OpenMed/multicare-articles huggingface dataset:
Case Report: Addition of PD-1 Antibody Camrelizumab Overcame Resistance to Trastuzumab Plus Chemotherapy in a HER2-Positive, Metastatic Gallbladder Cancer Patient
Authors: Li Wang, Xiaomo Li, Yurong Cheng, Jing Yang, Si Liu, Tonghui Ma, Li Luo, Yanping Hu, Yi Cai, Dong Yan
Journal: Front Immunol (2022)
Keywords: her2 amplification, camrelizumab, case report, combination immunotherapy, gallbladder cancer, irae, trastuzumab resistance
MeSH terms: Antibodies, Monoclonal, Humanized / administration & dosage, Drug Resistance, Neoplasm / drug effects, Gallbladder Neoplasms / drug therapy, Gallbladder Neoplasms / enzymology, Gallbladder Neoplasms / pathology, Receptor, ErbB-2 / antagonists & inhibitors, Trastuzumab / administration & dosage, Case Reports, Aged, Humans, Male, Neoplasm Metastasis, Antibodies, Monoclonal, Humanized, camrelizumab, ERBB2 protein, human, Receptor, ErbB-2, Trastuzumab

HER2 amplification/overexpression is a common driver in a variety of cancers including gallbladder cancer (GBC). For patients with metastatic GBC, chemotherapy remains the standard of care with limited efficacy. The combination of HER2 antibody trastuzumab plus chemotherapy is the frontline treatment option for patients with HER2-positive breast cancer and gastric cancer. Recently, this regime also showed antitumor activity in HER2-positive GBC. However, resistance to this regime represents a clinical challenge. Camrelizumab is a novel PD-1 antibody approved for Hodgkin lymphoma and hepatocellular carcinoma in China. In this study, we presented a HER2-positive metastatic GBC patient who was refractory to trastuzumab plus chemotherapy but experienced significant clinical benefit after the addition of camrelizumab. Our case highlights the potential of immunotherapy in combination with HER2-targeted therapy in HER2-positive GBC. We also demonstrated that two immune-related adverse events (irAEs) associated with camrelizumab can be managed with an anti-VEGF agent apatinib. This case not only highlights the importance of irAE management in patients treated with camrelizumab, but also demonstrates the potential of PD-1 antibody plus trastuzumab in HER2-positive GBC patients who have developed resistance to chemotherapy and trastuzumab-based targeted therapy.
Scrotal Involvement with Testicular Nonseminomatous Germ Cell Tumour
Authors: C G O'Leary, J A Allen, F O'Brien, A Tuthill, D G Power
Journal: Case Rep Oncol Med (2016)

A 37-year-old male presented with a traumatic injury to the scrotal region necessitating emergency surgery. Evacuation of a haematoma and bilateral orchidectomy were performed. A left sided nonseminomatous germ cell tumour (NSGCT), predominantly yolk sac, was identified. Microscopic margins were positive for tumour. Initial tumour markers revealed an AFP of 22,854 ng/mL, HCG of <1 mIU/mL, and LDH of 463 IU/L. Eight weeks after surgery, AFP levels remained elevated at 11,646 ng/mL. Computed tomography (CT) scanning demonstrated left inguinal adenopathy, 1.5 cm in max dimension. On review, extensive evidence of scrotal involvement was evident. His tumour was staged as stage IIIC, poor risk NSGCT. He was treated with 4 cycles of bleomycin, etoposide, and cisplatin over a 12-week period. His tumour markers normalised after 3 cycles. There was a marked improvement noted clinically. Follow-up CT scans demonstrated complete resolution of his tumour. He later underwent further surgery to remove a small amount of remaining spermatic cord. Histology revealed no malignant tissue. The patient suffered many complications including testosterone deficiency, osteopenia, infertility, and psychological distress. Discussion. A small proportion of testicular cancer may present in an atypical manner. The scrotum and testicle have markedly different embryonic origins and therefore a distinct anatomic separation. As a result the scrotum is not a typical site of spread of testicular cancer. Case reports have been described that were managed in a similar manner with good outcomes. Therefore, even with significant scrotal involvement, if timely and appropriate treatment is administered, complete resolution of the tumour may be achieved.
Case report: Conquer a complex variant: Coronary-pulmonary artery fistulas, atrial septal defect and bicuspid pulmonary valve, under beating heart surgery
Authors: Ting Zhou, Chaobing Liu, Songlin Zhang
Journal: Front Cardiovasc Med (2022)
Keywords: asd, cpaf, bicuspid pulmonary valve, moderate tricuspid regurgitation, on-pump beating heart surgery
MeSH terms: Case Reports

