OpenMed/multicare-articles huggingface dataset:
Purpura Fulminans Secondary to Streptococcus pneumoniae Meningitis
Authors: Erick F Alvarez, Karen E Olarte, Mayur S Ramesh
Journal: Case Rep Infect Dis (2012)
MeSH terms: Case Reports

Purpura fulminans (PF) is a rare skin disorder with extensive areas of blueblack hemorrhagic necrosis. Patients manifest typical laboratory signs of disseminated intravascular coagulation (DIC). Our case describes a 37-year-old previously healthy man who presented with 3 days of generalized malaise, headache, vomiting, photophobia, and an ecchymotic skin rash. Initial laboratory workup revealed DIC without obvious infectious trigger including unremarkable cerebrospinal fluid (CSF) biochemical analysis. There was further progression of the skin ecchymosis and multiorgan damage consistent with PF. Final CSF cultures revealed Streptococcus pneumoniae. Despite normal initial CSF biochemical analysis, bacterial meningitis should always be considered in patients with otherwise unexplained DIC as this may be an early manifestation of infection. PF is a clinical diagnosis that requires early recognition and prompt empirical treatment, especially, in patients with progressive altered mental status, ecchymotic skin rash, and DIC.
Case Report: A Novel LAMP2 Splice-Altering Mutation Causes Cardiac-Only Danon Disease
Authors: Zongzhe Li, Fei Ma, Rui Li, Zhichao Xiao, Hesong Zeng, Dao Wen Wang
Journal: Front Cardiovasc Med (2021)
Keywords: danon disease, lamp2, genetic diagnosis, splicing mutation, targeted sequencing
MeSH terms: Case Reports

Danon disease (DD) is a rare glycogen storage lysosomal disorder caused by mutations in the LAMP2 gene. Patients with DD are usually characterized clinically by severe multisystem syndromes. We describe a specific family with a novel pathogenic splice-altering mutation in the LAMP2 gene (c.741+2T>C) with cardiac-only symptoms (frequent ventricular tachycardia, intraventricular block, and hypertrophic cardiomyopathy). Minigene assays were used to evaluate the consequence of the splice-site mutation in the LAMP2 gene. The results showed that the c.741+2T>C mutation led to extra 6-bp preservation of intron 5 at the junction between exons 5 and 6 during transcriptional processing of the mRNA, which creates a stop codon and truncated the LAMP2 protein to 248-amino-acid residues. The mutant LAMP2 protein was predicted to have a conformational change, lacks the important transmembrane domain, and subsequent protein destabilization.
Treatment decision in a 4-year-old-boy with left ventricular outpouching after advanced hemodynamical flow evaluation with 4Dflow CMR: A case report
Authors: Kerstin Lagerstrand, Par-Arne Svensson, Linnea Andersson, Mats Synnergren, Annika Öhman, Magnus Petersson, Jan Sunnegardh, Frida Dangardt
Journal: Front Pediatr (2022)
Keywords: 4d flow cmr, 4dflow, case report, congenital heart disease, left ventricular outpouching, phase contrast
MeSH terms: Case Reports

Background:
The present study presents a diagnostic course for the characterization of a congenital left ventricular outpouching (LVO) in a 4-year-old boy with severe neonatal heart failure, evaluating the added value of cardiac magnetic resonance (CMR) 4Dflow.
Case presentation:
A boy, born at full term, presented with heart failure immediately after birth. Echocardiography showed dilated left ventricle with poor function and LVO was initially interpreted as an aneurysm. No infection, inflammation, or other cause for heart failure was found. With intensive medical treatment, the heart function returned to normal, and eventually, all medication was terminated. At follow-up, surgical treatment of the LVO was discussed but after CMR 4Dflow, a thorough evaluation of the function of the left ventricle as well as the LVO was possible and the LVO was determined a double-chambered left ventricle with a good prognosis.
Conclusions:
The present case demonstrates the clinical usability of CMR 4Dflow for improved decision-making and risk assessment, revealing advanced hemodynamic flow patterns with no need for operation.
Vertigo as the first sign of chronic myeloid leukemia: a case report and literature review
Authors: Rubén Martín-Hernández, Diego Hernando Macías-Rodríguez, Víctor Martín-Sánchez, Cristina Cordero-Civantos, Santiago Santa Cruz-Ruiz, Angel Batuecas-Caletrio
Journal: Case Rep Otolaryngol (2013)

