OpenMed/multicare-articles huggingface dataset:
Case Report: Severe rebound after withdrawal of fingolimod in a patient with neuromyelitis optica spectrum disorder
Authors: Wei Lin, Chung-Hsing Chou, Fu-Chi Yang, Chia-Kuang Tsai, Yu-Kai Lin, Yueh-Feng Sung
Journal: Front Immunol (2023)
Keywords: aquaporin-4 antibody, fingolimod rebound syndrome, fingolimod withdrawal syndrome, neuromyelitis optica spectrum disorder, relapse-remitting multiple sclerosis
MeSH terms: Multiple Sclerosis / drug therapy, Multiple Sclerosis, Relapsing-Remitting / drug therapy, Neuromyelitis Optica / diagnosis, Neuromyelitis Optica / drug therapy, Neuromyelitis Optica / pathology, Case Reports, Female, Fingolimod Hydrochloride / adverse effects, Humans, Immunologic Factors / therapeutic use, Middle Aged, Fingolimod Hydrochloride, Immunologic Factors

Purpose:
Fingolimod, an oral treatment for relapsing-remitting multiple sclerosis (RRMS), has been associated with a significant rebound in disease activity after therapy cessation. We described a patient with neuromyelitis optica spectrum disorder (NMOSD) who was previously diagnosed with RRMS and experienced fatal rebound syndrome after cessation of fingolimod.
Case report:
A 54-year-old woman, previously diagnosed with RRMS, experienced relapse after orthopedic surgery. The diagnosis was later revised to NMOSD based on a positive aquaporin-4 antibody. Three weeks after converting the immunomodulator from fingolimod to azathioprine, severe disease reactivation was observed. Considering the multiple new and enlarging magnetic resonance imaging lesions, the temporal relationship between fingolimod cessation and symptom onset, and the relatively low possibility of disease reactivation within a short time, the diagnosis of fingolimod withdrawal syndrome was proposed. Although immediate steroid pulse therapy and plasma exchange were performed, the patient eventually died owing to a fulminant clinical course.
Conclusion:
Fingolimod withdrawal syndrome is well known in patients with multiple sclerosis (MS). It can also occur in patients with NMOSD. Recognizing patients with NMOSD who present with MS-like manifestations, and avoiding drugs that may be harmful to patients with NMOSD, are important.
Iris metastasis of diffuse large B-cell lymphoma misdiagnosed as primary angle-closure glaucoma: A case report and review of the literature
Authors: Zebing Li, Zhongjing Lin, Yisheng Zhong, Xi Shen
Journal: Open Life Sci (2021)
Keywords: glaucoma, intraocular iris metastasis, lymphoma
MeSH terms: Case Reports

Background:
Lymphoma with intraocular metastasis is an uncommon and serious disease. We describe a case of diffuse large B-cell lymphoma (DLBCL) with iris metastasis. Meanwhile, we refer to published case reports retrieved via a PubMed search to summarize this rare disease.
Case presentation:
Glaucoma and uveitis symptoms were found in the left eye of a 50-year-old woman upon admission to the hospital. After treatment and pathological examination, the iris of her left eye was diagnosed with DLBCL. Given the patient's unfavorable treatment options in the local hospital, primary enucleation was offered as a therapeutic option.
Conclusions:
Iris metastasis of systemic lymphoma is an extremely rare ophthalmic disease with poor prognosis. Ophthalmologists should be able to definitively and differentially diagnose eye symptoms and pay attention to systemic conditions to provide a series of optimized treatments.
Radical Abdominal Trachelectomy for IB1 Cervical Cancer at 17 Weeks of Gestation: A Case Report and Literature Review
Authors: Yoichi Aoki, Morihiko Inamine, Sugiko Ohishi, Yutaka Nagai, Hitoshi Masamoto
Journal: Case Rep Obstet Gynecol (2014)

