OpenMed/multicare-articles huggingface dataset:
Juvenile Idiopathic Arthritis With Epstein-Barr Virus-Associated Smooth Muscle Tumor in a 6-Year-Old Girl: A Rare Case Report
Authors: Zhijuan Kang, Juan Xu, Zhihui Li
Journal: Front Pediatr (2021)
Keywords: children, epstein barr virus, hip joint, juvenile idiopathic arthritis, smooth muscle tumor
MeSH terms: Case Reports

Herein, we reported a rare case of Epstein-Barr virus-associated smooth muscle tumor (EBV-SMT) combined with juvenile idiopathic arthritis (JIA) in a 6-year old girl without HIV, organ transplantation, or congenital immunodeficiency. The patient suffered from pain in the bilateral hip joints, which drastically affected her physical activity. Consequently, she was diagnosed with JIA (September 2019). She was given methotrexate and methylprednisolone pills via oral route and a subcutaneous injection of Recombinant Human Tumor Necrosis Factor-α Receptor II;lgG Fc Fusion Protein for 4 weeks that successfully relieved the pain. In May 2020, the pain reoccurred and was accompanied by occasional headaches. After extensive pathological examination, the patient was diagnosed with EBV-SMT. The imaging examinations after admission showed multiple lesions in the skull, lungs, and vertebral body. Biopsy of the L2 vertebral body was then performed to clarify the diagnosis. Finally, the in-situ hybridization of the tumor of the lumbar vertebrae suggested a non-HIV/transplantation-related EBV-SMT. Consequently, the patient received surgery without chemotherapy and radiotherapy, after which her conditions improved.
Management of patients with issues related to opioid safety, efficacy and/or misuse: a case series from an integrated, interdisciplinary clinic
Authors: William C Becker, Jessica S Merlin, Ajay Manhapra, Ellen L Edens
Journal: Addict Sci Clin Pract (2016)
MeSH terms: Analgesics, Opioid / therapeutic use, Chronic Pain / drug therapy, Opioid-Related Disorders / diagnosis, Pain Management / methods, Research Support, N.I.H., Extramural, Research Support, U.S. Gov't, Non-P.H.S., Alcoholism / diagnosis, Alcoholism / epidemiology, Analgesics, Opioid / administration & dosage, Buprenorphine, Naloxone Drug Combination / therapeutic use, Humans, Opioid-Related Disorders / epidemiology, Opioid-Related Disorders / therapy, Primary Health Care, Quality Improvement, Analgesics, Opioid, Buprenorphine, Naloxone Drug Combination

Background:
Patients, providers, communities and health systems have struggled to achieve balance between access to opioid treatment for chronic pain and its potential harmful consequences: especially misuse, addiction and overdose. We developed an interdisciplinary clinic embedded within primary care (the Opioid Reassessment Clinic-ORC) with the goal of improving the quality of care of patients with co-occurring chronic pain and issues related to opioid safety, efficacy and/or misuse.
Case descriptions:
We present three cases referred to the ORC that highlight complex clinical scenarios related to assessment and treatment of patients with chronic pain and issues related to opioid safety, efficacy and misuse.
Discussion and evaluation:
In the context of the three cases, with respect to assessment, we discuss: making the diagnosis of opioid use disorder; allowing the patient space to endorse lack of efficacy; identification of co-occurring hazardous alcohol use; and recognizing barriers to multimodal pain care. With respect to treatment, we discuss: making a change in treatment with which the patient may not agree; effectiveness of buprenorphine/naloxone for the treatment of chronic pain; responding to low efficacy; and making continued opioid therapy contingent on engagement with substance abuse treatment.
Conclusions:
The core components of our approach-biopsychosocial assessment and multimodal treatment planning with an emphasis on promoting functional goals and safety using clear communication and a patient-centered stance-should guide providers in the management of similar clinical scenarios. More evidence is needed to definitively guide specific interventions and points of clinical equipoise.
Tocilizumab induced acquired factor XIII deficiency in patients with rheumatoid arthritis
Authors: Sho Mokuda, Yosuke Murata, Naoya Sawada, Kenichiro Matoba, Akihiro Yamada, Makoto Onishi, Yasuaki Okuda, Kazuo Jouyama, Eiji Sugiyama, Kiyoshi Takasugi
Journal: PLoS One (2013)
MeSH terms: Antibodies, Monoclonal, Humanized / pharmacology, Arthritis, Rheumatoid / drug therapy, Arthritis, Rheumatoid / metabolism, Factor XIII / metabolism, Case Reports, Adult, Aged, Antibodies, Monoclonal, Humanized / therapeutic use, Arthritis, Rheumatoid / blood, Female, Humans, Interleukin-6 / metabolism, Male, Middle Aged, Sex Factors, Antibodies, Monoclonal, Humanized, Interleukin-6, Factor XIII, tocilizumab

