OpenMed/multicare-articles huggingface dataset:
Schizophrenia Associated with Epileptiform Discharges without Seizures Successfully Treated with Levetiracetam
Authors: Dominique Endres, Evgeniy Perlov, Bernd Feige, Dirk-Matthias Altenmüller, Nils Venhoff, Ludger Tebartz van Elst
Journal: Front Psychiatry (2017)
Keywords: lani hypothesis, epilepsy, epileptiform discharges, levetiracetam, paraepileptic, schizophrenia
MeSH terms: Case Reports

Background:
Schizophrenia-like disorders can be divided into endogenic or primary, idiopathic, polygenetic forms, and different secondary, organic subgroups [e.g., (para)epileptic, immunological, degenerative]. Epileptic and paraepileptic explanatory approaches have a long tradition due to the high rate of electroencephalography (EEG) alterations in patients with schizophrenia.
Case presentation:
We present the case of a 23-year-old female patient suffering, since the age of 14 years, from a fluctuating paranoid-hallucinatory syndrome with formal thought disorder, fear, delusions of persecution, auditory, visual, and tactile hallucinations, as well as negative and cognitive symptoms. Laboratory measurements showed increased titers of antinuclear antibodies (ANAs) in the context of ulcerative colitis. While there was no clear history or evidence of epileptic seizures, the EEG showed generalized 3 Hz polyspike wave complexes. Under treatment with levetiracetam, the symptoms disappeared and the patient was able to complete vocational training.
Conclusion:
The schizophrenia-like symptoms associated with epileptiform discharges but not overt seizures and the good response to antiepileptic treatment could be interpreted in the context of a (para)epileptic pathomechanism. The EEG alterations might be due to a polygenetic effect due to different genes. Mild immunological mechanisms in the framework of ulcerative colitis and increased ANA titers might have supported the network instability. This case report illustrates (1) the importance of EEG screenings in schizophrenia, (2) a potential pathogenetic role of epileptiform discharges in a subgroup of patients with schizophrenia-like symptoms, and (3) that antiepileptic medication with levetiracetam could be a successful treatment alternative in schizophrenia-like disorders with EEG alterations.
Streptococcus Pneumoniae Bacteremia with Acute Kidney Injury and Transient ADAMTS13 Deficiency
Authors: Sam Van Hove, Alexis Werion, Ahalieyah Anantharajah, Leila Belkhir, Marie-Astrid van Dievoet, Philippe Hantson
Journal: Case Rep Infect Dis (2023)
MeSH terms: Case Reports

A 43-year-old woman with a medical history of splenectomy for immune thrombocytopenic purpura was diagnosed with Streptococcus pneumoniae bacteremia. Her initial complaints were fever and more importantly painful extremities that appeared cyanotic. During her hospitalisation, she never developed cardiocirculatory failure but presented acute kidney injury (AKI) with oliguria. Laboratory investigations confirmed AKI with serum creatinine 2.55 mg/dL which peaked at 6.49 mg/dL. There was also evidence for disseminated intravascular coagulation (DIC) with decreased platelet count, low fibrinogen levels, and high D-dimer levels. There were no signs of haemolytic anaemia. The initial ADAMTS13 activity was low (17%) but slowly recovered. Renal function progressively improved with supportive therapy, as opposed to the progressing skin necrosis. The association of DIC and low ADAMTS13 activity may have contributed to the severity of microthrombotic complications, even in the absence of thrombotic microangiopathy as thrombotic thrombocytopenic purpura (TTP) or pneumococcal-associated haemolytic uremic syndrome (pa-HUS).
Open elbow dislocation associated with distal ischemia in children about one case and review of the literature
Authors: Noureddine Redjil, Mwinyanne Narcisse Dabire, Pierre Weber
Journal: Pan Afr Med J (2015)
Keywords: children, elbow dislocation, ischimia, open, treatment
MeSH terms: Elbow Injuries, Ischemia / etiology, Joint Dislocations / complications, Case Reports, Review, Child, Debridement / methods, Follow-Up Studies, Humans, Joint Dislocations / surgery, Male

