OpenMed/multicare-articles huggingface dataset:
Case report: Hemophagocytic lymphohistiocytosis complicated by multiple organ dysfunction syndrome following aseptic encephalitis
Authors: Quan-Ting Chen, Ming-Hua Chen, Yu-Kai Lin, Ren-Hua Yeh, Chun-Chi Lu, Po-Jen Hsiao, Yueh-Feng Sung
Journal: Front Immunol (2023)
Keywords: encephalitis, hemophagocytic lymphohistiocytosis, multiple organ dysfunction syndrome, seizure, status epilepticus
MeSH terms: Cytopenia, Encephalitis / complications, Encephalitis / diagnosis, Lymphohistiocytosis, Hemophagocytic / diagnosis, Lymphohistiocytosis, Hemophagocytic / etiology, Lymphohistiocytosis, Hemophagocytic / therapy, Case Reports, Research Support, U.S. Gov't, Non-P.H.S., Research Support, Non-U.S. Gov't, Adult, Death, Humans, Male, Multiple Organ Failure / diagnosis, Multiple Organ Failure / etiology, Multiple Organ Failure / therapy

Hemophagocytic lymphohistiocytosis (HLH) is a rare but potentially life-threatening condition caused by excessive immune activation. Secondary HLH is usually triggered by infection, most often from viral infection or malignancy. Here, we present a case of secondary HLH, complicated by multiple organ dysfunction syndrome triggered by critical aseptic encephalitis. A 27-year-old man without any underlying disease presented to our hospital with fever, disturbance of consciousness, and generalized seizures. The patient was diagnosed with aseptic encephalitis with super-refractory status epilepticus. Although antiseizure medications and immunoglobulins were administered, the patient developed multiple organ dysfunction syndrome. HLH was later diagnosed based on hypertriglyceridemia, hyperferritinemia, splenomegaly, cytopenia, and phagocytosis of nucleated cells, as shown by a blood smear of bone marrow aspiration. Treatment with pulse steroid therapy and plasmapheresis was initiated rather than chemotherapy because of the patient's critical condition. However, the patient died of profound shock and multiple organ failure. Diagnosis of HLH is challenging in patients with severe infections because of similar clinical manifestations and laboratory findings. The early recognition of HLH provides patients with the opportunity to receive appropriate treatment, which can lead to increased survival and remission rates.
Case report: safety and efficacy of lidocaine infusion for the treatment of intractable zoster-associated neuralgia in solid organ transplant recipients
Authors: Huan Zheng, Bixin Zheng
Journal: Front Pharmacol (2024)
Keywords: case series, herpes zoster, intravenous, lidocaine, neuropathic pain, post-herpetic neuralgia, solid organ transplantation
MeSH terms: Case Reports

Introduction:
Solid organ transplant recipients are at high risk for developing severe zoster-associated neuralgia, and the pharmaceutic therapies of pain management for these patients with limited organ function are challenging. Intravenous lidocaine infusion showed positive analgesic effects and is used for the management of neuropathic pain. This case series reports the safety and effectiveness of intravenous lidocaine infusion in the treatment of intractable zoster-associated neuralgia in solid organ transplant recipients.
Case series presentation:
Five solid organ transplant recipients suffering from refractory zoster-associated neuralgia (numeric rating scale 8-10, despite using high doses of antiepileptic drugs or combined with opioids) were enrolled. Intravenous lidocaine (5 mg/kg ideal bodyweight) was administered over 1.5 h with the monitoring of vital signs. Pain intensity, patient satisfaction, adverse events, typical liver, and kidney function were evaluated. All subjects reported high satisfaction with their treatment and effective pain relief at the 6-month follow-up. One patient experienced short and mild numbness in the mouth and dizziness after the therapy, but no major adverse reactions were reported.
Conclusion:
This case series provides evidence that intravenous lidocaine infusion provided effective pain relief as an analgesic treatment option for transplant patients with intractable zoster-associated neuralgia.
Multiple variation of right renal and gonadal vascularization: report of two cases
Authors: Marcelo Calil Burihan, Silvio Antonio Garbelotti, Paulo Laino Cândido, Rodrigo Barbosa de Souza, Osvaldo Pelozo, Aluisio Andrade, Marco Antonio De Angelis
Journal: J Vasc Bras (2024)
Keywords: accessory renal artery, anatomical variation, gonadal vein, renal vein
MeSH terms: Case Reports

