OpenMed/multicare-articles huggingface dataset:
Immune Thrombocytopenic Purpura Secondary to Cytomegalovirus Infection: A Case Report
Authors: Bessy S Flores-Chang, Carlos E Arias-Morales, Francis G Wadskier, Sorab Gupta, Nicoleta Stoicea
Journal: Front Med (Lausanne) (2015)
Keywords: bleeding, cytomegalovirus, immune thrombocytopenic purpura, steroids, valgancyclovir
MeSH terms: Case Reports

Immune thrombocytopenic purpura (ITP) is defined as an acquired thrombocytopenia with antibodies detected against platelet surface antigens, and it is the most common form of thrombocytopenia in otherwise asymptomatic adults. ITP secondary to an underlying condition is a diagnosis of exclusion that is essential to establish for treatment efficacy. Secondary thrombocytopenia caused by cytomegalovirus (CMV) is common; however, case reports associated with diagnosis in immunocompetent adults are rare, and to the best of our knowledge only 20 publications have been associated with this diagnosis. Our report is based on a clinical presentation of a 37-year-old female complaining of petechiae, heavy menses, shortness of breath, and a platelet count of 1 × 10(9)/L. Treatment with IVIG and steroids failed to improve platelet count. Subsequently, an infectious laboratory workup was performed, detecting CMV infection, and treatment with antiviral agents was initiated, causing platelet count to increase as viral load decreased.
Encephalopathy Associated with Severe Cytomegalovirus Infection in an Immunocompetent Young Woman
Authors: Syuichi Tetsuka, Tomohiro Suzuki, Tomoko Ogawa, Ritsuo Hashimoto, Hiroyuki Kato
Journal: Case Rep Infect Dis (2021)
MeSH terms: Case Reports

Primary cytomegalovirus (CMV) infection in healthy young adults is usually an asymptomatic or mononucleosis-like syndrome, whereas in immunocompromised patients, CMV can cause significant disease. In this study, we report an unusual case of primary CMV infection wherein the patient, an immunocompetent 21-year-old woman, presented severe encephalopathy, acute hepatitis, retinitis, and reactivation of latent Epstein-Barr virus. She developed confusion, high fever, headache, and tonic-clonic seizures. Brain magnetic resonance imaging showed high-intensity lesions in the medial temporal lobe and basal ganglia. Liver dysfunction was observed, and abdominal computed tomography revealed splenohepatomegaly. After fundus findings, the patient was diagnosed with CMV retinitis. Upon admission, she was treated with intravenous acyclovir and steroid pulse therapy. Considering both her serious clinical condition and elevated serum levels of interleukin-6, we speculated that her condition was similar to cytokine-storm-induced encephalopathy. On day 2 after admission, she showed prompt recovery from these clinical manifestations. Since blood CMV pp65 antigenemia was found to be positive, we administered ganciclovir for 2 weeks. On the basis of her clinical manifestations and the presence of blood CMV DNA and CMV pp65 antigenemia along with IgM kinetics, we finally diagnosed this patient with severe primary CMV infection. She left our hospital without sequelae 20 days after admission. The incidence of severe CMV disease in immunocompetent young adults might be higher than previously recognized. Noninvasive testing for CMV (such as CMV pp65 antigenemia and CMV DNAemia) is widely available and can help early diagnosis. Short-term glucocorticoid therapy might be beneficial in the treatment of encephalopathy in the early stages of primary CMV infection. Considering such a background, clinicians should keep severe primary CMV infection in mind as a differential diagnosis in the clinical setting.
Exome-First Approach in Fetal Akinesia Reveals Chromosome 1p36 Deletion Syndrome
Authors: Masatake Toshimitsu, Shinichi Nagaoka, Shuusaku Kobori, Maki Ogawa, Fumihiko Suzuki, Takema Kato, Shunsuke Miyai, Rie Kawamura, Hidehito Inagaki, Hiroki Kurahashi, Jun Murotsuki
Journal: Case Rep Obstet Gynecol (2019)
MeSH terms: Case Reports

