OpenMed/multicare-articles huggingface dataset:
Total Pancreatectomy for Malignant Intraductal Papillary Mucinous Neoplasm (IPMN) Complicated by Gastropancreatic Fistulae
Authors: Oshan Basnayake, Pradeep Wijerathne, Umesh Jayarajah, Nilesh Fernandopulle, Sivasuriya Sivaganesh
Journal: Case Rep Surg (2020)
MeSH terms: Case Reports

Background:
Intraductal papillary mucinous neoplasms (IPMN) of the pancreas complicated by fistula formation to adjacent organs are an uncommon phenomenon. We present an IPMN of the pancreas with malignant transformation and multiple fistulae to the stomach and duodenum. Case Presentation. A 50-year-old female was referred for investigation of recent epigastric pain and a past history of recurrent pancreatitis. Imaging with computed tomography showed a gross dilatation of the entire pancreatic duct with a heterogeneous enhancement of the periductal parenchyma. A passage of oral contrast was noted from the greater curvature and pylorus of the stomach into the dilated duct suggestive of fistulae formation. Gastroduodenoscopy demonstrated these fistulae in the stomach and the proximal duodenum and an exophytic growth at the ampulla obliterating the view of ampullary opening. Endosonography- (EUS-) guided fine-needle aspiration cytology (FNAC) showed cells with high-grade atypia. A total pancreatectomy, distal gastrectomy, and splenectomy were performed, and recovery was uneventful. Histology revealed a ductal adenocarcinoma arising from an intestinal type intraductal papillary mucinous neoplasm with high-grade dysplasia. A year and a half after surgery, she is healthy with good glycaemic control and nutritional status.
Conclusion:
This case highlights the importance investigating patients for the aetiology in recurrent acute pancreatitis and their follow-up. Awareness of cystic pancreatic neoplasms including IPMN is important to avoid misdiagnosis or delayed diagnosis. Referral of these patients to centres with facilities for multidisciplinary input and specialised management is strongly recommended.
Recurrent Inflammatory Myositis as an Extra-Intestinal Manifestation of Dormant Ulcerative Colitis in a Patient on Long-Term Mesalamine
Authors: Srikanth Naramala, Venu Madhav Konala, Sreedhar Adapa, Pravallika Amudala, Romeo C Castillo, Nikhil Agrawal, Hemant Dhingra
Journal: Case Rep Gastrointest Med (2019)
MeSH terms: Case Reports

Ulcerative colitis (UC) is a chronic systemic inflammatory condition primarily involving the large bowel mucosa with relapsing and remitting episodes. It is also associated with multiple extra-intestinal manifestations [EIM], including skeletal muscle involvement which is rare. Review of the literature reported only a few cases of inflammatory myositis in association with UC. We report an unusual presentation of recurrent inflammatory myositis of lower extremities in a 28-year-old male with quiescent UC and on long-term mesalamine therapy.
Diabetic muscle infarction: a rare complication of long-standing and poorly controlled diabetes mellitus
Authors: Shridhar N Iyer, Almond J Drake 3rd, R Lee West, Robert J Tanenberg
Journal: Case Rep Med (2011)
MeSH terms: Case Reports

Objective. To report a case of diabetic muscle infarction (DMI), a rare complication of long-standing poorly controlled diabetes mellitus. Methods. We describe a case of a 45-year-old male with an approximately 8-year history of poorly controlled type 2 diabetes mellitus with multiple microvascular complications who presented with the sudden onset of left thigh pain and swelling. He had a swollen left thigh and a CK of 1670 U/L. He was initially treated with intravenous antibiotics for a presumptive diagnosis of pyomyositis or necrotizing fasciitis with no improvement. A diagnosis of diabetic muscle infarction was considered. Results. An MRI of the thigh demonstrated diffuse edema in the anterior compartment. A muscle biopsy demonstrated coagulation necrosis in skeletal muscle and inflammation and infarction in the walls of small blood vessels. These studies confirmed the final diagnosis of DMI. He was treated with supportive care and gradually improved. Conclusion. DMI is a rare complication of diabetes that is often mistaken for infections such as pyomyositis and necrotizing fasciitis or thrombophlebitis. Treatment is supportive. Although the short-term prognosis is good in these patients, the long-term prognosis is poor.
Cytologic findings in malignant myoepithelioma: a case report and review of the literature
Authors: Torill Sauer
Journal: Cytojournal (2007)

