OpenMed/multicare-articles huggingface dataset:
Fatal Outcome of Imatinib in a Patient with Idiopathic Hypereosinophilic Syndrome
Authors: Ashraf Abugroun, Ahmed Chaudhary, Gabriel Rodriguez
Journal: Case Rep Oncol Med (2018)
MeSH terms: Case Reports

Cytokine storm is a poorly explained clinical entity caused by an undesired and aggrandized immune system response leading to unregulated activation of the proinflammatory cascade, often contributing to multisystem organ failure and even death. Its potentially diverse etiologies and sepsis-like presentation have made it even more challenging to diagnose, and so far, no well-established treatment protocol has been proposed. Its association with certain medications, especially with monoclonal antibodies, has well been reported in literature. To the best of our knowledge, so far, no previous case of cytokine storm associated with imatinib has been reported. We herein present a case report of a 77-year-old male with a past medical history of hypereosinophilic syndrome who developed acute fatal cytokine storm following treatment with imatinib. This study highlights a life-threatening complication of the medication that may be underrecognized.
A Volume Challenge Reveals the Diagnosis of Pediatric Restrictive Cardiomyopathy
Authors: Elyssa Cohen, Conor P O'Halloran, Philip T Thrush, T Marsha Ma, Paul Tannous
Journal: Case Rep Cardiol (2022)
MeSH terms: Case Reports

A healthy 11-year-old girl presented with exercise intolerance of unclear etiology, and her physical exam was notable for a 3/6 systolic ejection murmur at the left upper sternal border with radiation to the back. Extensive noninvasive workup consisted of ECG, transthoracic echocardiogram, and cardiac MRI/MRA, which were all nondiagnostic. She was ultimately referred for cardiac catheterization. Baseline invasive hemodynamics demonstrated a normal cardiac index and pulmonary vascular resistance but was notable for mildly elevated right and left end-diastolic pressures. A diagnosis remained elusive, so a 500 mL volume challenge was performed, which unmasked right and left ventricular waveform transformations to reveal the pathognomonic "square root sign" of restrictive cardiomyopathy with concordant RV/LV respirophasic variation. These findings and her clinical history allowed for the rare pediatric diagnosis of restrictive cardiomyopathy early in her clinical course, prior to the development of overt signs of pathologic myocardial remodeling, such as pulmonary hypertension and biatrial enlargement.
25 Hz Magnetic Seizure Therapy Is Feasible but Not Optimal for Chinese Patients With Schizophrenia: A Case Series
Authors: Jiangling Jiang, Qingwei Li, Jianhua Sheng, Fuzhong Yang, Xinyi Cao, Tianhong Zhang, Yuping Jia, Jijun Wang, Chunbo Li
Journal: Front Psychiatry (2018)
Keywords: acceptability, cognition, feasibility, magnetic seizure therapy, schizophrenia
MeSH terms: Case Reports

Magnetic seizure therapy (MST) is a potential alternative to electroconvulsive therapy (ECT), but there is currently a lack of reports about MST in Chinese patients with schizophrenia. Our objective was to investigate the feasibility and acceptability of add-on MST in the treatment of patients with schizophrenia. Eight patients with schizophrenia were enrolled in a case series study to receive 10 sessions of add-on MST over 4 weeks. The MST was administrated using 25 Hz at 100% output with a titration duration ranging from 4 to 20 s by 4 s. The Positive and Negative Syndrome Scale (PANSS) and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) were employed to measure the symptom improvements and the cognitive effects, respectively. Six patients completed at least one-half of the planned sessions. Five showed a reduction in PANSS total score, and three achieved clinical response (≥30% reduction). Three of the participants receiving the RBANS, showed either improvements or no changes in the memory function. Regarding the subjective complaints about MST, two reported dizziness, and only one reported memory loss. Approximately one-fourth of the treatment sessions produced only brief seizures (<15 s). Overall, employing MST to treat Chinese patients with schizophrenia appeared feasible and acceptable. However, further evidence is needed to determine the therapeutic efficacy and effects of MST on the cognitive functions of patients with schizophrenia.
Clozapine-Induced Microseizures, Orofacial Dyskinesia, and Speech Dysfluency in an Adolescent with Treatment Resistant Early Onset Schizophrenia on Concurrent Lithium Therapy
Authors: Vivekananda Rachamallu, Ayman Haq, Michael M Song, Manish Aligeti
Journal: Case Rep Psychiatry (2017)
MeSH terms: Case Reports