Background. With regard to the therapy for early invasive cervical carcinoma during pregnancy, radical trachelectomy is also a treatment of choice, along with its advantages and disadvantages. Case Report. A 28-year-old woman, para 1-0-0-1, was diagnosed with FIGO stage IB1 squamous cell carcinoma of the cervix at 12 weeks of gestation. The patient underwent radical abdominal trachelectomy with pelvic lymphadenectomy at 17 weeks of gestation. Her pregnancy was successfully maintained after the surgery. The patient underwent a planned cesarean section at 38 weeks of gestation. A healthy baby girl weighing 2970 g was born with an Apgar score of 8/9. The mother and child in overall good health were discharged. Ten months after the delivery, there was no clinical evidence of recurrence. Conclusions. We believe that it is appropriate to perform radical abdominal trachelectomy in the early second trimester with preserving uterine arteries, although it is a technically challenging approach. It may be possible that radical abdominal trachelectomy during pregnancy can help women avoid the triple losses of a desired pregnancy, fertility, and motherhood.
SARS-CoV-2-specific humoral and cellular immune responses to BNT162b2 vaccine in Fibrodysplasia ossificans progressiva patients
Authors: Jitka Smetanova, Tomas Milota, Michal Rataj, Jana Hurnakova, Hana Zelena, Rudolf Horvath
Journal: Front Immunol (2022)
Keywords: covid-19, sars-cov-2, fibrodysplasia ossificans progressive, immunogenicity, safety, vaccination
MeSH terms: COVID-19 Vaccines / administration & dosage, COVID-19 / prevention & control, Myositis Ossificans, Vaccines, Research Support, Non-U.S. Gov't, BNT162 Vaccine, Humans, Immunity, Cellular, SARS-CoV-2, BNT162 Vaccine, COVID-19 Vaccines, Vaccines

Introduction:
Fibrodysplasia ossificans progressiva (FOP) is characterized by progressive heterotopic ossification triggered by various conditions, such as trauma, infection, including COVID-19 infection, and vaccination. Although SARS-CoV-2 vaccinations prevent poor outcomes in the general population, there is limited evidence on safety, immunogenicity, and efficacy of SARS-CoV-2 vaccines for inpatients with FOP.
Methods:
A case series of two patients with FOP focused on humoral, cellular post-vaccination response, and the incidence of adverse events after administration of the BNT162b2 vaccine (Comirnaty).
Results:
Injection site reactions, fever, myalgia, and fatigue were the most common adverse events (AE). Neither severe AE (SAE), nor disease flare-ups were observed. No differences between patients with FOP and healthy controls were observed in humoral and cellular responses.
Conclusions:
The BNT162b2 vaccine induced high humoral and cellular response levels in patients with FOP. Vaccination was not associated with SAE or disease relapse. The AEs spectrum was comparable to that of the general population.
Renal angiomyolipoma with IVC thrombus: A case report
Authors: Pietro Kheir, Maher Abdessater, Joey El Khoury, Rody Akiel, Charbel El Hachem, Nabil Tawil, Rahgid El Khoury
Journal: Int J Surg Case Rep (2020)
Keywords: angiomyolipoma, case report, inferior vena cava, thrombus
MeSH terms: Case Reports

Introduction:
Renal angiomyolipomas (AML) are often regarded as benign tumors. This article reports the case of a 47 year old patient with AML associated with a venous invasion of the inferior vena cava.
Presentation of case:
Our 47 year old male patient presented for flank pain and hematuria. CT Scan revealed a 3 cm lobulated low-density lesion in the renal sinus, middle and upper lobes of the right kidney, with evidence of IVC thrombus on angioscan. Right radical nephrectomy and thrombectomy were successfully done with use of cardiopulmonary bypass. On pathology, AML was confirmed.
Discussion:
Renal AML are unilateral and sporadic in most cases, with a female predominance. The occurrence of venous invasion in patients with AML is a rare and unique phenomenon. CT scan is the imaging of choice in such cases and surgery remains the optimal treatment.
Conclusion:
More focus should be put on the ability of AML to invade venous structures. Early imaging and therapeutic planning are necessary for the best outcome in case of vena cava invasion. Collaboration of the urologist with the vascular surgeon can lead to better surgical results.
Endoscopic Treatment of Sphenoid Sinus Mucocele: Case Report and Surgical Considerations
Authors: Joel Caballero García, Adolfo Michel Giol Álvarez, Iosmill Morales Pérez, Nélido Gonzales Gonzales, Adolfo Hidalgo Gonzáles, Peggys Oleidis Cruz Perez
Journal: Case Rep Otolaryngol (2017)
MeSH terms: Case Reports

