OpenMed/multicare-articles huggingface dataset:
A case of hypogonadtropic hypogonadism due to hypophysitis discovered by secondary male infertility
Authors: Masatoshi Konishi, Yoko Maegawa, Masaru Tani, Toshihisa Asakura, Yujiro Hayashi, Yoichi Kakuta, Koichi Tsutahara, Kazuhiko Komori, Tetsuya Takao
Journal: IJU Case Rep (2022)
Keywords: hormone replacement therapy, hypogonadtropic hypogonadism, hypophysitis, secondary male infertility
MeSH terms: Case Reports

Introduction:
The main causes of secondary male infertility are varicocele and aging. It is rarely caused by adult-onset hypopituitarism. The onset of hypopituitarism is often due to brain tumors, trauma, surgery, or congenital disorders.
Case presentation:
A 29-year-old man was admitted to the hospital with complaints of decreased libido and semen volume, which lasted for 4 months. He had no abnormalities in adolescence and has a 2-year-old child. Blood tests showed low luteinizing hormone and follicle-stimulating hormone, and semen tests showed azoospermia. Magnetic resonance imaging T1-weighted images showed swelling and enhancement effect of the pituitary gland, and lymphocytic hypophysitis was suspected. After an Insulin-thyroid-stimulating hormone releasing hormone-luteinizing hormone-releasing hormone test, a decrease in luteinizing hormone/follicle-stimulating hormone secretion was considered. We diagnosed hypogonadotropic hypogonadism due to lymphocytic hypophysitis. Currently, the patient is being treated with a hormone replacement therapy.
Conclusion:
We experienced a case of hypogonadotropic hypogonadism due to lymphocytic hypophysitis discovered by secondary infertility.
Primary lung cancer treatable with radical resection after complete remission with pembrolizumab therapy following gemcitabine and carboplatin chemotherapy for multiple metastases of bladder cancer
Authors: Ryohta Nakamura, Go Hasegawa, Kazumasa Ohashi, Takehisa Hashimoto, Yohei Ikeda, Noboru Hara, Tsutomu Nishiyama
Journal: IJU Case Rep (2022)
Keywords: advanced bladder cancer, pembrolizumab therapy following gemcitabine and carboplatin chemotherapy with complete remission, primary lung cancer with radical resection
MeSH terms: Case Reports

Introduction:
We report a patient with the complete remission of multiple metastases and primary bladder lesions of bladder cancer who developed primary lung cancer requiring radical resection.
Case presentation:
A 68-year-old man diagnosed with invasive bladder cancer, right hydroureteronephrosis, and multiple metastases were administered six courses of gemcitabine and carboplatin chemotherapy and thereafter has been receiving pembrolizumab therapy. Bladder cancer and multiple metastases decreased in size, whereas a ground-glass opacity lesion in the lung gradually increased in size. Fluorodeoxyglucose-positron emission tomography revealed the accumulation of fluorodeoxyglucose in the ground-glass opacity lesion only. The patient was diagnosed with primary lung cancer and underwent a thoracoscopic lobectomy. Histopathological findings showed ALK-negative, EGFR L858R mutation-positive invasive adenocarcinoma with a programmed death-ligand 1 tumor proportion score of less than 1%.
Conclusion:
This is the first case report of patients with the complete remission of multiple metastases of bladder cancer who developed primary lung cancer requiring radical resection.
Ruptured Sinus of Valsalva Aneurysm Accompanied by Aortic and Tricuspid Valve Endocarditis: A Case Report
Authors: Tahereh Davarpasand, Ali Hosseinsabet, Kyomars Abbasi
Journal: J Tehran Heart Cent (2017)
Keywords: aortic valve, endocarditis, sinus of valsalva, tricuspid valve
MeSH terms: Case Reports

A ruptured sinus of Valsalva aneurysm rarely accompanies the aortic and tricuspid valve endocarditis. A 36-year-old woman presented with low-threshold dyspnea on exertion and fever. Transthoracic and transesophageal echocardiography showed a ruptured noncoronary sinus of Valsalva aneurysm with large vegetations on the tricuspid and aortic valves, resulting in moderately severe tricuspid regurgitation and severe aortic regurgitation. Blood culture was negative. The patient was initially treated with antibiotics and then subjected to the surgical repair of the sinus of Valsalva aneurysm and the tricuspid and aortic valve replacement. The patient's postoperative period was uneventful, and she was discharged healthy.
Hypercalcemia associated with isolated bone marrow sarcoidosis in a patient with underlying monoclonal gammopathy of undetermined significance: case report and review of literature
Authors: John Gubatan, Xiaohui Wang, Abner Louissaint, Anuj Mahindra, John Vanderpool
Journal: Biomark Res (2016)
Keywords: bone marrow sarcoidosis, hypercalcemia, lymphoproliferative disorders, monoclonal gammopathy of underdetermined significance
MeSH terms: Case Reports