Clozapine is an atypical antipsychotic used in the treatment of refractory schizophrenia. It has a well-known side effect profile, including agranulocytosis, decreased seizure threshold, and tardive dyskinesia. In addition, numerous case reports have described clozapine-induced stuttering in adults. However, there has been only one previous case report describing it in the adolescent population. In addition, concurrent lithium therapy has been shown to enhance the neurotoxic effects of antipsychotics and lower the seizure threshold. Here, we report on the development of clozapine-induced microseizures, orofacial dyskinesia, and stuttering in a 17-year-old adolescent male with treatment of refractory early onset schizophrenia on clozapine and concurrent lithium therapy. The patient's symptoms of schizophrenia responded well to the clozapine regimen. However, with the escalating dose of clozapine, the patient developed speech dysfluency in the form of stuttering and perioral twitching. An electroencephalogram confirmed seizure activity. Due to similarities with tardive dyskinesia, symptoms of microseizures induced by atypical antipsychotics may not be accurately diagnosed. A multidisciplinary treatment of speech dysfluency is of particular importance in the adolescent schizophrenic patients, who are expected to have longer duration of lifetime exposure to antipsychotics and in whom peer group interaction is crucial for normal personal and social development.
Case report: First case of pemetrexed plus cisplatin-induced immune hemolytic anemia in a patient with lung adenocarcinoma
Authors: Hongkai Lu, Na Wang, Peng Wang, Haolin Zhang, Ru Zhao, Hongju Liu, Xirong He, Zeya Liu, Yue Chang, Yongtong Cao, Shiyao Wang
Journal: Front Med (Lausanne) (2022)
Keywords: cisplatin, complement-dependent antibody, drug-induced immune hemolytic anemia, non-immunologic protein adsorption, pemetrexed
MeSH terms: Case Reports

Background:
Drug-induced immune hemolytic anemia (DIIHA) is a rare but potentially life-threatening drug-related complication. There are no previous reports of pemetrexed plus cisplatin as first-line chemotherapy for non-small cell lung cancer, resulting in DIIHA.
Case presentation:
In this report, a patient with advanced-stage lung adenocarcinoma developed severe immune hemolytic anemia 21 days after pemetrexed plus cisplatin chemotherapy. Laboratory findings showed severe hemolysis, including a rapid decrease in hemoglobin (HGB) and an elevated level of reticulocytes (Rets), indirect bilirubin (IBIL), and lactate dehydrogenase (LDH). A workup for the possibility of DIIHA was performed, including a direct antiglobulin test (DAT), a test in the presence of the soluble drug, and a drug-treated red blood cell (RBC) test. It showed a strongly positive (3+) result for anti-C3d but not for anti-immunoglobin G (IgG) in DAT. Enzyme-treated RBCs reacted weakly with the patient's serum and pemetrexed when complement was added. In addition, the patient's serum and normal sera were reactive with cisplatin-treated RBCs. However, eluates from the patient's RBCs and diluted normal sera were non-reactive with cisplatin-coated RBCs. Untreated and enzyme-treated RBCs reacted with the patient's serum in the presence of soluble cisplatin. In vitro serological tests suggested that complement-dependent pemetrexed antibodies and cisplatin-associated non-immunologic protein adsorption (NIPA) might combine to cause immune hemolytic anemia. The patient's anemia gradually recovered when pemetrexed and cisplatin were discontinued.
Conclusion:
This rare case demonstrated that complement-dependent pemetrexed antibodies and cisplatin-associated NIPA might occur simultaneously in a patient with DIIHA.
Fatal Postpartum Hemorrhage in Diffuse Midline Glioma with H3-K27M Mutation
Authors: Takeshi Miyazaki, Masahiro Tsuji, Shinya Hagiwara, Toshiko Minamoto, Noriyoshi Ishikawa, Junko Hirato, Sumihito Nobusawa, Yasuhiko Akiyama
Journal: Case Rep Obstet Gynecol (2019)
MeSH terms: Case Reports

