OpenMed/multicare-articles huggingface dataset:
Acute Pancreatitis Secondary to Dengue Fever: An Uncommon Presentation of a Common Endemic Illness
Authors: Miguel A Flor, Jéssica V Andrade, Jorge A Bucaram
Journal: Case Rep Infect Dis (2022)
MeSH terms: Case Reports

Dengue viral infection is considered endemic in Ecuador. It is more frequent during winter, caused by an RNA virus in the Flavivirus group. Its presentation can range from an asymptomatic state to hemorrhagic fever with shock signs. Acute pancreatitis could be a rare form of acute abdomen presentation associated with dengue virus infection. This case illustrates a 26-year-old man who presents to the hospital with cramp-like pain in the epigastrium and radiation to the right upper quadrant, accompanied by nausea and vomiting. He also endorsed additional symptoms such as throbbing-like headache, myoarthralgias, and fever of 40.4°C (104.72°F). Laboratory tests revealed elevated hematocrit, thrombocytopenia, elevated pancreatic enzymes, transaminitis, elevated alkaline phosphatase (ALP), and gamma-glutamyl transferase (GGT). Ultrasonography of the abdomen revealed hepatic steatosis, free fluid in the abdominal cavity, and small bilateral pleural effusions. Additional testing revealed IgM and IgG antibodies positivity to dengue virus. The patient was treated conservatively with intravenous (IV) fluid hydration and bowel rest. Acute pancreatitis should be considered when a patient presents with a suspected acute abdomen in the emergency department, and a detailed medical history is necessary to make a correct approach to the differential diagnosis.
Case report: An occult hepatitis B virus infection reactivation in an HIV/HCV coinfected patient during an immune reconstitution inflammatory syndrome
Authors: Serena Zaltron, Anna Cambianica, Marco Di Gregorio, Cosimo Colangelo, Samuele Storti, Giorgio Tiecco, Francesco Castelli, Eugenia Quiros-Roldan
Journal: Front Cell Infect Microbiol (2023)
Keywords: hbv/hiv coinfection, hepatitis b virus, immune reconstitution inflammatory syndrome (iris), occult hbv, reactivation
MeSH terms: Coinfection / drug therapy, HIV Infections / complications, HIV Infections / drug therapy, Hepatitis B / complications, Hepatitis B / diagnosis, Hepatitis B / drug therapy, Hepatitis B, Chronic, Hepatitis C, Chronic / drug therapy, Immune Reconstitution Inflammatory Syndrome / diagnosis, Immune Reconstitution Inflammatory Syndrome / drug therapy, Case Reports, Antiviral Agents / therapeutic use, DNA, Viral / genetics, Hepatitis B virus / physiology, Humans, Symptom Flare Up, Antiviral Agents, DNA, Viral

The natural history of occult hepatitis B virus infection (OBI) and the mechanism involved in HBV reactivation are only partially understood. As regards people living with HIV (PLWH), HBV reactivation is estimated to occur with an incidence ratio of 0.019 cases per 100 person-year. Here we report the case of OBI reactivation in a HIV/HCV co-infected patient followed for 25 years at our Infectious Diseases Unit, but, unfortunately, lost to follow-up about 19 months after Direct-acting antivirals (DAAs) treatment. At re-engagement, blood tests showed high replication of plasmatic HIV-RNA along with severe immunosuppression and normal levels of liver enzymes. However, 3 months after ART reintroduction, an immune reconstitution inflammatory syndrome (IRIS) was diagnosed with high detectable HBV-DNA load and transaminase elevation. Our case report shows how the balance between the virus and the host immune system is quite a dynamic process that might significantly impact the course of the disease. The aim of this case report is to bring to the attention of physicians that, although OBI reactivation is a rather rare occurrence, even amongst PLWH, its potential consequences compel to a high alertness on the matter. Therefore, especially in patients with an impaired immune system and on a tenofovir or lamivudine-sparing regimen, HBV serological and virological markers should always be strictly monitored, even in the absence of a hepatitis flare.
Case Report: Factor VII Deficiency Presented With Cephalohematoma After Birth
Authors: Yuan-Chun Lo, Ching-Tien Peng, Yin-Ting Chen
Journal: Front Pediatr (2021)
Keywords: fvii
MeSH terms: Case Reports