Elbow's dislocations of the child are rare injuries. Its associated injuries such as the opening and the distal ischemia are an extreme therapeutic emergency. One case of open elbow dislocation with distal ischemia in a 10-year-old child is reported. In the clinical examination, there is a deformity of the elbow, a wound showing the cartilaginous distal humerus with the brachial artery under tension on the trochlea that creates a beginning distal ischemia and hypoesthesia in the territory of the median nerve. The surgical health care included a careful debridement, a reduction and scanning of the neurovascular bundle of humerus with reappearance of pulses after 45 minutes. After the last follow-up at three months, the child's examination does not show any neurovascular disorder with a steady elbow. The functional prognosis depends mainly on the reduction time, the importance of neurovascular injuries and the skin opening.
Full Thickness Retinal Hole Formation after Nd:YAG Laser Hyaloidotomy in a Case with Valsalva Retinopathy
Authors: Yasin Sakir Goker, Kemal Tekin, Cemile Ucgul Atilgan, Pinar Kosekahya, Pelin Yilmazbas
Journal: Case Rep Ophthalmol Med (2018)
MeSH terms: Case Reports

A 27-year-old male was presented with a sudden onset of visual loss in his right eye. A secondary care center referred the patient with fundus photographs which were screened 4 days before and after the Nd: YAG laser hyaloidotomy treatment. Snellen acuity was 10/10 in both eyes. Fundus examinations revealed a retinal pigment epithelium (RPE) alteration at the margin of the inferior temporal arterial vascular arcade in the right eye and resolved preretinal and subretinal hemorrhages were seen in the macula. A diagnosis of Valsalva retinopathy was made based on the history and the treatment photographs of Nd:YAG laser hyaloidotomy. At 1st month examination all hemorrhages were resolved but RPE alterations were still at the margin of the inferior temporal arterial vascular arcade. The optical coherence tomography angiography (OCTA) images revealed 2 lesions. On en face OCT angiogram of OCTA full thickness retinal hole formation and ellipsoid zone damage at the superior and inferior margin of the inferior temporal arterial vascular arcade were seen. Superficial vascular plexus was also damaged at that region. The projection of the evacuation of blood from subhyaloid space and the full thickness retinal hole formation were the same, indicating that the partial and full thickness retinal holes were created by the laser treatment.
Rapid-Onset Acute Respiratory Distress Syndrome (ARDS) in a Patient Undergoing Metastatic Liver Resection: A Case Report and Review of the Literature
Authors: Thorsten Brenner, Johann Motsch, Jens Werner, Lars Grenacher, Eike Martin, Stefan Hofer
Journal: Anesthesiol Res Pract (2010)
MeSH terms: Case Reports

Metastatic liver resection following cytoreductive chemotherapy is an accepted treatment for oligometastatic tumor diseases. Although pulmonary complications are frequently reported in patients undergoing liver surgery including liver transplantation, life-threatening acute respiratory failures in the absence of aspiration, embolism, transfusion-related acute lung injury (TRALI), pulmonary infection, or an obvious source of systemic sepsis are rare. We performed an extensive clinical review of a patient undergoing metastatic liver resection who had a clinical course compatible to an acute respiratory distress syndrome (ARDS) without an obvious cause except for the surgical procedure and multiple preoperative chemotherapies. We hypothesize that either the surgical procedure mediated by cytokines and tumor necrosis factor or possible toxic effects of oxygen applied during general anesthesia were associated with life-threatening respiratory failure in the patient. Discrete and subclinical inflammated alveoli (probably due to multiple preoperative chemotherapies with substances at potential risk for interstitial pneumonitis as well as chest radiation) might therefore be considered as risk factors.
Leptomeningeal Metastases in a Patient with Castration-Resistant Prostate Cancer
Authors: Takuya Koie, Yasuhiro Hashimoto, Yuichiro Suzuki, Yoshiomi Hatayama, Futoshi Kimura
Journal: Case Rep Urol (2020)
MeSH terms: Case Reports

