OpenMed/multicare-articles huggingface dataset:
Case Report: Overlap Between Long COVID and Functional Neurological Disorders
Authors: Luana Gilio, Giovanni Galifi, Diego Centonze, Mario Stampanoni Bassi
Journal: Front Neurol (2022)
Keywords: covid-19, case report, functional neurological disorders, long covid, post-acute covid
MeSH terms: Case Reports

Long lasting symptoms have been reported in a considerable proportion of patients after a severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection. This condition, defined as either "post-acute coronavirus disease (COVID)," "long COVID," or "long-haul COVID," has also been described in outpatients and in individuals who are asymptomatic during the acute infection. A possible overlap exists between this condition and the functional neurological disorders (FNDs). We report a 23-year-old man who developed, after asymptomatic COVID-19, a complex symptomatology characterized by fatigue, episodic shortness of breath, nocturnal tachycardia, and chest pain. He also complained of attention and memory difficulties, fluctuating limb dysesthesia, and weakness of his left arm. After neurological examination, a diagnosis of FND was made. Notably, the patient was also evaluated at a post-COVID center and received a diagnosis of long COVID-19 syndrome. After 4 months of psychoanalytic psychotherapy and targeted physical therapy in our center for FNDs, dysesthesia and motor symptoms had resolved, and the subjective cognitive complaints had improved significantly. However, the patient had not fully recovered as mild symptoms persisted limiting physical activities. Long-term post COVID symptoms and FNDs may share underlying biological mechanisms, such as stress and inflammation. Our case suggests that functional symptoms may coexist with the long COVID symptoms and may improve with targeted interventions. In patients presenting with new fluctuating symptoms after SARS-CoV-2 infection, the diagnosis of FNDs should be considered, and the positive clinical signs should be carefully investigated.
Case Report: How an Iliac Vein Lesion During Totally Endoscopic Preperitoneal Repair of an Inguinal Hernia Can Be Safely Managed
Authors: Navid Tabriz, Verena Nicole Uslar, Timur Cetin, Andreas Marth, Dirk Weyhe
Journal: Front Surg (2021)
Keywords: co2 pressure, peep, tapp, tep, groin hernia, iliac vein injury
MeSH terms: Case Reports

Inguinal hernia repair is a common surgical procedure with an acceptably low complication rate. However, complications with potentially life-threating consequences may occur in rare cases. These complications might be very challenging to manage, even more in laparo-endoscopic interventions compared to open repair. One of these challenges can be the treatment of an intraoperative injury to the iliac vein. To the best of our knowledge, a lesion of the iliac vein during TEP (totally endoscopic preperitoneal) for inguinal hernia repair, and a safe technique for its management have not been reported yet. We report the case of a 75-year-old male patient with previous abdominal surgery scheduled for TEP repair of an inguinal hernia. During surgery, the iliac vein was damaged. If we had performed a laparotomy in this situation, the potentially life-threatening condition of the patient could have deteriorated further. Instead, to avoid a potential CO2 associated embolism, the preperitoneal pressure was gradually reduced, and the positive end expiratory pressure (PEEP) was increased in the manner that a balance between excessive bleeding and potential development of a CO2 embolism was achieved. The injured vein was sutured endoscopically, and in addition a hemostatic patch was applied. We then continued with the planned surgical procedure. Thrombosis of the sutured vein was prevented by prophylactic administration of low molecular weight heparin until the 14th postoperative day. We conclude that in case of major vein injury during TEP, which might happen irrespective of prior abdominal surgery, the preperitoneal pressure and PEEP adjustment can be used to handle the complication.
A Rare Entity: Adult Asymptomatic Giant Vallecular Cyst
Authors: Mümtaz Taner Torun, Ender Seçkin, Ümit Tuncel, Caner Kılıç, Özalkan Özkan
Journal: Case Rep Otolaryngol (2015)