Background:
Myoepithelioma of the breast is a rare tumor and the cytologic features have only been described in one previous report.
Case presentation:
The present case comprises a 70 year old woman with a mammographic equivocal and ultrasonographic suspicious lesion. The aspirates were cellular and consisted mainly of single spindle or polymorphic, polygonal cells. The nuclei were generally large, ranging from 2 - > 5 x RBC. Most nuclei had a distinct medium-sized nucleolus. The nuclear outlines were irregular with buds and folds. The chromatin was granular. In the background there was abundant granular metachromatic ground substance and some metachromatic stromal fragments. A few mitotic figures were found. The cytologic diagnosis was suspicious for malignancy and a metaplastic carcinoma where only the non-epithelial component had been aspirated, or a non-epithelial lesion, was suggested.Macroscopically the tumor was round, seemingly well circumscribed, firm and with a white cut surface. The lesion consisted of spindled and polygonal cells with distinct pleomorphism. There were 6-9 mitoses per high power field (HPF). The tumor infiltrated in the surrounding fatty tissue. On immunohistochemistry, tumor cells were positive for smooth muscle actin, keratin MNF 116 and vimentin. Desmin and S-100 were negative.Ultrastructurally, there were abundant tonofilaments, including globular filamentous bodies and granulated endocytoplasmic reticulum with many dilated cisterns. The histologic diagnosis was malignant myoepithelioma.
Conclusion:
The case mirrors completely the WHO definition and the previous cytological and histological descriptions of malignant myoepitheliomas in the literature which describe a spindle cell population with unequivocal nuclear atypia, metachromatic background substance and mitoses.
Case Report: A Rare Case of Fourth Ventricle to Spinal Subarachnoid Space Shunt Migration: Surgical Pearl and Literature Review
Authors: Nicolas Serratrice, Joe Faddoul, Bilal Tarabay, Sarkis Taifour, Georges Naïm Abi Lahoud
Journal: Front Surg (2021)
Keywords: chiari syndrome, catheter migration, cranio-cervical junction, fourth ventricle to spinal subarachnoid space shunt, syringomyelia, trapped fourth ventricle, trapped fourth ventricle with syrinx
MeSH terms: Case Reports

Background: In the event of syringomyelia communicating with the fourth ventricle, a fourth ventricle to cervical subarachnoid space shunting could be proposed. Case Report: In this review article, we describe the case of a 40-year-old woman who had a previously implanted fourth ventricle to spinal subarachnoid space shunt for the treatment of syringomyelia in the context of Chiari syndrome. The catheter migrated intradurally to the lumbosacral space, but in the absence of neurological repercussions, we decided to leave it in place. Conclusions: To the best of our knowledge, this is the first case described in the literature review of a catheter migration in the subarachnoid space from occipitocervical to lumbosacral level.
Two-Pronged Treatment of Hemoperitoneum and Abnormal Uterine Bleeding in an Adolescent Girl With Congenital Fibrinogen Deficiency
Authors: Yiran Wang, Lanbo Zhao, Xue Feng, Qing Li, Sijia Ma, Dongxin Liang, Mingge Liu, Panyue Yin, Qiling Li, Qinrui Lu
Journal: Front Med (Lausanne) (2020)
Keywords: aub, cfd, coc, lng-ius, hemoperitoneum, hypermenorrhea
MeSH terms: Case Reports

Introduction: If a woman suffers from congenital fibrinogen deficiency (CFD), she might undergo hypermenorrhea monthly and possibly to suffer from hemoperitoneum due to a ruptured follicle or corpus luteal cyst every month, which seriously threaten her health and quality of life. Here, we creatively used a combination of the levonorgestrel-releasing intrauterine system (LNG-IUS) and the combined oral contraceptives (COC) for a girl with CFD. Case presentation: A 14-year-old girl presented with no obvious cause of persistent and severe lower abdominal pain that began 8 h prior. After examination, she was diagnosed as hemoperitoneum. CFD was diagnosed when she was 2 years old and she had two hospitalizations due to hemorrhagic anemia caused by menorrhagia. Therefore, after successful conservative treatment of hemoperitoneum, a combination of LNG-IUS and COC was used for the long-term conservative management of hypermenorrhea and hemoperitoneum. During the half-year of follow-up, she had hypomenorrhea without hemoperitoneum. Conclusions: To the best of our knowledge, this was the first patient treated with such a procedure in the literature, and we recommend every woman with CFD at puberty or reproductive age receives this two-pronged treatment.
Case Report: Rabies Vaccine-Induced Thrombotic Thrombocytopenic Purpura in a Patient With Systemic Lupus Erythematosus
Authors: Yanming Cui, Jianbo Wei, Xiang Peng
Journal: Front Immunol (2022)
Keywords: adamts13, autoimmune disease, systemic lupus erythematosus, thrombotic thrombocytopenic purpura, vaccine
MeSH terms: Autoimmune Diseases / complications, Lupus Erythematosus, Systemic / complications, Lupus Erythematosus, Systemic / diagnosis, Purpura, Thrombotic Thrombocytopenic / chemically induced, Purpura, Thrombotic Thrombocytopenic / diagnosis, Rabies Vaccines / adverse effects, Rabies, Case Reports, Female, Humans, Rabies Vaccines

