OpenMed/multicare-articles huggingface dataset:
Desflurane anaesthesia in myotonic dystrophy
Authors: Ranju Gandhi, Anil Kumar Jain, Jayashree Sood
Journal: Indian J Anaesth (2011)
Keywords: desflurane anaesthesia, laparoscopic cholecystectomy, myotonic dystrophy

Myotonic dystrophy (MD) is a rare genetic disorder with multisystem involvement characterised by myotonia and progressive muscle weakness and wasting. These patients pose significant challenges to the anaesthesiologist in view of the muscular and extramuscular involvement and sensitivity to anaesthetic drugs. The literature is replete with reports of postanaesthetic respiratory and cardiovascular complications in these patients. But an ideal anaesthetic technique in MD patients remains to be determined. Rapid recovery is desirable to reduce postoperative respiratory complications. Though there are a few case reports of maintenance of anaesthesia with isoflurane and sevoflurane, there are scanty reports of use of desflurane in these patients. We present successful management of a patient with MD for laparoscopic cholecystectomy using a carefully titrated desflurane-based anaesthesia and discuss the perioperative considerations.
Cardiac Resynchronization Therapy Device Implantation in a Patient with Congenitally Corrected Transposition of Great Vessels
Authors: Reza Mollazadeh, Masoud Eslami
Journal: J Tehran Heart Cent (2017)
Keywords: cardiac resynchronization therapy, congenitally corrected transposition of the great arteries, heart defects/ congenital
MeSH terms: Case Reports

A 29-year-old woman was referred to our hospital due to exacerbation in dyspnea on exertion and easy fatigability. A known case of congenitally corrected transposition of the great vessels and congenital complete heart block, she had already received a permanent single-chamber pacemaker. Decision was made to implant a biventricular pacemaker for the treatment of the failing heart. Excellent coronary sinus lead implantation was done, conferring amelioration of symptoms, QRS narrowing in the electrocardiogram, and improvement of systemic ventricular systolic function in echocardiography. Over a 15-month follow-up period, she had no dyspnea on exertion. This case highlights the significance of upgrading pacemakers in patients with heart failure.
Incisional site metastasis in a patient with cervical carcinoma: a case report and review of the literature
Authors: C Iavazzo, K Madhuri, A Tailor, S Butler-Manuel
Journal: Case Rep Obstet Gynecol (2012)

Abdominal wall metastasis either incisional, drain, or port is rather rare in patients treated for cervical carcinoma. We present a case of a patient who underwent an abdominal radical hysterectomy for a moderately differentiated cervical adenocarcinoma stage Ib1 and presented an incisional site metastasis 36 months after her operation. Moreover, we performed a literature search for abdominal wall metastases after radical hysterectomy for cervical cancer, and we present a table of the relative case reports. After our literature search, we clarified that the median time of recurrence was 14 months (range 1.5 month to 45 months). Thirty-three out of 42, 8/42, and 1/42 were squamous, adeno-, and adenosquamous carcinomas, respectively. Wide excision was performed in 30/37 cases of which we have information regarding the treatment option, while 11/37 and 13/37 underwent radiotherapy and chemotherapy, respectively. The possible mechanism of such a metastasis as well as the treatment options is discussed.
Metastatic Adenocarcinoma of Unknown Origin Presenting as Small Bowel Perforation: A Case Report and Literature Review
Authors: Samir Alkabie, Brian Bello, Roberto F Martinez, W Peter Geis, Michael S Ballo
Journal: J Investig Med High Impact Case Rep (2015)
Keywords: cancer of unknown primary site, diagnosis, immunohistochemistry, metastatic adenocarcinoma, occult primary, pulmonary primary, small bowel perforation

Metastatic malignant tumors that originate from occult primaries are defined as "cancers of unknown origin." We herein present the case of a 59-year-old man who presented with small bowel perforation secondary to metastatic adenocarcinoma of an unknown primary site. Imaging exhibited two pulmonary nodules, neither of which was dominant, along with mediastinal and retroperitoneal lymphadenopathy. Immunohistochemical profiling of the small bowel biopsy specimens revealed the tumor was most likely pulmonary in origin.
Systemic Lupus Erythematosus (SLE) and Antineutrophil Cytoplasmic Antibody-Associated Vasculitis (AAV) Overlap Syndrome: Case Report and Review of the Literature
Authors: Sathish Itikyala, Debendra Pattanaik, Syed Raza
Journal: Case Rep Rheumatol (2019)
MeSH terms: Case Reports

