OpenMed/multicare-articles huggingface dataset:
Cerebral infarction following bee stings: Case report and literature review
Authors: Shuiquan Yang, Jack Wellington, Juanmei Chen, Robert W Regenhardt, Alex Y Chen, Guilan Li, Zile Yan, Pingzhong Fu, Zhaohui Hu, Yimin Chen
Journal: Transl Neurosci (2022)
Keywords: bee stings, case report, cerebral infarction, thrombectomy
MeSH terms: Case Reports

Background:
To date, only 25 cases of cerebral infarction following a bee or wasp sting have been reported. Due to its rarity, undefined pathogenesis, and unique clinical features, we report a case of a 62-year-old man with progressive cerebral infarction following bee stings, possibly related to vasospasm. Furthermore, we review relevant literature on stroke following bee or wasp stings.
Case presentation:
A 62-year-old retired male presented with progressive ischemic stroke after bee stings to the ear and face. Initial magnetic resonance imaging of the brain showed small punctate infarcts in the left medulla oblongata. Head and neck computed tomography angiography showed significant stenosis in the basilar artery and occlusion in the left V4 vertebral artery. The patient received intravenous alteplase (0.9 mg/kg) without symptomatic improvement. Digital subtraction angiography later demonstrated additional near occlusion in the left posterior cerebral artery (PCA). Thrombectomy was considered initially but was aborted due to hemodynamic instability. Repeated CT brain after 24 h showed acute infarcts in the left parieto-occipital region and left thalamus. The near occluded PCA was found to be patent again on magnetic resonance angiography (MRA) 25 days later. This reversibility suggests that vasospasm may have been the underlying mechanism. Unfortunately, the patient had persistent significant neurological deficits after rehabilitation one year later.
Conclusion:
Cerebral infarction following bee stings is rare. There are several proposed pathophysiological mechanisms. While the natural course of this phenomenon is not well characterized, early diagnosis and treatment are essential. Furthermore, it is important to establish standardized care procedures for this unique entity.
A Novel Oncogenic Driver in a Lung Adenocarcinoma Patient Harboring an EGFR-KDD and Response to Afatinib
Authors: Dong Chen, Xing-Liang Li, Biao Wu, Xiao-Bin Zheng, Wen-Xian Wang, Hua-Fei Chen, Yi-Yu Dong, Chun-Wei Xu, Mei-Yu Fang
Journal: Front Oncol (2020)
Keywords: afatinib, epidermal growth factor receptor, kinase domain, next-generation sequencing, non-small cell lung cancer
MeSH terms: Case Reports

Introduction: Oncogenic mutations in the epidermal growth factor receptor (EGFR) occur frequently in patients with lung cancer. These mutations may serve as critical predictive biomarkers in patients with non-small cell lung cancer (NSCLC). Among them, EGFR exon 18-25 kinase domain duplication (EGFR-KDD) mutations have been identified as a novel EGFR gene subtype in NSCLC. Case Presentation: We reported a rare case of a 59-year-old male diagnosed with adenocarcinoma. A biopsy revealed an EGFR-KDD identified by the next generation sequencing (NGS). Effective treatment outcome has been observed after administration with afatinib. Conclusion: This case highlights that comprehensive NGS technique is valuable in detecting novel genetic mutations in tumors.
Total knee arthroplasty and physical therapy for arthropathy in alkaptonuria: A 4-year follow-up case report
Authors: Linfeng Wu, Yu Hu
Journal: Front Surg (2023)
Keywords: alkaptonuria (aku), arthropathy, arthroplasty, ochronosus, physical therapy
MeSH terms: Case Reports

