OpenMed/multicare-articles huggingface dataset:
Bile Salt Enterolith: An Unusual Etiology Mimicking Gallstone Ileus
Authors: Dana Ferrari-Light, Ariel Shuchleib, Joel Ricci-Gorbea
Journal: Case Rep Surg (2018)
MeSH terms: Case Reports

Primary enterolithiasis is a relatively uncommon but important cause of small bowel obstruction. We present a case of a 69-year-old male with a history of laparoscopic Roux-en-Y gastric bypass and asymptomatic duodenal diverticulum diagnosed with small bowel obstruction. CT imaging showed an obstruction distal to the jejunojejunostomy, and surgical intervention was warranted. A 4.5 cm enterolith removed from the distal jejunum was found to contain 100% bile salts, consistent with a primary enterolith. Clinicians should retain a high index of suspicion for enteroliths as a cause of small bowel obstruction, especially if multiple risk factors for enterolith formation are present.
Case Report: A Calculus-Free Ureteral Stent Forgotten for 29 Years
Authors: Cheng Tang, Genyi Qu, Guang Yang, Gang Wang, Yong Xu
Journal: Front Surg (2022)
Keywords: case report, endoscopy, forgotten, no calculus, ureteral stent, urology
MeSH terms: Case Reports

Ureteral stents are widely used. If ureteral stents remain in place for extended periods, the probability of migration and stone formation increases substantially. However, a 29-year-old ureteral stent that was placed and did not develop calculus is rare. We reported a 45-year-old man admitted with pain in the left side of his waist and abdomen for more than 10 years. He underwent a ureterotomy 29 years prior to admission for left ureteral calculi, and a ureteral stent was placed postoperatively to prevent ureteral strictures. The ureteral stent was not removed in the hospital due to poor compliance on the part of the patient. This left ureteral stent was not visible on computed tomography (CT) and plain films. On ureteroscopy or flexible ureteroscopy, no new calculus was found in the left ureter and kidney. No calculus was found in the stent that is usually easily removed with calculus-removing forceps. This phenomenon is rare, and it highlights the importance of follow-up.
Magnetic resonance imaging of vulvar dermatofibrosarcoma protuberans - report of a case
Authors: Evrim Ozmen, Güven Güney, Oktay Algin
Journal: Radiol Oncol (2013)
Keywords: mri, dermatofibrosarcoma protuberans, imaging features, vulvar carcinoma, vulvar sarcoma

Background:
Dermatofibrosarcoma protuberans (DFSP) of the vulva is a rare low-grade soft tissue sarcoma. Magnetic resonance imaging (MRI) findings of vulvar DFSP were essentially unreported in the literature.
Case report:
We report a DFSP of vulva with its clinical, histological and MRI features. As far we know this is the first case of histologically confirmed vulvar DFSP presenting with MR images. The diagnosis of DFSP is usually made by histopathologic and clinical findings.
Conclusions:
MRI is useful both for the diagnosis of DFSP and following up the patients since it has high soft tissue resolution and no risk of radiation exposure. With MRI the relation to the adjacent anatomical structures, extension and depth of the tumour and possible lymph node involvement can also be demonstrated.
Unexpected complications of vasospastic coronary artery disease and its successful management
Authors: Gülay Gök, Tufan Çinar
Journal: J Cardiovasc Thorac Res (2019)
Keywords: complication, myocardial infarction, percutaneous coronary intervention, vasospastic coronary artery disease
MeSH terms: Case Reports

Vasospastic coronary artery disease (CAD) usually occurs during the percutaneous interventions and responds to conventional medical treatment. However, in rare conditions, it may be resistant to medical treatment, resulting in lethal complications, including acute myocardial infarction, ventricular arrhythmia, cardiopulmonary arrest, cardiogenic shock, and acute pulmonary edema. In this case report, a 44-year-old woman was admitted to the hospital with a diagnosis of non-ST-segment elevation myocardial infarction. During a diagnostic coronary angiography and in-hospital stays, multiple catastrophic complications due to vasospastic CAD occurred, and we were able to demonstrate a successful management strategy of these complications.
Severe Drug-Induced Liver Injury From Over-the-Counter Medication
Authors: Kasumi Satoh, Manabu Okuyama, Nobuhisa Hirasawa, Hajime Nakae
Journal: Cureus (2023)
Keywords: drug-induced liver injury, herbal medicines, intensive care unit, kampo medicine (japanese herbal medicine), liver dysfunction, liver injury
MeSH terms: Case Reports