A 42-year-old man visited a community hospital with chief complaints of lumbago and dyschesia. Computed tomography (CT) showed multiple lung, lymph node, and bone metastases and the irregular enlarged prostate with urinary bladder invasion. Serum prostate-specific antigen (PSA) was 544.0 ng/mL. Histological evaluation showed adenocarcinoma with the Gleason score 5 + 4, and the clinical stage was T4N1M1c as an initial diagnosis. Although androgen deprivation therapy was performed immediately, he had castration-resistant PCa after 3 months. Therefore, he received 6 courses of docetaxel chemotherapy every 3 weeks. Serum PSA was decreased to 0.2 ng/mL, and multiple metastases and prostate size were obviously reduced based on CT. He underwent robot-assisted radical prostatectomy and radiation therapy for prostatic fossa and multiple metastases. Although serum PSA level remained low, CT showed multiple liver metastases after 3 years from surgery. He received the combination therapy of cisplatin and etoposide (PE) every 4 weeks. Liver metastases had complete response. However, he visited our hospital with complaint of vomiting and a right drooping eyelid after 6 weeks from withdrawal of PE therapy. T2-weighted magnetic resonance imaging revealed multiple leptomeningeal metastases (LM). He received RT for the brain and was administered amrubicin. However, he died of PCa after 6 weeks from the diagnosis of LM.
A symptomatic de novo pheochromocytoma 23 years after liver transplantation: a case report and review of the literature
Authors: M I Montenovo, F G Jalikis, B Hoch, R Bakthavatsalam
Journal: Case Rep Transplant (2014)

We report a case of subacute onset of headaches and tremors with a newly discovered adrenal pheochromocytoma 23 years after an orthotopic liver transplantation and provide a review of the scarce literature regarding endocrine malignancies in liver transplant recipients. We describe the clinical presentation, diagnostic work-up, and management. This is the second case report in the literature of a de novo pheochromocytoma after solid organ transplantation. It shows that new-onset common symptoms in transplant recipients are always challenging and deserve a very thorough work-up until the cause of the symptoms is elucidated. A broad differential diagnosis should always be included in the study of any abnormalities in this patient population.
Surgery of Kerion, a Nightmare for Nondermatologists
Authors: Vikash Paudel
Journal: Case Rep Dermatol Med (2020)
MeSH terms: Case Reports

Kerion is an inflammatory type of tinea capitis characterized by swelling and alopecia of the scalp, which could be mistaken as bacterial infection. It occurs most frequently in children. We report a 10-year-old child whose kerion was misdiagnosed as bacterial abscess and unnecessarily incised. Later, her condition was rediagnosed as kerion based on clinical appearance and potassium hydroxide wet mount. The lesions resolved completely with systemic antifungal treatment, griseofulvin, leaving residual scarring alopecia. The delay in the proper diagnosis and inappropriate treatment of this patient resulted in permanent scarring alopecia. Thus, clinicians must have a high index of suspicion for tinea capitis when dealing with inflammatory scalp lesions.
Peer-mentees' challenges in an undergraduate peer-group clinical mentoring programme in a nursing education institution
Authors: Tshepo A Ntho, Abel J Pienaar, Leepile A Sehularo
Journal: Health SA (2020)
Keywords: clinical learning and teaching, clinical mentoring, reinforcement, undergraduate nursing student, undergraduate peer-group clinical mentoring programme

Background:
Clinical competency and professional growth amongst nursing students is the cornerstone of a nursing education programme. The demanding and complex training of nursing students requires various clinical teaching and learning strategies such as peer-group clinical mentoring.
Aim:
The objective of this research was to explore and describe the challenges that peer-mentees experience in an undergraduate peer-group clinical mentoring programme in one-specific nursing education institution in the North West Province.
Setting:
The study was conducted at a nursing education institution in North West Province.
Methods:
A qualitative, retrospective case study research design was used. Two separate World Café sessions following a semi-structured schedule based on Gibbs Reflective Cycle were conducted with 51 peer-mentees who were mentored in clinical practice. Four levels of qualitative thematic data analyses were employed to analyse the data.
Results:
Five themes emerged from the findings of the study, namely, poor implementation of the peer-group clinical mentoring programme, ineffective undergraduate peer-group clinical mentoring programme, undesirable attitudes of the mentors, mentors unprofessional conduct as well as communication challenges. Ten sub-themes emerged from the findings. Literature control was done to support the findings.
Conclusion:
The findings showed that undergraduate nursing students faced a diversity of challenges in the effective learning and teaching of peer-mentees in a clinical context. Limitations and recommendations of the study were given. Recommendations were given for nursing practice, education and research.
A Large Pure Uterine Lipoma: Its Diagnosis by Pelvic MRI and Histopathology
Authors: Giannina Calongos, Yoshihiro Ito, Yoko Kubota, Masafumi Handa, Akinori Ida, Yoshiyuki Tsuji
Journal: Case Rep Obstet Gynecol (2019)
MeSH terms: Case Reports