Introduction:
Alkaptonuria is a rare autosomal recessive metabolic disorder which leads to accumulation of homogentisic acid in the body.
Case presentation:
We report a rare case of an alkaptonuria-related knee arthritis who underwent left total knee arthroplasty and received postoperative systematic physical therapy in a 57-year-old male patient. The patient has suffered from bilateral knee pain for over 4 years. The patient developed melanin pigmentation on the skin of the whole body, especially on the face and auricle. He self-reported that fresh urine was normal color but after standing overnight, the color deepened to black or soy color. He underwent routine urine examination for many times, but no obvious abnormality was found. The patient has suffered from low back pain for more than 20 years. He had been considered for lumbar disc herniation and ankylosing spondylitis after many in-hospital visits. After symptomatic medication, there was no obvious relief. We followed the patient for 4 years after surgery.
Result:
The patient presented with pain relief and enhanced range of motion at the 4-year follow-up. The improvements of daily living and the pain relief suggest that the surgery is appropriate for this rare disease.
Conclusion:
It is rare that the knee pain is diagnosed as alkaptonuria. After total knee arthroplasty and physical therapy, the patient had a good outcome. This case provides experience for the diagnosis and treatment of alkaptonuria-related knee arthritis.
Case Report: Peripheral blood T cells and inflammatory molecules in lung cancer patients with immune checkpoint inhibitor-induced thyroid dysfunction: Case studies and literature review
Authors: Mona A Marie, Justin D McCallen, Zahra S Hamedi, Abdul Rafeh Naqash, Alexander Hoffman, Druid Atwell, Suneetha Amara, Mahvish Muzaffar, Paul R Walker, Li V Yang
Journal: Front Oncol (2022)
Keywords: immune checkpoint inhibitor (ici), immune-related adverse events, iraes, lung cancer, thyroid dysfunction and thyroiditis
MeSH terms: Case Reports

Immunotherapy has changed the paradigm of cancer treatment, yet immune checkpoint inhibitors (ICIs) such as PD-1/PD-L1 monoclonal antibodies may cause immune-related adverse events (irAEs) in some patients. In this report, two non-small cell lung cancer (NSCLC) patients treated with nivolumab presented with checkpoint inhibitor-induced thyroid dysfunction (CITD), followed by a second irAE of pneumonitis and intestinal perforation, respectively. Increases in peripheral CD8+ T cells correlated with the onset of CITD in the patients. Intriguingly, common inflammatory biomarkers, including C-reactive protein (CRP) and neutrophil/lymphocyte ratio (NLR), were not consistently increased during the onset of CITD but were substantially increased during the onset of pneumonitis and intestinal perforation irAEs. The observations suggest that unlike other irAEs such as pneumonitis, CRP levels and NLR were non-contributory in diagnosing CITD, whereas T cell expansion may be associated with immunotherapy-induced thyroiditis.
Myocarditis mimicking an acute coronary syndrome: a case related to Salmonella enteritis
Authors: B Rossetti, G Nguisseu, A Buracci, L Migliorini, G Zanelli
Journal: Gastroenterol Res Pract (2009)
MeSH terms: Case Reports

Infective myocarditis is most commonly due to a viral infection; occasionally it has been related to bacteria. Gastrointestinal infections associated with myocarditis have only rarely been described in young people, and the pathogenesis is unclear. We report a case of myocarditis mimicking an acute coronary syndrome (ACS) in a patient hospitalized for fever and diarrhoea. Salmonella enteritidis was isolated from stool, and no other pathogens were found. The coronary angiography was normal, and there were not other coronary artery risk factors, other than hypertension. The patient was treated with ciprofloxacin, acetylsalicylate acid, and ramipril with rapid clinical improvement and normalization of cardiac abnormalities. Final diagnosis of Salmonella enteritis and related myocarditis was made based on clinical, laboratory, ECG and echocardiographical findings.
Transient Ischemic Attack in the Setting of Carotid Atheromatous Disease with a Persistent Primitive Hypoglossal Artery Successfully Treated with Stenting: A Case Report
Authors: Meng Huang, Marc Moisi, Michael E Zwillman, John J Volpi, Orlando Diaz, Richard Klucznik
Journal: Cureus (2016)
Keywords: atherosclerosis, hypoglossal, persistent, stent, tia
MeSH terms: Case Reports