Drug-induced liver injury (DILI) is difficult to diagnose as it presents with a wide variety of clinical manifestations and there is no established specific biomarker. However, clinicians require expertise in diagnosing DILI as it can lead to critical illness, is relatively common, and can be caused by a variety of drugs, herbal medicines, and supplements. A 67-year-old male was admitted to the hospital with a fever, jaundice, and fatigue. Abdominal ultrasonography, computed tomography, and magnetic resonance cholangiopancreatography revealed no morphological abnormalities in the hepatobiliary system. On the third day of hospitalization, the liver damage and acute kidney injury progressed, and the patient was transferred to our intensive care unit. To further investigate the cause of multiple organ damage, the patient underwent repeated history taking and additional laboratory testing. In addition to the common causes of hepatic and renal damage, we also tested for rickettsiosis and leptospirosis, as the patient reported partaking regularly in outdoor leisure activities. On day seven of hospitalization, the patient recalled taking over-the-counter herbal flu medications approximately five days prior to admission; therefore, we suspected DILI and performed a drug-induced lymphocyte stimulation test (DLST). The DLST was positive for one drug. As other causes had been ruled out, the patient was diagnosed with severe DILI. The clinical course of the patient was observed with the patient's laboratory data and fever improving spontaneously. This case taught us several important lessons for the investigation of liver injury. Firstly, even with over-the-counter drugs, liver injury can be severe. Secondly, while the DLST is available for investigating DILI, false positives, especially for medicinal herbs, should be noted, and it is necessary to adequately rule out other diseases. Finally, when the cause of liver injury is unclear, patient history taking should be repeated carefully.
Unusual Cardiac Presentation of COVID-19 and Use of Convalescent Plasma
Authors: William R Hartman, Aaron S Hess, Joseph P Connor
Journal: Case Rep Cardiol (2020)
MeSH terms: Case Reports

COVID-19 infection caused by the SARS-CoV-2 virus has been associated with cardiac abnormalities, including conduction abnormalities. Convalescent plasma is emerging as a potentially safe and effective treatment option for patients severely or critically ill with COVID-19. Here, we describe a case of a COVID-19 patient with new-onset cardiac ectopy who had near resolution of his cardiac sequelae following convalescent plasma transfusion.
Ligation of the internal jugular vein increased regional cerebral oxygen saturation but decreased the bispectral index in a 72-year-old man: a case report
Authors: Maiko Hasegawa-Moriyama, Kohei Godai, Tomotsugu Yamada, Akira Matsunaga, Yuichi Kanmura
Journal: JA Clin Rep (2016)
Keywords: bispectral index, internal jugular vein, regional saturation of oxygen

Regional cerebral oxygen saturation (rSO2) and the bispectral index (BIS) are used to detect cerebral perfusion abnormalities. However, whether rSO2 and BIS values change during ligation of the internal jugular vein (IJV) is unknown. We report a case in which BIS values were decreased, despite increased rSO2 during ligation of the IJV. A 72-year-old man was diagnosed with metastasis of renal cancer to the thyroid associated with tumor embolism in the right IJV. Thyroidectomy with total laryngectomy was performed. After right IJV ligation, right rSO2 was increased from 73 to 78 %, while the right BIS value was decreased from 40 to 27. Contralateral rSO2 and BIS values were unchanged. Right rSO2 and BIS values returned to pre-ligation values in 10 min. Ligation of the IJV might increase cerebral blood flow and ipsilateral rSO2. Physicians should use BIS values with caution during IJV ligation because a sudden decrease in the BIS value is not always associated with cerebral hypoperfusion.
Mesh Migration into the Neobladder and Ileum with Complicated Fistula Formation following Incisional Hernia Repair
Authors: Masatsugu Kuroiwa, Masato Kitazawa, Yusuke Miyagawa, Futoshi Muranaka, Shigeo Tokumaru, Satoshi Nakamura, Makoto Koyama, Yuta Yamamoto, Nao Hondo, Takehito Ehara, Satoru Miyazaki, Hirokazu Tanaka, Yuji Soejima
Journal: Case Rep Surg (2021)
MeSH terms: Case Reports