We report here the first case of systemic lupus erythematosus (SLE) and antineutrophil cytoplasmic antibody-associated vasculitis overlap syndrome (SLE/AAV) who had granulomatous polyangiitis (GPA) as the initial presentation. SLE/AAV overlap syndrome is an uncommon entity recently described in the literature. Prior reported patients with SLE/AAV overlap syndrome presented with SLE and microscopic polyangiitis (MPA). Our patient initially presented with granulomatous gastric ulcer and later developed respiratory failure. She was diagnosed with GPA. While on maintenance treatment with azathioprine 150 mg/day, she developed hematuria and proteinuria which turned out to be from class V lupus nephritis instead of relapse of vasculitis. Currently, the patient is doing well after treatment with rituximab. Although rare, this entity should be recognized and need to be treated appropriately.
Mucormycosis in a surgical defect masquerading as osteomyelitis: a case report and review of literature
Authors: Ashwini Kumar Mengji, Uday Shankar Yaga, Nishanth Gollamudi, Bhanu Prakash, Edunuri Rajashekar
Journal: Pan Afr Med J (2016)
Keywords: diabetes mellitus hyphae, pas stain, myiasis, zygomycosis
MeSH terms: Mucormycosis / diagnosis, Opportunistic Infections / diagnosis, Osteomyelitis / diagnosis, Case Reports, Review, Antifungal Agents / therapeutic use, Diabetes Mellitus / physiopathology, Humans, Male, Middle Aged, Mucormycosis / etiology, Mucormycosis / therapy, Opportunistic Infections / therapy, Antifungal Agents

Mucormycosis is a rare, highly lethal opportunistic fungal disease affecting immune compromised and diabetic patients. Mucormycosis is considered as the 3(rd) most common invasive mycosis after candidiasis and aspergillosis in debilitating patients. It is caused by the filamentous fungi of the class zygomycetes. The infection usually begins in the nose due to inhalation of fungal spores. This fatal fungal disease needs a prompt and early definitive diagnosis, aggressive surgical therapy and high dose anti-fungal therapy. Here, we present a case report of Mucormycosis in a 64 year elderly diabetic male patient who was previously operated for myiasis and also the extensive review of the literature of the mucormycosis.
Targeted next-generation sequencing of malignant peripheral nerve sheath tumor of the pterygopalatine fossa with intracranial metastatic recurrence
Authors: Xinjie Bao, Xiangyi Kong, Chengxian Yang, Huanwen Wu, Wenbin Ma, Renzhi Wang
Journal: Medicine (Baltimore) (2018)
MeSH terms: Brain Neoplasms / genetics, High-Throughput Nucleotide Sequencing, Neoplasm Recurrence, Local / genetics, Neurilemmoma / genetics, Skull Neoplasms / genetics, Case Reports, Review, Brain Neoplasms / secondary, Female, Humans, Mediator Complex / genetics, Mutation, Missense, Neoplasm Recurrence, Local / secondary, Neurilemmoma / secondary, Pterygopalatine Fossa / pathology, Skull Neoplasms / pathology, Young Adult, beta Catenin / genetics, CTNNB1 protein, human, MED12 protein, human, Mediator Complex, beta Catenin