Fetal brain perfusion is supplied by the primitive dorsal aorta anteriorly, longitudinal neural arteries posteriorly, and anastomotic transverse segmentals. Most notable of these connections are the primitive trigeminal, otic, hypoglossal, and proatlantal arteries. With cranial-cervical circulatory maturation and development of the posterior communicating segments and vertebro-basilar system, these primitive segmental anastomoses normally regress. Anomalous neurovascular development can result in persistence of these anastomoses. Due to its territory of perfusion, the persistent primitive hypoglossal artery (PPHA) is associated with vertebral artery and posterior communicating artery hypoplasia or aplasia. As a consequence, primary blood supply to the hindbrain comes chiefly from this single artery. Although usually clinically silent, PPHA is susceptible to common cerebrovascular disorders including athero-ischemic disease and saccular aneurysmal dilation to name a few. We present a case of transient ischemic attack in a patient with a PPHA and proximal atherosclerotic disease treated by endovascular stenting.
Evaluation of anterior segment parameters and possible influencing factors in normal subjects using a dual Scheimpflug analyzer
Authors: Xiaogang Wang, Jing Dong, Qiang Wu
Journal: PLoS One (2014)
MeSH terms: Anterior Eye Segment / anatomy & histology, Observational Study, Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Anterior Eye Segment / growth & development, Anterior Eye Segment / physiology, Child, Corneal Pachymetry / methods, Female, Humans, Male, Middle Aged, Ophthalmoscopy / methods, Refraction, Ocular

Purpose:
To investigate normal anterior segment parameters and analyze the possible influencing factors using a dual Scheimpflug system.
Setting:
Department of Ophthalmology, Affiliated Sixth People's Hospital Shanghai Jiao Tong University, Shanghai, China.
Design:
A prospective observational case series.
Methods:
A total of 153 normal subjects (153 eyes) were studied. The anterior segment parameters, including the central corneal thickness (CCT), anterior chamber depth (ACD), pupil diameter (PD), keratoconus prediction index (KPI), simulated keratometry (SimK) values, anterior instantaneous curvature (AIC), posterior axial curvature (PAC), corneal eccentricity, total corneal power (TCP), axial curvature (AC), total corneal wavefront (TCW), high order aberration (HOA), and spherical aberration (SA), were determined using a dual Scheimpflug analyzer.
Results:
The CCT and ACD were both negatively correlated with age (r = -0.203, p = 0.012; r = -0.589, p<0.001). There was no significant difference in the refractive indices of AIC and SimK. Compared with the negative correlation of HOA and SA (r = -0.358, p<0.001), a positive correlation was found between TCW and HOA (r = 0.561, p<0.001). Unlike the decreased tendency of AC, the TCP increased gradually from the center to the periphery in the central 8 mm diameter. TCP showed a significant correlation with AC in the analyzed area.
Conclusions:
AIC and SimK provide different information in clinic, but the refractive indices of them showed no difference in this healthy study population, and age should be considered when using CCT and ACD values.
Case Report: Adjuvant image-guided radiation therapy reduces surgical invasiveness in malignant peripheral nerve sheath tumors
Authors: Mandara M Harikar, Gianluca Ferini, Paolo Palmisciano, Muhammad Shakir, Paolo Amico, Stefano Ferraresi, Giuseppe E Umana
Journal: Front Oncol (2023)
Keywords: image-guided radiation therapy, malignant peripheral nerve sheet tumor, radiation oncology, radiotherapy, sarcoma
MeSH terms: Case Reports