We present two cases of multiple anatomical variations of the renal and gonadal vessels. The first case presented duplication of the renal vein and the presence of an accessory renal artery. However, the most interesting fact, in this case, was that the right gonadal vein emptied into the inferior right renal vein instead of ending in the inferior vena cava as would typically be the case. In the second case, we also found an accessory renal artery and the right gonadal vein emptied at the exact junction between the right renal vein and the inferior vena cava. Clinicians and surgeons should be familiar with anatomical variations to provide an accurate diagnosis during preoperative studies and to avoid surprises in abdominal surgical procedures.
A Case of Endovascular Aortic Repair for Abdominal Aortic Aneurysm with a Saccular Aneurysm in the Severely Angulated Proximal Landing Zone
Authors: Akito Imai, Kisato Mitomi, Masataka Sato, Kanji Matsuzaki, Yasunori Watanabe
Journal: Ann Vasc Dis (2023)
Keywords: evar, coil embolization, saccular aneurysm
MeSH terms: Case Reports

We report a case of endovascular aortic repair (EVAR) for the abdominal aortic aneurysm complicated by a saccular aneurysm due to a penetrating atherosclerotic ulcer in the severely angulated proximal landing zone. To secure the zone, coil embolization of the saccular aneurysm was performed before stent grafting to treat the abdominal aortic aneurysm. To precisely follow the severely angled proximal neck, we used the Excluder stent-graft system inserted by the body floss technique method instead of the stiff wire method to avoid accordion folding the proximal landing zone. These techniques may expand the indications of EVAR.
Bacterial pneumonia patients with elevated globulin levels did not get infected with SARS-CoV-2: two case reports
Authors: Qi Zhong, Qiu-Mei Lin, Hong-Bin Long, Cai-Xia Liao, Xiao-Xiao Sun, Miao-du Yang, Zhi-Hao Zhang, Yi-Hua Huang, Shi-Min Wang, Zhao-Shou Yang
Journal: Front Immunol (2024)
Keywords: sars-cov-2, bacterial pneumonia, case reports, cross-reactivity, globulin protein
MeSH terms: COVID-19 / complications, Pneumonia, Bacterial / diagnosis, Pneumonia, Bacterial / drug therapy, SARS-CoV-2, Case Reports, Aged, 80 and over, Anti-Bacterial Agents / therapeutic use, Humans, Male, Anti-Bacterial Agents

Background:
COVID-19 began in December 2019, rapidly spreading worldwide. China implemented a dynamic zero-COVID strategy and strict control measures after the outbreak. However, Guangzhou city ended closed-off management by the end of November 2022, leading to exposure to SARS-CoV-2. Despite most hospitalized patients being infected or co-infected with SARS-CoV-2, some remained uninfected. We report two cases of bacterial pneumonia with elevated globulin levels not infected with SARS-CoV-2, aiming to identify protection factors of SARS-CoV-2 infection and provide a scientific basis for SARS-CoV-2 prevention.
Case presentation:
Case 1, a 92-year-old male, admitted on October 21, 2022, developed worsening cough and sputum after aspiration, diagnosed with bacterial pneumonia with Pseudomonas aeruginosa, Escherichia coli (CRE) and carbapenem-resistant Acinetobacter baumannii (CRAB) infections. He was treated with imipenem anti-infective therapy and mechanical ventilation, then switched to a combination of meropenem, voriconazole and amikacin anti-infective therapy due to recurrent infections and septic shock, and died of sepsis on 8 January 2023. Case 2 is an 82-year-old male admitted on 30 September 2022, with recurrent cough, sputum, and shortness of breath, diagnosed with bacterial pneumonia with carbapenem-resistant Klebsiella pneumoniae (CRKP) and Mycobacterium pneumoniae infections. He was treated with ventilator-assisted ventilation, meropenem, amikacin, tigecycline and mucomycin nebulization and discharged with improvement on 26 October. He was readmitted on 21 November 2022 and diagnosed with bacterial pneumonia. He was treated with cefoperazone sulbactam, amikacin, meropenem and fluconazole and discharged on 31 December. Neither patient was infected with SARS-CoV-2 during hospitalization. Notably, their globulin levels were elevated before SARS-CoV-2 exposure, gradually decreasing afterward.
Conclusions:
Patients with bacterial pneumonia with high globulin levels likely have large amounts of immunoglobulin, and that immunoglobulin cross-reactivity causes this protein to be involved in clearing SARS-CoV-2 and preventing infection. Therefore, bacterial pneumonia patients with high globulin levels included in this study were not infected with SARS-CoV-2. After exposure to SARS-CoV-2, the amount of globulin in the patient's body was reduced because it was used to clear SARS-CoV-2. The results of this study are expected to provide a theoretical basis for the study of the mechanism of prevention and treatment of SARS-CoV-2 infection.
Case report: A case of Acute Macular Neuroretinopathy secondary to Influenza A virus during Long COVID
Authors: Jiaqi Zhang, Yihao Xia, Xiaodong Li, Runxi He, Xuejun Xie
Journal: Front Immunol (2024)
Keywords: inflammation, microvascular endothelial dysfunction, neutrophil extracellular trap, retinal diseases, retinoic acid depletion syndrome, virus infection
MeSH terms: COVID-19 / complications, Influenza A virus, Virus Diseases, White Dot Syndromes, Case Reports, Research Support, Non-U.S. Gov't, Female, Humans, Post-Acute COVID-19 Syndrome, SARS-CoV-2