Factor XIII is one of the twelve coagulation factors and also known as a fibrin-stabilizing factor. In 2012, we encountered a male RA patient with hemorrhagic factor XIII deficiency who had been treated with tocilizumab for two years. There are few reports regarding the relationship between tocilizumab (a humanized monoclonal antibody against the interleukin-6 receptor (IL-6R)) and factor XIII. We measured the factor XIII activity levels in the plasma of 40 RA patients (10 patients treated without biologics, 30 patients treated with biologics (15 patients treated with necrosis factor inhibitors and 15 patients treated with tocilizumab)) and 19 healthy controls. Consequently, the tocilizumab group exhibited lower levels than the other three groups according to the Steel-Dwass test (P<0.01). Furthermore, we compared the plasma factor XIII activity levels and the plasma factor XIII concentrations in the RA patients treated with biologics. Pearson's correlation test was used to assess the relationship between the factor XIII activity levels and the plasma factor XIII concentrations (r=0.449, P=0.019). According to the multiple regression analysis, the treatment with tocilizumab is an independent risk factor for plasma factor XIII reduction in RA patients. In conclusion, RA patients treated with tocilizumab, an IL-6R blocker, are at risk of developing acquired factor XIII deficiency. The mechanisms underlying the reduced factor XIII activity observed in RA patients treated with tocilizumab may result from the quantitative reduction in the plasma. These data imply that IL-6 plays an important role in maintaining the factor XIII activity level.
An unusual case of a glottic carcinoma metastasis to the tracheal lumen
Authors: Sarantis Blioskas, Peter Karkos, Iordanis Konstantinidis, Kyriakos Chatzopoulos, George Psillas, Prodromos Chytiroglou, Konstantinos Markou
Journal: Ecancermedicalscience (2018)
Keywords: endotracheal, glottic cancer, lymphatic spread, metastasis
MeSH terms: Case Reports

Various mechanisms such as second primary lesion, tumour seeding or lymphogenous and haematogenous metastasis could be proposed to explain the nature of dual malignant lesions. We report the case of a glottic laryngeal carcinoma combined with a secondary endotracheal tumour. Following the imaging modalities, the patient underwent total laryngectomy and wide excision of the trachea. Histopathology ultimately established that the tracheal lesion was a metastatic tumour secondary to regional lymphatic spread of the glottic tumour. To our knowledge, there is no previous report in the English literature concerning tracheal lymphogenous metastatic involvement in the context of laryngeal malignancy. Paradoxical lymphatic spread must always remain an issue of head and neck oncology.
Recurrent Anti-AMPA Receptor Limbic Encephalitis: A Case Report and Literature Review
Authors: Yuanyuan Fang, Dengji Pan, Hao Huang
Journal: Front Neurol (2021)
Keywords: anti-ampa receptor, autoimmune encephalitis, brain atrophy, case report, relapse
MeSH terms: Case Reports

Alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor encephalitis is a relatively rare anti-neuronal surface antigen autoimmune encephalitis (LE). We described a case of a 47-year-old Chinese man having anti-AMPA receptor limbic encephalitis initially presented with cognitive decline, undetectable antibodies, and normal imaging findings in magnetic resonance image (MRI) and then developed into typical autoimmune limbic encephalitis a few months later with a course of multiple relapses. In addition, we found progressive brain atrophy in our case, which was a rare presentation of LE. This report also summarized the characteristics of nine reported cases of anti-AMPA receptor limbic encephalitis with relapse up to date. This case highlighted that autoimmune limbic encephalitis is an important differential diagnosis for patients with typical symptoms even when the MRI and antibodies are normal, and more attention should be paid to the relapse of anti-AMPA receptor encephalitis.
Double systemic cytokine release syndrome following sequential infusion of anti-CD22 and anti-CD19 chimeric antigen receptor T cells after autologous hematopoietic stem cell transplantation for a central diffuse large B-cell lymphoma patient: A case report and literature review
Authors: Jing Zheng, Yao Xiao, Xue Q Wu, Qiong Z Xiao, Chun Feng, Kai B Gao
Journal: Front Immunol (2023)
Keywords: adverse reactions, central diffuse large b-cell lymphoma, chimeric antigen receptor t cell, cytokine release syndrome, immunotherapy
MeSH terms: Hematopoietic Stem Cell Transplantation / adverse effects, Lymphoma, Large B-Cell, Diffuse / therapy, Receptors, Chimeric Antigen, Case Reports, Review, Adult, Antigens, CD19, Cytokine Release Syndrome / etiology, Humans, Interleukin-6, Male, Receptors, Antigen, T-Cell, T-Lymphocytes, Antigens, CD19, Interleukin-6, Receptors, Antigen, T-Cell, Receptors, Chimeric Antigen

Background:
Chimeric Antigen Receptor T cell(CAR T-cell) therapy has been a great success in relapsed/refractory acute B lymphoblastic leukemia and B-cell lymphoma. At the same time, there are also related adverse reactions, especially cytokine release syndrome(CRS) and immune effector cell associated neurotoxicity syndrome(ICANS). However, Double CRS caused by CRA T cells are very rare.
Case report:
Here, we report a 33-year-male with secondary central diffuse large B-cell lymphoma(CNSL) who develpoed double CRS following sequential infusion of Anti-CD22 and Anti-CD19 CAR T cells after autologous hematopoietic stem cell transplantation(ASCT). On d+5, the patient developed high fever, along with chilly sensation, shivering, headache, blood oxygen desaturation, shock, weakness, severe thirst, and heart rate decline. IL-6 and ferritin increased significantly. The patient was diagnosed with the first CRS (grade 3). On d+36, the patient again had a persistent fever(T>39C) and limbs rash. IL-6 and ferritin again increased significantly on d+38. After exclusion of infection, a diagnosis of double CRS was made. The patient's symptoms were completely relieved after receiving tocilizumab, glucocorticoids, and other supportive treatments on d+45.On d+90, contrast-enhanced MR angiogram shows that the lesion basically disappeared, indicating the patient had achieved CR. At the end of the follow-up at d+150, the patient was functioning normally without any sequelae.
Conclusion:
This is the first reported case worldwide where the patient with secondary CNSL suffered double CRS after CAR T-cell infusion. Our findings showed that it is important to increase awareness of early detection and diagnosis of double CRS and adopt appropriate treatment strategies.
Neuroendocrine tumors of the urinary bladder - Report of two cases
Authors: Meenakshi Rao, Apoorvi Dubey, Himanshu Pandey, Binit Sureka, Pawan Kumar Garg, Harishkumar Bohra, Poonam Elhence
Journal: Autops Case Rep (2021)
Keywords: carcinoma, small cell, paraganglioma, urinary bladder neoplasms
MeSH terms: Case Reports

