OpenMed/multicare-articles huggingface dataset:
Atypical hemolytic uremic syndrome in first trimester pregnancy successfully treated with eculizumab
Authors: Gabriela Andries, Michael Karass, Srikanth Yandrapalli, Katherine Linder, Delong Liu, John Nelson, Rahul Pawar, Savneek Chugh
Journal: Exp Hematol Oncol (2017)
Keywords: atypical hemolytic uremic syndrome (ahus), eculizumab, first trimester, pregnancy, thrombotic microangiopathy (tma)
MeSH terms: Case Reports

Background:
Atypical hemolytic uremic syndrome is a rare disorder which is known to cause acute thrombotic microangiopathy during pregnancy with poor maternal and fetal outcomes. Atypical hemolytic uremic syndrome is caused mostly by dysregulation of alternative complement pathway secondary to genetic mutations. Most of the cases reported have been in the post-partum period. We report a rare case of a patient who presents with thrombotic microangiopathy in the first trimester of her eleventh pregnancy and was successfully treated with eculizumab.
Case presentation:
A 30-year-old woman presented at 10 weeks of gestation with hypertension, hemolytic anemia, thrombocytopenia, and acute kidney injury, consistent with thrombotic microangiopathy. She was managed initially with daily plasmapheresis. However, her kidney function did not recover, requiring hemodialysis. ADAMTS13 activity was later found to be within normal limit, hence diagnosis of atypical hemolytic uremic syndrome was strongly considered at that time and she was immediately treated with anti-C5 humanized monoclonal antibody (eculizumab). The patient responded well (resolution of thrombotic microangiopathy and recovery of renal function) to eculizumab, with continued remission after discharge and successfully delivered a healthy baby at term without any peripartum complications.
Conclusion:
Early recognition of atypical hemolytic uremic syndrome is often difficult as several other conditions also manifest as thrombotic microangiopathy during pregnancy, causing delay in initiating appropriate treatment. Our case suggests that treatment of atypical hemolytic uremic syndrome in early trimester of pregnancy with eculizumab results in good outcome to mother and fetus.
A Case of Thermal Esophageal Injury Induced by Sodium Picosulfate with Magnesium Citrate
Authors: Dong-Hyuk Yang, Byoung Wook Bang, Kye Sook Kwon, Hyung Kil Kim, Yong Woon Shin
Journal: Case Rep Gastrointest Med (2017)
MeSH terms: Case Reports

Although thermal esophageal injuries caused by hot food or tea have been reported, thermal esophageal injury due to sodium picosulfate with magnesium citrate (PSMC) used for bowel preparation is rarely reported. We report the case of a 56-year-old man who presented with esophageal injury after ingestion of PSMC. Instead of dissolving the PSMC in water before ingestion, he drank water immediately after swallowing PSMC powder. As soon as he drank water, he developed severe chest pain and hematemesis. Upper endoscopy revealed severe hemorrhagic, ulcerative mucosal change from upper to mid-esophagus. He was hospitalized for nine days, received conservative treatment (fasting and parenteral nutrition), and recovered without complications. When PSMC is used as a colonic cleansing agent, patients should be educated to take it after dissolving it sufficiently in 150 mL of water to avoid esophageal thermal injury.
Pleomorphic adenoma of nasal septum, an unusual site: a case report from Nepal
Authors: Gyan Raj Aryal, Nischal Shrestha, Meenakshi Basnet, Oshan Shrestha, Pratikshya Sharma
Journal: Oxf Med Case Reports (2023)
MeSH terms: Case Reports

Pleomorphic adenoma is the commonest benign salivary glands tumor. Major salivary glands are mainly involved, and there is very low reported incidence of such tumor in minor salivary glands of nasal cavity. We report a case of 69-year-old woman who complaint of chronic left nasal obstruction and recurrent scanty bleeding from left nostril for last 2 months. On anterior Rhinoscopy examination, there was a pinkish non-tender mass in left nasal cavity arising from cartilaginous part of nasal septum. Intranasal endoscopic excision was done under general anesthesia and histopathological examination of excised tissue revealed pleomorphic adenoma. Patient was discharged after 3 days. There was no recurrence at sixth month of follow-up.
Coexistence of two rare sarcomas: primary leiomyosarcoma of bone and epithelioid hemangioendothelioma of the liver
Authors: E Gonzalez-Billalabeitia, M Quintela-Fandino, I Alemany, G López-Alonso, A Ruiz-Ollero, F Martinez-Tello, R Hitt
Journal: Sarcoma (2008)
MeSH terms: Case Reports