Background:
Tension-free repair using mesh has become the standard treatment for abdominal wall incisional hernias. However, its postoperative complications reportedly include mesh infection, adhesions, and fistula formation in other organs. Here, we report an extremely rare case of mesh migration into the neobladder and ileum with entero-neobladder and neobladder-cutaneous fistulas. Case Presentation. An 80-year-old male who had undergone radical cystectomy 5 years ago and abdominal wall incisional hernia repair 3 years ago presented with fever and abdominal pain. Computed tomography (CT) scan revealed mesh migration into the neobladder and ileum. He was treated conservatively with antibiotics for a month but did not show improvement; hence, he was transferred to our hospital. He was diagnosed with mesh migration into the neobladder and ileum with complicated fistula formation. He underwent mesh removal, partial neobladder resection, and partial small bowel resection. He developed superficial incisional surgical site infection, which improved with drainage and antibiotics, and he was discharged 40 days after the surgery.
Conclusions:
We reported a rare case of mesh migration into the neobladder and ileum with fistula formation. Successful conservative treatment cannot be expected for this condition because mesh migration into the intestinal tract causes infection and fistula formation. Hernia repair requires careful placement of the mesh such that it does not come into contact with the intestinal tract. Early surgical intervention is important if migration into the intestinal tract is observed.
Management of Discolored Failure Root Canal-Treated Upper Lateral Incisor
Authors: Nik Abdul Ghani Nik Rozainah, Azih Nurul Farah, Mohmed Isaqali Karobari
Journal: Case Rep Dent (2020)
MeSH terms: Case Reports

Root canal treatment failure can be determined based on a patient's complaint and on the basis of clinical examination and radiographic findings. Most of the signs and symptoms for the failure are pain and discomfort, swelling and sinus formation at the surrounding soft tissue, and discoloration of the subjected tooth. Factors such as mechanical perforation during the procedures, overfilled or underfilled root canal, and missed or unfilled canals are the main factors for the failure outcome. This case report presents a discolored and infected upper lateral incisor which was previously root canal treated. The tooth was successfully managed under nonsurgical and surgical retreatment followed by an internal bleaching and full porcelain veneer. Apical tissue healing and acceptable tooth appearance was observed during a 12-month review.
Psychiatric Presentation of Anti-NMDA Receptor Encephalitis
Authors: Dominique Endres, Sebastian Rauer, Winfried Kern, Nils Venhoff, Simon J Maier, Kimon Runge, Patrick Süß, Bernd Feige, Kathrin Nickel, Timo Heidt, Katharina Domschke, Karl Egger, Harald Prüss, Philipp T Meyer, Ludger Tebartz van Elst
Journal: Front Neurol (2019)
Keywords: anti-nmda receptor encephalitis, antibodies, autoimmune psychosis, encephalopathy, steroids, vaccination
MeSH terms: Case Reports

Background: Anti-N-methyl D-aspartate (NMDA) receptor encephalitis is an autoimmune condition characterized by neuropsychiatric symptoms, including epileptic seizures, movement disorders, autonomic instability, disturbances of consciousness, paranoia, delusions, and catatonia. Ovarian teratomas and viral infections, typically Herpes simplex viruses, have previously been demonstrated to precipitate anti-NMDA receptor encephalitis, but in many cases, the trigger remains unclear. The detection of anti-NMDA receptor antibodies in cerebrospinal fluid (CSF), in combination with other CSF, electroencephalography (EEG), or magnetic resonance imaging (MRI) abnormalities, typically leads to diagnostic clarification. Case Presentation: We present the case of a 22-year-old female patient who developed an acute polymorphic psychotic episode 3 days after receiving a booster vaccination against tetanus, diphtheria, pertussis, and polio (Tdap-IPV). Her psychiatric symptoms were initially diagnosed as a primary psychiatric disorder. Her MRI, EEG, and CSF results were non-specific. Anti-NMDA receptor IgG antibodies against the GluN1 subunit were detected in her serum (with a maximum titer of 1:320), but not in her CSF. [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) showed pronounced relative hypermetabolism of her association cortices and a relative hypometabolism of the primary cortices, on the basis of which an anti-NMDA receptor encephalitis diagnosis was made, and treatment with a steroid pulse was initiated. The treatment led to fast and convincing clinical improvement with normalization of neuropsychological findings, considerable improvement of FDG-PET findings, and decreasing antibody titers. Conclusion: The patient's psychiatric symptoms were most likely caused by anti-NMDA receptor encephalitis. Her polymorphic psychotic symptoms first occurred after she had received a Tdap-IPV booster vaccination. Although the vaccination cannot have caused the initial antibody formation since IgG serum antibodies were detected only 3 days after administration of the vaccine, the vaccine may have exerted immunomodulatory effects. MRI, EEG, and CSF findings were non-specific; however, FDG-PET identified brain involvement consistent with anti-NMDA receptor encephalitis. This case shows the importance of implementing a multimodal diagnostic work-up in similar situations. The negative CSF antibody finding furthermore fits to the hypothesis that the brain may act as an immunoprecipitator for anti-NMDA receptor antibodies.
An Unusual Cause of Failure to Ventilate
Authors: John T Denny, Sagar S Mungekar, Benjamin R Landgraf, Zoe M Rocke, Valerie A McRae, Christian P McDonough, James T Tse, Scott J Mellender, Geza K Kiss
Journal: J Investig Med High Impact Case Rep (2018)
Keywords: icu equipment malfunction, complication of intubation, endotracheal tube malfunction, failure to ventilate, ventilator complications

