OpenMed/multicare-articles huggingface dataset:
Case report: Use of therapeutic drug monitoring and pharmacogenetic testing as opportunities to individualize care in a case of flecainide toxicity after fetal supraventricular tachycardia
Authors: Ronald Palmen, Tracy Sandritter, Lindsey Malloy-Walton, Christopher Follansbee, Jonathan B Wagner
Journal: Front Pediatr (2023)
Keywords: drug monitoring, flecainide, pharmacogenetic, pharmacogenomics, toxicity
MeSH terms: Case Reports

Flecainide is a class IC antiarrhythmic utilized in prophylaxis of refractory paroxysmal supraventricular tachycardias in pediatric populations. Despite being a highly effective agent, its narrow therapeutic index increases the risk of toxicity and proarrhythmic events, including wide-complex tachycardia. In the absence of direct plasma sampling in the fetus to quantitate flecainide systemic concentrations, clinicians typically make drug dosing decisions from maternal plasma concentrations and QRS duration on maternal ECGs. There remains a paucity of standard guidelines and data to inform the timing and frequency of the aforementioned test in pregnancy and timing of flecainide discontinuation prior to childbirth. Flecainide primarily undergoes metabolism via cytochrome P450 (CYP). Given the variance of CYP-mediated metabolism at the level of the individual patient, pharmacogenomics can be considered in patients who present with flecainide toxicity to determine the maternal vs. fetal factors as an etiology for the event. Finally, pharmacogenetic testing can be utilized as an adjunct to guide flecainide dosing decisions, but must be done with caution in neonates <2 weeks of age. This case report highlights utilization of pharmacogenomic testing and therapeutic drug monitoring as adjuncts to guide therapy for a newborn with refractory supraventricular tachycardia, who experienced flecainide toxicity immediately post-partum and was trialed unsuccessfully on multiple alternative antiarrhythmics without rhythm control.
Analysis of oral microbiota in non-vital teeth and clinically intact external surface from patients with severe periodontitis using Nanopore sequencing: a case study
Authors: Alessio Buonavoglia, Francesco Pellegrini, Gianvito Lanave, Georgia Diakoudi, Maria Stella Lucente, Fausto Zamparini, Michele Camero, Maria Giovanna Gandolfi, Vito Martella, Carlo Prati
Journal: J Oral Microbiol (2023)
Keywords: microbiota, nanopore, intact teeth, periodontitis, root canal

Periodontal diseases include a wide range of pathological conditions, damaging the supporting structures of the teeth. Origin and propagation of periodontal disease is believed to be caused by dysbiosis of the commensal oral microbiota. The aim of this study was to evaluate the presence of bacteria in the pulp cavity of teeth with severe periodontal disease with clinically intact external surface. Periodontal (P) and endodontic (E) tissue samples of root canals from six intact teeth of three patients were sampled for analysis of microbial population using Nanopore technology. Streptococcus was the predominant genus in E samples. Porphyromonas (33.4%, p = 0.047), Tannerella (41.7%, p = 0.042), and Treponema (50.0%, p = 0.0064) were significantly more present in P than in E samples. Some samples (E6 and E1) exhibited a remarkable difference in terms of microbial composition, whilst Streptococcus was a common signature in samples E2 to E5, all which were obtained from the same patient. In conclusion, bacteria were identified on both the root surface and the root canal system, thus demonstrating the possibility of bacteria to spread directly from the periodontal pocket to the root canal system even in the absence of crown's loss of integrity.
Thunderclap Headache: A Primary Symptom of a Steroid-Responsive Encephalopathy with Autoimmune Thyroiditis
Authors: Naman Zala, Lena Wirth, Berit Jordan, Hagen Meredig, Timolaos Rizos
Journal: Case Rep Neurol Med (2021)
MeSH terms: Case Reports

