neurosyphilis. Here, we report a rare case of a well-controlled human immunodeficiency virus- (HIV-) positive gentleman with a history of previous syphilis and epilepsy who presented with progressive left leg weakness leading to immobility and altered bowels and, on neurological examination, Brown-Sequard syndrome. Magnetic resonance imaging (MRI) of the spine revealed two peripherally enhancing cavitating lesions at T4-T5 with associated meningeal thickening and cord oedema. Cerebrospinal fluid (CSF) analysis revealed high protein (3.07 g/dL) and white cell count (7 × 109/L) with negative cryptococcal antigen, tuberculosis molecular testing (GeneXpert), microscopy and culture, and viral polymerase chain reaction (PCR). CSF serology was positive for Treponema pallidum particle agglutination (TPPA) 10240 and RPR 1 in 2 suggesting active disease. While TB treatment had been started prior to these investigations on day 11, 14-day high-dose benzylpenicillin therapy commenced. Repeat MRI of the spine at days 12 and 22 showed incremental improvements in all parameters which correlated with improving functionality and neurology. According to our literature search, this represents the 13th case recorded for spinal syphilitic gumma and the only case recorded in a HIV-positive individual and adds to the evidence that, in the absence of rapidly changing neurology, medical management can lead to good clinical outcomes.
Intrauterine infection and postpartum bacteremia due to Streptococcus gallolyticus subsp gallolyticus: An emerging concern
Authors: Sreethish Sasi, Fatma Ben Abid, Godwin Justus Wilson, Ahmed Zaqout, Arun Prabhakaran Nair, P Chitrambika
Journal: IDCases (2022)
Keywords: chorioamnionitis, group d streptococci, postpartum sepsis, sbsec, streptococcus gallolyticus
MeSH terms: Case Reports

Streptococcus gallolyticus is a gram-positive coccus belonging to the family Streptococcus bovis/Streptococcus equinus complex (SBSEC). Most cases of SBSEC bacteremia are reported in elderly males with underlying hepatobiliary disease and associated with infective endocarditis (IE) or colonic malignancy. The gastrointestinal tract is the most common portal of entry, followed by the urinary tract and hepatobiliary tree. We present 5 cases of intrapartum bacteremia caused by S. gallolyticus subsp gallolyticus reported from the labor unit of our hospital from 2019 to 2021. There was histopathological or microbiological evidence of chorioamnionitis in each case. All the mothers were below the age of 35 years, and none of them had underlying hepatobiliary or colonic disease. All maternal antenatal screenings for group B streptococci (GBS) were negative. All the isolates were susceptible to penicillins, ceftriaxone, carbapenems, and vancomycin. Three of them were treated with ceftriaxone and two with aminopenicillins. Duration of treatment varied from 8 days to 14 days. None of the babies were low birth weight or pre-term. All but one baby had clinical sepsis requiring neonatal intensive care unit (NICU) stay, with one having evidence of meningitis and three respiratory distress syndromes (RDS). None of the babies had S. gallolyticus bacteremia. All mothers and babies made a complete recovery without any complications. These cases suggest that S. gallolyticus subsp gallolyticus can be a rare but emerging cause of intrauterine infection complicated by post-partum bacteremia. There is possibility of colonization of maternal genital tract with S. gallolyticus causing neonatal infection.
Isolated trochlear nerve palsy with midbrain hemorrhage
Authors: S Raghavendra, K Vasudha, S Ravi Shankar
Journal: Indian J Ophthalmol (2010)
MeSH terms: Cerebral Hemorrhage / complications, Diplopia / etiology, Mesencephalon, Trochlear Nerve Diseases / complications, Case Reports, Adolescent, Cerebral Hemorrhage / diagnosis, Diagnosis, Differential, Diplopia / diagnosis, Female, Humans, Magnetic Resonance Imaging, Trochlear Nerve Diseases / diagnosis, Visual Acuity

Midbrain hemorrhage causing isolated fourth nerve palsy is extremely rare. Idiopathic, traumatic and congenital abnormalities are the most common causes of fourth nerve palsy. We report acute isolated fourth nerve palsy in an 18-year-old lady due to a midbrain hemorrhage probably due to a midbrain cavernoma. The case highlights the need for neuroimaging in selected cases of isolated trochlear nerve palsy.
Injury to the Extrasellar Portion of the Internal Carotid Artery during Endoscopic Transsphenoidal Surgery: A Case Report
Authors: Shinichiro Teramoto, Shigeyuki Tahara, Yasuo Murai, Shun Sato, Yujiro Hattori, Akihide Kondo, Akio Morita
Journal: Front Surg (2022)
Keywords: endoscopic transsphenoidal surgery, extrasellar portion, hemostatic procedure, internal carotid artery injury, pituitary and parasellar tumor
MeSH terms: Case Reports

