OpenMed/multicare-articles huggingface dataset:
Case Report: The Role of Neuropsychological Assessment and Imaging Biomarkers in the Early Diagnosis of Lewy Body Dementia in a Patient With Major Depression and Prolonged Alcohol and Benzodiazepine Dependence
Authors: Caroline Bouter, Niels Hansen, Charles Timäus, Jens Wiltfang, Claudia Lange
Journal: Front Psychiatry (2020)
Keywords: 123i-fp-cit, 18f-fdg-pet, biomarker, dementia, dementia with lewy bodies
MeSH terms: Case Reports

Dementia with Lewy bodies (DLB) is the second most common form of dementia and is assumed to be often under- or misdiagnosed, especially in early stages. Here we present a complex case of probable DLB with major depression and alcohol and benzodiazepine dependence in which DLB was ruled out initially. This case highlights the challenging diagnostic workup of DLB patients. Core clinical features can be missing and indicative biomarkers can be negative, especially in early stages of the disease. Initially, Fluorodeoxyglucose positron emission tomography as well as neuropsychological assessment were suspicious for a possible DLB diagnosis in our patient while core clinical criteria were missing and the indicative biomarker 123I-FP-CIT SPECT was negative. Follow up was performed two years later and the patients showed several core and supportive clinical features of DLB and 123I-FP-CIT SPECT showed a pathological pattern. Extensive neuropsychological assessment in combination with PET imaging might provide crucial evidence for DLB even in early stages. If neuropsychology and PET imaging point to an early DLB diagnosis careful follow-up should be performed as core symptoms and indicative biomarkers might appear in later stages of the disease.
Bladder metastasis presenting as neck, arm and thorax pain: a case report
Authors: Clinton J Daniels, Pamela J Wakefield, Glenn A Bub
Journal: Chiropr Man Therap (2016)
Keywords: bladder cancer, case report, chiropractic, metastasis, neck pain, transitional cell carcinoma

Background:
A case of metastatic carcinoma secondary to urothelial carcinoma presenting as musculoskeletal pain is reported. A brief review of urothelial and metastatic carcinoma including clinical presentation, diagnostic testing, treatment and chiropractic considerations is discussed.
Case presentation:
This patient presented in November 2014 with progressive neck, thorax and upper extremity pain. Computed tomography revealed a destructive soft tissue mass in the cervical spine and additional lytic lesion of the 1st rib. Prompt referral was made for surgical consultation and medical management.
Conclusion:
Distant metastasis is rare, but can present as a musculoskeletal complaint. History of carcinoma should alert the treating chiropractic physician to potential for serious disease processes.
Intraparenchymal metastases to the spleen from ovarian cancer: a case report
Authors: Abdul A Ghani, Zubair A Hashmi, Daniel M Chase, Shonak B Patel, Daniel F Jones
Journal: J Med Case Rep (2010)

Introduction:
Splenic tumors are rare and present a diagnostic dilemma. Metastatic carcinoma to the spleen is unusual. Visceral metastases in patients with ovarian cancer represent hematogenous spread of the disease; capsular involvement resulting from serosal and peritoneal seeding is more common. We present a patient with intraparenchymal splenic metastasis from ovarian carcinoma. This case demonstrates a rare etiology of an intraparenchymal solid splenic mass.
Case presentation:
An 85-year-old woman presented with left upper quadrant pain. During her evaluation, a computed tomography scan revealed intraparenchymal splenic masses. An elective splenectomy was performed, during which ovarian cancer, which had not been revealed by the pre-operative computed tomography, was detected. There was no involvement of the splenic capsule by direct extension of the tumor, as is usually the case for ovarian cancer, but only intraparenchymal metastases. This mode of metastasis to the spleen has been described but is quite rare, and ovarian cancer presenting as a splenic mass is even more so.
Conclusion:
Splenic metastasis is a relatively rare event. It is often asymptomatic and is usually detected as part of multiorgan metastases. Symptomatic cases, though rare, do occur, and as in our patient, a thorough clinical evaluation is important to help direct the treatment plan. This case is a reminder to be cognizant of one of the less likely differential diagnoses of an intraparenchymal solid splenic mass.
Role of Neutrophil Gelatinase-Associated Lipocalin in the Diagnosis and Early Treatment of Acute Kidney Injury in a Case Series of Patients with Acute Decompensated Heart Failure: A Case Series
Authors: Silvia Angeletti, Marta Fogolari, Davide Morolla, Federico Capone, Sebastiano Costantino, Silvia Spoto, Marina De Cesaris, Alessandra Lo Presti, Massimo Ciccozzi, Giordano Dicuonzo
Journal: Cardiol Res Pract (2016)