Malignant peripheral nerve sheath tumor (MPNST) is an uncommon neoplasm that rarely involves the head and neck region. Intracranial MPNSTs unrelated to cranial nerves are highly malignant tumors with poor overall survival, probably because of infiltrating growth into surrounding brain tissue. The pathogenesis of MPNST remains unclear. There are no conclusive explanations for the mechanisms underlying the initiation, progression, and metastasis of MPNST. In this paper, we describe a case of MPNST in the pterygopalatine fossa with intracranial metastatic recurrence and review related literatures. Meanwhile, targeted next-generation sequencing (NGS) revealed the presence of both a beta-catenin (CTNNB1) missense mutation p.Ser33Phe and a mediator complex subunit 12 (MED12) frameshift mutation p.Tyr1278fs in the recurrent intracranial tumor. Therapies that target CTNNB1 mutation, MED12 mutation, CTNNB1 activation, or Wnt pathway activation are worth future studying.
ANCA-Associated Vasculitis Co-Occurrence With Systemic Sclerosis: A Case Report of a Rare Diagnostic Dilemma
Authors: Jordana Cheta, Michael Binder, Jolanta Kowalewska, Sandeep Magoon
Journal: J Investig Med High Impact Case Rep (2018)
Keywords: aki, anca-associated vasculitis, mctd, mpo, src, acute kidney injury, scleroderma, scleroderma renal crisis

Systemic sclerosis (SSc) is a rare autoimmune disorder that is typically divided into limited cutaneous systemic sclerosis and diffuse cutaneous systemic sclerosis. Scleroderma renal crisis (SRC) is a severe complication of SSc and typically presents with new-onset hypertension and a reduction in renal functioning. In patients presenting with typical features of SRC, treatment with an angiotensin-converting enzyme inhibitor along with dialysis as needed is typically initiated empirically. Renal biopsy is not recommended in patients with SSc presenting with typical features of SRC. Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a rare co-occurrence with SSc, in around 2.5% to 9% of patients. AAV is an inflammatory condition that can result in renal failure due to mononuclear cell infiltration and destruction of blood vessels. Treatment of AAV is drastically different from SRC and typically consists of immunosuppressants and dialysis if needed. SRC and AAV can only reliably be distinguished by renal biopsy. We present a rare case of a 70-year-old female with limited cutaneous systemic sclerosis who presented to the emergency department with new-onset renal failure. Her serology was found to be positive for antinuclear antibodies and myeloperoxidase antibodies, resulting in a renal biopsy, which revealed an acute necrotizing vasculitis consistent with AAV. We suggest consideration of a renal biopsy in patients with SSc who present with new-onset renal failure, especially with nonresponse to SRC treatment or positive serology.
One case of iodine-125 therapy - A new minimally invasive treatment of intrahepatic cholangiocarcinoma
Authors: Xinju Chen, Xiaoqi Chen, Chuanlei Zhang, Xinting Wang, Changwei Yuan, He Yang, Lixia Yang
Journal: Open Life Sci (2022)
Keywords: intrahepatic cholangiocarcinoma, iodine-125, transcatheter arterial chemoembolization
MeSH terms: Case Reports

Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver cancer associated with a poor prognosis. ICC accounts for about 10% of primary liver malignancies but with increasing incidence in recent years. Recently, some studies suggested that minimally interventional therapy can be used in the treatment of ICC. However, there are few references on interventional therapy for the clinical treatment of ICC. Herein we reported a case of a 48-year-old man who suffered from ICC. The patient was diagnosed with ICC by computerized tomography scan and pathological biopsy. The patient was completely cured by minimally interventional therapy with iodine-125 seed implantation. These results provide an important reference for the treatment option of ICC.
Case report: A rare case of pulmonary mucormycosis caused by Lichtheimia ramosa in pediatric acute lymphoblastic leukemia and review of Lichtheimia infections in leukemia
Authors: Guo-Qian He, Ling Xiao, Zhen Pan, Jian-Rong Wu, Dong-Ni Liang, Xia Guo, Ming-Yan Jiang, Ju Gao
Journal: Front Oncol (2022)
Keywords: lichtheimia ramosa, acute lymphoblastic leukemia, child, fungal infection, mucormycosis
MeSH terms: Case Reports

Mucormycosis caused by Lichtheimia ramosa is an emerging and uncommon opportunistic infection in patients with hematological malignancies, with high mortality rates. Herein, we first report a case of pulmonary mucormycosis with Lichtheimia ramosa in a 3-year-old girl recently diagnosed with B-cell acute lymphoblastic leukemia. The diagnosis was made using computerized tomography of the lung, metagenomic next-generation sequencing (mNGS) of blood and sputum specimens, and microscopic examination to detect the development of Lichtheimia ramosa on the surgical specimen. She was effectively treated after receiving prompt treatment with amphotericin B and posaconazole, followed by aggressive surgical debridement. In our case, the fungal isolates were identified as Lichtheimia ramosa using mNGS, which assisted clinicians in quickly and accurately diagnosing and initiating early intensive treatment. This case also indicated the importance of strong clinical suspicion, as well as aggressive antifungal therapy combined with surgical debridement of affected tissues.
Chlorambucil-induced acute interstitial pneumonitis
Authors: Hammad Shafqat, Adam J Olszewski
Journal: Case Rep Hematol (2014)