Introduction:
Malignant peripheral nerve sheath tumors (MPNSTs) are a group of rare soft tissue sarcomas of mesenchymal origin. These tumors generally require extensive local excision owing to their aggressive potential. Though the role of radiotherapy is controversial, in this report, we present the case of an MPNST in the forearm that was treated with microsurgery followed by image-guided radiation therapy to achieve complete tumor disappearance at the 18-month follow-up.
Case report:
A 69-year-old woman with underlying paranoid schizophrenia was referred to our department with pain, severe swelling, and ecchymosis of her right forearm. Physical examination showed hypoesthesia in the segments innervated by the median nerve and reduced motor strength of her right hand. A gadolinium-enhanced MRI showed a large malignant peripheral nerve sheath tumor (13 x 8 x 7 cm) of the median nerve in the forearm. She underwent microsurgical en-bloc tumor resection with sparing of the median nerve. Thirty-five days postoperatively, she underwent image-guided radiotherapy (IGRT) using volumetric modulated arc therapy (VMAT). Serial MRI scans of the forearm with Gadolinium and whole-body CT scan with contrast enhancement at 30 days, 6 months, 1 year, and 18 months postoperatively documented no tumor recurrence, remnants, or metastases.
Conclusions:
In this report, we demonstrate the successful use of advanced radiotherapy techniques such as IGRT while avoiding demolitive surgery for MPNST. Though a longer follow-up is necessary, at the 18-month follow-up, the patient demonstrated good outcomes from surgical resection followed by adjuvant RT for MPNST in the forearm.
Uterine Angioleiomyoma with Atypia, Raised CA-125 Levels, and Pseudo-Meigs Syndrome: An Alarming Presentation
Authors: Sunitha Thomas, Laxmi Radhakrishnan, Latha Abraham, Anna Matthai
Journal: Case Rep Pathol (2012)
MeSH terms: Case Reports

Angioleiomyomas are benign mesenchymal tumours commonly occurring in the subcutis of extremities. They are typically composed of interlacing fascicles of smooth muscle cells with intersecting vascular channels. Angioleiomyomas of the uterus are rare with only very few case reports available in literature. Herein, we report a case of this rare entity in a 47-year-old woman owing to its highly unusual features of cellular atypia, raised CA-125 levels, and pseudo Meigs syndrome.
A rare cause of Fatty liver and elevated aminotransferase levels: chanarin-dorfman syndrome: a case report
Authors: Ozdal Ersoy, Canan Alkım, Mehmet Derya Onuk, Hüseyin Demirsoy, Dilek Argon
Journal: Int J Hepatol (2011)
MeSH terms: Case Reports

Chanarin-Dorfman syndrome is a rare, inherited metabolic disorder of neutral lipid storage characterized by ichthyosis, lipid vacuoles in leukocytes, and involvement of several internal organs, mostly the liver. Since the initial case was reported by Dorfman in 1974, nearly 50 cases have been reported, and the majority were from Middle East countries. Here, we report a 20-year-old patient with ichthyosis from Turkey, diagnosed as Chanarin-Dorfman syndrome presented with asypmtomatic elevated transaminases and hepatosteatosis, and also briefly review the updated clinical implications and management of this rarely seen syndrome. Prompt diagnosis of this syndrome avoids further unnecessary investigations in patients with ichthyosis.
Revisiting community case management of childhood pneumonia: perceptions of caregivers and grass root health providers in Uttar Pradesh and Bihar, northern India
Authors: Shally Awasthi, Mark Nichter, Tuhina Verma, Neeraj Mohan Srivastava, Monica Agarwal, Jai Vir Singh, CAP-Lucknow Team, Anant Prakash Mishra, Gulshan Sami, Ram Dhani Sharma, Ranjan Khare, Vijay Verma, Manish Pandey, Vineet Shukla, Sushil Kumar, Atul Chandra, Hasib-ur-Rehman, Shobha Pandey
Journal: PLoS One (2015)
MeSH terms: Pneumonia / therapy, Research Support, Non-U.S. Gov't, Adult, Aged, Caregivers, Child, Preschool, Community Health Services, Community Networks, Community-Acquired Infections / epidemiology, Community-Acquired Infections / therapy, Disease Management, Female, Hospitalization, Humans, India / epidemiology, Male, Middle Aged, Pneumonia / epidemiology, Tertiary Healthcare, Young Adult