For patients with autoimmune diseases, vaccination is controversial. The use of vaccination in patients with autoimmune diseases is controversial. There are many reports of secondary thrombotic thrombocytopenic purpura cases after various vaccinations. Thrombotic thrombocytopenic purpura is a rare thrombotic microangiopathy characterized by microvascular pathological hemolytic anemia, severe thrombocytopenia, and ischemic organ damage with a very high fatality rate. We report a case of thrombotic thrombocytopenic purpura in a patient with systemic lupus erythematosus after rabies vaccination. She developed gastrointestinal bleeding nearly a month after the vaccination. Laboratory tests confirmed a severe deficiency of ADAMTS13 and the presence of ADAMTS13 autoantibodies. Through early identification of thrombotic thrombocytopenic purpura, immunosuppressive therapy, and plasma exchange treatment, the patient was saved from danger. This case suggests that attenuated vaccines may also have unexpected adverse effects in patients with long-term use of immunosuppressive drugs and autoimmune diseases. To our knowledge, this is the first case report of thrombotic thrombocytopenic purpura in a patient with systemic lupus erythematosus secondary to rabies vaccination.
Purple urine bag syndrome may not be benign: a case report and brief review of the literature
Authors: Mukul Bhattarai, Hamid Bin Mukhtar, Thomas Walter Davis, Alok Silodia, Hitekshya Nepal
Journal: Case Rep Infect Dis (2013)

Purple urine bag syndrome (PUBS) is a rare condition in which there is purple discoloration of the urine with its collecting bag and associated tubing occurs. It is considered a benign condition. We report an unusual case of PUBS in an 87-year-old female from nursing home who had a history of recurrent UTI. She also had a history of ureteral obstruction requiring left nephrostomy tube. She was brought to emergency department with altered mental status which developed five days after the occurrence of purple discoloration of the urinary bag. Her urine culture grew vancomycin-resistant Enterococci (VRE) and Pseudomonas aeruginosa. She died within three days of hospitalization despite intensive care in tertiary center. This case highlights that PUBS may not always be benign and should be approached on a case-by-case basis because it may signal the underlying UTI which might be very difficult to treat. Failure of recognition of this peculiar color early could delay the appropriate intervention leading to fatal complication. This case also represents the rare occurrence of PUBS in the setting of nephrostomy tube.
Case Report: Atezolizumab plus bevacizumab for combined hepatocellular-cholangiocarcinoma
Authors: Tomoyuki Satake, Taro Shibuki, Kazuo Watanabe, Mitsuhito Sasaki, Hiroshi Imaoka, Shuichi Mitsunaga, Motohiro Kojima, Masafumi Ikeda
Journal: Front Oncol (2023)
Keywords: atezolizumab, bevacizumab, case series, combined hepatocellular-cholangiocarcinoma, immunotherapy
MeSH terms: Case Reports

Combined hepatocellular cholangiocarcinoma (cHCC-CCA) is a rare subtype of primary liver cancers. Therapeutic strategies for patients with cHCC-CCA are limited, and no standard systemic treatment has been established for unresectable cHCC-CCA. Here, we present six cases of cHCC-CCA treated with atezolizumab plus bevacizumab. We observed three partial responses and one stable disease as the best responses; two of these patients were still being treated with atezolizumab plus bevacizumab at the time of reporting (at least five months of treatment), whereas the remaining two patients were unable to continue treatment owing to adverse events. Atezolizumab plus bevacizumab may be an effective treatment for unresectable cHCC-CCA.
Case Report: Infantile Ischemic Stroke and Antiphospholipid Antibodies, Description of Four Cases
Authors: Teresa Giani, Angela Mauro, Giovanna Ferrara, Rolando Cimaz
Journal: Front Pediatr (2020)
Keywords: aps—antiphospholipid antibody syndrome, autoimmune disorders, brain damage, perinatal stroke, transplacental passage autoantibodies
MeSH terms: Case Reports

