OpenMed/multicare-articles huggingface dataset:
Management of Unrepaired Tetralogy of Fallot in an 86-Year-Old Patient Undergoing Transcatheter Aortic Valve Replacement
Authors: Armish Singh, Samantha Arzillo, Kevin Ergle
Journal: Cureus (2024)
Keywords: adult congenital heart disease (achd), aortic stenosis (as), eisenmenger syndrome, tetrology of fallot, transcatheter aortic valve replacement (tavr)
MeSH terms: Case Reports

Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart defect, typically requiring early treatment in infancy. Untreated TOF is associated with poor survival, with most uncorrected patients not surviving beyond the third decade. Here, we present a unique case of an 86-year-old female with uncorrected TOF who underwent a transcatheter aortic valve replacement (TAVR) procedure due to severe aortic stenosis (AS). The patient's TOF was identified during infancy, and she was categorized as an acyanotic "pink baby." Notably, the first palliative surgery for TOF was performed in 1944, when the patient was seven years old. The patient never underwent corrective surgery for TOF and continued to lead a symptom-free life until she developed severe AS later in life. The TAVR procedure significantly improved her symptoms, illustrating the importance of considering alternative etiologies for symptoms in elderly patients with uncorrected TOF and AS. In addition, we underscore the anesthetic management during TAVR, specifically highlighting the challenges addressed, such as the utilization of general anesthesia with transesophageal echocardiography (TEE) and the placement of a pulmonary artery (PA) catheter.
Spinal manipulation and mobilization forces delivered treating sciatica: a case report
Authors: Theodore B Siciliano, Maruti R Gudavalli, Ralph Kruse
Journal: Front Integr Neurosci (2024)
Keywords: cox technic flexion distraction decompression spinal manipulation, case report, force-based spinal manipulation, low back pain, sciatica
MeSH terms: Case Reports

Introduction:
Accurately measuring the forces applied during spinal manipulation and its biomechanical effects on the spine are critically important in current research. This single case report discusses the potential benefit of accurately monitoring manipulative forces in treating low back pain with sciatica. The type of force-based spinal manipulation used to manage this case was Cox Technic flexion distraction decompression (CTFDD) spinal manipulation care, along with other ancillary modalities.
Methods:
The treatment plan, in this case, was primarily force-based CTFDD, equal-force bi-directional traction (EqFT), pre-modulated electrical muscle stimulation (EMS), infrared light therapy (ILT), and a home stretching and strengthening program.
Clinical findings:
Initially, the case study patient presented with complaints of left lumbar spine pain, which radiated into the left buttock, down the left leg, accompanied by an inability to dorsiflex the left foot. The patient was concerned with this condition as the left leg pain and left lower extremity motor deficit were having a profound effect on the patient's ability to perform activities of daily living and work. The patient was recommended to undergo spinal decompression surgery, which the patient did not want, and elected to exhaust all alternative, non-surgical treatments first.
Diagnosis intervention and outcomes:
A diagnosis of sciatica with a sequestered disk fragment and left lower extremity motor deficit was rendered through objective physical examination results and a review of a lumbar MRI study. Past interventions included prescription medications, physical rehabilitation, chiropractic, pain management, and neurosurgical consultation. All past interventions prior to initiating CTFDD care provided minimal subjective and/or objective clinical improvement. This patient had a positive clinical outcome from a force-based CTFDD treatment plan along with other modalities consisting of pre-modulated EMS, ILT, and a home stretching and strengthening program.
Conclusion:
Force-based CTFDD spinal manipulation, along with other modalities consisting of pre-modulated EMS, ILT, and a home stretching and strengthening program, has been found to be an alternative, non-surgical treatment for discogenic sciatica. Continued research is needed on force-based CTFDD spinal manipulation to further evaluate the neurological and biomechanical effects of the forces and motion applied to the spine and determine health benefits for the treatment of low back pain.
Case Report: Resolution of high grade anal squamous intraepithelial lesion with antibiotics proposes a new role for syphilitic infection in potentiation of HPV-associated ASCC
Authors: A Ranabhotu, N Habibian, B Patel, E Farrell, J Do, S Sedghi, L Sedghi
Journal: Front Oncol (2023)
Keywords: anal intraepithelial lesions, anogenital squamous cell carcinoma (ascc), coinfection, human papillomavirus (hpv), syphilis
MeSH terms: Case Reports