Thunderclap headache is frequently associated with serious intracranial vascular disorders and a usual reason for emergency department admissions. Association of thunderclap headaches with autoimmune disorders, such as steroid-responsive encephalopathy with autoimmune thyroiditis (SREAT), is highly unusual. Here, we report a patient who presented with high-intensity headache of abrupt onset. Cerebrospinal fluid (CSF) analysis revealed moderate lymphocytic pleocytosis without evidence of infectious, neoplastic, or metabolic causes. Brain magnetic resonance imaging showed no specific pathologies, and examinations for neuronal antibodies in serum and CSF were negative. The medical history revealed that seven years before, an episode of an aseptic meningoencephalitis with remarkable response to steroids was present. Finally, increased levels of serum anti-TPO antibodies were identified, and against the background of a previous steroid-responsive aseptic meningoencephalitis, diagnosis of SREAT was highly probable. Methylprednisolone therapy was initiated, and the patient recovered completely. In particular, because most SREAT patients respond very well to steroids, this case underlines the importance of taking SREAT into consideration during the assessment of a high-intensity headache of abrupt onset.
The use of 11carbon methionine positron emission tomography (PET) imaging to enhance radiotherapy planning in the treatment of a giant, invasive pituitary adenoma
Authors: Nicolette Taku, Olympia Koulouri, Daniel Scoffings, Mark Gurnell, Neil Burnet
Journal: BJR Case Rep (2017)
MeSH terms: Case Reports

A 54-year-old male presented with visual loss owing to a giant, infiltrative pituitary adenoma. Following decompressive trans-sphenoidal surgery, the patient was referred for adjuvant radiotherapy. We describe the potential utility of 11carbon methionine positron emission tomography imaging in confirming the true extent of tumour infiltration, which included the cavernous sinuses and the bones of the skull base. The co-registration of positron emission tomography imaging to planning MR and CT imaging provided assurance of complete radiotherapy coverage of the target volume and assisted with the minimisation of collateral radiation dose to adjacent organs at risk.
A Case Report of Monkeypox in a 4-Year-Old Boy from the DR Congo: Challenges of Diagnosis and Management
Authors: Anna Korsgaard Eltvedt, Michael Christiansen, Anja Poulsen
Journal: Case Rep Pediatr (2020)
MeSH terms: Case Reports

Monkeypox (MP) is a rare zoonotic disease that most commonly transmits from bush animals to humans in the Congo Basin of Africa. However, an increase in cases of MP has been observed over the past decades with frequent outbreaks as well as export of the disease out of the African continent. MP belongs to the same genus of viruses as smallpox, the Orthopoxvirus, and vaccination against smallpox gives some protection against MP. With the eradication of smallpox in 1980, vaccination against smallpox has ceased. The resulting decrease of immunity against Orthopoxvirus is thought to be related to the increase in MP cases. Furthermore, closer contact between humans and bush animals could play a role along with the ongoing difficulties of controlling HIV in the same geographical area. MP remains a diagnostic challenge. Lack of knowledge about the disease among health personnel plays an important role, as well as access to diagnostic tools is limited. Treatment of MP is for now symptomatic. We report the case of a 4-year-old boy from the DR Congo with the clinical diagnosis of MP. This case illustrates some of the abovementioned challenges related to the management of MP in the field.
Cryptococcal chest wall mass and rib osteomyelitis associated with the use of fingolimod: A case report and literature review
Authors: Kent Carpenter, Ali Etemady-Deylamy, Victoria Costello, Mohammad Khasawneh, Robin Chamberland, Katherine Tian, Maureen Donlin, Brenda Moreira-Walsh, Emily Reisenbichler, Getahun Abate
Journal: Front Med (Lausanne) (2022)
Keywords: chest mass, cryptococcus, fingolimod, immunosuppression, osteomyelitis
MeSH terms: Case Reports

Being introduced in 2010, fingolimod was among the first oral therapies for relapsing multiple sclerosis (MS). Since that time, postmarketing surveillance has noted several case reports of various cryptococcal infections associated with fingolimod use. To date, approximately 15 such case reports have been published. We present the first and unique case of cryptococcal chest wall mass and rib osteomyelitis associated with fingolimod use. The patient presented with left-side chest pain and was found to have a lower left chest wall mass. Computerized tomography (CT) showed chest wall mass with the destruction of left 7th rib. Aspirate from the mass grew Cryptococcus neoformans. The isolate was serotype A. Fingolimod was stopped. The patient received liposomal amphotericin B for 2 weeks and started on fluconazole with a plan to continue for 6-12 months. The follow-up CT in 6 weeks showed a marked decrease in the size of the chest wall mass. In conclusion, our case highlights the atypical and aggressive form of cryptococcal infection possibly related to immunosuppression from fingolimod use.
Clozapine-Induced Pericardial Effusion Presenting with Persistent Tachycardia
Authors: Nathan Gilbreth, Hari Nath, Fernando Quesada, Delatre Lolo
Journal: Case Rep Med (2021)
MeSH terms: Case Reports

