OpenMed/multicare-articles huggingface dataset:
Polymyalgia Rheumatica Revealing a Lymphoma: A Two-Case Report
Authors: Frank Verhoeven, Xavier Guillot, Mickaël Chouk, Clément Prati, Daniel Wendling
Journal: Case Rep Rheumatol (2016)

Introduction. Polymyalgia rheumatica (PMR) is one of the most common inflammatory rheumatism types in elderly population. The link between cancer and PMR is a matter of debate. Methods. We report two cases of PMR leading to the diagnosis of lymphoma and the growing interest of PET-TDM in this indication. Results. A 84-year-old man known for idiopathic neutropenia presented an inflammatory arthromyalgia of the limb girdle since one month. Blood exams highlighted the presence of a monoclonal B cell clone. Bone marrow concluded to a B cell lymphoma of the marginal zone. He was successfully treated with 0.3 mg/kg/d of prednisone, and response was sustained after 6 months. A 73-year-old man known for prostatic neoplasia in remission for 5 years presented arthromyalgia of the limb girdle since one month. PET-CT revealed bursitis of the hips and the shoulders, no prostatic cancer recurrence, and a metabolically active iliac lymphadenopathy whose pathologic exam concluded to a low grade follicular lymphoma. He was successfully treated with 0.3 mg/kg/d of prednisone. Conclusion. These observations may imply that lymphoma is sometimes already present when PMR is diagnosed and PET-CT is a useful tool in the initial assessment of PMR to avoid missing neoplasia.
Subdural Hygroma: A Morbid Complication of Intrathecal Chemotherapy in a Patient with B-Cell Acute Lymphocytic Leukemia
Authors: Mina Shenouda, Madhulika Urella, Jennifer Dotson, Hassaan Yasin, Yehuda Lebowicz
Journal: Case Rep Hematol (2019)
MeSH terms: Case Reports

A subdural hygroma is an accumulation of cerebrospinal fluid in the subdural space that may occur secondary to trauma and surgery, or for iatrogenic reasons, such as a lumbar puncture. Lumbar puncture is a procedure used commonly for intrathecal chemotherapy for patients with B-cell acute lymphocytic leukemia (B-ALL) though subdural hygroma is a very rare complication. We present a case of a fatal, refractory subdural hygroma in a patient with B-ALL.
Case report: Strong low-density-cholesterol reduction accompanied by shrinkage of low-attenuation coronary plaque during lipid-lowering treatment with bempedoic acid-serial evaluation by coronary computed tomography angiography
Authors: Grigorios Korosoglou, Alexander Giesen, Eva Geiss, Ksenija Stach
Journal: Front Cardiovasc Med (2023)
Keywords: bempedoic acid, coronary artery disease, hyperlipidemia, non-calcified plaque, statin intolerance
MeSH terms: Case Reports

Here, we present a patient with coronary artery disease and prior percutaneous coronary interventions. This patient had to discontinue taking multiple statins and ezetimibe due to intolerance with musculoskeletal complaints and nausea. Monotherapy with bempedoic acid was well tolerated and was exceptionally effective at lipid lowering, enabling patients to achieve the low-density lipoprotein target of <55 mg/dl, as recommended by current guidelines. In addition, serial coronary computed tomography angiography performed upon clinical indications, during 20 months of lipid-lowering treatment with bempedoic acid, demonstrated signs of favorable plaque component modification, with shrinkage of the low-attenuation plaque component compared to baseline findings.
Clear Cell Sarcoma: A Case Report and Review of Literature
Authors: Alireza Abdollahi, Fatemeh Khatami, Seyed Mohammad Tavangar
Journal: Int J Hematol Oncol Stem Cell Res (2018)
Keywords: clear cell sarcoma, malignant melanoma, melanoma of soft part, soft tissues
MeSH terms: Case Reports

Clear cell sarcoma (CCS), a deep-rooted tumor with a predilection for lower extremities, has a proclivity to involve the tendons and aponeuroses. This sarcoma is seen predominantly around the foot and ankle region. Diagnosis is mainly finalized using histological and immunohistochemical assessment. The main treatment strategy is surgery followed by chemotherapy. An erratic challenge is posed by histological similarity and immunohistochemical overlap to the diagnosis and distinguishing of clear cell sarcoma from primary or metastatic malignant melanoma (MM) which is more common. Here, we described a CCS case located in the left leg of a 37-year-old male patient.
Spontaneous Rupture of Pyometra in a Nonpregnant Young Woman
Authors: Parvin Mostafa-Gharabaghi, Shima Bordbar, Shabnam Vazifekhah, Mohammad Naghavi-Behzad
Journal: Case Rep Obstet Gynecol (2017)
MeSH terms: Case Reports