The patient is a 74-year-old female previously diagnosed with an ovarian tumor at age 55. No changes were noted for one year; however, she was lost to follow-up. Eighteen years later, she presented to a local clinic complaining of diffuse abdominal and flank pain. Abdominal and pelvic ultrasound, CT, and gynecological examination showed a fatty pelvic tumor of approximately 12 cm in diameter. A left ovarian teratoma was suspected, and per the patient's request, she was transferred to Kobe Adventist Hospital for further evaluation and treatment. Pelvic MRI revealed no ovarian enlargement; however, a mass in the uterine body was appreciated with a high signal on T1 and T2 images and signal dropout in the fat suppression images, a finding most consistent with a uterine lipoma. A total hysterectomy and bilateral salpingo-oophorectomy was performed, and histopathological examination confirmed the preliminary diagnosis. No complications were observed during the postoperative period. A pure uterine lipoma is an extremely rare tumor with only a few cases reported worldwide. It is a benign tumor; however, it can sometimes be misdiagnosed as a malignant neoplasm. Pelvic MRI appears to be a useful tool in order to make the correct diagnosis preoperatively.
Husband and wife with sarcoidosis: possible environmental factors involved
Authors: Ilaria Leli, Ivano Salimbene, Francesco Varone, Leonello Fuso, Salvatore Valente
Journal: Multidiscip Respir Med (2013)
MeSH terms: Case Reports

Sarcoidosis is a granulomatous multisystem disorder of unclear etiology that involves any organ, most commonly the lung and the lymph nodes. It is hypothesized that the disease derives from the interaction between single or multiple environmental factors and genetically determined host factors. Multiple potential etiologic agents for sarcoidosis have been proposed without any definitive demonstration of causality.We report the case of two patients, husband (57 years old) and wife (55 years old), both suffering from sarcoidosis. They underwent a lymph node biopsy by mediastinoscopy which showed a "granulomatous epithelioid giant cell non-necrotising chronic lymphadenitis". They had lived up to 3 years ago in the country in a farm, in contact with organic dusts, animals such as dogs, chickens, rabbits, pigeons; now they have lived since about 3 years in an urban area where there are numerous chemical industries and stone quarries. The aim of this case report was to focus on environmental factors that might be related to the pathogenesis of the sarcoidosis.
Management of lercanidipine overdose with hyperinsulinaemic euglycaemia therapy: case report
Authors: George Hadjipavlou, Aqib Hafeez, Ben Messer, Tom Hughes
Journal: Scand J Trauma Resusc Emerg Med (2011)
MeSH terms: Antidotes / therapeutic use, Calcium Channel Blockers / poisoning, Dihydropyridines / therapeutic use, Glucagon / therapeutic use, Glucose / therapeutic use, Hypotension / drug therapy, Case Reports, Dihydropyridines / poisoning, Drug Overdose, Glucose Clamp Technique / methods, Humans, Hypotension / chemically induced, Insulin / therapeutic use, Male, Middle Aged, Antidotes, Calcium Channel Blockers, Dihydropyridines, Insulin, Glucagon, Glucose, lercanidipine

This case report describes the first reported overdose of the dihydropyridine calcium channel blocker (CCB) lercanidipine. A 49 yr old male presented to the Emergency Department 3 hrs after the ingestion of 560 mg of lercanidipine. In the department he had a witnessed seizure within 15 minutes of arrival attributed to the overdose. Following immediate recovery of consciousness after the seizure, he had refractory hypotension and bradycardia which failed to respond to fluid resuscitation, glucagon therapy, and intravenous calcium. He went on to require vasopressor support with noradrenaline and was treated with high dose insulin therapy which was successful in achieving cardiovascular stability. Vasopressor therapy was no longer required within one half life of lercanidipine, and the total stay on intensive care was one day before transfer to a ward.Calcium channel blocker overdose is an uncommon but life-threatening overdose. Treatment for severe toxicity is similar to b-blocker overdose. Hypotension is treated with intravenous fluid therapy, intravenous calcium and possibly glucagon with vasopressor or inotropic support as required. Atropine is used to attempt reversal of bradycardia. High doses of intravenous insulin with intravenous dextrose as required (hyperinsulinaemic euglycaemia or HIET), has also been successfully reported. Experimental animal data suggests that HIET is of benefit and potentially superior to fluid therapy, calcium, glucagon and potentially vasopressor therapy. HIET effectively and sustainably reverses hypotension, bradycardia and improves myocardial contractility and metabolism. Current advice in calcium channel blocker overdose is to begin therapy early in toxicity, starting with a 1.0 IU/kg insulin bolus followed by an infusion of 0.5 IU/kg/hr of insulin and dextrose as required titrated to clinical response.
Maternal-Fetal Perinatal Transmission of Staphylococcal Infections: A Report of Two Neonates
Authors: V Thadchanamoorthy, Kavinda Dayasiri
Journal: Case Rep Pediatr (2020)
MeSH terms: Case Reports