Primary paraganglioma and small cell neuroendocrine carcinoma of the urinary bladder are rare tumors, comprising 0.05% of all bladder tumors and <1% of all malignant bladder tumors, respectively. These tumors can be the cause of a diagnostic dilemma or misdiagnosis on morphology. Paraganglioma is often mistaken for urothelial carcinoma and small cell carcinoma for poorly differentiated carcinoma or lymphoma. Herein, we report a case of primary paraganglioma and another of a small cell carcinoma of the urinary bladder and discuss their closest differential diagnoses. The diagnostic pitfalls should be kept in mind so that correct, timely diagnosis of these entities can be made due to implications in the management and prognosis.
Fecal Impaction in the Rectum and Rectosigmoid Colon Secondary to Sunflower Seed Ingestion
Authors: Alexander Lyons, Jamie Lee, Kristen Cares
Journal: Case Rep Pediatr (2021)
MeSH terms: Case Reports

A 35-month-old male who had eaten a bag of sunflower seeds initially presented to the emergency department (ED) with visible seeds in the anus and was discharged home with a stool softener after manual disimpaction. He then returned to the hospital 2 days later, and abdominal radiographs confirmed significant fecal material within the rectum and rectosigmoid colon. After failed oral and rectal laxative therapy attempts, subsequent disimpaction under anesthesia revealed an undigested sunflower seed bezoar in the rectum extending to the distal segment of his sigmoid colon. This case highlights the dangers and possible complications of seed ingestion even in small quantities in children along with the pathophysiology of impaction. This is one of the youngest cases reported in the United States involving the rectum and rectosigmoid colon with a sunflower bezoar.
Hepatocellular Carcinoma Complicated by Echinococcal Cyst: A Case Report
Authors: Jiwu Guo, Chenzhe Ma, Xuewen Song, Futian Tang, Lingyun Guo, Jie Mao, Yumin Li
Journal: Front Surg (2022)
Keywords: alpha-fetoprotein, case report, hepatic hydatid disease, hepatitis b virus, hepatocellular carcinoma
MeSH terms: Case Reports

Hepatocellular carcinoma (HCC), combined with hepatic hydatid disease, is a rare clinical case, having certain specificity in clinical diagnosis and treatment. We report a case of HCC combined with hepatic hydatid disease treated in our clinic to arouse the attention of clinicians to the disease. A 54-year-old female patient was admitted to the clinic on October 31, 2016 because of "Intermittent upper abdominal pain and discomfort for 1 month." Abdominal CT in the previous hospital showed liver space-occupying lesions, and hepatic hydatid disease should be considered. The patient had a history of hepatitis B virus (HBV) infection since childhood but has not received antiviral treatment. She did have a history of life in pastoral areas. Laboratory examination results were as follows: alpha-fetoprotein (AFP) 1,210 ng/ml, HBV DNA: 5.32E + 3 IU/ml. Casoni test was positive. Enhanced CT of abdomen suggestion was: malignant liver tumor, hepatic hydatid disease. Gastroscopy and colonoscopy showed no abnormalities. She underwent an operation on November 10, 2016. Segment 5, 8 of hepatic, echinococcus internal capsule, and cholecyst were all removed. She took albendazole (0.4 g/day) for 6 months and oral entecavir (0.5 mg/day) antiviral treatment for a long time after surgery. From May 2017 to October 2019, a total of 5 cycles of transarterial chemotherapy embolization (TACE) were performed. The patient underwent surgical treatment, followed by TACE, antiviral therapy, and sequential albendazole treatment. The AFP level increased significantly, but there was no obvious recurrence of HCC in imaging.
Severe toxic rhabdomyolysis under combined palbociclib and simvastatin treatment: A case report
Authors: Poumeaud François, Fontanier Anna, Dion Jérémie, Mathevet Quentin, Cointault Olivier, Uro-Coste Emmanuelle, Marty Céline, Dalenc Florence, Girardie Pierre, Rataboul Anaïs
Journal: Front Oncol (2022)
Keywords: interaction, myositis, palbociclib, plasmatic exchange, rhabdomyolysis, simvastatin
MeSH terms: Case Reports

