OpenMed/multicare-articles huggingface dataset:
Thoracic Spinal Intradural Arachnoid Cyst With a Fulminant Course
Authors: Temitayo O Ayantayo, Oluwafemi F Owagbemi, Serge Rasskazoff, Olawale A R Sulaiman
Journal: Ochsner J (2023)
Keywords: arachnoid cysts, laminectomy, paraplegia, spinal cord compression, spinal intradural arachnoid cysts, thoracic vertebrae
MeSH terms: Case Reports

Background: Spinal arachnoid cysts are rarely occurring benign cerebrospinal fluid-containing lesions that can occur anywhere along the spinal axis but are principally seen in the thoracic spine. They occur either ventrally or dorsally and can be extradural, intradural extramedullary, or intramedullary. They may be asymptomatic or can present with insidious pain and neurologic symptoms related to spinal cord and/or nerve root compression. Case Report: A 49-year-old male developed sudden midback pain with rapid progression to gait instability, urinary retention, and paraplegia within 10 hours. His presentation for neurosurgical care was delayed because of lack of funds and unfavorable insurance policies. At presentation 3 months after the onset of symptoms, magnetic resonance imaging of his spine showed a ventrolateral intradural extramedullary cystic lesion at T5-T6 with severe cord compression. He underwent T5-T6 and T6-T7 laminectomies with a limited left sixth rib costotransversectomy for microsurgical resection of the cyst. Postoperatively, the patient reported improvement in bladder and bowel control, but his paraplegia persisted. Conclusion: Arachnoid cysts are mostly benign lesions; however, they may have disastrous outcomes if not promptly addressed with the necessary urgency when symptoms are progressive, as in our patient.
Rare presentations of small bowel endometriosis
Authors: Anthony Sakiris, Ezaam Naik Fraz, Arvinf Rajandran, Jason Smith, Benjamin Allen, Sooraj Pillai, Pradeep Kakkadasam Ramaswamy, Sneha John
Journal: DEN Open (2024)
Keywords: abdominal pain, anemia, endometriosis, ileal diseases, iron‐deficiency
MeSH terms: Case Reports

Despite endometriosis being a relatively common chronic gynecological condition in women of childbearing age, small bowel endometriosis is rare. Presentations can vary from completely asymptomatic to reported symptoms of abdominal pain, bloating, and diarrhea. The following two cases depict very atypical manifestations of ileal endometriosis that presented as obscure intermittent gastrointestinal bleeding and bowel obstruction requiring surgical intervention. The first case describes a previously healthy 40-year-old woman with severe symptomatic iron deficiency anemia and intermittent melena. A small bowel enteroscopy diagnosed multiple ulcerated strictures in the distal small bowel as the likely culprit. Despite nonsteroidal anti-inflammatory drug-induced enteropathy being initially considered as the likely etiology, histopathological examination of the resected distal ileal segment revealed evidence of endometriosis. The second case describes a 66-year-old with a presumptive diagnosis of Crohn's disease who reported a 10-year history of intermittent perimenstrual abdominal pain, diarrhea, and nausea with vomiting. Following two subsequent episodes of acute bowel obstruction and surgical resection of the patient's stricturing terminal ileal disease, histopathological examination demonstrated active chronic inflammation with endometriosis. Small bowel endometriosis should be considered as an unusual differential diagnosis in women who may present with obscure gastrointestinal bleeding from the small bowel or recurrent bowel obstruction.
Case Report: Termination of unplanned pregnancy led to rapid deterioration of non-small-cell lung cancer during osimertinib treatment
Authors: Qizhi Ma, Pei Shu, Kexun Zhou, Yongsheng Wang
Journal: Front Oncol (2023)
Keywords: deterioration, epidermal growth factor receptor, non-small-cell lung cancer, pregnancy, tyrosine kinase inhibitor
MeSH terms: Case Reports