Background:
Injury to the internal carotid artery (ICA) during endoscopic transsphenoidal surgery (ETSS) is a serious complication with a risk of mortality. ICA injury during ETSS usually occurs during intrasellar manipulations and rarely occurs in the extrasellar portion. Several hemostatic procedures have been proposed for ICA injury in the intrasellar portion, whereas hemostatic methods for ICA injury in the extrasellar portion, where the ICA is surrounded by bone structures, are less well known.
Case presentation:
A 65-year-old man with an incidental pituitary tumor underwent ETSS. The petrous portion of the left ICA was injured during resection of the sphenoid septum connected with left carotid prominence using a cutting forceps. Bleeding was too heavy for simple hemostatic techniques. Hemostasis using a crushed muscle patch was tried unsuccessfully during controlling of the bleeding. Eventually, the injured site of the ICA was covered with cotton patties followed by closing with a vascularized pedicled nasoseptal flap. Cerebral angiography immediately after surgery showed no extravasation from the injured site of the left ICA petrous portion. However, a carotid-cavernous sinus fistula originating from the injured ICA site was detected 7 days after surgery, so the vascular reconstructive surgery combined with left ICA occlusion was performed. The overall postoperative course was uneventful.
Conclusion:
We believe that emergency application of the cottonoids may be effective for hemostasis against ICA injury in the extrasellar portion during ETSS, but further vascular reconstruction combined with ICA occlusion on the injured side and removal of the cottonoids would be required.
Extensive colonic pneumatosis in a patient on adjuvant chemotherapy after right colectomy for primary terminal ileum lymphoma: A decision-making process between surgical and non-surgical management
Authors: M Kirmanidis, K A Boulas, A Paraskeva, I Kariotis, N Barettas, S Kariotis, Ch Keskinis, A Hatzigeorgiadis
Journal: Int J Surg Case Rep (2018)
Keywords: case report, chemotherapy, pneumatosis coli, pneumatosis intestinalis, primary intestinal lymphoma

Introduction:
Pneumatosis intestinalis is a rare condition that may be idiopathic or a sign of numerous underlying gastrointestinal, pulmonary and systemic diseases.
Presentation of case:
Herein, the case an otherwise-healthy 82-year-old female patient with vague abdominal pain due to total colonic pneumatosis 20 days after completion of R-CHOP chemotherapy for a stage IIE primary non-Hodgkin's lymphoma of the terminal ileum submitted to right hemicolectomy and ileal resection 6 months previously is presented. As no evidence of intramural bowel gas was present on pre-operative CT, pneumatosis coli considered to be secondary. As no worrisome clinical, laboratory and imaging findings were present, pneumatosis coli seemed to be benign. As no other etiologic factors identified, pneumatosis coli considered to be chemotherapy-induced. The patient treated conservatively with cessation of enteral nutrition and broad spectrum antibiotics with uneventfull recovery.
Discussion:
Pneumatosis intestinalis can be benign or life-threatening. Bowel obstruction, perforation, ischemia and severe colitis represent the most life-threatening causes. In clinical practice it is often challenging to distinguish between life-threatening and benign pneumatosis intestinalis, a decision which should be based on the presence or absence of worrisome clinical, laboratory and imaging findings.
Conclusion:
In analogous cases, the main dilemma for the physicians is to identify whether surgical intervention is required or not. Given the potential severity of pneumatosis intestinalis, early diagnosis and recognition of its severity is critical as it would dictate surgical or non-surgical management.
Unexpected effects of ivermectin and selamectin on inducible CreER activity in mice
Authors: Peter A Kropp, Gabrielle V Rushing, Asa A Brockman, Erin N Z Yu, Rebecca A Ihrie, Maureen Gannon
Journal: Lab Anim Res (2020)
Keywords: creer, ivermectin, selamectin, transgenic mice
MeSH terms: Case Reports