A 33-year-old woman sought medical attention for a painful swelling of the left ankle. Plain radiographs revealed an osteolytic lesion involving the left distal tibia. An excisional biopsy provided the diagnosis of leiomyosarcoma in the tibia. A staging work-up was performed and an abdominal CT showed 4 liver hypodense lesions in both lobes with peripheral contrast enhancement. A liver biopsy confirmed the diagnosis of epithelioid hemangioendothelioma of the liver. No association between these two entities has been described before. This case introduces the importance of the pathological confirmation of apparent metastatic lesions in low grade sarcomas and provides a review of the literature of both tumours.
Case report: Use of penicillin G potassium in poloxamer 407 gel to aid in healing of an equine sublingual abscess
Authors: Elizabeth A Larsen, Amy C Lack, Erica Wassack
Journal: Front Vet Sci (2022)
Keywords: abscess, equine, horse, poloxamer 407, wound
MeSH terms: Case Reports

The use of poloxamer 407 gels have been reported in several studies to prolong the release of drugs at the injection site. Oral lesions unrelated to dental disease are rare but may result in ulceration and sequestration of bone. To date, there have been no reports on the use of penicillin G potassium poloxamer 407 gel and its effect on wound healing. The present case report describes the use of a penicillin G potassium poloxamer 407 gel for the treatment of a sublingual abscess involving the mandible in a 20 year old Arabian mare who initially presented with acute onset of dysphagia, hypersalivation, and a mass under the tongue. A presumptive diagnosis of lingual cellulitis was made, and a sublingual abscess ruptured on day 7 of hospitalization. In this case, poloxamer 407 gel was used to decrease wound contamination, protect the exposed mandible, and potentially prolong the release of penicillin G potassium into the wound.
Tiptoeing on Metastatic Adenocarcinoma of the Lung
Authors: Arupreet Kochar, Harrison D Winters, Li Zhang, Bin Zhang, Kamia Thakur, Rajesh Essrani
Journal: Case Rep Oncol Med (2019)
MeSH terms: Case Reports

Lung cancer remains the top cause of cancer-related death in the United States. Metastases to the distal phalanges are rare. This case illustrates an interesting presentation of metastatic adenocarcinoma of the lung that was mistaken for a benign condition of the toe.
Proof of principle for bevacizumab activity in desmoid-type fibromatosis
Authors: Viktor Grünwald, Florian Länger, H J Raatschen, Andreas Beilken
Journal: Clin Sarcoma Res (2016)
Keywords: aggressive fibromatosis, anti-angiogenic therapy, bevacizumab, desmoid
MeSH terms: Case Reports

Background:
Desmoid-type fibromatosis (DF) is a rare disease, which often occurs in young adults. Medical treatment is an important option in the treatment algorithm of DF. Different chemotherapeutic regimens showed clinical activity in DF, but overall treatment tolerability remains poor for this patient cohort. Novel approaches investigated tyrosine kinase inhibitors in DF, but tolerability remained an issue.
Case presentation:
We treated a patient with progressive DF after failure of chemotherapy for 1 year with singe agent bevacizumab. He achieved a symptomatic and radiologic response while attainning excellent tolerability.
Conclusions:
This is the first report on single agent bevacizumab in DF, which showed both, good tolerability and efficacy in our patient, thereby warranting future trials in DF.
Delayed Presentation of a Giant Ascending Aortic Aneurysm following Aortic Valve Replacement
Authors: Tugrul Göncü, Mustafa Sezen, Hasan Ari, Osman Tiryakioglu, Gündüz Yumun, Senol Yavuz
Journal: Case Rep Med (2009)
MeSH terms: Case Reports

Giant ascending aortic aneurysm formation following aortic valve replacement is rare. A 28-year-old man who underwent aortic valve replacement with a prosthetic valve for aortic regurgitation secondary to congenital bicuspid aortic valve about 10 years ago was diagnosed with a giant ascending aortic aneurysm about 16 cm in diameter in follow-up. The aneurysm was resected leaving the functional old mechanical prosthesis in place and implanted a 34-mm Hemashield woven graft, associated with the left and right coronary artery button implantation. Histological findings of the aortic aneurysm wall showed cystic medial necrosis. The postoperative course was uneventful and postoperative examination demonstrated good surgical results.
A liver fibrosis cocktail? Psoriasis, methotrexate and genetic hemochromatosis
Authors: Joseph Mathew, May Y Leong, Nick Morley, Alastair D Burt
Journal: BMC Dermatol (2005)
MeSH terms: Dermatologic Agents / therapeutic use, Hemochromatosis / complications, Liver / pathology, Methotrexate / therapeutic use, Psoriasis / drug therapy, Case Reports, Dermatologic Agents / adverse effects, Fatty Liver / chemically induced, Fatty Liver / diagnosis, Fibrosis / etiology, Humans, Male, Methotrexate / adverse effects, Middle Aged, Psoriasis / complications, Risk Factors, Dermatologic Agents, Methotrexate

