OpenMed/multicare-articles huggingface dataset:
Nonsurgical Management of a Papillary Fibroelastoma of the Aortic Valve
Authors: Antonino M Grande, Nicoletta Castiglione, Adelaide Iervolino, Francesco Nappi, Antonio Fiore
Journal: Case Rep Cardiol (2021)
MeSH terms: Case Reports

We report the case of a 63-year-old woman who had an incidental echocardiographic diagnosis of papillary fibroelastoma (PFE) of the right coronary cusp of the aortic valve. The patient was informed about the embolic risk due to the pedunculated mass located on the aortic valve but she refused the proposed surgical removal. She was followed up yearly, and each follow-up included an echocardiographic evaluation of the mass. The lady is taking lysine acetylsalycilate 160 mg daily, and after more than 19 years later, she does not complain any symptoms or complications as a result of possible embolic episodes. If on one hand, our report is provocative for PFE nonsurgical management; on the other, we do believe that in symptomatic patients PFE located in the left heart chambers, the standard of care remains surgical excision after diagnosis. Anyway, our analysis shows that further data in this issue are needed in asymptomatic patients, and surgical indication should be proposed considering carefully the risk-benefit balance.
Infectious Aortitis with Abdominal Aortic Aneurysm in a 47-Year-Old Female with Systemic Lupus Erythematosus
Authors: Valerie R Ramiro, Carmegie C Saliba, John Anthony D Tindoc, Marinette R Jambaro, Enrique M Chua 3rd, Donna Ricca M Hornilla, Maria Teresa B Abola
Journal: Case Rep Cardiol (2019)
MeSH terms: Case Reports

Aortic aneurysms are not commonly reported among patients with systemic lupus erythematosus (SLE). We report a case of a 47-year-old Filipino female diagnosed with SLE 17 years ago maintained on prolonged oral steroids, azathioprine, and hydroxychloroquine. She also had lupus nephritis, secondary hypertension, and dyslipidemia. She initially presented with a week-long watery nonbloody diarrhea with associated diffuse crampy abdominal pain and generalized weakness. She was admitted for a week at a provincial hospital and was given an unrecalled antibiotic with resolution of symptoms. Upon discharge, however, she experienced two weeks of severe right lower quadrant pain radiating to the back and left lower quadrant, with no history of diarrhea, vomiting, dysuria, and fever. Complete blood count showed slight leukocytosis and elevated C-reactive protein. Abdominal imaging revealed a saccular infrarenal aneurysm with dissection. An atherosclerotic mechanism was primarily considered, but a vasculitic process was likewise considered due to elevated acute phase reactants. The initial plan was Endovascular Aneurysm Repair (EVAR) but due to financial limitations, an exploratory laparotomy with infrarenal endoaneurysmorrhaphy was eventually performed. Intraoperative findings were a saccular infrarenal aneurysm with dissection up to the proximal right common iliac artery and an abscess compartment within the false lumen in the anterior aortic wall. Abscess culture yielded high growth of Salmonella group B. Micrographs of the aortic wall biopsy showed fibrin deposition necrosis and calcification with peripheral viable cellular infiltrates consisting of neutrophils and foamy macrophages. Inadvertently placing an endovascular graft in an infected aortic aneurysm would have led to graft infection and catastrophic morbidity. We highlight the significance of having a high index of suspicion for infectious causes of aortitis among immunocompromised patients presenting with aneurysm prior to pursuing an endovascular versus an open approach for repair.
Endovascular management of an isolated common iliac artery aneurysm: a case report
Authors: Imtinene Ben Mrad, Melek Ben Mrad, Sobhi Mleyhi, Rim Miri, Ihsen Zairi, Yassine Khaddar, Mohamed Ben Hammamia, Raouf Denguir
Journal: Pan Afr Med J (2021)
Keywords: iliac artery, aneurysm, case report, embolization, endovascular
MeSH terms: Embolization, Therapeutic / methods, Endovascular Procedures / methods, Iliac Aneurysm / therapy, Case Reports, Humans, Intermittent Claudication / etiology, Male, Middle Aged, Stents, Treatment Outcome

