OpenMed/multicare-articles huggingface dataset:
Syncope With Sinus Arrest Following a Single Dose of a COVID-19 Vaccine
Authors: Mohamed Ghoweba, Muhie Dean Sabayon
Journal: Cureus (2023)
Keywords: cardiac electrophysiology, covid-19, covid-19 vaccine related adverse events, pfizer-biontech covid-19 vaccine related adverse events, sars cov-2, sinus arrest, syncope, vaccine induced bradycardia
MeSH terms: Case Reports

Vaccines against the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) are of paramount importance in combating the current coronavirus disease 2019 (COVID-19) pandemic. Syncopal episodes following routine vaccinations are well-reported; however, only a few cases of syncope following SARS-CoV-2 vaccines exist in the literature. This is a case report of a 21-year-old female patient who developed recurrent syncopal attacks over three months that started one day after receiving the first dose of the Pfizer-BioNTech COVID-19 vaccine (Pfizer, New York City; BioNTech, Mainz, Germany). Holter monitoring during successive episodes showed progressive bradycardia followed by a prolonged sinus arrest. The patient eventually required pacemaker placement that resulted in the total resolution of her symptoms. Further studies are required to investigate a possible correlation and the mechanisms involved.
Large Vaginal Varicosities in the Setting of Pregnancy without Known Hepatic or Vascular Risks: A Case Report and Review of the Literature
Authors: Mark Sueyoshi, Steven Clevenger, Elaine Hart
Journal: Case Rep Obstet Gynecol (2018)
MeSH terms: Case Reports

Pregnancy may cause the onset of vaginal or vulvar varicosities that may be a concern for hemorrhage risk during childbirth. A 38-year-old female G4P1112 at 34 weeks and 1 day was referred to an outpatient OB/Gyn clinic for evaluation of a large vaginal mass. The referring provider had concern for malignancy. Lesions of the vulva were biopsied and found to be benign. For two months prior to presentation, she was experiencing discomfort with walking, yellow vaginal discharge, and dysuria. Treatment with fluconazole showed no improvement. She denied any personal or family history of malignancies, varicosities, or hepatic issues. Past surgical history was significant for laparoscopic cholecystectomy and two cesarean sections. A large vaginal mass during pregnancy is a concern whether it is malignancy or large vaginal varicosities that may put the patient at risk of severe hemorrhage during childbirth. We concluded that the mass was large vaginal varicosities as there was no discernible etiology. A repeat cesarean section was recommended due to the risk of hemorrhage during childbirth. For long-term management, close observation postpartum was recommended. Spontaneous resolution is a potential outcome and this is what our patient experienced. Without an underlying etiology, supportive measures are the best options.
The clinical dilemma of the persistent idiopathic pneumoperitoneum: A case report
Authors: Enda Hannan, Eltaib Saad, Shu Hoashi, Desmond Toomey
Journal: Int J Surg Case Rep (2019)
Keywords: conservative, idiopathic, laparotomy, perforation, pneumoperitoneum, spontaneous

Introduction:
Idiopathic pneumoperitoneum (IP) is a rare phenomenon which merits special attention. It is defined as free intraperitoneal air which is not caused by viscus perforation and does not require surgical intervention. It is generally considered a diagnosis of exclusion and often poses a genuine diagnostic dilemma.
Presentation of case:
We present an unusual case of persistent pneumoperitoneum with no identifiable cause which was found incidentally on a computed tomography (CT) scan in a patient with chronic cough and no prior surgical history. Serial consults revealed no abdominal symptoms or signs. He was managed conservatively and remains asymptomatic despite having a persistent IP on serial radiology.
Discussion:
To our knowledge, our case is the first in the literature of an idiopathic pneumoperitoneum that persisted on subsequent radiology and was managed successfully without surgical intervention. This is a highly important case for all practicing general surgeons to learn from as knowledge of this phenomenom may help avoid unnecessary surgical intervention and potential morbidities associated with this.
Conclusion:
IP is a diagnosis of exclusion which should only be made after surgical and non-surgical causes have been outruled. In the absence of signs of peritonitis and evidence of gastrointestinal perforation on CT, a conservative approach is warranted, allowing patients to avoid unnecessary surgical intervention.
Case Report: Add-on treatment with odevixibat in a new subtype of progressive familial intrahepatic cholestasis broadens the therapeutic horizon of genetic cholestasis
Authors: Angela Pepe, Angelo Colucci, Martina Carucci, Lucia Nazzaro, Cristina Bucci, Giusy Ranucci, Angelo Di Giorgio, Pietro Vajro, Claudia Mandato
Journal: Front Pediatr (2023)
Keywords: ibat, pfic, cholestasis, itching, odevixibat
MeSH terms: Case Reports