Antiphospholipid syndrome (APS) is a rare condition in childhood, but even more in the neonatal age. Most neonatal cases are considered a passively acquired autoimmune disease, due to a transplacental passage of maternal antiphospholipid antibodies (aPL) from mothers with primary or secondary APS or, more often, from asymptomatic aPL carriers. Exceedingly unusual is the neonatal de novo production of aPL. We present four infants with presumed perinatal stroke in presence of increased and persistent aPL levels, even after 6 months of life, opening the window on a gray zone related to the origin of these antibodies (maternal or neonatal) and on their role in the pathogenesis of stroke.
Haemophilus aphrophilus endocarditis after tongue piercing
Authors: Hossein Akhondi, Ali R Rahimi
Journal: Emerg Infect Dis (2002)
MeSH terms: Endocarditis, Bacterial / complications, Endocarditis, Bacterial / microbiology, Haemophilus / isolation & purification, Haemophilus Infections / complications, Haemophilus Infections / microbiology, Tongue, Wounds, Penetrating / complications, Case Reports, Adult, Ampicillin / therapeutic use, Anti-Bacterial Agents / therapeutic use, Cosmetic Techniques / adverse effects, Endocarditis, Bacterial / drug therapy, Gentamicins / therapeutic use, Haemophilus Infections / drug therapy, Humans, Male, Nafcillin / therapeutic use, Penicillins / therapeutic use, Anti-Bacterial Agents, Gentamicins, Penicillins, Nafcillin, Ampicillin

Piercing invades subcutaneous areas and has a high potential for infectious complications. The number of case reports of endocarditis associated with piercing is increasing. We studied a 25-year-old man with a pierced tongue, who arrived at Memorial Health University Medical Center with fever, chills, rigors, and shortness of breath of 6 days' duration and had an aortic valvuloplasty for correction of congenital aortic stenosis.
Spontaneous chronic epidural hematoma in the lumbar spine associated with Warfarin intake: a case report
Authors: Axel Sandvig, Håkan Jonsson
Journal: Springerplus (2016)
Keywords: anticoagulant treatment, l5-root compression, mri, radiculating pain

Introduction:
Spontaneous spinal epidural hematomas are rare. However, in patients on anticoagulant treatment the risk may increase. Symptomatically patients may present with radiculopathy and even progressive neurological deficits.
Case description:
We present a case of a warfarin treated patient with left L5 radiculopathy. MRI was evaluated as showing a lumbar disc prolapse or synovial cyst at L4-L5 level. The patient was operated and an organized material was removed and analysed as a hematoma. No prolapsed disc or synovial cyst was found. The patient was neurologically restored following the operation.
Discussion and evaluation:
This case illustrates how spontaneous epidural spinal hematomas can present with symptoms of radiculopathy and radiologically be misinterpreted as a protruding disc or cyst.
Conclusion:
Warfarin treated patients may have an increased risk of spontaneous spinal epidural hematomas.
Acute Brainstem Dysfunction Caused by Cavernous Sinus Dural Arteriovenous Fistula
Authors: Yuwa Oka, Kenichi Komatsu, Soichiro Abe, Naoya Yoshimoto, Junya Taki, Sadayuki Matsumoto
Journal: Case Rep Neurol Med (2020)
MeSH terms: Case Reports

Symptoms of cavernous sinus dural arteriovenous fistula depend on the drainage patterns and are very diverse. Among these, brainstem dysfunction is a rare but serious complication. Here, we describe a case with isolated and rapidly progressive brainstem dysfunction due to cavernous sinus dural arteriovenous fistula. An 80-year-old woman presented with a 2-day history of progressive gait disturbance. Neurological examination revealed mild confusion, dysarthria, and left hemiparesis. Magnetic resonance imaging (MRI) revealed pontine swelling without evidence of infarction. Magnetic resonance angiography suggested a faint abnormality near the cavernous sinus. Dural arteriovenous fistula was suspected, and digital subtraction angiography was planned for the next day. Her condition had progressed to coma by the next morning. Pontine swelling worsened, and hyperintensity appeared on diffusion-weighted imaging. Digital subtraction angiography revealed a right-sided cavernous sinus dural arteriovenous fistula with venous reflux into the posterior fossa. Orbital or ocular symptoms had preceded brainstem symptoms in all nine previously reported cases, but brainstem symptoms were the only presentation in our case, making the diagnosis difficult. Some dural arteriovenous fistulas mimic inflammatory diseases when the clinical course is acute. Prompt diagnosis using enhanced computed tomography or MRI and emergent treatment are needed to avoid permanent sequelae.
A Large Grade 5 Mobile Aortic Arch Atheromatous Plaque: Cause of Cerebrovascular Accident
Authors: Chikezie Alvarez, Hafiz Muhammad Aslam, Sara Wallach, Muhammad U Mustafa
Journal: Case Rep Med (2018)
MeSH terms: Case Reports