Acute vestibular deficit as the first sign of leukemia is extremely rare. The literature shows some cases of sudden hearing loss accompanied by instability and associated with hyperviscosity syndrome. We present the case of a patient who presents a harmonic vestibular deficit of the right ear. The complementary studies revealed an abnormally high level of leukocytes. A peripheral blood cytogenetic analysis is performed due to a high suspicion of leukemia, and the results show BCR/ABL fusion gene with a cut point in the M-BCR region, which confirms the diagnosis of chronic myeloid leukemia. In this case we detail the importance of taking hematological disorders into consideration in the differential diagnosis of patients with otoneurological symptoms, and we also review the etiopathogenic mechanisms, symptoms, diagnosis, and therapeutic options for chronic myeloid leukemia with sudden hearing loss and vertigo.
The first case of septicemia due to nontoxigenic Corynebacterium diphtheriae in Poland: case report
Authors: Aleksandra Anna Zasada, Maria Zaleska, Regina Beata Podlasin, Ilona Seferynska
Journal: Ann Clin Microbiol Antimicrob (2005)
MeSH terms: Bacteremia / etiology, Corynebacterium diphtheriae / isolation & purification, Endocarditis, Bacterial / etiology, Case Reports, Adult, Corynebacterium diphtheriae / drug effects, Humans, Male, Microbial Sensitivity Tests

Background:
Toxigenic strains of Corynebacterium diphtheriae are well known agent of diphtheria. Nontoxigenic strains can cause atypical course of the disease. Invasive diseases caused by C. diphtheriae occur very rare.
Case presentation:
We have described the first case of septicemia and endocarditis due to nontoxigenic C. diphtheriae biotype gravis in Poland. The patient has not belonged to any group of risk such infection.
Conclusion:
The case presented in this article shows unusual case of infection connected with nontoxigenic C. diphtheriae that took place in the area where have been no cases of diphtheria and other C. diphtheriae infections for near ten years. It shows the importance of identifying Corynebacterium isolates at the species level especially when the strain has been isolated from normally sterile sites.
Spontaneous neck hematoma in a patient with fibromuscular dysplasia: a case report and a review of the literature
Authors: Oded Cohen, Moshe Yehuda, Meital Adi, Yonatan Lahav, Doron Halperin
Journal: Case Rep Otolaryngol (2013)

Background. Fibromuscular dysplasia (FMD) is a vascular disease that may present as aneurysms in the cervical arteries. Spontaneous neck hematoma is a rare life threatening medical condition. This is the first report of neck hematoma in a patient with FMD. Methods and Results. We present a case of a 69-year-old woman, with diagnosed cervical FMD and a 3-day history of sore throat and neck pain, who presented with enlarging neck hematoma. No active bleeding was noticed on CT angiography, airway was not compromised, and patient was managed conservatively. Next day, invasive angiography was performed, and no bleeding vessel was demonstrated. Patient has improved and was discharged after 5 days of hospitalization. We have discussed the different etiology of this condition, focusing on systemic vascular diseases. Conclusion. Complaint of neck pain in a patient with a FMD should raise suspicion for possible neck hematoma. Conversely, spontaneous neck hematoma without clear etiology should raise suspicion for a systemic vascular disease.
Severe Vitamin A Deficiency After Biliopancreatic Diversion
Authors: Lauren M Lemieux, Vijaya Surampudi
Journal: J Investig Med High Impact Case Rep (2019)
Keywords: bariatric surgery, biliopancreatic diversion, malabsorption, vitamin a
MeSH terms: Biliopancreatic Diversion / adverse effects, Blindness / etiology, Malabsorption Syndromes / complications, Vitamin A / administration & dosage, Vitamin A Deficiency / etiology, Case Reports, Aged, Bariatric Surgery / adverse effects, Blindness / drug therapy, Exanthema / etiology, Female, Humans, Injections, Intramuscular / adverse effects, Malabsorption Syndromes / etiology, Postoperative Complications / etiology, Vitamin A Deficiency / drug therapy, Weight Loss, Vitamin A

Biliopancreatic diversion is a surgical procedure that causes weight loss via volume restriction and malabsorption. It is now rarely performed due to the risk of severe nutritional deficiencies including vitamin A. We report a case of severe vitamin A deficiency due to malabsorption from a biliopancreatic diversion procedure for weight loss. By the time the patient presented to our department, she had developed blindness refractory to parenteral vitamin A treatment. A unique feature of her case is the development of a rash with vitamin A injections. This reaction has only been reported in one case series of 3 patients in the published literature. Her case highlights the importance of vitamin deficiency screening in patients after bariatric surgery, and her skin reaction to the injections is a unique side effect that is not frequently observed.
Chronic Myeloid Leukemia and Cesarean Section: The Anesthesiologist's Point of View
Authors: Houssam Rebahi, Mourad Ait Sliman, Ahmed-Rhassane El Adib
Journal: Case Rep Obstet Gynecol (2018)
MeSH terms: Case Reports