Coronary artery to pulmonary artery fistula (CPAF) is a congenital or acquired abnormal channel between arteries, with a left-to-right cardiac shunting, which may lead to myocardial ischemia, arrhythmia, thrombotic complications, and heart failure. CPAF is usually detected by coronary angiography but few reports have used beating-heart surgery as a detection method. The patient in this case report is a 39-year-old male diagnosed with atrial septal defect (ASD), bicuspid pulmonary valve, and moderate tricuspid regurgitation (TR). He is asymptomatic. In preoperative evaluation, significant CPAF was suspected using echocardiography. The patient refused coronary angiography due to allergic history. Therefore, the cardiac team designed and performed on-pump beating-heart surgery (OPBHS) to detect and repair these disorders, and suggested OPBHS as a myocardial protection strategy for the patient at low surgical risk. A rare and complex cardiovascular case with CPAFs from two branches of the left anterior descending coronary (LAD) artery to the main pulmonary artery (MPA) with ASD, bicuspid pulmonary valve, and moderate TR has not yet been reported in the literature, and its embryological hypothesis has been further analyzed in this report.
Sugammadex and reversal of neuromuscular block in adult patient with duchenne muscular dystrophy
Authors: Ahmed Abdelgawwad Wefki Abdelgawwad Shousha, Maria Sanfilippo, Antonio Sabba, Paolo Pinchera
Journal: Case Rep Anesthesiol (2014)

Duchenne's muscular dystrophy (DMD) is the most common and severe form of myopathy. Patients with DMD are more sensitive to sedative, anesthetic, and neuromuscular blocking agents which may result in intraoperative and early postoperative cardiovascular and respiratory complications, as well as prolonged recovery from anesthesia. In this case report, we describe a 25-year-old male patient admitted for cholecystectomy under general anesthesia. We induced our anesthesia by oxygen, propofol, fentanyl, and rocuronium bromide. Maintenance was done by fentanyl, rocuronium bromide, sevoflurane, and O2. We report in this case the safety use of sugammadex to antagonize the neuromuscular block and rapid recovery in such category of patients.
Delayed Radial Nerve Palsy after Closed Reduction of a Pediatric Humeral Shaft Fracture
Authors: Robert Runner, Emily Whicker, Sayan De
Journal: Case Rep Orthop (2017)
MeSH terms: Case Reports

Humeral shaft fractures are common in the United States and may be associated with radial nerve injuries due to their close anatomic relationship in the spiral groove. Most radial nerve palsies are found at presentation due to the initial trauma; however, they can present secondary to orthopaedic intervention following reduction. In this case report, we present a case of delayed radial nerve palsy in a pediatric patient that was identified four days after closed reduction and splinting which required open reduction, nerve exploration, and internal fixation. Fortunately, full motor and sensory recovery was observed at 6 weeks post-op. A unique aspect of this case is that immediate postreduction exam in the emergency department showed no signs of injury or entrapment of the radial nerve.
Chromobacterium violaceum in siblings, Brazil
Authors: Isadora Cristina de Siqueira, Juarez Dias, Hilda Ruf, Eduardo Antonio G Ramos, Elves Anderson Pires Maciel, Ana Rolim, Laura Labur, Luciana Vasconcelos, Célia Silvany
Journal: Emerg Infect Dis (2005)
MeSH terms: Bacterial Infections / physiopathology, Chromobacterium / pathogenicity, Water Microbiology, Case Reports, Adolescent, Bacterial Infections / etiology, Brazil, Child, Chromobacterium / isolation & purification, Fatal Outcome, Humans, Male, Siblings

Chromobacterium violaceum, a saprophyte bacterium found commonly in soil and water in tropical and subtropical climates, is a rare cause of severe, often fatal, human disease. We report 1 confirmed and 2 suspected cases of C. violaceum septicemia, with 2 fatalities, in siblings after recreational exposure in northeastern Brazil.
Multifocal C-cell Hyperplasia and Marked Hypercalcitoninemia in a Diabetic Patient Treated With Glucagon-Like Peptide-1 Agonist With Concurrent Multinodular Goiter and Hyperparathyroidism
Authors: Sifan Zou, Alexandria D McDow, Zeb Saeed, Tieying Hou
Journal: Cureus (2023)
Keywords: c cell hyperplasia, calcitonin, glucagon-like peptide-1 receptor agonists, hyperparathyroidism, medullary thyroid carcinoma
MeSH terms: Case Reports