Odevixibat, an ileal bile acid transporter (IBAT) inhibitor, is effective for the treatment of pruritus in children diagnosed with progressive familial intrahepatic cholestasis (PFIC) type 1 and 2. There are no studies showing the efficacy of Odevixibat in children with different subtypes of PFIC. We describe the case of a 6-year-old girl with chronic cholestatic jaundice. In the last 12 months laboratory data showed high serum levels of bilirubin (total bilirubin x 2.5 ULN; direct bilirubin x 1.7 ULN) and bile acids (sBA x 70 ULN), elevated transaminases (x 3-4 ULN), and preserved synthetic liver function. Genetic testing showed homozygous mutation in ZFYVE19 gene, which is not included among the classic causative genes of PFIC and determined a new non-syndromic phenotype recently classified as PFIC9 (OMIM # 619849). Due to the persistent intensity of itching [score of 5 (very severe) at the Caregiver Global Impression of Severity (CaGIS)] and sleep disturbances not responsive to rifampicin and ursodeoxycholic acid (UDCA), Odevixibat treatment was started. After treatment with odevixibat we observed: (i) reduction in sBA from 458 to 71 μmol/L (absolute change from baseline: -387 μmol/L), (ii) reduction in CaGIS from 5 to 1, and (iii) resolution of sleep disturbances. The BMI z-score progressively increased from -0.98 to +0.56 after 3 months of treatment. No adverse drug events were recorded. Treatment with IBAT inhibitor was effective and safe in our patient suggesting that Odevixibat may be potentially considered for the treatment of cholestatic pruritus also in children with rare subtypes of PFIC. Further studies on a larger scale could lead to the increasing of patients eligible for this treatment.
Successful Treatment of Intracranial Hemorrhage with Recombinant Activated Factor VII in a Patient with Newly Diagnosed Acute Myeloid Leukemia: A Case Report and Review of the Literature
Authors: Naveen Pemmaraju, Koji Sasaki, Daniel Johnson, Naval Daver, Vahid Afshar-Kharghan, Merry Chen, Sairah Ahmed, Rivka R Colen, Michael Kwon, Yang Huh, Gautam Borthakur
Journal: Front Oncol (2015)
Keywords: acute myeloid leukemia, intracranial hemorrhage, recombinant activated factor vii

Intracranial hemorrhage (ICH) is a common complication in acute myeloid leukemia (AML) patients with an incidence rate of 6.3% (1). Bleeding disorders related to disseminated intravascular coagulation (DIC) are common complications in AML cases (2). Recombinant activated Factor VII [rFVIIa (NovoSeven(®))] is approved for the treatment of bleeding complications with FVIII or FIX inhibitors in patients with congenital FVII deficiency. Use of rFVIIa for the treatment of acute hemorrhage in patients without hemophilia has been successful (3, 4). Herein, we describe the successful use of rFVIIa in a patient with acute ICH in the setting of newly diagnosed AML.
Bronchogenic cyst removal via thoracoscopic surgery in the prone position: A case report and literature review
Authors: Yoshihiro Ota, Takafumi Watanabe, Kosuke Takahashi, Takeshi Suda, Shingo Tachibana, Jun Matsubayashi, Yuichi Nagakawa, Yoshiaki Osaka, Kenji Katsumata, Akihiko Tsuchida
Journal: Int J Surg Case Rep (2019)
Keywords: bronchogenic cyst, imaging, prone position, thoracoscopic surgery

Introduction:
Mediastinal bronchogenic cysts are encountered relatively often, but in many cases, diagnosis using imaging modalities, is difficult. Early surgical excision of bronchogenic cysts is recommended as a diagnostic and therapeutic measure. Here, we report the case of patient with a lower mediastinal bronchogenic cyst, who was treated using thoracoscopic surgery with prone positioning and include a review of literature on diagnosis and treatment of this condition.
Presentation of case:
The patient was a 66-year-old woman with an asymptomatic cystic lesion in the posterior, lower mediastinum. The lesion was diagnosed as an esophageal cyst using preoperative imaging and was scheduled for thoracoscopic removal with the patient in the prone position. Intraoperatively, the lesion was found to have no continuity with the esophageal wall and was easily separated from it. Moreover, a cord extending to the lesion, appeared to arise from the crura of the diaphragm. On histopathological examination of the extracted mass, the lesion was diagnosed as a bronchogenic cyst. Postoperatively, the patient recovered uneventfully and was discharged after 7 days.
Conclusion:
Thoracoscopic mediastinal cystectomy with the patient in the prone position may be an optimal surgical strategy for the treatment of bronchogenic cysts in the posterior, lower mediastinum.
Cocaine-induced renal infarction: report of a case and review of the literature
Authors: Shahrooz Bemanian, Mazda Motallebi, Saeid M Nosrati
Journal: BMC Nephrol (2005)
MeSH terms: Cocaine / adverse effects, Infarction / chemically induced, Kidney / blood supply, Case Reports, Review, Diagnosis, Differential, Humans, Infarction / diagnosis, Kidney Calculi / diagnosis, Male, Middle Aged, Tomography, Emission-Computed, Single-Photon, Tomography, X-Ray Computed, Urinary Tract Infections / diagnosis, Cocaine

