OpenMed/multicare-articles huggingface dataset:
Subacute Cutaneous Lupus Erythematosus-Like Eruption Induced by EGFR -Tyrosine Kinase Inhibitor in EGFR-Mutated Non-small Cell Lung Cancer: A Case Report
Authors: Alessandra Ferro, Angela Filoni, Alberto Pavan, Giulia Pasello, Valentina Guarneri, PierFranco Conte, Mauro Alaibac, Laura Bonanno
Journal: Front Med (Lausanne) (2021)
Keywords: cutaneous drug reactions, immune- related adverse events, immunotherapy, osimertinib, targeted therapy
MeSH terms: Case Reports

EGFR tyrosine kinase inhibitors (TKIs) are the front-line treatment in EGFR mutation positive advanced non-small cell lung cancer (aNSCLC) patients. Generally, they are well-tolerated but skin toxicity is common (45-100% of patients) and may adversely affect quality of life. Pathogenesis of cutaneous side effects is usually linked to EGFR expression in normal cells of the epidermis and not immune-related. Subacute cutaneous lupus erythematosus (SCLE) is an autoimmune disease and about 40% of SCLE cases are drug related, but no reports are available involving osimertinib. Our report depicts a drug induced-SCLE (DI-SCLE) caused by erlotinib and worsened by osimertinib. The adverse event is characterized by the absence of systemic symptoms. Diagnosis has been performed by skin biopsy and the conditions improved with systemic steroids administration and EGFR-TKIs discontinuation. The report underlines the importance of a complete dermatologic diagnosis of skin lesions induced by EGFR inhibitors, according to symptom severity and timing of improving with standard clinical management. The diagnosis of immune-related skin toxicity in this context affects the treatment and the outcome of skin toxicity and must be taken into account when planning subsequent treatments, potentially including immune checkpoint inhibitors (ICIs).
Outcome of Nivolumab-Induced Vogt-Koyanagi-Harada Disease-Like Uveitis in a Patient Managed without Intravenous Methylprednisolone Therapy
Authors: Ryoji Nagai, Akinari Yamamoto, Akiko Yoshida, Akiko Mikawa
Journal: Case Rep Ophthalmol Med (2023)
MeSH terms: Case Reports

Background:
In recent years, immune checkpoint inhibitors (ICI) have been often used for several types of cancers. Immune-related adverse events (irAEs) are autoimmune responses caused by ICI. Among the different types of irAEs, uveitis is common in ophthalmology. Moreover, there are reports on Vogt-Koyanagi-Harada (VKH) disease-like uveitis. In most cases, VKH, as in the usual VKH, is managed with intravenous methylprednisolone therapy. Case Report. A 72-year-old man was diagnosed with gastric cancer, and he was treated with nivolumab, a type of ICI. After eight cycles of nivolumab therapy, he developed fulminant type 1 diabetes mellitus and diabetic ketoacidosis. Thus, the treatment was discontinued. Subsequently, the patient was referred to our department due to bilateral blurry vision. He had decreased visual acuity in both eyes, and slit lamp examination revealed the presence of bilateral anterior chamber cells and keratic precipitates. Fundus examination showed bilateral serous retinal detachment (SRD), wavy retinal pigment epithelium (RPE), and choroidal thickening. Cerebrospinal fluid examination revealed prominent pleocytosis. Thus, we initiated eye drop therapy and subtenon injection of triamcinolone acetonide on the right eye only. After 1 month, SRD and wavy RPE disappeared, and the patient's visual acuity improved. Further, both eyes had similar improvements in visual acuity and abnormal findings. Oral prednisolone was subsequently administered for hearing loss. However, intravenous methylprednisolone was not used, and ophthalmologic findings and visual acuity did not change before and after systemic steroid therapy. One year after disease onset, SRD and wavy RPE did not relapse.
Conclusion:
Nivolumab-induced VKH disease-like uveitis can have good outcomes even in a patient managed without intravenous methylprednisolone therapy.
Cardiac metastasis in cervical cancer
Authors: Ajay Sasidharan, Vinod Hande, Umesh Mahantshetty, Shyam Kishore Shrivastava
Journal: BJR Case Rep (2016)
MeSH terms: Case Reports

