OpenMed/multicare-articles huggingface dataset:
Durable disease control and refractory bullous pemphigoid after immune checkpoint inhibitor discontinuation in metastatic renal cell carcinoma: A case report
Authors: Roxane Mari, Mathilde Guerin, Cécile Vicier, Jochen Walz, Nathalie Bonnet, Géraldine Pignot, Gwenaelle Gravis
Journal: Front Immunol (2022)
Keywords: bullous pemphigoid, durable response, immunotherapy, late adverse event, renal cell carcinoma
MeSH terms: Carcinoma, Renal Cell / drug therapy, Kidney Neoplasms / drug therapy, Kidney Neoplasms / pathology, Pemphigoid, Bullous / chemically induced, Pemphigoid, Bullous / diagnosis, Pemphigoid, Bullous / drug therapy, Case Reports, Aged, Humans, Immune Checkpoint Inhibitors, Male, Nivolumab / adverse effects, Immune Checkpoint Inhibitors, Nivolumab

Background:
Immune checkpoint inhibitors deeply modified metastatic renal cell carcinoma's management, and confront us to adverse events that we were not used to with conventional anti-cancer therapies. We report the case of a patient who received nivolumab as second-line treatment of a metastatic clear cell renal cell carcinoma and who developed bullous pemphigoid four years after nivolumab introduction, with persistent exacerbations even after its discontinuation.
Case presentation:
A 66-year-old man was diagnosed with lung metastasis eight years after radical nephrectomy for a clear cell renal cell carcinoma. He firstly received an anti-angiogenic agent combination, and then received anti-programmed death 1 (PD1) nivolumab as second-line treatment. Nivolumab led to prolonged disease control, but after four years of exposure the patient developed skin lesions consistent with bullous pemphigoid. After seven years of nivolumab administration and perfect disease stability, nivolumab was discontinued and surveillance was proposed. Despite nivolumab discontinuation, the patient continued to develop bullous pemphigoid exacerbations. Metastatic renal cell carcinoma was still perfectly stable more than two years after immune checkpoint discontinuation with no further anti-cancer therapy.
Discussion:
We report the case of a refractory bullous pemphigoid which occurred four years after nivolumab introduction and lasted despite nivolumab discontinuation, in a patient whose metastatic renal cell carcinoma is still controlled after more than two years without any anticancer treatment. This highlights the potential association between immune-related adverse events and response to immune checkpoint inhibitors, and underlines the occurrence of late-onset and long-lasting immune-related adverse events even after discontinuation of treatment, which must encourage us to remain vigilant in the long term.
Case report: Presumed contact lens-induced intracorneal hemorrhage in a diabetic dog
Authors: Sunjun Jung, Shin Ae Park
Journal: Front Vet Sci (2022)
Keywords: scced, bandage contact lens, diabetes mellitus, indolent ulcer, intracorneal hemorrhage
MeSH terms: Case Reports

A 10-year-old castrated male miniature poodle dog with diabetes mellitus was presented for a week history of blepharospasm and epiphora in the right eye. The spontaneous chronic corneal epithelial defect (SCCED) was diagnosed, and a bandage contact lens was applied following corneal debridement with sterile cotton-tip applicators. In 1 week, SCCED was improving uneventfully, though an annular pattern of intracorneal hemorrhage was observed. The contact lens was removed and the intracorneal hemorrhage resorbed in 4 weeks. To the author's knowledge, this is the first report of presumed contact lens-induced intracorneal hemorrhage characterized by an annular pattern in a dog.
Peripheral Ulcerative Keratitis Associated with HCV-Related Cryoglobulinemia
Authors: Pedro Coelho, Carlos Menezes, Rita Gonçalves, Pedro Rodrigues, Elena Seara
Journal: Case Rep Ophthalmol Med (2017)
MeSH terms: Case Reports

Purpose:
To describe a case of peripheral ulcerative keratitis associated with type II cryoglobulinemia in the context of Hepatitis C infection.
Methods:
Case report and literature review.
Results:
A 36-year-old male patient presented to our emergency department with unilateral moderate pain in his right eye, associated with redness and photophobia. Medical background elicited a history of Hepatitis C and IV illicit drug abuse. Ocular examination revealed a BCVA of 20/30 of the affected eye and slight discomfort with eye movement. Biomicroscopy revealed a ring shaped peripheral corneal ulcer, with a dense white stromal infiltrate sparing the limbus, plus an adjacent area of mild anterior diffuse nonnecrotizing scleritis. No intraocular inflammation was present. Posterior segment was normal. The patient was placed under oral prednisolone (1 mg/Kg/day) with gradual tapering. A dramatic clinical response occurred, with complete resolution of the clinical condition. Systemic analytic workup aiming at autoimmune and infectious diseases was negative, except for high HCV-viral load and the presence of type 2 cryoglobulins.
Conclusion:
Albeit rare, cryoglobulinemia, even in the absence of systemic vasculitis, should be considered in the differential diagnosis of PUK, when systemic workout for autoimmune diseases is negative.
Intradural solitary fibrous tumor of the lumbar spine: a distinctive case report
Authors: Recep Basaran, Mustafa Kaksi, Mustafa Onoz, Ece Balkuv, Aydin Sav
Journal: Case Rep Neurol Med (2015)