Clozapine is an atypical antipsychotic used in refractory schizophrenia and depression. Its use is often complicated by its vast side-effect profile including cardiovascular reactions, agranulocytosis, and seizures. Specifically, the cardiac complications of clozapine have been shown to predominantly cause myocarditis and pericarditis. In this case report, the case of a 58-year-old male being treated for treatment-resistant depression and schizophrenia who suffers from tachycardia is presented. He is treated empirically for orthostatic hypotension with IV fluids without much success. Further imaging and echocardiography demonstrated a pericardial effusion, a rare reaction (≤1 : 10000) that has only been documented in a handful of case reports. This anecdotal evidence highlights the significance of polyserositis/pericardial effusion in the context of clozapine-induced orthostatic hypotension resistant to rehydration. When starting a patient on clozapine, it is important to consider further workup and monitoring with laboratory baseline biomarkers and cardiac evaluation with symptomatic individuals. Upon immediate cessation of clozapine, the pericardial effusion should spontaneously resolve without complication and should not be rechallenged.
Splenic artery aneurysm presenting as extrahepatic portal vein obstruction: a case report
Authors: T P Elamurugan, S Suresh Kumar, R Muthukumarassamy, Vikram Kate
Journal: Case Rep Gastrointest Med (2011)
MeSH terms: Case Reports

Splenic artery aneurysms are the most common visceral aneurysm occuring predominantly in females. They are usually asymptomatic, and the symptomatic presentation includes chronic abdominal pain of varied severity or an acute rupture with hypotension. Splenic artery aneurysm causing extrahepatic portal hypertension is very rare and is due to splenic vein thrombosis that develops secondary to compression by the aneurysm. We report one such rare presentation of splenic artery aneurysms in a pregnant female with the features of EHPVO (variceal bleed, hypersplenism) treated by splenectomy along with excision of the aneurysm.
Massive GI bleeding in a patient with 2 small AVMs in the small intestine: a case report
Authors: Tatiana B Jacobson, Victor O Kolade
Journal: Cases J (2010)

A 53 year-old Caucasian man with no previous history of gastrointestinal bleeding presented with sudden, massive hematochezia and abdominal pain; his hemoglobin dropped from 12 to 8.3. Colonoscopy revealed coagulated blood in a diverticulum, but bleeding recurred after cautery of the lesion.Repeated upper and lower gastrointestinal (GI) endoscopy, visceral selective angiogram, bleeding scan, and Meckel diverticulum scan did not locate the source of bleeding. Further investigation with capsule endoscopy demonstrated two arteriovenous malformations in the small bowel.Wireless capsule endoscopy is a sensitive and specific test for overt obscure gastrointestinal bleeding. Clinicians need not hesitate to employ this procedure when other diagnostic modalities fail.
The Unusual Journey of a Pericardial Drainage Catheter in Pentalogy of Cantrell
Authors: Margaret P Ivy, Gareth J Morgan, Jenny E Zablah
Journal: Case Rep Pediatr (2021)
MeSH terms: Case Reports

A 4-month-old male infant diagnosed with Pentalogy of Cantrell presented to the cardiac catheterization laboratory with a large pericardial effusion. During an urgent pericardial drain placement, the patient, whose prior hemodynamics and clinical findings had suggested a noncritical cardiac lesion, had a profound desaturation, with echocardiography suggesting minimal or no flow across the right ventricular outflow tract (RVOT). The position of the drainage catheter on fluoroscopy and echocardiography suggested that the spell was being caused by obstruction of the main pulmonary artery (MPA) by the pericardial drain. After partially withdrawing the drain to reposition it, there was immediate resolution of the hypoxemia, and echocardiography once again showed adequate flow across the outflow tract.
Case Report: Vasculitis Triggered by SIRT in a Patient With Previously Untreated Cholangiocarcinoma
Authors: Antonia Stamatiou, Jeremy Jankovic, Petr Szturz, Francois Fasquelle, Rafael Duran, Niklaus Schaefer, Antonella Diciolla, Antonia Digklia
Journal: Front Oncol (2021)
Keywords: sirt, cancer, case report, cholangiocarcinoma, radioembolization, vasculitis
MeSH terms: Case Reports