Background:
Anti-parasitics are frequently used in research animal facilities to treat a multitude of common infections, with pinworms and fur mites being amongst the most common. Ivermectin and selamectin are common oral and topical treatments for these infections, respectively. Although commonly thought to be innocuous to both the research animals and any transgenic elements that the animals may carry, evidence exists that ivermectin is capable of activating the recombinase activity of at least one CreER. The goal of the current study was to determine if there was an effect of either anti-parasitic agent on the activity of CreER proteins in transgenic mice.
Case presentation:
We analyzed the offspring of transgenic mice exposed to either ivermectin or selamectin during pregnancy and nursing. Through analysis of reporter genes co-expressed with multiple, independently generated transgenic CreER drivers, we report here that ivermectin and selamectin both alter recombinase activity and thus may have unintended consequences on gene inactivation studies in mice.
Conclusions:
Although the mechanisms by which ivermectin and selamectin affect CreER activity in the offspring of treated dams remain unclear, the implications are important nonetheless. Treatment of pregnant transgenic mice with these anti-parasitics has the potential to alter transgene activity in the offspring. Special considerations should be made when planning treatment of transgenic mice with either of these pharmacologics.
Case report: Urgent liver pathologies: All in one
Authors: Goran Pavlek, Ivan Romic, Kristina Juzbasic, Ana Marija Alduk, Igor Petrovic, Rudolf Radojkovic, Dario Grbavac, Hrvoje Silovski
Journal: Front Surg (2022)
Keywords: hcc, abscess, cyst, hematoma, rupture
MeSH terms: Case Reports

Ruptured hepatocellular carcinoma (HCC) is a well-known serious complication of this most common primary liver malignancy. However, when HCC rupture is associated with other focal liver lesions, the diagnosis and therapy may be very challenging. Correct differentiation of focal liver lesions is of paramount importance for successful treatment. The aim of this report is to present a unique case of HCC rupture complicated with liver abscess, hematoma and portal vein thrombosis. We discuss possible pathophysiological mechanisms and radiologic findings of such clinical scenarios and review literature related to the management of HCC rupture.
A Successfully Treated Multiple Metastatic Choriocarcinoma Coexistent With Live Fetus: A Case Report and Literature Review
Authors: Wei Ding, Na Zhang, Yang Rao, Xiaoning Xu, Tonggang Nie, Pengpeng Qu
Journal: Front Oncol (2022)
Keywords: case report, chemotherapy, gestational choriocarcinoma, literature review, metastases, short tandem repeat
MeSH terms: Case Reports

Management of metastatic choriocarcinoma coexistent with live fetus is tricky for gynecologists. There is no consensus on treatment because of its rarity. We present a unique case of gestational choriocarcinoma with multiple metastases, who received EP chemotherapy in the third trimester. At 31 + 5 weeks, a healthy male baby was delivered by cesarean section. Then, she received six cycles of EMA/CO as postpartum chemotherapy. Her beta-human chorionic gonadotropin (β-hCG) level decreased to the normal range, and the metastases vanished. The patient had no clinical symptoms 4 years after discharge, and the baby was also free from this disease. Short tandem repeat polymorphism (STR) analysis was performed to determine the genotype of the choriocarcinoma, placenta, and normal curettage tissue of the maternal uterine. Comparing the polymorphic genetic markers revealed that the tumor was gestational choriocarcinoma, but did not originate from the coexistent pregnancy. In spite of extensive metastases, antepartum chemotherapy is an effective and safe treatment for patients with gestational choriocarcinoma concurrent with pregnancy. STR analysis can be useful in distinguishing gestational choriocarcinoma from non-gestational, as well as the causative pregnancy, and serve as a helpful examination tool for guiding clinical management.
Electronic Cigarette or Vaping-Associated Lung Injury Case Report
Authors: Amy Chuang, Lauren Bacon, Anthony Lucero
Journal: J Educ Teach Emerg Med (2023)

Electronic cigarette (e-cigarette) or vaping associated lung injury (EVALI) cases have increased with the popularity of e-cigarettes in the mostly young, healthy population. Some common symptoms associated with EVALI include shortness of breath and chest pain, and the most common diagnostic imaging findings are organizing pneumonia and diffuse alveolar damage seen on computed tomography (CT). Pneumomediastinum is a known sequela of EVALI.1 In the setting of pneumomediastinum in EVALI, EVALI is a diagnosis of exclusion, so other sources of pneumomediastinum need to be evaluated. EVALI has diverse presentations, and this case is a unique representation of a disease process that is becoming more commonplace with the increase in popularity of vaping. It is important to be aware of the clinical symptoms of EVALI, which can be nonspecific and can include gastrointestinal symptoms along with respiratory symptoms. It is equally important to recognize the diverse image findings of EVALI, which can include subcutaneous emphysema and pneumomediastinum. In this case, pneumomediastinum is seen in EVALI, and the patient was successfully treated with empiric antibiotic coverage, steroids, and conservative measures- making sure to limit any coughing or increases in intrathoracic pressure that can cause worsening of pneumomediastinum.
Topics:
EVALI, vaping, pneumomediastinum, E-cigarette, ground-glass opacity.
Liposclerosing myxofibrous tumor of the distal femur: A case report
Authors: Mingyang Zhang, Daguang Zhang, Wenjiang Yu, Chengxue Wang
Journal: Front Surg (2023)
Keywords: lsmft, bone tumor, case report, liposclerosing myxofibrous tumor, the distal femur
MeSH terms: Case Reports