Background:
Chronic Myeloid Leukemia (CML) is a myeloproliferative neoplasm related to chromosomal reciprocal translocation t(9;22). Tyrosine kinase inhibitors (TKIs) such as imatinib have drastically revolutionized the course and the prognosis of this hematologic malignancy. As we know, the association pregnancy-CML is an infrequent situation. Also the use of TKI in pregnant women is unsafe with a lack of alternatives and effective therapeutic options. Thus its cessation during gestation puts those patients at high risk of developing blast crisis characterized by poor outcomes.
Case report:
A 37-year-old pregnant woman, gravida 2, para 2, with a previous cesarean section in 2011, presented to the obstetric unit. Her medical past revealed that she is a newly diagnosed patient with CML managed by TKI during her preconception period. Due to the perilous use of TKI during her pregnancy, a switch to interferon-α administration was adopted. But after the completion of 36 weeks of gestation, disease progression (relapse with blast crisis), attested by biological worsening, a white blood cell count = 245000/mm3 with 32% blasts in the peripheral blood, urged the medical team to opt for cesarean delivery. She underwent general endotracheal anesthesia without any perioperative incidents and gave birth to a healthy newborn. Ten days later, the patient was started on TKI.
Discussion:
Although data on this specific and challenging situation are limited, this case highlights the difficulties encountered by the anesthesiologists when choosing the accurate anesthetic strategy and how important it is to weigh the risks and benefits inherent to each technique. Above all, taking into consideration the possible central nervous system (CNS) contamination by circulating blast cells when performing spinal or epidural approach is primordial. This potential adverse event (CNS blast crisis) is extremely scarce but it is responsible for high rates of morbidity and mortality.
Conflicting Priorities Between Risk Management and Treatment of Schizophrenia in Swiss Forensic Services-A Case Report
Authors: Sarah Steinau, Nathalie Brackmann, Ulf Sternemann, Nikola Biller-Andorno, Elmar Habermeyer
Journal: Front Psychiatry (2018)
Keywords: correctional psychiatry, deprivation of liberty, ethics, forensic psychiatry, incarceration, therapeutic measures
MeSH terms: Case Reports

The Swiss Criminal Code provides measures for mentally-ill offenders focusing on their need for treatment. This may lead to the deprivation of the patient's liberty up to several years. Under certain circumstances the mentally-ill offender can be sentenced to an indefinite incarceration. This case presentation we will describe a forensic psychiatric patient diagnosed with schizophrenia who was ordered an indefinite incarceration in Switzerland after he had been sentenced to 8 years of imprisonment for a deliberate killing. Initial presentation of symptomatology included formal thought disorders and negative symptoms such as affective flattening and alogia. Due to a scarcity of adequate treatment sites in the 90s and lack of scope for risk assessment and management, the patient could only be treated within highly regiment prison environments in the past. There, the patient's treatment concept primarily focused on short-term psychiatric care instead of providing an adequate treatment plan that would have been essential for the patient's improvement of chronic symptoms. This case description aims to present some of the fundamental issues observed in the forensic mental health system, where strong efforts are made to balance risk management and the treatment of severe mental health disorders. We will put the patient's own course of treatment and his progress within the penal system into context with ethical challenges in the forensic and correctional services and will provide potential recommendations for future research in the field of forensic psychiatry.
Occipital osteomylelitis and epidural abscess after occipital nerve block: A case report
Authors: Sean D Christie, Nelofar Kureshi, Ian Beauprie, Renn O Holness
Journal: Can J Pain (2018)
Keywords: epidural abscess, occipital nerve block, occipital neuralgia
MeSH terms: Case Reports

