OpenMed/multicare-articles huggingface dataset:
Case Report: Clinical and Imaging Characteristics of a Patient with Anti-flotillin Autoantibodies: Neuromyelitis Optica or Multiple Sclerosis?
Authors: Ke Shang, Chang Cheng, Chuan Qin, Jun Xiao, Gang Deng, Bi-Tao Bu, Sha-Bei Xu, Dai-Shi Tian
Journal: Front Immunol (2021)
Keywords: anti-flotillin autoantibody, case report, demyelination, flotillin, multiple sclerosis, neuromyelitis optica
MeSH terms: Brain / pathology, Membrane Proteins / immunology, Multiple Sclerosis / diagnosis, Neuromyelitis Optica / diagnosis, Case Reports, Adult, Autoantibodies / metabolism, Brain / diagnostic imaging, Demyelinating Diseases, Diagnosis, Differential, Diagnostic Imaging, Humans, Male, Muscle Weakness, Tomography, X-Ray Computed, Autoantibodies, Membrane Proteins, flotillins

Background:
Demyelination diseases are complex puzzles that are not always straightforward to diagnose. Multiple sclerosis and neuromyelitis optica are two that are frequently encountered. Numerous autoantibodies newly discovered in recent years have significantly aided clinical reasoning and diagnosis in differentiating demyelination disorders. Here we report a case of demyelination disease with anti-flotillin autoantibodies positive, which is not common in past references.
Case summary:
The patient presented with characteristic neuromyelitis optica symptoms and had remission and relapse. But his images exhibited characteristics of both neuromyelitis optica spectrum illness and multiple sclerosis.
Conclusion:
This is the first case report describing the clinical course and imaging characteristics of demyelination illness associated with anti-flotillin autoantibodies. Although so far it appears to be a subtype of multiple sclerosis, there is still a potential that it is separate from MS and NMOSD.
Acute-on-Chronic Liver Failure in Pregnant Patients with Chronic Hepatitis B: A Retrospective Observational Case Series Study
Authors: Shiwei Wang, Haofeng Xiong, Changling Luo, Hong Zhao, Ying Fan, Ting Zhang, Lili Wang, Qi Wang, Wen Xie
Journal: Gastroenterol Res Pract (2020)

Background and aims:
Acute-on-chronic liver failure (ACLF) is common in patients with end-stage liver disease and chronic hepatitis B (CHB) or hepatitis B virus- (HBV-) related cirrhosis. To date, no uniform definition and management strategy are available for ACLF. Although a considerable number of studies on ACLF has been published, there are few reports on ACLF in pregnant women with CHB. This study retrospectively reviewed five patients who were diagnosed with ACLF during pregnancy in the past 10 years. We aimed at investigating their clinical characteristics, treatment, biochemical test results, and maternal and fetal outcomes.
Results:
Asthenia, anorexia, and jaundice were the main initial clinical manifestations in these patients during the second or third trimester of pregnancy. All patients received antiviral therapy. None of the pregnant women died after treatment. Patient #4 was treated with an artificial liver support system, and patients #2 and #5 underwent transfusion therapy. The acute insult in all patients was HBV DNA reactivation. Except for patient #3, who chose an actively induced vaginal delivery because of intrauterine fetal demise, the remaining four patients underwent a preterm delivery via a cesarean section. The four neonates were alive, although all were small for gestational age.
Conclusion:
Asthenia, anorexia, and jaundice during mid-late pregnancy should be immediately investigated. Before and during the pregnancy, hepatologists or obstetricians should actively screen pregnant women with CHB for HBV DNA status and alanine aminotransferase levels. Reactivation of HBV replication in pregnant women with CHB may lead to ACLF, especially in multiparous women. Once ACLF is diagnosed, antiviral therapy should be considered as soon as possible to protect maternal and fetal health.
Alcohol-induced severe acute pancreatitis followed by hemolytic uremic syndrome managed with continuous renal replacement therapy
Authors: Peng Fu, Ai-hong Yuan, Chun-hua Wang, Xin Li, Hai-yang Wu
Journal: BMC Nephrol (2014)
MeSH terms: Alcoholic Intoxication / complications, Alcoholic Intoxication / therapy, Hemolytic-Uremic Syndrome / etiology, Hemolytic-Uremic Syndrome / therapy, Pancreatitis, Alcoholic / complications, Pancreatitis, Alcoholic / etiology, Renal Replacement Therapy, Case Reports, Adult, Alcoholic Intoxication / diagnosis, Combined Modality Therapy, Female, Hemolytic-Uremic Syndrome / diagnosis, Humans, Plasma Exchange, Treatment Outcome

