OpenMed/multicare-articles huggingface dataset:
Avascular Necrosis of the Femoral Head Following Intramedullary Nailing of a Femoral Shaft Fracture in a Skeletally Mature Adult: A Case Report
Authors: Hamza R Gomaa, Ali A Buanq, Ahmed M Hazeem, Salma M Daoud, Ali H Almajed
Journal: Cureus (2024)
Keywords: femoral nailing, femoral shaft fractures, hip avascular necrosis, intramedullary femur nailing, skeletally mature
MeSH terms: Case Reports

Avascular necrosis (AVN) of the femoral head is a well-documented complication that occurs following femoral neck fractures in both adults and pediatrics. Incidence of AVN following intramedullary nailing (IMN) for femoral shaft fractures is relatively rare. We are reporting an exceptional case of a 28-year-old skeletally mature adult, with no risk factors, who developed stage 3 AVN following trochanteric entry-point IMN for a traumatic femur shaft fracture. Our case contributes to the existing literature by adding to the limited number of reported cases available. In addition, it emphasizes the importance of observation and anticipation for such complications and shows the need for further studies to understand the relationship between this modality of treatment and the development of AVN of the femoral head.
Case report: A Boy with an inability to walk; do not forget about scurvy
Authors: Emira Mansor Noor Emilia, Abdul Hadi Said
Journal: Malays Fam Physician (2024)
Keywords: autism spectrum disorder, lower limb pain, nutritional deficiency, scurvy
MeSH terms: Case Reports

Scurvy, a condition caused by vitamin C deficiency, is characterized by a syndrome of multisystem disorder due to defective collagen production and antioxidative function. This condition is infrequent in this modern era; thus, it is often not within the list of differential diagnoses. The broad clinical picture is generally overlooked as other systemic illnesses, resulting in an extensive investigation that delays the diagnosis. Herein, we report a case of an 8-year-old boy with underlying autism spectrum disorder who presented with lower limb pain and other constitutional symptoms. Examination revealed multiple hyperpigmented scars over the upper and lower limbs and gingival hyperpigmentation. With history of picky eating habits and clinical symptoms supported by radiographic findings, scurvy was suspected and subsequently confirmed based on a low level of ascorbic acid. With vitamin C supplementation and proper nutritional support, the patient recovered well.
Nodular pulmonary amyloidosis diagnosed by ultrasound-guided percutaneous needle biopsy
Authors: Yuki Ko, Kazunori Tobino, Yuri Hiramatsu, Takuto Sueyasu, Saori Nishizawa, Yuki Yoshimatsu
Journal: Respir Med Case Rep (2024)
Keywords: 18f-fluoro-deoxyglucose (18f-fdg) positron emission tomography, nodular pulmonary amyloidosis, systemic al amyloidosis, ultrasound-guided percutaneous needle biopsy
MeSH terms: Case Reports

Pulmonary amyloidosis is characterized by extracellular deposition of fibrous protein called amyloid in the lungs and has three subtypes: nodular, diffuse, and tracheobronchial amyloidosis. Pulmonary nodular amyloidosis can mimic other lung diseases including infectious diseases, metastatic lung tumors, sarcoidosis, and pulmonary hyalinizing granuloma. A biopsy of the lesion is essential for a definitive diagnosis. Herein, we report the case of a 66-year-old man who presented for shortness of breath on exertion and was diagnosed with nodular pulmonary amyloidosis on ultrasound-guided percutaneous needle biopsy. A chest X-ray and computed tomography (CT) revealed bilateral slowly growing multiple calcified pulmonary nodules and cavities. Malignancy was suspected based on 18F-fluoro-deoxyglucose (18F-FDG) positron emission tomography/CT (PET/CT) images. An ultrasound-guided percutaneous needle biopsy was performed, and histopathologic examination of the lesion confirmed nodular pulmonary amyloidosis. This case highlights the importance of considering nodular pulmonary amyloidosis in the differential diagnosis of pulmonary nodules with increased uptake of 18F-FDG on PET/CT and the utility of ultrasound-guided needle biopsy in the definitive diagnosis.
Antimicrobial peptide for bacterial infection imaging: first case reported in Brazil
Authors: Solange Amorim Nogueira, Marycel Rosa Felisa Figols de Barboza, Rosemeire Pereira Bezerra, Jorge Mejia Cabeza, Adriana Macedo Dell'Aquila, Durval do Carmo Barros Santos, Lilian Yuri Itaya Yamaga, Akemi Osawa
Journal: Einstein (Sao Paulo) (2023)
MeSH terms: Positron Emission Tomography Computed Tomography / methods, Staphylococcal Infections / diagnosis, Case Reports, Adult, Antimicrobial Peptides, Brazil, Female, Humans, Inflammation, Antimicrobial Peptides

