OpenMed/multicare-articles huggingface dataset:
Transverse laparostomy is feasible and effective in the treatment of abdominal compartment syndrome in severe acute pancreatitis
Authors: Ari Leppäniemi, Panu Mentula, Piia Hienonen, Esko Kemppainen
Journal: World J Emerg Surg (2008)

Background:
Only recently has the important role of abdominal compartment syndrome (ACS) been recognized as a contributing factor to the multiple organ failure commonly seen in severe acute pancreatitis (SAP). Decompressive laparostomy for ACS is a life-saving procedure usually performed through a midline incision followed by a negative pressure wound dressing. High risk of intestinal fistulas and frequent inability to close the fascia with ensuing planned ventral hernia has prompted the search for alternative techniques. Subcutaneous fasciotomy may be effective in early and less severe cases of ACS but it is always accompanied with a ventral hernia.
Case report:
A patient with SAP developed manifest ACS and was treated with bilateral subcostal laparostomy. Immediately after decompression, the intra-abdominal pressure dropped from 23 mmHg to 10 mmHg, and the respiratory, cardiovascular and renal functions improved markedly leading to full recovery. The abdominal incision including the fascia and the skin was closed gradually over 4 relaparotomies, and during the 6 months' follow up there are no signs of ventral hernia or other wound complications.
Discussion:
Transverse subcostal laparostomy is a promising alternative decompression technique for ACS in SAP. It is feasible, effective and might provide a chance of early fascial closure. Comparative studies are needed to define its role as a decompressive technique for ACS.
Utility of [18F] Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Scan in Inflammatory Myopathies: Case Report and Literature Review
Authors: Juan Pablo Rivas-de Noriega, Javier Andrés Galnares-Olalde, Javier Zúñiga-Varga, Juan Pablo Herrera-Félix, Marco Antonio Alegría-Loyola, Alonso Turrent-Carriles
Journal: Case Rep Rheumatol (2018)
MeSH terms: Case Reports

Introduction:
Inflammatory myopathies are a rare group of diseases characterized by proximal weakness. Incidence ranges from 7.98/million/year and prevalence at 14/100,000. The utility of [18F] fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) scan is increasing for the complementary diagnosis of myopathies.
Case report:
An 84-year-old male was admitted with a history of difficulty rising from a chair and a fall. Laboratory results showed increased creatine kinase levels of more than 50 times the normal reference values. Electromyography (EMG) showed myopathic changes, and FDG-PET/CT scan showed increased FDG uptake in bilateral quadriceps. A biopsy was performed revealing lymphocytic predominant infiltrates and myonecrosis. Prednisone and intravenous immunoglobulin (IVIG) were administered with strength improvement. The patient was discharged for further follow-up.
Discussion:
FDG-PET/CT in inflammatory diseases has proven useful as muscle fibers have increased FDG uptake. In some cases, FDG-PET/CT is also useful in determining associated neoplastic diseases.
Primary amoebic meningoencephalitis in an Iranian infant
Authors: Zahra Movahedi, Mohammad Reza Shokrollahi, Mohammad Aghaali, Hosein Heydari
Journal: Case Rep Med (2012)

Introduction. Naegleria fowleri, a free living amoeba, can cause devastating and deadly diseases in humans. This is the first report of primary amoebic meningoencephalitis from Iran. Case report. A five-month-old male infant presented with the history of fever and eye gaze for three days, after beginning of bacterial meningitis, a plain and contrast CT revealed communicated hydrocephalus. In the repeat of CSF analysis on microscopic examination of wet preparation of CSF, Naegleria Fowleri was seen. Then, Amphotericin B and Rifampin were started. On followup, two months later, the patient was totally asymptomatic. Conclusion. Though occurrence of PAM is rare, this unusual disease has grave prognosis, so infection with free living amoebas must be considered in differential diagnosis of pediatric patients of purulent meningitis without evidence of bacteria on Gram's stain and imaging findings, nonspecific brain edema on CT or hydrocephalus even without history of contact.
Recurrent Liver Abscess in a Non-toxic Patient
Authors: Ayham Khrais, Ahmad S Ali, Catherine Choi, Siddharth Verma
Journal: Cureus (2023)
Keywords: asymptomatic disease, bacterial liver abscess, e coli, hepatic lesion, pyogenic abscess
MeSH terms: Case Reports