Background:
Cocaine abuse has been known to have detrimental effects on the cardiovascular system. Its toxicity has been associated with myocardial ischemia, cerebrovascular accidents and mesenteric ischemia. The pathophysiology of cocaine-related renal injury is multifactorial and involves renal hemodynamic changes, alterations in glomerular matrix synthesis, degradation and oxidative stress, and possibly induction of renal atherogenesis. Renal infarction as a result of cocaine exposure, however, is rarely reported in the literature.
Case presentation:
A 48 year-old male presented with a four-day history of severe right flank pain following cocaine use. On presentation, he was tachycardic, febrile and had severe right costovertebral angle tenderness. He had significant proteinuria, leukocytosis and elevated serum creatinine and lactate dehydrogenase. Radiographic imaging studies as well as other screening tests for thromboembolic events, hypercoagulability states, collagen vascular diseases and lipid disorders were suggestive of Cocaine-Induced Renal Infarction (CIRI) by exclusion.
Conclusion:
In a patient with a history of cocaine abuse presenting with fevers and flank pain suggestive of urinary tract infection or nephrolithiasis, cocaine-induced renal infarction must be considered in the differential diagnosis. In this article, we discuss the prior reported cases of CIRI and thoroughly review the literature available on this disorder. This is important for several reasons. First, it will allow us to discuss and elaborate on the mechanism of renal injury caused by cocaine. In addition, this review will demonstrate the importance of considering the diagnosis of CIRI in a patient with documented cocaine use and an atypical presentation of acute renal injury. Finally, we will emphasize the need for a consensus on optimal treatment of this disease, for which therapy is not yet standardized.
Ileocecal ulcers accompanied by relapsing polychondritis: a case report
Authors: Yoko Kawakami, Katsuya Endo, Tomonori Ishii, Sho Haneda, Fumiyoshi Fujishima, Yoichi Kakuta, Hisashi Shiga, Yoshitaka Kinouchi, Tooru Shimosegawa
Journal: Springerplus (2014)
Keywords: ileocecal ulcers, intestinal behçet’s disease, magic syndrome, relapsing polychondritis

Introduction:
Mouth and genital ulcers with inflamed cartilage (MAGIC) syndrome is a rare overlap syndrome that includes features characteristic of both Behçet's disease (BD) and relapsing polychondritis (RP).
Case description:
A 30-year-old female complained of lower abdominal pain and bloody stools during medical treatment for RP. Total colonoscopy revealed oval-shaped deep ulcers on the terminal ileum similar to those of intestinal BD. After performing the ileocecal resection, both RP and gastrointestinal lesions relapsed, but improved with infliximab treatment.
Discussion and evaluation:
During medical treatment for RP, we experienced a rare case with ileocecal ulcers similar to intestinal BD. Although our case did not meet the diagnosis criteria of intestinal BD because of the lack of BD's major clinical symptoms, intestinal lesions shared quite similar features with intestinal BD. Our case could possibly be a rare subtype of MAGIC syndrome that had the features characteristic of both intestinal BD and RP.
Conclusions:
We described a rare case of ileocecal ulcers without any BD symptoms but accompanied by RP, possibly be a subtype of MAGIC syndrome.
Acute Hypocalcemia and Metabolic Alkalosis in Children on Cation-Exchange Resin Therapy
Authors: Aadil Kakajiwala, Kevin T Barton, Elisha Rampolla, Christine Breen, Madhura Pradhan
Journal: Case Rep Nephrol (2017)
MeSH terms: Case Reports