Isolated iliac artery aneurysms are rare, and treatment by conventional surgery gives good results. Endovascular repair of such aneurysms has recently become the preferred form of treatment, provided the appropriate anatomy for endovascular repair exists. We report the case of a 60-year-old man admitted in our department for an aneurysm of the left primitive iliac artery revealed by intermittent claudication and treated by a covered stent after embolization of the hypogastric artery by an Amplatzer Vascular Plug with a good result. This case highlights the importance of preservation of the collaterals of the hypogastric artery when you treat such entity; in order to avoid transient gluteal claudication and sexual dysfunction.
Nicolau syndrome following intramuscular benzathine penicillin injection: a case report
Authors: Walaza Phiri, Maen Shulammite Musonda, Kebby Kyakilika, Michelo Haluuma Miyoba, Malan Malumani
Journal: Pan Afr Med J (2020)
Keywords: livedo-like dermatitis, nicolau syndrome (ns), case report, embolia cutis medicamentosa, intramuscular injections
MeSH terms: Anti-Bacterial Agents / adverse effects, Nicolau Syndrome / etiology, Penicillin G Benzathine / adverse effects, Case Reports, Amputation, Surgical / methods, Anti-Bacterial Agents / administration & dosage, Child, Preschool, Female, Humans, Injections, Intramuscular, Lower Extremity / surgery, Penicillin G Benzathine / administration & dosage, Anti-Bacterial Agents, Penicillin G Benzathine

Nicolau syndrome (NS) is a rare injection site reaction, following intramuscular injection of drugs characterized by severe pain, skin discoloration and varying level of tissue necrosis. The case outcomes vary from severe pain, atrophic ulcers to sepsis and limb amputation. We describe a case of the five-year-old girl with diagnosis of NS after intramuscular benzathine penicillin injection. The case was complicated with above the knee amputation of lower limb. This case report intends to remind clinicians that such rare cases should always be thought of in all patients receiving whatsoever drug via intramuscular injections.
A new mutation in the RP1L1 gene in a patient with occult macular dystrophy associated with a depolarizing pattern of focal macular electroretinograms
Authors: Takenori Kabuto, Hisatomo Takahashi, Yoko Goto-Fukuura, Tsutomu Igarashi, Masakazu Akahori, Shuhei Kameya, Takeshi Iwata, Atsushi Mizota, Kunihiko Yamaki, Yozo Miyake, Hiroshi Takahashi
Journal: Mol Vis (2012)
MeSH terms: Asian People / genetics, Eye Proteins / genetics, Macular Degeneration / genetics, Mutation, Retina / metabolism, Case Reports, Amino Acid Substitution, Base Sequence, Case-Control Studies, Electroretinography, Exons, Female, Humans, Introns, Macular Degeneration / metabolism, Macular Degeneration / physiopathology, Middle Aged, Molecular Sequence Data, Pedigree, Retina / physiopathology, Sequence Analysis, DNA, Eye Proteins, RP1L1 protein, human

Purpose:
To determine whether a mutation in the RP1-like protein 1 (RP1L1) gene is present in a Japanese patient with sporadic occult macular dystrophy (OMD) and to examine the characteristics of focal macular electroretinograms (ERGs) of the patient with genetically identified OMD.
Methods:
An individual with OMD underwent detailed ophthalmic clinical evaluations including focal macular ERGs. Mutation screening of all coding regions and flanking intron sequences of the RP1L1 gene were performed with DNA sequencing analysis in this case with OMD.
Results:
A new RP1L1 mutation (c.3596 C>G in exon 4) was identified. The variant c.3596 C>G in exon 4 resulted in the substitution of cysteine for serine at amino acid position 1199. The serine at position 1199 is well conserved among the RP1L1 family in other species. Four out of five computational assessment tools predicted that this mutation is damaging to the protein function. This mutation was not present in 294 control alleles. The waveform of focal macular ERGs recorded from the patient with OMD had a depolarizing pattern, simulating the ERG waveforms observed after the hyperpolarizing bipolar cell activity is blocked.
Conclusions:
We have demonstrated in a Japanese patient the possibility that sporadic OMD may also be caused by an RP1L1 mutation. The waveform of focal macular ERGs elicited from the OMD patient with the RP1L1 mutation showed a depolarizing pattern. This characteristic is the same as reported for the focal macular ERGs of OMD.
Mycobacterium lepromatosis as a Second Agent of Hansen's Disease
Authors: Patrícia Deps, Simon M Collin
Journal: Front Microbiol (2021)
Keywords: hansen’s disease, mycobacterium leprae, mycobacterium lepromatosis, leprosy, zoonosis
MeSH terms: Review