Introduction:
Human Papillomavirus (HPV) is the primary risk factor for the development of anal intraepithelial neoplasia (AIN) and is a leading risk factor for anogenital squamous cell carcinoma (ASCC). Despite common shared risk factors for both HPV and syphilis, co-infection is not well documented, and the role of syphilitic infection in HPV-associated AIN and ASCC potentiation is not defined.
Case description/methods:
A 72-year-old single male presented with complaints of mild rectal pain and intermittent rectal bleeding. A flexible sigmoidoscopy was performed, and a firm 4.5cm x 3cm perianal mass was detected and superficially biopsied. Pathology findings demonstrated evidence of a high grade squamous intraepithelial lesion (HGSIL, AIN II/III/AIS) with viral cytopathic effect, consistent with HPV infection. Much of the biopsied lesion showed acanthotic squamous mucosa with intraepithelial neutrophils and abundant submucosal plasma cells, suggesting possible syphilitic involvement. Subsequent immunohistochemical staining for p16 as a surrogate marker for HPV was positive, as was an immunohistochemical stain for spirochetes, supportive of co-infection with Treponema pallidum pallidum (T. pallidum), the causative agent in venereal syphilis. The patient was referred to an infectious disease specialist for syphilitic infection and was treated with penicillin with surprisingly complete resolution of the lesion. EUAs were performed 2- and 3-months following treatment without lesion recurrence. However, one year following diagnosis, a flexible sigmoidoscopy revealed a 5 mm recurrent HPV-related low-grade AIN 1 lesion at the dentate line.
Discussion:
Resolution of the lesion by antibiotic treatment for syphilitic infection suggested that co-infection by T. pallidum may potentiate HPV-associated squamous cell carcinoma based on histological findings. Findings from this case, as well as a review of bacterial involvement and potentiation in various cancers, are reviewed here. Such findings offer new insight regarding the role of STI-associated bacteria and HPV co-infection in the establishment of AIN and may additionally propose new treatment modalities for ASCC.
Case Presentation of Duodenal Obstruction Caused by Complete Annular Pancreas
Authors: Ahmet Bozer, Zehra Hilal Adıbelli
Journal: J Belg Soc Radiol (2024)
Keywords: duodenal obstruction, complete annular pancreas, congenital anomaly, recurrent vomiting

Teaching Point: A complete annular pancreas, a rare congenital anomaly, can lead to duodenal obstruction, causing recurrent symptoms like vomiting and often requiring surgical intervention for relief.
Femoral Neck Fracture in a Pediatric Patient with Primary Hyperparathyroidism
Authors: Mark W Schmitt, Maxwell J Modrak, Soumar J Bouza, Brian G Smith, Murillo A Adrados
Journal: Case Rep Orthop (2023)
MeSH terms: Case Reports

Case:
A previously healthy 11-year-old girl underwent expedited surgical fixation of a femoral neck fracture sustained while jump-roping. After further work up, she was diagnosed with primary hyperparathyroidism. Parathyroidectomy of a hypertrophic adenoma proved curative. Now, five months post left hip surgery, the patient is pain-free and walks without a limp.
Conclusion:
We describe the first published case of primary hyperparathyroidism presenting as a pathologic hip fracture in a child. Although presentation with a fracture is exceedingly rare, bone pain is a frequent complaint of pediatric hyperparathyroidism. Orthopedic surgeons may find themselves the front-line caregivers for the condition.
Case Report: Lung cancer with rare cardiac and other multiple metastases
Authors: Li Chen, Jing Zhang, Chunquan Zhang
Journal: Front Cardiovasc Med (2024)
Keywords: case report, diagnostic, left atrial tumors, metastasiscase, microenvironment
MeSH terms: Case Reports

Metastasis to the left atrium is exceptionally uncommon, occurring at a rate of only 3.1%. The clinical manifestations of lung cancer metastasizing to the heart can vary widely. They range from paraneoplastic syndrome, dyspnea, and ST-segment elevation on an electrocardiogram to no clinically significant symptoms. Diverging from typical metastatic patterns observed in lung cancer, this case report presents a detailed description, from the perspective of the microenvironment, of a rare instance where lung cancer metastasized to the mediastinal lymph nodes, adrenal glands, brain, and notably, the left atrium, in a non-smoking female patient.
Survival after Consecutive Myocardial Infarction and Stroke: A Case Report
Authors: Kristina Ratautė, Greta Burneikaitė, Jolita Badarienė
Journal: Acta Med Litu (2024)
Keywords: cerebral infarction, mortality, myocardial infarction, stroke
MeSH terms: Case Reports