A 40-year-old woman presented with severe vaginal bleeding. Initial workup with an abdominal sonography revealed endometrium for about 3 mm and free fluid in the abdomen. Hemodynamic instability with abdominal pain and free fluid in the abdomen prompted blood transfusion and laparotomy. There were about 1000 cc blood and clots in the abdomen at laparotomy. There was a longitudinal rupture from fundus up to cervix at the left side of the uterus. Tearing was in full thickness from serosa to endometrium. Scar of previous cesarean was transvers and not associated with this tearing. There was not any myomectomy scar.
A sequentially metastatic gastric and jejunal cancer originating from colon cancer: A case report
Authors: Woo Yong Lee, Hye Kyeon Lee
Journal: Int J Surg Case Rep (2020)
Keywords: blind loop of roun-en-y anastomosis, metastatic gastric and jejunal cancer, primary colon cancer
MeSH terms: Case Reports

Introduction:
Metastatic intraluminal cancer arising from gastrointestinal tract cancer is very rare. In this report, we describe a case of an 82-year-old man with sequentially metastatic gastric and jejunal cancer originating from primary colon cancer.
Presentation of case:
An 82-year-old Korean male patient with a history of right colon cancer was initially treated with extended right hemicolectomy. The tumour was classified as pT3N0M0 and stage II. After nine months, a gastroscopy revealed an infiltrating ulcerative mass in the cardia of the stomach, a colonoscopy revealed no specific findings in the previous operation site, and a positron emission tomography-computed tomography scan revealed no distant metastasis. The patient underwent radical total gastrectomy, and the final pathologic diagnosis was T3N2M0, stage IIIA. During follow-up without chemotherapy, a gastroscopy revealed tumours in the blind jejunal loop of Roux-en-Y anastomosis, and an endoscopic biopsy confirmed adenocarcinoma. The patient then underwent segmental resection of the blind loop jejunal cancer. Finally, further pathological examination of the resected specimen confirmed that the lesion represented a sequentially metastatic gastric and jejunal cancer originating from colon cancer.
Discussion:
The exact mechanism of intraluminal metastasis of gastrointestinal tract cancer is not known. Immunohistochemical staining might prove useful in sequentially metastatic cases when a differential diagnosis must be assessed on consecutive biopsies.
Conclusion:
Although intraluminal metastasis of gastrointestinal tract cancer is very rare, researchers should be aware of this uncommon intraluminal metastasis.
Superior Patellar Dislocation Misdiagnosed as Patellar Tendon Rupture: The Value of Ultrasonography
Authors: Artit Boonrod, Sermsak Sumanont, Manusak Boonard, Arunnit Boonrod
Journal: Case Rep Orthop (2016)
MeSH terms: Case Reports

Superior dislocation of the patella with intact patellar tendon is a rare condition. Most cases in literatures were diagnosed by clinical examination and plain radiography; however there are many cases that were misdiagnosed as patellar tendon rupture. In this case, we demonstrate the use of ultrasound for diagnosis of superior dislocation of the patella in the emergency department. We also include a literature review of similar cases and discuss the advantages of different types of imaging for diagnosis in this condition.
Intracochlear drug delivery in combination with cochlear implants : Current aspects
Authors: S K Plontke, G Götze, T Rahne, A Liebau
Journal: HNO (2017)
Keywords: cochlea, cochlear implant, drug delivery, impedance, inner ear
MeSH terms: Cochlear Implantation / trends, Cochlear Implants / trends, Labyrinth Diseases / prevention & control, Neuroprotective Agents / administration & dosage, Postoperative Complications / prevention & control, Premedication / trends, Evaluation Study, Review, Cochlea / drug effects, Cochlear Implants / adverse effects, Combined Modality Therapy / adverse effects, Combined Modality Therapy / methods, Evidence-Based Medicine, Humans, Labyrinth Diseases / etiology, Treatment Outcome, Neuroprotective Agents