Ocular abnormalities have been reported in association with viral infections, including Long COVID, a debilitating illness caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). This report presents a case of a female patient diagnosed with Acute Macular Neuroretinopathy (AMN) following an Influenza A virus infection during Long COVID who experienced severe inflammation symptoms and ocular complications. We hypothesize that the rare occurrence of AMN in this patient could be associated with the immune storm secondary to the viral infection during Long COVID.
Autoimmune glial fibrillary acidic protein astrocytopathy complicated with low flow perimedullary arteriovenous fistula: a case report
Authors: Ting Xu, Jingyun Chen, Tingting Xuan, Jiang Cheng, Haining Li
Journal: Front Immunol (2023)
Keywords: autoimmune disease, glial fiber acidic protein, low flow, perimedullary arteriovenous fistula, spinal vascular malformation
MeSH terms: Arteriovenous Fistula / complications, Arteriovenous Fistula / diagnostic imaging, Spinal Cord Diseases / etiology, Case Reports, Research Support, Non-U.S. Gov't, Brain, Glial Fibrillary Acidic Protein, Humans, Male, Middle Aged, Glial Fibrillary Acidic Protein

Autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy and low-flow perimedullary arteriovenous fistulas (PMAVFs) may cause longitudinal widespread myelopathy. We report a middle-aged male patient with autoimmune GFAP astrocytopathy complicated with low flow PMAVFs disease, presenting with lower extremity weakness and dysuria. Magnetic resonance imaging (MRI) of the spinal cord revealed a significant longitudinal extent of T2 high signal from T11 to L1, with the lesion located proximal to the vascular territory supplied by the anterior spinal artery. Multiple patchy abnormal signals were seen adjacent to the anterior and posterior horns of the lateral ventricles bilaterally and at the centers of the semi-ovals on MRI of the cranial brain, with iso signal in T1Flair, the high signal in T2WI, and no high signal seen in Diffusion Weighted Imaging (DWI). Subsequently, the presence of anti-GFAP antibodies was detected in the cerebrospinal fluid (CSF), and the diagnosis of autoimmune GFAP astrocytopathy in conjunction with low-flow PMAVFs was confirmed through spinal digital subtraction angiography (DSA). This case report aims to increase neurologists' awareness of this disease and avoid missed or misdiagnosed cases that may lead to delayed treatment.
Case report: Suspected organizing pneumonia secondary to severe respiratory syncytial virus pneumonia in an elderly patient
Authors: Min Feng, Jie Zhang, Xiangrui Li, Shuai Wang, Yanxia Li, Chang Dong
Journal: Front Med (Lausanne) (2024)
Keywords: case report, corticosteroids, elderly patient, oral ribavirin, organizing pneumonia, respiratory syncytial virus infection
MeSH terms: Case Reports