Background:
Myocardial infarction and stroke are prevalent and potentially fatal urgent medical conditions. Stroke as a subsequent cardiovascular event after the myocardial infarction significantly decreases the odds of survival for the patient.
Clinical case:
We report a case of a 48-year-old man admitted to Vilnius University Hospital Santaros Klinikos due to an ST-segment elevation myocardial infarction. Patient also experienced a cardioembolic cerebral infarction on the tenth day in the hospital. The patient survived this dual infarction, his general condition improved and he was discharged to the rehabilitation center.
Discussion and conclusions:
Cardiovascular diseases are the most common cause of death in the world. Stroke, as a complication of myocardial infarction, affects 0.76-3.2% of patients and demonstrates an increasing incidence trend. In such a dual infarction, in-hospital mortality can be as high as 18-41%. It is hopeful that targeted research and evidence-based prevention with treatment can improve outcomes of concomitant myocardial infarction and stroke.
Case Report: Non-convulsive seizure following traumatic brain injury - a significant occurrence that needs to be considered due to potential long-term sequelae
Authors: Azra Zafar
Journal: F1000Res (2024)
Keywords: nonconvulsive seizure, diffuse axonal injury, temporal lobe, excitotoxicity, nonconvulsive status epilepticus
MeSH terms: Brain Injuries, Traumatic / complications, Electroencephalography, Seizures / etiology, Case Reports, Adolescent, Female, Humans, Magnetic Resonance Imaging, Status Epilepticus / etiology

Introduction/background:
Non convulsive seizures (NCS) following traumatic brain injury (TBI) may remain undiagnosed due to lack of overt clinical manifestation and can have long-term sequelae due to delay in timely treatment. Occurrence of early NCS is known to have subsequent neurologic sequelae due to excitotoxic neuronal injury.
Case report:
This is a case report of a young girl who sustained a TBI due to a motor vehicle accident (MVA) and was admitted with a fluctuating level of consciousness. Her clinical presentation was attributed to TBI; however as her conscious level did not recover, an electroencephalogram (EEG) was requested, which detected non convulsive status epilepticus (NCSE). Anti-seizure medication (ASM) was started. Her follow-up EEG and magnetic resonance imaging (MRI) were suggestive of the potential adverse effects of prolonged NCSE.
Conclusion:
NCS may remain undiagnosed in TBI due to a paucity of overt clinical manifestations. Every patient with TBI and altered consciousness at presentation should be evaluated by continuous EEG monitoring immediately, if possible, in the emergency department to avoid long-term sequelae of NCS in such cases.
Successful inguinal interstitial brachytherapy in metastatic cervical carcinoma: a case report
Authors: Yi Qin, Ping Guan, Dan Li, Huailin He, Wenfeng He, Longjing Tan, Xiangyu Deng, Bizhen Liao, Qinglian Wen, Zhenhua Zhang
Journal: Front Oncol (2024)
Keywords: anlotinib, case report, cervical carcinoma, interstitial brachytherapy, multiple metastases
MeSH terms: Case Reports

Background:
Treatment of metastatic cervical cancer is a tricky issue. Currently, the National Comprehensive Cancer Network (NCCN) guideline recommends chemotherapy combined with bevacizumab for recurrent or metastatic cervical cancer. Still, the recurrence rate is high and the survival rate is low after standard treatment. We urgently need to achieve a multimodal therapy approach for recurrent or metastatic cervical cancer.
Case description:
We report the case of a patient with stage IB2 cervical squamous carcinoma who developed multiple metastases within a short term after receiving first-line standard treatment, and she underwent interstitial brachytherapy after systemic therapy with an encouraging outcome. The patient developed suspected inguinal lymph node metastases after 9 months at the end of first-line therapy and multiple metastases in the inguinal lymph nodes, anterior abdominal wall, and right lung after 17 months. As the patient had residual inguinal lymph nodes after systemic therapy, she received 3D-printed template-guided interstitial brachytherapy to the inguinal lymph nodes and maintenance therapy. By Sep 2023, she had achieved a good treatment outcome with a progression-free survival (PFS) of 36 months.
Conclusion:
Based on our patient response, when multiple metastases develop in the short term in early-stage cervical squamous carcinoma after first-line therapy, we may consider implementing local therapy combined with systemic therapy.
Severe pneumonia with empyema due to multiple anaerobic infections: case report and literature review
Authors: Fangyu Yu, Xiaojing Zhang, Yujiao Li, Wei Gai, Yafeng Zheng, Xudong Cai
Journal: Front Med (Lausanne) (2024)
Keywords: anaerobic, empyema, metagenomic next generation sequencing, mixed infection, severe pneumonia
MeSH terms: Case Reports