Background:
Bone marrow sarcoidosis is extremely rare. The association between sarcoidosis and lymphoproliferative disorders has been previously speculated, although the diagnosis of sarcoidosis often precedes any hematological derangements.
Case presentation:
Here, we report for the first time, a case of a 57-year-old Caucasian woman with a previous diagnosis of monoclonal gammopathy of undetermined significance (MGUS) developing hypercalcemia and renal failure with workup notable for isolated bone marrow sarcoidosis and not multiple myeloma as expected. The patient was successfully managed with prednisone taper therapy with resolution of her hypercalcemia and repeat bone marrow biopsies demonstrating resolving granulomas.
Conclusions:
Our case illustrates the diagnostic challenges associated with bone marrow sarcoidosis and suggest that chronic immune stimulation in the bone marrow in the setting of MGUS may be associated with the development of localized sarcoidosis. The long term consequences of steroid therapy targeting sarcoidosis in this patient with underlying MGUS remain unknown. Greater surveillance and closer followup is planned in light of the increased risk of malignant transformation of MGUS into multiple myeloma in the setting of bone marrow sarcoidosis.
Isolated sixth cranial nerve palsy as the presenting symptom of a rapidly expanding ACTH positive pituitary adenoma: a case report
Authors: Norman Saffra, Elizabeth Kaplow, Irina Mikolaenko, Alice Kim, Benjamin Rubin, Jafar Jafar
Journal: BMC Ophthalmol (2011)
MeSH terms: Abducens Nerve Diseases / etiology, Adenoma / complications, Adenoma / metabolism, Adrenocorticotropic Hormone / metabolism, Pituitary Neoplasms / complications, Pituitary Neoplasms / metabolism, Case Reports, Adenoma / diagnosis, Adenoma / surgery, Adult, Emergency Medical Services, Female, Humans, Hypophysectomy / methods, Magnetic Resonance Imaging, Pituitary Neoplasms / diagnosis, Pituitary Neoplasms / surgery, Sarcoidosis / complications, Sphenoid Bone / surgery, Stroke / complications, Adrenocorticotropic Hormone

Background:
Pituitary adenoma may present with neuro-ophthalmic manifestations and, typically, rapid tumor expansion is the result of apoplexy. Herein, we present the first case of an isolated sixth cranial nerve palsy as initial feature of a rapidly expanding ACTH positive silent tumor without apoplexy.
Case presentation:
A 44 year old female with a history of sarcoidosis presented with an isolated sixth cranial nerve palsy as the initial clinical feature of a rapidly expanding ACTH positive silent pituitary adenoma. The patient underwent emergent transsphenoidal hypophysectomy for this rapidly progressive tumor and subsequently regained complete vision and ocular motility. Despite tumor extension into the cavernous sinus, the other cranial nerves were spared during the initial presentation.
Conclusions:
This case illustrates the need to consider a rapidly growing pituitary tumor as a possibility when presented with a rapidly progressive ophthalmoplegia.
Severe Pulmonary Hypertension in a Patient with Scurvy: Can a Vitamin Reverse It?
Authors: Vandan Shah, Ruchit N Shah, Lauren Greene, Lauren M DiMarino
Journal: Case Rep Med (2021)
MeSH terms: Case Reports

Introduction:
Pulmonary hypertension secondary to scurvy is a rare manifestation that historically has not been well studied and is only described in a handful of case reports.
Case:
Our case is about a 35-year-old female with a history significant for drug and tobacco abuse, obesity, poor diet, anxiety, and major depressive disorder who was found to have severe pulmonary hypertension in the setting of vitamin C deficiency (<0.01 mg/L).
Conclusion:
We present a case that shows pulmonary hypertension can be associated with scurvy and reversed rapidly with adequate vitamin C supplementation.
Hidradenitis Suppurativa Recurrence in a Caesarean Scar
Authors: K M Darch, T L Holland, L J Spelman
Journal: Case Rep Obstet Gynecol (2020)
MeSH terms: Case Reports