Staphylococcal infection in terms of fetus is rare and is associated with either maternal staphylococcal sepsis or colonization that leads to vertical transmission. Antenatal invasive procedures are a recognized risk factor. Most reported newborns with fetal-onset staphylococcal infections have had a worse outcome. We report the story of two newborns who had pustular-bullous skin lesions at birth and responded successfully to antistaphylococcal antibiotics. Both neonates made complete recovery. It is important to suspect clinically the staphylococcal infections when bullous skin lesions are present in the newborn.
Treatment complexities of a young woman suffering psychosis and pituitary adenoma
Authors: Maxine Sigman, Kate Drury
Journal: Case Rep Psychiatry (2011)
MeSH terms: Case Reports

This paper is a clinical description of the presentation, therapy, and pharmacological management of a 28-year-old woman who had nine admissions to a psychiatry ward, the last four within one year. It became clear that the treatments, which the patient had received concurrently for ten years for a pituitary adenoma and for psychotic symptoms, were counteractive. The case highlights the importance of the role of prolactin in psychosis and of an interdisciplinary team approach when patients present with complex symptoms.
Primary ectopic meningioma in the thoracic cavity: A rare case report and review of the literature
Authors: Xu Liu, Jiao Liu, Ting Nai, Yuxia Yang, Yuchang Hu
Journal: Front Oncol (2023)
Keywords: case report, diagnosis, immunohistochemistry, primary ectopic meningioma, thoracic cavity
MeSH terms: Case Reports

Background:
Meningioma is a common type of intracranial tumor in adults. It rarely arises in the chest, with only a few case reports in the English literature. Here, we report the case of a patient with a primary ectopic meningioma (PEM) located in the thoracic cavity.
Case presentation:
A 55-year-old woman presented with exercise-induced asthma, chest tightness, intermittent dry cough and fatigue for several months. Computed tomography revealed the presence of a huge mass in the thoracic cavity, with no connection to the spinal canal. Lung cancer and mesothelioma were suspected, and surgery was performed. Grossly, the mass was a grayish-white solid 9.5 cm × 8.4 cm × 5.3 cm in size. The microscopic morphology of the lesion was consistent with that of typical central nervous system meningioma. The pathological subtype was transitional meningioma. The tumor cells were arranged in a fascicular, whorled, storiform and meningithelial pattern, with occasional intranuclear pseudo-inclusions and psammoma bodies. In focal areas tumor cells were considerably dense, and the cells were round or irregular in shape, with less cytoplasm, uniform nuclear chromatin, and visible nucleoli and mitoses (2/10 HPF). By immunohistochemistry, the neoplastic cells showed strong and diffuse staining with vimentin, epithelial membrane antigen and SSTR2 with variable expression of PR, ALK and S100 protein. However, the cells were negative for GFAP, SOX-10, inhibin, CD34, STAT6, smooth muscle actin, desmin, CKpan, D2-40, WT-1, CK5/6 and CD45. The highest proliferation index by Ki-67 was 15%. The abnormal expression of ALK led to the initial misdiagnosis of an inflammatory myofibroblastic tumor. After 12 months of follow-up, no disease progression was observed.
Conclusion:
The presence of primary ectopic meningiomas in the thoracic cavity is extremely rare, and this tumor is easily misdiagnosed clinically. Imaging is suggested to determine the location and possible differential diagnosis, while the final diagnosis should be via pathological examination. Immunohistochemistry is crucial for disease diagnosis. Owing to our limited knowledge of PEM, its pathogenesis and tissue of origin remain unclear. Clinicians should pay close attention to such potential patients. The present case report may provide insights into the diagnosis and therapy of patients with this tumor.