Background:
Sodium polystyrene sulfonate (SPS) is a chelating agent used for the treatment of hyperkalemia. SPS has a wide range of exchange capacity requiring close monitoring of serum electrolytes. We observed two patients who developed acute hypocalcemia and increased metabolic alkalosis after initiating SPS therapy. We report these cases to draw attention to the potential risk of this medication in pediatric patients.
Case diagnosis/treatment:
Two children with chronic kidney disease on dialysis were started on SPS for hyperkalemia. Within a week after initiation of the medication, both patients developed hypocalcemia on routine labs without overt clinical manifestations. The hypocalcemia was rapidly corrected with oral supplementation and discontinuation of SPS.
Conclusions:
Severe hypocalcemia can develop after SPS therapy. The metabolic alkalosis in these patients associated with the hypocalcemia put them at increased risk for complications. Hence, careful attention must be paid to the state of calcium metabolism in all patients receiving SPS. Often calcium supplementation is required to maintain normal calcium levels.
Pseudomonas aeruginosa: An Uncommon Cause of Antibiotic-Associated Diarrhea in an Immunocompetent Ambulatory Adult
Authors: Ryan T Hoff, Ami Patel, Alan Shapiro
Journal: Case Rep Gastrointest Med (2020)
MeSH terms: Case Reports

Pseudomonas aeruginosa is an opportunistic Gram-negative pathogen known to cause enterocolitis in children, amongst other types of infections. Pseudomonas aeruginosa has been widely reported as a cause of antibiotic-associated diarrhea in adult immunocompromised hosts. We present an 81-year-old previously healthy female as the first reported case of Pseudomonas aeruginosa antibiotic-associated diarrhea in an immunocompetent host in the United States.
Aplasia cutis congenita: a report of two cases from National Hospital Abuja, Nigeria and review of the literature
Authors: Mariya Mukhtar-Yola, Lauretta Mshelia, Amsa Baba Mairami, Adekunle Tolutope Otuneye, Edith Terna Yawe, Patricia Igoche, Lamidi Isah Audu
Journal: Pan Afr Med J (2020)
Keywords: aplasia cutis congenita, nigeria, newborn, scalp
MeSH terms: Ectodermal Dysplasia / therapy, Patient Care Team / organization & administration, Case Reports, Review, Ectodermal Dysplasia / physiopathology, Humans, Infant, Newborn, Male, Nigeria

Aplasia cutis congenita is a rare congenital abnormality first described in 1767 by cordon. It mostly appears as a solitary lesion involving various layers of the skin and sometimes the bone on the scalp, limbs or abdomen. Genetics, environmental and exogenous causes have been implicated as potential causes. Only about 500 cases have been reported globally as of 2013. Two cases of Aplasia Cutis Congenita (ACC) who presented with scalp and bone defects at birth are reported, one in a syndromic child delivered to a consanguineous family, with associated cardiac, skin and nail anomalies (likely Adams Oliver syndrome) and the other as an isolated scalp lesion. Both were large defects managed conservatively by a multidisciplinary team. The challenges of investigating and managing such complex scalp anomalies in sub-Saharan Africa are highlighted.
Central retinal artery occlusion in a patient with metabolic syndrome x
Authors: Sonja Predrag Cekić, Tatjana Petković, Gordana Ljubomir Stanković-Babić, Jovica Mile Mršić
Journal: J Ophthalmic Vis Res (2010)
Keywords: central retinal artery, mets, metabolic syndrome x, occlusion
MeSH terms: Case Reports

Purpose:
To report a case of central retinal artery occlusion (CRAO) in a patient with metabolic syndrome X.
Case report:
A 64 year-old-man presented with abrupt, painless, and severe loss of vision in his left eye. Indirect ophthalmoscopy disclosed signs compatible with CRAO and laboratory investigations revealed erythrocyte sedimentation rate of 74 mm/h, C-reactive protein (CRP) level of 21 mg/l, hyperglycemia, hyperuricemia, hypertriglyceridemia and hypercholesterolemia. Fluorescein angiography and immunological studies excluded other systemic disorders. The patient met the full criteria of the National Cholesterol Education Program for metabolic syndrome X.
Conclusion:
In addition to different vascular complications such as stroke, and cardiovascular disease, metabolic syndrome X may be associated with retinal vascular occlusions.
Seizures, Vitamin D Deficiency, and Severe Hypophosphatemia: The Unique Presentation of a SARS-CoV-2 Case
Authors: Benson Yeh, Christopher Bell, Christopher Anderson, Mack Sheraton
Journal: Cureus (2023)
Keywords: hypophosphatemia, neurological manifestations in covid-19, recurrent seizures, sars-cov-2 infection, vitamin-d deficiency
MeSH terms: Case Reports