Patients with acute decompensated heart failure (ADHF) frequently develop worsening in renal function until Acute Kidney Injury (AKI). The use of kidney injury biomarkers could be useful in the early diagnosis of AKI. In the present study, the role of the neutrophil gelatinase-associated lipocalin (NGAL), compared to the standard creatinine, in ADHF patients, was analyzed to evaluate if an early treatment could affect the outcome. A case series of 24 ADHF patients was enrolled and patients randomly divided in two groups (Group A and Group B). In Group A, NGAL, creatinine, and eGFR were measured, while in Group B, creatinine and eGFR alone were measured. NGAL was measured by turbidimetric immunoassay and creatinine using an enzymatic spectrophotometric method. In presence of AKI, creatinine increase and eGFR decrease were significantly lower in Group A than in Group B, whereas in absence of AKI the difference between the two groups was not significant. Hospitalization stay was significantly lower in Group A (receiving early treatment based on NGAL) than in Group B. In ADHF patients, plasma NGAL in combination with creatinine was superior to the standard creatinine in the diagnosis and early treatment of AKI with a better outcome and a decreased hospital stay.
Rapid palliation of symptoms with platinum-based chemotherapy plus cetuximab in recurrent oral cancer: a case report
Authors: Ricard Mesía, Ramón Palmero, Mònica Cos, Esther Vilajosana, Silvia Vázquez
Journal: Head Neck Oncol (2010)
MeSH terms: Antineoplastic Combined Chemotherapy Protocols / therapeutic use, Carcinoma, Squamous Cell / drug therapy, Mouth Neoplasms / drug therapy, Neoplasm Recurrence, Local / drug therapy, Case Reports, Antibodies, Monoclonal / administration & dosage, Antibodies, Monoclonal, Humanized, Carboplatin / administration & dosage, Cetuximab, Female, Fluorouracil / administration & dosage, Humans, Middle Aged, Antibodies, Monoclonal, Antibodies, Monoclonal, Humanized, Carboplatin, Cetuximab, Fluorouracil

Background:
Symptom control is an important consideration in the choice of treatment for patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck (SCCHN). Patients who demonstrate objective tumour responses to platinum-based chemotherapy are more likely to have symptom relief than those who do not have such responses. A phase III trial (EXTREME) showed that adding the epidermal growth factor receptor (EGFR)-targeting IgG1 monoclonal antibody cetuximab to first-line platinum-based chemotherapy significantly prolongs progression-free and overall survival and increases response rate compared with platinum-based chemotherapy alone. We report here the case of a 60-year old female with recurrent squamous cell carcinoma of the gum who had rapid palliation of symptoms and reduction of facial disease mass following treatment with a combination of carboplatin/5-fluorouracil (5-FU) and cetuximab.
Case presentation:
The patient was diagnosed with T4N0 M0 disease of the oral cavity in November 2006 and underwent surgery, with R0 resection, followed by adjuvant radiotherapy and concomitant cisplatin chemotherapy. Around 3 months later, the disease recurred and the patient had severe pain (9/10 on a visual pain scale), marked facial oedema and a palpable facial mass of 89 mm. The patient received 4 21-day cycles of carboplatin (AUC 5), 5-FU (1,000 mg/m2/day for 4 days) and cetuximab (400 mg/m2 initial dose followed by subsequently weekly doses of 250 mg/m2), with continuation of cetuximab monotherapy at the end of this time, and pain relief with topical fentanyl and oral morphine. After 7 days of treatment, pain had reduced to 2/10, with discontinuation of morphine after 4 days, and the facial mass had reduced to 70 mm. After 2 cycles of treatment, the facial mass had decreased to 40 mm. After 3 cycles of treatment, pain and facial oedema had resolved completely and a cervical computed tomography scan showed a marked reduction in tumour mass. Cetuximab monotherapy was continued uninterrupted for 7 months.
Conclusion:
This case illustrates the rapid reduction of tumour mass and disease-associated pain and oedema that can be achieved with a combination of platinum-based chemotherapy and cetuximab in recurrent and/or metastatic SCCHN.
Case Report: Double Germline Mutations in BRCA1 and MSH2 in a Patient With Mixed Serous-Endometrioid Endometrial Carcinoma
Authors: Hong Zheng, Mingming Yuan, Huanwen Wu, Rongrong Chen, Yunong Gao
Journal: Front Med (Lausanne) (2020)
Keywords: double germline mutations, mixed serous-endometrioid endometrial carcinoma, next-generation sequencing, tislelizumab, tumor heterogeneity
MeSH terms: Case Reports

