OpenMed/multicare-articles huggingface dataset:
Renal Cell Carcinoma with Cardiac Metastases: A Case Report and Review of the Literature
Authors: Ellen M Cahill, Alexandra Tabakin, Brian Shinder, Mark Bramwit, Biren Saraiya, Xinyang Xu, Cristo G Salazar, Zhongren Zhou, Eric A Singer
Journal: J Kidney Cancer VHL (2022)
Keywords: cardiac mass, clear cell, metastatic renal cell carcinoma, renal cell carcinoma, systemic therapy
MeSH terms: Case Reports

Cardiac metastases from renal cell carcinoma (RCC) are very rare. We describe the case of a woman with RCC with cardiac metastases involving the entire right atrium, penetrating through the myocardium, with extension into the tricuspid valve and right ventricle. This report highlights the unique challenge of the diagnosis and treatment of cardiac metastases in RCC.
Cone beam computed tomography evaluation of the periapical status of nonvital tooth with open apex obturated with mineral trioxide aggregate: a case report
Authors: Vijay Shekhar, K Shashikala
Journal: Case Rep Dent (2013)

Management of a tooth with open apex is a challenge to the dental practitioners. Evaluation of the periapical healing is required in such cases by radiographic techniques. The objective of this paper was to assess the healing of a periapical lesion in a non-vital tooth with open apex treated with mineral trioxide aggregate (MTA) obturation using cone beam computed tomography (CBCT). The endodontic treatment of a fractured non-vital discolored maxillary left lateral incisor with an open apex was done with MTA obturation. The clinical and radiographic followup done regularly showed that the tooth was clinically asymptomatic and that the size of the periapical lesion observed by intraoral periapical (IOPA) radiographs and CBCT was decreased remarkably after two years. CBCT and IOPA radiographs were found to be useful radiographic tools to assess the healing of a large periapical lesion in a non-vital tooth with open apex managed by MTA obturation.
Iatrogenic anetoderma of prematurity: a case report and review of the literature
Authors: Laura Maffeis, Lorenza Pugni, Carlo Pietrasanta, Andrea Ronchi, Monica Fumagalli, Carlo Gelmetti, Fabio Mosca
Journal: Case Rep Dermatol Med (2014)

Anetoderma is a skin disorder characterized by focal loss of elastic tissue in the mid dermis, resulting in localized areas of macular depressions or pouchlike herniations of skin. An iatrogenic form of anetoderma has been rarely described in extremely premature infants and has been related to the placement of monitoring devices on the patient skin. Because of the increasing survival of extremely premature infants, it is easy to foresee that the prevalence of anetoderma of prematurity will increase in the next future. Although it is a benign lesion, it persists over time and can lead to significant aesthetic damage with need for surgical correction. Sometimes the diagnosis can be difficult, especially when the atrophic lesions become evident after discharge. Here, we report on a premature infant born at 24 weeks of gestation, who developed multiple anetodermic patches of skin on the trunk at the sites where electrocardiographic electrodes were previously applied. The knowledge of the disease can encourage a more careful management of the skin of extremely premature babies and aid the physicians to diagnose the disease when anetoderma patches are first encountered later in childhood.
Case Report: Dexmedetomidine for Intractable Clusters of Myoclonic Jerks and Paroxysmal Sympathetic Hyperactivity in Progressive Encephalomyelitis With Rigidity and Myoclonus
Authors: Yuzo Fujino, Kensuke Shiga, Masatoshi Hori, Aiko Tamura, Takahiro Iizuka
Journal: Front Neurol (2021)
Keywords: dexmedetomidine, glycine receptor, myoclonus, paroxysmal sympathetic hyperactivity, stiff–person syndrome, α2-adrenergic receptor
MeSH terms: Case Reports