Respiratory syncytial virus (RSV) usually causes acute respiratory tract infection in infants. In recent years, it has gradually become an important pathogen of lower respiratory tract infection in elderly people with an underlying disease. However, at present, the treatment of severe RSV pneumonia in adults is unclear, and organizing pneumonia (OP) after severe RSV infection has rarely been reported. We reported a 76-year-old man with multiple chronic heart and lung diseases who presented with fever, cough and progressive dyspnea. Finally, severe RSV pneumonia was diagnosed after his nasopharyngeal swabs and bronchoalveolar lavage metagenomic next-generation sequencing tests were positive for RSV. After combined treatment with oral ribavirin, intravenous immunoglobulin and corticosteroids, the patient's condition largely resolved, and he was discharged. However, when the corticosteroids were gradually tapered, the disease relapsed twice, and the patient experienced fever and aggravated dyspnea. Despite the lack of pathological evidence, we highly suspected organizing pneumonia secondary to severe RSV pneumonia based on the typical imaging manifestations and the clinical characteristics of a good response to corticosteroids. Finally, this patient was successfully treated with a course of corticosteroids and followed up for 14 months in total.
The effect of using group-averaged or individualized brain parcellations when investigating connectome dysfunction in psychosis
Authors: Priscila T Levi, Sidhant Chopra, James C Pang, Alexander Holmes, Mehul Gajwani, Tyler A Sassenberg, Colin G DeYoung, Alex Fornito
Journal: Netw Neurosci (2023)
Keywords: connectomics, functional connectivity, individualized parcellation, psychosis, resting-state fmri, schizophrenia

Functional magnetic resonance imaging (fMRI) is widely used to investigate functional coupling (FC) disturbances in a range of clinical disorders. Most analyses performed to date have used group-based parcellations for defining regions of interest (ROIs), in which a single parcellation is applied to each brain. This approach neglects individual differences in brain functional organization and may inaccurately delineate the true borders of functional regions. These inaccuracies could inflate or underestimate group differences in case-control analyses. We investigated how individual differences in brain organization influence group comparisons of FC using psychosis as a case study, drawing on fMRI data in 121 early psychosis patients and 57 controls. We defined FC networks using either a group-based parcellation or an individually tailored variant of the same parcellation. Individualized parcellations yielded more functionally homogeneous ROIs than did group-based parcellations. At the level of individual connections, case-control FC differences were widespread, but the group-based parcellation identified approximately 7.7% more connections as dysfunctional than the individualized parcellation. When considering differences at the level of functional networks, the results from both parcellations converged. Our results suggest that a substantial fraction of dysconnectivity previously observed in psychosis may be driven by the parcellation method, rather than by a pathophysiological process related to psychosis.
Normal-Pressure Hydrocephalus-Like Appearance in Myotonic Dystrophy Type 1
Authors: Asuka Suzuki, Koji Hayashi, Yuka Nakaya, Maho Hayashi, Kouji Hayashi, Yasutaka Kobayashi, Mamiko Sato
Journal: Cureus (2024)
Keywords: brain anatomy, csf tap test, mri, myotonic dystrophy type 1, normal-pressure hydrocephalus
MeSH terms: Case Reports

Myotonic dystrophy type 1 (DM1) is one of the monogenic neurological diseases that neurologists most often experience. DM1 can develop several symptoms, including muscle weakness, gait disturbance, urinary incontinence, and cognitive decline. Other hand, normal pressure hydrocephalus (NPH) is more frequent in the elderly population and is characterized by a triad of symptoms, gait disturbance, urinary urge incontinence, and cognitive decline. Therefore, some symptoms overlap between DM1 and NPH. In this report, we described a case of DM1 that presented with a triad of NPH, and NPH-like changes in brain images. A 54-year-old man with DM1 visited our hospital for rehabilitation. He had a history of dyslipidemia, diabetes, and cataracts. He developed muscle weakness, blepharoptosis, and dysarthria at 43 years. Neuro-exam revealed percussion and grip myotonia, distal muscle weakness and atrophy, broad-based gait, and urinary incontinence. The mini-mental state examination score was 18. Brain magnetic resonance imaging revealed enlarged lateral and third ventricles and Evans index was 0.38 (NPH criterion; >0.3), which was mimicking for NPH. Tap test (TT) was evaluated twice. First TT improved clinical symptoms slightly, but second was unremarkable. Based on the second TT result, we could not diagnose with NPH and could prevent unnecessary surgical shunting. Brain imaging of DM1 can show an NPH-like appearance in patients older than 50. Although TT is the gold standard for diagnosing NPH, its sensitivity and specificity vary among reports. TT results should be interpreted with caution before performing a surgical shunt. If necessary, multiple TTs should be considered in DM1 patients.
Testicular metastasis from urothelial carcinoma: case report and literature review
Authors: Changxue Liu, Jing Liu, Qingbo Yang, Leilei Song, Xiaocheng Ma, Yonghua Wang
Journal: Front Oncol (2024)
Keywords: case report, chemotherapy, immunotherapy, metastasis, testis, urothelial carcinoma
MeSH terms: Case Reports