Introduction:
Liposclerosing myxofibrous tumor (LSMFT) is a rare benign fibro-osseous tumor that most frequently occurs in the proximal femur. The reported literature shows that the proximal femur, ilium, tibia, humerus, rib, and skull have occurred, but so far, the female distal femur has not been characterized in detail. This, we think, is the first single comprehensive case report of the female distal femur. To prevent misdiagnosis and overtreatment of this illness, it is critical for us to continue strengthening our knowledge of it and to add it to the differential diagnosis of the space-occupying lesion of the female distal femur.
Case summary:
Two months ago, a 55-year-old female patient was found to have a space-occupying lesion of the left distal femur and the pain symptom was aggravated. She underwent thorough curettage and bone grafting without additional treatment to relieve the current symptoms and determine the nature of the lesion in our hospital. The intraoperative specimens were submitted to the pathology laboratory for analysis, and the result was reported as LSMFT. And six months after the operation, the patient returned to our hospital for another x-ray examination and we found that she had recovered well without any signs of recurrence. The patient self-reported that she had now resumed her daily life without any uncomfortable symptoms.
Conclusion:
The incidence of LSMFT itself is relatively low, and the occurrence of the distal femur is even rarer. However, it is recommended to add LSMFT into the differential diagnosis of the occupying lesions of the distal femur. Once the diagnosis is made, thorough curettage and bone grafting without additional special treatment can achieve better postoperative outcomes. The patient gave her agreement after learning that information about the case will be submitted for publication.
Noninvasive Recanalization of a Coronary Chronic Total Occlusion
Authors: Nikola Kos, Vjekoslav Radeljić, Nikola Pavlović, Krešimir Kordić, Kristijan Đula, Nikola Bulj, Tomislav Krčmar, Diana Delić Brkljačić, Ivan Zeljković, Šime Manola
Journal: Case Rep Cardiol (2019)
MeSH terms: Case Reports

Background:
Spontaneous recanalization of a chronically occluded artery is rare and reported anecdotally.
Case summary:
We report a case of a patient with a chronically occluded right coronary artery, found on a coronary angiography performed due to acute ST elevation myocardial infarction with an occluded circumflex artery as a culprit lesion. Three months later, a follow-up angiography was performed and a recanalization of the occluded right coronary artery was detected.
Discussion:
There is a possibility that intrinsic fibrinolytic mechanisms with the additional effect of standard antithrombotic drugs administrated after the acute coronary event led to the recanalization.
Three-Dimensional Digital Surgical Planning and Rapid Prototyped Surgical Guides in Bernese Periacetabular Osteotomy
Authors: Bruno Gonçalves Schröder E Souza, Flavia de Souza Bastos, Valdeci Manoel de Oliveira, Alfredo Chaoubah
Journal: Case Rep Orthop (2020)
MeSH terms: Case Reports

Bernese periacetabular osteotomy (PAO) developed by Ganz is currently the treatment of choice for skeletally mature symptomatic patients with developmental dysplasia of the hip (DDH) without osteoarthritis. However, the steep learning curve and considerable number of severe complications lead surgeons to seek for alternatives to promote greater reproducibility and safety of this procedure. This is a report of a DDH case surgically treated with the aid of a digital three-dimensional (3D) planning and rapidly prototyped sterile ABS plastic osteotomy guide, developed in Brazil. We present details regarding the planning, guide production, and surgical technique and report the early results of this treatment approach in a single patient. Digital 3D planning and rapidly prototyped surgical guides are applicable and helpful in PAO surgery as shown in this case. We noted no safety issues, good accuracy, and low production costs with this approach.
Native Valve Endocarditis due to Ralstonia pickettii: A Case Report and Literature Review
Authors: Joseph Orme, Tomas Rivera-Bonilla, Akil Loli, Negin N Blattman
Journal: Case Rep Infect Dis (2015)