Liver abscesses range in presentation from asymptomatic infection to sepsis. Recurrence is rare. We describe a case of an asymptomatic liver abscess that recurred 10 years after a previous abscess. The patient presented with flu-like symptoms and dark urine. Laboratory evaluation showed an elevation of aminotransferases and bilirubin. Triple-phase CT showed a 2.8 cm mass in the right liver lobe with linear enhancement. The abscess was aspirated, with cultures growing Escherichia coli. The patient was started on ceftriaxone and metronidazole and then discharged with outpatient follow-up. We describe an unusual case of asymptomatic pyogenic liver abscess growing E. coli, with the same location and causative organism as an abscess that occurred 10 years prior.
HER-2-Positive Ampullary Adenocarcinoma: A Case Report
Authors: Kevin O'Hayer, John Farber, Charles J Yeo, Ashwin R Sama
Journal: Case Rep Pancreat Cancer (2015)
Keywords: her-2, ampullary, ctdna
MeSH terms: Case Reports

Background: Ampullary adenocarcinomas are a rare subset of periampullary tumors with an overall poor prognosis. Treatment decisions are generally extrapolated from pancreatic chemotherapy protocols and consist mainly of traditional chemotherapy drugs. There are no known targets for therapeutic intervention in ampullary adenocarcinoma at this time. Next generation sequencing and other novel molecular profiling of tumors, including circulating tumor DNA (ctDNA), have recently made it possible to better understand tumor biology and elucidate driver mutations which are amenable to targeted therapy. This case describes the use of novel DNA sequencing technology to provide a targeted treatment option, HER-2 inhibition, in a patient with HER-2 overexpressing ampullary adenocarcinoma. This is the first time this has been described in the literature. Case presentation: The patient is a 63-year-old Caucasian man who initially presented with symptoms of obstructive jaundice and was found to have a periampullary tumor. He underwent resection of his tumor and pathology confirmed a stage IIB ampullary adenocarcinoma. He unfortunately developed a recurrence in the liver and lung two years later. Next generation sequencing of his tumor at the time of resection as well as ctDNA analysis demonstrated a HER-2 overexpressing tumor. Following first line therapy with FOLFOX he had progression and was treated with trastuzumab and pertuzumab with stabilization of his disease prior to his ultimate demise from multifocal pneumonia. Conclusion: The use of next generation sequencing as well as ctDNA technology generated a novel therapeutic intervention in our patient. As these techniques become more widespread, it is likely more targeted therapies will be used in these difficult to treat diseases.
Polyethylene glycol as a cause of anaphylaxis
Authors: Katharina Wylon, Sabine Dölle, Margitta Worm
Journal: Allergy Asthma Clin Immunol (2016)
Keywords: anaphylaxis, drug additives, hypersensitivity, macrogol, polyethylene glycol
MeSH terms: Case Reports

Background:
Polyethylene glycols (PEGs) or macrogols are polyether compounds and are widely used as additives in pharmaceuticals, cosmetics, and food.
Case report:
We report on a Caucasian patient experiencing recurrent severe allergic reactions to several drugs. An extensive diagnostic workup including skin prick tests, intradermal tests (IDT) and a double-blind oral challenge was performed to identify the trigger of anaphylaxis. In the present case hypersensitivity to the additive polyethylene glycol was confirmed by an IDT suggesting an Immunoglobulin E-dependent mechanism as a cause of the reaction.
Conclusion:
Potential life-threatening hypersensitivity reactions to hidden molecules like macrogol may be underdiagnosed. Cases of immediate-type PEG hypersensitivity were reported with increasing frequency. The awareness regarding the allergenic potential of PEG should be raised and a proper product labelling is crucial to prevent PEG mediated hypersensitivity.
Pitfalls in Diagnosing Heterotopic Pregnancy in Sub-Saharan Africa: A Case Report at the Yaounde University Teaching Hospital (Cameroon)
Authors: Andre Ngandji Dipanda, Jovanny Tsuala Fouogue, Valere Koh Mve, Bruno Kenfack, Jean Dupont Ngowa Kemfang
Journal: Case Rep Obstet Gynecol (2021)
MeSH terms: Case Reports