Mycobacterium lepromatosis was identified as a new species and second causal agent of Hansen's disease (HD, or leprosy) in 2008, 150years after the disease was first attributed to Mycobacterium leprae. M. lepromatosis has been implicated in a small number of HD cases, and clinical aspects of HD caused by M. lepromatosis are poorly characterized. HD is a recognized zoonosis through transmission of M. leprae from armadillos, but the role of M. lepromatosis as a zoonotic agent of HD is unknown. M. lepromatosis was initially associated with diffuse lepromatous leprosy, but subsequent case reports and surveys have linked it to other forms of HD. HD caused by M. lepromatosis has been reported from three endemic countries: Brazil, Myanmar, and Philippines, and three non-endemic countries: Mexico, Malaysia, and United States. Contact with armadillos in Mexico was mentioned in 2/21 M. lepromatosis HD case reports since 2008. M. lepromatosis in animals has been investigated only in non-endemic countries, in squirrels and chipmunks in Europe, white-throated woodrats in Mexico, and armadillos in the United States. To date, there have only been a small number of positive findings in Eurasian red squirrels in Britain and Ireland. A single study of environmental samples found no M. lepromatosis in soil from a Scottish red squirrel habitat. Future studies must focus on endemic countries to determine the true proportion of HD cases caused by M. lepromatosis, and whether viable M. lepromatosis occurs in non-human sources.
Colocolic Intussusception in an Adult Patient Secondary to Caecal Adenocarcinoma
Authors: Hicham Elmajdoubi, Marouane Baiss, Mohamed El Absi, El Hassan El Faricha El Alami, Mohamed El Ouanani, El Mahjoub Echarrab, Mohamed El Amraoui, Abdelkader Errougani
Journal: Case Rep Gastrointest Med (2021)
MeSH terms: Case Reports

Acute intestinal invagination is the pathology of infants and small children. Its occurrence in adults is rare, and it represents 1 to 5% of intestinal occlusions often leading to the discovery of an organic cause that may be tumor. We report the case of a 72-year-old patient admitted to the emergency room of Ibn Sina Rabat, Morocco, for intestinal occlusion. The abdominal CT scan showed a voluminous intestinal invagination on a very probable heterogeneous digestive mass. The treatment was an open right hemicolectomy. The histopathological examination of the surgical specimen concluded a colonic well-differentiated adenocarcinoma with a 30% mucinous component. By review of literature, we discuss diagnostic and therapeutic procedures in emergency.
Anticoagulation Resumption in a Patient With Mechanical Heart Valves, Antithrombin Deficiency, and Hemorrhagic Transformation Following Thrombectomy After Ischemic Stroke
Authors: Yi-Chen Li, Rong Wang, Hang Xu, Lan-Ping Ding, Wei-Hong Ge
Journal: Front Pharmacol (2020)
Keywords: anticoagulation, argatroban, hemorrhagic transformation (ht), thrombectomy, valve thrombosis
MeSH terms: Case Reports