Background. Solitary fibrous tumors are ubiquitous mesenchymal neoplasms of putative fibroblastic origin. They were originally described in the pleura but subsequently have been reported in many extraserosal sites. Solitary fibrous tumors may also occur in the meninges, central nervous system parenchyma, and spinal cord. Case. A 67-year-old male patient with progressive lower extremity weakness, urinary urgency, and sexual dysfunction has been admitted to our hospital. On his lumbar MRI, we detected an intradural lesion posterior to the L3 vertebral corpus. We resected the lesion by L3 total laminectomy. Immunohistological findings revealed strong and diffuse immunopositivity with vimentin, CD34, and bcl-2. Ki-67 proliferation index was 5-8%. We did not detect any recurrence 12 months after his operation. Conclusion. SFT is mostly seen in young and middle-aged patients and should be considered among differential diagnosis in cases suffering from pain, hypoesthesia, and urinary dysfunction. Gross total resection should be primary treatment. Tumors that have high Ki-67 labeling should be followed up for potential recurrences.
Anomalous Coronary Artery Origin in a Young Patient with Marfan Syndrome
Authors: S B C P Duarte, D O Beraldo, L A M Cesar, A P Mansur, J Y Takada
Journal: Case Rep Cardiol (2017)
MeSH terms: Case Reports

Marfan syndrome is an autosomal dominant genetic disorder that affects connective tissue and is caused by mutations in the fibrillin 1 gene present at chromosome 15. Aortic aneurysm is its main complication, and along the dilation of the aorta root and its descending portion (60-100%), with secondary aortic insufficiency, it increases risk of acute aortic dissection and death. Coronary artery anomalies affect between 0.3% and 1.6% of the general population and are the second leading cause of sudden death in young adults, especially if the anomalous coronary passes through aorta and pulmonary artery. The anomalous origin of the left main coronary artery in the right Valsalva sinus has a prevalence of 0.02%-0.05% and is commonly related to other congenital cardiac anomalies, such as transposition of great vessels, coronary fistulas, bicuspid aortic valve, and tetralogy of Fallot. Its association with Marfan syndrome is not known, and there is no previous report in the literature. We describe here a case of a female with Marfan syndrome diagnosed with symptomatic anomalous origin of the left coronary artery in the right Valsalva sinus.
Direct Intrahepatic Portosystemic Shunt in Budd-Chiari Syndrome: A Case Report and Review of the Literature
Authors: V Chandra, E Wajswol, M Shahid, A Kumar, S Contractor
Journal: Case Rep Radiol (2018)
MeSH terms: Case Reports

Transjugular intrahepatic portosystemic shunt (TIPS) is an alternative interventional procedure used to manage refractory Budd-Chiari syndrome (BCS) when conservative medical therapy has failed. However, TIPS is not always technically successful because of hepatic vein thrombosis and inability to catheterize the hepatic veins. In these situations, direct intrahepatic portosystemic shunt (DIPS) with access to the portal vein from the IVC has been shown to be a viable alternative that may ameliorate portal hypertension in these patients. Typically, DIPS involves the use of transabdominal ultrasound to target the portal vein. Herein a case in which a 39-year-old female underwent DIPS without the use of ultrasound guidance is presented. Instead, a hepatic venogram generated using collateral circulation was used to opacify and guide access to the portal vein.
Choledochotomy for Obstructive Choledocholithiasis in Two Dogs
Authors: Christian Folk, Cassie Lux
Journal: Case Rep Vet Med (2019)
MeSH terms: Case Reports

Two geriatric (> 9 years old) dogs presented for vomiting, lethargy, and anorexia. Obstructive choledocholithiasis was diagnosed based on analysis of a serum biochemical analysis and abdominal radiographs and ultrasonography. In both dogs, choledocholiths were removed from the common bile duct via a choledochotomy without a cholecystectomy, and survival without recurrence occurred in both dogs for more than 1 year.
Massive non-incisional abdominal wall hernia caused by abdominal wall weakness resulting from childhood radiation therapy: a case report
Authors: Tatsuya Ichida, Yuki Otsuki, Koichi Ueda
Journal: Case Reports Plast Surg Hand Surg (2022)
Keywords: abdominal wall hernia, non-incisional, non-traumatic, radiation therapy
MeSH terms: Case Reports