Hidradenitis suppurativa (HS), also known as acne inversa, is a chronic, relapsing inflammatory skin condition characterised by the presence of painful nodules, abscesses, and sinus tracts or scarring. Affecting up to 4% of the population, it is not uncommon and is seen predominantly in females at a ratio of 3 : 1. HS carries a substantial burden for those who suffer from it, from the significant psychosocial impact, to the cost of the multitude of topical and systemic treatments which often do not successfully control its symptoms. In this case report, we discuss a 33-year-old female known to our clinic, who presented with a recurrence of her HS in a caesarean scar, with otherwise silent disease. From our review of the literature, this appears to be only the second case of recurrence of HS in a caesarean scar reported to date. With a predilection for females of reproductive ages, involvement of sensitive areas, and an average of greater than seven years from onset of symptoms until diagnosis, the ability to recognise HS and ensure referral for specialist management is essential for all who are regularly involved in the management of this patient group.
Raising the suspicion of a non-autochthonous infection: identification of Leishmania guyanensis from Costa Rica exhibits a Leishmaniavirus related to Brazilian north-east and French Guiana viral genotypes
Authors: Carlos Mata-Somarribas, José Quesada-López, María F Matamoros, César Cervantes-Gómez, Annia Mejía, Karen Chacón, Ivannia Bendig, Roger Campos, Raphael Quesada-Morera, Lilian Motta Cantanhêde, Luiza de Oliveira R Pereira, Elisa Cupolillo
Journal: Mem Inst Oswaldo Cruz (2023)
MeSH terms: Leishmania guyanensis / genetics, Leishmaniasis, Cutaneous / parasitology, Leishmaniavirus / genetics, Case Reports, Brazil / epidemiology, Costa Rica, French Guiana, Genotype, Humans

Background:
Costa Rica has a history of neglecting prevention, control and research of leishmaniasis, including limited understanding on Leishmania species causing human disease across the country and a complete lack of knowledge on the Leishmania RNA virus, described as a factor linked to the worsening and metastasis of leishmanial lesions.
Objectives:
The aim of this work was to describe a case of cutaneous leishmaniasis by Leishmania (Viannia) guyanensis, bearing infection with Leishmaniavirus 1 (LRV1) in Costa Rica, raising the suspicion of imported parasites in the region.
Methods:
The Leishmania strain was previously identified by routine hsp70 polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) in Costa Rica and subsequently characterised by isoenzyme electrophoresis and Sanger sequencing in Brazil. Screening for LRV1 was conducted with a dual RT-PCR approach and sequencing of the fragment obtained.
Findings:
Since 2016 Costa Rica performs Leishmania isolation and typing as part of its epidemiological surveillance activities. Amongst 113 strains typed until 2019, only one was characterised as a L. (V.) guyanensis, corresponding to the first confirmed report of this species in the country. Interestingly, the same strain tested positive for LRV1. Sequencing of the viral orf1 and 2, clustered this sample with other LRV1 genotypes of South American origin, from the Northeast of Brazil and French Guiana.
Main conclusion:
The unique characteristics of this finding raised the suspicion that it was not an autochthonous strain. Notwithstanding its presumed origin, this report points to the occurrence of said endosymbiont in Central American Leishmania strains. The possibility of its local dispersion represents one more challenge faced by regional health authorities in preventing and controlling leishmaniasis.
Glucose Control in Post-hemolytic-Uremic Syndrome Diabetes: A New Approach Offered by Sensor-Augmented Pump Therapy
Authors: Valeria Grancini, Federica Alessandra Vianello, Santo Colosimo, Alessia Gaglio, Veronica Resi, Maura Arosio, Gianluigi Ardissino, Giovanni Montini, Emanuela Orsi
Journal: Front Pediatr (2022)
Keywords: sap therapy, continuous glucose monitoring, diabetes, hemolytic-uremic syndrome, insulin, insulin pump therapy
MeSH terms: Case Reports