Metastasis of cervical carcinoma to the heart is uncommon. Most cases are found during autopsy. These type of metastasis occur mostly in epicardium and myocardium. We present a case report of a patient with carcinoma cervix stage IIIB who presented to the hospital with pitting edema of right lower limb, post 1 year of completion of treatment. PET-CT scan showed FDG avid inguinal, iliac and retroperitoneal lymph nodes, which were bulky on right side causing pedal edema. There was FDG avid uptake seen in right atrial wall and in the atrioventricular groove indicative of metastasis to the heart. Patient refused biopsy or further treatment and hence received best supportive care only. She had a disease free survival of 12 months, and survived for 11 months after being diagnosed with recurrence. Overall survival was 23 months.
A Case of Atrioventricular Block Potentially Associated with Right Coronary Artery Lesion and Ticagrelor Therapy Mediated by the Increasing Adenosine Plasma Concentration
Authors: Xiaoye Li, Ying Xue, Hongyi Wu
Journal: Case Rep Vasc Med (2018)
MeSH terms: Case Reports

Purpose:
To report a case of atrioventricular block (AVB) which might be associated with the right coronary artery lesion and the novel oral antithrombotic drug ticagrelor mediated by the increasing adenosine plasma concentration (APC).
Case report:
A 65-year-old man was given loading dose of ticagrelor (180 mg) before coronary angiography with total thrombotic occlusion of right coronary artery and one stent was implanted. On second day after successful percutaneous coronary intervention, ECG monitoring showed second-degree (Mobitz type I) AVB with prolonged PR interval (299 ms). Hypothesis was drawn that elevated APC levels caused by ticagrelor would be the reason for AVB after excluding combination drugs or underlying disease. APC might be an indicator of this side effect caused by the P2Y12 receptor inhibitors. On fourth day after shifting to clopidogrel, the ECG showed normal sinus rhythm and PR interval depressed to 190 ms and APC dropped from 1.62 umol/L to 0.92 umol/L. The bradycardia and AVB did not occur in the three-month follow-up.
Conclusion:
It was important to take the ticagrelor induced bradycardia into account particularly with the myocardial infarction of right coronary artery, treated with atrioventricular block drugs after initiating ticagrelor. Also, we should shift ticagrelor to clopidogrel if AVB occurred.
Case Report: Iatrogenic Dental Progress of Phantom Bite Syndrome: Rare Cases With the Comorbidity of Psychosis
Authors: Motoko Watanabe, Chaoli Hong, Zhenyan Liu, Chihiro Takao, Takayuki Suga, Trang Thi Huyen Tu, Tatsuya Yoshikawa, Miho Takenoshita, Yusuke Sato, Norihisa Higashihori, Keiji Moriyama, Haruhiko Motomura, Akira Toyofuku
Journal: Front Psychiatry (2021)
Keywords: bipolar disorder, case report, medical collaboration, occlusal dysesthesia, phantom bite syndrome, psychiatric background, psychosis, schizophrenia
MeSH terms: Case Reports

Introduction: Phantom bite syndrome (PBS) is considered as the preoccupation with dental occlusion and the continual inability to adapt to changed occlusion. These patients constantly demand occlusal corrections and undergo extensive and excessive dental treatments. We present three cases with PBS-suspected iatrogenic concerns and the attribution to underlying psychosis. Case Presentation: A 70-year-old female demanded orthodontic retreatment and complained of tightness and cramped sensation of teeth in the oral cavity, uncomfortable occlusion, and pain in her neck and legs that she was convinced was induced by orthodontic treatment. However, even earlier than the orthodontic treatment, she had kept doctor shopping for over 35 years, not merely dentists but also psychiatrists, neurologists, and so on; she was diagnosed with bipolar disorder. A 48-year-old female complained of malaligned improper occlusion and demanded occlusal adjustment. These symptoms occurred in the absence of a dental trigger and were worsened by orthodontic treatment. She underwent psychiatric treatment for 15 years with a diagnosis of bipolar disorder. A 38-year-old female, who had a history of schizophrenia for over 20 years, complained of occlusal discomfort and revisited with a complaint of abnormal occlusion due to excessive dental procedures. In the last two cases, requests for dental procedures had reduced owing to the collaboration between the psychiatrists and dentists. All the cases first visited our clinic following a succession of dental visits. They were strongly convinced that occlusal correction was the only solution to their symptoms, including the symptoms of discomfort in other body parts. Their misleading perceptions were uncorrectable, and repeated dental treatments exacerbated their complaints. Moreover, the dentists overlooked the psychotic histories of the patients, while the comorbid psychosis resulted in a strict demand for dental treatment by the patients. Conclusions: The presented PBS cases with psychosis suggest that repeated dental treatments and comorbid psychosis exacerbate PBS. Moreover, their persistent demands reflecting comorbid psychosis led dentists to perform numerous procedures. Early detection of underlying psychosis and the prompt collaboration between psychiatrists and dentists are integral to help prevent complications in PBS cases with psychosis.
Retained stone retrieval basket causing chronic pancreatitis: a case report
Authors: James Wai Kit Lee, Ming Yuan Tan, Calvin Koh, Shridhar Ganpathi Iyer, Yujia Gao
Journal: Front Surg (2023)
Keywords: ercp (cholangiopancreatography), biliary disease, hepatobiliary surgery, pancreatitis, retained foreign body, unusual presentation