Introduction:
The paranasal sinuses mucoceles are benign expansive cystic lesions that occur rarely in the sphenoid sinus and contain mucous material enclosed by cylindrical pseudostratified epithelium.
Objective:
To report one case of sphenoid sinus mucocele that occurred with headache and was submitted to surgical treatment through endonasal endoscopy approach.
Case report:
59-year-old male patient with history of increasing frontoorbital, bilateral, fluctuating headache and exophthalmos. There was no other associated clinical abnormality. Computed Tomography (CT) and Magnetic Resonance Image (MRI) scans confirmed an expansive mass of sphenoid sinus, suggesting mucocele. The patient was submitted to endonasal endoscopic surgery with posterior ethmoidotomy, large sphenoidotomy, and marsupialization of the lesion.
Conclusion:
Mucoceles of the sphenoid sinus are a very rare condition with variable clinical and radiological presentation. Surgical treatment is absolutely indicated and early treatment avoids visual damage that can be permanent. Endonasal endoscopic approach with drainage and marsupialization of sphenoid sinus, using a transnasal corridor, is a safe and effective treatment modality.
Concomitant Central Nervous System Toxoplasmosis and Seronegative Disseminated Coccidioidomycosis in a Newly Diagnosed Acquired Immune Deficiency Syndrome Patient
Authors: Michael Valdez, Leila Moosavi, Arash Heidari
Journal: J Investig Med High Impact Case Rep (2019)
Keywords: cns toxoplasmosis, coccidioidomycosis, disseminated, fungemia, miliary pneumonia, seronegative
MeSH terms: AIDS-Related Opportunistic Infections / diagnosis, Coccidioides, Coccidioidomycosis / diagnosis, Coinfection / diagnosis, Toxoplasma, Toxoplasmosis, Cerebral / diagnosis, Case Reports, AIDS-Related Opportunistic Infections / microbiology, AIDS-Related Opportunistic Infections / parasitology, Adult, Coccidioidomycosis / complications, Coccidioidomycosis / etiology, Coinfection / etiology, Coinfection / microbiology, Coinfection / parasitology, Humans, Male, Toxoplasmosis, Cerebral / complications, Toxoplasmosis, Cerebral / etiology

Opportunistic infections (OIs) are a significant cause of morbidity and mortality in immunosuppressed patients and may be due to bacteria, virus, protozoa, or fungi. Toxoplasmosis is a common cause of central nervous system infection in human immunodeficiency virus (HIV) patients. Coccidioidomycosis is a relatively common fungal infection that may lead to disseminated disease and fungemia in immune-compromised hosts living in endemic regions. This single-patient case report documents the presentation, diagnosis, management, and outcome of concomitant central nervous system toxoplasmosis and diffuse miliary pneumonia with fungemia due to disseminated seronegative Coccidioides immitis in a 33-year-old male patient recently diagnosed with chronic advanced HIV. Impaired cellular immune function, such as defects in the IL-12/IFN-γ pathway or T-helper IL-17-mediated response, is associated with increased severity of coccidioidomycosis. Fungemia and acute respiratory distress syndrome are both associated with very high mortality in coccidioidomycosis. In HIV hosts, negative Coccidioides serology can be seen in up to 25% of cases and therefore other diagnostic modalities should be initiated promptly and simultaneously. This case demonstrates simultaneous OI in the setting of advanced acquired immune deficiency syndrome and emphasizes the need for early diagnosis of HIV and OI in order to ensure prompt initiation of antiretroviral therapy, prophylactic, and therapeutic medications.
Management of Massive Rivaroxaban Overdose With Acetaminophen and Isosorbide Mononitrate Overdose
Authors: Bradley Casey 3rd, Abigail Daniels, Amol Bahekar, Divyang Patel, Alejandro Chapa-Rodriguez
Journal: Cureus (2023)
Keywords: acetaminophen toxicity, drug overdose, hemorrhage, isosorbide mononitrate, rivaroxaban
MeSH terms: Case Reports

Direct oral anticoagulants (DOACs) have been used more frequently for the prevention and management of thromboembolic disease in comparison to their predecessors. DOACs provide greater ease of administration, shorter half-lives, less monitoring, and fewer drug-drug interactions. With the rise of DOACs such as rivaroxaban, the opportunity for abuse also increases. Therefore, standardization of care based on rivaroxaban misuse must also be explored, an area in which there is not ample information. We present a case where a patient consumed a stockpile of her home medications in hopes to commit suicide. A 64-year-old female presented to the emergency department due to the ingestion of rivaroxaban 5,000 mg along with ingestion of acetaminophen 30,000 mg and isosorbide mononitrate 1000 mg in the setting of intentional self-harm with multiple declarations of being classified as Do Not Resuscitate. There have been documented cases of rivaroxaban overdose, however, there are no documented cases with levels of ingestion reaching 5,000 mg along with signs of severe bleeding. Our case study reviews the previously documented management of rivaroxaban abuse and the treatment that was given to our patient in the setting of extreme anticoagulant ingestion.
Lipin-1 Deficiency-Associated Recurrent Rhabdomyolysis and Exercise-Induced Myalgia Persisting into Adulthood: A Case Report and Review of Literature
Authors: Neluwa Liyanage Ruwan Indika, Dinesha Maduri Vidanapathirana, Eresha Jasinge, Roshitha Waduge, Narangoda Liyanage Ajantha Shyamali, Poruthotage Pradeep Rasika Perera
Journal: Case Rep Med (2020)
MeSH terms: Case Reports