Chlorambucil is an alkylating agent commonly used in treatment of chronic lymphocytic leukemia (CLL). We report a case of interstitial pneumonitis developing in an 83-year-old man 1.5 months after completing a six-month course of chlorambucil for CLL. The interstitial pneumonitis responded to therapy with prednisone. We performed a systematic review of literature and identified 13 other case reports of chlorambucil-induced pulmonary toxicity, particularly interstitial pneumonitis. No unifying risk factor could be discerned and the mechanism of injury remains unknown. In contrast, major randomized trials of chlorambucil therapy in CLL have not reported interstitial pneumonitis as an adverse effect, which may be due to the rarity of the phenomenon or due to underreporting of events occurring after completion of treatment. Clinicians should consider drug-induced interstitial pneumonitis in the differential diagnosis of a suggestive syndrome developing even after discontinuation of chlorambucil.
Nonsurgical Intervention in a Preeclamptic Patient with Spontaneous Spinal Epidural Hematoma
Authors: Michelle Nguyen, Maria Raquel Kronen, Alex Nhan, Antonio Liu
Journal: Case Rep Obstet Gynecol (2018)
MeSH terms: Case Reports

Background:
Spontaneous epidural hematoma (SEH) is a rare finding in pregnancy, especially since most pregnant women do not have risk factors for developing SEH. The presence of epidural anesthesia can delay the diagnosis of SEH in pregnant patients. Immediate surgical decompression is the current standard of care for treating SEH.
Case presentation:
We present the case of a 37-year-old pregnant woman with preeclampsia with severe features who developed neurological deficits that were initially attributed to her epidural anesthesia. She was eventually found to have SEH with spinal stenosis at T5-T6 on MRI. Oral antihypertensives were used to keep the patient's blood pressures within normal limits, and she subsequently had complete resolution of her neurological symptoms and her SEH on imaging.
Conclusion:
Preeclampsia may contribute to the development of SEH in pregnancy, and strict blood pressure control may potentially provide a safe and effective alternative to neurosurgery for these patients.
A rare case of IgG4-related disease masquerading as periurethral malignancy and review of the literature
Authors: Zhiru Zeng, Shasha Gao, Xiaoyong Lu
Journal: Front Immunol (2023)
Keywords: contrast-enhanced ultrasound (ceus), dysuria, immunoglobulin g4-related disease, periurethral mass, urethra
MeSH terms: Immunoglobulin G4-Related Disease / diagnosis, Immunoglobulin G4-Related Disease / pathology, Neoplasms / pathology, Review, Case Reports, Dysuria / pathology, Female, Humans, Liver / pathology, Lung / pathology, Middle Aged

Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated fibroinflammatory disease that typically manifests as mass lesions affecting almost any organ including the pancreas, lacrimal and salivary glands, liver, lung and kidney. However, IgG4-RD with urethra involvement is scarce. We describe a rare case of IgG4-RD involving the urethra mimicking urethral carcinoma and review the published literature. A 64-years-old female presented with progressive dysuria for more than 2 months. Pelvic gadolinium-enhanced magnetic resonance imaging revealed a huge mass encasing the urethra which showed obvious enhancement in the arterial phase. And contrast-enhanced ultrasound showed that the entire mass was heterogeneously enhanced and displayed a fast-forward and fast-out pattern, which was highly suggestive of malignant tumor. The diagnosis of IgG4-RD was finally established by ultrasound-guided transvaginal mass needle biopsy. The patient was treated with methylprednisolone and cyclophosphamide and dysuria disappeared in the first week of therapy. She has been followed up in our clinic for 1 year without recurrence. The diagnosis of IgG4-RD should be considered in the differential diagnosis of a periurethral mass. Ultrasound-guided transvaginal mass needle biopsy is a safe and well-established tissue sampling method and should be performed in order to avoid unnecessary surgery.
Ovarian Solid Pseudopapillary Tumor Resembling Benign Hemorrhagic Cyst on Rapid Frozen Section
Authors: Michelle T Nguyen, Michael Carter, Zimin Zhao, Alireza Abidi, Melissa Hodeib
Journal: Case Rep Obstet Gynecol (2020)
MeSH terms: Case Reports