Local drug application to the inner ear offers a number of advantages over systemic delivery. Local drug therapy currently encompasses extracochlear administration (i. e., through intratympanic injection), intracochlear administration (particularly for gene and stem cell therapy), as well as various combinations with auditory neurosensory prostheses, either evaluated in preclinical or clinical studies, or off-label. To improve rehabilitation with cochlear implants (CI), one focus is the development of drug-releasing electrode carriers, e. g., for delivery of glucocorticosteroids, antiapoptotic substances, or neurotrophins to the inner ear. The performance of cochlear implants may thus be improved by protecting neuronal structures from insertion trauma, reducing fibrosis in the inner ear, and by stimulating growth of neuronal structures in the direction of the electrodes. Controlled drug release after extracochlear or intracochlear application in conjunction with a CI can also be achieved by use of a biocompatible, resorbable controlled-release drug-delivery system. Two case reports for intracochlear controlled release drug delivery in combination with cochlear implants are presented. In order to treat progressive reduction in speech discrimination and increased impedance, two cochlear implant patients successfully underwent intracochlear placement of a biocompatible, resorbable drug-delivery system for controlled release of dexamethasone. The drug levels reached in inner ear fluids after different types of local drug application strategies can be calculated using a computer model. The intracochlear drug concentrations calculated in this way were compared for different dexamethasone application strategies.
Isolated hydatid cyst in a single moiety of an incomplete duplex kidney
Authors: Vinod Priyadarshi, Shwetank Mishra, Malay Kumar Bera, Dilip Kumar Pal
Journal: APSP J Case Rep (2015)
Keywords: duplex kidney, echinococcosis, hydatid cyst
MeSH terms: Case Reports

Isolated hydatid cyst of kidney is very rare. Hydatid cyst of a duplex renal system is even more rare. We report a 13-year old girl with duplex system of right kidney with isolated hydatid cyst in upper moiety. Right nephrectomy was done to cure the condition.
Expansion, mosaicism and interruption: mechanisms of the CAG repeat mutation in spinocerebellar ataxia type 1
Authors: Cara Kraus-Perrotta, Sarita Lagalwar
Journal: Cerebellum Ataxias (2016)
MeSH terms: Review

Spinocerebellar ataxia type 1 (SCA1) is an autosomal dominant neurodegenerative disorder that primarily affects the cerebellum and brainstem. The genetic mutation is an expansion of CAG trinucleotide repeats within the coding region of the ataxin-1 gene, characterizing SCA1 as a polyglutamine expansion disease like Huntington's. As with most polyglutamine expansion diseases, SCA1 follows the rules of genetic anticipation: the larger the expansion, the earlier and more rapid the symptoms. Unlike the majority of polyglutamine expansion diseases, the presence of histidine interruptions within the polyglutamine tract of ataxin-1 protein can prevent or mitigate disease. The present review aims to synthesize three decades of research on the ataxin-1 polyglutamine expansion mutation that causes SCA1. Data from genetic population studies and case studies is gathered along with data from manipulation studies in animal models. Specifically, we examine the molecular mechanisms that cause tract expansions and contractions, the molecular pathways that confer instability of tract length in gametic and somatic cells resulting in gametic and somatic mosaicism, the influence of maternal or paternal factors in inheritance of the expanded allele, and the effects of CAT/histidine interruptions to the ataxin-1 allele and protein product. Our review of existing data supports the following conclusions. First, polyCAG expansion of gametic alleles occur due to the failure of gap repair mechanisms for single or double strand breaks during the transition from an immature haploid spermatid to a mature haploid sperm cell. Equivalent failures were not detected in female gametic cells. Second, polyCAG expansion of somatic alleles occur due to hairpins formed on Okazaki fragments and slipped strand structures due to failures in mismatch repair and transcription-coupled nucleotide excision repair mechanisms. Third, CAT trinucleotide interruptions, which code for histidines in the translated protein, attenuate the formation of slipped strand structures which may protect the allele from the occurrence of large expansions. Many of the mechanisms of expansion identified in this review differ from those noted in Huntington's disease indicating that gene -or sequence-specific factors may affect the behavior of the polyCAG/glutamine tract. Therefore, synthesis and review of research from the SCA1 field is valuable for future clinical and diagnostic work in the treatment and prevention of SCA1.
Significant Neutrophilic Emperipolesis in Squamous Cell Carcinoma
Authors: Seza Tetikkurt, Faruk Taş, Funda Emre, Şule Özsoy, Zeki Tolga Bilece
Journal: Case Rep Oncol Med (2018)
MeSH terms: Case Reports