Ralstonia pickettii is a rare pathogen and even more rare in healthy individuals. Here we report a case of R. pickettii bacteremia leading to aortic valve abscess and complete heart block. To our knowledge this is the first case report of Ralstonia species causing infective endocarditis with perivalvular abscess.
Cutaneous manifestation of metastatic infantile choriocarcinoma
Authors: Timothy Brooks, Laura Nolting
Journal: Case Rep Pediatr (2014)

Infantile choriocarcinoma is a highly malignant rare germ cell tumor that arises from the placenta. Simultaneous intraplacental choriocarcinoma involving both mother and infant is extremely rare. Cutaneous metastasis in infantile choriocarcinoma is even rarer with only a few case reports available. Here we describe a case of a female neonate who presented to the ED with a rapidly growing and bleeding vascular lesion to her right cheek. She was eventually diagnosed by biopsy with metastatic choriocarcinoma. In addition to the cutaneous tumor, she also had metastatic disease in her lungs. Her mother was subsequently found to have choriocarcinoma with metastatic disease to the lungs as well.
The coexistence of an intrasellar adenoma, lymphocytic hypophysitis, and primary pituitary lymphoma in a patient with acromegaly
Authors: Jose Hernan Martinez, Mariel Davila Martinez, Marcos Mercado de Gorgola, Luis F Montalvo, Jaime E Tome
Journal: Case Rep Endocrinol (2011)
MeSH terms: Case Reports

The concomitant presence of three histopathologically different entities in the pituitary gland is a rare occurrence. Most publications identify at least two distinct pathologies, mainly, a pituitary adenoma coexisting with a second intrasellar lesion. We present a case of a 71-year-old female referred for evaluation and treatment of acromegaly. Questioning revealed she was experiencing facial palsy, visual disturbances, and syncopal spells for several weeks. When laboratory evaluation showed elevated somatomedin (IGF-I) levels and an oral glucose tolerance test failed to demonstrate any suppression of her growth hormone (GH) values, an MRI of the pituitary revealed a sellar mass. A presumptive diagnosis of pituitary adenoma was established. The patient underwent transsphenoidal resection of the sellar mass, which proved to be a large B-cell lymphoma (Stage I-E) associated with areas of adenoma and lymphocytic hypophysitis.
A Devastating Case of Hepatitis C-Induced Mixed Cryoglobulinemia
Authors: Sameeha Khalid, Dhuha Alhankawi, Kamalmeet Kaur, Ali Ali, Anna Kazaryan, Marina Roytman
Journal: Case Reports Hepatol (2021)
MeSH terms: Case Reports

Hepatitis C-induced mixed cryoglobulinemia leading to rapidly progressive gangrene, necessitating amputations, is a rare presentation. We describe a case of a 55-year-old man with untreated chronic hepatitis C virus (HCV) presenting with arthralgia and palpable purpura, which rapidly progressed to life-threatening gangrene of all extremities requiring amputations in the setting of mixed cryoglobulinemia. Treatment for HCV was initiated which led to the arrest of gangrene progression and the patient's survival. Patients with HCV-induced cryoglobulinemia should be closely monitored and started on early therapy with direct-acting antiviral therapy to prevent progression of vasculitis to gangrene. Universal screening for HCV can aid in early diagnosis and treatment to prevent devastating consequences.
Glomerulonephritis and Interstitial Nephritis Originating from Vasculitis of the Interlobular Arteries of the Kidney in a Patient with Eosinophilic Granulomatosis with Polyangiitis
Authors: Takashi Nawata, Masaki Shibuya, Yukio Takeshita, Makoto Kubo, Noriko Uesugi, Masafumi Yano
Journal: Case Rep Rheumatol (2022)
MeSH terms: Case Reports

Eosinophilic granulomatosis with polyangiitis (EGPA) is a type of antineutrophil cytoplasmic antibody-associated vasculitis. Patients often present with peripheral neuropathy and purpura, suggesting impairment of small vessels, especially capillaries. However, medium-sized vessels and small vessels with a vascular diameter larger than that of capillaries may also be impaired, causing atypical findings. We report a case of EGPA treated with corticosteroids, cyclophosphamide, and mepolizumab. Renal biopsy revealed vasculitis of the interlobular arteries as the cause of glomerulonephritis and interstitial nephritis. This case suggests the importance of considering vessels upstream of capillaries dominant EGPA as a differential diagnosis in patients with eosinophilia.