Huge abdominal wall hernias after radiation therapy in the absence of any previous surgical incisions or trauma are rare and, to the best of our knowledge, have not previously been reported. we report a patient with a massive hernia caused by abdominal wall weakness resulting from childhood radiation therapy.
Ciliated Hepatic Foregut Cyst: Definitive Diagnosis Is Critical to the Optimal Treatment Pathway
Authors: Tatsuhiro Kato, Christine M G Schammel, Hubert Fenton, Steven D Trocha, A Michael Devane
Journal: Case Reports Hepatol (2023)
MeSH terms: Case Reports

Background. Ciliated hepatic foregut cyst (CHFC) is a rare, benign cyst of the liver, derived from the embryonic foregut epithelium. Although CHFCs are typically asymptomatic, some present with nonspecific abdominal symptoms. Imaging modalities alone are insufficient for diagnosis, with intrahepatic cholangiocarcinoma included in the differential due to nonspecific imaging features; definitive diagnosis relies on histologic confirmation. These lesions are often benign; however, larger lesions can have malignant transformation into squamous cell carcinoma (SCC), which carries a poor prognosis, thus making a definitive diagnosis, no matter what size, essential. Here, we present a case of CHFC as well as a comprehensive literature review. Given these data, we propose an algorithm for definitive diagnosis.
Statin-Associated Necrotizing Autoimmune Myositis Complicated by an Uncommon Adverse Effect to Treatment
Authors: Brian M Fung, Emil R Heinze, Andrew L Wong
Journal: Case Rep Med (2019)
MeSH terms: Case Reports

Statin-associated necrotizing autoimmune myositis (NAM) is an autoimmune condition characterized by severe acute-onset proximal muscle weakness, a very high creatinine kinase (CK) level, and prominent myofiber necrosis and minimal lymphocytic infiltration on muscle biopsy. Unlike self-limited statin myopathy, this condition usually requires aggressive immunomodulation therapy to assist recovery and prevent future disability. In this case report, we present a patient who developed progressive muscle weakness after taking atorvastatin for one year. At initial presentation, her CK level was 28,000 U/L. She was diagnosed with statin-associated NAM and started on high-dose intravenous solumedrol, mycophenolate, and intravenous immunoglobulin (IVIG) therapy. However, she subsequently developed acute bilateral vision loss and right side hemineglect; she was diagnosed with posterior reversible encephalopathy syndrome (PRES), thought to be a possible delayed adverse reaction to IVIG. IVIG was discontinued, and the patient was treated with supportive therapy. At six-month follow-up, she had significant improvement in muscle strength and vision.
Case Report: In Situ Expression of a Proliferation-Inducing Ligand in Neuromyelitis Optica
Authors: Laurie Baert, Romain Marignier, Hans P Lassmann, Bertrand Huard
Journal: Front Neurol (2021)
Keywords: april (tnfsf13), b cells, taci, astrocytes, neuromyelitis optica
MeSH terms: Case Reports

A proliferation inducing ligand (APRIL) mediates a key role in the generation and survival of antibody-inducing plasmocytes. Based on this, APRIL has been targeted in autoimmune diseases including multiple sclerosis (MS) and optic neuritis (ON). In MS lesions, APRIL has a new cellular target, the reactive astrocyte and mediates an immunosuppressive activity. Here, we analyzed APRIL expression in a case of neuromyelitis optica (NMO), another autoimmune neurodegenerative disease, showing selective aquaporin-4 depletion in the spinal cord, complement deposition and infiltration of polymorphonuclear cells. We analyzed by immunohistochemistry the presence of APRIL-producing cells, plasmocytes, astrocytes and the localization of secreted APRIL in a lesion from NMO. Plasmocytes were present close to APRIL-producing cells in meninges. However, our main observation was that APRIL targets reactive astrocytes in this lesion of NMO similarly to MS.
Rare appendicitis-like syndrome: the case of the obstructing broccoli
Authors: Stephen Jones, Patrick Narh-Martey, Mitun Patel, Amanpreet Dhaliwal, Jessica Persson, Denis Orr 2nd
Journal: Case Rep Med (2014)