Thyroid C-cell hyperplasia (CCH) is divided into physiologic or reactive CCH and neoplastic CCH. Glucagon-like peptide-1 receptor agonists (GLP-1 Ra) is a group of medications used to treat type 2 diabetes that has documented C-cell stimulation effect in rodents, leading to subsequent CCH and medullary thyroid carcinoma (MTC) in rats and/or mice. Currently, there is no sufficient evidence supporting the association between GLP-1 Ra and human thyroid CCH and/or MTC. Here, we present a case of significant hypercalcitoninemia in a 53-year-old diabetic male patient receiving GLP-1 Ra treatment with concurrent multinodular goiter and hyperparathyroidism. Total thyroidectomy and central neck dissection revealed multifocal CCH involving bilateral thyroid lobes and several negative lymph nodes. Subsequent genetic testing did not detect germline mutation of RET gene. However, due to marked hypercalcitoninemia and massive thyromegaly, unsampled medullary thyroid microcarcinoma cannot be completely ruled out. The patient's postsurgical calcitonin level was back to normal. Our case indicates the significant clinical value of monitoring serum calcitonin levels in patients receiving GLP-1 Ra, especially in presence of other thyroid and/or parathyroid pathology that may be associated with increased calcitonin and/or CCH. Literature regarding the association between GLP-1 Ra and CCH is also reviewed.
Persistently erected penis in a child for 6 months: A management dilemma
Authors: Sukanta Das, Dipak Ghosh, Akhilesh Agarwal, Suranjan Haldar
Journal: J Indian Assoc Pediatr Surg (2008)
Keywords: malignancy idiopathic, priapism
MeSH terms: Case Reports

Priapism is the presence of a persistent, usually painful, erection of the penis unrelated to sexual stimulation or desire. It is a true emergency requiring urgent intervention. Priapism is frequently idiopathic in etiology, but it is associated with a number of important medical conditions and pharmacologic agents. Cases have been reported in world literature on children having priapism, the etiology of these cases are mostly hematological. Our case is a child having persistently erected penis for more than 6 months. Despite a thorough search, no report of similar case could be found in world literature.
A novel mutation (p.Glu1389AspfsX16) of the phosphoinositide kinase, FYVE finger containing gene found in a Japanese patient with fleck corneal dystrophy
Authors: Satoshi Kawasaki, Kenta Yamasaki, Hiroko Nakagawa, Katsuhiko Shinomiya, Mina Nakatsukasa, Yoshihide Nakai, Shigeru Kinoshita
Journal: Mol Vis (2012)
MeSH terms: Asian People, Cornea / metabolism, Corneal Dystrophies, Hereditary / genetics, Mutation, Phosphatidylinositol 3-Kinases / genetics, Case Reports, Research Support, Non-U.S. Gov't, Base Sequence, Cornea / pathology, Corneal Dystrophies, Hereditary / pathology, DNA Mutational Analysis, Exons, Female, Humans, Middle Aged, Molecular Sequence Data, Phenotype, Polymorphism, Restriction Fragment Length, PIKFYVE protein, human, Corneal Dystrophy, Fleck

Purpose:
The phosphoinositide kinase, FYVE finger containing (PIKFYVE) gene has been identified as a gene responsible for fleck corneal dystrophy (FCD). The purpose of this study is to report a novel mutation of the PIKFYVE gene in a Japanese patient with fleck corneal dystrophy.
Methods:
Slit-lamp microscopy, corneal topography, and optical coherence tomography were performed for the clinical examination of the patient's eye. For genetic analysis, peripheral blood was obtained from the patient and her sister. DNA was extracted from the blood and subjected to mutation analysis by sequencing of the PIKFYVE gene. The sequencing results were validated with a PCR-fragment length polymorphism analysis.
Results:
A 63-year-old woman presented at our clinic with complaints of decreased vision and metamorphopsia in her right eye occurring 1 month before presentation. Both eyes exhibited small, dot-like, white flecks scattered throughout all layers of the corneal stroma, which corresponds to the typical FCD phenotype. The opacities were relatively dominant at the peripheral region of the cornea, yet were found throughout the entire cornea. Sequence analysis revealed that the patient has a heterozygous c.4166_4169delAAGT mutation located at exon 24 of the PIKFYVE gene that may cause p.Glu1389AspfsX16 flame-shift mutation, which has never before been reported for FCD.
Conclusions:
To the best of our knowledge, this is the first study to show that a novel mutation (p.Glu1389AspfsX16) causing the truncation of the PIKFYVE protein causes fleck corneal dystrophy in the Japanese population.
Case Report: Novel Dietary Supplementation Associated With Kidney Recovery and Reduction in Proteinuria in a Dialysis Dependent Patient Secondary to Steroid Resistant Minimal Change Disease
Authors: Rasheed A Gbadegesin, Loren P Herrera Hernandez, Patrick D Brophy
Journal: Front Pediatr (2021)
Keywords: antioxidants, glycocalyx, kidney disease, minimal change disease, nephrotic syndrome
MeSH terms: Case Reports