Background:
Fetal akinesia refers to a broad spectrum of disorders with reduced or absent fetal movements. There is no established approach for prenatal diagnosis of the cause of fetal akinesia. Chromosome 1p36 deletion syndrome is the most common subtelomeric terminal deletion syndrome, recognized postnatally from typical craniofacial features. However, the influence of chromosome 1p36 deletion on fetal movements remains unknown.
Case report:
A 32-week-old fetus with akinesia showed multiple abnormalities, including fetal growth restriction, congenital cardiac defects, and ventriculomegaly. G-banding analysis using cultured amniocytes revealed 46,XY,22pstk+. Postnatal whole exome sequencing and subsequent chromosomal microarray identified a 3 Mb deletion of chromosomal region 1p36.33-p36.32. These results of molecular cytogenetic analyses were consistent with the fetal sonographic findings.
Conclusion:
Using the exome-first approach, we identified a case with fetal akinesia associated with chromosome 1p36 deletion. Chromosome 1p36 deletion syndrome may be considered for differential diagnosis in cases of fetal akinesia with multiple abnormalities.
Solid Pseudo-Papillary Tumor of the Pancreas in a 10 Year Old Girl
Authors: K Goudarzipour, A Jenabzadeh, H Mirzaei Ilali, B Behnam, H Tavassol
Journal: Iran J Ped Hematol Oncol (2015)
Keywords: solid pseudo-papillary tumor of the pancreas
MeSH terms: Case Reports

Background Solid pseudo-papillary tumor of the pancreas (SPTP) is a rare disease with a low malignant potential. Though it shows low malignant potential 10% to 15% of the cases show aggressive behavior with metastatic involvement of the liver. The symptoms include abdominal discomfort and abdominal pain. It is very rare in early years of age. This is the case of a 10 year old girl with abdominal pain and her evaluation revealed solid pseudo papillary tumor of pancreas. In family history, her grandmother died because of pancreas cancer. The mass was excised and in her 6-month follow up she didn't have any problems. This case is presented to point out physicians that more attention to pseudo- papillary tumor can bring us significant improvement in the diagnosis of this pathology, though pseudo- papillary tumor is a rare pathologic condition in children.
The surgical treatment of familial cylindromatosis through subgaleal scalp excision
Authors: Amar Karalija, Magnus N Andersson
Journal: Case Reports Plast Surg Hand Surg (2015)
Keywords: brooke-spiegler syndrome, cylindromatosis, familial cylindromatosis, head and neck, skin cancer, subgaleal excision, turban tumor syndrome
MeSH terms: Case Reports

We treated a 65-year-old woman with familial cylindromatosis, with cylindromas covering the entire scalp. Subgaleal tumor excision and split skin grafting was performed. The graft take was deemed to be excellent, with almost 100% coverage 2.5 weeks after operation, no complications and a satisfying esthetic result.
Allergen specific immunotherapy induced multi-organ failure
Authors: Aissa Sana, Chaker Ben Salem, Khedher Ahmed, Azouzi Abdelbeki, Sehli Jihed, Ben Saida Imene, Boussarsar Mohamed
Journal: Pan Afr Med J (2013)
Keywords: allergen specific immunotherapy, allergy, desensitization, drug reaction, multi-organ failure
MeSH terms: Desensitization, Immunologic / adverse effects, Multiple Organ Failure / etiology, Case Reports, Adolescent, Fatal Outcome, Female, Humans

Allergen specific immunotherapy (ASI) is a well-documented treatment for allergic asthma, rhinitis and allergy to bee venoms. Immunotherapy with subcutaneous injections of allergens extracts has proved beneficial in reducing symptoms of allergic rhinitis and asthma. Side effects due to specific immunotherapy in short term have been largely documented. These effects were various but were usually mild. Fatal reactions are less frequent. We reported a case of a woman, with a history of allergic asthma under specific desensitization protocol who developed an acute multi-organ failure (MOF) consecutive to administration of ASI (Alustal(®) Stallergenes SA, France). This fatal reaction has never been described as adverse event of specific immunotherapy. We aimed to describe this dramatic reaction, expose the arguments to define the relationship between the administration of allergen extract and the occurrence of this fatal reaction.
Successful Management of Acute Catastrophic Juvenile Vaginal Bleeding in Glanzmann's Thromboasthenia by Uterine Tamponade: A Case Report and Review of The Literature
Authors: Nazli Hossain, Tahir S Shamsi, Adeel Feroz
Journal: Case Rep Hematol (2012)
MeSH terms: Case Reports

