OpenMed/multicare-articles huggingface dataset:
Case Report: Complete atrioventricular block in an elderly patient with acute pulmonary embolism
Authors: Moojun Kim, Chang-Ok Seo, Hangyul Kim, Hye Ree Kim, Kyehwan Kim, Min Gyu Kang, Jeong Rang Park
Journal: Front Cardiovasc Med (2024)
Keywords: atrioventricular block, left bundle branch block, pulmonary embolism, right bundle branch block, right ventricle
MeSH terms: Case Reports

Introduction:
Multiple abnormal electrocardiographic findings have been documented in patients experiencing acute pulmonary embolism. Although sinus tachycardia is the most commonly encountered rhythmic disturbance, subsequent reports have highlighted other findings. These include right bundle branch block, right axis deviation, nonspecific ST segment/T wave changes, and T wave inversion in the right precordial leads. To date, only a limited number of cases involving a complete atrioventricular block have been reported in acute pulmonary embolism.
Case presentation:
Here, we present the case of a 91-year-old woman with acute pulmonary embolism, whose initial electrocardiogram showed a complete atrioventricular block. She presented with presyncope and an initial blood pressure of 77/63 mmHg. Echocardiography confirmed signs of right ventricular dysfunction. Catheter-directed thrombolysis and a temporary pacemaker insertion were carried out sequentially. The following day, electrocardiography showed sinus rhythm with a left bundle branch block.
Discussion:
The presence of a complete atrioventricular block in patients with acute pulmonary embolism serves as a clinical marker of high-risk status.
A Case Report of Dextrocardia with Situs Inversus: A Rare Condition and Its Clinical Importance
Authors: Girma Deshimo, Haile Abebe, Getiye Damtew, Enguday Demeke, Seife Feleke
Journal: Case Rep Med (2024)
MeSH terms: Case Reports

Situs inversus totalis (SIT) is a rare medical condition characterized by a complete mirror-image reversal of the normal positioning of the internal organs. Aristotle initially described situs inversus in animals, while Fabricius first characterized it in humans. Although the specific cause is uncertain, there is evidence of autosomal recessive and X-linked inheritance. Before seeking treatment for an unrelated ailment, many people with SIT are unaware of their distinct anatomy, as in our case. The presented case is a 30-year-old female patient from Central Ethiopia, presented to Hakim Gizaw Teaching Hospital outpatient department of medicine with the complaint of right-sided anterior chest pain for five days. Clinically, the apical beat was heard in the right 5th intercostal space. After undergoing an electrocardiogram (ECG), echocardiogram, chest X-ray, and abdominal ultrasound, she was diagnosed with situs inversus totalis. The clinical implications of SIT encompass challenges in diagnosis and procedures, potential congenital cardiac abnormalities, considerations for organ transplantation, and clinical decision-making, particularly in emergency scenarios. Key Clinical Messages. This case highlights the clinical implications of dextrocardia with situs inversus totalis, emphasizing the importance of awareness for accurate diagnosis, procedural challenges, and informed clinical decision-making. Understanding this rare condition is crucial for providing appropriate medical care and to navigate potential complications in affected individuals.
A case report on a rare case of primary tuberculous otitis media
Authors: Dr Yadav Sagar Shyamlal, Dr Shikha Gianchand, Dr Rahul Kurkure
Journal: J Otol (2024)

Although tuberculosis has become more common in recent years, it still accounts for just a small percentage of cases of chronic otitis media. Common symptoms of tuberculous otitis media (TOM) include otorrhoea, hearing loss, and multiple tympanic membrane perforations. Due to its rarity, the illness is frequently misdiagnosed. When a patient does not improve with standard antibacterial and antifungal treatment, this may be a possible diagnosis to explore. Complete healing is possible if the illness is diagnosed and treated timely to prevent consequences.
Dextrocardia With Situs Inversus in a COVID-19 Patient
Authors: Anastasia Rigatou, Konstantinos C Christodoulou, Xafnoula Zlatidou, Ioannis Nikolakakis
Journal: Cureus (2024)
Keywords: anatomic variation, clinical examination, electrocardiography (ecg), miror anatomy, sars-cov-2
MeSH terms: Case Reports