Background:
Acute kidney injury in patients with acute pancreatitis carries a poor prognosis. Hemolytic uremic syndrome (HUS) is characterized by non-immune hemolytic anemia, thrombocytopenia, and renal failure caused by platelet thrombi in the microcirculation of the kidney, and though rare in adults it is associated with high mortality and a high rate of chronic renal failure.
Case presentation:
Herein, we report a case of alcohol-induced acute pancreatitis in a 38-year-old Chinese female complicated by HUS. Her renal function progressively deteriorated in 2 days, and daily continuous renal replacement therapy (CRRT) was thus performed for a total of 13 treatments. She also received intermittent transfusions of fresh frozen plasma. Her renal failure was successfully managed, with subsequent return of normal renal function. She was discharged 1 month after admission and follow-up at 3 months revealed normal urea and creatinine.
Conclusion:
CRRT was shown to be useful for the treatment of HUS following acute pancreatitis. Prior case reports and our case should remind clinicians that HUS is a possible complication of acute pancreatitis. This study highlights the importance of early diagnosis and prompt initiation of CRRT to prevent mortality and improve outcomes.
Attempted Suicide in the Older Adults: A Case Series From the Psychiatry Ward of the University Hospital Maggiore Della Carità, Novara, Italy
Authors: Carla Gramaglia, Maria Martelli, Lorenza Scotti, Lucia Bestagini, Eleonora Gambaro, Marco Romero, Patrizia Zeppegno
Journal: Front Public Health (2022)
Keywords: psychiatry ward, elderly, gender, multiple attempters, suicide attempt
MeSH terms: Psychiatry, Suicide, Attempted / psychology, Aged, Female, Hospitals, University, Humans, Italy / epidemiology, Male, Retrospective Studies

Introduction: As suicide rates increase with age, it is mandatory to carefully assess old age suicidal behaviors. Our aim was to describe the main socio-demographic and clinical features of a sample of suicide attempters aged 65 years and older, and to assess differences within the sample (men vs. women; patients with vs. without a previous history of suicide attempt; patients with vs. without a previous psychiatric history). Methods: Retrospective study conducted at the Maggiore della Carità University Hospital, Novara, Italy. Results: A higher percentage of female patients in our sample were treated by or referred to mental health services, while a greater percentage of male patients required a prolonged clinical observation in the Emergency Room (ER) or in non-psychiatric wards before psychiatric admission. The percentage of patients without previous psychiatric history taking anxiolytic and sedative medications was 25%. Conclusion: It is likely that different clusters and types of suicide attempters exist. Women in our sample appeared more proactive in asking for help, and more likely to be already treated by or referred to a psychiatric service, suggesting the need to facilitate the access to psychiatric services for the male population aged 65 years and older, or to offer support and care for the non-psychiatric reasons (comorbidities, pain, and loss of autonomy) possibly underlying suicidal behavior in this specific group. The use of medications deserves more attention considering the possible critical diagnostic issues in this age group.
Cooccurrence of Chorea-Acanthocytosis and Mesial Temporal Sclerosis: A Possible Role of Caudate Nucleus
Authors: Mehri Salari, Alexander C Lehn, Masoud Etemadifar, Seyed Amir Hejazi
Journal: Case Rep Neurol Med (2017)
MeSH terms: Case Reports