We present a case of a woman with non-small-cell lung cancer (NSCLC) who experienced disease progression during treatment with the epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) osimertinib due to an unplanned pregnancy. Given the risk of tumor progression, the patient underwent an artificial abortion. However, disease deterioration occurred shortly after termination of the pregnancy, with severe chest pain, increased dyspnea, and pleural effusion. After positive rescue measures, including emergency thoracic drainage, thoracentesis, and oxygen uptake, her symptoms improved. Considering pregnancy as an immune escape physiological process, the patient continued treatment with osimertinib, and a partial response (PR) lasting 16 months was observed. Therefore, this case highlights the importance of being vigilant about the rapid development of the tumor after delivery in pregnant patients with EGFR-mutation lung cancer and taking preventive measures to cope with various emergencies.
Multimodal imaging findings of primary liver clear cell carcinoma: a case presentation
Authors: Xianwen Hu, Xiaotian Li, Wei Zhao, Jiong Cai, Pan Wang
Journal: Front Med (Lausanne) (2024)
Keywords: mri, pet/ct, clear cell carcinoma, imaging findings, liver
MeSH terms: Case Reports

Primary clear cell carcinoma of liver (PCCCL) is a special and relatively rare subtype of hepatocellular carcinoma (HCC), which is more common in people over 50 years of age, with a preference for men and a history of hepatitis B or C and/or cirrhosis. Herein, we present a case of a 60-year-old woman who came to our hospital for medical help with right upper abdominal pain. The imaging examination showed a low-density mass in the right lobe of his liver. In contrast enhanced computed tomography (CT) or T1-weighted imaging, significant enhancement can appear around the tumor during the arterial phase, and over time, the degree of enhancement of the tumor gradually decreases. The lession showed obviously increased fluorine-18 fluorodeoxyglucose (18F-FDG) uptake on positron emission tomography/CT. These imaging findings contribute to the diagnosis of PCCCL and differentiate it from other types of liver tumors.
Simultaneous management of aortic and mitral regurgitation through one-stage transcatheter aortic valve replacement and transcatheter edge-to-edge repair: case report
Authors: Hao Lin, Mei Zhu, Meng Lv, Zhengjun Wang
Journal: Front Cardiovasc Med (2024)
Keywords: aortic insufficiency, case report, mitral regurgitation, transcatheter aortic valve replacement, transcatheter edge-to-edge mitral valve repair
MeSH terms: Case Reports

This case report presents a 72-year-old male patient who presented with exertional dyspnea for over 10 years, which had progressively worsened over the past 4 months. Transthoracic echocardiography revealed severe aortic and mitral regurgitation, with a left ventricular ejection fraction of 37% and a left ventricular end-diastolic diameter of 64 mm. Despite receiving long-term optimal medical management, there was no improvement in symptoms or severity of valvular regurgitation. Given the relatively high surgical risk associated with double valve replacement in this elderly patient and his preference for minimally invasive procedures, a one-stage transapical aortic valve replacement and transcatheter mitral valve repair using the edge-to-edge technique were planned. The patient was discharged 8 days post-procedure without any complications. At 1-month follow-up, the patient's New York Heart Association (NYHA) functional class had improved to grade II.
Helmet Ventilation in a Child with COVID-19 and Acute Respiratory Distress Syndrome
Authors: Ke-Yun Chao, Chao-Yu Chen, Xiao-Ru Ji, Shu-Chi Mu, Yu-Hsuan Chien
Journal: Case Rep Pediatr (2024)
MeSH terms: Case Reports

Background:
In pediatric patients with severe COVID-19, if the respiratory support provided using high-flow nasal cannula (HFNC) becomes insufficient, no definitive evidence exists to support the escalation to noninvasive ventilation (NIV) or mechanical ventilation (MV). Case Presentation. A 9-year-old boy being treated with face mask-delivered biphasic positive airway pressure ventilation developed fever, tachypnea, and frequent desaturation. The COVID-19 polymerase chain reaction test and urine antigen test for Streptococcus pneumoniae were both positive, and sputum culture yielded Pseudomonas aeruginosa. The do-not-resuscitate order precluded the use of endotracheal intubation. After 2 h of HFNC support, the respiratory rate oxygenation (ROX) index declined from 7.86 to 3.71, indicating impending HFNC failure. A helmet was used to deliver NIV, and SpO2 was maintained at >90%. Dyspnea and desaturation gradually improved, and the patient was switched to HFNC 6 days later and discharged 10 days later.
Conclusion:
In some cases, acute respiratory distress syndrome severity cannot be measured using the oxygenation index or oxygenation saturation index, and the SpO2/FiO2 ratio and ROX index may serve as useful alternatives. Although NIV delivered through a facemask or HFNC is more popular than helmet-delivered NIV, in certain circumstances, it can help escalate respiratory support while providing adequate protection to healthcare professionals.
Recurrent bladder urothelial carcinoma complicated with primary bladder large cell neuroendocrine carcinoma: a case report and literature review
Authors: Jiarui Cui, Qing Zhao, Chunhong Yu, Pengfei Ma, Shoubin Li
Journal: Front Oncol (2024)
Keywords: lcnec, bladder tumor, diagnosis, prognosis, treatment
MeSH terms: Case Reports