With an estimated incidence of one in 10,000 to one in 50,000 patients, Situs inversus totalis (SIT) is a rare innate anomaly, portraying a mirror image of the normal anatomy, as the cardiac position and abdominal viscera are completely inverted. Despite the fact that physicians and researchers have been dealing with the SARS-CoV-2 pandemic for three years, there is a lack of published data examining the potential effects of anatomic variations on coronavirus disease 2019 (COVID-19) infection. This study aimed to contribute to this domain by presenting a rare case of a COVID-19 infection coexisting with SIT as one of the very few cases reporting the simultaneous presence of the two pathologies. We sought to present this case of COVID-19 in a quinquagenarian female, in whom SIT was an incidental radiological finding. The reversed anatomy did not seem to affect the clinical progression of the virus. However, due to the lack of scientific evidence, the potential long-term effects, if any, of COVID-19 on SIT cannot be predicted. The recognition of the mirror pattern will offer a personalized treatment plan, reducing the risk of severe complications and management mishaps.
A case report of dipeptidyl peptidase 4 inhibitor-related kidney disease combined with renal cancer
Authors: Shigekazu Kurihara, Naoki Sawa, Keiichi Sumida, Daisuke Ikuma, Yuki Oba, Hiroki Mizuno, Akinari Sekine, Masayuki Yamanouchi, Eiko Hasegawa, Tatsuya Suwabe, Shinji Urakami, Kei Kono, Keiichi Kinowaki, Kenichi Ohashi, Yutaka Yamaguchi, Yoshifumi Ubara
Journal: Front Nephrol (2024)
Keywords: dipeptidyl peptidase (dpp) 4 inhibitors, end-stage renal failure, kidney biopsy, renal cell carcinoma, thrombotic microangiopathy (tma)-like lesion
MeSH terms: Case Reports

A kidney biopsy was performed in a 64-year-old woman with type 2 diabetes mellitus and less than 1 g of proteinuria who rapidly progressed to end-stage renal failure after approximately 2 years of treatment with two dipeptidyl peptidase 4 (DPP-4) inhibitors for type 2 diabetes mellitus. The biopsy revealed not only a coincidental diagnosis of renal cell carcinoma, which was not evident on pre-biopsy computed tomography, but also severe thrombotic microangiopathy (TMA)-like glomerular endothelial cell damage in the noncancerous areas. These results suggest that DPP4 inhibitors may have been involved in two kidney diseases.
Case report: Unveiling a less severe congenital nephrotic syndrome in a Rapa Nui patient with a NPHS1 Maori founder variant
Authors: Paola Krall, Angélica Rojo, Anita Plaza, Sofia Canals, María Luisa Ceballos, Francisco Cano, José Luis Guerrero
Journal: Front Nephrol (2024)
Keywords: maori founder variant, nphs1, rapa nui (easter island), congenital nephrotic syndrome, kidney survival
MeSH terms: Case Reports

Background:
Congenital nephrotic syndrome (CNS) is a severe kidney disorder characterized by edema, massive proteinuria, and hypoalbuminemia that manifests in utero or within three months after birth. CNS affects 1-3 per 100,000 children, primarily associated with genetic variants and occasionally with infections. Genetic analysis is the first-line method for diagnosis. The most common founder variants have been identified in European populations, often resulting in end-stage kidney disease by 1-2 years of age.
Case-diagnosis/treatment:
A female full-term neonate, without prenatal signs of kidney disease, was admitted to Rapa Nui (Eastern Island) Hospital at the age of 2 months due to bronchial obstruction. She presented fever, oliguria, edema, urine protein-to-creatinine ratio (UPCR) 433.33, and hypoalbuminemia (0.9 g/dL). She was transferred to a mainland Chilean hospital following CNS diagnosis. Viral screening detected cytomegalovirus (CMV) positivity in both blood and urine. A kidney biopsy revealed interstitial nephritis and diffuse podocyte damage and the tissue PCR resulted negative for CMV. Interviews with the parents revealed consanguinity, suggestive of hereditary CNS. Genetic analysis identified the Maori founder variant, NPHS1 c.2131C>A (p.R711S), in homozygosis. The patient received albumin infusions and antiviral therapy, being discharged when she was 5 months old, with improved laboratory parameters evidenced by UPCR 28.55, albumin 2.5 g/dL, and cholesterol 190 mg/dL. Subsequent clinical monitoring was conducted through virtual and in-person consultations. At her last follow-up at 4 years 2 months old, she presented UPCR 16.1, albumin 3.3 g/dl and cholesterol 220 mg/dL, maintaining normal kidney function and adequate growth.
Conclusions:
To our knowledge, this represents the first case of CNS in Chile carrying a NPHS1 variant associated with prolonged kidney survival. As described in the Maori population, the patient exhibited a less severe clinical course compared to classical NPHS1 patients. Genetic testing for the Maori founder variant in CNS patients related to the New Zealand population, could impact management decisions and potentially prevent the need for nephrectomies.
The Last Straw: How Stress Can Unmask Parkinson's Disease
Authors: Anouk van der Heide, Claudia Trenkwalder, Bastiaan R Bloem, Rick C Helmich
Journal: J Parkinsons Dis (2024)
MeSH terms: Parkinson Disease / complications, Stress, Psychological, Case Reports, Aged, Diagnostic Errors, Female, Humans, Middle Aged, Tremor / etiology