Glanzmann's thromboasthenia (GT) is a rare platelet disorder, due to membrane defects involving glycoprotein GP IIb/IIIa complex. Symptoms appear in infancy with episodes of bruising, gingival bleeding, epistaxis, or at the time of menarche acute episode of uterine bleeding. Hormonal therapy and antifibrinolytic agents are first-line treatment. Platelet transfusion is given to control hemorrhage when medical treatment fails. However, repeated transfusions may result in development of platelet refractioness, due to development of antibodies against membrane glycoprotein. Activated recombinant FVII is licensed for use in acute control of bleeding in GT. Here we report a case of acute juvenile uterine bleeding at menarche, which responded successfully to uterine tamponade. To our knowledge, this is the first case report on use of balloon tamponade for control of acute catastrophic juvenile bleeding at menarche.
Snake bite on scrotum--a case report
Authors: Anjum Arshad, Mateen Azfar, Husain Munawwar, Usmani A Jawed
Journal: Pan Afr Med J (2011)
Keywords: india, snake bite, scrotum
MeSH terms: Neurotoxicity Syndromes / etiology, Scrotum, Snake Bites / complications, Case Reports, Humans, Male, Young Adult

A 22-year old man was bitten by a snake on his scrotum. This interesting and unusual case occurred in the rural area of District Aligarh, India. The uniqueness of the case lies in the fact that scrotum is an extremely rare and unusual site for snake bite. Further, with negligible local signs of envenoming the patient presented with classical signs of neurotoxicity. Due to numerous superstitions associated with snake bite, the patient was treated with traditional home made ointment before coming to hospital. The authors realized that the case may be brought to the notice of the readers because the scrotal bite by the snake with no local signs of envenomation is the first reported case.
Potential pitfalls in diagnosis of immunotherapy-induced hypothalamic-pituitary-adrenal axis abnormalities: a clinical case
Authors: Yixi Bi, Safwaan Adam, Viktoria Chatzimavridou, Paul Lorigan, Yinglai Huang
Journal: Endocr Oncol (2022)
Keywords: acth deficiency, sst, assay, cortisol, hypophysitis, immune checkpoint inhibitor, immunotherapy, short synacthen test
MeSH terms: Case Reports

Summary:
Short synacthen tests (SST) are frequently used for assessing adrenocorticotropin hormone (ACTH) deficiency. In this study, we present the case of a 53-year-old man receiving immunotherapy for metastatic melanoma, who subsequently developed immune checkpoint inhibitor (ICI)-induced hypothyroidism and was investigated for the presence of ICI-induced hypocortisolaemia on different occasions. Despite two reassuring SSTs, he subsequently developed clinical and biochemical evidence of ACTH deficiency. The ACTH on local measurement was not conclusive in keeping with ICI-related ACTH deficiency but when repeated using an alternative assay confirmed the diagnosis. The case illustrates the evolution of ACTH deficiency and exposes the potential pitfalls of screening strategies. Two important lessons may be gleaned from this case: (i) SSTs can be normal in early cases of secondary adrenal insufficiency, for example, hypophysitis due to adrenal reserve and (ii) when there is mismatch between the clinical and biochemical presentation, the ACTH should be repeated using a different assay.
Learning points:
Short synacthen tests, useful for ruling out adrenalitis and primary adrenal failure, may be normal in early adrenocorticotrophic hormone deficiency and secondary adrenal failure due to residual adrenal reserve.If clinical suspicion of adrenal insufficiency persists despite an initial satisfactory SST, it is important to recognise the need for re-assessment of cortisol levels.Insulin tolerance test remains a useful tool in the investigation of secondary adrenal insufficiency.Levothyroxine replacement may accelerate the metabolism of cortisol in cases of concurrent hypothyroidism and hypoadrenalism, and therefore, glucocorticoid replacement must precede levothyroxine treatment, to avoid adrenal crisis.The prevalence of immunotherapy-related endocrinopathies is likely to increase with increasing use of ICI and it is crucial that clinicians are alert to their subtle symptoms.
Case Report: Severe Rashes Associated With Fruquintinib in a Patient With Metastatic Colorectal Cancer
Authors: Yefei Shu, Song Zheng
Journal: Front Oncol (2021)
Keywords: case report, colorectal cancer, fruquintinib, rash, vascular endothelial growth factor receptor
MeSH terms: Case Reports