Background. Cysts in the larynx are rare and generally asymptomatic. However, large cysts in adults can be symptomatic. If they are symptomatic, they typically present with respiratory and feeding difficulties. They are usually benign in terms of pathology. Several surgical techniques may be used for treatment. Case Report. A 56-year-old man presented to our clinic with hoarseness. Routine laryngeal examination revealed a giant mass and the larynx could not be visualized. At magnetic resonance imaging (MRI), a cystic mass originating from the vallecula was detected. There was no pathology at the glottic level. We planned tracheotomy for the airway and endoscopic surgery for excision. The mass was excised using CO2 laser and was reported as benign. Conclusion. An asymptomatic vallecular cyst may cause difficult intubation in any operation. It may also cause respiratory or other complications. Airway management should be led by an ear, nose, and throat surgeon, since tracheotomy may be required. Endoscopic excision with CO2 laser is a good choice for treatment in elective cases. In this report, we discuss the diagnosis and treatment of a patient with an asymptomatic giant vallecular cyst.
Acute Abducens Nerve Palsy in a Patient who Sustained Mechanical Trauma to the Orbit
Authors: Adam Geressu, Jayaprakash Patil, Jessica Cody
Journal: Br Ir Orthopt J (2021)
Keywords: abducens nerve, cranial nerve six, head trauma, lateral rectus palsy, orbital fracture
MeSH terms: Case Reports

Background:
Abducens nerve (Cranial Nerve VI) innervates the lateral rectus (LR) muscle. Head trauma is one of the most common causes of abducens nerve palsy. Orbital and/or facial injuries could also affect the LR muscle directly or the orbital course of abducens nerve and lead to palsy. We present a case of a young man with multiple orbital fractures and an impingement of the LR muscle resulting in a complete loss of abduction.
Case report:
A 29-year-old male reported falling 15 feet. He presented with diplopia and had complete abduction deficit of the left eye. Orbital CT imaging revealed a bony spur from his left zygomatic bone impinging on the lateral rectus muscle. In view of -4 abduction deficit, he was operated upon to remove the bony spur. This led to a gradual, but complete recovery of his abduction.
Discussion:
The abducens nerve has a tortuous course and as a result is commonly injured during head trauma, in particular due to its vulnerability as it passes into Dorello's canal, or its journey through the cavernous sinus. The case report highlights orbital causes such as direct muscle avulsion or injury to the orbital portion of the abducens nerve, as reasons for how LR weakness could be easily overlooked, unless specifically examined with high-resolution orbital imaging.
Conclusion:
Orbital mechanical causes can be overlooked in LR palsy. We emphasise the role of orbital imaging in any patient with abducens nerve or LR Palsy and reaffirm that not all cases are associated with an intracranial cause.
Audiovestibular Symptoms in Systemic Autoimmune Diseases
Authors: Massimo Ralli, Vittorio D'Aguanno, Arianna Di Stadio, Armando De Virgilio, Adelchi Croce, Lucia Longo, Antonio Greco, Marco de Vincentiis
Journal: J Immunol Res (2018)
MeSH terms: Autoimmune Diseases / physiopathology, Ear, Inner / physiology, Meniere Disease / physiopathology, Review, Hearing Loss, Conductive, Hearing Loss, Sensorineural, Humans, Tinnitus

Immune-mediated inner ear disease can be primary, when the autoimmune response is against the inner ear, or secondary. The latter is characterized by the involvement of the ear in the presence of systemic autoimmune conditions. Sensorineural hearing loss is the most common audiovestibular symptom associated with systemic autoimmune diseases, although conductive hearing impairment may also be present. Hearing loss may present in a sudden, slowly, rapidly progressive or fluctuating form, and is mostly bilateral and asymmetric. Hearing loss shows a good response to corticosteroid therapy that may lead to near-complete hearing restoration. Vestibular symptoms, tinnitus, and aural fullness can be found in patients with systemic autoimmune diseases; they often mimic primary inner ear disorders such as Menière's disease and mainly affect both ears simultaneously. Awareness of inner ear involvement in systemic autoimmune diseases is essential for the good response shown to appropriate treatment. However, it is often misdiagnosed due to variable clinical presentation, limited knowledge, sparse evidence, and lack of specific diagnostic tests. The aim of this review is to analyse available evidence, often only reported in the form of case reports due to the rarity of some of these conditions, of the different clinical presentations of audiological and vestibular symptoms in systemic autoimmune diseases.
Repair of an Extensive External Cervical Resorption Lesion Using Intentional Replantation with Crown Rotation
Authors: Motoki Okamoto, Yoko Asahi, Henry Fergus Duncan, Nanako Kuriki, Yusuke Takahashi, Mikako Hayashi
Journal: Case Rep Dent (2023)
MeSH terms: Case Reports