Occipital neuralgia is a paroxysmal jabbing pain in the distribution of the greater or lesser occipital nerves accompanied by diminished sensation in the affected area. Occipital nerve block is a common diagnostic and therapeutic tool used in the course of occipital neuralgia and is considered a safe treatment with few localized adverse events. Occipital nerve block is also indicated for cervicogenic and cluster headache and is often used as a rescue treatment for headaches not responding to conventional therapies. We describe a case of epidural abscess formation 16 days following occipital nerve block in a patient with no underlying medical conditions. This case report emphasizes the importance of strict aseptic technique to reduce infection rates in patients undergoing this procedure, despite the overall safety of occipital nerve block. Clinicians must remain aware of acute and late complications arising postprocedure for the safe practice of this technique.
Psychotic Features Abated with Vitamin D Treatment in a Patient with Major Depressive Disorder
Authors: David C Fipps, Elisabet Rainey
Journal: Case Rep Psychiatry (2020)
MeSH terms: Case Reports

Introduction:
Vitamin D deficiency is common in psychiatric populations, and vitamin D has been used as an add-on medication in major depressive disorder. Case Report. Here, we present the case of a 49-year-old man diagnosed with major depressive disorder, severe, with psychotic features, who was treated with antidepressants and underwent multiple antipsychotic trials. The patient was found to have low serum levels of vitamin D. During treatment with vitamin D, serum levels normalized and the patient's psychotic symptoms abated.
Conclusion:
Ensuring adequate vitamin D levels could be a method of focus for the augmentation or treatment of psychotic features in major depressive disorder.
Case reports: a variety of clinical presentations and long-term evolution of Bochdalek hernias
Authors: Sebastien Frey, Maurice Chazal, Eric Sejor, Patrick Baque, Jerome Mouroux
Journal: Front Surg (2023)
Keywords: bochdalek hernia, abdominal surgery, congenital hernia, diaphragmatic hernia, thoracic surgery, thoracotomy
MeSH terms: Case Reports

Bochdalek hernias are the most common congenital diaphragmatic hernias, followed by Morgagni hernias. The failure of closure of the pleuroperitoneal membrane results in a posterolateral foramen, which can remain silent until adulthood. They remain a rare pathology with nearly a hundred cases published. Its clinical presentation is variable, making its diagnosis challenging for clinicians. Additionally, its symptoms are not necessarily representative of the content of the hernia. Its management is balanced between the abdominal and the thoracic approaches. However, no guidelines or algorithms are available to help surgeons in the decision-making process. We report here four consecutive cases of symptomatic Bochdalek hernias. Each case has a singular presentation, and we share how they were approached at our institution. In particular, this series shows no reoccurrence in 10+ years of follow-up in two cases and 20+ in one case, underlying the importance of surgical management when Bochdalek hernias are symptomatic.
Left Superior Homonymous Quadrantanopia due to Giant Virchow-Robin Space
Authors: Michelle Lim, Jonathan A Micieli
Journal: Case Rep Ophthalmol (2023)
Keywords: hemianopia, virchow-robin space, vision loss
MeSH terms: Case Reports

A 51-year-old man was referred by his optometrist for an incidental finding of a visual field defect. Humphrey 24-2 SITA-Fast visual field testing revealed a left superior homonymous quadrantanopia, and magnetic resonance imaging of the brain showed a 2.0 × 0.5-cm oblong-shaped cerebrospinal fluid space posterior to the right basal ganglia. This space coursed close to the lateral geniculate body and was thought to represent a giant perivascular (Virchow-Robin) space. This case demonstrates that patients with a visual field defect without other neurological symptoms could be a result of an enlarged Virchow-Robin space along the visual pathway.
Postoperative Endophthalmitis after Combined Cataract Extraction and iStent Inject Implantation
Authors: Johnson Huang, Minh T Nguyen, Mai Tsukikawa, Andrew Chen
Journal: Case Rep Ophthalmol Med (2023)
MeSH terms: Case Reports

Purpose. To report a case of postoperative endophthalmitis after combined cataract extraction and iStent inject implantation. Observation. A 70-year-old male with a nuclear sclerotic cataract and primary open-angle glaucoma underwent an uneventful phacoemulsification cataract extraction with implantation of an intraocular lens and an iStent inject trabecular bypass stent. The patient was prescribed a postoperative regimen of ofloxacin 0.3% and prednisolone acetate 1%, 1 drop four times a day each. On postoperative day five, he presented to the emergency room for eye pain and had 4+ mixed cells in the anterior chamber (AC) without hypopyon or vitritis on exam. Prednisolone 1% eye drops were increased from four times a day to every two hours while awake. Overnight, he developed worsening vision and severe eye pain. The next morning, he was found to have increased AC cells, vitritis, and intraretinal hemorrhages and was diagnosed with endophthalmitis. The patient underwent a vitreous tap and intravitreal injections of vancomycin (1 mg/0.1 mL) and amikacin (0.4 mg/0.1 mL). Cultures grew Staphylococcus epidermidis. Lab work-up revealed underlying neutropenia. Visual acuity eventually recovered to 20/20. Conclusion and Importance. This report highlights a case of endophthalmitis associated with placement of the iStent inject. The infection was well-controlled after administration of intravitreal antibiotics without removal of the iStent inject, and visual acuity eventually recovered to 20/20. Surgeons should be aware of endophthalmitis risk following combined iStent inject placement, and good recovery is possible without removal of the implant.
Two cases of orbital myositis as a rare feature of lyme borreliosis
Authors: Arnaud Sauer, Claude Speeg-Schatz, Yves Hansmann
Journal: Case Rep Infect Dis (2011)
MeSH terms: Case Reports