Introduction: Factor VII deficiency is a rare inherited autosomal recessive bleeding disorder with a global prevalence of 1/500,000. Most cases remain asymptomatic, and cases with severe clinical presentation are rarely reported. Case Presentation: A newborn male with no relevant maternal antenatal history, delivered via vacuum-assisted cesarean section, presented with a large cephalohematoma after delivery. Poor appetite, pale appearance, and bulging fontanelles were observed 2 days later, progressing to hypovolemic shock. Further imaging examination revealed a large intracranial hemorrhage. Serial laboratory examination revealed remarkable coagulopathy with prolonged prothrombin time and factor VII deficiency (<1%, severe type). The patient was genetically confirmed to have the FVII:c 681+1 G>T homozygous mutation. Brain hemorrhage was resolved with high-dose factor VII replacement therapy with recombinant activated factor VII. However, repeated hemothorax and intracranial hemorrhage were detected. Therefore, the patient was under regular factor VII supplementation with a rehabilitation program for cerebral palsy. Conclusions: A case of factor VII deficiency with large cephalohematoma and intracranial hemorrhage after birth is described herein, which was treated with high-dose replacement therapy. Variants of the FVII:c 681+1 G>T (IVS6+1G>T) homozygous genotype may present with a severe phenotype at the neonatal stage. We aim to share a unique neonatal presentation with a certain genotype and treatment experience with initial replacement therapy, followed by regular prophylactic dosage.
Standardized cannabis in multiple sclerosis: a case report
Authors: Paul Hornby, Manju Sharma
Journal: Cases J (2010)

A 52 year old female suffering from severe progressive multiple sclerosis was administered quantifiable amounts of standardized cannabis and monitored over the period of one year, while providing daily pain charts and records of her condition. An average daily intake of 500 mg of Tetrahydrocannabinol as cannabis was required to achieve a desired quality of life.
Treatment of Multiple Primary Malignancies With PD-1 Inhibitor Camrelizumab: A Case Report and Brief Literature Review
Authors: Yuchen Wan, Zhixue Wang, Ning Yang, Fenye Liu
Journal: Front Oncol (2022)
Keywords: acquired resistance, camrelizumab, immune checkpoint inhibitors, immunotherapy, multiple primary malignancies
MeSH terms: Case Reports

Background:
With significant advances in the diagnostic tools and treatment modalities of cancer, the incidence of multiple primary malignancies (MPMs) has increased in the last decades. The therapeutic option changed with the arising of immune checkpoint inhibitors (ICIs), which have improved the survival of a broad spectrum of tumors. However, little information is available when it comes to the efficacy, resistance, and underlying mechanisms of ICIs.
Case presentation:
A 67-year-old woman was diagnosed with pulmonary sarcomatoid carcinoma (PSC) with a history of hepatocellular carcinoma (HCC) and viral hepatitis B. Following the lack of response to systemic chemotherapy, she was treated with camrelizumab, an anti-programmed cell death protein 1 monoclonal antibody, in combination with chemotherapy, and a partial response was obtained both in PSC and HCC. After a course of 9-month treatment, the PSC lesion shrank still, while HCC was evaluated as a progressive disease with an increase in the diameter of liver neoplasm, elevated alpha-fetoprotein, and enlarged abdominal lymph nodes. Then, with the addition of radiotherapy for abdominal metastasis, the lung lesion was continuously shrinking. In the meantime, the liver neoplasm and abdominal lymph nodes showed no significant enlargement.
Conclusion:
Camrelizumab combination therapy could consistently benefit the MPM patients with PSC and HCC, which may be a promising option for patients with MPMs.
Monitoring public awareness about the endangered northern bald ibis: a case study involving primary school children as citizen scientists
Authors: Didone Frigerio, Verena Puehringer-Sturmayr, Brigitte Neuböck-Hubinger, Gudrun Gegendorfer, Kurt Kotrschal, Katharina Hirschenhauser
Journal: PeerJ (2019)
Keywords: citizen science, education, northern bald ibis, science literacy, sciencecommunication