Arising from the biliary tract, cholangiocarcinoma is a rare and aggressive epithelial cancer. According to the primary site, it can be further classified into intrahepatic, perihilar and distal types. Due to the lack of symptoms early in the disease course, most patients are diagnosed at advanced stages. Being not candidates for curative surgical management, these patients are treated with palliative systemic chemotherapy, and their prognosis remains poor. Using radioisotopes like yttrium-90 -labeled microspheres (90Y), radioembolization represents a local approach to treat primary and secondary liver tumors. In the case of intrahepatic cholangiocarcinoma, radioembolization can be used as a primary treatment, as an adjunct to chemotherapy or after failing chemotherapy. An 88-year-old man underwent radioembolization for a previously untreated stage II intrahepatic cholangiocarcinoma. One week later, he presented to our clinic with a non-pruritic maculopapular rash of the lower extremities and abdomen, worsening fatigue and low-grade fever. Laboratory exams, including hepatitis screening, were within normal limits. Showing positive immunofluorescence staining for immunoglobulin M (IgM) and complement 3 (C3) in vessel walls without IgA involvement, the skin biopsy results were compatible with leukocytoclastic vasculitis. Apart from the anticancer intervention, there have been no recent medication changes which could explain this complication. Notably, we did not observe any side effects during or after the perfusion scan with technetium-99m macroaggregated albumin (MAA) performed prior to radioembolization. The symptoms resolved quickly after a short course of colchicine and did not reappear at cholangiocarcinoma progression. In the absence of other evident causes, we conclude that the onset of leukocytoclastic vasculitis in our patient was directly linked to the administration of yttrium-90 -labeled microspheres. Our report therefore demonstrates that this condition can be a rare but manageable complication of 90Y liver radioembolization.
Severe gestational hypertriglyceridemia: a rare but serious situation
Authors: Anissa Ben Amor, Kaouther Dimassi, Moez Attia, Chiraz Amrouche, Amel Triki
Journal: Pan Afr Med J (2019)
Keywords: hypertriglyceridemia, acute pancreatitis, management, pregnancy
MeSH terms: Hypertriglyceridemia / diagnosis, Pregnancy Complications / diagnosis, Case Reports, Adult, Female, Gestational Age, Humans, Hypertriglyceridemia / physiopathology, Pregnancy, Pregnancy Complications / physiopathology, Severity of Illness Index

The severe hypertriglyceridemia during pregnancy is a rare condition. It is a problem for diagnostic, prognostic and therapeutic. This dyslipidemia benefit from specific and effective treatments, but it is still poorly codified. Dietary is still the essential therapeutic, but fetal extraction should also be considered if the gestational age permits. Post-partum monitoring is required but etiologic thorough is not recommended if the triglycerides rate normalizes. The major complication of hypertriglyceridemia should be actively sought because of important maternal mortality rate.
Unusual Methylobacterium fujisawaense Infection in a Patient with Acute Leukaemia Undergoing Hematopoietic Stem Cell Transplantation: First Case Report
Authors: Rosa Fanci, Giampaolo Corti, Alessandro Bartoloni, Enrico Tortoli, Alessandro Mariottini, Patrizia Pecile
Journal: Case Rep Med (2010)
MeSH terms: Case Reports

Microorganisms of the genus Methylobacterium are facultative methylotrophic, gram-negative rods that are ubiquitous in nature and rarely cause human disease, mostly in subjects with preexisting causes of immune depression. Methylobacterium fujisawaense, first proposed as a new species in 1988, has never been reported as a bacterial agent of human infections so far. Here we describe a case of M. fujisawaense infection in a relapsed acute leukaemia undergoing unrelated allogeneic hematopoietic stem cell transplantation. Molecular identification of an M. fujisawaense strain was obtained from multiple mycobacterial blood cultures.
About a case report of giant hydronephrosis
Authors: Enrique Mediavilla, Roberto Ballestero, Miguel Angel Correas, Jose Luis Gutierrez
Journal: Case Rep Urol (2013)

Introduction. Our objective is to report a case of an infrequent entity as the giant hydronephrosis. Case Report. We report the case of an 82-syear-old male referred for a poor general condition. A radiological study revealed a great left hydronephrosis secondary to an urothelial carcinoma. The patient died due to his poor general condition. A histological diagnosis revealed a transitional cell carcinoma of renal pelvis and ureter and atrophic renal parenchyma. Conclusion. Giant hydronephrosis represents a very often entity to be taken into account in cases with big cystic abdominal masses in absence of unilateral or bilateral kidney. Simple nephrectomy is the treatment of choice in most cases. Nevertheless, in cases of nonsubsidiary surgery, percutaneous drainage may be necessary.
Rare Anomaly of Common Bile Duct in Association with Distal Cholangiocarcinoma
Authors: Arun Pandey, Rajesh Mandal, Paleswan Joshi Lakhey
Journal: Case Rep Surg (2018)
MeSH terms: Case Reports