Solid pseudopapillary tumors are rare, with the majority of described cases originating in the pancreas. To date, there are only 10 documented reports of primary ovarian solid pseudopapillary tumors. Here, we describe the case of a 24-year-old woman who presented with worsening pelvic pain and dysmenorrhea. Workup demonstrated a right ovarian solid mass on ultrasound and an elevated serum LDH, which raised concerns for dysgerminoma due to her relatively young age. Therefore, she was taken to the operating room and underwent laparoscopic right salpingo-oophorectomy. On initial rapid frozen section, her ovarian cyst had a grossly hemorrhagic appearance with multiple hemosiderin deposits noted microscopically, which suggested a benign hemorrhagic cyst. However, the final pathology was reported as solid pseudopapillary tumor based on several defining histologic characteristics. Most importantly, immunostaining was positive for β-catenin and negative for E-cadherin. This report presents a brief review of the current literature on primary ovarian solid pseudopapillary tumors, including a discussion of expected prognosis after surgical resection, as well as a discussion of the role of immunohistochemistry (IHC) in differentiating ovarian neoplasms in young premenopausal women.
A 24-Year-Old Female Transplant Recipient with Type 2 Membranoproliferative Glomerulonephritis and Disseminated Shingles: A Cautionary Tale of Deferring to Primary Care
Authors: Benjamin T Burdorf
Journal: Case Rep Nephrol (2021)
MeSH terms: Case Reports

In this report, the case of a 24-year-old Caucasian female with type 2 membranoproliferative glomerulonephritis status-post living donor kidney transplant managed on triple regimen immunosuppressive therapy who developed shingles is discussed. With its onset, she promptly reached out to her nephrologist who deferred her to primary care. Prior to seeing her primary provider, she developed disseminated herpes zoster. She consulted emergency services where she was given inadequate care and again deferred to primary care. One day later, the dissemination included her entire torso, face, oral cavity, and all extremities. Fortunately, the patient had the insight to again reach out to her nephrologist who arranged for her to be admitted for appropriate care 6 days after her initial inquiry that carried 6 days of zoster progression. This case demonstrates how it is pertinent that specialists recognize potentially lethal complications associated with the conditions they follow. Although convenient to defer to primary care, if specialists were to take on the responsibility of providing a broader scope of care for their unique subsets of patients, it would likely result in a reduction in the 80% of serious medical errors that occur as a result of miscommunication, or lack thereof, between care providers.
Endovascular iliac vein reconstruction through an obstructive pelvic nodal recurrence of urothelial carcinoma
Authors: Bedros Taslakian, Varshaa Koneru, Akhilesh K Sista
Journal: CVIR Endovasc (2018)
Keywords: deep venous thrombosis, endovenous intervention, sharp recanalization, venous compression

Background:
Chronic venous occlusion is common particularly in cancer patient due to hypercoagulate state associated with venous compression. Treatment options include endovascular management with venoplasty and stenting. Recanalization can be challenging in patients with complete venous occlusion secondary to significant external compression by a mass.
Case presentation:
We report a case of a 73-year-old man with a history of bladder and prostate cancer who presented with worsening right leg edema and pain due to deep venous thrombosis secondary to a retroperitoneal mass. Management was sharp recanalization, venoplasty and stenting.
Conclusion:
Endovascular intervention of chronic venous occlusion is technically challenging and time consuming. Sharp venous recanalization is feasible and safe in patients who failed standard recanalization procedures. We present a case of cancer-related obstruction of the right iliac veins and acute thrombosis of the femoral vein with symptomatic lower limb swelling relieved by sharp recanalization through the tumor mass.