Background:
Pathologists are often faced with the dilemma of whether to recommend continuation of methotrexate therapy for psoriasis within the context of an existing pro-fibrogenic risk factor, in this instance, patients with genetic hemochromatosis.
Case presentations:
We describe our experience with two male psoriatic patients (A and B) on long term methotrexate therapy (cumulative dose A = 1.56 gms and B = 7.88 gms) with hetero- (A) and homozygous (B) genetic hemochromatosis. These patients liver function were monitored with routine biochemical profiling; apart from mild perivenular fibrosis in one patient (B), significant liver fibrosis was not identified in either patient with multiple interval percutaneous liver biopsies; in the latter instance this patient (B) had an additional risk factor of partiality to alcohol.
Conclusion:
We conclude that methotrexate therapy is relatively safe in patients with genetic hemochromatosis, with no other risk factor, but caution that the risk of fibrosis be monitored, preferably by non-invasive techniques, or by liver biopsy.
An Unusual Amyloid Goiter in a 48-Year-Old Woman with Rheumatoid Arthritis, Secondary Amyloidosis and Renal Failure
Authors: B López-Muñoz, L Greco Bermúdez, D Marín-Jiménez, M F Sánchez de la Fuente, A Franca Capparelli, I Mascarell Martínez, S Serrano Corredor
Journal: Case Rep Endocrinol (2019)
MeSH terms: Case Reports

Amyloid goiter (AG) is characterized by the presence of deposits of amyloid protein in the thyroid tissue in sufficient amounts to produce enlargement of the gland, accompanied by fat deposition or thyrolipomatosis. It can be seen in long-standing inflammatory disorders, with the common characteristic of amyloidotic renal failure. In daily practice, practitioners should pay attention to the differential diagnosis in patients with suggestive co-morbidities for amyloidosis. The clinic is a progressive increase of the thyroid gland with compressive symptomatology (dyspnea, dysphagia, and changes in the voice). The main imaging finding is diffuse fatty infiltration of the thyroid. The amyloid goitre was most probably in the general context of amyloidosis, regardless of the other complications. We present a case of a 48-years-old female with amyloid goiter secondary to rheumatoid arthritis and renal failure.
Case Report: Treatment of a Comorbid Attention Deficit Hyperactivity Disorder and Obsessive-Compulsive Disorder With Psychostimulants
Authors: Ezgi Dogan-Sander, Maria Strauß
Journal: Front Psychiatry (2021)
Keywords: adhd, ocd, case report, comorbidity, methylphenidate, psychostimulant
MeSH terms: Case Reports

Introduction: Attention deficit hyperactivity disorder (ADHD) is a common disease in childhood and adolescence. In about 60% of pediatric patients, the symptoms persist into adulthood. Treatment guidelines for adult ADHD patients suggest multimodal therapy consisting of psychostimulants and psychotherapy. Many adult ADHD patients also suffer from psychiatric comorbidities, among others obsessive-compulsive disorder (OCD). The treatment of the comorbidity of ADHD and OCD remains challenging as the literature is sparse. Moreover, the impact of psychostimulants on obsessive-compulsive symptoms is still unclear. Case Presentation: Here, we report on a 33-year-old patient with an OCD who was unable to achieve sufficient remission under long-term guideline-based treatment for OCD. The re-examination of the psychological symptoms revealed the presence of adult ADHD as a comorbid disorder. The patient has already been treated with paroxetine and quetiapine for the OCD. Due to the newly established diagnosis of ADHD, extended-release methylphenidate (ER MPH) was administered in addition to a serotonin reuptake inhibitor. After a dose of 30 mg ER MPH, the patient reported an improvement in both the ADHD and the obsessive-compulsive symptoms. After discharge, the patient reduced ER MPH without consultation with a physician due to subjectively described side effects. The discontinuation of medication led to a renewed increase in ADHD and obsessive-compulsive symptoms. The readjustment to ER MPH in combination with sertraline and quetiapine thereafter led to a significant improvement in the compulsive symptoms again. Conclusion: The present case shows that in ADHD and comorbid obsessive-compulsive disorder, treatment with psychostimulants can improve the obsessive-compulsive symptoms in addition to the ADHD-specific symptoms. To our knowledge, this is only the second case report describing a treatment with ER MPH for an adult patient with OCD and ADHD comorbidity in the literature. Further research, especially randomized controlled trials, is needed to standardize treatment options.
Mycobacterium abscessus Prosthetic Joint Infections of the Knee
Authors: Lydie Nengue, Mark Anthony A Diaz, Courtney E Sherman, Arveen Bhasin, Claudia R Libertin
Journal: J Bone Jt Infect (2019)
Keywords: knee arthroplasty, mycobacterium abscessus, non-tuberculous mycobacterium, prosthetic joint infections, rapidly growing mycobacteria
MeSH terms: Case Reports

