OpenMed/multicare-articles huggingface dataset:
Adrenal Gland Incidentaloma: A Rare Case of Extranodal B-cell Lymphoma
Authors: Inês Figueiredo, Francisco Guimarães, Cristina Duarte, Luísa Fontes
Journal: Cureus (2024)
Keywords: adrenal gland incidentaloma, adrenalectomy, diffuse large b-cell lymphoma, r-chop therapy, rituximab
MeSH terms: Case Reports

The prevalence of adrenal incidentalomas (i.e., incidental findings) has grown in recent years with the evolution of imaging methods. Adrenal masses can be benign or malignant. Malignant ones are less frequent, but the detection of primary adrenal neoplasms is even less frequent, especially in the case of a diffuse large B-cell lymphoma (DLBCL). This case concerns a 68-year-old man who presented to the emergency department due to fatigue and anorexia. Given his blood test results on admission, he underwent a computed tomography (CT) with angiography that identified a mass in the left adrenal gland with displacement of the ipsilateral kidney. Left tumorectomy, adrenalectomy, and nephrectomy were performed, and the mass corresponded to a nongerminal center-type DLBCL. This case highlights the importance of prompt diagnosis and surgical and pharmacologic treatment of DLBCL.
Cardiac Tuberculoma Presenting as Sudden Cardiac Death in an Immunocompetent Young Man: A Case Report and Literature Review
Authors: Alemayehu Shiferaw Lema
Journal: Case Rep Cardiol (2023)
MeSH terms: Case Reports

Tuberculosis is one of several preventable and curable communicable diseases that is a major cause of morbidity and one of the top ten causes of death worldwide. Cardiac tuberculosis frequently affects the pericardium. Although rare, most cases of tuberculosis involving the myocardium and endocardium present as sudden cardiac death in asymptomatic cases. Information about the myocardial involvement of tuberculosis appears in the literature once in a blue moon. As a result, there is a knowledge gap about cardiac tuberculosis among health professionals. Here, a case of sudden cardiac death from tuberculoma of the right atrium with a secondary thrombus causing bicaval obstruction that is observed in an asymptomatic immunocompetent young man is presented. Furthermore, challenges related to the diagnosis and management of cardiac tuberculosis are discussed, and an overview of the relevant literature is provided to break new ground in early diagnosis and therapy.
Case report: Impact of mixed reality on anatomical understanding and surgical planning in a complex fourth ventricular tumor extending to the lamina quadrigemina
Authors: Elisa Colombo, Delal Bektas, Luca Regli, Tristan van Doormaal
Journal: Front Surg (2023)
Keywords: 3d visualization, fourth ventricle, mixed reality, posterior fossa microneurosurgery, tumors of the iv ventricle
MeSH terms: Case Reports

Background and importance:
Tumors of the fourth ventricle account for 1%-5% of all intracranial neoplastic lesions and present with different configurations and anatomical challenges. Microsurgery represents the primary therapeutic strategy for the majority of fourth ventricular tumors, and adequate anatomical understanding and visualization are paramount to surgical planning and success. The authors present the case of a young patient with a complex fourth ventricular tumor, whose surgery was successfully planned using a novel mixed reality (MxR) system.
Case description:
We present a case of a 31-year-old woman with a lesion extending from the fourth ventricle to the lamina quadrigemina and causing symptomatic hydrocephalus occlusus. Through the combined use of routine 2D images and an interactive 3D anatomical model, an interhemispheric transtentorial approach was used to remove 98% of the lesion with successful functional outcomes.
Conclusions:
The application of advanced 3D visualization with a novel MxR system to the surgical planning of a complex fourth ventricular lesion proved relevant in designing the best surgical approach and trajectory to better identify potential intraoperative challenges and rehearse the patient-specific anatomy. The present case report endorses the implementation of advanced 3D visualization in routine perioperative practice.
Case report: Whole exome sequencing and genome-wide methylation profiling of Czech dysplasia in a Chinese pedigree
Authors: Mengfei Zhao, Runrun Zhang, Cen Chang, Yehua Jin, Lingxia Xu, Shicheng Guo, Steven Schrodi, Yong He, Dongyi He
Journal: Front Med (Lausanne) (2023)
Keywords: col2a1, chinese pedigree, czech dysplasia, mutation, whole exome-sequencing
MeSH terms: Case Reports