Mixed serous-endometrioid endometrial carcinoma is a type of endometrial cancer with relatively low incidence. The genetic factors contributing to the tumorigenesis of mixed carcinoma remains to be explored. Here, we report the first identification of two germline mutations in BRCA1 and MSH2 in a woman with mixed serous papillary adenocarcinoma and endometrioid carcinoma. Immunohistochemistry analysis showed loss of MSH2 and MSH6 protein expression in the endometrioid component. The patient showed partial response to tislelizumab treatment following progression on chemotherapy. Two germline mutations in BRCA1 and MSH2 may collectively promote the tumorigenesis of uterine endometrium with two distinct histological components.
Renal Tubular Acidosis an Adverse Effect of PD-1 Inhibitor Immunotherapy
Authors: Sandy El Bitar, Chanudi Weerasinghe, Elie El-Charabaty, Marcel Odaimi
Journal: Case Rep Oncol Med (2018)
MeSH terms: Case Reports

Immune checkpoint blockade therapy is gaining popularity among oncologists for treatment of solid and hematologic malignancies. The widespread use of these agents resulted in increasing incidence of renal immune-related adverse events. Reported renal toxicity described so far includes acute interstitial nephritis, minimal change disease, and immune complex glomerulonephritis. We report the case of a 79-year-old female with metastatic non-small cell lung cancer on anti-PD-1 therapy nivolumab. After the 4th administration of nivolumab, the treatment course was complicated with normal anion gap metabolic acidosis. Urine and blood studies were in favor of distal renal tubular acidosis (RTA). Following a negative workup for an underlying etiology, immunotherapy-induced RTA was suspected. Withholding of the offending agent and initiation of steroid therapy resulted in adequate response. The present report provides the first presentation of RTA as a renal immune-related adverse event secondary to nivolumab. Nephrologists and oncologists should be familiar with potentially life-threatening renal side effects induced by immune checkpoint inhibitors.
Sorafenib-induced liver failure: a case report and review of the literature
Authors: Anneleen Van Hootegem, Chris Verslype, Werner Van Steenbergen
Journal: Case Reports Hepatol (2011)

In patients with hepatocellular carcinoma characterized by vascular invasion and/or extrahepatic disease, Sorafenib is considered treatment of choice. Although mild liver test abnormalities were reported in less than 1% of the patients in the two large randomized, controlled phase III trials, four cases of severe acute Sorafenib-induced hepatitis have been described. One of these four cases died from liver failure. In this paper, a patient with HCC with lung metastases developed high fever and a severe hepatitis that rapidly evolved into liver coma and death, two weeks after the initiation of Sorafenib. Biochemical parameters pointed to a hepatocellular type of injury. Clinical and biochemical presentations were compatible with a drug-induced hypersensitivity syndrome such as it has mainly been described for aromatic anticonvulsants, sulphonamides, and allopurinol. We hypothesize that an underlying cytochrome P450 dysfunction with the presence of reactive drug metabolites might lead to this potentially fatal Sorafenib-induced severe liver dysfunction.
Successful outcome of triangle tilt as revision surgery in a pediatric obstetric brachial plexus patient with multiple previous operations
Authors: Rahul K Nath, Vishnu Halthore, Chandra Somasundaram
Journal: Case Rep Surg (2014)

Introduction. Obstetric brachial plexus injury (OBPI) occurs during the process of labor and childbirth. OBPI has been reported to be associated with shoulder dystocia, macrosomia, and breech delivery. Its occurrence in uncomplicated delivery is possible as well. Case Presentation. The patient in the present report is a 6.5-year-old girl, who suffered a severe brachial plexus injury at birth and had many reconstructive surgical procedures at an outside brachial plexus center before presenting to us. Discussion. The traditional surgical treatments by other surgical groups were unsuccessful and therefore the patient came to our clinic for further treatment. She had triangle tilt surgery with us, as a salvage procedure. Conclusion. The OBPI patient in this study clearly showed noticeable clinical and functional improvements after triangle tilt surgical management. The posture of the arm at rest was greatly improved to a more normal position, and hand to mouth movement was improved as well. Triangle tilt surgery should be conducted as a first choice treatment for medial rotation contracture of the shoulder in OBPI patients.
Spindle Cell Variant of Ameloblastic Carcinoma: Another Example in a Japanese Male
Authors: Hiroshi Harada, Akio Tanaka, Masatomo Kimura, Shinsuke Ieda, Takeshi Wada, Tatsushi Matsumura, Akira Kurose
Journal: Case Rep Dent (2023)
MeSH terms: Case Reports