M. abscessus complex prosthetic joint infections (PJI) of the knee are rare. We present a patient with an M. abscessus subsp. massiliense, a nontuberculous mycobacterium (NTM), peri-prosthetic knee infection who presented with wound drainage followed by sepsis. The published peer-reviewed literature on knee PJIs due to this organism is reviewed to highlight its clinical presentation,symptomatology, microbiology, surgical interventions, antimicrobial regimens, and outcomes.
Mass safe male circumcision: early lessons from a Ugandan urban site - a case study
Authors: Moses Galukande, Denis Bbaale Sekavuga, Kevin Duffy, Nicholas Wooding, Sam Rackara, Florence Nakaggwa, Teddy Nagaddya, Alex Emmanuel Elobu, Alex Coutinho
Journal: Pan Afr Med J (2012)
Keywords: safe male circumcision, public and private partnership, task shifting
MeSH terms: Circumcision, Male / statistics & numerical data, HIV Infections / prevention & control, Public-Private Sector Partnerships / organization & administration, Adolescent, Adult, Circumcision, Male / adverse effects, Counseling / methods, Follow-Up Studies, Humans, Male, Middle Aged, Practice Guidelines as Topic, Uganda, Urban Health Services / organization & administration, Young Adult

Introduction:
It has been proven in several randomized clinical trials that HIV transmission from female to male is reduced by 60% and more among circumcised males. The national target for Uganda by 2015 is to circumcise 4.2 million adult males, an unprecedented number requiring a pragmatic approach and effective model(s) to deliver this target. The objective of the study was to describe early lessons learnt at a start up of a mass safe male circumcision (SMC) program in an urban Ugandan site, implemented through task shifting and a private public partnership approach.
Methods:
A case study of an urban SMC site in Uganda's capital, Kampala with a catchment population of approximately 0.8 million adult males aged between 15 and 49 years. Client enrollment was voluntary; mobilization was by word of mouth and through the media. Non Physician clinicians (NPC) carried out the majority of the SMCs. The SMC and voluntary counseling and testing (VCT), adverse events (AE) management and follow up were done as per set national guidelines. The supervision was by a public and private service provider. All clients were consented.
Results:
A total of 3000 males were circumcised in 27 days spread over four months. The AE rate was 2.1% all AEs were mild and reversible. No deaths occurred. The work rate was 111 SMCs per day. There was sufficient demand for SMC despite minimal mobilization effort. The bulk of the SMC work was successfully carried out by the NPCs.
Conclusion:
Private Public Partnership and task shifting approaches were successful at the start up phase and we anticipate will be feasible for the scale up.
Hooked epinephrine auto-injector devices in children: four case reports with three different proposed mechanisms
Authors: Ran D Goldman, Katharine C Long, Julie C Brown
Journal: Allergy Asthma Clin Immunol (2020)
Keywords: anaphylaxis, auto-injector complication, children, epinephrine auto-injectors, hooked needles
MeSH terms: Case Reports

Background:
The prevalence of epinephrine auto-injectors (EAI) use is on the rise. Our objective was to describes children with hooked EAI needles that were embedded in soft tissues.
Case presentation:
Results: Two children self-injected in their shins. The embedded EAIs required removal in the Emergency Department. Both needles were hooked and splayed at the tip. A boy in anaphylaxis kicked his leg during EAI injection and the hooked needle embedded under his skin and was difficult to dislodge. The exposed needle was curved. A girl had an EAI administered for anaphylaxis, which was also difficult to dislodge. On removal, the distal needle tip was hooked approximately 160 degrees. Images of the device revealed that the needle fired off-center from the device and the device components were cracked. We propose three different explanations for these hooked EAI needles. The first is that the needle could hit bone during injection and curve rather than penetrates further. Secondly, the needle could bend when the patient moves during injection. Thirdly, if a needle fires sufficiently off-center to hit the cartridge carrier, this could hook the needle prior to injection.
Conclusions:
Awareness of the reasons for needle hooking, damage observed, and challenges and successful approaches to their removal, can better prepare the provider for these uncommon events. Teaching parents, children and educators about safe EAI storage and appropriate restraint during use may prevent some of these accidental injuries. Reporting device failures may lead to improvements in device performance and design.
Giant Adrenal Myelolipoma in a Patient without Endocrine Disorder: A Case Report and a Review of the Literature
Authors: Yoshifumi Nakayama, Nobutaka Matayoshi, Masaki Akiyama, Yusuke Sawatsubashi, Jun Nagata, Masanori Hisaoka, Keiji Hirata
Journal: Case Rep Surg (2018)
MeSH terms: Case Reports