Treatment of large external cervical resorption (ECR) lesions may be compromised, rendering the tooth unrestorable. Intentional replantation is a potential treatment option depending on the site and extent of ECR. We present a case of a large ECR successfully managed with intentional replantation with rotation of the tooth. The female patient consulted the hospital clinic, with an extensive palatal ECR on the maxillary lateral incisor. Routine planar radiographs and cone-beam computed tomography demonstrated a larger palatal than the ECR lesion (Heithersay Class III and Patel's Class 2Bp) not amenable to nonsurgical treatment. Intentional replantation after short-term extrusion was planned. The defect was restored, then a palatal ferrule was achieved by rotating the tooth by 180°. At the 18-month follow-up, the periradicular and periodontal tissues remained healthy, and no other symptoms were reported. In conclusion, this successful video-illustrated clinical case highlights the benefits of intentional replantation in saving teeth with advanced ECR.
Tigecycline application in a 3-month-old infant with multiple drug resistant Klebsiella pneumonia: a case report
Authors: Cheng Peng, Xiaofeng Wang, Jiangwei Zhang, Yi Jiang, Xinlin Hou
Journal: Gut Pathog (2018)
Keywords: klebsiella pneumoniae, multiple drug resistant, pediatric, tigecycline
MeSH terms: Case Reports

Background:
Tigecycline is an 'immature' antibiotic for children. We report the youngest surviving patient who received a complete tigecycline treatment, and no significant adverse effects occurred in the patient.
Case presentation:
The 3-month old infant suffered from a catheter-associated bloodstream infection by multiple drug resistant Klebsiella pneumoniae. Tigecycline was considered as a salvage therapy to control the severe sepsis. The therapy consisted of 3 mg/kg as a loading dose and 1.5 mg/kg Q12 h as a maintenance dose for 26 days.
Conclusion:
Current researches are limited in clinical trials directly focused on children. This therapeutic schedule might be safe for patients who are above 3 months old.
Efficacy of Rituximab in a Systemic Lupus Erythematosus Patient Presenting with Diffuse Alveolar Hemorrhage
Authors: Gabriela Montes-Rivera, Grissel Ríos, Luis M Vilá
Journal: Case Rep Rheumatol (2017)
MeSH terms: Case Reports

Diffuse alveolar hemorrhage (DAH) is a life-threatening complication of systemic lupus erythematosus (SLE). Although infrequent, its mortality is very high. While there are no established therapeutic guidelines, DAH has been traditionally managed with high-dose intravenous (IV) corticosteroids, cyclophosphamide, and plasma exchange. The efficacy of alternative therapies such as rituximab has been described only in a few cases. Herein, we report a 25-year-old Hispanic man who presented with acute-onset SLE manifested by polyarthralgia, nephritis, seizures, pancytopenia, severe hypocomplementemia, and elevated anti-dsDNA antibodies. His disease course was complicated by DAH. His condition was refractory to high-dose intravenous (IV) methylprednisolone pulses, IV cyclophosphamide, and plasmapheresis. Given the lack of clinical response, he was started on IV rituximab 375 mg/m2 weekly for a total of four courses. He rapidly improved after the first two doses. Over the next seven months, he did not present recurrent pulmonary symptoms. Follow-up chest computed tomography did not show residual abnormalities. This case, together with other reports, suggests that rituximab is an effective therapeutic option for DAH in SLE.
Coronary Artery Fistulae Discovered during Presentation of a Patient Having Heart Failure due to Severe Aortic Stenosis
Authors: Abdulrahman Khalifa Alammar
Journal: Case Rep Cardiol (2014)

Introduction. Coronary artery fistulae (CAF) are rare defects with abnormal communication between a coronary artery with either a cardiac chamber or another vascular structure, bypassing the myocardial capillary network. We report a rare multiple arterial coronary fistulae with drainage to the right pulmonary artery. Case Presentation. A 56-year-old male was brought to our hospital for work-up of severe aortic stenosis. Further evaluation revealed multiple CAF with abnormal drainage to the right pulmonary artery. He was discharged after aortic valve replacement and closure of the coronary fistula. Conclusion. This case demonstrates that patients with complex CAF and drainage to the right pulmonary artery can remain asymptomatic and diagnosed accidentally during cardiac imaging, presenting particular challenges in both medical and surgical treatment.
Modified total humeral replacement on unusual osteosarcoma of the humerus: A case report
Authors: Yogi Prabowo, Adisa Yusuf Reksoprodjo
Journal: Int J Surg Case Rep (2019)
Keywords: case report, limb salvage, osteosarcoma