Background:
Cases of severe pneumonia complicated by empyema due to normal anaerobic flora from the oral cavity are infrequent. Diagnosing anaerobic infections through conventional microbiological test (CMT) is often challenging.
Case presentation:
This study describes the case of a 67-year-old man, bedridden long-term, who developed severe pneumonia with empyema caused by multiple anaerobic bacterial infections. The patient was hospitalized with a 5-day history of cough, sputum and fever, accompanied by a 2-day history of dyspnea. Despite CMT, the specific etiology remained elusive. However, metagenomic next-generation sequencing (mNGS) identified various anaerobic bacteria in bronchoalveolar lavage fluid (BALF), blood and pleural effusion. The patient was diagnosed with a polymicrobial infection involving multiple anaerobic bacteria. Following treatment with metronidazole and moxifloxacin, the patient's pulmonary symptoms improved.
Conclusion:
mNGS serves as a valuable adjunctive tool for diagnosting and managing patients whose etiology remains unidentified following CMT.
Case report: A case of primary angiitis of the central nervous system: misdiagnosed for 3.5 years
Authors: Lixia Qin, Miao He, Wei Lu
Journal: Front Neurol (2023)
Keywords: pacns, brain biopsy, misdiagnosis, mitochondrial encephalomyopathy, serial mris, tumor-like presentation
MeSH terms: Case Reports

Introduction:
Primary angiitis of the central nervous system (PACNS) is an uncommon inflammatory condition that exclusively affects blood vessels within the brain parenchyma, leptomeninges, and spinal cord. Due to its infrequency and the variability in its clinical presentation and imaging findings, diagnosing PACNS can be challenging.
Case description:
In this study, we present the case of a teenager who initially presented with headaches and epilepsy. Comprehensive laboratory tests yield normal results. A series of brain magnetic resonance imaging (MRI) revealed a progression of changes, starting from localized cerebral atrophy and culminating in the development of a contrast-enhanced mass with vasogenic edema. Immune-associated encephalitis and mitochondrial encephalopathy were suspected, but immunologic investigations, mitochondrial DNA (mtDNA) and nuclear DNA (nDNA) sequencing using biopsied muscle, and muscle pathologies were all negative. Ultimately, a diagnosis of PACNS was confirmed through a stereotactic brain biopsy, which took place 3.5 years after the onset of symptoms. The patient responded favorably to treatment with glucocorticoids and cyclophosphamide.
Conclusion:
In summary, we have described a case of PACNS characterized by localized cerebral atrophy and tumor-like MRI findings, who was misdiagnosed as immune-associated encephalitis or mitochondrial encephalopathy for 3.5 years. We emphasize the importance of dynamic observation of MRI changes, as well as brain biopsy.
Successful long-term management of metastatic clear cell renal cell carcinoma with nivolumab: a case report and literature review
Authors: Nicolás Duque Clavijo, Paula A Lara, John Alejandro Murillo Silva, Iván Camilo Triana, Henry Alexander Vargas, Luis Eduardo Pino, Javier Mauricio Segovia, Erick Andrés Cantor
Journal: Ecancermedicalscience (2023)
Keywords: clear cell renal cell carcinoma, complete remission, immune checkpoint inhibitor, immunotherapy, metastatic disease
MeSH terms: Case Reports