Heterotopic pregnancy (HP) is a dizygotic twin pregnancy in which one gestational sac is intrauterine and the other is extrauterine. The prevalence of HP is unknown in Cameroon where the diagnosis is difficult and usually fortuitous like in other resource-poor settings. We herein depict pitfalls and delays in the diagnosis and management of a ruptured heterotopic pregnancy at the Yaounde University Teaching Hospital. After a wrong diagnosis and inadequate treatment, our patient presented at our emergency unit with severe pelvic pain and clinical signs of hemoperitoneum with shock. She underwent a total left salpingectomy through laparotomy. She had a complete spontaneous abortion five days after the surgery. Given that sonography is not routinely available in emergency departments in resource-poor settings, it may be relevant for practitioners to always bear HP in mind when facing ruptured ectopic pregnancies.
Biliary Hyperkinesia and Its Association With Bariatric Surgery: A Case Report and Review of Management Strategies
Authors: Shaniah S Holder, Ulochi Nwagwu, Farhana Ghouse, Muhammad Zain Ali, Frederick Tiesenga
Journal: Cureus (2023)
Keywords: bariatric surgery, biliary dyskinesia, cholecystectomy, ejection fraction, functional gallbladder disorder, hida scan, hyperactive gallbladder, sleeve gastrectomy
MeSH terms: Case Reports

In a post-bariatric surgery patient with suspected biliary dyskinesia, what does an ejection fraction (EF) of 87% on hepatobiliary iminodiacetic acid (HIDA) scan indicate to a healthcare provider? Conventionally, in post-bariatric patients, the gallbladder becomes hypofunctional; however, in this case, the gallbladder activity increased exponentially. Of note, there are no previously documented cases of developing an overactive gallbladder after undergoing a bariatric surgery procedure. This report aims to explore the possible associations between bariatric surgery and the development of gallbladder hyperkinesis in the early postoperative period, the diagnostic tool used to discover the source of our patient's ailment, as well as the rationality behind a surgical procedure that led to an excellent response, namely, laparoscopic cholecystectomy.
Gingival Anaplastic Large-Cell Lymphoma Mimicking Hyperplastic Benignancy as the First Clinical Manifestation of AIDS: A Case Report and Review of the Literature
Authors: Rafaela Elvira Rozza-de-Menezes, Stefânia Jeronimo Ferreira, Diogo Lenzi Capella, Stephan Schwartz, Ana Helena Willrich, Lúcia de Noronha, Aline Cristina Batista Rodrigues Johann, Paulo Henrique Couto Souza
Journal: Case Rep Dent (2013)

This paper presents an unusual case of gingival ALCL, which mimicked a benign hyperplastic lesion that occurred in a 57-year-old white man representing the first clinical manifestation of acquired immunodeficiency syndrome (AIDS). The patient was referred to the Dental Clinic of PUCPR complaining of a lobulated nodule on the gingiva of his upper central incisors. The presence of advanced chronic periodontitis and dental plaque raised suspicion for a benignancy. An excisional biopsy was performed, and large pleomorphic cells with an abundant cytoplasm, sometimes containing prominent nucleoli and "Hallmark" cells, were observed through hematoxylin and eosin staining. The tumor cells showed strong CD30 expression, EMA, Ki-67, and LCA, and negative stain for p80(NPM/ALK), CKAE1/AE3, CD20, CD3, CD56, and CD15. The final diagnosis was ALCL (ALK-negative). Further laboratory tests revealed positivity for human immunodeficiency virus (HIV). The patient was submitted to chemotherapy, but four months after diagnosis, the patient died due to pneumonia and respiratory failure. Oral anaplastic large-cell lymphoma (ALCL) is a rare disorder. Only 5 cases involving the gingiva have been reported, and to our knowledge, this is the first case reported of the ALCL, which mimicked a hyperplastic benignancy as the first clinical manifestation of AIDS.
Acute Renal Failure due to a Tobramycin and Vancomycin Spacer in Revision Two-Staged Knee Arthroplasty
Authors: Ronak A Patel, Hayden P Baker, Sara B Smith
Journal: Case Rep Nephrol (2018)
MeSH terms: Case Reports