Background:
Endoscopic retrograde cholangiopancreatography is a common procedure performed for choledocholithiasis and gallstone pancreatitis. Although a relatively low risk procedure, it is not without its complications. Cases of impacted Dormia baskets during stone retrieval have been reported, but these are usually retrieved surgically during the same setting.
Case summary:
A 40-year-old man presented to our hospital with an episode of epigastric pain and discomfort. He has a prior background of recurrent episodes of pancreatitis of which he underwent prior endoscopic therapy in his home country. Initial investigations revealed a metallic object seen on abdominal x-ray, computer tomographic scan of the abdomen and pelvis, and magnetic resonance imaging of the pancreas. Further evaluation was done with endoscopy, which revealed a retained stone extraction basket from a previous endoscopic retrograde pancreatography, resulting in recurrent episodes of acute chronic pancreatitis. Although the retained foreign body was removed, he subsequently developed further complications of portal vein thrombosis as a result of recurrent acute chronic pancreatitis, which required anticoagulation.
Conclusion:
This case highlights the importance of retrieving any foreign body from the pancreas, especially on the head, to prevent the development of further complications.
Clinical Thyrotoxicosis Resulting from Liothyronine Augmentation of Antidepressant Therapy in an Adolescent
Authors: Benjamin A Pallant, Claire E Moore, Lisa Swartz Topor
Journal: Case Rep Psychiatry (2022)
MeSH terms: Case Reports

Background/Objective. Thyrotoxicosis, a condition resulting from excessive peripheral thyroid hormone, is typically accompanied by thyroid function tests demonstrating a high free thyroxine (free T4) with appropriate suppression of thyroid-stimulating hormone (TSH). Case report. We describe a 17-year-old female presenting with symptoms of thyrotoxicosis along with suppressed TSH and low free T4, a laboratory pattern concerning for central hypothyroidism. Further history revealed that she was prescribed liothyronine as an adjunct therapy for depression. Discussion. Due to the short half-life of liothyronine, clinical signs and symptoms of thyrotoxicosis may develop before detection by interval lab monitoring. Conclusion. This case highlights the need for close monitoring and caution when treating adolescents with liothyronine and the importance of interpreting atypical laboratory findings within clinical context.
Spastic paraplegia is the main manifestation of a spinocerebellar ataxia type 8 lineage in China: a case report and review of literature
Authors: Shuling Chen, Siyu Li, Ying Liu, Renyi She, Wei Jiang
Journal: Front Hum Neurosci (2023)
Keywords: antispasmodic rehabilitation, case report, cerebellar atrophy, spastic paraplegia, spinocerebellar ataxia type 8
MeSH terms: Case Reports

The diagnosis and treatment of cerebellar atrophy remain challenging owing to its nonspecific symptoms and laboratory indicators. Three patients with spinocerebellar ataxia type 8 caused by ATXN8OS were found among the 16 people in the studied family. The clinical manifestations of the patients included progressive spastic paraplegia of the lower extremities, mild ataxia, mild cognitive impairment, and cerebellar atrophy. After administering antispasmodic rehabilitation treatment, using oral drugs, botulinum toxin injection, baclofen pump, and other systems in our hospital, the patients' lower extremity spasticity was significantly relieved. To our knowledge, till date, this is the first domestic report of spinocerebellar ataxia type 8 affecting a family, caused by ATXN8OS with spasticity onset in early childhood. Manifestations of the disease included spastic dyskinesia (in early disease stages) and cerebellar atrophy. Through systematic rehabilitation, the daily life of patients with this movement disorder was improved. This case report adds to the literature on spinocerebellar ataxia type 8 by summarizing its features.
Late-Onset Carnitine-Acylcarnitine Translocase Deficiency With SLC25A20 c.199-10T>G Variation: Case Report and Pathologic Analysis of Liver Biopsy
Authors: Min Chen, Yao Cai, Sitao Li, Hui Xiong, Mengxian Liu, Fei Ma, Xin Xiao, Hu Hao
Journal: Front Pediatr (2020)
Keywords: slc25a20 gene, carnitine-acylcarnitine translocase deficiency, iron deposition, late-onset cactd, liver biopsy, steatosis
MeSH terms: Case Reports