Duplication of common bile duct is a rare entity and its association with distal cholangiocarcinoma is extremely rare. It represents failure of regression of the embryological double biliary system. Here, we describe the diagnostic and therapeutic challenges of a type I variant of the extrahepatic bile duct duplication coexistent with distal cholangiocarcinoma that was diagnosed intraoperatively while treating with Whipple procedure for distal cholangiocarcinoma.
Transfusion-associated babesiosis after heart transplant
Authors: Joseph Z Lux, Don Weiss, Jeanne V Linden, Debra Kessler, Barbara L Herwaldt, Susan J Wong, Jan Keithly, Phyllis Della-Latta, Brian E Scully
Journal: Emerg Infect Dis (2003)
MeSH terms: Babesia microti, Babesiosis / diagnosis, Heart Transplantation / adverse effects, Transfusion Reaction, Case Reports, Babesiosis / microbiology, Humans, Male, Middle Aged

We describe a 54-year-old spleen-intact man with transfusion-associated Babesia microti infection after a heart transplant. Adult respiratory distress syndrome developed in the patient, and he required mechanical ventilation. Our experiences with this patient suggest that babesiosis should be considered in the differential diagnosis of transplant patients who have fever and hemolytic anemia.
Tolvaptan-induced isolated elevation of bilirubin in a patient with Gilbert syndrome
Authors: Matthew Nguyen, Beshoy T Yanny, Tai Ld Truong, Hongyu Zhao, Ramy Hanna
Journal: SAGE Open Med Case Rep (2023)
Keywords: gilbert’s syndrome, tolvaptan, autosomal dominant polycystic kidney disease
MeSH terms: Case Reports

Tolvaptan is the current standard of treatment for autosomal dominant polycystic kidney disease. It operates by acting on V2 receptors and blocks vasopressin interactions, causing a reduction in the rate of renal cyst growth and preserving kidney function. The current known risks of tolvaptan involve a serious liver injury characterized by an elevation in total bilirubin and alanine transaminase and aspartate transaminase levels. In this report, we document a unique liver injury characterized by an elevated bilirubin with normal alanine transaminase and aspartate transaminase levels in a patient who is homozygous for the UGT1A1 consistent with Gilbert syndrome.
Serious Hypokalemia Associated with Abiraterone Acetate in Patients with Castration-Resistant Prostate Cancer
Authors: Yutaka Yamamoto, Yasunori Akashi, Takahumi Minami, Masahiro Nozawa, Keisuke Kiba, Motokiyo Yoshikawa, Akihide Hirayama, Hirotsugu Uemura
Journal: Case Rep Urol (2018)
MeSH terms: Case Reports

Introduction:
The treatment strategy for castration-resistant prostate cancer (CRPC) has changed with the approval of several new agents. In 2011, abiraterone acetate was approved for the treatment of metastatic CRPC; however abiraterone is known to cause mineralocorticoid excess syndrome characterized by hypokalemia, fluid retention, and hypertension. We experienced two cases of grade 4 hypokalemia associated with abiraterone treatment.
Case presentation:
Case 1: a 71-year-old male with metastatic CRPC presented with convulsive seizures two weeks after receiving abiraterone plus prednisone. The serum potassium level was 2.1mEq/l. We determined that convulsive seizure was caused by hypokalemia associated with abiraterone. Case 2: a 68-year-old male with metastatic CRPC presented with severe lethargy one month after receiving abiraterone plus prednisone. The serum potassium level was 1.7mEq/l and we concluded that severe lethargy was caused by hypokalemia associated with abiraterone. They were treated with potassium supplementation and increased prednisone following withdrawal of abiraterone.
Discussion:
The two patients had been on glucocorticoid therapy before abiraterone therapy. Prolonged administration of exogenous glucocorticoid can lead adrenocortical insufficiency and consequently reduce endogenous glucocorticoid production. This situation may increase the risk of abiraterone-induced mineralocorticoid excess. To reduce the risk of abiraterone-induced hypokalemia, evaluation of adrenocortical insufficiency is required.