We discuss two people with Parkinson's disease (PD), in whom tremor manifested directly following a severely stressful event. Both were initially misdiagnosed with a functional neurological disorder. These stories highlight that stress can trigger the onset of clinical manifestations of PD, by unveiling an underlying disease that had been unfolding for many years. Thus, the sudden symptom onset after a stressful event is not unique to functional disorders, and may lead to avoidable feelings of guilt if people wrongly attribute PD to this event. It remains unclear what mechanism explains this phenomenon, and why symptoms persist after the stressful event has passed.
Immune-Related Peripheral Neuropathy Associated with Immune Checkpoint Inhibitors: Case Report and Review of Literature
Authors: Carlos Eduardo Bonilla, Vaneza Ávila
Journal: Case Rep Oncol Med (2024)
MeSH terms: Case Reports

Immune checkpoint inhibitors (ICIs) are a group of drugs that have improved outcomes for patients with various cancers. Generally considered safe and well tolerated, these drugs are occasionally linked to immune-mediated or immune-related adverse events. Among these, autoimmune neurological events are rare, displaying varying incidence rates across different studies. Peripheral neuropathy, although one of the more common neurological immune-related events, is at times underestimated. This case report highlights an adult patient diagnosed with metastatic intrahepatic cholangiocarcinoma. Initially, the patient underwent chemoimmunotherapy with gemcitabine, cisplatin, and durvalumab for eight cycles, achieving partial response without significant toxicity. Following this, the patient continued with maintenance monotherapy with durvalumab every 28 days. After completing six cycles of maintenance therapy, the patient suddenly experienced paresthesia and hypoesthesia in four limbs, accompanied by apraxia in the hands that was more pronounced on the right side. Additionally, the patient reported neuropathic pain in the right arm and encountered limitations in certain instrumental activities of daily living. Diagnostic studies, including laboratory and electrophysiological studies, combined with the clinical presentation, identified immune-related peripheral polyneuropathy. Durvalumab was suspended and prednisolone therapy was initiated, resulting in a rapid resolution of all neuropathic symptoms. In addition to the clinical case, this article reviews the literature on immunotherapy-associated peripheral neuropathy.
Radiation-Induced Low-Grade Glioma following Radiotherapy for Squamous Cell Carcinoma of the Scalp: Case Report and Literature Review
Authors: Moayad M Z Ahmed, Fawaz E M Abdelradi, Rabee A ELfeel
Journal: Case Rep Surg (2024)
MeSH terms: Case Reports

Introduction:
Radiation-induced gliomas (RIGs) were reported in the literature in general. In most of the reported cases and the reviewed articles, patients have a history of primary intracranial tumors like craniopharyngioma, medulloblastoma, and ependymoma, and the commonly resulting secondary tumors are meningiomas and sarcomas, mainly not gliomas. Case Presentation. A 50-year-old woman had a history of left scalp temporal region periauricular squamous cell carcinoma, which was verified by the histology result of a biopsy 11 years ago. On the basis of that, she began receiving low-dose radiation sessions when she was 39 years old. She exhibits cranial symptoms and a radiological sign of cancer 9 years later. After a successful excision procedure, histology revealed diffuse astrocytoma Grade 2. Our case is suspected to fit the criteria for being identified as RIG, which is a syndrome that is thought to occur infrequently in the literature.
Conclusion:
In conclusion, the way that this condition manifested in our case is considered rare due to old age and the low doses of radiation received. Despite being an important part to confirm the diagnosis, genetic studies were unfortunately not done in our case, but we mainly based on the criteria mentioned by Cahan et al., which are mainly taken from the clinical history and histopathology. Here, we present an example of considering such a diagnosis when suspected clinically, but a genetic study for confirmation should be thought of even if it is not available in the locality.
Spontaneous Subcapsular Renal Hematoma as Cause of Hypovolemic Shock in a Chronic Hemodialysis Patient
Authors: Jorge Luis Bermudez-Gonzalez, Bethsabel Rodríguez-Encinas, Ángel Miguel Beverido-Florido, Jesús Alejandro Gabutti-Thomas
Journal: Case Rep Radiol (2023)
MeSH terms: Case Reports