Urothelial carcinoma (UC) with testicular metastasis is extremely rare, and its modes of metastasis, prognosis, and treatment are unclear. In this report, we present an extraordinarily rare case of testicular metastasis arising from UC 8 years after surgery. The patient underwent left orchiepididymectomy and received immunotherapy postoperatively. After a 6-month follow-up, there were no signs of recurrence. Moreover, the clinical characteristics, metastasis pattern, and treatment plan were also summarized based on 14 earlier reported cases of UC with testicular metastasis.
A rare case of Sporadic Creutzfeldt-Jakob disease at a remote mountain hospital in the Indian Himalayan Region
Authors: Nitu Sharma, Jitender Kumar Sharma, Ashima Chander, Khushdeep Shergill, Meghna Yadav
Journal: Autops Case Rep (2024)
Keywords: autopsy, creutzfeldt-jakob disease, electroencephalography, neuropathology, prions
MeSH terms: Case Reports

Sporadic Creutzfeldt-Jakob disease (CJD) is a rare neurodegenerative spongiform encephalopathy that causes neuronal derangement secondary to prion protein. Its initial diagnosis is often complex and challenging due to non-specific clinical presentation, lack of awareness, and low clinical suspicion. This disease is invariably fatal, and most patients die within 12 months of presentation. Definite diagnosis of prion disease requires neuropathological analysis, usually done at autopsy. Here, we present the autopsy findings of a 57-year-old male patient, illustrating the complexity of diagnosing this disease early in the clinical course and the need for a broad differential diagnosis at the onset.
The Discovery of an S-shaped Kidney in a Patient With Prostate Cancer: A Rare Finding
Authors: Stavros Tsiakaras, Georgios Langas, Vasileios Rafailidis, Dimitrios Memmos, Ioannis Mykoniatis, Irene Asouhidou, Paraskevi Karamitsou, Petros Sountoulides, Dimitrios Kikidakis, Ioannis Vakalopoulos, George K Paraskevas, Alexandros Poutoglidis
Journal: Cureus (2024)
Keywords: anatomical variations, congenital abnormality, crossed fused ectopic kidney, s-shaped kidney, upper urinary tract
MeSH terms: Case Reports

Crossed fused renal ectopia (CFRE) constitutes a rare congenital anomaly of the urinary tract, typically characterized by its predominantly asymptomatic nature and frequent incidental discovery. This case report delineates the clinical profile of a 56-year-old male admitted to our Prostate Cancer Outpatient Clinic due to elevated prostate-specific antigen (PSA) levels, ultimately leading to the diagnosis of prostate cancer. The patient was asymptomatic, with no family or surgical background. Notably, a fused ectopic kidney was incidentally identified during the staging process involving abdominal computed tomography (ACT) scanning. Remarkably, no additional abnormalities of the urinary tract or renal dysfunction manifested in this specific case. The significance of this report lies in the underscored emphasis on the importance of employing precise imaging techniques and tailored management strategies for patients harboring such anatomical variations.
Glass in the Airways: A Bronchoscopic Challenge
Authors: Sai Doppalapudi, Ked Fortuzi, Abeer Qasim, Diaz Saez Yordanka, Misbahuddin Khaja
Journal: Cureus (2024)
Keywords: aspiration, bronchoscopy, chronic cough, foreign body aspiration, rigid bronchoscopy
MeSH terms: Case Reports

Foreign body aspiration (FBA) in adults is indeed a significant medical concern, albeit less common than in children. The increase in incidence with advancing age can be attributed to factors such as a decline in mental status and impairment of the swallowing reflex, which is more prevalent in the elderly population. The symptoms of FBA are highly variable, ranging from severe, acute asphyxiation, which may or may not involve complete airway obstruction, to more subtle signs like coughing, shortness of breath (dyspnea), choking, or fever. These varied presentations, coupled with the fact that many other medical conditions can mimic the respiratory symptoms seen in FBA, make diagnosis challenging. A high index of suspicion is often required, especially in cases where the patient's history does not clearly point toward aspiration. Immediate management focuses on supporting the airway, which is crucial given the potential for severe obstruction. Radiographic imaging plays a key role in localizing the foreign body, which is vital for planning its removal. Bronchoscopy, particularly flexible bronchoscopy, is the cornerstone of both diagnosis and treatment. This technique allows for direct visualization of the airways, localization of the foreign body, and its subsequent removal. This is crucial to avoid long-term complications, which can arise if the foreign body is not promptly and effectively removed. In this case report, we present a 64-year-old female patient who was found to have a foreign object positioned in the right lower lobe of the lungs that was removed via flexible bronchoscopy.