Introduction:
Osteosarcoma of the humerus is an unusual case. In order to salvage the limb, resection followed with total humeral replacement is preferred. In situations where those prostheses are not available, a technique of modified total humeral replacement could be used.
Case presentation:
A 20-year-old female patient came with osteosarcoma of the right humerus accompanied by pathological humeral shaft fracture, with the onset of six months. The lesion extended along the proximal to distal part of humerus. The patient underwent a neoadjuvant chemotherapy before surgery and a limb salvage surgery by wide excision of the humerus and reconstruction using modified total humeral replacement was performed. Modifications to the shoulder hemiarthoplasty and total elbow prostheses were made, so both prostheses could join as one unit.
Discussion:
After the surgery, no disturbances of hand function were seen, and functional outcome was evaluated by using Musculoskeletal Tumour Society Score (MSTS) score with score of 83% (excellent). After 3 years of follow up, patient could work and resume daily activity with improved MSTS score. There were neither sign of tumor recurrence nor distant metastasis on follow up.
Conclusion:
Total Humeral Replacement for the treatment of humerus malignancy was feasible by using this modification. This procedure yielded good functional outcome.
Case Report: A Novel Homozygous Frameshift Mutation of the SKIV2L Gene in a Trichohepatoenteric Syndrome Patient Presenting With Short Stature, Premature Ovarian Failure, and Osteoporosis
Authors: Minyi Yang, Yu Jiang, Xinyu Shao
Journal: Front Genet (2022)
Keywords: skiv2l gene mutation, case report, intractable diarrhea, premature ovarian failure, trichohepatoenteric syndrome
MeSH terms: Case Reports

Background: Trichohepatoenteric syndrome (THES) is a rare Mendelian autosomal recessive genetic disease characterized by intractable diarrhea, woolly hair, facial abnormality, immune dysfunction, and intrauterine growth restriction. THES mutations are found in the TTC37 and SKIV2L genes, which encode two components of the human superkiller (SKI) complex. Methods and results: We report one case of a 32-year-old woman of Chinese descent with THES, who was born with a low weight (2000 g). She had intractable diarrhea during the neonatal period and was allergic to cow's milk and condensed milk, but did not require total parenteral nutrition. She experienced menarche at age 12 and amenorrhea at age 28. In May 2019, the patient presented with a left fibular head fracture and was diagnosed with osteoporosis. Genetic testing showed a novel mutation in exon1 [p.E5Afs∗37 (c.12_13del)] of SKIV2L, which is composed of 28 exons. After the diagnosis, hormone replacement therapy was prescribed, in addition to the routine calcium and vitamin D supplements. Conclusion: This case expands the clinical characteristic and phenotype spectrum of THES, providing further understanding of SKIV2L and its autoimmune influence.
Complex Recanalization of Chronic Total Occluison Supported by Minimal Extracorporeal Circulation in a Patient with an Aortic Valve Bioprothesis in Extraanatomic Position
Authors: Ruben Jansen, Brigitte Bathgate, Alexander Bufe, Jan-Erik Guelker
Journal: Case Rep Cardiol (2018)
MeSH terms: Case Reports

Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) still remains a major challenge in interventional cardiology. This case describes a complex PCI of the left main coronary artery and of a CTO of the right coronary artery using a minimal extracorporeal circulation system (MECC) in a patient with an aortic valve bioprothesis in extraanatomic position. It illustrates that complex recanalization strategies can be solved combining it with mechanical circulatory support technologies.
"Almost bleeding to death": the conundrum of acquired amegakaryocytic thrombocytopenia
Authors: Gabrielle Elena Brown, Hani M Babiker, Carlos L Cantu, Andrew M Yeager, Ravitharan Krishnadasan
Journal: Case Rep Hematol (2014)

Acquired amegakaryocytic thrombocytopenia (AAT) is a rare hematological disorder causing severe thrombocytopenia and bleeding. Previous in vitro studies postulated both cell-mediated suppression of megakaryocytopoiesis in early megakaryocytic progenitor cells and humoral-mediated suppression by anti-thrombopoietin antibodies as possible etiologies of AAT. Patients with AAT usually present with severe bleeding and thrombocytopenia that is unresponsive to steroids and intravenous immunoglobulin (IVIG). Although standard guidelines have not been established for management of AAT, a few case reports have indicated a response to immunosuppressive treatment. The prompt recognition of this disease entity is essential in view of the substantial risk of morbidity and mortality from excessive bleeding. We report a case of AAT successfully treated with equine antithymocyte globulin (ATG) and cyclosporine (CSP).
Porto-Sinusoidal Vascular Disease as the Cause of Portal Hypertension in Felty's Syndrome: A Case Report and Literature Review
Authors: Song Yang, Min Quan, Yue Li, Calvin Qian Pan, Huichun Xing
Journal: Biomed Res Int (2020)
MeSH terms: Capillaries / pathology, Felty Syndrome / complications, Hypertension, Portal / etiology, Vascular Diseases / complications, Case Reports, Review, Biopsy, Capillaries / diagnostic imaging, Endoscopy, Esophageal and Gastric Varices / blood, Esophageal and Gastric Varices / complications, Esophageal and Gastric Varices / diagnostic imaging, Felty Syndrome / blood, Felty Syndrome / diagnostic imaging, Female, Follow-Up Studies, Humans, Hypertension, Portal / blood, Hypertension, Portal / diagnostic imaging, Liver / pathology, Liver / physiopathology, Liver Function Tests, Middle Aged, Rheumatoid Factor / blood, Tomography, X-Ray Computed, Vascular Diseases / blood, Vascular Diseases / diagnostic imaging, Rheumatoid Factor