Background:
Citizen science has evolved over the past decades by motivating members of the public to interact with scientists and actively participate in scientific research and monitoring. For this purpose, a proficient communication is mandatory in order to efficiently convey messages and reduce the gap of knowledge between scientists and lay people. In the present study, we aimed at evaluating the multiplying effect of children, who were trained to communicate their knowledge on an endangered bird species in order to engage the local community in the long-term ornithological monitoring of the free flying and individually marked colony of northern bald ibis (NBI, Geronticus eremita), which was established at the research station in 1997.
Methods:
Pupils of the local primary schools were in regular contact with researchers, enjoyed outdoor encounters with the birds, and were invited to talk about their experience with as many people as possible. Later on, they acted as surveyors to assess the knowledge of the public on (i) the general knowledge about the species, (ii) specific knowledge about the local colony, and (iii) attitudes towards science. In two different years of evaluation (2012 and 2016) a total number of 387 persons were surveyed. The questions were generated together with the pupils and their teachers and the questionnaires were similar for both years of evaluation. All queries were in a closed format.
Results:
Our results show an increase in the proportion of correct answers provided by the surveyed persons between the two years of evaluation. Education-based activities may encourage children to effectively act as multipliers of information and attitudes. This has the potential to induce sustainable changes with respect to attitude towards science, at least among local communities. Furthermore, the study suggests caution with the quality of some information reported by citizen scientists, which might be solved by more careful training actions and more specific information about local particularities. Even though the study would have gained more informative power with some additional precautions than in its current form, our findings recommend the empowerment of pupils as multipliers of scientific knowledge.
Acute Amiodarone Pulmonary Toxicity after Drug Holiday: A Case Report and Review of the Literature
Authors: Ahmed Abuzaid, Marwan Saad, Mohamed Ayan, Amjad Kabach, Toufik Mahfood Haddad, Aiman Smer, Amy Arouni
Journal: Case Rep Cardiol (2015)

Amiodarone is reported to cause a wide continuum of serious clinical effects. It is often challenging to detect Amiodarone-induced pulmonary toxicity (AIPT). Typically, the diagnosis is made based on the clinical settings and may be supported by histopathology results, if available. We describe a 57-year-old patient who developed severe rapidly progressive respiratory failure secondary to AIPT with acute bilateral infiltrates and nodular opacities on chest imaging. Interestingly, Amiodarone was discontinued 3 weeks prior to his presentation. He had normal cardiac filling pressures confirmed by echocardiography. To our knowledge, this is the first case of isolated acute lung injury induced by Amiodarone, three weeks after therapy cessation, with adequate clinical improvement after supportive management and high dose steroid therapy.
Case report: Clinical and molecular characterization of two siblings affected by Brody myopathy
Authors: Daniele Velardo, Sara Antognozzi, Martina Rimoldi, Serena Pagliarani, Filippo Cogiamanian, Sergio Barbieri, Stefania Corti, Giacomo Pietro Comi, Dario Ronchi
Journal: Front Neurol (2023)
Keywords: atp2a1, brody myopathy, serca1, wes, neuromuscular disorder
MeSH terms: Case Reports

Exercise-induced muscle stiffness is the hallmark of Brody disease, an autosomal recessive myopathy due to biallelic pathogenic variants in ATP2A1, encoding the sarcoplasmic/endoplasmic reticulum Ca2+ ATPase SERCA1. About 40 patients have been reported so far. Our knowledge about the natural history of this disorder, genotype-phenotype correlations and the effect of symptomatic treatment is partial. This results in incomplete recognition and underdiagnosis of the disease. Here, we report the clinical, instrumental, and molecular features of two siblings presenting childhood-onset exercise-induced muscle stiffness without pain. Both the probands display difficulty in climbing stairs and running, frequent falls, delayed muscle relaxation after exertion. Cold temperatures worsen these symptoms. No myotonic discharges were observed at electromyography. Whole Exome Sequencing analysis in the probands revealed the presence of two ATP2A1 variants: the previously reported frameshift microdeletion c.2464delC and the likely pathogenic novel splice-site variant c.324 + 1G > A, whose detrimental effect was demonstrated in ATP2A1 transcript analysis. The bi-allelic inheritance was verified by Sanger sequencing in the unaffected parents. This study expands the molecular defects associated with Brody myopathy.
Panic Disorder Induced by the Coronavirus Disease Pandemic in a Patient with Organic Mood Disorder Successfully Treated with Vortioxetine
Authors: Reiji Yoshimura, Naomichi Okamoto, Yuki Konishi, Atsuko Ikenouchi
Journal: Case Rep Psychiatry (2020)
MeSH terms: Case Reports