Anticoagulation is essential for patients undergoing mechanical heart valve replacement; however, the timing to reinitiate the anticoagulant could be a dilemma that imposes increased risk for bleeding events in patients suffering from the life-threatening hemorrhagic transformation (HT) after ischemic stroke. Such a situation was presented in this case report. A 71-year-old woman was transferred directly to the Neurocritical Care Unit because of a HT that occurred following the mechanical thrombectomy for ischemic stroke. Since she had a history of prosthetic metallic valve replacement, how the anticoagulating therapy could balance the hemorrhagic and thrombotic risks was carefully evaluated. On day 6 after the onset of hemorrhage transformation, the laboratory results of coagulation and fibrinolysis strongly suggested thrombosis as well as antithrombin deficiency. The short-acting and titratable anticoagulant argatroban was immediately initiated at low dose, and thrombosis was temporarily terminated. On day 3 of anticoagulation resumption, argatroban was discontinued for one dose when the prothrombin time and activated partial thromboplastin time significantly prolonged after argatroban infusion. Aortic valve thrombosis was detected the next day. The anticoagulation was then strengthened by dose adjustment to keep mitral valve intact, to stabilize the aortic valve thrombosis, and to decrease the aortic flow rate. The intravenous argatroban was transited to oral warfarin before the patient was discharged. This study is the first report of administering argatroban and titrating to its appropriate dose in the patient with valve thrombosis, antithrombin deficiency, and HT after mechanical thrombectomy for acute ischemic stroke. Notably, the fluctuations argatroban brings to the coagulation test results might not be interpreted as increased bleeding risk. This case also suggested that the reported timing (day 6 to day 14 after hemorrhage) of anticoagulant resumption in primary intracerebral hemorrhage with mechanical valves might be late for some patients with HT.
Case report: Hypnic headache responds to agomelatine-a potential prophylactic treatment option
Authors: Sui-Yi Xu, Ling Li, Wen-Xiu Sun, Jia-Yu Shen, Chang-Xin Li
Journal: Front Neurol (2023)
Keywords: hypnic headache, agomelatine, circadian rhythm, melatonin, serotonin
MeSH terms: Case Reports

Introduction:
Hypnic headache (HH) is a rare primary headache that is characterized by strict sleep-related attacks. However, the pathophysiology of HH remains unclear. The nocturnal nature of this activity suggests a hypothalamic involvement. The pathogenesis of HH may involve the brain structure that regulates circadian rhythms and is related to an imbalance between hormones, such as melatonin and serotonin. Currently, evidence-based medicine for HH pharmacotherapy is lacking. Acute and prophylactic treatment of HH is based on only a few case reports. Here, we report a case study in which agomelatine showed desirable responsiveness for the prophylactic treatment of HH for the first time.
Case description:
We present the case of a 58-year-old woman with a 3-year history of nocturnal left temporal pain that awakened her during the wee hours. Brain magnetic resonance imaging did not reveal any midline structural abnormalities associated with circadian rhythms. Polysomnography revealed headache-related awakening at approximately 5:40 am, after the last rapid eye movement phase. No sleep apnea-hypopnea events were observed, without oxygen saturation or blood pressure abnormalities. The patient was prescribed agomelatine 25 mg at bedtime as a prophylactic treatment. In the following month, the frequency and severity of the headaches decreased by 80%. After 3 months, the patient's headache completely resolved, and the medication was discontinued.
Conclusion:
HH only occurs during sleep in the real world, leading to substantial sleep disturbances in older populations. Headache center neurologists need to focus on the prophylactic treatment of patients before bedtime to avoid nocturnal awakening. Agomelatine is a potential prophylactic treatment option for patients with HH.
Antenatal diagnosis of vasa previa: report of three cases in an African setting
Authors: Yaw Amo Wiafe, Theophilus Kofi Adu-Bredu, Kwame Appiah-Denkyira, Charles Mawunyo Senaya
Journal: Pan Afr Med J (2020)
Keywords: africa, vasa previa, perinatal mortality, ultrasound
MeSH terms: Ultrasonography, Prenatal / methods, Vasa Previa / diagnostic imaging, Case Reports, Adult, Africa, Female, Humans, Pregnancy, Pregnancy Outcome, Prenatal Diagnosis / methods

Vasa previa is characterised by unprotected umbilical vessels that are crossing the internal cervical os or lying close to it. When vasa previa is not detected during antenatal period, the perinatal outcome could be grievous. Ultrasound is the modality of choice in detection of vasa previa. Despite the increasing availability of ultrasound in modern times, its use in diagnosing vasa previa still remain very low in Africa. We present the sonographic findings and perinatal outcomes of three cases of vasa previa which were detected antenatally within a period of nine months in an African setting.
Pitfall in the Diagnosis of Diabetes Insipidus and Pregnancy
Authors: Melissa Sum, Jessica B Fleischer, Alexander G Khandji, Sharon L Wardlaw
Journal: Case Rep Obstet Gynecol (2017)
MeSH terms: Case Reports