Management of pregnant women with brain tumors necessitates difficult decision-making especially for estimating or preventing its intratumoral hemorrhage. A 26-year-old, 19-week pregnant woman complaining of headache and vomiting was admitted to our hospital. Magnetic resonance imaging (MRI) revealed hydrocephalus and a mass lesion without contrast enhancement extending from the left thalamus. To resolve severe symptoms, a ventriculoperitoneal shunt was inserted, and a biopsy was taken via the right ventricle. Pathological examination suggested diffuse or pilocytic astrocytoma, but subsequent genetic analysis revealed the diagnosis of midline glioma with H3-K27M mutation. The patient opted not to terminate the pregnancy, and MRIs conducted every four weeks revealed no change in tumor aspect. The patient delivered a healthy baby by cesarean section, and postpartum day 1 was uneventful. However, she was found in a coma due to a massive intratumoral hemorrhage on postpartum day 2 and died 3 weeks after the hemorrhage. This is the first case report of diffuse midline glioma with H3-K27M mutation in a pregnant woman followed by fatal hemorrhage. It highlights the necessity of careful clinical management and frequent neuroimaging during the entire perinatal period, even if the tumor has hypovascularity or low proliferative potential on radiological or pathological findings.
A Rare Case of Transient Second-Degree Mobitz Type II Heart Block Complicating a Saddle Pulmonary Embolism
Authors: Muhammad Ghallab, Lilian Tran, Ibrahim Shahid, Salma Abdelmoteleb, Ibrahim Mohamed, Allison Foster, Zakaria Alagha, Most Munira
Journal: Cureus (2023)
Keywords: massive pulmonary embolism, mobitz type 2 av block, pulmonary embolism, right bundle branch block, second degree heart block
MeSH terms: Case Reports

Presentations of pulmonary embolism (PE) are often associated with various cardiac arrhythmias and conduction abnormalities detected on electrocardiograms (EKG). We describe a 65-year-old female with no known history of heart disease or arrhythmias who presented with an acute onset of shortness of breath. Initial EKG showed right bundle branch block (RBBB), and first-degree atrioventricular (AV) block with subsequent development of second-degree Mobitz type II AV block. The patient's clinical appearance was highly suggestive of a massive pulmonary embolism with hemodynamic instability, and treatment with alteplase (tPA) was given, followed by heparinization. A CT pulmonary angiography confirmed the provisional diagnosis and revealed a large saddle embolus within the right and left main pulmonary arteries. Subsequent EKG showed resolution of the RBBB, first-degree AV block, and second-degree AV block. The patient improved clinically and was discharged to a subacute rehab facility with follow-up appointments. This case highlights that pulmonary embolism may present with many EKG changes, including RBBB, first-degree, second-degree, or complete heart block. Early recognition of PE and thrombolytic treatment can improve cardiac function and restore heart rhythms. Further evaluation for underlying conduction abnormalities can later be performed.
Actinomyces meyeri: A Rare Cause of Postsurgical Pelvic Actinomycosis
Authors: C Michele Markey, Lauren E Vestal
Journal: Case Rep Obstet Gynecol (2018)
MeSH terms: Case Reports

Actinomyces meyeri bacterium resides on mucosal surfaces and is uncommonly pathogenic. When A. meyeri does cause infection, these infections are typically pulmonary in origin and have the capacity to disseminate throughout the body. A. meyeri is an uncommon cause of pelvic infection. We present a unique case of a posthysterectomy abscess caused by this particular bacterium.
Miliary Tuberculosis with Acute Respiratory Distress Syndrome: A Deadly Combination
Authors: Gaurang M Aurangabadkar, Ulhas S Jadhav, Sumer S Choudhary, Shafee M Khan, Pankaj Wagh, Puja Upadhyay
Journal: Cureus (2023)
Keywords: acute respiratory distress syndrome, antitubercular therapy, dexamethasone, hyponatremia, miliary tuberculosis
MeSH terms: Case Reports

A unique and deadly presentation of miliary tuberculosis is acute respiratory distress syndrome. In this case report, we present the case of a 22-year-old male patient who presented with a history of weight loss, appetite loss for eight months, and rapidly worsening dyspnea for 15 days, for which he was admitted to the intensive care unit. Chest X-ray and computed tomography (CT) of the thorax revealed bilateral miliary opacities. Routine blood tests revealed hyponatremia and leukocytosis. The patient was started on non-invasive ventilatory support, intravenous corticosteroids, and anti-tubercular therapy on clinical and-radiological suspicion of miliary tuberculosis. The patient was admitted for one month and started to show rapid recovery after initiating anti-tubercular and corticosteroid therapy.
EBV Infection Unmasking a Choledochal Cyst in an Infant
Authors: Hassan El Khatib, Batoul Kawtharany, Diyaa Mohammad, Mohammad Siblini, Nahida El-Rifai
Journal: Case Rep Pediatr (2019)
MeSH terms: Case Reports