We report the case of a 3-year-old girl admitted to her town emergency department for fever (39°C) associated with diarrhea, generalized edema, oliguria, and drowsiness. The blood test revealed metabolic acidosis, leucocytosis, increased inflammatory markers, anemia, thrombocytopenia, and acute kidney failure. Based on the diagnosis of hemolytic-uremic syndrome, the patient was referred to a third-level children hospital. Assisted ventilation, hemodialysis, and parenteral nutrition were instituted. The blood glucose levels increased above 200 mg/dl with peaks at 500 mg/dl. Islet auto-antibodies were negative and C-peptide was undetectable, thus ruling out the diagnosis of type 1 diabetes. Multiple-daily-injection insulin therapy was then instituted with the following regimen: Detemir 2 U once daily and Aspart 0.5 U if blood glucose >200 mg/dl. Despite the very low insulin dosage, the patient experienced frequent and severe hypoglycemic events during the following 24 h and was therefore switched to sensor-augmented pump therapy. Optimal glucose control was achieved without further hypoglycemic episodes. Moreover, thanks to the possibility to customize insulin therapy hour by hour during the day and the use of a pre-low glucose suspend system, glucose control was maintained even despite the continuous modifications in the nutritional scheme due to the multiple complications that arose during hospitalization. This rare case of post-hemolytic-uremic syndrome diabetes, treated with sensor-augmented therapy from its outbreak, suggests for the first time the potential of this therapeutic strategy in achieving glucose control without significant hypoglycemic episodes in children with secondary forms of diabetes associated with very low insulin requirement.
Dent's disease: An unusual cause of kidney failure
Authors: Luís Leite de Sousa, Gonçalo Pimenta, Rita Veríssimo, Tiago J Carvalho, Ivo Laranjinha
Journal: Clin Nephrol Case Stud (2023)
Keywords: clcn5, dent’s disease, hypercalciuria, low-molecular-weight proteinuria, nephrocalcinosis
MeSH terms: Case Reports

Dent's disease is an X-linked recessive disease characterized by proximal tubulopathy with low-molecular weight proteinuria, hypercalciuria, nephrolithiasis, nephrocalcinosis, and kidney failure. It is mainly caused by mutations in the CLCN5 or OCRL1 genes, and only ~ 250 families have been identified with these mutations. We present a 31-year-old male referred to a nephrology consultation due to elevated serum creatinine and a history of nephrolithiasis. Complementary evaluation revealed protein/creatinine ratio of 1.9 g/g and albumin/creatinine ratio of 0.5 g/g, hypercalciuria and medullary nephrocalcinosis. These findings raised the suspicion of Dent's disease, which was confirmed by genetic testing. A missense mutation in the CLCN5 gene (c.810C>G, p.(Ser270Arg)), not previously reported in populational databases, was identified. During the evaluation of the patient, it came to our attention that a first-degree male cousin was being followed in our kidney transplantation unit. Given the unknown etiology of his chronic kidney disease, genetic testing was performed, identifying the same mutation. This case highlights the importance of considering the diagnosis of Dent's disease in the setting of a male patient with chronic kidney disease of unknown etiology, low-molecular-weight proteinuria, hypercalciuria, and nephrocalcinosis. Despite progression to end-stage kidney failure in a significant portion of male patients, there are no reports of recurrence after kidney transplantation.
Ruminococcus gnavus bacteraemia in a patient with multiple haematological malignancies
Authors: Caroline Gren, Malene Roed Spiegelhauer, Emelie Curovic Rotbain, Boje Kvorning Ehmsen, Peter Kampmann, Leif Percival Andersen
Journal: Access Microbiol (2019)
Keywords: bacteremia, maldi-tof ms, gut commensals, microbiology, ruminococcus gnavus, hematology
MeSH terms: Case Reports

We present a case of Ruminococcus gnavus sepsis in a woman suffering from multiple myeloma and myelodysplastic syndrome. R. gnavus , a Gram-positive coccus and a gut commensal, has been described in nine cases of infection in the literature, with most infections having occurred in patients with either gastrointestinal symptoms or prosthesis infections. In this case, R gnavus was identified by mass spectrometry, and showed susceptibility to penicillin, meropenem, tetracycline, metronidazole and clindamycin. The patient was successfully treated initially with intravenous piperacillin/tazobactam and metronidazole, and then switched to oral penicillin and metronidazole. The cause of infection is hypothesized to have been a shift in the gut microbiota towards an excess growth of R. gnavus caused by immunosuppression, and bacterial translocation across a vulnerable mucosal barrier due to prednisolone treatment and severe thrombocytopenia.
Hyperechogenicity of the Substantia Nigra in Parkinson's Disease: Insights from Two Brothers with Markedly Different Disease Durations
Authors: Julie M Hall, Matthew J Georgiades, Deborah A Hammond, Xiaoting Feng, Ahmed A Moustafa, Simon J G Lewis, Gabrielle Todd
Journal: Case Rep Neurol Med (2017)
MeSH terms: Case Reports

We present clinical features and substantia nigra morphology for two brothers with Parkinson's disease (PD) aged 60 and 59 years. The brothers were diagnosed at 41 and 50 years of age, respectively. Both patients exhibited an abnormally large area of substantia nigra echogenicity bilaterally when viewed with transcranial ultrasound. The abnormality was similar in both brothers despite one having a much longer disease duration than the other. These findings further highlight that transcranial ultrasound is not associated with severity of clinical symptoms, but it might assist in the diagnosis of PD provided that it is combined with other variables known to precede PD.
COVID-19 Associated Imported Plasmodium vivax Malaria Relapse: First Reported Case and Literature Review
Authors: Zubair Shahid, Nadia Karim, Fakhar Shahid, Zohaib Yousaf
Journal: Res Rep Trop Med (2021)
Keywords: sars-cov-2, co-infection, fever, headaches, reactivation
MeSH terms: Case Reports