Phosphatidate phosphatase-1 (lipin-1) is encoded by LPIN1 gene. Lipin-1 deficiency has been reported as the second most common cause of early-onset rhabdomyolysis after primary fatty acid oxidation disorders. We report a case of a 32-year-old Sri Lankan female with a history of more than 10 episodes of rhabdomyolysis and exercise intolerance since childhood. These episodes were triggered by infections and exercise. A temporal relationship between the acute episodes and use of drugs such as theophylline, mefenamic acid, co-trimoxazole, and combined oral contraceptive pills was also noted. There was marked elevation of serum creatine kinase and transaminases during acute episodes. Family history revealed parental consanguinity and an affected sibling who died of an acute episode associated with muscle weakness, dark coloured urine, and cyanosis, at the age of 2 years. The histochemical findings of the patient under discussion were consistent with a metabolic myopathy affecting membrane integrity. A homozygous, likely pathogenic variant c.1684G>T encoding p.(Glu562∗) was identified by clinical exome sequencing. Even though the studies to date give no convincing evidence of a possible causal or contributory relationship between the drugs under discussion and lipin-1 related rhabdomyolysis, this case highlights the importance of pharmacovigilance and reporting adverse drug reactions in patients with lipin-1 deficiency.
Irregular Migration as a Potential Source of Malaria Reintroduction in Sri Lanka and Use of Malaria Rapid Diagnostic Tests at Point-of-Entry Screening
Authors: Kolitha Wickramage, Gawrie N L Galappaththy, D Dayarathne, Sharika L Peiris, Rajeeka N Basnayake, Davide Mosca, Jan Jacobs
Journal: Case Rep Med (2013)

Background. We describe an irregular migrant who returned to Sri Lanka after a failed people smuggling operation from West Africa. Results. On-arrival screening by Anti-Malaria Campaign (AMC) officers using a rapid diagnostic test (RDT) (CareStart Malaria HRP2/PLDH) indicated a negative result. On day 3 after arrival, he presented with fever and chills but was managed as dengue (which is hyperendemic in Sri Lanka). Only on day 7, diagnosis of Plasmodium falciparum malaria was made by microcopy and CareStart RDT. The initially negative RDT was ascribed to a low parasite density. Irregular migration may be an unrecognized source of malaria reintroduction. Despite some limitations in detection, RDTs form an important point-of-entry assessment. As a consequence of this case, the AMC is now focused on repeat testing and close monitoring of all irregular migrants from malaria-endemic zones. Conclusion. The present case study highlights the effective collaboration and coordination between inter-governmental agencies such as IOM and the Ministry of Health towards the goals of malaria elimination in Sri Lanka.
Spontaneous Otogenic Pneumocephalus due to Frequent Plane Travelling
Authors: Katherine Pollaers, Jafri Kuthubutheen
Journal: Case Rep Otolaryngol (2019)
MeSH terms: Case Reports

A 31-year-old male presented with a history of chronic right-sided facial and mastoid tip pain with associated tinnitus and hearing loss. These symptoms were aggravated by the regular aeroplane trips he made to work as a "fly-in, fly-out" worker in regional Australia. Imaging revealed significant pneumocephalus secondary to mastoid air cell defects, which were repaired via a transmastoid approach. This is the fourth case of spontaneous otogenic pneumocephalus associated with air travel at altitude reported in the literature. This case is remarkable for the chronic nature of the symptoms, which were aggravated by the patient's regular aeroplane travel. This has implications for occupations which require frequent flying in those patients who may be at risk.
Spontaneous Massive Vulvar Edema in Pregnancy: A Case Report
Authors: Olivier Mulisya, Mbusa Mastaki, Tambavira Gertrude, Kyakimwa Tasi, Jeff K Mathe
Journal: Case Rep Obstet Gynecol (2018)
MeSH terms: Case Reports

Spontaneous massive vulvar edema in pregnancy is unusual and a cause for concern. This condition should be taken seriously since it might be caused by some conditions such as preeclampsia, diabetes, vulvovaginitis, severe anemia, and neoplasms. We report a case of massive vulvar edema in a 15-year-old primigravida following tocolysis therapy at 33 weeks of gestation. Other causes of vulvar edema were excluded. The vulvar edema appeared spontaneously after tocolysis and rapidly increased in size, associated with severe vulvar pains. The vulvar edema resolved progressively with antibiotics, corticoids, and analgesics. The patient delivered by spontaneous vaginal delivery a term live newborn with an unremarkable postpartum period. The aim of this report is to alert clinicians that conservative attempts could be considered for vulvar edema complicating tocolysis.
Well-differentiated liposarcoma disguised as a recurrent lipoma of the forearm flexor compartment: A case report
Authors: Wahyu Widodo, Wildan Latief, Dina Aprilya
Journal: Int J Surg Case Rep (2020)
Keywords: forearm, giant lipoma, lipoma-like, well differentiated liposarcoma
MeSH terms: Case Reports