Background:
Czech dysplasia is a rare skeletal disorder with symptomatology including platyspondyly, brachydactyly of the third and fourth toes, and early-onset progressive pseudorheumatoid arthritis. The disorder segregates in an autosomal dominant fashion. A specific missense mutation (R275C, c.823C > T) in exon 13 of the COL2A1 gene has been identified in German and Japanese families.
Case summary:
We present the case of a Chinese woman diagnosed with Czech dysplasia (proband) who carried a variant in the COL2A1 gene. Whole-exome sequencing (WES) identified the COL2A1 missense mutation (R275C, c.823C > T) in close relatives of the proband who also exhibited the same disorder.
Conclusion:
This study is a thorough clinical and physiological description of Czech dysplasia in a Chinese patient.
DIETERICH's disease of both the third and the fourth metacarpal head in a teenage boy: case report and review of literature
Authors: Mehdi Drissi Kaitouni, Aleid C J Ruijs
Journal: Case Reports Plast Surg Hand Surg (2024)
Keywords: dieterich’s disease, adolescent, avascular necrosis, metacarpal bone
MeSH terms: Case Reports

Dieterich's disease or avascular osteonecrosis of the metacarpal head is rare and not often described in the literature. It affects typically the middle of metacarpal bones and can occur at all age groups. A case of a teenager with chronic pain of the third and fourth metacarpal head is presented.
Left ventricular outflow tract obstruction after transcatheter mitral valve replacement: a case report with a multifaceted approach
Authors: Berenice Caneiro-Queija, Claudio E Guerreiro, Julio Echarte-Morales, Rodrigo Estévez-Loureiro, Manuel Barreiro-Pérez, Rocío González-Ferreiro, Francisco Estévez-Cid, Juan José Legarra, Jose Antonio Baz, Andrés Íñiguez-Romo
Journal: Front Cardiovasc Med (2024)
Keywords: tendyne, alcohol septal ablation (asa), left ventricular outflow tract obstruction, mitral annular calcification, transcatheter mitral valve replacement
MeSH terms: Case Reports

An 83-year-old woman was admitted to our center because of heart failure. Transthoracic echocardiography revealed severe mitral annular calcification resulting in a double mitral valve lesion. After discussion by the heart team, transcatheter mitral valve replacement with Tendyne (Abbott Structural, Santa Clara, CA, USA) was performed. Despite having a predicted neo-left ventricular outflow tract (LVOT) above the cut-off value, the patient developed clinically significant LVOT obstruction (LVOTO) refractory to medical treatment. This situation is often treated before the intervention, and dealing with LVOTO afterward can be challenging. After taking the patient's anatomy into consideration, we decided to perform alcohol septal ablation. Applying a combined strategy of medical treatment and intervention led to success. In this case report, we discuss this event and the strategies available for preventing and managing the condition.
Unmasking hemoglobin Köln: a rare cause of discrepancies between pulse oximetry and arterial oxygen saturation-a case report
Authors: Awni Alshurafa, Ahmed Elsabagh, Koutaibah Rida Obaid, Youssef Elhaji, Mohamed A Yassin
Journal: Front Med (Lausanne) (2024)
Keywords: hemoglobin, hemoglobinopathies, hemolysis, hypoxia, unstable hemoglobin
MeSH terms: Case Reports

Discrepancies between pulse oximetry and arterial oxygen saturation can pose challenges in clinical assessment. Possible underlying causes include poor peripheral perfusion, skin pigmentation, motion artifacts, and conditions like unstable hemoglobin and methemoglobinemia. Unstable hemoglobin variants, such as hemoglobin Köln, are rare inherited mutations affecting globin genes, potentially disrupting the folding, assembly, or interactions among subunits in globin molecules and the essential interactions between heme and globin for oxygen-binding properties. In this case report, we present the case of a 44-year-old Arabic woman who underwent extensive investigations due to disparities in pulse oximetry and arterial oxygen saturation, ultimately leading to the diagnosis of the unstable hemoglobin variant, hemoglobin Köln.
Case report: Successful treatment of refractory membranous nephropathy with telitacicept
Authors: Lei Zhang, Hua Jin, Dong Wang, Yiping Wang
Journal: Front Immunol (2023)
Keywords: case report, refractory membranous nephropathy, successful, telitacicept, treatment
MeSH terms: Glomerulonephritis, Membranous / diagnosis, Glomerulonephritis, Membranous / drug therapy, Case Reports, Research Support, Non-U.S. Gov't, Cyclophosphamide, Glucocorticoids, Humans, Male, Middle Aged, Rituximab / therapeutic use, Glucocorticoids, telitacicept, Rituximab, Cyclophosphamide