Plasmodium vivax (P. vivax) is a protozoan parasite that causes vivax malaria. Disease relapse post-treatment is reported in P. vivax co-infection with other bacterial and parasitic infections, but Plasmodium vivax reactivation is not very common with viral infections. Early recognition and diagnosis of a Plasmodium vivax malaria relapse in a non-endemic region pose a diagnostic dilemma. COVID-19 co-infection compounds this dilemma due to overlapping symptoms. Early diagnosis and treatment are essential for a favorable clinical outcome. We report a middle-aged gentleman with high-grade fever and headaches who had COVID-19 and was found to have a relapse of Plasmodium vivax malaria.
Vitamin D deficiency following Billroth II surgery - How much vitamin D is enough?: a case report
Authors: Eva Sampl, Doris Wagner, Claudia Friedl, Harald Dobnig, Astrid Fahrleitner-Pammer
Journal: Cases J (2010)

Background:
Vitamin D deficiency with all its consequences is a global health problem.
Case presentation:
We reported a 62-year-old Caucasian woman with alcohol-related liver cirrhosis (Child class A) and a medical history of Billroth II surgery. Although she has taken an oral dose of 16 800 IU vitamin D daily for six weeks to normalise her 25-hydroxyvitamin D level the raise was only moderate.
Conclusion:
High-dose oral or parenteral vitamin D therapy is necessary to gain sufficient 25-hydroxyvitamin D serum levels in patients following gastric surgery.
Midgut malrotation complicated by small bowel obstruction in an 80-year-old woman: A case report
Authors: Maha Haqqani, Mani Seetharaman, Richard Teo, Christian Adkisson, Michelle Nessen, Marc Dauer, Peter K Kim
Journal: Int J Surg Case Rep (2019)
Keywords: case report, ladd procedure, malrotation, small bowel obstruction

Introduction:
Midgut malrotation results from abnormalities in the 270-degree counterclockwise rotation of the midgut around the axis of the superior mesenteric artery during embryological development, and classically presents early in life with symptoms of intestinal obstruction. Nevertheless, adult cases have occasionally been reported.
Presentation of case:
An 80-year-old female with no surgical history was brought to our emergency department for acutely altered mental status. On exam, her abdomen was distended and diffusely tender to palpation. Computed tomography (CT) scan of the abdomen and pelvis showed a dilated loop of jejunum with evidence of mesenteric twist concerning for closed-loop small bowel obstruction. The patient was taken for exploratory laparotomy and was found to have Ladd bands and other findings suggestive of intestinal malrotation. A Ladd procedure was performed and the patient remained under observation. She experienced intermittent abdominal distension and bilious nasogastric tube output, but subsequent CT scans revealed no evidence of obstruction. She was discharged following clinical improvement and ability to tolerate a diet.
Discussion:
Malrotation of the small bowel exists on a spectrum depending on the embryologic stage during which anomalous rotation occurs. Classic findings on CT imaging (including abnormal mesenteric vasculature, right-sided duodenojejunal junction, whirlpool signs, and left-sided ascending colon) can provide clues to the existence of malrotation.
Conclusion:
Although malrotation is rare in adults, clinical and radiologic findings play an important role in the correct diagnosis of adult malrotation for appropriate and timely intervention.
Bilateral Tensor Fasciae Suralis Muscles in a Cadaver with Unilateral Accessory Flexor Digitorum Longus Muscle
Authors: Logan S W Bale, Sean O Herrin
Journal: Case Rep Med (2017)
MeSH terms: Case Reports

Muscle variants are routinely encountered in the dissection laboratory and in clinical practice and therefore anatomists and clinicians need to be aware of their existence. Here we describe two different accessory muscles identified while performing educational dissection of a 51-year-old male cadaver. Tensor fasciae suralis, a rare muscle variant, was identified bilaterally and accessory flexor digitorum longus, a more common muscle variant, was present unilaterally. Tensor fasciae suralis and accessory flexor digitorum longus are clinically relevant muscle variants. To our knowledge, the coexistence of tensor fasciae suralis and accessory flexor digitorum longus in the same individual has not been reported in either cadaveric or imaging studies.