Chorea-acanthocytosis (ChAc) is an orphan disease, caused by mutations on chromosome 9. Epileptic seizures of mesial temporal origin can be a predominant symptom. We report on a 29-year-old woman with ChAc and bilateral MTS. Previously, few patients with coexisting ChAc and MTS were reported. The underlying pathophysiology is unknown, and further studies are needed.
Seldinger Technique for Placement of "Peripheral" Internal Jugular Line: Novel Approach for Emergent Vascular Access
Authors: Adam J Ash, Christopher Raio
Journal: West J Emerg Med (2016)
MeSH terms: Catheterization, Peripheral / methods, Catheters, Indwelling, Hypotension / therapy, Renal Dialysis / adverse effects, Case Reports, Aged, Catheterization, Central Venous, Catheterization, Peripheral / instrumentation, Female, Humans, Jugular Veins, Practice Guidelines as Topic, Treatment Outcome

This is a case report describing the ultrasound-guided placement of a peripheral intravenous catheter into the internal jugular vein of a patient with difficult vascular access. Although this technique has been described in the past, this case is novel in that the Seldinger technique was used to place the catheter. This allows for safer placement of a longer catheter (2.25″) without the need for venous dilation, which is potentially hazardous.
Case report: Induction and maintenance of steroid-free remission with vedolizumab in a case of steroid-dependent autoimmune pancreatitis
Authors: Paul Griebel, Florian Tran, Janina Luehring, Stefan Schreiber
Journal: Front Immunol (2023)
Keywords: autoimmune pancreatitis, autoimmunity, case report, gastroenterology, pancreatitis, vedolizumab
MeSH terms: Autoimmune Pancreatitis, Case Reports, Research Support, Non-U.S. Gov't, Female, Humans, Middle Aged, Prednisolone / therapeutic use, Recurrence, Steroids / therapeutic use, vedolizumab, Prednisolone, Steroids

Autoimmune pancreatitis responds well to corticosteroids in most instances. Additional immunosuppression or low-dose maintenance steroids may be necessary upon relapse. There is limited data on alternative strategies when these regiments fail or cause adverse reactions. We report a case of a middle-aged woman with autoimmune pancreatitis in whom tapering of prednisolone below the dose of 25mg per day resulted in relapse of symptoms and long-term steroid use led to development of steroid induced hyperglycaemia. Induction and maintenance of steroid-free remission was ultimately successful under vedolizumab therapy. Remission has been stable for over one year with reduced need for antidiabetic intervention. This is the first reported case of treatment of refractory autoimmune pancreatitis with vedolizumab. It highlights the overlap of immunological mechanisms within inflammatory diseases of the digestive tract and how knowledge of biological data can inform treatment decisions for individual cases. The demonstrated efficacy of vedolizumab and low risk of severe side effects warrant further investigation into its use in autoimmune pancreatitis.
Successfully treated unusual case of primary adrenal and spinal tuberculosis with three years follow up
Authors: Biswas Shrestha, Ahmed Omran, Pengfei Rong, Wei Wang
Journal: Pan Afr Med J (2014)
Keywords: adrenal insufficiency, adrenal tuberculosis, follow up, spinal tuberculosis
MeSH terms: Adrenal Gland Diseases / drug therapy, Antitubercular Agents / administration & dosage, Prednisolone / administration & dosage, Tuberculosis / drug therapy, Tuberculosis, Spinal / drug therapy, Case Reports, Adult, Drug Therapy, Combination, Follow-Up Studies, Humans, Male, Remission Induction, Treatment Outcome, Vitamin B 6 / administration & dosage, Antitubercular Agents, Vitamin B 6, Prednisolone