Diabetes insipidus (DI) during pregnancy and the perinatal period is an uncommon medical problem characterized by polyuria and excessive thirst. Diagnosis of DI may be overlooked in the setting of pregnancy, a time when increased water intake and urine output are commonly reported. We report two cases: one of transient DI in a young woman during her third trimester of twin pregnancy in association with acute fatty liver and hypertension and one of postpartum DI secondary to Sheehan syndrome from rupture of a splenic artery aneurysm. These cases illustrate the spectrum with which DI related to pregnancy and delivery can present and highlight the difficulty in making the diagnosis since the symptoms are often initially overlooked.
Severe Rhabdomyolysis without Systemic Involvement: A Rare Case of Idiopathic Eosinophilic Polymyositis
Authors: Ayesha Farooq, Vivek Choksi, Andrew Chu, Dhruti Mankodi, Sameer Shaharyar, Keith O'Brien, Uday Shankar
Journal: Case Rep Rheumatol (2015)

Introduction. Eosinophilic polymyositis (EPM) is a rare cause of rhabdomyolysis characterized by eosinophilic infiltrates in the muscle. We describe the case of a young patient with eosinophilic polymyositis causing isolated severe rhabdomyolysis without systemic involvement. Case Presentation. A 22-year-old Haitian female with no past medical history presented with progressive generalized muscle aches without precipitating factors. Examination of the extremities revealed diffuse muscle tenderness. Laboratory findings demonstrated peripheral eosinophilia and high creatinine phosphokinase (CPK) and transaminase levels. Workup for the common causes of rhabdomyolysis were negative. Her CPK continued to rise to greater than 100,000 units/L so a muscle biopsy was performed which showed widespread eosinophilic infiltrate consistent with eosinophilic polymyositis. She was started on high dose systemic corticosteroids with improvement of her symptoms, eosinophilia, and CPK level. Discussion. This case illustrates a systematic workup of rhabdomyolysis in the presence of peripheral eosinophilia. Many differential diagnoses must be considered before establishing a diagnosis of idiopathic eosinophilic polymyositis. To our knowledge, our case of eosinophilic polymyositis is unique as it presented with severe rhabdomyolysis without another organ involvement. Clinicians should maintain a high index of suspicion for this physically debilitating disease to aid in prompt diagnosis.
Disruptive Communication as a Means to Engage Children in Solving Environmental Challenges: A Case Study on Plastic Pollution
Authors: Erica Löfström, Isabel Richter, Ine H Nesvold
Journal: Front Psychol (2021)
Keywords: children, co-creation activities, disruptive communication, environmental communication, human and environment, plastic pollution

Environmental degradation and how we care for our planet are some of the greatest challenges the world is up against at this moment. These challenges has received increased focus in both, research and the public sphere. So far, most of this attention revolved around adult's attitudes and behavior. However, environmental engagement amongst the younger generation gains in popularity. Using plastic pollution as a case, this qualitative study aims to acquire insights into the mental models of children. We collected qualitative data during an innovative, structured workshop according to the "Nature In Your Face" (NIYF) framework. The approach challenges the assumption that the societal change can be achieved gradually, with non-invasive techniques. Instead, we explore the potential of disruption to push citizens out of their comfort zone, thereby making room for co-creation. The disruption was performed by confronting 36 fifth graders from a Norwegian primary school, with disturbing images of plastic contaminating their local shorelines. The data was obtained by using the workshop framework, combined with semi-structured group interviews. The interview data was analyzed by means of thematic analysis. We found that the disruptions triggered emotional reactions like anger and fear. With these emotions as a driving force, the first workshop step was introduced, the Framing of the problem. The next step, Twisting the problem, was reflected in the children developing their own, creative solutions and creatively engaged with them in groups. The last step, Using, was only touched upon in the workshop and is therefore beyond the scope of this paper. Our results indicate that there are three prominent themes reflecting how children discuss plastic pollution. The children talked about their (1) Emotions related to plastic pollution, (2) Attitudes related to plastic, and (3) Perceptions of plastic pollution. These themes were further subdivided into different types of emotions, characteristics of plastic as a material as well as perceptions on different locations of unnecessary plastic. Psychologically, the mechanisms underlying the identified themes were linked to eco-anxiety, denial, self-efficacy, and cognitive dissonance. We conclude that disruptive eco-visualization can create an emotional response amongst children, which can be transformed into co-creation of ideas.