Minimal change disease (MCD) is the most common cause of nephrotic syndrome worldwide. For decades, the foundation of the treatment has been corticosteroids. However, relapse rate is high and up to 40% of patients develop frequent relapsing/steroid dependent course and one third become steroid resistant. This requires treatment with repeated courses of corticosteroids, and second and third line immunomodulators increasing the incidence of drug related adverse effects. More recently, there have been reports of a very small subset of Nephrotic Syndrome (NS) patients who are initially steroid sensitive and later become secondarily steroid resistant. The disease course in this small subset is often protracted leading ultimately to end stage kidney disease requiring dialysis or kidney transplantation. Unfortunately, patients with this disease course do not do well post transplantation because 80% of them will develop disease recurrence that will ultimately lead to graft failure. Few approaches have been tried over many years to reduce the frequency of relapses, and steroid dependence and there is absolutely no therapeutic intervention for patients who develop secondary steroid resistance. Nonetheless, their therapeutic index is low, evidencing the need of a safer complementary treatment. Several hypotheses, including an oxidative stress-mediated mechanism, and immune dysregulation have been proposed to date to explain the underlying mechanism of Minimal Change Disease (MCD) but its specific etiology remains elusive. Here, we report a case of a 54-year-old man with steroid and cyclosporine resistant MCD. The patient rapidly progressed to end stage kidney disease requiring initiation of chronic dialysis. Intradialytic parenteral nutrition (IDPN), albumin infusion along with a proprietary dietary supplement, as part of the supportive therapy, led to kidney function recovery and complete remission of MCD without relapses.
The anterolateral approach to the proximal humerus for nonunions and delayed unions
Authors: Carolyn M Hettrich, Omesh Paul, Andrew S Neviaser, Emily A Borsting, Dean G Lorich
Journal: Int J Shoulder Surg (2011)
Keywords: nonunion, proximal third humerus fractures
MeSH terms: Case Reports

Nonunions of proximal humerus fractures can be disabling as a result of pain, deformity and instability, and are often found in geriatric patients with poor bone quality. There are relatively few studies examining the treatment of nonunions of the proximal third of the humerus and the ideal treatment and surgical approach remains unclear. This case series reports the successful use of the anterolateral acromial approach for treatment of the symptomatic proximal third humerus nonunions in a geriatric group of patients with clear challenges as a result of patient comorbidities and bone quality.
Case Report: Maintenance Nivolumab in Complete Responder After Multimodality Therapy in Metastatic Pancreatic Adenocarcinoma
Authors: Shih-Hung Yang, Jen-Chieh Lee, Bang-Bin Chen, Sung-Hsin Kuo, Chiun Hsu, Li-Yuan Bai
Journal: Front Immunol (2022)
Keywords: case report, chemotherapy, maintenance therapy, nivolumab, pancreatic ductal adenocarcinoma
MeSH terms: Adenocarcinoma / drug therapy, Adenocarcinoma / secondary, Carcinoma, Pancreatic Ductal / drug therapy, Pancreatic Neoplasms / drug therapy, Pancreatic Neoplasms / pathology, Case Reports, Research Support, Non-U.S. Gov't, Humans, Male, Middle Aged, Nivolumab / adverse effects, Nivolumab, Pancreatic Carcinoma

Maintenance therapy is rarely considered in pancreatic ductal adenocarcinoma (PDAC). We describe the case of a 57-year-old man with metastatic PDAC treated with an initially full but subsequently de-escalated dose of combination chemotherapy due to intolerance to neurotoxicity. After a complete response to combined radiofrequency ablation for the liver metastasis and radiotherapy for the pancreatic tumor was achieved, chemotherapy was terminated and maintenance therapy was applied: nivolumab plus cytokine-induced killer cell therapy initially and then a de-escalated dosing interval of nivolumab monotherapy subsequently. No adverse events occurred during nivolumab therapy for more than 2 years, and the patient remains disease-free. To date, this is the first report of maintenance nivolumab after successful multimodality therapy in metastatic PDAC.
Proton Pump Inhibitor-Induced Galactorrhea in a Kidney Transplant Recipient: A Friend or Foe?
Authors: Marios Prikis, Julie MacDougall, Nina Narasimhadevara
Journal: Case Rep Transplant (2020)
MeSH terms: Case Reports