Aortic atheromas (aortic atheromatous plaques) are defined by an irregular thickening of the intima ≥2 mm, and a complex plaque is defined as a protruding atheroma ≥4 mm with or without an attached mobile component. Stroke incidence is approximately 25% in patients with mobile plaques of the aortic arch and 2% in patients with quiescent nonmobile plaques. Antiplatelet agents, oral anticoagulants, and statins have been suggested in the management of atheromas. We present an 80-year-old male, with non-ST-segment elevation myocardial infarction (NSTEMI) and chronic dysarthria, found to have an acute cerebrovascular accident (CVA) secondary to embolism from a large 12 mm aortic arch plaque, treated medically with oral antiplatelet therapy, anticoagulation, and statin therapy.
Erdheim-Chester disease, moving away from the orphan diseases: A case report
Authors: Jessica M Stempel, Jean G Bustamante Alvarez, Andres Mora Carpio, Varun Mittal, Claudia Dourado
Journal: Respir Med Case Rep (2016)
Keywords: braf v600e mutation, erdheim-chester disease, vemurafenib
MeSH terms: Case Reports

With approximately 750 cases reported, Erdheim-Chester disease is an exceedingly rare histiocyte cell disorder. Affected sites typically include long bones, large vessels and central nervous system. However, cutaneous and pulmonary involvement can also occur. The diagnosis is ascertained by identification of foamy histiocytes positive for CD68, CD163, and factor XIIIa on immunoperoxidase staining. Recently published literature have described an association between Erdheim-Chester disease and BRAF V600E mutation. This finding prompted the investigation of therapeutic possibilities with BRAF inhibitors, successful agents against other BRAF mutation-positive diseases. Vemurafenib, a BRAF kinase inhibitor, has been shown to be effective in BRAF V600E mutation-positive malignancies, such as NSCLC and melanoma, as well as in several case reports of Erdheim-Chester disease. We report a case of Erdheim-Chester disease diagnosed at our institution, treated with vemurafenib.
Bradycardia after Tube Thoracostomy for Spontaneous Pneumothorax
Authors: Yomi Fashola, Sanjeev Kaul, Douglas Finefrock
Journal: Case Rep Emerg Med (2018)
MeSH terms: Case Reports

We present the case of an elderly patient who became bradycardic after chest tube insertion for spontaneous pneumothorax. Arrhythmia is a rare complication of tube thoracostomy. Unlike other reported cases of chest tube induced arrhythmias, the bradycardia in our patient responded to resuscitative measures without removal or repositioning of the tube. Our patient, who had COPD, presented with shortness of breath due to spontaneous pneumothorax. Moments after tube insertion, patient developed severe bradycardia that responded to Atropine. In patients requiring chest tube insertion, it is important to be prepared to provide cardiopulmonary resuscitative therapy in case the patient develops a life-threatening arrhythmia.
A Rare and Potentially Fatal Etiology of Hypercalcemia in an Infant
Authors: Ambreen Sonawalla, Vildan Tas, Manish Raisingani, Emir Tas
Journal: Case Rep Endocrinol (2019)
MeSH terms: Case Reports

Hypercalcemia is an uncommon finding in children. Hypercalcemia has various etiologies including parathyroid dependent and independent mechanisms. Increased activity of the 1-alpha-hydroxylase enzyme in granulomatous diseases is a well-defined but an extremely rare cause of hypercalcemia in pediatric patients, particularly in infants. We describe the case of an infant who presented with failure to thrive, hepatosplenomegaly, and hypercalcemia who was initially treated with steroids but was later diagnosed with disseminated histoplasmosis in the absence of an underlying immunodeficiency. Extra caution should be used before considering steroids for the treatment of hypercalcemia and, whenever possible, steroids should not be initiated until a definite etiology is identified.
Combined Dorsal and Ulnarward Carpometacarpal Dislocation Associated with Open Fracture of the Base of First Metacarpal and Severe Degloving Injury
Authors: Ali J Electricwala, Jaffer T Electricwala
Journal: Case Rep Emerg Med (2017)
MeSH terms: Case Reports

We report a rare case of dislocation of second to fourth carpometacarpal (CMC) joints of the right hand with combined dorsal and ulnarward displacement of the second to fourth digits and fracture of the shaft of the first metacarpal associated with degloving injury. These injuries were diagnosed early and treated successfully with closed reduction and internal fixation using Kirschner wires. The functional outcome was good at follow-up at 5 years. A high index of suspicion is required to successfully diagnose and treat this condition.