Despite various treatment methods, the remission rate of membranous nephropathy remains limited. Refractory membranous nephropathy especially lacks effective treatment plans. Telitacicept achieves comprehensive inhibition of CD20-positive B cells, plasma cells, and T cells, thereby bringing new hope to the treatment of membranous nephropathy and refractory membranous nephropathy. Here, we report a case of a 46-year-old man with membranous nephropathy. Although the combined treatment with glucocorticoid, tacrolimus, mycophenolate mofetil, cyclophosphamide, and rituximab was not successful, the patient achieved complete remission of urinary protein after glucocorticoid combined with telitacicept. This is the first report on the application of telitacicept in the treatment of membranous nephropathy, especially refractory membranous nephropathy. The application of telitacicept in the treatment of membranous nephropathy deserves further attention.
Case report: Malignant epithelioid angiosarcoma in a Chinese female patient
Authors: Xiaohong Li, Lu Chen, Rong Ye, Chunyan Wu, Wenlei Zhuo
Journal: Front Oncol (2024)
Keywords: pecoma, dermatology, dermatopathology, immunohistochemistry, skin tumor
MeSH terms: Case Reports

Perivascular epithelioid cell tumors (PEComas) are mesenchymal tumors that exhibit characteristic epithelioid or spindle cell morphology and typically grow around blood vessels. These tumors are characterized by the expression of melanocytic and smooth muscle markers, such as HMB-45, Melan-A, and smooth muscle actin, indicating a dual differentiation phenotype. PEComas are extremely rare diseases, and patients typically have a very poor prognosis. Here, we report a case of malignant cutaneous PEComa with pulmonary metastasis in a Chinese female and review relevant literature. The patient underwent surgical resection of a soft tissue tumor in the left upper arm under general anesthesia, and the subsequent pathological findings suggested a tumor with perivascular epithelioid cell differentiation (PEComa). The patient received adjuvant chemotherapy and radiotherapy after surgical resection, along with monitoring through computed tomography (CT) scans. Three months later, pulmonary metastasis was detected, but both the cutaneous PEComa in the left upper limb and the pulmonary metastatic lesions were stably controlled under active management and treatment. This is a rare case worth reporting and studying, and therefore, we conducted a long-term follow-up, and we hope to provide help for the clinical treatment of PEComa.
Ceftriaxone-resistant Salmonella enterica serovar Newport: a case report from South India
Authors: Mahadevaiah Neelambike Sumana, Yogeesh D Maheshwarappa, Morubagal Raghavendra Rao, R Deepashree, M V S Krishna Karthik, Nikita K Shah
Journal: Front Public Health (2024)
Keywords: salmonella newport, ceftriaxone resistance, ceftriaxone resistant non-typhoidal salmonella, gastroenteritis, septic shock
MeSH terms: Anti-Bacterial Agents / pharmacology, Anti-Bacterial Agents / therapeutic use, Ceftriaxone / pharmacology, Ceftriaxone / therapeutic use, Salmonella Infections / drug therapy, Salmonella Infections / microbiology, Salmonella enterica / drug effects, Salmonella enterica / isolation & purification, Case Reports, Drug Resistance, Multiple, Bacterial, Female, Gastroenteritis / drug therapy, Gastroenteritis / microbiology, Humans, India, Microbial Sensitivity Tests, Middle Aged, Serogroup, Ceftriaxone, Anti-Bacterial Agents

Salmonella enterica serovar Newport is a human pathogen underreported in most developing countries. It is known for causing gastroenteritis and extraintestinal infections. In this case report, we report the case of ceftriaxone-resistant Salmonella enterica serovar Newport from South India, causing acute gastroenteritis in a sixty-year-old female patient having a history of antimicrobial therapy and recent hospital admission. Serovar Newport, especially among antibiotic-exposed patients, poses a significant public health threat due to its ability to acquire multidrug resistance. This emphasizes the necessity for robust surveillance and monitoring of nontyphoidal Salmonella infections, particularly given the limited data on serovar Newport in India. Vigilance in clinical practice and public health initiatives is crucial to effectively address the emergence and spread of multidrug-resistant strains.
Ileal Schwannoma: A Rare Cause of Pelvic Mass
Authors: Martin Jezovit, Hasan Bakirli, Ifrat Bakirov, Khalid Hureibi, Gultakin Bakirova, Roman Okolicany, Pavol Janac, Iveta Meciarova, Nasser Alhwaymel, Ilkin Bakirli, Augustin Prochotsky
Journal: Case Rep Surg (2024)
MeSH terms: Case Reports