Molecular imaging markers can be used to differentiate between infection and aseptic inflammation, determine the severity of infection, and monitor treatment responses. One of these markers is ubiquicidin(29-41) (UBI), a cationic peptide fragment that binds to the bacterial membrane wall and is labeled with gallium-68 (68Ga), a positron emitter radioisotope. The use of UBI in positron emission tomography (PET)/computed tomography (CT) for improved detection of lesions has been receiving considerable attention recently. Herein, we report the first case of 68Ga-UBI PET/CT performed in Brazil. The patient was a 39-year-old woman referred for a scan to confirm a clinical suspicion of chronic osteomyelitis of her fractured left tibia. PET images revealed radiotracer uptake near the posterior contour of the tibial fracture focus and the fixation plate, in the soft tissue around the distal half of the tibia, and in the non-consolidated fracture of the left distal fibula. Surgery for local cleaning was performed, and culture of a specimen collected from the surgical site confirmed the presence of Staphylococcus aureus. In the present case, 68Ga-UBI PET/CT, a non-invasive imaging modality, identified the infection foci in vivo, indicating its potential for clinical use.
Case series: Intraoperative neuromonitoring and angiography in the surgical treatment of vascular malformations
Authors: Tomaž Šmigoc, Ninna Kozorog, Janez Ravnik
Journal: Front Neurol (2023)
Keywords: angiography, arteriovenous malformation, case report, indocyanine green, neuromonitoring, subarachnoid hemorrhage
MeSH terms: Case Reports

In the surgical treatment of cerebral vascular malformations, e.g., aneurysms and arteriovenous malformations, the risk of ischemic complications is 6.7%, and a residual aneurysm is possible in 5.2% of these cases. Ischemic lesions can result in permanent neurological deficits, and a residual aneurysm can lead to the recurrence of the aneurysm in 2% of cases. In this article, we present five cases (two cases of ruptured aneurysms, two cases of non-ruptured aneurysms, and a case of arteriovenous malformation) in which we reduced the aforementioned risks with the use of intraoperative neuromonitoring and angiography. Intraoperative neuromonitoring (IONM) is used to measure motor and sensory-evoked potentials to detect brain hypoperfusion. Intraoperative angiography with the dye indocyanine green (ICG-A), which fluoresces in a vessel under a microscope after intravenous administration, helps to identify residual aneurysm sacs and distal blood flow. With the use of IONM and ICG-A, we identified abnormalities and adjusted our interventions and treatments. IONM and ICG-A can lead to a better outcome after surgical treatment of cerebral vascular abnormalities.
An unresectable and metastatic intrahepatic cholangiocarcinoma with EML4-ALK rearrangement achieving partial response after first-line treatment with ensartinib: a case report
Authors: Senmiao Huang, Dianhe Li, Yongye Huang, Guojie Lu, Ying Tian, Xuefeng Zhong, Yating Zheng, Mengli Huang, Fuxi Huang
Journal: Front Oncol (2023)
Keywords: alk fusion, eml4-alk rearrangement, ensartinib, intrahepatic cholangiocarcinoma (icc), targeted therapy
MeSH terms: Case Reports

Systemic chemotherapies are the primary treatment options for patients with unresectable and metastatic intrahepatic cholangiocarcinoma (ICC), but the effectiveness of current systemic therapies is limited. The development of targeted-therapy has changed the treatment landscape of ICC, and comprehensive genome sequencing of advanced cholangiocarcinoma patients could be beneficial to identify potential targets to guide individualized treatment. Herein, we reported an unresectable and metastatic ICC patient who detected EML4-ALK rearrangement in peripheral blood, which was later confirmed on tissue-based testing, and achieved partial response (PR) after first-line treatment with ensartinib. This case suggests that the liquid biopsy is of clinical value for unresectable or metastatic ICC, and the discovery of rare molecular targets provides new therapeutically approaches for advanced ICC patients.
Case Report: Multiple types of arrhythmias in a late-confirmed Danon disease
Authors: Nan Wang, Yu Cao, Jie Wang, Qing Zhang
Journal: Front Cardiovasc Med (2024)
Keywords: danon disease, lamp2 variant, wolff–parkinson–white (wpw) syndrome, arrhythmia, case report
MeSH terms: Case Reports