Introduction: Progressive encephalomyelitis with rigidity and myoclonus (PERM) is a severe form of stiff-person spectrum disorder characterized by painful spasms, myoclonic jerks, hyperekplexia, brainstem dysfunction, and dysautonomia, which is sometimes resistant to γ-amino-butyric acid (GABA)-ergic agents. The response to immunotherapy varies depending on identified autoantibodies. We report a dramatic response to dexmedetomidine in a patient with glycine receptor (GlyR) antibody-positive PERM who developed intractable clusters of myoclonic jerks and paroxysmal sympathetic hyperactivity (PSH) that was highly refractory to conventional symptomatic treatment with GABAergic drugs and immunotherapy. Case Presentation: A 62-year-old Japanese man was transferred to our center for intermittent painful spasms that progressed in severity over the preceding 7 weeks. On admission, he had gaze-evoked nystagmus, and paroxysmal painful spasms/myoclonic jerks triggered by sound or touch. The myoclonic jerks rapidly worsened, along with the development of hyperekplexia, opisthotonus, and PSH, leading to prolonged apnea requiring mechanical ventilation. Brain and spinal cord magnetic resonance imaging was unremarkable. Cerebrospinal fluid (CSF) examination revealed mild pleocytosis and oligoclonal bands. Surface electromyography confirmed simultaneous agonist-antagonist continuous motor unit activity. Based on the clinico-electrophysiological features, PERM was suspected. He was initially treated with intravenous steroids, immunoglobulin, benzodiazepines, and propofol, but the symptoms persisted. On day 9, he received a continuous infusion of dexmedetomidine, which resulted in dramatic reduction in the frequency of clusters of myoclonic jerks and PSH. The effect of dexmedetomidine was confirmed by surface electromyography. The addition of plasma exchange resulted in further clinical improvement. GlyR antibodies were identified in the CSF but not the serum, leading to the diagnosis of GlyR antibody-positive PERM. Conclusions: PERM is an immune-mediated disorder, but dexmedetomidine, a highly selective α2-adrenergic agonist, may alleviate paroxysmal symptoms by decreasing noradrenergic neuronal activity, resulting in attenuation of antibody-mediated disinhibited increased motor and sympathetic activity. Dexmedetomidine may be useful as an adjunctive symptomatic therapy in PERM and related disorders.
Case Report: A 3D-Printed Surgical Guide for Breast-Conserving Surgery After Neoadjuvant Chemotherapy
Authors: Zhen-Yu Wu, Guk Bae Kim, Sangwook Lee, Seung Hyun Choi, Namkug Kim, BeomSeok Ko
Journal: Front Oncol (2021)
Keywords: breast surgical guide, breast-conserving surgery, neoadjuvant chemotherapy, three-dimensional-printing, tumor localization
MeSH terms: Case Reports

Background:
A challenging problem for patients undergoing breast-conserving surgery after neoadjuvant chemotherapy (NACT) is the accuracy of preoperative tumor localization. After chemotherapy, the original tumor is likely to shrink or scatter dramatically or even show complete remission. For breast-conserving surgery, the development of a guidance device to accurately estimate the resection area is imperative.
Case presentation:
We produced a three-dimensional (3D)-printed breast surgical guide (BSG) based on prone and supine magnetic resonance imaging (MRI). This device was tested on a patient who underwent breast-conserving surgery after NACT. Both ultrasonography and MRI revealed that the tumor shrank substantially after NACT. Identifying the target tumor area using pre-NACT MRI was feasible, and the tumor was safely removed with clear resection margins.
Conclusion:
The BSG has several advantages over conventional methods for tumor localization after NACT. In particular, the BSG provided precise quantitative MRI information about the tumor area.
Isolated splenic hydatid disease
Authors: Alper Dilli, Idil Güneş Tatar, Umit Yasar Ayaz, Baki Hekimoglu
Journal: Case Rep Med (2011)
MeSH terms: Case Reports

Hydatid disease (HD) continues to be a significant health problem in areas where animal husbandry is common but no proper veterinary control exists. The involvement of the spleen in HD is rare, and isolated splenic involvement is even less common. In this case report, we present isolated splenic HD in a 26-year-old female with complaint of abdominal pain, and we discuss some of the clinical aspects of HD. Evaluation of the patient with ultrasonography, computed tomography, and magnetic resonance imaging revealed the presence of an isolated splenic HD as a multivesicular cystic mass located near splenic hilus, measuring 12 × 11 cm. No other organ or system involvement could be demonstrated.
A combination of flexible and rigid bronchoscopy in the successful removal of a residual fish bone from a peripheral bronchus: A case report
Authors: Hanqing Shao, Shuxian Li, Jing He, Lei Wu, Zhimin Chen
Journal: Front Pediatr (2023)
Keywords: case report, flexible bronchoscopy, foreign body, inhalation, rigid bronchoscopy
MeSH terms: Case Reports