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a virus that belongs to the species severe acute respiratory syndrome-related coronavirus (SARSr-CoV), which is related to the SARS-CoV-1 virus that caused the 2002-2004 SARS outbreak. SARS-CoV-2 causes coronavirus disease 2019 (COVID-19). It has been associated with electrolyte abnormalities. In this report, we discuss the case of a SARS-CoV-2-infected person presenting with recurrent seizure episodes resulting from hypophosphatemia. A 52-year-old male patient with questionable prior seizure history presented to the emergency department (ED) twice within eight days with recurring seizure episodes. While the physical examination at the first presentation was significant for a head laceration with post-ictal confusion, that at the second presentation was only significant for post-ictal confusion. Laboratory examination at the first visit revealed SARS-CoV-2 positivity, hypokalemia, hypophosphatemia, and low vitamin D levels. On the second visit, the patient was again found to have hypophosphatemia. CT of the head and the cervical spine, as well as radiographs of the chest done on the first visit, were all normal. On his first visit, the patient's electrolyte abnormalities were corrected, and he was discharged with antiepileptic medications after 24 hours of observation and consultation with neurology. However, his vitamin D levels, the results of which came back only after his first discharge, were corrected only during his second visit. This time, he was discharged from the ED and had an effective resolution of symptoms. SARS-CoV-2 infections can result in vitamin D deficiency and hypophosphatemia, resulting in seizures, and hence should be treated with both replacement therapies and antiepileptic medications. This case also highlights the importance of obtaining phosphorus and vitamin D levels in SARS-CoV-2-infected patients with seizures.
Fibula-Assisted Segment Transport (FAST) for Defect Reconstruction after Resection of Tibial Adamantinoma: Report of Two Treatments
Authors: A Rachbauer, A Laufer, G Gosheger, G Toporowski, A Frommer, E Jacob, N Deventer, R Roedl, B Vogt
Journal: Case Rep Orthop (2021)
MeSH terms: Case Reports

Intramedullary limb lengthening via lengthening nails has been performed for more than three decades to overcome leg length inequalities. Plate-assisted bone segment transport (PABST) has recently been described for the reconstruction of segmental bone defects. We modified this procedure by using the ipsilateral fibula as a "biological plate" and report on its technical particularities and application in the reconstructive treatment of adamantinomas of the tibia in two patients. Both patients were successfully treated by wide resection and reconstruction of the tibial bone via bone segment transport through an expandable intramedullary nail using the remaining ipsilateral fibula to provide stabilization and guidance. This procedure was titled "fibula-assisted segment transport" (FAST). This is a new and promising technique that allows an entirely biological reconstruction of large bone defects of the tibia.
Severe fever with thrombocytopenia syndrome presenting as hemophagocytic syndrome: two case reports
Authors: Akihito Kitao, Ryuji Ieki, Hiroki Takatsu, Yuki Tachibana, Masaaki Nagae, Takuya Hino, Hitoshi Nakaji, Masayuki Shimojima, Masayuki Saijo, Masanobu Okayama, Tsuneaki Kenzaka
Journal: Springerplus (2016)
Keywords: consciousness level, hemophagocytic syndrome, severe fever with thrombocytopenia syndrome, ticks

Introduction:
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease that was first reported in China in 2011. However, it is now endemic in Japan, and the SFTS viruses in Japan and China have evolved independently. Its fatality rate is 26.5 % in Japan, and the viral load is related to morbidity.
Case description:
We encountered two patients with SFTS. Case 1 is a 72-year-old woman who visited our hospital owing to severe fatigue, diarrhea, and nausea. Her consciousness level score on the Glasgow Coma Scale was 14 points, and her serum lactate dehydrogenase level was 646 IU/L. Case 2 is an 82-year-old woman who visited our hospital owing to diarrhea and general fatigue. Her consciousness level score on the Glasgow Coma Scale was 11 points, and her serum lactate dehydrogenase level was 935 IU/L.
Discussion and evaluation:
Both patients had hemophagocytic syndrome and presented with similar symptoms. Although both were treated with similar drug regimens, their clinical courses were different: after treatment, the 72-year-old woman survived whereas the 82-year-old woman died. In addition to age, the two patients differed in terms of time between symptom onset and treatment initiation, consciousness level, viral load, and extent of elevation of liver enzyme levels.
Conclusions:
The viral load, which is a predictor of morbidity, was associated with the level of consciousness and the serum lactate dehydrogenase level, both of which might be useful for predicting death in patients with SFTS.