Introduction:
Danon disease is an X-linked disorder caused by pathogenic variants in lysosome-associated membrane protein 2 (LAMP2) gene, typically characterized by the triad of hypertrophic cardiomyopathy, myopathy, and intellectual disability. However, many patients may not present the typical presentation, especially in the early stage. Electrocardiogram (ECG) abnormalities can be found in almost all patients, with Wolff-Parkinson-White (WPW) syndrome being the most common. We reported the case of a 51-year-old woman who experienced multiple types of arrhythmias over three decades and was diagnosed with Danon disease late by genetic testing.
Case summary:
A 51-year-old woman with a 36-year history of intermittent palpitations was admitted due to hemodynamically stable ventricular tachycardia (VT). Her past medical history revealed multiple arrhythmias and ECG abnormalities in her 30s and 40s, including WPW syndrome with paroxysmal supraventricular tachycardia, paroxysmal atrial flutter, atrial fibrillation, ventricular tachycardia, and complete left bundle branch block. She denied any family history of cardiovascular disease or sudden death. Upon arrival, her vital signs were unremarkable. Cardiovascular magnetic resonance (CMR) imaging revealed left ventricular enlargement and late gadolinium enhancement (LGE) in the anterior, inferior, and lateral walls. Subsequent, whole-exome sequencing (WES) gene testing revealed a pathogenic heterozygous variant in LAMP2 gene (c.696T>A; p.Cys232Ter), which confirmed the diagnosis of Danon disease.
Conclusion:
Genetic testing should be considered in patients who display multiple arrhythmias with LV structural abnormalities of unknown etiology for a possible Danon disease.
Guillain-Barré syndrome in ulcerative colitis and SARS-CoV-2 infection: a case report and literature review
Authors: Shema Ayadi, Rabeb Hammouga, Mohamed Slim Majoul, Hela Jamoussi, Yosra Zaimi, Asma Mensi, Mohamed Fredj, Leila Mouelhi
Journal: Future Sci OA (2024)
Keywords: covid-19, guillain barré syndrome, sars-cov-2, inflammatory bowel diseases, ulcerative colitis, venous thrombosis
MeSH terms: Case Reports

Aim: Guillain-Barré syndrome (GBS) occurrence is rare during inflammatory bowel disease (IBD) and SARS-CoV-2 infection. Its association with thrombotic vascular events, which are common during these two entities, is extremely rare. Case report: We report an exceptional association of GBS and cerebral venous thrombosis in a 28-year-old woman with active ulcerative colitis and no previous history of SARS-CoV-2 vaccination. Mildly symptomatic SARS-CoV-2 infection was diagnosed during etiological investigations of cerebral venous thrombosis. GBS symptoms began 10 days later with clinical and electrical abnormalities consistent with axonal GBS. Other GBS causes were excluded. Favorable outcomes were noted after intravenous immunoglobulin perfusion with full recovery 12 months later. Conclusion: Greater attention should be focused on IBD patients with SARS-CoV-2 infection regardless of its severity.
Case report: Recovery from refractory myasthenic crisis to minimal symptom expression after add-on treatment with efgartigimod
Authors: Keiko Watanabe, Shinichi Ohashi, Takuya Watanabe, Yuki Kakinuma, Ryuta Kinno
Journal: Front Neurol (2024)
Keywords: efgartigimod, intravenous immunoglobulins, minimal symptom expression, myasthenic crisis, plasmapheresis
MeSH terms: Case Reports

Myasthenic crisis, a life-threatening exacerbation of myasthenia gravis, is a significant clinical challenge, particularly when refractory to standard therapies. Here, we described a case of myasthenic crisis in which the patient transitioned from refractory myasthenic crisis to minimal symptom expression after receiving add-on treatment with efgartigimod, a novel neonatal Fc receptor antagonist. A 54 years-old woman who was diagnosed with anti-acetylcholine receptor antibody-positive myasthenia gravis experienced respiratory failure necessitating mechanical ventilation. Despite aggressive treatment with plasmapheresis, intravenous immunoglobulins, and high-dose corticosteroids, her condition continued to deteriorate, culminating in persistent myasthenic crisis. Efgartigimod was administered as salvage therapy. Remarkable improvement in neuromuscular function was observed within days, allowing for successful weaning from mechanical ventilation. Over the subsequent weeks, the patient's symptoms continued to ameliorate, ultimately reaching a state of minimal symptom expression. Serial assessments of her serum anti-acetylcholine receptor antibody titer showed a consistent decline in parallel with this clinical improvement. This case highlights efgartigimod's potential as an effective therapeutic option for refractory myasthenic crisis, offering new hope for patients facing this life-threatening condition.
Bilothorax: A Case Report and Systematic Literature Review of the Rare Entity
Authors: Roshan Acharya, Smita Kafle, Yub Raj Sedhai, Dhan Bahadur Shrestha, Kevin Walsh, Wasif Elahi Shamsi, Suraj Gyawali, Nikita Acharya, Anthony Lukas Loschner, Edmundo Raul Rubio
Journal: Pulm Med (2024)
MeSH terms: Bilirubin / blood, Pleural Effusion / etiology, Case Reports, Systematic Review, Aged, Bile, Female, Humans, Thoracentesis, Thoracostomy, Bilirubin