In Colombia, renal cancer is a rare condition, with clear cell renal cell carcinoma (ccRCC) being the most prevalent neoplasm. In recent years, immune checkpoint inhibitors (ICI) have been proposed for the management of metastatic disease, as they have shown improved rates of response and long-term survival. Furthermore, they exhibit a favourable tolerance profile, and adverse events causing significant morbidity are infrequent. We report the case of a 61-year-old male patient initially diagnosed with early-stage ccRCC who underwent right nephrectomy in 2009. Six years later, disease recurrence with metastatic compromise was documented, which led to the resection of the L1 vertebral body followed by radiotherapy and maintenance treatment with sunitinib. Due to disease progression, treatment with sunitinib was discontinued. Subsequently, everolimus was initiated as second-line immunotherapy, which was later discontinued due to the appearance of new metastatic lesions. In 2017, the patient was referred to our institution, where a third-line pharmacological treatment with nivolumab was initiated. In 2022, complete remission by positron emission tomography-computed tomography (PET-CT) was evidenced, which has been sustained to date. This case demonstrates the efficacy and safety of ICI in patients with metastatic ccRCC. The case presented is relevant in that it describes the achievement of complete remission in a patient who did not respond to the first two lines of immunotherapy. Given the limited literature regarding the discontinuation of therapy after achieving sustained remission, further research is warranted to explore this topic.
Pyruvate carboxylase deficiency type C; variable presentation and beneficial effect of triheptanoin
Authors: I Bernhardt, L Van Dorp, M Dixon, M McSweeney, C Gan, J Baruteau, A Chakrapani
Journal: JIMD Rep (2023)
MeSH terms: Case Reports

Pyruvate carboxylase is a mitochondrial enzyme essential for the tricarboxylic acid cycle (TCA), gluconeogenesis and fatty-acid synthesis. Pyruvate carboxylase deficiency (PCD) mostly presents with life-limiting encephalopathy (types A/B). A milder type C presentation is rare, with a comparatively favourable prognosis. Therapies remain essentially supportive. Triheptanoin is an odd-chain triglyceride, with the potential to replenish TCA intermediates (anaplerosis), and its metabolites cross the blood-brain-barrier. Outcomes of triheptanoin treatment in PCD types A/B have been disappointing, but have not been reported in type C. Here, we present two new patients with PCD type C, and report the response to treatment with triheptanoin in one. Patient 1 (P1) presented with neonatal-onset lactic acidosis and recurrent symptomatic lactic acidosis following exercise and during illnesses, with frequent hospitalisations. Speech development was delayed. MRI-brain showed delayed cerebral myelination. Patient 2 (P2) presented with episodic ketoacidosis, hyperlactataemia and hypoglycaemia at 2 years of age, with gross motor delay and mild global volume loss on MRI brain. Treatment with triheptanoin was commenced in P1 at 3 years of age with up-titration to 35 mL/day (25% of daily energy intake) over 6 months, due to transient diarrhoea. Dietary long-chain triglycerides were restricted, with fat-soluble vitamin supplementation. Subsequently, hospitalisations during intercurrent illnesses decreased, post-exertional hyperlactataemia resolved and exercise tolerance improved. Continued developmental progress was observed, and repeat MRI 18 months after initiation showed improved myelination. Triheptanoin was well-tolerated and appeared efficacious during 2 years' follow-up, and has potential to restore energy homeostasis and myelin synthesis in PCD type C.
A Case Report of Primary Malignant Melanoma of the Gallbladder with Multiple Metastases
Authors: Steven H Adams, Erinn Luo, Daniel Lozeau, Xiaoyun Wen
Journal: Case Rep Pathol (2023)
MeSH terms: Case Reports

Primary malignant melanoma of the gallbladder is an extremely rare tumor with approximately 39 cases described in the literature so far. However, since the first case was reported in 1907, it remains controversial whether gallbladder involvement in malignant melanoma is primary or metastatic. Here, we report a case of primary malignant melanoma of the gallbladder. A 52-year-old male presented to the emergency department with right upper quadrant abdominal pain and was found to have tumefactive sludge filling the majority of the gallbladder with possible gallbladder wall thickening on ultrasonography. A laparoscopic cholecystectomy was performed for presumed acute cholecystitis. Histopathologic examination of the gallbladder revealed malignant melanoma arising from the mucosa of the gallbladder. Further clinical investigation excluded other primary sites, supporting a diagnosis of primary malignant melanoma of the gallbladder.