A 53-year-old man was admitted for tooth mobility. A mass was identified at the tooth base by CT. Histopathology of the excisional biopsy revealed a moderately differentiated squamous cell carcinoma. Many intact neutrophils were observed within the malignant cell cytoplasm. The patient underwent partial maxillectomy and bilateral neck dissection. Significant neutrophilic emperipolesis was detected in the resected material. Four tumor recurrences developed in the head and neck region during follow-up. Surgery and chemoradiotherapy was performed. The latest tumor recurrence occurred in the peripharyngeal and the posterior parotideal region. The patient was started on pembrolizumab therapy and nearly complete treatment response occurred. Pembrolizumab was discontinued due to the adrenal insufficiency and pulmonary tuberculosis that developed as a treatment side effect. Pembrolizumab was commenced again when tumor recurrence occurred. The patient is currently alive with ongoing pembrolizumab and antituberculous treatment. We present this case to remark the presence of a significant neutrophilic emperipolesis in the squamous cell carcinoma of the hard palate and maxilla which is rarely encountered. Emperipolesis may predict tumor behavior and the consequences of immune-modulating treatment response in squamous cell carcinomas of the head and neck in regard to the findings of our case.
Case Report: Multi-Omics Analysis and CAR-T Treatment of a Chronic Myeloid Leukemia Blast Crisis Case 5 Years After the Discontinuation of TKI
Authors: Ya-Ru Miao, Wen Liu, Zhaodong Zhong, Yong You, Yutong Tang, Weiming Li, Xiaojian Zhu, An-Yuan Guo
Journal: Front Oncol (2021)
Keywords: car-t, tgf-β, blast crisis, discontinuation, single-cell sequencing
MeSH terms: Case Reports

Most relapsed chronic myeloid leukemia (CML) patients after tyrosine kinase inhibitor (TKI) discontinuation are in a chronic phase and could achieve remission through restarting the TKI treatment. Here we reported a case of sudden lymphoid blast crisis after 67 months of TKI discontinuation and depicted the patient by DNA and RNA sequencing to investigate intrinsic molecular features. The mutations of TGFBR2 and PCNT and the dysregulations of TGF-β and other pathways might accelerate the B cell transformation, which may serve as a blast crisis risk indicator of CML. Single-cell transcriptome data revealed that several clusters of immature B cells and late pro-B cells presented clone evolution during the treatment. After failing multiple lines of TKIs, conditioning chemotherapies and chimeric antigen receptor T cells (CAR-T) targeting CD19 and CD22 were performed to achieve remission. In conclusion, we report the first case of a CML patient with sudden lymphoid blast crisis after a long treatment-free remission and additional gene abnormalities other than BCR-ABL1 might participate in the progression, which need to be closely monitored, and CAR-T could be a solution to the chemoresistant progression.
When the Benign Pneumatosis Intestinalis Becomes No Longer Benign: A Rare Case of Bowel Perforation in a Patient with Systemic Sclerosis
Authors: Jian Guan, Alvina Munaf, Alric V Simmonds, Irteza Inayat
Journal: Case Rep Gastrointest Med (2018)
MeSH terms: Case Reports

Systemic sclerosis is a multisystem disease featured with autoimmunity and organ fibrosis. Although gastrointestinal (GI) tract involvement is common in patients with systemic sclerosis, colonic perforation is extremely rare. Benign pneumatosis intestinalis, a phenomenon more frequently seen in rheumatologic conditions, makes the diagnosis of colonic perforation even more challenging. We report a unique case of colonic perforation in a patient with chronic systemic sclerosis. This patient initially presented with mild abdominal pain and hematemesis. Urgent upper endoscopy was unremarkable and radiology showed stable pneumatosis intestinalis. Due to worsening abdominal pain, laparotomy exploration was performed and colonic perforation with transmural ischemic necrosis was found.
First Report of Nocardia asiatica Presenting as an Anterior Mediastinal Mass in a Patient with Myasthenia Gravis: A Case Report and Review of the Literature
Authors: Rima I El-Herte, Souha S Kanj, George F Araj, Hassan Chami, Walid Gharzuddine
Journal: Case Rep Infect Dis (2012)

The spectrum of infections with Nocardia spp. is heterogeneous. It has classically been associated with lung, brain, or skin involvement. We describe an unusual presentation of Nocardia asiatica (N. asiatica) in an Iraqi patient with myasthenia gravis suffering from a disseminated infection and presenting with an anterior mediastinal cystic mass. N. asiatica has only been three times described outside Japan and Thailand, and the rarity of this entity deserves this communication.
Is It T3 Thyrotoxicosis? A Case of Falsely Elevated Tri-Iodothyronine (T3) Levels Leading to a Diagnosis of Multiple Myeloma
Authors: Nanik Ram, Saira Furqan, Sibtain Ahmed
Journal: Case Rep Endocrinol (2019)
MeSH terms: Case Reports

