OpenMed/multicare-articles huggingface dataset:
Vitiligo Adverse Event Observed in a Patient With Durable Complete Response After Nivolumab for Metastatic Renal Cell Carcinoma
Authors: Emilien Billon, Jochen Walz, Serge Brunelle, Jeanne Thomassin, Naji Salem, Mathilde Guerin, Cecile Vicier, Slimane Dermeche, Laurence Albiges, Florence Tantot, Soazig Nenan, Geraldine Pignot, Gwenaëlle Gravis
Journal: Front Oncol (2019)
Keywords: complete response, immune adverse events, immunotherapy, nephrectomy, nivolumab, renal cell carcinoma, thyroid dysfunction, vitiligo
MeSH terms: Case Reports

Background: Renal cell carcinoma is the third most prevalent urological cancer worldwide and about 30% of patients present with metastatic disease at the time of diagnosis. Systemic treatments for metastatic renal cell carcinoma have improved recently. Vascular endothelial growth factor targeting therapies were the previous standard of care. However, immune checkpoint inhibitors used in second line therapy have now been shown to improve patient survival. We report a case of metastatic renal cell carcinoma with nivolumab as a second-line therapy after progression with tyrosine kinase inhibitor therapy. Unusual adverse events in metastatic renal cell carcinoma, such as vitiligo, were observed in this patient who developed a remarkable documented pathological complete response to his renal tumor. Case presentation: A 60-year-old caucasian male was diagnosed with a pulmonary metastatic clear cell renal cell carcinoma. Sunitinib was used as first line treatment without success. He received nivolumab in second-line treatment. He developed several immune-related adverse events, most notably vitiligo. The patient had a radiological complete response on metastatic sites, with a significant decrease of renal tumor volume and underwent cytoreductive nephrectomy after 2 years of treatment, confirming the pathological complete response. The patient remains disease-free for 10 months without further systemic therapy after nivolumab discontinuation. Conclusions: Pathological complete response with nivolumab in metastatic renal cell carcinoma is rare. This case further highlights the potentially predictive role of immune-related adverse events during nivolumab therapy for metastatic renal cell carcinoma and raises questions concerning the role of nephrectomy after immune checkpoint inhibitor therapy. Further studies are needed to better identify predictive factors for treatment response to immunotherapy in metastatic renal cell carcinoma, and to better understand the role of nephrectomy after nivolumab treatment.
Pneumonia and Pleural Empyema due to a Mixed Lactobacillus spp. Infection as a Possible Early Esophageal Carcinoma Signature
Authors: Eleftheria Chaini, Nikolaos D Chainis, Anastasios Ioannidis, Maria Magana, Chryssoula Nikolaou, Joseph Papaparaskevas, Melina-Vassiliki Liakata, Panagiotis Katopodis, Leonidas Papastavrou, George P Tegos, Stylianos Chatzipanagiotou
Journal: Front Med (Lausanne) (2016)
Keywords: lactobacillus delbrueckii, lactobacillus gasseri, bacterial translocation, esophageal carcinoma, pleural empyema, pneumonia
MeSH terms: Case Reports

Lactobacilli are human commensals found in the gastrointestinal and genitourinary tract. Although generally conceived as non-pathogenic microorganisms, the existence of several reports implicating them in certain severe pathological entities renders this species as opportunistic pathogens. The case of a 58-year-old woman with mixed Lactobacillus infection is described. The patient was admitted in an outpatient clinic with community acquired pneumonia, and on the third day of hospitalization she presented rapid pneumonia deterioration. Subsequent imaging techniques revealed increased pleural empyema in alignment with the general deterioration of her clinical condition. Pleural fluid culture revealed the presence of Lactobacillus delbrueckii and Lactobacillus gasseri and the infection was successfully treated with clindamycin. Five months after hospital discharge and an overall good condition, the patient developed signs of dysphagia and upon re-admission an inoperable esophageal carcinoma was diagnosed. The patient succumbed to the cancer 11 months later. Herein, we report for the first time a mixed respiratory infection due to lactobacilli, possibly associated with a formerly unveiled esophageal malignancy.
Federico di Montefeltro's hyperkyphosis: a visual-historical case report
Authors: Anthony V D'Antoni, Stephanie L Terzulli
Journal: J Med Case Rep (2008)