Subcapsular renal hematomas may appear spontaneously in patients in chronic hemodialysis, though other causes as neoplasms, vasculitis, and infections should be excluded. Patients may present with abdominal pain and hemorrhagic shock; hence, early diagnosis is vital. Nephrectomy or renal artery embolization are suitable treatment options.
Case report: Breaking CNS immuno-privilege: TNFα-inhibitor triggers aseptic meningitis in a patient with rheumatoid arthritis
Authors: Benedetta Kassabian, Monica Facco, Alessandro Miscioscia, Samuela Carraro, Francesca Rinaldi, Paolo Gallo, Marco Puthenparampil
Journal: Front Immunol (2024)
Keywords: pet-mri, aseptic meningitis, blood-brain barrier, cerebrospinal fluid, etanercept, rheumatoid arteritis
MeSH terms: Arthritis, Rheumatoid / drug therapy, Etanercept / adverse effects, Etanercept / therapeutic use, Meningitis, Aseptic / chemically induced, Tumor Necrosis Factor-alpha / antagonists & inhibitors, Case Reports, Antirheumatic Agents / adverse effects, Antirheumatic Agents / therapeutic use, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Positron-Emission Tomography, Tumor Necrosis Factor Inhibitors / adverse effects, Tumor Necrosis Factor Inhibitors / therapeutic use, Tumor Necrosis Factor-alpha, Etanercept, Antirheumatic Agents, Tumor Necrosis Factor Inhibitors

Blood-brain barrier dysfunction might be driven by peripheral inflammation. TNFα inhibitors (TNF-αi) are occasionally associated with a wide spectrum of neurological immuno-mediated disorders. However, patients with systemic autoimmune disorders, including rheumatoid arthritis (RA), might be prone to develop further organ-specific, including central nervous system (CNS), autoimmunity. Here we report the case of a patient, affected by RA and treated with etanercept, who suddenly developed focal neurological symptoms. Cerebrospinal fluid, magnetic resonance imaging (MRI), and positron emission tomography (PET)/MRI findings are reported and support the diagnosis of TNF-αi -associated aseptic meningitis.
A case report: Gliosarcoma associated with a germline heterozygous mutation in MSH2
Authors: Yuhan Wang, Zhiyuan Zhang
Journal: Front Neurol (2024)
Keywords: lynch syndrome, msh2, case report, germline heterozygous mutation, gliosarcoma
MeSH terms: Case Reports

Gliosarcoma is a rare subtype of glioblastoma (GBM) with a shorter medical history and a worse prognosis compared to other Grade 4 gliomas. Most gliosarcomas are sporadic, but it is undeniable that a small percentage are linked to germline mutations and several inherited cancer susceptibility syndromes, including Lynch Syndrome (LS). The authors present a case of a primary mismatch repair-deficient gliosarcoma in LS. A 54-year-old Chinese male patient was admitted to the hospital with a history of facial asymmetry for over 1 month and right temporo-occipital pain for 5 days. Head MRI revealed a complex mass lesion in the right frontoparietal region, consisting of cystic and solid components. The patient's history of colon malignancy and family history of rectal carcinoma were noteworthy. Postoperative pathology indicated the presence of gliosarcoma with high-frequency microsatellite instability (MSI-H) and mismatch repair deficiency (MMRD). Further genetic testing results confirmed a germline heterozygous mutation in MSH2, which is considered the gold standard for diagnosing LS. This case report enriches the existing literature on germline MSH2 mutations and gliosarcomas. It highlights the importance for neurosurgeons to consider possible hereditary disorders when treating patients with a history of concurrent tumors outside the nervous system. Genetic testing is crucial for further identification of such disorders.
The challenge of managing ischemic stroke in brucellosis: a case report
Authors: Linfa Chen, Xiaolong Lin, Xiuqu Cai, Shiting Zeng, Yanquan Yuan, Zhiyong Huang, Jinjin Yan, You Li
Journal: Front Immunol (2024)
Keywords: t lymphocytes, brucellosis, intravenous thrombolysis, metagenome next-generation sequencing, stroke
MeSH terms: Anti-Infective Agents, Brucella melitensis, Brucellosis, Ischemic Stroke, Stroke / complications, Case Reports, Research Support, Non-U.S. Gov't, Female, Humans, Middle Aged, Anti-Infective Agents