We herein present a surgically treated case of huge adrenal myelolipoma. A 62-year-old woman presented to our surgical outpatient clinic with a retroperitoneal tumor. A clinical examination revealed an elastic soft, smooth-surfaced, painless, child-head-sized tumor with poor mobility, which was located in the left upper abdomen. Computed tomography (CT) and magnetic resonance imaging (MRI) of the abdomen revealed an uneven tumor surrounding the stomach, spleen, pancreas, and left kidney, which was 20 × 18 × 10 cm in size. The retroperitoneal tumor was resected. The tumor was attached to the surrounding organs, including the pancreas, spleen, and left kidney, but had not directly invaded these organs. The tumor was yellow and elastic soft and covered with a thin film. The origin of the tumor was suggested to be the left adrenal gland. The weight of the excised tumor was 1500 g. The histopathological diagnosis was adrenal myelolipoma. The patient had an uneventful recovery and was discharged from the hospital on the thirteenth day after the operation. She has been followed up in our outpatient clinic.
Detailed genetic and clinical analysis of a novel de novo variant in HPRT1: Case report of a female patient from Saudi Arabia with Lesch-Nyhan syndrome
Authors: Albandary AlBakheet, Hanan AlQudairy, Joud Alkhalifah, Sheikhah Almoaily, Namik Kaya, Zuhair Rahbeeni
Journal: Front Genet (2023)
Keywords: hprt1, lesch–nyhan syndrome, rtpcr, x-inactivation assay, de novo
MeSH terms: Case Reports

Background: Hypoxanthine-guanine phosphoribosyltransferase (HPRT1) deficiency is an inborn error of purine metabolism responsible for Lesch-Nyhan syndrome (LNS). The disease is inherited in an X-linked recessive manner and predominantly affects male individuals. Female individuals can carry a mutation as heterozygotes, but typically, they are asymptomatic because of the random inactivation of the affected allele. Nevertheless, although rare, heterozygote female individuals may manifest LNS with full characteristics. Herein, we describe a female patient from Saudi Arabia with LNS. Results: The patient (a 4-year-old girl) presented with typical characteristics of the disease, which include global developmental delay, self-mutilation, hyperuricemia, hypotonia, speech delay, spasticity, and seizures. Her general biochemical laboratory results were normal except for high levels of uric acid. The abdominal MRI\MRS, mostly unremarkable, showed bilateral echogenic foci within the renal collecting system. Genetic testing (whole-exome sequencing, iterative variant filtering, segregation analysis, and Sanger sequencing) pointed a novel de novo frameshift variant in HPRT1. X-inactivation assay using HpaII showed the presence of a 100% skewed X chromosome carrying the affected allele. RT-PCR of the cDNA indicated complete loss of the expression of the normal allele. Conclusion: Our study presents a female patient who has a severe case of LNSand found to be the 15th female patient with the disease in the world. The study emphasizethe need for a streamlined protocol that will help an early and accurate diagnosis of female LNS patients to avoid unnecessary interventions that lead to costly patient care.
Plexiform Fibromyxoma: A Rare Gastric Tumor
Authors: Casmir Wambura, Salim Surani
Journal: Case Rep Gastrointest Med (2017)
MeSH terms: Case Reports

Plexiform fibromyxoma is a rare and distinctive benign mesenchymal neoplasm that occurs in the gastric antrum. This tumor has a potential for misdiagnosis as gastrointestinal stromal tumor (GIST). It causes mucosa and vascular ulcerations without advancement of the tumor. Cytological bland spindle cells within a variably myxoid stroma characterize the histology of the tumor. We report the case of a 41-year-old African Tanzanian lady who presented with melena and recurrent anemia. Endoscopy and imaging studies revealed antral mass with initial suspicion of a GIST. However, immunohistochemically it turned to be a plexiform fibromyxoma. Follow-up evaluation 12 months after surgery revealed no evidence of recurrence or metastasis. This is a very uncommon tumor, which, to our knowledge, has been reported only once in Africa. The clinicians need to be aware of this rare occurrence to avoid misdiagnosis as GIST tumor.