Introduction:
The literature contains several publications describing the use of visual arts to develop observational skills in medical students. Portraits of individuals of the Italian Renaissance can be used to enhance these skills and stimulate the development of differential diagnoses in medical students. The Duke of Urbino, Federico di Montefeltro (1422-1482), lost his right eye and nasal bridge during a jousting accident in 1450. Consequently, almost every profile of him in existence today depicts his face in a left lateral view. Although some authors have described the Duke's missing nasal bridge, none have described his prominent thoracic hyperkyphosis, which is clearly discernible in two paintings by Piero della Francesca. The purpose of this report is to describe the Duke's hyperkyphosis, develop relevant differential diagnoses, and suggest a possible etiology of the convexity.
Case presentation:
We have examined two paintings of the Duke by Piero della Francesca - the diptych, The Duke and Duchess of Urbino (1465), and the Madonna of the Egg (1472). A MEDLINE search revealed 2 articles that were relevant to this study. This search was complemented by a search of the collection at the library of Seton Hall University, and the first author's experience studying at the University of Urbino. The historical data obtained from these searches were incorporated with the visual analysis to formulate a plausible etiology of the Duke's thoracic hyperkyphosis.
Conclusion:
Differential diagnoses of the Duke's thoracic hyperkyphosis include Scheuermann disease, osteoporosis, and trauma-related spinal changes. Based on the available evidence, the Duke's thoracic hyperkyphosis could have been caused by repetitive trauma to the spine due to numerous hours on horseback with heavy armor. The role that osteoporosis played in the development of the hyperkyphosis is unclear, as is whether the Duke had the convexity during childhood. The hyperkyphosis as a stylistic variant by Piero della Francesca is unlikely. This report is an example of a teaching strategy that can be used to enhance the observational skills of medical students in evidence-based medical education.
Do novo del(9)(p13) in a childhood T-cell prolymphocytic leukemia as sole abnormality
Authors: Abdulsamad Wafa, Abdulmunim Aljapawe, Moneeb Ak Othman, Thomas Liehr, Eyad Alhourani, Walid Al Achkar
Journal: Exp Hematol Oncol (2014)
Keywords: childhood t-cell prolymphocytic leukemia (t-pll), chromosomal aberrations, fluorescence in situ hybridization (fish), multicolor banding (mcb)
MeSH terms: Case Reports

T-cell prolymphocytic leukemia (T-PLL) is a rare and aggressive subtype of chronic lymphocytic leukemia. Usually it presents in older people with a median age of 61 years. T-PLL is characterized by elevated white blood cell (WBC) count with anemia and thrombocytopenia, hepatosplenomegaly, and lymphadenopathy; less common findings are skin infiltration and pleural effusions. The most frequent chromosomal abnormalities in T-PLL include 14q11.2, chromosome 8, and 11q rearrangements. Also deletions in the short arm of a chromosome 9 are reported in ~30% of T-PLL together with other aberrations. Here we report a childhood T-PLL case with a de novo del(9)(p13) as sole acquired anomaly leading to monosomy of the tumor suppressor gene CDKN2A (cyclin-dependent kinase inhibitor 2A). Also, to the best of our knowledge this is the first case of a childhood T-PLL with this aberration.
Lack of flow on time-of-flight MR angiography does not always indicate occlusion
Authors: Grant Mair
Journal: BJR Case Rep (2015)
MeSH terms: Case Reports

A patient presented acutely with symptoms of cerebellar ischaemia. While non-contrast CT imaging was normal, MRI demonstrated an apparent occlusion of the left vertebral artery on time-of-flight angiography. However, concurrent contrast-enhanced MR angiography (and subsequent CT angiography) demonstrated normal contrast filling of the left vertebral artery. This article discusses the benefits and limitations of time-of-flight angiography for the investigation of possible stroke and highlights a particular technical limitation which could be misinterpreted as an arterial occlusion.
Lung Volume Reduction following Recurrent Pneumonia: An Unusual Finding in a COPD Patient
Authors: Yihenew Negatu, Philip T Diaz
Journal: Case Rep Med (2017)
MeSH terms: Case Reports