Myositis has been reported as a rare manifestation of Lyme disease, and the Lyme disease spirochetes can be an important consideration in the differential diagnosis of unusual cases of myositis, especially in patients who live in or travel to endemic areas. We report the case of two patients who presented with focal orbital myositis which are rare localization for Lyme disease. Myositis were confirmed by magnetic resonance imaging. Diagnosis criteria for Borrelia burgdorferi (B. burgdorferi) infection was supported by (i) medical history (tick bite in an endemic area), (ii) systemic clinical findings (Erythema migrans, neurological manifestation or arthritis), (iii) positive Lyme serology and/or the detection of B. burgdorferi DNA by polymerase chain reaction, as well as (iv) exclusion of other infectious and inflammatory causes. The current cases are reviewed in the context of findings from previous myositis descriptions.
Utility of F-18 FDG PET/CT for Detection of Bone Marrow Metastases in Prostate Cancer Patients Treated with Radium-223
Authors: Kaoru Maruyama, Keita Utsunomia, Takahiro Nakamoto, Shigenari Kawakita, Takashi Murota, Noboru Tanigawa
Journal: Asia Ocean J Nucl Med Biol (2018)
Keywords: bone marrow, pet, prostate cancer, radiotherapy, radium
MeSH terms: Case Reports

A 76-year-old man with symptomatic bone metastases from castration-resistant prostate cancer underwent Radium-223-dichloride (Ra-223) therapy. Before Ra-223 therapy, he had normal peripheral blood cell counts. Ra-223 therapy relieved his shoulder and low back pain. The elevation of the serum prostate-specific antigen (PSA), doubling every month during Ra-223 therapy, suggested a PSA flare or relapse. Some lesions showed decrease and some lesions showed increase on Tc-99m hydroxymethylene diphosphonate bone scintigraphy at two weeks after the third injection of Ra-223 therapy. Ra-223 therapy was discontinued due to thrombocytopenia that was getting worse rapidly. After treatment discontinuation, namely four weeks after the third injection of Ra-223, F-18 fluorodeoxyglucose (FDG) Positron Emission Tomography (PET)/CT and a biopsy were performed to evaluate for metastases, and bone marrow metastases were found. Ra-223 was effective for osteoblastic lesions, but not for bone marrow metastases. FDG PET/CT, but not a Tc-99m based bone scan, detected diffuse bone marrow involvement by cancer. This case report is the first to clarify the utility of FDG PET for the detection of bone marrow metastases confirmed by pathological examination in Ra-223 therapy for progressive castration-resistant prostate cancer.
Multi-organ failure caused by lasagnas: A case report of Bacillus cereus food poisoning
Authors: Marin Thery, Vladimir L Cousin, Pierre Tissieres, Maxime Enault, Luc Morin
Journal: Front Pediatr (2022)
Keywords: bacillus cereus, continuous venovenous hemofiltration, food poisoning, liver failure acute, pediatrics, sepsis
MeSH terms: Case Reports

We report a Bacillus cereus, cereulide producing strain, food poisoning of two sisters. After eating a few bites of pasta cooked 3 days earlier, a 13-year-old girl developed mild symptoms. However, her 11-year-old sister suffered, 40 h after ingestion of the entire platter, a multi-organ failure including acute liver failure, rhabdomyolysis, disseminated intravascular coagulation, and acute kidney injury (AKI). She received supportive care in pediatric intensive care using mechanical ventilation, hemofiltration, and high-doses vasopressors. She was specifically treated for toxin-mediated disease using blood purification and further digestive decontamination. This report highlights the potential severity of B. cereus food poisoning but also a successful dual treatment including toxin removal and antimicrobial treatment to prevent toxin production.