We report an unusual case of endotracheal tube failure. It was due to a manufacturing defect in the internal white plastic piece that is normally depressed by the luer-lock syringe within the blue pilot balloon. Prior to use, the endotracheal tube was tested and functioned normally. A 64-year-old patient in the intensive care unit with a history of hypertension was being mechanically ventilated after uneventful abdominal surgery. After several hours in the intensive care unit, he was noted to be suddenly no longer receiving adequate tidal volumes from the ventilator. It was found that the cuff on the endotracheal tube was not retaining air when it was filled with air from a syringe. This lead to a large "leak" around the endotracheal tube such that the intended tidal volumes set on the ventilator were not delivered to the patient. The patient was uneventfully reintubated and did well. Subsequent investigation revealed the cause to be a manufacturing defect in the internal white plastic piece that is normally depressed by the luer-lock syringe within the blue pilot balloon. Other mechanisms of cuff failure are reviewed in this case report. This case is an unusual reason for cuff failure. Illustrations supplied alert the reader how to identify the appearance of this manufacturing defect in a pilot balloon. This case illustrates the potential device malfunctions that can develop during a procedure, even when the equipment has been tested and previously functioned well. Even small defects developing in well-engineered products can lead to critical patient care emergencies.
No-needle jet intradermal aminolevulinic Acid photodynamic therapy for recurrent nodular Basal cell carcinoma of the nose: a case report
Authors: Daniel Barolet, Annie Boucher
Journal: J Skin Cancer (2011)
MeSH terms: Case Reports

Photodynamic therapy (PDT) with aminolevulinic acid (ALA) to treat nodular basal cell carcinoma (BCC) has been shown to be beneficial. The success rate of ALA-PDT in the treatment of nodular BCC is dependent on optimal penetration of the photosensitizing agent and subsequent PpIX production. To enhance topical delivery of drugs intradermally, a needleless jet injection (NLJI), which employs a high-speed jet to puncture the skin without the side effects of needles, was used in one patient with recurrent BCC of the nose. Photoactivation was then performed using red light emitting diode [CW @ λ 630 nm, irradiance 50 mW/cm(2), total fluence 51 J/cm(2)] for 17 minutes. Excellent cosmesis was obtained. Aside from mild crusting present for six days, no other adverse signs were noted. Clinically, there was no recurrent lesion up two years postintervention. Additional studies in larger samples of subjects are needed to further evaluate this promising technique.
A case of allergy to Silybum marianum ( milk thistle) and Eragrostis tef ( teff)
Authors: O Wojas, E Krzych-Fałta, P Samel-Kowalik, M Żalikowska-Gardocka, E Majsiak, A Mari, B Samoliński
Journal: Allergy Asthma Clin Immunol (2020)
Keywords: allergen, allergies, eragrostis tef, milk thistle, silybum marianum, teff
MeSH terms: Case Reports