Introduction:
Lipomas are common benign mesenchymal tumor that arise from the adipose tissue. Differential diagnosis between the benign and malignant form (liposarcoma) must be made to prevent complication and recurrence.
Presentation of case:
We reported a 63-year-old man who presented with recurrent large-sized mass on the right forearm with the first presentation approximately 28 years before being treated in our center. Main complaints were discomfort, social embracement, and difficulty in dressing. There were no compression symptoms observed. We performed marginal excision and sent the sample for histopathological examination. The work has been reported in line with the Surgical Case Report (SCARE) criteria.
Discussion:
During one year of post-operative period, no recurrence was detected and a complete relief of symptoms was as expected.
Conclusion:
Diagnostic challenge in such a large-sized (giant) lipoma is in differentiating it with the malignant form. Surgical excision is the choice of treatment. However, long-term follow up is needed due to the risk of recurrence.
Case Report: Rhabdomyolysis in aneurysmal subarachnoid hemorrhage: A rare case with implications for management
Authors: Gang Liao, Kang Chen, Jiang Xu, Chunliang Wang
Journal: Front Surg (2023)
Keywords: case, cerebral aneurysm, postoperative, rhabdomyolysis, subarachnoid hemorrhage
MeSH terms: Case Reports

Background:
In recent years, some cases of rhabdomyolysis after surgery have been reported. In this report, we present an adult patient with rhabdomyolysis after intracranial aneurysm surgery.
Case report:
A 59-year-old male suffered from a coma, fever, and soy sauce urine after intracranial aneurysm clipping. A routine blood examination showed that liver and kidney function were impaired, and creatine phosphokinase(CK) and creatine phosphokinase isoenzyme(CK-MB) levels increased. Therefore, we consider patients with rhabdomyolysis after intracranial aneurysm surgery. A series of treatment schemes, such as intravenous fluid infusion, alkalized urine, and hemodialysis, were adopted immediately, and finally the patient was discharged safely.
Conclusion:
For some postoperative patients, once the level of CK/CK-MB increases, acute renal damage occurs, and the urine color turns soy sauce, we should be alert to postoperative rhabdomyolysis.For those patients who have been diagnosed with rhabdomyolysis, we need to take timely treatment measures to avoid an unfortunate occurrence.
Improving Equity of Access Through Electronic Consultation: A Case Study of an eConsult Service
Authors: Clare Liddy, Justin Joschko, Sheena Guglani, Amir Afkham, Erin Keely
Journal: Front Public Health (2019)
Keywords: access to care, complex circumstances, econsult, equity, health inequality, low resource

Background: Patients with complex circumstances pertaining to geography, socioeconomic status, or functional health often face inequities in accessing care. Electronic consultation (eConsult) is a secure online application that allows primary care providers (PCPs) and specialists to communicate regarding a patient's care. eConsult has demonstrated an ability to improve access to specialist care, and may be of particular use in cases of inequitable access. Methods: We examined how eConsult is used to improve equity of access for patients in complex circumstances by conducting a multiple case study of eConsults from seven patient groups: addiction, frail elderly, homeless, long-term care, rural, special needs, and transgender. Cases from these groups were selected from all eConsult cases completed between January 1 and December 31, 2017 using a data collection strategy tailored to each group. An access framework by Levesque et al. was applied to the data to examine five dimensions of access, arranged in chronological order, that reflect the process of a patient seeking care: approachability, acceptability; availability, affordability, and appropriateness. Two reviewers analyzed the cases using an iterative approach, regularly presenting findings to the research team for discussion and interpretation. Results: Eight hundred and twenty-five cases emerged across the seven target groups. The selected cases highlighted a number of key factors, including the value of the patient-PCP relationship, the importance of considering patient perspectives when providing care, and efforts to accommodate patients facing particular challenges to accessing care. Examples emerged among all five dimensions of the Levesque et al. access framework, with the final dimension, appropriateness, emerging across all cases. Conclusions: By leveraging the eConsult platform, PCPs can help improve equitable access to specialist care. More research is needed to understand why patients with complex circumstances face a longer wait time compared to the general population, and the impact that eConsults can have in improving health outcomes and wait times for this population.