Spindle cell variant of ameloblastic carcinoma (SpCAC) is a rare subtype of ameloblastic carcinoma. Herein, we describe an additional case of SpCAC of the mandible of a 76-year-old Japanese male. We discuss diagnostic problems we encountered in this case, focusing on unusual expression of myogenic/myoepithelial markers, such as smooth muscle actin and calponin.
Social and Cultural Factors Leading to Suicide Attempt via Organophosphate Poisoning in Nepal
Authors: Christine Licata, Lawrence Liu, Dale Mole, Jonathon Thorp, Rajesh Chand, Sabin Chaulagain
Journal: Case Rep Psychiatry (2019)
MeSH terms: Case Reports

Organophosphates are commonly used in rural, agricultural communities worldwide. Poisoning in Nepal is commonly a result of suicide attempt via ingestion with a mortality rate of 41 times higher than in the United States even after appropriate treatment. The patient discussed in this case is a 46-year-old Nepalese female with a complicated psychosocial history that presented with a suicide attempt via organophosphate ingestion. She required higher doses and greater lengths of treatment of atropine and pralidoxime to resolve symptoms of toxicity that resulted in atropine-induced psychosis, a side effect rarely cited in the literature. This patient was one of many who attempt suicide in Nepal, where suicide is the leading cause of death for young to middle aged women in the country.
Daith Piercing in a Case of Chronic Migraine: A Possible Vagal Modulation
Authors: Angelo Cascio Rizzo, Matteo Paolucci, Riccardo Altavilla, Nicoletta Brunelli, Federica Assenza, Claudia Altamura, Fabrizio Vernieri
Journal: Front Neurol (2017)
Keywords: ear acupuncture, medication overuse headache, neuromodulation, transcutaneous vagal stimulation, vagus nerve
MeSH terms: Case Reports

Daith piercing is an ear piercing located at the crus of the helix, bilaterally. It is getting great consent on social media as alternative treatment in chronic migraine. No data about its efficacy and action are available in scientific literature so far. We present the case of a 54-year-old male patient suffering from refractory chronic migraine with medication-overuse, who substantially improved after bilateral ear daith piercing. His migraine was refractory to symptomatic as well as prophylactic therapies. He used to treat headaches with up to five symptomatic drugs per attack and had attempted several pharmacological preventive therapies, including Onabotulinumtoxin A. He also underwent detoxification treatments with intravenous steroids and diazepam, without durable benefit. At the time of daith piercing, the headache-related disability measures showed a HIT-6 score of 64, a MIDAS-score of 70, and a 11-point Box scale of 5. On his own free will, he decided to get a "daith piercing." After that, he experienced a reduction of migraine attacks, which became very rare, and infrequent, less disabling episodes of tension-type headache (HIT-6 score of 56; MIDAS score of 27, 11-point Box scale of 3). Painkiller assumption has much decreased: he takes only one tablet of indomethacin 50 mg to treat tensive headaches, about four times per month. Beyond a placebo effect, we can speculate a vagal modulation as the action mechanism of daith piercing: a nociceptive sensory stimulus applied to trigeminal and vagal areas of the ear can activate ear vagal afferents, which can modulate pain pathways by means of projections to the caudal trigeminal nucleus, to the locus coeruleus and to the nucleus raphe magnus. Currently, daith piercing cannot be recommended as migraine treatment because of the lack of scientific evidence, the unquantified rate of failure and the associated risks with insertion. However, given the increasing but anecdotal evidence, we think that the mechanism needs testing by means of a controlled clinical trial in a population of chronic migraineurs.
Diagnosing and Managing Linear Scleroderma in a Low-Resource Setting
Authors: Sreyleak Luch, Pauravy Men, Gwenyth Fischer, Andrew Wu
Journal: Case Rep Pediatr (2023)
MeSH terms: Case Reports