We present a case of panic disorder induced by the coronavirus disease (COVID-19) pandemic in a patient with an organic mood disorder. The patient was a 62-year-old woman with mild mood swings and reduced motivation and volition caused by a traumatic brain injury after a traffic accident. She was maintained on carbamazepine (600 mg/day). When the COVID-19 outbreak occurred in Japan, she developed concerns regarding the illness and complained of multiple episodes of panic attacks. Further, her depressive symptoms worsened. Thus, vortioxetine was added to the ongoing CBZ treatment. Four weeks after initiating vortioxetine treatment, the symptoms of panic disorder and depressive state were ameliorated. The present case suggests that vortioxetine augmentation can improve symptoms of depressive state and panic disorder induced by the COVID-19 pandemic.
Accumulation of CD103+ CD8+ T cells in a cutaneous melanoma micrometastasis
Authors: Katharina Hochheiser, Han Xian Aw Yeang, Teagan Wagner, Candani Tutuka, Andreas Behren, Jason Waithman, Christopher Angel, Paul J Neeson, Thomas Gebhardt, David E Gyorki
Journal: Clin Transl Immunology (2019)
Keywords: melanoma, micrometastasis, tissue‐resident memory t cells
MeSH terms: Case Reports

Objective:
The immune system can halt cancer progression by suppressing outgrowth of clinically occult micrometastases in a state of cancer-immune equilibrium. Cutaneous melanoma provides a unique opportunity to study the immune contexture of such lesions, as miniscule skin metastases are accessible to clinical inspection and diagnostic biopsy.
Methods:
Here, we analysed by multiplex immunofluorescence microscopy samples from a melanoma patient presenting with an overt and an occult in-transit metastasis (ITM), the latter of which appeared as a small erythematous papule.
Results:
Microarchitecture and immune composition in the two lesions were vastly different. CD4+ and CD8+ T cells accumulated around the margin of the overt SOX10+ Melan A+ ITM but were largely excluded from the tumor centre. By contrast, the occult micrometastasis contained only few SOX10+ Melan A- melanoma cells which were scattered within a dense infiltrate of T cells, including a prominent population of CD103+ CD8+ T cells resembling tissue-resident memory T (TRM) cells. Notably, almost every single melanoma cell in the micrometastasis was in close proximity to these TRM-like cells.
Conclusion:
Such results support the emerging concept that CD103+ CD8+ TRM cells are key mediators of cancer surveillance and imply an important function of these cells in controlling clinically occult micrometastases in humans.
Perioperative management of esophagectomy in a patient who previously underwent bilateral lung transplantation
Authors: Hiroaki Toyama, Kazutomo Saito, Yusuke Takei, Kana Saito, Takuya Fujimine, Yutaka Ejima, Takashi Kamei, Tatsuaki Watanabe, Yoshinori Okada, Masanori Yamauchi
Journal: JA Clin Rep (2016)
Keywords: artificial pneumothorax, bilateral lung transplantation (bltx), esophageal cancer, esophagectomy, thoracoabdominal major surgery, thoracoscopic esophagectomy

Background:
General theory of anesthetic managements for nontransplant procedures in lung transplant patients was proposed. However, there are few literatures reporting the perioperative management of thoracoabdominal major surgery following lung transplantation in detail. Herein, we scrupulously report a perioperative management of esophagectomy in a patient who previously underwent bilateral lung transplantation (BLTx), focusing on protection of the transplanted lungs and the respiratory function of the patient.
Case presentation:
A 50-year-old woman was listed for cadaveric BLTx for severe respiratory failure due to end-stage diffuse panbronchiolitis. She underwent BLTx under veno-arterial extracorporeal membranous oxygenation support. Blood loss during the BLTx was 13,675 mL, and mild lung edema developed. She was weaned from the ventilator on the sixth postoperative day (POD) and discharged on the 65th POD. Two years after the BLTx, respiratory function improved markedly, but she was diagnosed with esophageal cancer and was scheduled for thoracoscopic esophagectomy with radical lymph node dissection, hand-assisted laparoscopic gastric mobilization, and anastomosis of the gastric conduit to the cervical esophagus via posterior mediastinum. We were concerned that impaired lymphatic drainage could cause pulmonary edema or lymphangiogenesis could cause a severe immunologic response against the lung grafts. To avoid graft injury and rejection, we addressed lung protective ventilation, reduced transfusion volume, continued immunosuppressive agents, administered volatile anesthetics, and prevented dynamic pain by epidural analgesia. These factors and the improved respiratory function may have contributed to successful management of esophagectomy. During the perioperative period, the major respiratory problems were a slight right lung edema and a persistent pulmonary air leak due to the division of thoracic adhesions, which resolved on 13th POD.
Conclusions:
Cancer surgeries in lung transplant recipients become more common. When such patients undergo thoracoabdominal major surgery, we should pay special attention to respiratory function, operative stress, immunosuppressive therapy, transfusion volume for the prevention of lung edema, and thoracic adhesions.
Case report: Treatment of a patient with STEMI and cardiogenic shock caused by RCA originating from LAD
Authors: Qiang Niu, Yunhe Zhao, Haiying Li, Qilei Wang, Haijun Zhu, Chenglong Bi, Hui Zhang, Jian Wang, Cheng Cheng, Beibei Song, Chengwei Jin, Ming Lv, Bo Li
Journal: Front Cardiovasc Med (2023)
Keywords: ami, anomaly, drug-coated balloon (dcb), percutaneous coronary intervention (pci), ventricular fibrillation (vf)
MeSH terms: Case Reports