Two-stage revision total knee arthroplasty (TKA) is the standard of care for prosthetic joint infections. The first stage involves removal of the infected prosthesis and placement of an antibiotic impregnated cement spacer; following a period ranging from 4 weeks to 6 months, the spacer is then removed and replaced with a permanent prosthesis. The advantage to this approach is that antibiotic impregnated spacers provide supratherapeutic levels in the joint without toxic accumulation in serum. However, it remains important for physicians and pharmacists to be aware of antibiotic associated complications in knee revisions. We present a case of a two-stage revision total knee arthroplasty in which a cement antibiotic spacer caused acute renal failure and ultimately resulted in persistent chronic kidney disease without hemodialysis at 2 months' follow-up. Our case reports the third highest serum tobramycin (13.7 mcg/ml) and second highest serum creatinine (8.62 mg/dl) for patients experiencing ARF due to an antibiotic spacer in two-stage revision TKA.
Case report: Cellular therapy for hydroa vacciniforme-like lymphoproliferative disorder in pediatric common variable immunodeficiency with chronic active Epstein-Barr virus infection
Authors: Elżbieta Grześk, Sylwia Kołtan, Anna Dąbrowska, Anna Urbańczyk, Jadwiga Małdyk, Bogdan Małkowski, Tomasz Bogiel, Robert Dębski, Krzysztof Czyżewski, Mariusz Wysocki, Jan Styczyński
Journal: Front Immunol (2022)
Keywords: allo-hct, cvid - common variable immunodeficiency disorders, ebv-ctls, ebv-specific cytotoxic t cells, hv-lpd, ngs - next generation sequencing, allogeneic hematopoietic stem cell transplantation
MeSH terms: Common Variable Immunodeficiency / complications, Common Variable Immunodeficiency / therapy, Epstein-Barr Virus Infections / complications, Epstein-Barr Virus Infections / therapy, Hydroa Vacciniforme / diagnosis, Hydroa Vacciniforme / therapy, Lymphoproliferative Disorders / diagnosis, Lymphoproliferative Disorders / etiology, Lymphoproliferative Disorders / therapy, Skin Neoplasms, Case Reports, Research Support, Non-U.S. Gov't, Child, Herpesvirus 4, Human, Humans

Hydroa vacciniforme-like lymphoproliferative disorder (HV-LPD) is a cutaneous form of chronic active Epstein-Barrvirus (EBV) infection, which can develop into the extremely rare systemic lymphoma. Patients with Inborn errors of immunity (IEI), such as common variable immunodeficiency (CVID), are at higher risk of developing a severe course of infections especially viral and malignancies than the general population. The aim of the study was to present complex diagnostic and therapeutic management of HV-LPD. The clinical diagnosis was confirmed at the histological and molecular level with next generation sequencing. HV-LPD was diagnosed in a patient with CVID and chronic active Epstein-Barr virus (CAEBV) infection. The patient was refractory to CHOP chemotherapy and immunosuppressive treatment in combination with antiviral drugs (prednisone, bortezomib, gancyclovir). The third-party donor EBV-specific cytotoxic T cells (EBV-CTL, tabelecleucel) were used, which stabilised the disease course. Finally, matched unrelated donor hematopoietic cell transplantation (MUD-HCT) was performed followed by another cycle of EBV-CTL.
Liver Transplantation for Unresectable Calcifying Nested Stromal Epithelial Tumor: Case Report With a 1-Year Follow-Up and Review of Literature
Authors: Emilia Kruk, Konrad Kobryń, Paweł Rykowski, Benedykt Szczepankiewicz, Waldemar Patkowski, Krzysztof Zieniewicz
Journal: Front Surg (2022)
Keywords: cnset, liver oncology, liver resection, liver transplantation, liver tumor
MeSH terms: Case Reports

Introduction:
Calcifying nested stromal epithelial tumor (CNSET) is an extremely rare diagnosis among patients treated for primary hepatic neoplasms. There are only 45 cases reported worldwide. Histopathological characteristics are well-demarcated nests of spindle and epithelioid cells in a dense desmoplastic stroma with variable calcification and ossification. It is mostly diagnosed in children and young females. Treatment strategies implemented for the management of CNSET include radiofrequency ablation, transarterial chemoembolization, surgical resection, adjuvant and neoadjuvant chemotherapy, and liver transplantation. Given the small number of available cases, there are still no established standards of treatment for this neoplasm.
Case presentation:
A 28-year-old female diagnosed with CNSET presented mild abdominal pain, with normal laboratory values. The tumor was initially deemed unresectable, therefore, the patient was disqualified from liver resection. Further deterioration of the patient's clinical condition and local tumor progression led to qualification for liver transplantation. The patient underwent liver transplantation 1 year following initial diagnosis and a 12 months recurrence-free period was observed. During the course of treatment, she did not receive systemic chemotherapy, radiotherapy, or loco-regional treatment.
Conclusion:
Multiple strategies have been implemented for the treatment of CNSET, with liver resection providing the best outcomes. Transarterial chemoembolization, radiofrequency ablation, and radiotherapy are reported to be insufficient in the management of this tumor. Various chemotherapy regimens turned out to be ineffective as well. There have been only eight reported cases of patients undergoing liver transplantation for CNSET, with tumor recurrence in two cases. CNSET appears to be a neoplasm with low malignancy potential, although an aggressive progression has subsequently been reported. Further investigation is still required in this field.
Upper Gastrointestinal Crohn's Disease: Literature Review and Case Presentation
Authors: Soorya N Aggarwal, Yana Cavanagh, Lan Wang, Amer Akmal, Matthew A Grossman
Journal: Case Rep Gastrointest Med (2019)
MeSH terms: Case Reports