Chronic Obstructive Pulmonary Disease (COPD) is a progressive disease. Frequent pneumonias and exacerbations are known to accelerate its progression. We present a case of severe emphysema whose lung function paradoxically improved following recurrent pneumonia, without lung volume reduction surgery (LVRS). A 54-year-old female with severe COPD presented for LVRS evaluation. She was not a candidate for the surgery because of the unsuitable anatomic distribution of her emphysema. The patient experienced recurrent pneumonia over the years but her lung function and oxygen requirement showed marked improvement. Follow-up imaging studies showed decreased lung volumes and focal fibrotic changes. We believe that the improvement in her lung function overtime is the reflection of lung volume reduction as a result of parenchymal remodeling due to repeated lung infection. These findings seen in our patient contribute important information for the continued effort in developing nonsurgical lung volume reduction techniques.
Cyclin-Dependent Kinase 4/6 Inhibitor (Palbociclib) Induced Aplastic Anemia in a Patient with Metastatic Breast Cancer
Authors: Stanley Madu Nwabudike, Camille V Edwards, Oladimeji Akinboro, Kathryn Quinn, Shayna Sarosiek, Naomi Ko
Journal: Case Rep Hematol (2018)
MeSH terms: Case Reports

Breast cancer is the most common cancer diagnosed in women worldwide. Over the years, breast cancer treatment has undergone revolutionary changes especially for women with hormone receptor positive metastatic disease. As a result, women are living longer with their disease, particularly in developed countries. The use of cyclin-dependent kinase (CDK) 4/6 inhibitors with antiestrogen therapy is a relatively new therapeutic option which has been shown to improve progression-free survival. Hematologic adverse events, most frequently neutropenia, are well-known side effects of CDK 4/6 inhibitors. However, to our knowledge, aplastic anemia has never been reported. We report a case of aplastic anemia in a patient with metastatic breast cancer treated with palbociclib after multiple prior lines of therapy.
A Novel Four-Way Complex Variant Translocation Involving Chromosome 46,XY,t(4;9;19;22)(q25:q34;p13.3;q11.2) in a Chronic Myeloid Leukemia Patient
Authors: Muhammad Asif, Mohammad Sarwar Jamal, Abdul Rehman Khan, Muhammad Imran Naseer, Abrar Hussain, Hani Choudhry, Arif Malik, Shahida Aziz Khan, Maged Mostafa Mahmoud, Ashraf Ali, Saima Iram, Kashif Kamran, Asim Iqbal, Zainularifeen Abduljaleel, Peter Natesan Pushparaj, Mahmood Rasool
Journal: Front Oncol (2016)
Keywords: bcr–abl gene, philadelphia chromosome, chronic myeloid leukemia, complex variant translocation
MeSH terms: Case Reports

Philadelphia (Ph) chromosome (9;22)(q34;q11) is well established in more than 90% of chronic myeloid leukemia (CML) patients, and the remaining 5-8% of CML patients show variant and complex translocations, with the involvement of third, fourth, or fifth chromosome other than 9;22. However, in very rare cases, the fourth chromosome is involved. Here, we found a novel case of four-way Ph+ chromosome translocation involving 46,XY,t(4;9;19;22)(q25:q34;p13.3;q11.2) with CML in the chronic phase. Complete blood cell count of the CML patient was carried out to obtain total leukocytes count, hemoglobin, and platelets. Fluorescence in situ hybridization technique was used for the identification of BCR-ABL fusion gene, and cytogenetic test for the confirmation of Ph (9;22)(q34;q11) and the mechanism of variant translocation in the bone marrow. The patient is successfully treated with a dose of 400 mg/day imatinib mesylate (Gleevec). We observed a significant decrease in white blood cell count of 11.7 × 10(9)/L after 48-month follow-up. Patient started feeling better generally. There was a reduction in the swelling of the body, fatigue, and anxiety.
Diagnostic and Therapeutic Approach in a Patient with Buerger's and Coronary Artery Disease
Authors: Fotios Mitropoulos, Fotios Eforakopoulos, Meletios A Kanakis, Maria Vassili, Irene Mastorakou, Michael Georgiadis
Journal: Case Rep Med (2013)

Occlusive coronary artery disease coexisting with Buerger's disease has rarely been reported. Potential difficulties regarding diagnostic workup and therapeutic management in this group of patients are discussed through this case report. We present an interesting case of a 52-year-old patient suffering from Buerger's disease, with a history of generalized peripheral occlusive arteriopathy, who presented with acute coronary syndrome. A difficulty in accessing and performing coronary angiography was evident due to the vascular status of the patient. Diagnosis was performed by computed tomography (CT) of the coronary arteries. It showed 80-90% obstruction of the LAD, and since percutaneous coronary intervention was impossible, a single aortocoronary bypass grafting was performed with the off-pump technique. Coronary artery disease coexisting with Burger's disease is a rare entity, and CT angiography is a useful diagnostic tool, when the classic angiography could not be performed. In addition, off-pump coronary artery bypass should be the therapeutic option of choice in this high risk group of patients. The uncomplicated postoperative course of the patient and his hitherto good condition showed that both diagnostic and therapeutic procedures were the best possible.
Exploring students' learning experience in online education: analysis and improvement proposals based on the case of a Spanish open learning university
Authors: Pablo Rivera-Vargas, Terry Anderson, Cristina Alonso Cano
Journal: Educ Technol Res Dev (2021)
Keywords: autonomous learning, competences in digital technologies, digital divide, online education, student support