The incidence of small bowel schwannomas is extremely low. In the current literature, we found just a few reported small intestine schwannomas that were located in the duodenum, jejunum, or ileum. This study reports a surprising finding of a relatively large size ileal schwannoma in a patient whose preoperative magnetic resonance imaging described a tumour in the lesser pelvis probably derived from the right adnexa. Pfannenstiel incision was made by the gynaecology team, which found a large mass lesion arising from the small intestine and occupying nearly the entire lesser pelvis. The general surgeon was invited, and pathology was successfully managed by segmental resection of the small bowel with primary end-to-end anastomosis. The histopathology study reported a submucosal tumour composed of S-100 protein-positive spindle cells, and the diagnosis of ileal schwannoma was made. The possibility of intestinal neoplasms, including schwannomas, might be contemplated in the differential diagnosis of any pelvic mass lesions. A detailed histology study and immunohistochemical stain are required for the final diagnosis of intestinal schwannomas and to rule out malignant changes, which are extremely important for the further management of patients. To the best knowledge, our case is one of the biggest intestinal schwannomas reported in the current literature.
Tako-Tsubo Syndrome Triggered by a Fibroscopy: Case Report
Authors: Jaouad Nguadi, Raid Faraj, Zaynab Mouhib, Zouhair Lakhal, Hicham Bouzelmat
Journal: Cureus (2024)
Keywords: atypical chest pain, clinical case report, systolic heart failure, tako-tsubo cardiomyopathy (ttc), transthoracic echocardiogram, ventriculography
MeSH terms: Case Reports

Tako-Tsubo cardiomyopathy, also called stress cardiopathy, is a rare syndrome characterized by transient regional systolic dysfunction. It can mimic myocardial infarction but the absence of coronary obstruction allows to redress the diagnosis. Its pathogenesis is not well understood. However, the role of physical or emotional stress has often been associated with this pathology. Here we report, a rare case of a 63-year-old female, with no cardiac risk factors, who presented Tako-Tsubo syndrome after a fibroscopy. This case aims to show that Tako-Tsubo syndrome should be suspected in patients, especially women, with no cardiac risk factors, who present acute chest pain in the context of physical or emotional stress, after excluding differential diagnoses.
Late-Onset Exudative Pleural Effusions Without Concomitant Airway Obstruction or Lung Parenchymal Abnormalities: A Novel Presentation of Chronic Lung Allograft Dysfunction
Authors: Devika Sindu, Sandhya Bansal, Bhuvin Buddhdev, Kendra McAnally, Hesham Mohamed, Rajat Walia, Thalachallour Mohanakumar, Sofya Tokman
Journal: Transpl Int (2024)
Keywords: chronic lung allograft dysfunction, exudative pleural effusion, lung transplant, new clad phenotype, small extracellular vesicles
MeSH terms: Airway Obstruction, Lung Transplantation, Pleural Effusion / etiology, Respiratory Insufficiency, Case Reports, Allografts, Humans, Lung, Retrospective Studies

Restrictive allograft syndrome (RAS) is an aggressive variant of CLAD characterized by progressive restrictive ventilatory decline and persistent pleuro-parenchymal changes that can be seen on chest CT. We identified four lung transplant recipients with a progressive restrictive ventilatory defect due to lymphocyte-predominant exudative pleural effusions, but no pleuro-parenchymal abnormalities typical of RAS. Using molecular analysis, we also found increased levels of previously described immune markers of RAS, including NFkB, 20S proteasome, lipocalin, TNFα, and TGFβ, within the circulating small extracellular vesicles of the remaining living lung transplant recipient. Despite the absence of lung parenchymal changes, these patients had a poor prognosis with rapid deterioration in allograft function and no response to pleural-based interventions such as thoracentesis, decortication, and pleurodesis. We hypothesize that these cases represent a distinct CLAD phenotype characterized by progressive restriction due to pleural inflammation, lymphocyte-predominant pleural effusion, resultant compressive atelectasis, and eventual respiratory failure in the absence of lung parenchymal involvement.
Case report: Coronary atherosclerosis in a patient with long-standing very low LDL-C without lipid-lowering therapy
Authors: Giorgio Mottola, Francine K Welty, Hamid R Mojibian, Kamil F Faridi
Journal: Front Cardiovasc Med (2023)
Keywords: ldl-c, atherosclerosis, coronary artery disease, familial hypobetalipoproteinemia (fhbl), primordial prevention of cvd
MeSH terms: Case Reports