The global increase in incidence of Tuberculosis (TB) is returning to be a major health issue grabbing a universal concern. Although extrapulmonary tuberculosis (EPTB) has a broad spectrum of clinical manifestations, primary involvement of the adrenal glands along with spine without pulmonary affection has been rarely reported. We report a case of successfully treated adult Asian male patient presented with primary adrenal TB, complicated with chronic adrenal insufficiency accompanied with upper lumber spinal TB. We also present the follow up of our patient after three years.
Damage Control Management of Perforating Pyometra Presenting with Septic Shock after the Return of Spontaneous Circulation
Authors: Jumpei Takamatsu, Jinkoo Kang, Aya Fukuhara, Tomoya Matsuda, Tomo Ishida
Journal: Case Rep Med (2020)
MeSH terms: Case Reports

Introduction:
Perforation of pyometra is often severe but rare. We report a case of pyometra detected on second-look surgery in an elderly patient with life-threatening septic shock and cardiopulmonary arrest before hospital arrival. Case Presentation. A 70-year-old woman with cardiopulmonary arrest received adrenaline. Computed tomography revealed ascites, and abdominal paracentesis was performed to identify the cause of cardiopulmonary arrest. The ascitic fluid was purulent, and intraperitoneal infection was identified. Emergency exploratory laparotomy revealed pyometra.
Conclusion:
If perforated, pyometra may cause peritonitis and lethal septic shock. Not only gynecologists but also emergency physicians should be aware of this possibility. Moreover, patient education is necessary. In patients with cardiopulmonary arrest, diagnostic abdominal paracentesis should be performed when the sole imaging finding is ascites. Improving outcomes in patients with difficult-to-diagnose pyometra with cardiopulmonary arrest by implementing damage control strategies before hysterectomy is possible.
Dengue 2 serotype and yellow fever coinfection
Authors: Flávia Gehrke, Katharyna Cardoso Gois, Beatriz da Costa Alves Aguiar Reis, Gabriel Zorello Laporta, Fernando Luiz Affonso Fonseca
Journal: Access Microbiol (2021)
Keywords: arbovirus infections and diagnosis, coinfection
MeSH terms: Case Reports

Case presentation:
Arboviruses primarily consist of RNA, which favours greater genetic plasticity, with a higher frequency of mutations that allow the virus to adapt to different hosts. The initial symptomatology is nonspecific, in that the patient can present fever, myalgia, arthralgia, rash and headache. This makes a clinical diagnosis using laboratory tests difficult and time-consuming. In Brazil, the main arboviruses involved in epidemics belong to the family Flaviviridae. The patient in this case is from the municipality of São Bernardo do Campo, an area endemic for arboviruses. He presented symptoms of fever, myalgia and headache.
Results:
The multiplex assay for arboviruses detected genetic material from the dengue 2 and yellow fever viruses.
Conclusion:
This result confirms the importance of molecular tests showing high sensitivity and specificity that can assist clinical diagnosis, particularly in endemic areas during periods of outbreak for other arboviruses, like the epidemiological picture in Brazil in 2018, when significant co-circulation of dengue virus and yellow fever virus occurred. The presence of co-circulating arboviruses increases the chance of coinfection and demonstrates the importance of differential diagnosis.
Rotational Flap to Enhance Buccal Gingival Thickness and Implant Emergence Profile in the Esthetic Zone: Two Cases Reports
Authors: Mohammed Jasim Al-Juboori
Journal: Open Dent J (2017)
Keywords: emergence profile, esthetic zone, flap, gingival level, soft tissue
MeSH terms: Case Reports