Objective:
To improve the understanding, diagnosis and treatment of bladder large cell neuroendocrine carcinoma (LCNEC).
Methods:
A clinical case of bladder LCNEC admitted to our hospital was reported. The epidemiology, prognosis, diagnosis and treatment methods of large cell neuroendocrine carcinoma were reviewed. The diagnosis and treatment status and prognosis were discussed based on the literature.
Results:
The female patient was admitted to hospital for "more than 4 years after TURBT and intermittent hematuria for more than 2 years". She was diagnosed as recurrent bladder cancer and underwent "radical cystotomy + hysterectomy". The postoperative pathological findings were high-grade urothelial carcinoma of the bladder neck and large cell neuroendocrine carcinoma of the bladder. The patient recovered well after surgery, but refused radiotherapy and chemotherapy and is still under close follow-up.
Conclusion:
Bladder LCNEC is clinically rare, has unique pathological features, is more aggressive than traditional urothelial carcinoma, and has a poor prognosis. Surgery, chemotherapy and radiotherapy should be combined with multi-mode treatment.
Malignant transformation of a long-term ulcer in a patient with leprosy sequelae: a case report
Authors: Aline Gabriele Etur Dos Santos, Antônio Augusto Moreira
Journal: J Vasc Bras (2024)
Keywords: carcinoma, leprosy, malignant tumor, surveillance, ulcer, wounds
MeSH terms: Case Reports

Marjolin's ulcer (MU) is a rare condition defined as a malignant skin tumor arising from chronic wounds and inflammation. The most common histological findings in MUs are squamous cell carcinomas (SCC) (or spinocellular carcinomas [SPC]), such as basal cell carcinomas (BCC) and malignant melanomas (MM). The aim of this study is to report the case of a patient with sequelae of leprosy who presented malignant transformation in a long-standing ulcer on the right leg, thereby contributing to understanding of the progression and significance of early diagnosis of MU. The MU was diagnosed by incisional biopsy of the lesion and upon obtaining a positive result the patient was referred to an oncology service. Treatment of MU is multidisciplinary and surgical excision is the first therapeutic option. Proper management and surveillance of chronic ulcers by the healthcare team are necessary for early recognition of MU.
Case report: Checkpoint inhibitor pneumonitis with positive anti-melanoma differentiation-associated gene 5 antibodies in a patient with lung cancer
Authors: Siqi Pan, Huaiya Xie, Luo Wang, Yuanzhuo Wang, Menglian Zou, Yan Xu, Xinlun Tian, Junping Fan, Jinglan Wang
Journal: Front Immunol (2024)
Keywords: anti-mda5 antibodies, immune checkpoint inhibitors, immune-related adverse events, pneumonitis, rapidly progressive interstitial lung disease
MeSH terms: Lung Diseases, Interstitial / diagnosis, Lung Diseases, Interstitial / drug therapy, Lung Diseases, Interstitial / etiology, Lung Neoplasms / complications, Lung Neoplasms / drug therapy, Pneumonia / diagnosis, Pneumonia / drug therapy, Pneumonia / etiology, Case Reports, Research Support, Non-U.S. Gov't, Comment, Aged, Autoantibodies, Humans, Immune Checkpoint Inhibitors / adverse effects, Male, Autoantibodies, Immune Checkpoint Inhibitors

With the widespread use of immune checkpoint inhibitors to treat various cancers, pulmonary toxicity has become a topic of increasing concern. Anti-melanoma differentiation-associated gene 5 (anti-MDA5) antibodies are strongly associated with rapidly progressive interstitial lung disease (RP-ILD) in patients with clinically amyopathic dermatomyositis. However, anti-MDA5 antibody expression has not been reported in patients with immune-related adverse events. We present the case of a 74-year-old man with lung adenocarcinoma who developed RP-ILD after treatment with immune checkpoint inhibitors. Further investigation revealed multiple autoantibodies, including anti-MDA5 antibodies. He initially responded to systemic glucocorticoids, immunosuppressants, and tocilizumab but eventually died from worsening pneumomediastinum. This case is the first one to suggest that checkpoint inhibitor pneumonitis can present as RP-ILD with positive anti-MDA5 antibodies, which may be predictive of a poor prognosis.
Case report: Gross total resection of a primary fourth ventricular meningioma using the telovelar approach in a dog
Authors: Jaemin Jeong, Haebeom Lee, Yoonho Rho, YoungJin Jeon
Journal: Front Vet Sci (2024)
Keywords: dog, fourth ventricle, fourth ventricular meningioma, meningioma, telovelar approach
MeSH terms: Case Reports