The diagnosis of acute appendicitis can be somewhat obscure in a patient that presents with right lower quadrant abdominal pain. The advancement and ease of imaging have made CT scanning readily available in the emergency department. Management can be challenging when the patient has a high likelihood of appendicitis based on clinical suspicion and negative CT scan. The purpose of this case report is to demonstrate how an obstructing bezoar caused an appendicitis-like syndrome in a patient with negative CT scan and clinical diagnosis of acute appendicitis. This case report will discuss the appendicitis-like syndrome of an obstructing bezoar and an approach at management.
A Novel ATP1A2 Gene Variant Associated With Pure Sporadic Hemiplegic Migraine Improved After Patent Foramen Ovale Closure: A Case Report
Authors: Armando Perrotta, Stefano Gambardella, Anna Ambrosini, Maria Grazia Anastasio, Veronica Albano, Francesco Fornai, Francesco Pierelli
Journal: Front Neurol (2018)
Keywords: atrial septal aneurysm, incomplete penetrance, migraine aura, sporadic hemiplegic migraine, vascular factors
MeSH terms: Case Reports

We describe the case of one patient with pure sporadic hemiplegic migraine (SHM) with a novel ATP1A2 gene variant and a large patent foramen ovale (PFO) with atrial septal aneurysm. In hemiplegic migraine (HM), the relationship between incomplete penetrance, environmental triggers, and phenotypic expression is underdetermined. A genetic evaluation of the proband was requested for the HM associated genes and extended to the members of his family. Genetic analysis revealed a never described before ATP1A2 gene mutation, inherited by his father, who never experienced motor aura but only typical visual aura. The proband-but not his father-was also affected by a large PFO with atrial septal aneurysm. SHM patient showed a marked reduction in motor aura episodes per year in the 12 months following the PFO percutaneous closure, followed by a complete remission from attacks at least in the following 24 months. We speculated that as well as incomplete penetrance of the novel mutation and natural history of the disease, an additional pathological condition such as the PFO could contribute to the phenotypical expression in this case of HM.
Diffuse Hair Loss Induced by Sertraline Use
Authors: Yüksel Kıvrak, İbrahim Yağcı, Mehmet Fatih Üstündağ, Halil Özcan
Journal: Case Rep Psychiatry (2015)

Hair loss is a rare side effect of psychotropic drugs. The most related drug class with this side effect is the mood stabilizers. Studies reporting the sertraline-induced alopecia are limited in number. Sertraline is a potent antidepressant which inhibits the serotonin reuptake from the presynaptic terminals selectively. The reason for hair loss could not be elucidated completely. Psychotropic drugs are usually considered to lead to hair loss through influencing the telogen phase of hair follicle. This paper reports a 21-year-old male with diffuse hair loss induced by sertraline use and improved by quitting the drug. To the best of our knowledge, there are no other case reports on sertraline-induced alopecia within 2 weeks.
Breast schwannoma
Authors: Vandana Dialani, Neely Hines, Yihong Wang, Priscilla Slanetz
Journal: Case Rep Med (2011)
MeSH terms: Case Reports

Schwannomas arise from Schwann cells of the peripheral nerve sheath. The most common locations include the head, neck, and extensor surfaces of the extremities. Intramammary schwannomas are very rare and account for only 2.6% of schwannomas. A review of the English literature reveals 27 such cases of breast schwannoma. In this paper we describe another such rare case.
Breast Cancer Complicated by Cardiac Tamponade in a Patient With Neurofibromatosis Type 1
Authors: Narek Hakobyan, Nosakhare Ilerhunmwuwa, Henry O Aiwuyo, Ephrem Sedeta, Ifeanyi Uche, Mustafa Wasifuddin, Jamal C Perry
Journal: Cureus (2023)
Keywords: breast cancer, cardiac tamponade, invasive ductal cell carcinoma, neurofibromatosis type 1, neurofibromatosis type 1 (nf-1), recurrent pericardial effusion
MeSH terms: Case Reports