We report the fourth described case of severe toxic rhabdomyolysis occurring in an 81-year-old woman caused by the concomitant administration of palbociclib taken at the usual dosage (125 mg per day) and simvastatin. To the best of our knowledge, this is the first reported case successfully treated by plasma exchanges, with complete functional recovery within two months. The severity of this case justifies further consideration of pharmacokinetic interactions between palbociclib or other CDK-4-6 inhibitors and statins, which potentially increase the risk of an adverse event.
Sirolimus for the Treatment of Airway Obstruction due to Indolent T-Lymphoblastic Proliferation
Authors: Eric Moughames, Ana P Kiess, Lee M Akst, Antoine Azar
Journal: Case Reports Immunol (2019)
MeSH terms: Case Reports

Introduction:
Indolent T-lymphoblastic proliferation (iT-LBP) is a rare nonmalignant entity that presents as a proliferation of T-lymphoblasts. We report a first such case with a recurrent laryngeal obstruction presentation that was successfully controlled with Sirolimus.
Case presentation:
This is the case of a 29-year-old female who presented with a recurrent significant lymphoid hyperplasia in the adenoid and tongue base region as well as a right cervical lymph node. After repeated adenoidectomies and tonsillectomies, and based on pathological and clinical findings she was diagnosed with iT-LBP. Trials of radiotherapy and immunotherapy with cyclosporine and rituximab all failed to control the progression of the disease. Sirolimus was finally able to restrict the growth and improve her symptoms.
Conclusion:
While It-LBP does not usually require treatment, it is important to report cases in which treatment was crucial for the survival of the patient, and the effective role of Sirolimus in doing so, without any major adverse effects.
Successful conservative treatment of multiorgan infiltrating placenta percreta by uterine embolization and followup with serial magnetic resonance. A case report
Authors: Ebtehaj Alshammary, Mohamed Fawaz Elmuzaini
Journal: Int J Surg Case Rep (2019)
Keywords: abnormal placentation, adherent placenta, case report, placenta percreta

Introduction:
Conservative management was recently adopted as an option with an aim to reduce surgical complication and improve maternal outcome. We present a case of placenta percreta that invaded the urinary bladder, sigmoid colon, rectum, and vagina of a patient treated with conservative management successfully. The work has been reported in line with the SCARE criteria (Agha et al., 2018 [1]).
Case presentation:
A 32-year-old woman, gravida 4, para 3. She had previously had 3 caesarean sections. At 36 week of gestation patient referred to our centre with a diagnosis of placenta praevia with a high suspicion of placenta percreta. Ultrasound and MRI repeated and confirmed the diagnosis with invasion to the rectum/sigmoid colon, urinary bladder, and upper vagina. Patient treated successfully by uterine embolization and follow up without any complication and we performed serial MRI to evaluate the course of conservative management.
Discussion:
Placenta percreta is a serious condition with high maternal morbidity and mortality rate. Cesarean hysterectomy is the standard treatment for now. However, conservative management was recently adopted as an option. Many case reports were published with placenta percreta that invaded the urinary bladder and treated conservatively but this is a placenta percreta that invaded the urinary bladder, sigmoid colon, rectum, and vagina. We opted conservative management and performed serial MRI to evaluate the course of conservative management.
Conclusion:
We believe that this case is the first case of placenta percreta that invaded the urinary bladder, sigmoid colon, rectum, and vagina. That treated successfully by conservative management and publishing this case will improve the clinical information about the course of the conservative management of placenta percreta.
Reconstruction of a Giant Wound Induced by Advanced Penile Carcinoma with Bilateral Anteromedial Thigh Flap and Left Deep Circumflex Iliac Artery Flaps
Authors: Chenyang Ji, Ruiting Li, Ganlin Zhang, Jinming Zhang, Weiqiang Liang, Yuhong Chen
Journal: World J Plast Surg (2018)
Keywords: abdominoperineal defect, anteromedial thigh flap, deep circumflex iliac artery flap, penile, squamous cell carcinoma
MeSH terms: Case Reports