Hepatic involvement is common in acute Epstein-Barr virus (EBV) infection in children. It usually manifests as a transitory elevation of transaminases in up to 80% to 90% of patients, and they normalize by 2 to 6 weeks. A cholestatic pattern with elevated gamma-glutamyl transferase (γGT) and alkaline phosphatase (ALP) is common, in up to 60% in young adults. However, jaundice is very rare occurring in only 5% of pediatric patients. We report here an 8-month-old female with EBV infection who developed obstructive jaundice 2 weeks after the initial infection. Radiologic investigations were compatible with choledochal cyst type IVa complicated by stone formation in the common bile duct. In case of clinical exacerbation or nonamelioration of liver function tests in EVB infection, another diagnosis should be addressed. This highlights the importance of close follow-up in these patients in order not to miss a serious underlying condition such as choledochal malformation.
Case report: Long-term partial response of apatinib plus paclitaxel as second-line therapy in a patient with metastatic gastric cancer
Authors: Shengya Fu, Linjuan Li, Xiaofen Li, Qiang Wu, Xiaohui Wang, Yan Huang, Haoyue Hu, Dan Cao
Journal: Front Pharmacol (2022)
Keywords: apatinib, biomarker, hyper-vascular, metastatic gastric cancer, second-line treatment
MeSH terms: Case Reports

Gastric cancer is the second most prevalent cancer and the second leading cause of cancer-related death in China. The prognosis of metastatic gastric cancer is poor with a median overall survival of 8-10 months. Apatinib, an oral small-molecule, selective vascular endothelial growth factor receptor-2 tyrosine kinase inhibitor, is approved as third-line or subsequent therapy for gastric cancer in China. Several recent small-scale studies and case reports showed that it may be great help in improvement of prognosis as second-line treatment in patients with advanced or metastatic gastric cancer. Here, we present a case of advanced gastric adenocarcinoma with multiple hepatic metastases who was treated with apatinib plus paclitaxel as second-line therapy, realized a long progression-free survival of 37 months. Until 29 January 2022, the disease remains an efficacy of partial response. We believe that the good outcome of this case is not an accident, because of the typically hyper-vascular of his liver metastases, the treatment toxicities of hypertension and proteinuria, all may be potential predictive biomarkers for anti-angiogenic treatments.
Rhabdomyolysis as a manifestation of a metabolic disease: a case report
Authors: Marta Sousa Moniz, Maria Inês Mascarenhas, Carlos Escobar, Pedro Nunes, Clara Abadesso, Helena Loureiro, Helena Almeida
Journal: Rev Bras Ter Intensiva (2017)
MeSH terms: Acute Kidney Injury / diagnosis, Metabolic Diseases / diagnosis, Rhabdomyolysis / etiology, Case Reports, Acute Kidney Injury / therapy, Adolescent, Female, Humans, Metabolic Diseases / complications, Oliguria / etiology, Oliguria / therapy, Renal Replacement Therapy / methods, Rhabdomyolysis / diagnosis

Rhabdomyolysis is a process of muscle destruction that can present with varying clinical manifestations. In pediatric patients, its main etiology is infectious diseases. We present a previously healthy adolescent who was admitted to our emergency department with a four-day history of myalgia, muscle weakness and dark urine. At presentation, she was dehydrated. Blood analysis revealed acute renal failure and increased muscular enzymes. She was transferred to our pediatric intensive care unit. Medical therapies for correction of dehydration and the ionic and metabolic consequences of renal failure were performed. Due to oliguria, renal replacement therapy was initiated. An etiological investigation revealed a beta-oxidation defect. Metabolic diseases are a known cause of rhabdomyolysis. Muscular destruction should be diagnosed early in order to avoid its potential consequences. Generally, the treatment of rhabdomyolysis is conservative, although in some situations, a more invasive approach is needed.
Early-Onset Signet-Ring Cell Adenocarcinoma of the Colon: A Case Report and Review of the Literature
Authors: Maliha Khan, Krittiya Korphaisarn, Aneeqa Saif, Wai C Foo, Scott Kopetz
Journal: Case Rep Oncol Med (2017)
MeSH terms: Case Reports