Objective:
Many techniques have been developed to enhance the gingival thickness, gingival level and emergence profile around the implant in the esthetic zone.
Introduction:
In this study, a buccal rotational flap was used to improve the implant site in the esthetic zone and increase gingival tissue thickness.
Methods:
Two cases involved the use of a rotational flap during second-stage implant surgery, one case involved the use of a temporary crown with a healing abutment, and another case involved the use of a healing abutment.
Result:
The cases were followed up until the final crown was placed. The implant site was improved in 2 cases; the gingival thickness increased, the gingival level was enhanced and the emergence profile was developed.
Conclusion:
Many factors affect the results of a rotational flap; some factors are surgical, while others are prosthetic, biological and anatomical.
Early Neurodevelopmental Outcomes after Previable Preterm Prelabour Rupture of Membranes (pPPROM)
Authors: Christy L Pylypjuk, Katarina Nikel, Chelsea Day, Ladonna Majeau, Adelicia Yu, Yasmine ElSalakawy, M Florencia Ricci
Journal: Case Rep Pediatr (2022)
MeSH terms: Case Reports

Objective:
To describe the early neurodevelopmental outcomes following fetal exposure to previable preterm prelabour rupture of membranes (pPPROM).
Methods:
This was a secondary analysis of a subgroup of neonates born following pPPROM from a retrospective cohort study (2009-2015). Surviving infants who underwent standardized neurodevelopmental evaluation at 18-24 months corrected age (CA) between 2017 and 2019 were eligible for inclusion. Data abstracted from hospital charts were linked to prospectively collected developmental outcomes stored in an electronic database from a regional neonatal follow-up clinic. The primary outcome was Bayley-III composite scores (compared to the population mean 100, standard deviation (SD) 15). Secondary outcomes included presence of cerebral palsy, vision loss, hearing impairment, and requirement of rehabilitation therapy. Descriptive statistics were used to present results.
Results:
25.7% (19/74) of neonates born after pPPROM survived to hospital discharge, but only 21.6% (16/74) survived to 18-24 months CA. Of these, 9 infants were eligible for follow-up at the regional clinic and 7 had developmental outcomes stored in the electronic database. Infants exposed to pPPROM exhibited Bayley-III scores more than 1 SD below the population mean across all three domains: cognitive 84.9 (SD 12.2); motor 82.3 (SD 11.5); and language 66.4 (SD 18.9). There were particular deficiencies in language development with 71% (5/7) scoring more than 2 SDs below the population mean. There were no cases of cerebral palsy.
Conclusions:
Only 1 in 5 infants born following expectantly managed pPPROM survived to 18-24 months CA. These infants born after pPPROM had significantly lower Bayley-III scores and particular deficiencies in language development. Better understanding of early neurodevelopmental challenges following pPPROM will help refine counselling of families contemplating expectant management and provide insights into the postnatal educational resources required to improve long-term developmental outcomes for these children.
A Case of Adenoid Cystic Carcinoma Mimicking a Bartholin Cyst and Literature Review
Authors: Siew Pei Goh, Brian McCully, Matthew Kyle Wagner
Journal: Case Rep Obstet Gynecol (2018)
MeSH terms: Case Reports

Adenoid cystic carcinoma of the Bartholin Gland (BG-ACC) is a rare form of vulval cancer with only approximately 350 reported cases since 1864. A review of available literature and case reports suggests an aggressive nature with protracted clinical symptoms and a tendency for local recurrence despite adequate surgical excision with or without adjuvant radiotherapy. Survival rates of 71% and 59% are reported at five and ten years. This case report endeavours to add to our body of knowledge regarding this rare disease and thus help broaden and improve our understanding of management and treatment success.
Jaw tumor in recurrent primary hyperparathyroidism: A case report
Authors: Farzaneh Amini Nezhad, Moloud Payab, Sara Nayebandi, Shirin Hasani-Ranjbar
Journal: Int J Surg Case Rep (2018)
Keywords: brown tumor, hypercalcemia, hyperparathyroidism, hyperparathyroidism jaw-tumor syndrome