The right coronary artery (RCA) originating from the left anterior descending artery (LAD) is a very rare variation of coronary artery anomaly. This kind of anomaly is usually considered to be clinically benign. Here, we present an acute myocardial infarction patient with a single coronary artery (SCA), in whom the LAD and RCA are both occlusive at the same time. He suffered from ventricular fibrillation, cardiogenic shock, and severe bradyarrhythmias many times. Fortunately, this patient survived from death through our effective medical procedures.
Case Report: Chemoimmunotherapy in microsatellite-instability-high advanced goblet cell carcinoma of the colon
Authors: Arda Ulaş Mutlu, Erman Aytaç, Mehmet Gülmez, Sibel Erdamar, Leyla Özer
Journal: Front Immunol (2023)
Keywords: msi-h, chemoimmunotherapy, complete response, goblet cell, metastatic colon cancer (mcrc), microsatellite unstable (high)
MeSH terms: Adenocarcinoma, Mucinous, Pancreatic Neoplasms, Case Reports, Aged, Antineoplastic Combined Chemotherapy Protocols / therapeutic use, Colon, Goblet Cells, Humans, Immunotherapy, Male, Microsatellite Instability, Microsatellite Repeats, Turcot syndrome

Background:
Mismatch repair (MMR) deficiency is a fundamental factor affecting the management treatment outcomes of colorectal cancer (CRC). MMR status can be diagnosed by both immunohistochemistry (IHC) polymerase chain reaction (PCR). Since tumors with MMR deficiency are prone to respond to immunotherapy immune checkpoint inhibitors are used to treat such tumors.
Case presentation:
A 69-year-old male patient presented to an outside clinic with weight loss and abdominal pain. Radiological investigations detected a mesenteric mass of 10 cm, peritoneal implants, and mediastinal lymphadenopathy. The eventual biopsy result from the mesenteric mass was mucinous adenocarcinoma with a goblet cell pattern. Since the IHC result was unclear for deficiency in mismatch repair (dMMR) metastatic CRC (mCRC), the diagnosis was confirmed with PCR. The patient received 8 cycles of FOLFIRINOX + bevacizumab followed by FOLFOX combined with pembrolizumab. No adverse effect was reported related to immunotherapy which resulted in radiologic and metabolic regression. The patient underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). The final pathology results revealed a pathological complete response and R0 resection. In the 6th month follow-up, no recurrence or metastasis was reported.
Conclusion:
Chemotherapy and immunotherapy combination is a promising treatment modality which can also be used for mCRC. This is the index case who received chemotherapy in combination with immunotherapy for mucinous adenocarcinoma of the colon with a goblet cell pattern and had pCR.
Dislodged Bonded Molar Tube into Wound during Orthognathic Surgery
Authors: Tengku Aszraf Tengku Shaeran, A R Samsudin
Journal: Case Rep Dent (2018)
MeSH terms: Case Reports

Introduction:
Dislodgement of orthodontic appliance into operation wounds may occur while performing orthognathic surgery. Its occurrence is commonly associated with bonded upper molar tube.
Case report:
A 25-year-old gentleman presented with recurrent upper right vestibular abscess three months following a bimaxillary orthognathic surgery. A bonded molar orthodontic tube had dislodged into the wound during the operation. The clinical presentation initially mimics an odontogenic infection until our investigations revealed that it originated from the dislodged appliance. The abscess was drained, the wound site was explored, and the molar tube and neighbouring rigid fixation plates and screws were removed. The patient recovered well following the procedure.
Conclusion:
Dislodged metal orthodontic appliance in oral wound acts as a foreign body that may exert allergic reactions, infection, or inflammation. Pre- and postoperative intraoral examination of fixed orthodontic appliances including its count should be recorded in orthognathic surgery protocol.