Metastatic colorectal cancer (mCRC) is a common and high-risk malignant tumor. Fruquintinib is a novel small-molecule compound with high selective inhibition of vascular endothelial growth factor (VEGF) receptor (VEGFR) for mCRC for which second-line or higher standard chemotherapy has been ineffective. A female patient with mCRC developed severe rashes after 2 weeks of taking fruquintinib. Considering the relationship between fruquintinib and the rashes, she discontinued taking the drug, and her condition improved. Although fruquintinib has shown good safety and manageable toxicity in previous trials, the patient in the present case developed severe rashes after 2 weeks of taking fruquintinib. The common skin reactions of hand and foot are erythema and paresthesia of hand and foot. Because few people have reported a severe rash caused by fruquintinib, which is different from the common hand foot skin reaction. We hope the case attracts the attention of oncologists.
A favorable outcome of intensive immunotherapies for new-onset refractory status epilepticus (NORSE)
Authors: Satoshi Kodama, Noritoshi Arai, Akiyoshi Hagiwara, Akio Kimura, Sousuke Takeuchi
Journal: J Intensive Care (2018)
Keywords: autoimmune encephalitis, immunotherapy, intravenous immunoglobulin (ivig), new-onset refractory status epilepticus (norse), plasma exchange (pe), status epilepticus
MeSH terms: Case Reports

Background:
New-onset refractory status epilepticus (NORSE) is a newly defined critical disease entity characterized by prolonged periods of refractory epileptic seizure with no readily identifiable cause in otherwise healthy individuals. Its etiology is uncertain, but autoimmune encephalitis is a possible candidate for the underlying cause of this condition. Immunotherapies could be considered for this condition, but its efficacy is not established.
Case presentation:
A 31-year-old man with no prior history presented with refractory status epilepticus. His seizure persisted even with multiple anti-epileptic drugs and required prolonged general anesthesia under mechanical ventilation. Magnetic resonance imaging and cerebrospinal fluid did not indicate the cause of seizure, and autoantibodies related to encephalitis were not detected. It was speculated that the patient had occult autoimmune encephalopathy because of its acute-onset clinical course preceded by fever, even without definite evidence of an autoimmune mechanism. The patient received intravenous methylprednisolone, plasma exchange, and intravenous immunoglobulin in succession and manifested a favorable outcome after these treatments.
Conclusion:
Our case supports the efficacy of immunotherapies for NORSE even though it does not manifest definite evidence for autoimmune background. Clinicians should consider these immunotherapies for NORSE as early as possible, because this condition is associated with high mortality and morbidity owing to prolonged seizure activity and long-term intensive care including general anesthesia and mechanical ventilation.
Graft calcifications and dysfunction following liver transplantation
Authors: George N Tzimas, Mohammad Afshar, Eric Chevet, Anouk Emadali, Hojatollah Vali, Peter P Metrakos
Journal: BMC Surg (2004)
MeSH terms: Calcinosis / etiology, Calcinosis / pathology, Liver / pathology, Liver Diseases / etiology, Liver Diseases / pathology, Liver Transplantation / adverse effects, Case Reports, Research Support, Non-U.S. Gov't, Adult, Aged, Fatal Outcome, Humans, Male, Microscopy, Electron, Transmission, Middle Aged, Necrosis / pathology, Reperfusion Injury / etiology, Reperfusion Injury / pathology

Background:
The molecular events, following ischemia and reperfusion (I/R) of the liver during transplantation are largely unknown. There is evidence that apoptotic and necrotic events may take place, and occasionally result in primary graft dysfunction. We herein report two cases, where significant I/R injury correlated with the development of liver calcification and primary liver dysfunction.
Case presentation:
Both patients with clinical and biochemical evidence of primary graft dysfunction demonstrated calcification at light and electron microscopy levels. In addition, one patient had macroscopic evidence of calcification on cross-sectional imaging. Both patients died secondary to the sequelae of the graft dysfunction.
Conclusions:
Severe I/R-induced injury to the liver, clinically leads to graft dysfunction. This is due to advanced apoptotic and/or necrotic events at the hepatocyte level that may, on the most severe form, lead to calcification. The study of microcalcification at the early posttransplant period could provide insight in the events taking place following significant ischemia/reperfusion-induced injury to the graft.
MULTISYSTEM INFLAMMATORY SYNDROME IN A CHILD ASSOCIATED WITH CORONAVIRUS DISEASE 19 IN THE BRAZILIAN AMAZON: FATAL OUTCOME IN AN INFANT
Authors: Emmerson Carlos Franco de Farias, Maria Cleonice Aguiar Justino, Mary Lucy Ferraz Maia Fiuza de Mello
Journal: Rev Paul Pediatr (2020)
MeSH terms: Betacoronavirus / isolation & purification, Coronavirus Infections / blood, Coronavirus Infections / diagnosis, Coronavirus Infections / physiopathology, Coronavirus Infections / therapy, Multiple Organ Failure / etiology, Multiple Organ Failure / therapy, Pandemics, Pneumonia, Viral / blood, Pneumonia, Viral / physiopathology, Pneumonia, Viral / therapy, Resuscitation / methods, Shock / etiology, Shock / therapy, Systemic Inflammatory Response Syndrome / therapy, Systemic Inflammatory Response Syndrome / virology, Case Reports, COVID-19, COVID-19 Testing, Clinical Deterioration, Clinical Laboratory Techniques / methods, Fatal Outcome, Female, Humans, Infant, Infant, Low Birth Weight, Infant, Newborn, Infant, Newborn, Diseases, Premature Birth, Respiration, Artificial / methods, Risk Factors, SARS-CoV-2, Tomography, X-Ray Computed / methods