Upper gastrointestinal tract predominant Crohn's Disease (CD) remains an elusive clinical entity, manifesting limited or vague symptomatology, eluding clinical suspicion, and delaying subsequent diagnostic evaluation. As a result, it has not been widely described and there is a lack of clear recommendations for diagnosis or management. Standard IBD evaluation including serologic testing, imaging, and endoscopy may initially not be fruitful. Furthermore, endoscopic evaluation may be grossly normal in patients without long standing-disease. We describe an 18-year-old male who presented with only unexplained, persistent iron-deficiency anemia. Extensive outpatient testing including multiple endoscopic evaluations with standard biopsies was unfruitful. Ultimately, a positive fecal calprotectin prompted enteroscopy with endoscopic mucosal resection (EMR) in an effort to obtain a larger, deeper tissue specimen. Grossly cobblestoned mucosa along with histopathology revealing focal crypt abscesses, chronic inflammation in the lamina propria, and superficial foveolar epithelial regenerative changes were consistent with CD. This patient's case illustrates the need for a high degree of suspicion for CD in patients with unexplained or persistent iron deficiency anemias. Persistent investigation yielded an elevation in fecal calprotectin suggesting underlying gastrointestinal inflammation and prompted advanced endoscopic evaluation with EMR. Waxing and waning tissue findings are characteristic of CD and pose a unique challenge in patients with upper gastrointestinal predominant pathology. As such, diligent workup including laboratory evaluation, imaging, and serial endoscopy is critical to establish pathology and dictate subsequent management in IBD, especially upper gastrointestinal tract predominant CD.
Vasculitis Leading to Gangrene: An Early Presentation in a Rheumatoid Arthritis Patient
Authors: Abhishek Vadher, Karthik Yeruva, Chitralekha Vora, Karthik Gangu, Swati Baraiya
Journal: Cureus (2023)
Keywords: amputation, arthritis, gangrene, rheumatoid, vasculitis
MeSH terms: Case Reports

Vasculitis is a late complication in rheumatoid arthritis (RA) and is seen in RA patients with long-standing disease. Rheumatoid vasculitis affects small-to-medium-sized vessels. In a few patients, vasculitis develops early in the course of the disease. Here, we report the case of a 32-year-old female who presented with gangrene in the second and third digits of the right foot and gangrene in the second digit of the left foot. She was on hydroxychloroquine and methotrexate for one year since the diagnosis of RA. The patient then developed Raynaud's phenomenon and blackish discoloration of toes. She was started on pulse methylprednisolone, aspirin, nifedipine, and pentoxifylline. As no improvement was seen, intravenous cyclophosphamide was started. There was no improvement even after starting cyclophosphamide, and the gangrene further worsened. Eventually, after consulting the surgical team, it was decided to amputate the digits. The second digits in both feet were subsequently amputated. Hence, a physician should always be careful in checking for signs of vasculitis in RA patients early in the course of the disease as well.
Posterior Reversible Encephalopathy Syndrome in a Patient with Newly Diagnosed HIV Infection and End Stage Renal Disease
Authors: Mohankumar Kurukumbi, Maria I Castellanos, Amanda K Crawford, Shreyas D Gowdar, Annapurni Jayam-Trouth
Journal: Case Rep Neurol Med (2013)

Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological syndrome in which patients present with an acute or subacute clinical presentation of seizures, visual disturbances, headache, and altered mental status. The pathophysiology of PRES may be explained by endothelial dysfunction that leads to transudation of fluids and protein, resulting in vasogenic cerebral edema. PRES is typically associated with many conditions such as hypertension, uremia, immunosuppressive drugs, and sepsis. This is a case report of a 39-year-old woman with untreated HIV infection and end-stage renal disease (ESRD) who developed PRES with a normal blood pressure and no other known causes of PRES. Untreated HIV is associated with known endothelial dysfunction and we believe that this, in combination with her untreated end-stage renal disease, contributed to her unique presentation of PRES. Although uncommon in HIV-infected patients and challenging to diagnose, prompt recognition of PRES is critical to provide appropriate care and ensure reversibility of the vasogenic edema seen in PRES.