Background:
Bilothorax is defined as the presence of bile in the pleural space. It is a rare condition, and diagnosis is confirmed with a pleural fluid-to-serum bilirubin ratio of >1.
Methods:
The PubMed, Embase, Google Scholar, and CINAHL databases were searched using predetermined Boolean parameters. The systematic literature review was done per PRISMA guidelines. Retrospective studies, case series, case reports, and conference abstracts were included. The patients with reported pleural fluid analyses were pooled for fluid parameter data analysis.
Results:
Of 838 articles identified through the inclusion criteria and removing 105 duplicates, 732 articles were screened with abstracts, and 285 were screened for full article review. After this, 123 studies qualified for further detailed review, and of these, 115 were pooled for data analysis. The mean pleural fluid and serum bilirubin levels were 72 mg/dL and 61 mg/dL, respectively, with a mean pleural fluid-to-serum bilirubin ratio of 3.47. In most cases, the bilothorax was reported as a subacute or remote complication of hepatobiliary surgery or procedure, and traumatic injury to the chest or abdomen was the second most common cause. Tube thoracostomy was the main treatment modality (73.83%), followed by serial thoracentesis. Fifty-two patients (51.30%) had associated bronchopleural fistulas. The mortality was considerable, with 18/115 (15.65%) reported death. Most of the patients with mortality had advanced hepatobiliary cancer and were noted to die of complications not related to bilothorax.
Conclusion:
Bilothorax should be suspected in patients presenting with pleural effusion following surgical manipulation of hepatobiliary structures or a traumatic injury to the chest. This review is registered with CRD42023438426.
Intrasphenoidal cephalocoeles: Knowing the less known
Authors: Prachi Mann, Sanjog S Gajbhiye, Deoyani Sarjare, Aarti Anand, Shrikant Kalbagwar, Pramod Giri
Journal: SA J Radiol (2024)
Keywords: csf rhinorrhoea, ct cisternography, slsc, sternberg’s canal, intrasphenoidal encephalocoeles, lateral craniopharyngeal canal, spontaneous lateral sphenoid cephalocoeles
MeSH terms: Case Reports

Intrasphenoidal encephalocoeles are acquired or congenital herniations of meninges and brain parenchyma through a structural sphenoid bone defect. Acquired causes are most common, either iatrogenic, post-traumatic, or spontaneous. However, defects in the lateral wall of the sphenoid sinus are uncommon and cephalocoeles through them relatively underexplored in current literature, warranting dedicated attention to unravel their complexities. Congenital causes such as persistence of Sternberg's canal, which can lead to lateral cephalocoeles, is a rare entity, seen in two of the presented cases, based on the location of the defect with respect to the line connecting the foramen rotundum and the vidian canal (VR line). Three cases of intrasphenoidal cephalocoeles are presented; two patients presented with watery nasal discharge without prior trauma or surgery and the third case was incidentally detected in an elderly patient with intraparenchymal haemorrhage. Imaging with CT cisternography and brain MR were performed to ascertain the exact location of the leak and confirm the presence of herniated brain tissue via the defects. Patients were evaluated by otolaryngology for transnasal endoscopic repair, which was deemed unfeasible, and referred to neurosurgery for transcranial duroplasty.
Contribution:
These cases provide crucial insights into the aetiology of lateral intrasphenoidal cephalocoeles, offering a practical system to classify cerebrospinal fluid (CSF) leaks based on the bony defect location. The three illustrative cases and emphasis on advanced imaging modalities refine the knowledge of their aetiology, clinical presentation and management, which hold direct clinical relevance for accurate diagnosis and tailored management of these rare anomalies.
Boswellia serrata intoxication manifesting with syndrome of inappropriate antidiuretic hormone secretion, hyponatremia, seizure, and rhabdomyolysis
Authors: Josef Finsterer
Journal: Crit Care Sci (2024)
MeSH terms: Boswellia, Hyponatremia / chemically induced, Hyponatremia / etiology, Inappropriate ADH Syndrome / chemically induced, Inappropriate ADH Syndrome / diagnosis, Rhabdomyolysis / chemically induced, Rhabdomyolysis / diagnosis, Seizures / chemically induced, Seizures / etiology, Case Reports, Adult, Female, Humans, Plant Extracts / adverse effects, Plant Extracts