Objective:
Recently, there have been reports of children with severe inflammatory syndrome and multiorgan dysfunction associated with elevated inflammatory markers. These cases are reported as presenting the Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19. In this study, we describe with parental permission a case of MIS-C in an infant with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
Case description:
A seven-month-old infant, with SARS-CoV-2 infection and a history of extreme preterm birth and very low weight at birth, with an initial course of mild respiratory symptoms and abrupt progression to vasoplegic shock, myocarditis and hyperinflammation syndrome, shown by high levels of troponin I, ferritin, CRP, D-dimer and hypoalbuminemia. Despite the intensive care provided, the child developed multiple organ dysfunction and died.
Comments:
Patients with a history of extreme prematurity may present with MIS-C in the presence of COVID-19 and are a group of special concern.
Case Report: A woman with pelvic hydatid disease
Authors: Nabeela Adam
Journal: S Afr J Infect Dis (2022)
Keywords: bone hydatid, hydatid, hydatid disease, pelvic hydatid
MeSH terms: Case Reports

Hydatid disease is found in many low-income countries, where humans are deemed accidental hosts. Bone hydatid disease is a rare entity as the lungs and liver are usually the target organs. However, there are currently a handful of case reports around the world with bone hydatid disease.
Contribution:
We present South Africa's first case report of pelvic hydatid disease and looking to uncover some treatment options for this patient.
Diagnosis and intervention of severe tricuspid regurgitation secondary to rupture of the chordae tendineae: A case report and literature review
Authors: Jiaxi Huang, Chaojun Du, Wenbo Zhang, Yaping Mi, Yaping Shan, Huifeng Zhang, Qiqi Shi, Gang Chen
Journal: Front Pediatr (2023)
Keywords: chordae tendinea, neonates, rupture, surgery, tricuspid regurgitation
MeSH terms: Case Reports

Unguarded severe tricuspid regurgitation caused by rupture of papillary muscle or chordae tendineae is rare but fatal in neonates. The experience in the management of these patients is still limited. A newborn presenting severe cyanosis after delivery was diagnosed with severe tricuspid regurgitation secondary to rupture of chordae tendineae by echocardiography (Echo), then treated by surgical reconstruction of chordae/papillary muscle connection without artificial materials. A takeaway lesson from this case is that Echo is an important method to diagnose a rupture of chordae tendineae or papillary muscle and that prompt diagnosis and timely surgery can be life-saving.
Elbow Cystic Lymphangioma in an 8-Month-Old Boy
Authors: Mohammad Jawad H Rahal, Morad R Abou Al Ezz, Rabab A El Hajj, Jad Z Chokor, Selim M Nasser, Ramzi C Moucharafieh
Journal: Case Rep Orthop (2019)
MeSH terms: Case Reports

Cystic lymphangiomas are benign tumors originating mainly in the head and neck of the pediatric population. The authors report a rare case of cystic lymphangioma in the right elbow of an 8-month-old baby treated successfully by complete surgical resection.
Bilateral giant juvenile fibroadenomas of breasts:a case report
Authors: D B Nikumbh, S R Desai, P S Madan, N J Patil, J V Wader
Journal: Patholog Res Int (2011)
MeSH terms: Case Reports

Juvenile fibroadenoma constitutes only 4% of the total fibroadenomas. The incidence of giant juvenile fibroadenomas is found to be only 0.5% of all the fibroadenomas. Bilateral giant juvenile fibroadenomas are extremely rare, and only four cases have been reported in the literature. To the best of our knowledge, we are presenting the fifth case of bilateral giant juvenile fibroadenomas in a 12-year-old prepubertal girl. The diagnosis was made on fine-needle aspiration cytology which was confirmed on histopathology. In this paper, we present this rare case to illustrate the diagnosis and management of this tumour and to emphasize that these tumours are almost always benign and should be treated with breast-conserving surgery to provide a healthy physical and social life to the patient.