Background:
ApoB-containing lipoproteins including low-density lipoprotein cholesterol (LDL-C) are necessary for the development of atherosclerosis, and lifelong exposure to low serum levels of LDL-C have been associated with a substantial reduction of cardiovascular risk. Although plaque regression has been observed in patients with serum LDL-C less than 70-80 mg/dl on lipid-lowering therapy, an LDL-C level under which atherosclerosis cannot develop has not been established.
Case presentation:
In this case we describe a 60-year-old man with well-controlled diabetes mellitus and hypertension who presented to the hospital after an acute stroke likely due to an atrial myxoma discovered on imaging. A coronary computed tomography angiography scan performed in preparation for the planned surgical myxoma resection revealed an anomalous origin of the right coronary artery as well as evidence of nonobstructive coronary atherosclerosis in the right coronary and non-anomalous left coronary system. Despite not having ever been on any lipid-lowering therapy, this patient was found to have low LDL-C levels (<40 mg/dl) during this admission and on routine laboratory data collected over the prior 16 years. His family history strongly suggested heterozygous familial hypobetalipoproteinemia as a possible diagnosis.
Conclusions:
This case illustrates that even long-standing, very low levels of LDL-C may be insufficient to completely prevent atherosclerosis and emphasizes the importance of primordial prevention of all cardiovascular risk factors.
The First-Known Case of Hereditary Heterozygous Butyrylcholinesterase Deficiency in a Patient on Dialysis
Authors: Naoki Tokunaga, Hisato Shima, Takuya Okamoto, Masato Maekawa, Jun Minakuchi
Journal: Cureus (2024)
Keywords: albumin, butyrylcholinesterase, dialysis, hereditary deficiency, liver dysfunction, protein-energy wasting
MeSH terms: Case Reports

Serum levels of butyrylcholinesterase (BChE) are commonly used to assess liver function. Its levels have been reported to be significantly lower in patients undergoing dialysis. To the best of our knowledge, this is the first report of hereditary heterozygous BChE deficiency in a patient undergoing dialysis. Medical staff involved in the care of patients with BChE deficiency should be aware of anesthetic usage, because prolonged neuromuscular paralysis following the administration of succinylcholine or mivacurium may occur. However, in the heterozygotes, BChE activity is not completely absent. Therefore, differentiating patients undergoing dialysis is challenging. A 52-year-old man underwent living-related kidney transplantation for focal segmental glomerulosclerosis at 22 years of age. As the renal function gradually worsened, the patient began to receive combined hemodialysis and peritoneal dialysis therapy. No problems with anesthesia were observed in past surgeries. The patient's BChE levels fluctuated between 76 and 170 U/L (reference range: 198-495 U/L); however, they had never been previously investigated. We suspected hereditary heterozygous BChE deficiency because the patient's sister was also diagnosed with it. DNA sequencing revealed a heterozygous missense mutation (Gly365Arg) and a K-variant (Ala539Thr). Patients on dialysis with low serum BChE levels often present with low albumin levels which may be overlooked as malnutrition. Thus, BChE deficiency should be suspected in patients on dialysis with unexplained low serum BChE levels. In the case of heterozygous BChE deficiency, the reference value is low, and continuous monitoring is crucial.
Atrial lead perforation early after device implantation-a case report and literature review
Authors: Zefeng Wang, Zhongyu Yuan, Haiwei Li, Ke Zhang, Hongkai Zhang, Xiaoyan Li, Changhua Wang, Yilun Tian, Yiqing Shen, Xiaoping Zhang, Yongquan Wu
Journal: Front Surg (2024)
Keywords: active fixation, active fixation lead, atrial perforation, cardiac perforation, pacemaker complications
MeSH terms: Case Reports

We report three patients with screw-in lead perforation in the right atrial free wall not long after device implantation. All the patients complained of intermittent stabbing chest pain associated with deep breathing during the implantation. The "dry" epicardial puncture was utilized to avoid hemopericardium during lead extraction in the first case. The atrial electrode was repositioned in all cases and replaced by a new passive fixation lead in two patients with resolution of the pneumothorax or pericardial effusion. A literature review of 50 reported cases of atrial lead perforation was added to the findings in our case report.