Felty's syndrome (FS) is a disorder wherein patients with rheumatoid arthritis develop splenomegaly, neutropenia, and in some cases, portal hypertension without underlying cirrhosis. Esophageal variceal bleeding is a complication of FS in patients with portal hypertension. In contrast to splenectomy, few reports exist on the management of variceal bleeding with endoscopic therapy. Moreover, the long-term outcome has not been reported. We present a patient with esophageal variceal bleeding due to portal hypertension secondary to Felty's syndrome. The patient was followed up for two years postendoscopy intervention. Literature review was performed and the histological features of portal hypertension in FS are discussed. The patient presented with a typical triad of rheumatoid arthritis (RA), splenomegaly, and neutropenia and was diagnosed as Felty's syndrome in 2012. She was admitted to our hospital in September 2017 for esophageal variceal bleeding. At the time of admission, her liver function test was normal. Abdominal CT showed no signs of cirrhosis and portal vein obstruction. Liver biopsy further excluded diagnosis of cirrhosis and supported the diagnosis of porto-sinusoidal vascular disease (PSVD), which was previously named as noncirrhotic idiopathic portal hypertension (NCIPH). An upper abdominal endoscopy revealed gastric and esophageal varices. A series of endoscopies was performed to ligate the esophageal varices. The patient was followed up for two years and did not show rebleeding. In conclusion, comorbid PSVD might be a cause of portal hypertension in FS patients. The present case had excellent outcome in two years, which supported the use of endoscopic therapy for the management of variceal bleeding in FS patients. Further large prospective study is needed to confirm the findings.
Cutaneous squamous cell carcinomas of the nose in a child treated with external radiation therapy: a case report
Authors: Samia Khalfi, Zineb El Ayachi, El Mehdi Sadiki, Noureddine Slassi, Wissal Hassani, Fatima Zahra Farhane, Zenab Alami, Touria Bouhafa
Journal: Ecancermedicalscience (2023)
Keywords: cutaneous squamous cell carcinomas, facial localizations, radiation therapy
MeSH terms: Case Reports

Cutaneous squamous cell carcinomas are very rare in children. The recommended treatment for localized cancers is surgery with sufficient margins which can sometimes be mutilating especially for facial localizations. We report a rare case of facial skin carcinoma in a 13-year-old girl measuring 3 cm in diameter infiltrating the tip of the nose. The treatment was an exclusive external radiation therapy with a dose of 70 Gy in 35 fractions in standard fractionation. The technique used was intensity-modulated conformational radiotherapy. It was proposed as an alternative to surgery which could be mutilating. A complete tumour response was obtained with a good aesthetic result and without major toxicity.
Systemic steroid treatment for severe expanding pneumococcal pneumonia
Authors: Eran Lavi, David Shoseyov, Natalia Simanovsky, Rebecca Brooks
Journal: Case Rep Pediatr (2015)

The treatment of bacterial community-acquired pneumonia (CAP) is based on appropriate antibiotic therapy and supportive care such as intravenous fluids and supplemental oxygen. There is no available data regarding the use of steroids in CAP in children. We present an unusual case of a child with severe respiratory distress, on the brink of mechanical ventilation, due to a rapidly expanding pneumococcal pneumonia. The administration of systemic steroids resulted in a dramatic response with rapid improvement of clinical and radiological abnormalities followed by improvement of laboratory abnormalities. This case report should raise the awareness of the potential benefits of steroids in the treatment of severe pneumonia in children. Prospective randomized trials are needed to confirm the efficacy of steroids in this setting and to determine which patients would benefit most from this.