Over the last decades, proton pump inhibitors (PPIs) have been widely used as the mainstay for treatment and prevention of gastrointestinal side effects, gastroesophageal reflux, and peptic ulcer disease. However, their safety profile has come into question recently after reports relating them to several side effects as well as kidney disease. Omeprazole, one of the mainly used PPIs, is almost entirely metabolized by the liver but the resulting metabolites are renally excreted. These metabolites may inhibit cytochrome P450 2C19 (CYP2C19) and cytochrome P450 3A4 (CYP3A4) reversibly, but as recent evidence suggests, they may also be involved in causing kidney disease. In the setting of renal dysfunction, these metabolites will not be excreted from the body and will accumulate further causing kidney damage and inhibiting CYP enzymes to a greater extent. Abnormally high serum prolactin levels leading to galactorrhea may be the result of such an accumulation. To our knowledge, there have been only three previously reported cases of PPI-induced galactorrhea in the literature but none in a kidney transplant recipient. In patients with established kidney disease and reduced glomerular filtration rate like kidney transplant recipients, the use of PPIs should be thoroughly assessed. Reduced clearance of their metabolites may lead to progression of the kidney disease and lead to more unwanted side effects. We present a case of a female kidney transplant recipient with worsening allograft function who presented with sudden galactorrhea and hyperprolactinemia while on a high-dose omeprazole for gastroesophageal reflux disease.
Successful laparoscopic management of ruptured tubal pregnancy with an ipsilateral ectopic pelvic kidney
Authors: Jimmy Belotte, Jim Belotte, Mitchell Alexis, Awoniyi O Awonuga, Tina Jessica Aguin
Journal: Case Rep Obstet Gynecol (2014)

Objective. To report a case of successful laparoscopic management of a left ruptured tubal pregnancy in the setting of an ipsilateral ectopic pelvic kidney. Method. Case report was prepared at Wayne State University/Detroit Medical Center. The patient is a young woman gravida 2 para 0 in her twenties who presented with severe abdominal pain and vaginal bleeding. She had a plateaued beta HCG and ultrasonographic findings suggestive of ectopic left tubal pregnancy along with an ectopic ipsilateral pelvic kidney. The IRB approval is not needed, as this is a case report. The informed consent could not be obtained, as the patient was not reachable. Result. Multiple intraperitoneal adhesions, left ruptured ampullary ectopic pregnancy and left retroperitoneal pelvic mass consistent with ipsilateral ectopic pelvic kidney. Conclusion. Laparoscopic management of tubal pregnancy can be safely performed in the setting of an ipsilateral ectopic pelvic kidney.
A Patient With Focal Myositis and Primary Cutaneous Diffuse Large B-Cell Lymphoma: A Case Report
Authors: Quanxin Wu, Cheng Xu, Li Wang
Journal: Front Oncol (2021)
Keywords: ck-mb, pcdlbcl, ezetimibe, focal myositis, statin
MeSH terms: Case Reports

We report a rare case of a 92-year-old male, with a history of statin/ezetimibe intake, complained of pain and swelling of left forearm. The patient was diagnosed with focal myositis at first. Symptoms aggravated after 2 months of immunomodulatory therapy, and accompanied with protrusion lesion at left elbow. Biopsy of the protrusion lesion turned out to be primary cutaneous diffuse large B-cell lymphoma.
Case Report: Treatment of porphyria cutanea tarda with low dose hydroxychloroquine
Authors: Andrew Awad, Alexander Nirenberg, Rodney Sinclair
Journal: F1000Res (2022)
Keywords: porphyria cutanea tarda, hemochromatosis, hydroxychloroquine
MeSH terms: Hemochromatosis / genetics, Porphyria Cutanea Tarda / drug therapy, Porphyria Cutanea Tarda / genetics, Case Reports, Aged, Humans, Hydroxychloroquine / therapeutic use, Male, Uroporphyrinogen Decarboxylase / genetics, Uroporphyrinogen Decarboxylase / metabolism, Hydroxychloroquine, Uroporphyrinogen Decarboxylase

Background: Porphyria cutanea tarda (PCT) is a complex metabolic disease resulting from altered activity of the enzyme uroporphyrinogen decarboxylase (UROD) in the liver resulting in accumulation of uroporphyrin. PCT presents as a blistering photodermatitis with skin fragility, vesicles, scarring and milia. Case: We report a case of PCT in a 67-year-old man with hemochromatosis (HFE) gene mutation who, following a major syncopal episode in response to venesection was commenced on low dose hydroxychloroquine. Conclusions: Low dose hydroxychloroquine provided a safe and effective alternative to venesection in this patient who was needle phobic.