Background:
This paper presents a peculiar first case of an allergy to Silybum marianum (milk thistle) and Eragrostis tef (teff). Both teff and milk thistle have been presented in the literature (both domestic and foreign) in a positive light, the former as a new part of gluten-free diet, and the latter as a treatment for a number of conditions, particularly those of the liver.
Case presentation:
A 29-year-old male presented at our clinic due to an episode of itching and burning in his mouth, swollen tongue, and difficulty swallowing following ingestion of teff flakes. He also reported sneezing, runny nose, watering and burning eyes, and wheezing following inhalation exposure to ground milk thistle. The patient's occupation is associated with exposure to these allergens. The patient underwent comprehensive allergy diagnostic assessments (including skin-prick testing, serum specific IgE levels, Faber test, spirometry, and acoustic rhinometry) and gastroenterological assessments. The diagnosis was established on skin tests with native allergens (milk thistle 16/35, teff flour 22/60, negative control 0/0, histamine 3/5) provided by the patient. There are no commercially available (standardized) tests for milk thistle or teff either in Poland or anywhere else in the world.
Conclusions:
Milk thistle is available in the form of dry, finely-ground preparations (which are used as additives to bread, soups, and yoghurts) and extracts (which are used as ingredients in over-the-counter herbal remedies). Teff is a gluten-free cereal whose grains are rich in methionine, calcium, iron, folic acid, and antioxidants. This case report presents milk thistle and teff as potentially new allergens. A literature review revealed no similar allergy cases in Poland or elsewhere in the world.
Case Report: Long-Term Suppression of Paroxysmal Kinesigenic Dyskinesia After Bilateral Thalamotomy
Authors: Masato Murakami, Shiro Horisawa, Kenko Azuma, Hiroyuki Akagawa, Taku Nonaka, Takakazu Kawamata, Takaomi Taira
Journal: Front Neurol (2021)
Keywords: antiepileptic drugs, dystonia, paroxysmal kinesigenic dyskinesia, remission, ventro-oral thalamotomy
MeSH terms: Case Reports

Background: Paroxysmal kinesigenic dyskinesia (PKD) is a movement disorder characterized by transient dyskinetic movements, including dystonia, chorea, or both, triggered by sudden voluntary movements. Carbamazepine and other antiepileptic drugs (AEDs) are widely used in the treatment of PKD, and they provide complete remission in 80-90% of medically treated patients. However, the adverse effects of AEDs include drowsiness and dizziness, which interfere with patients' daily lives. For those with poor compatibility with AEDs, other treatment approaches are warranted. Case Report: A 19-year-old man presented to our institute with right hand and foot dyskinesia. He had a significant family history of PKD; his uncle, grandfather, and grandfather's brother had PKD. The patient first experienced paroxysmal involuntary left hand and toe flexion with left forearm pronation triggered by sudden voluntary movements at the age of 14. Carbamazepine (100 mg/day) was prescribed, which led to a significant reduction in the frequency of attacks. However, carbamazepine induced drowsiness, which significantly interfered with his daily life, especially school life. He underwent right-sided ventro-oral (Vo) thalamotomy at the age of 15, which resulted in complete resolution of PKD attacks immediately after the surgery. Four months after the thalamotomy, he developed right elbow, hand, and toe flexion. He underwent left-sided Vo thalamotomy at the age of 19. Immediately after the surgery, the PKD attacks resolved completely. However, mild dysarthria developed, which spontaneously resolved within three months. Left-sided PKD attacks never developed six years after the right Vo thalamotomy, and right-sided PKD attacks never developed two years after the left Vo thalamotomy without medication. Conclusion: The present case showed long-term suppression of bilateral PKDs after bilateral thalamotomy, which led to drug-free conditions.
Case Report: Recurrent retinal vein occlusion as the first clinical manifestation of systemic lupus erythematosus in a male patient
Authors: Marwa Ben Brahim, Sondes Arfa, Fadia Boubaker, Jihen Chelly, Wafa Ammari, Sonia Hammami, Fatma Arbi, Olfa Berriche
Journal: F1000Res (2021)
Keywords: intra-vitreal anti-vascular endothelial growth factor antibodies treatment, male patient, retinal vein occlusion, systemic lupus erythematosus, case report
MeSH terms: Lupus Erythematosus, Systemic / complications, Lupus Erythematosus, Systemic / diagnosis, Retinal Vein Occlusion / diagnosis, Retinal Vein Occlusion / drug therapy, Retinal Vein Occlusion / etiology, Case Reports, Adult, Humans, Male

Systemic lupus erythematosus (SLE) is a chronic, autoimmune disease characterized by widespread clinical manifestations and immunological disorders. A myriad of ocular manifestations can be seen in patients with SLE. The most vision-threatening complication is vaso-occlusive retinopathy including retinal vein occlusion (RVO). RVO associated with SLE is well described in the literature and its association with antiphospholipid antibodies is recognized. However, RVO as the initial manifestation of SLE is scarcely reported. Herein, we report the first case of recurrent RVO as the revealing manifestation of SLE in a 40-year-old male patient. He had two consecutive episodes of decreased vision. Ophthalmologic examination disclosed a branch retinal vein occlusion the first time and a central retinal vein occlusion the second time. The diagnosis of SLE was established based on clinical and immunological criteria. He was prescribed antiplatelet therapy, hydroxychloroquine at 5.5 mg/kg/day, and intravitreal anti-vascular endothelial growth factor (VEGF) antibodies regimen. He slowly improved under treatment.