An 11-year-old spayed female Maltese dog presented with a 2-month history of gait alterations, wide-based stance, and chronic vomiting. Neurological examination revealed cerebellovestibular signs, including head tilt, nystagmus, strabismus, intentional tremor, and hypermetric gait. MRI showed a mass with iso- to hypointensity on T1-weighted (T1W) images and heterogeneous hyperintensity on T2-weighted (T2W) images, with marked non-uniform contrast enhancement. The tumor was removed via a telovelar approach without intraoperative complications. Postoperatively, the dog developed non-ambulatory paraparesis with the rigidity of the pelvic limbs but recovered ambulation within 6 days. Preoperative neurological signs progressively improved, and the patient was discharged without complications 10 days after surgery. Histological examination revealed dense spindle cells with an abundant collagen matrix and oval-shaped nucleated cells with small whorls, leading to a diagnosis of transitional meningioma of the fourth ventricle. MRI follow-up at 8 months postoperatively showed no definitive evidence of recurrence. At the final follow-up, 15.4 months postoperatively, mild neurological signs, including a slight head tilt and subtle strabismus, remained, but the rest of the neurological examination was normal. This is the first reported case of a meningioma in the fourth ventricle of a dog successfully removed using the telovelar approach.
18F-FDG PET/CT findings in a patient with blastic plasmacytoid dendritic cell neoplasm and post-transplant lymphoproliferative disorder after hematopoietic stem cell transplantation: a case report
Authors: Jinzhi Chen, Xi Zhang, Linlin Ma, Yuan Gao, Zhanli Fu, Meng Liu
Journal: Front Med (Lausanne) (2023)
Keywords: 18f-fdg, pet/ct, blastic plasmacytoid dendritic cell neoplasm, hematopoietic stem cell transplantation, post-transplant lymphoproliferative disorder
MeSH terms: Case Reports

Background:
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is an extremely rare hematopoietic malignancy, which originating from precursors of plasmacytoid dendritic cells. Allogeneic hematopoietic stem cell transplantation (HSCT) is normally considered in the treatment of BPDCN patients to acquire sustained remission. Post-transplant lymphoproliferative disorder (PTLD) is a group of conditions involving abnormal lymphoid cells proliferation in the context of extrinsic immunosuppression after solid organ transplantation (SOT) or HSCT. Herein, we report a patient with BPDCN, who suffered from PTLD after allogeneic HSCT.
Case presentation:
A 66-year-old man was diagnosed with BPDCN, confirmed by pathologic examination after splenectomy. The post-surgery 18F-fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography (18F-FDG PET/CT) showed multifocal 18F-FDG avidity in the left cheek, lymph nodes and bone marrow. The patient started chemotherapy, followed by allogeneic HSCT and immunosuppressive therapy. Four months after the HSCT, the patient developed intermittent fever and recurrent lymphadenopathy, accompanied with progressively elevated Epstein-Barr virus (EBV)-DNA both in serum and lymphocytes. 18F-FDG PET/CT was performed again and found multiple new enlarged 18F-FDG-avid lymph nodes, while the previous hypermetabolic lesions all disappeared. The pathology of mesenteric lymph node indicated a monomorphic PTLD (diffuse large B-cell lymphoma). Then the immunosuppressive medications were stopped and two cycles of Rituximab were given, and the follow-up CT scan indicated a complete response.
Conclusion:
When patients with BPDCN recurred new enlarged lymph nodes after allogeneic HSCT and immunosuppressive therapy, PTLD should be taken into consideration. 18F-FDG PET/CT may provide additional evidence for supporting or refuting the suspicion of PTLD, and suggest lesions accessible for biopsy.
Relapsed refractory multiple myeloma with CNS involvement successfully treated with Elranatamab: first reported case
Authors: Yasa Gul Mutlu, Sureyya Yıgıt Kaya, Senem Maral, Elif Melek, Zafer Baslar, Leylagul Kaynar, Omur Gokmen Sevindik
Journal: Front Immunol (2023)
Keywords: bcma, cns involvement, elranatamab, bispecific ab, multiple myeloma
MeSH terms: Antibodies, Bispecific / therapeutic use, Multiple Myeloma / drug therapy, Case Reports, Adult, B-Cell Maturation Antigen, Humans, Immunotherapy, Adoptive / methods, Male, Antibodies, Bispecific, B-Cell Maturation Antigen