Colorectal cancer (CRC) remains the second leading cause of cancer-related deaths in the United States. While a decline has been observed in the older population, the occurrence of CRC in the adolescent and young adult (AYA) population has increased over the past two decades. The histopathologic characteristics and clinical behavior of CRC in AYA patients have been shown to be distinct from those of CRC in older adults. The rarer subtypes of CRC such as mucinous adenocarcinoma and signet-ring cell carcinoma are associated with a poorer prognosis compared to the more common subtypes. Here we report a case of a 20-year-old man who was diagnosed with stage IVB (T4 N2 M1, with peritoneal carcinomatosis) signet-ring cell adenocarcinoma of the colon. The scarcity of information on these rarer subtypes merits further study and investigation.
Case Report: A Case of Late-Onset Combined Methylmalonic Acidemia and Hyperhomocysteinemia Induced by a Vegetarian Diet
Authors: Bei Xu, Lihong Zhang, Qiang Chen, Yajuan Wang, Yahong Peng, Hui Tang
Journal: Front Pediatr (2022)
Keywords: china, homocysteinemia, metabolic disease, methylmalonic academia, pediatrics, vegetarian diet
MeSH terms: Case Reports

Methylmalonic acidemia is a rare autosomal recessive metabolic disease. However, because of the atypical clinical symptoms, the type of late-onset methylmalonic academia is often misdiagnosed. Especially when the blood vitamin B12 and folic acid levels are normal, it is not easy to think of this disease. Herein we report a 9-year-old girl who developed normally on a relatively balanced diet before 7 years of age. However, she presented with fatigue and attention deficit when she followed a vegetarian diet. Laboratory examination showed moderate macrocytic anemia, high levels of homocysteine, high level of propionylcarnitine/acetylcarnitine, urinary methylmalonic acid and methyl citrate. Gene mutation analysis showed c.609G > A and c.80A > G compound heterozygous mutations in the MMACHC gene, supported late-onset combined methylmalonic academia with homocysteinemia. Then treatment performed with add meat to the diet, vitamin B12, folic acid betaine and L-carnitine supplement. One week later, the child's clinical symptoms and the laboratory examinations were significantly improved.
Urea Cycle Defects: Early-Onset Disease Associated with A208T Mutation in OTC Gene-Expanding the Clinical Phenotype
Authors: Ana Isabel Sánchez, Alejandra Rincón, Mary García, Fernando Suárez-Obando
Journal: Case Rep Genet (2017)
MeSH terms: Case Reports

Ornithine transcarbamylase deficiency (OMIM: 311250) is the most common disorder of urea cycle disorders, accounting for nearly 50% of all cases. We report a case of a two-month- old male patient, who attends our medical genetics consultation because of low citrulline levels and elevated glutamine to citrulline ratio detected by expanded newborn screening with tandem mass spectrometry. He is an asymptomatic male with a normal physical examination and appropriate neurodevelopmental milestones. The patient has a family history of one older brother who died at 18 months old from severe and sudden hyperammonemia and a maternal aunt who suddenly died at two years old. He had high plasma ammonium concentration and a confirmed OTC mutation (p.A208T). Usually, this mutation causes OTC deficiency of late onset in adult males. However, this report raises awareness about mutations previously described as a late-onset causing disease, which can cause severe hyperammonemia and high risk of dying at an early age.
Synchronous Occurrence of Primary Breast Carcinoma and Primary Colon Adenocarcinoma
Authors: Gurkan Yetkin, Fevzi Celayir, Ismail Ethem Akgun, Ramazan Ucak
Journal: Case Rep Surg (2017)
MeSH terms: Case Reports

A 65-year-old female patient presented to the emergency clinic with abdominal pain, meteorism, and intermittent rectal bleeding. Colonoscopy was performed, and a hepatic flexure tumor was detected. Histopathological examination of biopsy revealed adenocarcinoma. Thoracoabdominal CT was performed for staging, and a spiculated contour mass was found incidentally on the left breast. Mammography and ultrasonography were performed for the cause of these findings, and suspicious lesions of malignancy were seen in the left breast. Invasive ductal carcinoma was detected in core needle biopsy samples from lesions. In the multidisciplinary council consisting of oncologist, pathologist, radiologist, and general surgery specialist, it was decided to perform breast operation first and then colon operation, followed by adjuvant chemotherapy. In the first operation, left total mastectomy and sentinel lymph node biopsy were performed. One week after her initial operation, the patient underwent right hemicolectomy. After operations, the patient did not develop postoperative complications and was sent to medical oncology department for adjuvant chemotherapy.