A 39-year-old male patient presented with an extensive putrescent ulceration of abdominoperineal region infiltrated by advanced penile squamous cell carcinoma. To our knowledge, it is the largest defect after aggressive palliative resection of penile squamous cell carcinoma (pSCC) in the literature, which was 36×23 cm. The defect was divided into three sub-defects, and was repaired by bilateral anteromedial thigh (AMT) and left deep circumflex iliac artery (DCIA) flaps. The postoperative course was uneventful and no flap necrosis occurred. The symptom relief was excellent.
An Unusual Case of Asystole Occurring during Deep Brain Stimulation Surgery
Authors: Ha Son Nguyen, Harvey Woehlck, Peter Pahapill
Journal: Case Rep Neurol Med (2016)

Background. Symptomatic bradycardia and hypotension in neurosurgery can produce severe consequences if not managed appropriately. The literature is scarce regarding its occurrence during deep brain stimulation (DBS) surgery. Case Presentation. A 67-year-old female presented for left DBS lead placement for essential tremors. During lead implantation, heart rate and blood pressure dropped rapidly; the patient became unresponsive and asystolic. Chest compressions were initiated and epinephrine was given. Within 30 seconds, the patient became hemodynamically stable and conscious. A head CT demonstrated no acute findings. After deliberation, a decision was made to complete the procedure. Assuming the etiology of the episode was the Bezold-Jarisch reflex (BJR), appropriate accommodations were made. The procedure was completed uneventfully. Conclusion. The episode was consistent with a manifestation of the BJR. The patient had a history of neurocardiogenic syncope and a relatively low-volume state, factors prone to the BJR. Overall, lead implantation can still occur safely if preventive measures are employed.
Elevated Serum IgG4 Levels in a Young Patient with Polyserositis and Necator americanus Infection
Authors: Giuseppe D Sanna, Roberto Manetti, Valentina de Filippo, Sergio Babudieri
Journal: Case Reports Immunol (2018)
MeSH terms: Case Reports

IgG4-related disease is a fibroinflammatory systemic condition characterized by tumefactive lesions, lymphoplasmacytic infiltrate rich in IgG4-positive plasma cells, storiform fibrosis, and elevated serum IgG4 concentrations. It has been described in virtually every organ system. Autoimmunity and infectious agents are potential immunologic triggers in IgG4-related disease. Herein, we describe a peculiar case of effusive-constrictive pericarditis in an 18-year-old boy with polyserositis and concomitant Necator americanus infection.
Esophageal Lung in a Preterm Boy-Report on a Multidisciplinary Treatment
Authors: Enrique Villamizar, Maria Daniela Moreno Villamizar, Mauricio Pedraza Ciro, Jean Pulido, Maria Rodriguez, Juan Carlos Villamizar
Journal: European J Pediatr Surg Rep (2019)
Keywords: bronchopulmonary malformations, communicating foregut malformations, esophageal lung, recurrent pneumonia
MeSH terms: Case Reports

Esophageal lung is a rare entity that results from embryological alterations during the formation of the ventral wall of the anterior intestine. The clinical manifestations of this pathology are vague, including respiratory or digestive symptoms, repetitive respiratory infections, dysphagia, or inability to swallow. The management is based on the exact anatomical and vascular abnormalities. We report the diagnostic and therapeutic approach in a preterm boy with esophageal lung. Also, we present a three-dimensional model for the classification of this pathology. In conclusion, the management relies on proper definition of the anatomy and the surgical strategy.