Not surprisingly, the number of online universities continues to expand-especially in Covid-19 times. These institutions all offer "online education" with diverse institutional, technological, and pedagogical processes. However, a fundamental element has to do with the experience of the students, and how they adapt to the educational model of the online university in which they are studying. In this article, we present the main results of the case-study developed in one of the most historical and relevant virtual universities in an international context. We have explored and analysed the process of adaptation to the educational model by the student body, and their perceptions of their interactions with the pedagogical, institutional, and technological elements designed to support their learning. Qualitative and quantitative methods are used to gather and analyse the data. From 1715 students who participated in the survey and the perceptions of 30 students individually interviewed, the results show positive evaluations regarding the integration and adoption of technological competencies, and also, that the online education generally serves as a responsive model to the emergent needs of the learner. However, the results also show that students have important concerns regarding the pedagogical and institutional support provided.
Diffuse Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage in a 15-Year-Old Girl: A Case Report
Authors: Dajeong Lee, Jeehun Lee, Keon Ha Kim, Ji Hye Kim, Jiwon Lee
Journal: Front Radiol (2022)
Keywords: diffuse cerebral vasospasm, pediatric multiple aneurysm, seizure, subarachnoid hemorrhage, triple-h therapy
MeSH terms: Case Reports

Diffuse cerebral vasospasm after subarachnoid hemorrhage (SAH) is a complication resulting in an ischemic condition presenting with altered mentality and followed by motor or speech impairment. It is uncommon in pediatric population and requires differential diagnosis from Moyamoya disease, which is relatively common in Korea. We report a case of a 15-year-old girl who was presented with a seizure and subsequent headache, poor oral intake, and altered mentality, who was finally diagnosed with sporadic vasospasm followed by multiple aneurysm ruptures. The patient had recurrent seizures and persistent headache at the time of transfer. On the second day after transfer, she showed focal motor weakness and dysarthria, and her symptoms gradually progressed, showing paraplegia and aphasia on the third hospitalization day. Brain magnetic resonance imaging and magnetic resonance angiography demonstrated diffuse narrowing cerebral vasospasm of bilateral middle cerebral arteries, anterior cerebral arteries, and distal internal carotid arteries and three unruptured aneurysms. The patient was treated with intravenous hydration and nimodipine to expand the narrowed vessels. After confirming that the vessels were enlarged, we successfully executed the endovascular coil embolization. Her neurological deficits were improved through medical, interventional, and rehabilitation treatments and fully restored 11 months after discharge.
New observations in the fragile X-associated tremor/ataxia syndrome (FXTAS) phenotype
Authors: Avram Fraint, Padmaja Vittal, Aimee Szewka, Bryan Bernard, Elizabeth Berry-Kravis, Deborah A Hall
Journal: Front Genet (2014)
Keywords: cgg, fmr1, fxs, fxtas, premutation
MeSH terms: Case Reports

Purpose:
Fragile X-associated tremor/ataxia syndrome (FXTAS) was originally defined as tremor, ataxia, cognitive decline, and parkinsonism in individuals who carry between 55 and 200 CGG repeats in the promoter region of the fragile X mental retardation 1 (FMR1) gene. This paper describes a series of patients who meet the definition of FXTAS who presented for care between 2009 and 2014.
Methods/results:
Retrospective chart review of patients seen in the FXTAS clinic at Rush University in Chicago.
Conclusions:
Patients with FXTAS may present with a progressive supranuclear palsy-like phenotype and other eye movement abnormalities are common in these patients as well. Rapid worsening of gait abnormalities in FXTAS may be due to a secondary spinal issue and should be aggressively treated to regain function. Finally, the FXTAS Rating Scale score does not reliably inform the certainty of diagnosis or CGG repeat size in these patients.
Subdural hematoma: an adverse event of electroconvulsive therapy-case report and literature review
Authors: Ranganath R Kulkarni, Sateesh Melkundi
Journal: Case Rep Psychiatry (2012)