A 64-year-old woman was admitted to the hospital for sudden weakness in one of her left limbs. The patient was diagnosed with acute ischemic stroke (IS) of undetermined cause and received intravenous thrombolysis. Following thrombolysis, the patient's left limb weakness improved, but she subsequently developed recurrent high fever and delirium. Further diagnostic tests revealed that she had been infected with Brucella melitensis. The patient showed significant improvement during anti-infection treatment for Brucellosis and secondary prevention treatment for IS. However, her condition unexpectedly worsened on the 44th day after admission due to a hemorrhagic stroke (HS), which required an urgent craniotomy. Immunohistochemical analysis of the hematoma sample collected during the operation showed the presence of CD4+ and CD8+ T lymphocytes surrounding the blood vessels. This case highlights the unique challenge of managing IS in brucellosis and sheds light on the potential role of T lymphocytes in the immune response related to stroke.
Projectile Embolism From a Firearm Injury: A Case Report
Authors: Mateo Zuluaga-Gomez, Daniela Giraldo-Campillo, Daniel González-Arroyave, Robinson A Orjuela-Correa, Manuela Bedoya-Ortiz, Carlos M Ardila
Journal: Cureus (2024)
Keywords: cerebral venous circulation, embolism, emergency medical service, firearms, pulmonary circulation
MeSH terms: Case Reports

Projectile embolism resulting from firearm injuries is a rare but highly lethal complication when not diagnosed early. This report presents a case of projectile embolism from a firearm injury with an unusual entry site, the cerebral venous circulation, which subsequently migrates to the pulmonary circulation with a fatal outcome. A 24-year-old male patient was admitted to a high-complexity hospital due to a gunshot wound. A plain skull computed tomography (CT) revealed a left laminar subdural hematoma and traumatic subarachnoid hemorrhage with multiple metallic fragments embedded in the skull, some penetrating the galeal sinus, with perilesional bleeding. Contrast-enhanced chest tomography showed non-thrombotic embolism of metallic fragments in the pulmonary artery for the apical segment of the left upper lobe and right intraventricular regions. Transthoracic echocardiography revealed a hyperechoic image of 3 mm in the subvalvular apparatus toward the interventricular septum. Subsequently, the patient experienced neurological deterioration with signs of cerebral edema and parieto-occipital epidural hematomas with metallic fragments and projectiles. Measures to counteract cerebral edema were initiated. Later, the patient developed mydriasis, the absence of brainstem reflexes, and experienced cardiac arrest. This report delineates a case of projectile embolism, highlighting a distinctive aspect characterized by an unusual entry point.
A maternally derived complex small supernumerary marker chromosome involving chromosomes 8 and 14: case report and review of the literature
Authors: Fatima Ouboukss, Zhour El Amrani, Hicham Bouchahta, Ilham Ratbi, Aziza Sbiti, Thomas Liehr, Abdelaziz Sefiani, Abdelhafid Natiq
Journal: Front Genet (2024)
Keywords: chromosome 8 and 14, clinical features, complex small supernumerary marker chromosome (ssmc), molecular cytogenetics, partial trisomy
MeSH terms: Case Reports

Introduction: The majority of small supernumerary marker chromosomes (sSMCs) are derived from one single chromosome. Complex sSMCs, on the other hand, consist of genetic material derived from more than one, normally two chromosomes. Complex sSMCs involving chromosomes 8 and 14 are rarely encountered. Case presentation: We present here a 14-month-old boy born from an unrelated couple. At birth, the baby was hypotonic and had a cleft lip and palate, as well as ocular involvement. Throughout the course of development, the baby experienced feeding difficulties, stunted growth, and delayed psychomotor development. Banding together with molecular cytogenetics revealed a balanced maternal translocation t(8;14)(p22.3;q21)mat, leading due to meiotic 3:1 segregation to a partial trisomy of chromosomes 8 and 14 in the affected boy. Discussion/Conclusion: This report highlights the importance of cytogenetics in diagnosis of rare genetic disorders, with impact on genetic counselling of patients and their families. There are three comparable cases in the literature involving both chromosomes 8 and 14, but with different breakpoints; the complex sSMC derived from chromosomes 8 and 14 in this case, characterized as der(14)t(8;14) (p22.3;q21)mat.