Background:
Community-acquired pneumonia (CAP) is the leading cause of under-five mortality globally with almost one-quarter of deaths occurring in India.
Objectives:
To identify predisposing, enabling and service-related factors influencing treatment delay for CAP in rural communities of two states in India. Factors investigated included recognition of danger signs of CAP, health care decision making, self-medication, treatment and referral by local practitioners, and perceptions about quality of care.
Methods:
Qualitative research employing case studies (CS) of care-seeking, key informant interviews (KII), semi-structured interviews (SSI) and focus group discussions (FGD) with both video presentations of CAP signs, and case scenarios. Interviews and FGDs were conducted with parents of under-five children who had suffered CAP, community health workers (CHW), and rural medical practitioners (RMP).
Results:
From September 2013 to January 2014, 30 CS, 43 KIIs, 42 SSIs, and 42 FGDs were conducted. Recognition of danger signs of CAP among caregivers was poor. Fast breathing, an early sign of CAP, was not commonly recognized. Chest in-drawing was recognized as a sign of serious illness, but not commonly monitored by removing a child's clothing. Most cases of mild to moderate CAP were brought to RMP, and more severe cases taken to private clinics in towns. Mothers consulted local RMP directly, but decisions to visit doctors outside the village required consultation with husband or mother-in-law. By the time most cases reached a public tertiary-care hospital, children had been ill for a week and treated by 2-3 providers. Quality of care at government facilities was deemed poor by caregivers.
Conclusion:
To reduce CAP-associated mortality, recognition of its danger signs and the consequences of treatment delay needed to be better recognized by caregivers, and confidence in government facilities increased. The involvement of RMP in community based CAP programs needs to be investigated further given their widespread popularity.
HHV-6 Meningoencephalitis in a Healthy Adult Female
Authors: Nicholas Valentini, Cynthia Chen
Journal: Case Rep Emerg Med (2023)
MeSH terms: Case Reports

Introduction:
We describe the case of a 47-year-old female who presented to an academic tertiary emergency department with two to three days of worsening fever, headache, malaise, and rigors. A broad infectious workup revealed a diagnosis of Human Herpesvirus 6 (HHV-6) meningoencephalitis without any additional identifiable causes. HHV-6, the virus responsible for the childhood disease roseola, is a common cause of fever, seizures, diarrhea, and a characteristic faint-pink rash in children. Symptomatic HHV-6 infection in adults is far less common. We believe this represents one of only a few reported cases of HHV-6 meningoencephalitis in an immunocompetent host. Case Report. A 47-year-old female presented to the emergency department with two to three days of fever, headache, malaise, and rigors. She had a noncontributory medical, surgical, and family history but had traveled extensively in northeast Africa six months prior. A physical exam was notable for a wide based gait, photophobia, mild nuchal rigidity, and pain with active range of motion of the neck. A broad infectious workup was pursued; however, given headache, fever, and subjective nuchal rigidity, the highest concern was for meningoencephalitis. A lumbar puncture was positive for HHV-6 without any other diagnostic findings to otherwise explain the patient's symptoms. The patient was discharged on hospital day 3 with improving symptoms.
Conclusion:
HHV-6 meningoencephalitis has previously been described as a pathogen associated with individuals with immunosuppressive conditions. There have been several prior case reports of symptomatic meningoencephalitis in immune-competent individuals, and we believe this case adds to a growing body of evidence that HHV-6 meningoencephalitis can cause symptomatic infection in a broader patient population.
The diagnosis and treatment for a patient with cancer of unknown primary: A case report
Authors: Hong Hu, Qin Pan, Jiaying Shen, Junlin Yao, Guoxiang Fu, Fengjuan Tian, Na Yan, Weidong Han
Journal: Front Genet (2023)
Keywords: cancer of unknown primary, case report, gene expression profile, lung metastasis of breast cancer, traceability of tumor tissue