Electroconvulsive therapy (ECT) is commonly used in the management of medication nonresponsive depressive disorder, with proven efficacy in psychiatric practice since many decades. A rare complication of intracranial bleed following this therapeutic procedure has been reported in sporadic case reports in the English literature. We report a case of such a complication in a 42-year-old male, a known case of nonorganic medication nonresponsive depressive disorder for the last two years who required ECT application. Presenting symptoms included altered mental state, urinary incontinence, and repeated episodes of vomiting; following ECT procedure with magnetic resonance imaging (MRI) of the brain suggestive of bilateral acute subdural hematoma. Despite the view that it may be used in neurological conditions without raised intracranial tension, it will be worthwhile to be vigilant during post-ECT recovery for any emergent complications.
An unusual case of an ulcerative colitis flare resulting in disseminated intravascular coagulopathy and a bladder hematoma: a case report
Authors: David L Suskind, Karen Murray, Dennis Christie
Journal: BMC Gastroenterol (2004)
MeSH terms: Colitis, Ulcerative / complications, Disseminated Intravascular Coagulation / etiology, Hematoma / etiology, Urinary Bladder Diseases / etiology, Case Reports, Adolescent, Humans, Male

Background:
Disorders of coagulation have long been associated with inflammatory bowel disease. Children, as well as adults, with both active and inactive ulcerative colitis have been found to have abnormal coagulation and fibrinolysis. Disseminated intravascular coagulation arises from an overwhelming of the haemostatic regulatory mechanisms leading to an excessive generation of thrombin and a failure of the normal inhibitory pathways to prevent systemic effects of this enzyme. Ulcerative colitis has been associated with disseminated intravascular coagulation in conjunction with septicemia, toxic megacolon and surgery.
Case presentation:
A fourteen-year-old boy with a history of poorly controlled ulcerative colitis presented with nonbilious emesis, hematochezia, and hematuria. Laboratory workup revealed disseminated intravascular coagulation. He was placed on triple antibiotics therapy. An infectious workup came back negative. A computerized tomography (CT) scan of the abdomen revealed a marked thickening and irregularity of the bladder wall as well as wall thickening of the rectosigmoid, ascending, transverse, and descending colon. Patient's clinical status remained stable despite a worsening of laboratory values associated with disseminated intravascular coagulation. Patient was begun on high dose intravenous steroids with improvement of the disseminated intravascular coagulation laboratory values within 12 hours and resolution of disseminated intravascular coagulopathy within 4 days. A thorough infectious workup revealed no other causes to his disseminated intravascular coagulation.
Conclusions:
The spectrum of hypercoagulable states associated with ulcerative colitis varies from mild to severe. Although disseminated intravascular coagulation associated with ulcerative colitis is usually related to septicemia, toxic megacolon or surgery, we present a case of an ulcerative colitis flare resulting in disseminated intravascular coagulation and a bladder hematoma.
Trichobezoar Causing Airway Compromise during Esophagogastroduodenoscopy
Authors: Erica Y Kao, Nicholas J Scalzitti, Gregory R Dion, Sarah N Bowe
Journal: Case Rep Med (2015)

Objectives. (1) Report the case of a 5-year-old female with trichotillomania and trichophagia that suffered airway compromise during esophagogastroduodenoscopy for removal of a trichobezoar. (2) Provide management recommendations for an unusual foreign body causing extubation and partial airway obstruction. Methods. Case report of a rare situation of airway compromise caused by a trichobezoar. Results. A 5-year-old patient underwent endoscopic retrieval of a gastric trichobezoar (hairball) by the gastroenterology service under general endotracheal anesthesia in a sedation unit. During removal, the hairball, due to its large size, dislodged the endotracheal tube, effectively extubating the patient. The bezoar became lodged at the cricopharyngeus muscle. Attempts to remove the bezoar or reintubation were unsuccessful. The child was able to be mask ventilated while the otolaryngology service was called. Direct laryngoscopy revealed a hairball partially obstructing the view of the glottis from its position in the postcricoid area. The hairball, still entrapped in the snare from the esophagoscope, was grasped with Magill forceps and slowly extracted. The patient was then reintubated and the airway and esophagus were reevaluated. Conclusions. Trichobezoar is an uncommon cause of airway foreign body. Careful attention to airway management during these and similar foreign body extractions can prevent inadvertent extubations.