Introduction: Carnitine-acylcarnitine translocase deficiency (CACTD) is a rare and life-threatening autosomal recessive disorder of mitochondrial fatty acid oxidation caused by variation of the Solute carrier family 25 member 20 (SLC25A20) gene. Carnitine-acylcarnitine translocase is one of the crucial transport proteins in the oxidation process of mitochondrial fatty acids. In Asia, the c.199-10T>G splice site variation is the most frequently reported variant of SLC25A20. Patients with CACTD with c.199-10T>G variation usually present with a severe clinical phenotype. Materials and Methods: Herein, we report a neonatal case of late-onset CACTD in mainland China. Symptoms emerged 61 days after birth; the patient presented with a severe metabolic crisis, and her clinical condition rapidly deteriorated, and she died of respiratory insufficiency and cardiac arrest at 61 days. We present the clinical and biochemical features of this patient and briefly review previously reported CACTD cases with c.199-10T>G variation. Results: Acylcarnitine profiling by tandem mass spectrometry and high-throughput sequencing revealed that our patient was homozygous for the c.199-10T>G variation, confirming the diagnosis of CACTD. Histopathologic analysis of the liver by Prussian blue staining showed focal iron deposition in hepatocytes, and electron microscopy analysis revealed a large number of lipid droplet vacuoles in diffusely distributed hepatocytes. Conclusion: The development of CACTD in our patient 61 days after birth is the latest reported onset for CACTD with SLC25A20 c.199-10T>G variation. Early recognition of symptoms and timely and appropriate treatment are critical for improving the outcome of this highly lethal disorder. Death from late-onset CACTD may be caused by the accumulation of long-chain fatty acids as well as iron deposition in the heart leading to heart failure.
Case Report: Serial Cases: Prolongation of High Immunoglobulin G Level in Repetitive COVID-19 Convalescence Plasma Donor in Saiful Anwar Hospital Malang, Indonesia
Authors: Nina Nurarifah, Herwindo Pudjo Brahmantyo, Shinta Oktya Wardhani, Djoko Heri Hermanto, Putu Moda Arsana
Journal: Front Immunol (2021)
Keywords: covid-19, convalescent plasma, antibody, immunoglobulin g, repetitive donor
MeSH terms: COVID-19 / immunology, COVID-19 / therapy, Immunoglobulin G / blood, Immunoglobulin G / immunology, Plasma / immunology, Case Reports, Adult, Antibodies, Neutralizing / immunology, Antibodies, Neutralizing / therapeutic use, Antibodies, Viral / immunology, Blood Donors, COVID-19 Serotherapy, Convalescence, Female, Humans, Immunization, Passive, Indonesia, Male, Middle Aged, Antibodies, Neutralizing, Antibodies, Viral, Immunoglobulin G