Background: Cancer of unknown primary (CUP) is a class of metastatic malignant tumors whose primary location cannot be determined. The diagnosis and treatment of CUP are a considerable challenge for clinicians. Herein, we report a CUP case whose corresponding primary tumor sites were successfully identified, and the patient received proper treatment. Case report: In February 2022, a 74-year-old woman was admitted to the Medical Oncology Department at Sir Run Run Shaw Hospital for new lung and intestinal tumors after more than 9 years of breast cancer surgery. After laparoscopically assisted right hemicolectomy, pathology revealed mucinous adenocarcinoma; the pathological stage was pT2N0M0. Results from needle biopsies of lung masses suggested poorly differentiated cancer, ER (-), PR (-), and HER2 (-), which combined with the clinical history, did not rule out metastatic breast cancer. A surgical pathology sample was needed to determine the origin of the tumor tissue, but the patient's chest structure showed no indications for surgery. Analysis of the tumor's traceable gene expression profile prompted breast cancer, and analysis of next-generation amplification sequencing (NGS) did not obtain a potential drug target. We developed a treatment plan based on comprehensive immunohistochemistry, a gene expression profile, and NGS analysis. The treatment plan was formulated using paclitaxel albumin and capecitabine in combination with radiotherapy. The efficacy evaluation was the partial response (PR) after four cycles of chemotherapy and two cycles combined with radiotherapy. Conclusion: This case highlighted the importance of identifying accurate primary tumor location for patients to benefit from treatment, which will provide a reference for the treatment decisions of CUP tumors in the future.
Ex-vivo repair for multiple and intraparenchymal renal artery aneurysms
Authors: Prashant Jain, Anil L Naik, Azharuddin Ansari, Lileshwar Kaman, Cherring Tandup, Ujjwal Gorsi, Ajay Savlania
Journal: J Vasc Bras (2021)
Keywords: auto-transplantation, complex renal artery aneurysm, ex-vivo repair, orthotopic
MeSH terms: Case Reports

A 45-year-old woman with known hypothyroidism and no other comorbidities was incidentally found to have multiple right renal artery aneurysms. The largest aneurysm measured 5 x 4.5 cm and arose from an inferior segmental branch while two smaller aneurysms arose from an upper segmental branch of the right renal artery. We performed an ex-vivo repair with reverse saphenous vein graft under cold preservation followed by orthotopic kidney auto-transplantation. Her postoperative course was unremarkable and at 1-year follow-up her right kidney is preserved. In this article, we report successful treatment of complex multiple right renal artery aneurysms and describe the surgical technique used for successful repair.
COVID-19 and Plasmodium vivax malaria co-infection
Authors: Sundus Sardar, Rohit Sharma, Tariq Yousef Mohammad Alyamani, Mohamed Aboukamar
Journal: IDCases (2020)
Keywords: artesunate, covid-19, co-infection, malaria, plasmodium vivax, sars-cov-2
MeSH terms: Case Reports

The ongoing outbreak of COVID-19 poses an unprecedented global health challenge. With its variety of clinical manifestations including, but not limited to, fever, cough, diarrhea, vomiting, headache, myalgia and fatigue, it may be challenging to distinguish COVID-19 from a spectrum of diseases with similar presentations, such as malaria, especially in endemic areas. Risk of concomitant infections also remains a concern owing to overburdening of healthcare services and possible scarcity of resources. We present the first reported case of confirmed COVID and malaria co-infection. In this case, we emphasize the need for vigilance from frontline clinicians for timely diagnosis and appropriate clinical management of potential co-infections in the COVID era.