Boswellia serrata is an herbal extract from the Boswellia serrata tree that has anti-inflammatory and analgesic properties and alleviates pain caused by rheumatoid arthritis, gout, osteoarthritis, and sciatica. Syndrome of inappropriate antidiuretic hormone secretion accompanied by hyponatremia, seizures, and rhabdomyolysis as a manifestation of Boswellia serrata intoxication has not been reported previously. A 38-year-old female suffered clinically isolated syndrome and has since been regularly taking B. serrata capsules (200mg/d) to strengthen her immune system. She experienced hypersensitivity to light, ocular pain, nausea, dizziness, and lower limb weakness four days after receiving her first BNT162b2 vaccine dose, and she increased the dosage of B. serrata to five capsules (1000mg/d) one week after vaccination. After taking B. serrata at a dosage of 1000mg/d for 3 weeks, she was admitted to the intensive care unit because of a first, unprovoked generalized tonic-clonic seizure. The patient's workup revealed syndrome of inappropriate antidiuretic hormone secretion, which resolved completely upon treatment and discontinuation of B. serrata. In summary, B. serrata potentially causes syndrome of inappropriate antidiuretic hormone secretion when it is taken at high doses. Patients should not self-medicate.
Centrifugally Spreading Annular Erythema as a Dermatological Indicator of Metastatic Breast Carcinoma
Authors: Joohyung Youh, Yasuyuki Yamaguchi, Etsuo Hiraguchi
Journal: Cureus (2024)
Keywords: annular erythema, breast cancer, cutaneous metastasis of breast cancer, erythema annulare centrifugum, skin metastasis
MeSH terms: Case Reports

Breast cancer is the leading cause of skin metastasis in women with internal malignancies. This report highlights an atypical case of cutaneous metastasis of breast cancer (CMBC) in a 66-year-old woman. Starting four months before her dermatology consultation, the patient underwent a chemotherapy regimen comprising pertuzumab, trastuzumab, and vinorelbine for right breast cancer, right axillary lymph node enlargement, and bone metastases. After commencing chemotherapy, erythematous macules appeared around her right nipple. Subsequently, the cutaneous lesions developed into annular erythematous patches around her right nipple and began to coalesce and expand to the contralateral breast. A skin biopsy revealed dysplastic cells indicative of metastasis from invasive ductal carcinoma. In addition, lymphovascular tumor cell invasion was noted in the reticular dermis. Based on these clinical progressions and histopathologic findings, a diagnosis of CMBC was made, specifically considering the possibility of inflammatory breast cancer (IBC). The patient continued the same chemotherapy regimen for 17 cycles, which improved the skin lesions, but she succumbed to breast cancer two years later. This case emphasizes the importance of considering CMBC in breast cancer patients with expanding, treatment-resistant thoracic cutaneous lesions, especially in aggressive subtypes like IBC. The diverse presentations of CMBC require thorough histopathological evaluation.
Case Report: A leadless and endovascular pacemaker teamwork
Authors: Sarah Zeriouh, Vasileios Sousonis, Roberto Menè, Serge Boveda, Quentin Voglimacci-Stephanopoli, Stéphane Combes
Journal: Front Cardiovasc Med (2023)
Keywords: atrioventricular synchrony, device infection, endovascular pacemaker, lead dysfunction, leadless pacemaker
MeSH terms: Case Reports

Background:
Cardiac Implantable Electronic Device infections increase short- and long-term mortality, along with healthcare costs. Leadless pacemakers (PM) were developed to overcome pocket- and minimize lead-related complications in selected high-risk patients. Recent advancements enable leadless devices to mechanically detect atrial activity, facilitating atrioventricular (AV) synchronous stimulation.
Case summary:
A 90-year-old woman, implanted with a dual-chamber pacemaker eight years ago due to sinus node dysfunction, presented with syncope. A diagnosis of complete AV block, in the setting of ventricular lead dysfunction was made. Due to a high risk of infection, the patient was implanted with a leadless PM capable of maintaining AV synchrony in VDD mode (MICRA™ model MC1AVR1). The transvenous PM was programmed to AAI-R mode to drive the atria, which, in turn, triggered the leadless PM to stimulate the ventricles. At six month follow-up, the AV synchrony rate was 85%.
Conclusion:
The combination of classic atrial pacing with leadless ventricular stimulation can be used in high-risk patients to reduce the risk of complications, in the setting of ventricular lead dysfunction. In this manner, AV synchrony can be maintained, improving hemodynamic parameters and quality of life. Low sinus rate variability at rest is essential to achieve a high AV synchrony rate in such cases.