Background:
Convalescent plasma therapy is expected to be a promising alternative to supportive therapy during the SARS-CoV-2 pandemic outbreak. Altered immune response in repetitive convalescent plasma donors has not been widely studied. This case series was reported to analyze the patterns of immune responses and the factors that might influence them in repetitive convalescent plasma donors and increase awareness of COVID-19 survivors to donate their convalescent plasma.
Cases illustration:
There were five repetitive donors who were eligible as convalescent plasma donor requirements. It was found two donors who showed increment of anti-SARS-CoV-2 IgG level after donation and two others who showed persistent anti-SARS-CoV-2 IgG level more than two months after recovered.
Discussion:
There was a difference in immune response in survivors who have the probability of being exposed to same antigens with survivors who did not, where the group of survivors who are at risk of exposure to antigens after recovery could trigger anamnestic immune response that can increase antiSARS-CoV-2 IgG levels. The other factor that influence the prolongation of anti-SARS-CoV-2 IgG levels are the possibility of neutralizing antibodies in plasma upregulation.
Conclusion:
Immunological phenomenon in SARS-CoV-2, both in survivors and convalescent plasma donors, have not been widely observed and studied. From the case series discussed above, it can be concluded that convalescent plasma donation does not yet have strong evidence of decreasing levels of specific antibodies against SARS-CoV-2 and plasmapheresis procedure is safe to be done without reducing the protective effect of donor antibody post-plasma donation.
Gastrointestinal Talaromyces marneffei infection in a patient with AIDS: A case report and systematic review
Authors: Fangmei Ling, Tao Guo, Junrong Li, Yidong Chen, Mingyang Xu, Shuang Li, Liangru Zhu
Journal: Front Immunol (2022)
Keywords: hiv, talaromyces marneffei, endoscopy, intestine, talaromycosis
MeSH terms: AIDS-Related Opportunistic Infections / diagnosis, AIDS-Related Opportunistic Infections / drug therapy, Acquired Immunodeficiency Syndrome / complications, Acquired Immunodeficiency Syndrome / drug therapy, Case Reports, Systematic Review, Research Support, Non-U.S. Gov't, Abdominal Pain, Antifungal Agents / therapeutic use, Diarrhea, Fever / drug therapy, Humans, Male, Methylamines, Mycoses, Periodic Acid / therapeutic use, Antifungal Agents, Methylamines, Periodic Acid, talaromycosis

Talaromyces marneffei is a thermally dimorphic fungus that affects multiple organs and frequently invades immunocompromised individuals. However, only a few studies have reported the presence of intestinal infection associated with T. marneffei. Herein, we reported a case of intestinal T. marneffei infection in a man who complained of a 1-month history of intermittent fever, abdominal pain, and diarrhea. The result of the human immunodeficiency virus antibody test was positive. Periodic acid-Schiff and Gomorrah's methylamine silver staining of the intestinal biopsy tissue revealed T. marneffei infection. Fortunately, the patient's symptoms rapidly resolved with prompt antifungal treatment. In addition, we summarized and described the clinical characteristics, management, and outcomes of patients with intestinal T. marneffei infection. A total of 29 patients were identified, the majority of whom (65.52%) were comorbid with acquired immunodeficiency syndrome. The main clinical features included anemia, fever, abdominal pain, diarrhea, weight loss, and lymphadenopathy. The transverse and descending colon, ileocecum, and ascending colon were the most common sites of lesions. A considerable number of patients (31.03%) developed intestinal obstruction, intestinal perforation, and gastrointestinal bleeding. Of the 29 patients, six underwent surgery, 23 survived successfully with antifungal treatment, five died of T. marneffei infection, and one died of unknown causes. T. marneffei intestinal infection should be considered when immunodeficient patients in endemic areas present with non-specific symptoms, such as fever, abdominal pain, and diarrhea. Appropriate and timely endoscopy avoids delays in diagnosis. Early aggressive antifungal therapy improves the clinical outcomes of patients.
Metastases from renal cell carcinoma presenting as gastrointestinal bleeding: two case reports and a review of the literature
Authors: Gareth J Sadler, Mark R Anderson, Mark S Moss, Paul G Wilson
Journal: BMC Gastroenterol (2007)
MeSH terms: Carcinoma, Renal Cell / secondary, Duodenal Neoplasms / secondary, Gastrointestinal Hemorrhage / etiology, Kidney Neoplasms / diagnosis, Pancreatic Neoplasms / secondary, Case Reports, Review, Aged, Anemia / etiology, Carcinoma, Renal Cell / complications, Carcinoma, Renal Cell / diagnosis, Duodenal Neoplasms / complications, Duodenal Neoplasms / diagnosis, Fatal Outcome, Humans, Male, Pancreatic Neoplasms / complications, Pancreatic Neoplasms / diagnosis

Background:
Bleeding from small bowel neoplasms account for 1-4% of cases of upper gastrointestinal haemorrhage. Renal cell carcinoma constitutes 3% of all adult malignancies and often presents insidiously. Consequently 25-30% of patients have metastases at the time of diagnosis. Gastrointestinal bleeding from renal cell carcinoma metastases is an uncommon and under-recognised manifestation of this disease.
Case report:
In this report we describe two cases of gastrointestinal bleeding from renal cell carcinoma metastases - in one patient bleeding heralded the primary manifestation of disease and in the other signified recurrence of disease following nephrectomy.
Conclusion:
These cases highlight the importance endoscopic vigilance in cases of undiagnosed upper gastrointestinal haemorrhage, especially in patients with a past history of renal cell carcinoma.