We are presenting a case of falsely elevated T3 levels in a patient due to interference from monoclonal immunoglobulins. A 56-year-old, clinically euthyroid man referred to the endocrinology clinic of the Aga Khan university, Karachi Pakistan, for possible T3 thyrotoxicosis after thyroid function tests revealed total T3 >12.32 nmol/L (reference range 0.6-2.79), normal TSH, and total T4 level. There was a mismatch in clinical and laboratory parameters and preliminary laboratory results were suggestive of thyroid binding globulin abnormalities. Further evaluation in this context unmasked multiple myeloma. The presence of monoclonal immunoglobulins can lead to assay interference and spurious results. To the best of our knowledge, this is the second case defining the cause of falsely elevated T3 levels, due to assay interferences with binding of T3 only to monoclonal immunoglobulins.
Neoadjuvant immunotherapy combined with chemotherapy for locally advanced squamous cell lung carcinoma: A case report and literature review
Authors: Yuan Zheng, Wei Zhu, Xinjie Huang, Dongqun Lin, Yu Lin
Journal: Open Life Sci (2021)
Keywords: case report, chemotherapy, durvalumab, locally advanced resectable nsclc, neoadjuvant immunotherapy
MeSH terms: Case Reports

The benefit of immunochemotherapy in treating resectable locally advanced non-small cell lung cancer (NSCLC) is not well established. Here, we report a case of resectable stage III NSCLC treated with neoadjuvant immunotherapy combined with chemotherapy before surgery. A 61 years old man was admitted to our hospital due to paroxysmal cough and was diagnosed as squamous cell carcinoma T4N2M0 in the upper lobe of the right lung, which was locally advanced and resectable. He was treated with 3 courses of paclitaxel 250 mg intravenous (IV), carboplatin 0.65 g IV, and durvalumab 620 mg IV followed by thoracoscopic upper lobectomy and lymph node dissection. There was considerable regression of the tumor before surgery, and the patient achieved a complete pathological response after surgery. Our case study demonstrates the benefit of durvalumab and chemotherapy in the treatment of resectable locally advanced NSCLC.
Targeted Sequencing and RNA Assay Reveal a Noncanonical JAG1 Splicing Variant Causing Alagille Syndrome
Authors: Yiyao Chen, Xueli Liu, Songchang Chen, Junyu Zhang, Chenming Xu
Journal: Front Genet (2020)
Keywords: alagille syndrome, jag1, rna assay, prenatal diagnosis, targeted sequencing
MeSH terms: Case Reports

Alagille syndrome (ALGS), as known as congenital arteriohepatic dysplasia, is a rare autosomal dominant multi-systemic disorder. Mutations in JAG1 or more rarely NOTCH2 have been reported as the cause of ALGS. In this study, a 5-year old girl with typical ALGS feature and her pregnant mother came to our reproductive genetics clinic for counseling. We aimed to clarify the genetic diagnosis and provide prenatal genetic diagnosis for the pregnant. Next generation sequencing (NGS)-based multigene panel was used to identify pathogenic variant of the proband. Then the candidate variant was verified by using Sanger sequencing. RNA assay was performed to clarify splicing effect of the candidate variant. Amniocentesis, karyotyping, and Sanger sequencing were performed for prenatal testing. We found a novel de novo noncanonical JAG1 splicing variant (c.2917-8C > A) in the proband. Peripheral blood RNA assay suggested that the mutant transcript might escape nonsense-mediated messenger RNA (mRNA) decay (NMD) and encode a C-terminal truncated protein. Information of the variant has resulted in a successful prenatal diagnosis of the fetus. Our results clarified the genetic diagnosis of an ALGS patient and ensured utility of prenatal genetic testing.
The first evidence of lyme neuroborreliosis in southern bosnia and herzegovina
Authors: Jurica Arapovic, Sinisa Skocibusic, Svjetlana Grgic, Jadranka Nikolic
Journal: Case Rep Infect Dis (2014)

Lyme borreliosis (LB) is caused by the spirochete Borrelia burgdorferi, which is transmitted to humans by ticks of the Ixodes ricinus complex. It is manifested by a variety of clinical symptoms and affects skin, joints, heart, and nervous system. Neurological manifestations are predictable and usually include meningoencephalitis, facial palsy, or radiculopathy. Recently, a dramatic rise in the number of diagnosed cases of LB has been observed on the global level. Here we show the first case of Lyme neuroborreliosis in southern Bosnia and Herzegovina, which was first presented by erythema chronicum migrans. Unfortunately, it was not recognized or well treated at the primary care medicine. After eight weeks, the patient experienced headache, right facial palsy, and lumbar radiculopathy. After the clinical examination, the neurologist suspected meningoencephalitis and the patient was directed to the Clinic for Infectious Disease of the University Hospital Mostar, where he was admitted. The successful antimicrobial treatment with the 21-day course of ceftriaxone was followed by normalization of neurological status, and then he was discharged from the hospital. This case report represents an alert to all physicians to be aware that LB is present in all parts of Bosnia and Herzegovina, as well as in the neighboring regions.