Background:
Linear scleroderma is one of the five forms of scleroderma, but it is the most common form of localized scleroderma in childhood. If left untreated, it can lead to severe disfigurement and functional impairment. The typical appearance is a linear streak with cutaneous induration on the face or head in association with various ophthalmological and neurological signs and symptoms. Treatment typically includes corticosteroids and/or methotrexate with life-long monitoring for recurrence. Case Presentation. A 12-year-old girl presented to our clinic in northern rural Cambodia with a history of a linear streak on her forehead that was growing down her nasal bridge. She denied any tenderness or family history of rheumatic disease. Her history was significant for strabismus as a child. A visiting pediatric rheumatologist assisted us with the appropriate diagnosis and treatment plan.
Conclusion:
In our case report, we present a child with linear scleroderma who fortunately came to medical attention early and received appropriate treatment before the onset of complications. She was treated with systemic immunosuppression as well as topical steroids. After treatment, she had no further progression on her face and continued to follow up with us to monitor for disease activity. To summarize, linear scleroderma is an uncommon diagnosis for general pediatricians and should be recognized early to provide appropriate treatment and follow-up.
Bilateral Sterile Pyogranulomatous Keratitis in a Dog
Authors: Michael C Rahe, Aubrey Cordray, Joseph Haynes
Journal: Case Rep Vet Med (2019)
MeSH terms: Case Reports

Purpose:
To describe the clinicopathologic features of bilateral sterile pyogranulomatous keratitis in a 16-year-old spayed female rat terrier dog.
Methods:
The dog presented one year prior due to ulceration of the right and left corneas. The ulcers healed but plaques developed on both eyes which progressed, during the course of one year, to cover both the left and the right corneas. Due to the animal's loss of sight and its painful condition, bilateral enucleation was performed with submission of the eyes for histopathology.
Results:
Microscopic examination revealed bilateral pyogranulomatous keratitis absent of etiological organisms.
Conclusions:
To the authors' knowledge, this is the first documented case of bilateral sterile pyogranulomatous keratitis in a dog.
A Case Report of X-Linked Hyperimmunoglobulin M Syndrome with Lipoma Arborescens of Knees
Authors: Qiuting Dong, Jinxia Zhao, Zhongqiang Yao, Xiangyuan Liu, Huiying He
Journal: Case Rep Med (2016)

The X-linked hyperimmunoglobulin M syndrome (HIGM), caused by mutations in the CD40LG gene, is a kind of primary immunodeficiency disease (PID). Patients with X-linked HIGM are susceptible to infection as well as autoimmune diseases. Lipoma arborescens (LA) is a rare benign tumor, of which the pathogenesis mechanism has not been clearly understood. We report a case of HIGM combined with LA in a 22-year-old male patient. A new deletion mutation of CD40LG gene was detected in this case. The possible relationship between HIGM and LA was also discussed.
Knee megaprosthesis: a salvage solution for severe open and complex distal femoral fracture associated with an ipsilateral brachial plexus injury (a case report with literature review)
Authors: Badr Ennaciri, Christian Vasile, Thierry Lebredonchel, Mohamed Saleh Berrada, Eric Montbarbon, Emmanuel Beaudouin
Journal: Pan Afr Med J (2015)
Keywords: knee megaprosthesis, femoral spacer, open fracture
MeSH terms: Brachial Plexus / injuries, Femoral Fractures / surgery, Fractures, Open / surgery, Knee Prosthesis, Case Reports, Review, Accidents, Traffic, Femoral Fractures / pathology, Femoral Fractures / rehabilitation, Follow-Up Studies, Fractures, Open / pathology, Fractures, Open / rehabilitation, Humans, Male, Middle Aged, Motorcycles

Complex distal femoral fractures in the young patient often occur as a result of high velocity trauma. Timely recognition and treatment is everything in such a situation, and it needs a robust staged management pathway to optimize the chance of limb preservation. We report a case of a motorcyclist admitted to the department of orthopedics at Chambery hospital, France, with a complex comminuted and open distal femoral fracture of the left leg, associated with a brachial plexus injury to the ipsilateral upper limb. On arrival to the emergency department, damage control stabilization and surgery was commenced, debridement of contaminated non-viable tissue, abundant antiseptic lavage and application of external fixation coupled with the use of antibiotic spacer. Following normalization of inflammatory markers and ensuring no clinical signs of infection, subsequent management consisted of joint reconstruction to achieve a functional knee. The external fixator and femoral spacer was removed and a modular megaprosthesis was implanted with a lateral gastrocnemius flap to cover the exposed knee joint and reinforce the extensor apparatus. Nerve graft to the left brachial plexus injury was performed at University Hospital of Grenoble. Our patient entered an intensive rehabilitation program and at 1 year follow-up achieved good knee function and sensation to the left upper limb.