Background:
Brown tumor may present as uni/multilocular osteolytic lesions with bone expansion, bone pain or pathologic fracture in primary, secondary and tertiary hyperparathyroidism. However, recently, such presentation is rare due to early detection using blood screening techniques before symptomatic bone lesions appear.
Case report:
A 65-year-old woman was admitted to our hospital with generalized bone pain and a progressive painless mass in her jaw appeared since 6 months ago. She had a history of two times parathyroidectomy. In recent hospitalization, she presented with the complaint of weakness, bone pain and a progressive swelling in her jaw. Laboratory analysis showed a hypercalcemia and plasma PTH of 398 pg/ml. Dual energy X-ray (DXA) showed osteoporosis at the neck of hip and lumbar spine. The neck MRI revealed an 11 * 6 mm soft tissue nodule posterior to left thyroid lobe and a 20*18 mm T2 hypersignal, T1hyposignal nodule at right thyroid lobe. The SPECT-CT scintigraphy with 99mTc-MIBI was suggestive of bilateral parathyroid adenomas and/or parathyroid hyperplasia and showed a MIBI- avid lytic lesion in the mandible. Surgical management was performed. After removing the adenoma the PTH marked a decrease from the initial value to 57 pg/ml. The histological examination revealed the thyroid tissue with MNG and a left parathyroid adenoma. Follow-up after surgery revealed normal blood calcium and urine calcium levels with no increase. PTH levels also did not increase. The patient was treated with calcium and vitamin D supplements and the jaw mass decreased gradually.
Conclusions:
Primary or secondary HPT may be recognized by the presence of an osteolytic lesion with giant cells, a condition referred as brown tumor. Consideration should be made that non-specificity of hypercalcemia symptoms can also be a bone tumor including jaw lesion as a manifestation of hyperparathyroidism.
Safety and rapid response of dabrafenib and trametinib therapy during hyperbilirubinemia in metastatic melanoma
Authors: Walid Shalata, Rachel Steckbeck, Ilya Polishchuk, Ahron Yehonatan Cohen, Keren Rouvinov, Margarita Tokar, Ashraf Abu Jama, Omar Abu Saleh, Kim Sheva, Alexander Yakobson
Journal: Front Oncol (2023)
Keywords: braf mutation (v600e), dabrafenib, hyperbilirubinemia, metastatic melanoma, safety, trametinib

This case report describes the occurrence of hyperbilirubinemia as a complication of metastatic melanoma. A 72-year-old male patient was diagnosed with BRAF V600E-mutated melanoma with metastases in the liver, lymph nodes, lungs, pancreas, and stomach. Due to a lack of clinical data and specific guidelines for the treatment of mutated metastatic melanoma patients with hyperbilirubinemia, a conference of specialists debated between initiating treatment or providing supportive care. Ultimately, the patient was started on the combination therapy of dabrafenib and trametinib. This treatment resulted in a significant therapeutic response via normalization of bilirubin levels and an impressive radiological response of metastases just one month post-treatment initiation.
Pneumocystis jirovecii Pneumonia during Brentuximab Vedotin Therapy: A Case Report and Literature Review
Authors: Aliana Meneses Ferreira, Jessica Fernandes Ramos, Giancarlo Fatobene, Vanderson Rocha
Journal: Case Rep Hematol (2019)
MeSH terms: Case Reports

Brentuximab vedotin (BV), an antibody drug conjugate against CD30, has been increasingly used in clinical practice, and the less common adverse events associated to the drug are not well described. Also, opportunistic infections have been reported, and data on immune reconstitution after use of BV are lacking. The authors describe a case of a 45-year-old man with Hodgkin lymphoma receiving BV as a consolidation therapy after autologous hematopoietic stem cell transplant. After nine months of consolidation with BV, the patient developed a respiratory disorder characterized by fever, chills, dyspnea, and hypoxemia, and pneumonia by Pneumocystis jirovecii (PJ) was confirmed by bronchoscopy with bronchoalveolar lavage. In spite of the fact that there are no specific recommendations about infectious prophylaxis in patients using the drug, we would like to draw the attention of professionals who use the medication in relation to the risk of opportunistic infections, such as pneumonia by PJ.