Central nervous system (CNS) involvement in multiple myeloma (MM) is a rare and challenging complication associated with poor prognosis and limited treatment options. Emerging T-cell directing therapies, such as bispecific antibodies (bsAbs) and chimeric antigen receptor T cells (CAR-T), have shown remarkable success in treating MM, but their efficacy in CNS involvement remains unclear. Elranatamab, a humanized bispecific antibody targeting B-cell maturation antigen (BCMA) and CD3-expressing T cells, has demonstrated promising results in relapsed refractory MM. However, its efficacy in treating CNS-MM has not been reported. We present a case of a 37-year-old male MM patient with CNS involvement who has been successfully treated with Elranatamab.
Rapid response to fifth-line brigatinib plus entrectinib in an ALK-rearranged lung adenocarcinoma with an acquired ETV6- NTRK3 fusion: a case report
Authors: Dan Li, Yue Zhu, Jincheng Song, Dafu Yang, Saiqiong Cui, Xin Liu, Le Wang, Jiangyan Zhang, Evenki Pan, Zhaoxia Dai
Journal: Front Oncol (2024)
Keywords: alk rearrangement, etv6-ntrk3, brigatinib, entrectinib, resistance mutations
MeSH terms: Case Reports

The management of non-small cell lung cancer (NSCLC), specifically targeting the anaplastic lymphoma kinase (ALK) with tyrosine kinase inhibitors (TKIs), is challenged by the emergence of therapeutic resistance. Resistance mechanisms to ALK TKIs can be broadly classified into ALK-dependent and ALK-independent pathways. Here, we present a case with lung adenocarcinoma (LUAD) harboring an ALK rearrangement. The patient had developed resistance to sequential ALK TKI therapies, with an acquired ETV6-NTRK3 (E4:N14) fusion as a potential mechanism of ALK-independent resistance to lorlatinib. Subsequently, the patient was treated with the combination of brigatinib plus entrectinib and demonstrated a positive response, achieving an 8-month progression-free survival. Our case provides a potential treatment option for LUAD patients with ALK rearrangements and highlights the utility of next-generation sequencing (NGS) in uncovering genetic alterations that can guide the selection of effective treatment strategies.
Successful Termination of Insulin Therapy in Transient Neonatal Diabetes Mellitus
Authors: Risa Sakai, Nobuyuki Kikuchi, Daisuke Nishi, Haruko Horiguchi
Journal: Case Rep Pediatr (2023)
MeSH terms: Case Reports

A sensor-augmented pump (SAP) therapy is used to treat neonatal diabetes mellitus (NDM). We treated a case for which SAP therapy was successful and prevented hypoglycemia. The patient was a baby boy who was small for his gestational age. He had hyperglycemia at 4 days of age, and a diagnosis of NDM had previously been made at another hospital. A continuous intravenous insulin infusion was initiated. At 29 days of age, the patient was transferred to our hospital for further treatment. SAP therapy was initiated at 39 days, which was successful and prevented hypoglycemia. Gradually, blood glucose levels improved. The insulin infusion was stopped to determine if any potential pump issues arose prior to discharge; the patient's blood glucose level did not increase. The decision was therefore made to discharge the patient from the hospital at 58 days of age with discontinued insulin. After discharge, genetic analysis showed hypomethylation on one of the alleles within 6q24, leading to a diagnosis of 6q24-related diabetes mellitus. Although almost all 6q24-related NDM cases are transient, no evidence exists for the appropriate timing of insulin discontinuation. Retrospective continuous glucose monitoring (CGM) analysis showed improved standard deviation (SD) values as well as improved blood glucose variability. This experience suggested SD values of CGM may be used as an index for tapering and discontinuing insulin in SAP therapy. However, future collaborative studies at other centers that focus on SD values as a guide for insulin discontinuation in SAP are required.