Pericardial effusion may occur as a result of malignant pericarditis, which may in turn result in cardiac tamponade. This paper reports on a rare case of cardiac tamponade that occurred in an African American patient with breast cancer and neurofibromatosis. Herein, we present a case of a 38-year-old woman with neurofibromatosis type 1 (NF1) and breast cancer. She presented with sudden shortness of breath and hypotension. Computed tomography of the chest and an echocardiogram confirmed the presence of cardiac tamponade. Symptomatic relief was obtained following an emergency pericardiocentesis. The patient experienced a recurrence of symptomatic pleuro-pericardial effusion, requiring repeat therapeutic pericardiocentesis and thoracocentesis. To eliminate accumulating fluid, an indwelling drain was placed. The clinical condition of the patient, however, continued to deteriorate and she expired a few days after admission. When patients with breast cancer present with dyspnea, clinicians should maintain a high index of suspicion of cardiac tamponade; urgent imaging should be performed to exclude tamponade. Further research is needed to identify the factors that predict cardiac tamponade in breast cancer patients as well as the optimal treatment for the condition. It is also necessary to examine the relationship between a history of neurofibromatosis and cardiac tamponade.
Immediate and non-immediate allergic reactions to amoxicillin present a diagnostic dilemma: a case series
Authors: Caroline Weisser, Moshe Ben-Shoshan
Journal: J Med Case Rep (2016)
MeSH terms: Amoxicillin / adverse effects, Anti-Bacterial Agents / adverse effects, Drug Hypersensitivity / diagnosis, Hypersensitivity, Delayed / diagnosis, Hypersensitivity, Immediate / diagnosis, Otitis Media / drug therapy, Pneumonia / drug therapy, Case Reports, Amoxicillin / administration & dosage, Anti-Bacterial Agents / administration & dosage, Child, Child, Preschool, Drug Hypersensitivity / etiology, Female, Humans, Hypersensitivity, Delayed / chemically induced, Hypersensitivity, Immediate / chemically induced, Infant, Male, Practice Guidelines as Topic, Predictive Value of Tests, Skin Tests, Anti-Bacterial Agents, Amoxicillin

Background:
Allergic reactions to amoxicillin are very common occurrences in the pediatric age group; however, onset of symptoms can present a diagnostic dilemma.
Case presentation:
We present a case series that describes three children (8-year-old white girl, 2-year-old white boy and 14-month-old Chinese boy) who presented with varied onset of allergic reactions to amoxicillin, specifically immediate (within the first hour after exposure) and non-immediate onset. One child developed immediate onset allergy to oral challenge with amoxicillin although his clinical history was evident for non-immediate onset allergy to amoxicillin. He was the only case that had a positive skin test to penicillin. Two other children presented with reactions toward the end of their treatment course of amoxicillin, yet one patient developed immediate onset allergy while the other patient developed non-immediate onset allergy after challenge.
Conclusions:
This case series demonstrates diagnostic challenges facing physicians assessing allergic reactions to amoxicillin. As onset of reactions can dictate severity and pathogenic type of allergy, a thorough clinical history and subsequent appropriate diagnostic testing including medication challenge can help establish the diagnosis.
Postcoital haemoptysis: a case report and a review of the literature
Authors: Emeka B Kesieme, Browne C Okonkwo, Peter O Okokhere, Georgi Prisadov, Eghosa Aigbe, Christopher Affusim
Journal: Case Rep Med (2013)

Haemoptysis is rarely reported following coitus, and cardiac decompensation has been mostly implicated in the aetiology. We present a 53-year-old Nigerian, known hypertensive diabetic woman with background ischaemic heart disease who presented with postcoital haemoptysis of one-year duration. Echocardiography revealed combined ischaemic and mitral valvular heart disease, probably of rheumatic aetiology. There has been no previous report in an African population. This case illustrates the need to rule out coitus as a rare but potential cause of haemoptysis in middle aged patients with underlying cardiac pathologies and the need for an extensive cardiac workup in a population with predominantly pulmonary causes of haemoptysis.
Magnetic Resonance Enterography Findings of Intestinal Behçet Disease in a Child
Authors: Tommaso D'Angelo, Romina Gallizzi, Claudio Romano, Giuseppe Cicero, Silvio Mazziotti
Journal: Case Rep Radiol (2017)
MeSH terms: Case Reports

Behçet's disease (BD) is a multisystem disorder of unknown aetiology, characterized by recurrent oral ulcers, genital ulcers, uveitis, skin lesions, and pathergy. Gastrointestinal disease outside the oral cavity is well recognized and usually takes the form of small intestinal ulcers, with the most significant lesions frequently occurring in the ileocaecal region. Symptoms usually include nausea, vomiting, colicky abdominal pain, and change in bowel habit and it is not unusual that patients may present late, with life-threatening complications requiring surgery. Diagnosis has been hindered for many years by limitations in imaging the small bowel and it is usually achieved by means of endoscopy and CT of the abdomen. Magnetic resonance enterography (MRE) is a relatively new technique, which has a high diagnostic rate in patients with Crohn's disease (CD). Although many similarities between CD and intestinal BD have already been described in literature, the role of MRE in the evaluation of intestinal BD has never been defined up to now. We report a case of a 12-year-old female patient with diagnosis of BD who presented at our institution for recurrent colicky abdominal pain and diarrhoea. The patient underwent MRE that demonstrated the gastrointestinal involvement.