Although rigid bronchoscopy remains the gold standard for the management of foreign body (FB) inhalation, sometimes it still misses residual FBs. Inhalation of sharp FBs by infants is an uncommon but hazardous occurrence, which presents a significant challenge and demands expertise in therapeutic bronchoscopy. Particularly, residual sharp FBs in the peripheral tracheobronchial tree may pose challenging management problems for bronchoscopists. Herein, we describe the case of 1-year-old girl, who presented with persistent atelectasis in the left lower lobe for 20 days without responding to antibiotic therapy after removal of fish bone by rigid bronchoscopy at local hospital. Flexible bronchoscopy at our department showed a residual fish bone in the outer basal segment of the left lower lobe. A combined flexible and rigid bronchoscopy was then applied, and a fish bone measuring 1.5 cm in length was extracted on multiple attempts without any complications. Thus, our reports demonstrated that removal of challenging residual sharp FBs in the distal airways is possible with the aid of combined flexible and rigid bronchoscopy by an experienced multidisciplinary team. Additionally, a physician should pay special attention to abnormal chest images after removal of FBs.
The Use of 99mTc-Methoxy-isobutyl-isonitrile (sestaMIBI) Uptake on Scintigraphy (99m-STS) in Amiodarone-Induced Thyrotoxicosis: Case Series and Review of the Literature
Authors: Ghada Elshimy, Mahmoud Alsayed, Jerome Targovnik, Gamal Sidarous, Kresimira M Milas
Journal: Case Rep Endocrinol (2020)
MeSH terms: Case Reports

Amiodarone is a class III antiarrhythmic drug, used by cardiologists to treat arrhythmia including atrial fibrillation (A fib) and ventricular fibrillation. However, amiodarone is associated with endocrine dysfunction including both hypo- and hyperthyroidism. In the literature, two types of amiodarone-induced thyrotoxicosis (AIT) were described: AIT-1 and AIT-2. Mixed AIT also called AIT type 3 (AIT-3) has been described in the literature when the cases do not have a typical presentation. In order to differentiate different types of AIT, various clinical, biochemical, and radiological tools have been proposed. The use of 99mTc-methoxy-isobutyl-isonitrile (sestaMIBI) uptake on scintigraphy (99m-STS) has been suggested in the literature in only few studies (no large retrospective or prospective studies have been established in the United States). We present a case series describing 5 patients presenting to the University of Arizona with AIT where we used 99m-STS to assess in diagnosis and treatment of different types of AIT followed by a review of the literature.
First Case Report of a Late Onset Knee Periprosthetic Joint Infection Caused by Lactococcus garvieae
Authors: V-I Neagoe, S Zytoun, H-J Neuhaus
Journal: Case Rep Orthop (2016)

Lactococcus garvieae is known as a Gram-positive, catalase-negative, and facultatively anaerobic fish pathogen. The association between Lactococcus spp. and human infectious diseases is described as being mainly associated with lumbar osteomyelitis, hepatic abscess, and infective endocarditis. In the literature of orthopedic post-prosthetic infections, L. garvieae was associated with a case of hip prosthetic infection in a fishmonger woman. We present the case of a 79-year-old male patient with multiple comorbidities, who is admitted to our center with a 5-day history of pain, swelling, and motility disorder of the right knee by the presence of a bicondylar knee replacement surgery, which was performed due to gonarthrosis 17 years ago. The radiographies of the right knee revealed no signs of displacement or loosening of the prothesis. After multiple radical debridements including VAC therapy and targeted antibiotic therapy we have managed to defeat the infection without exchange arthroplasty. Although we could not demonstrate the source of infection, we can only presume that in our case the source of infection was represented by the ingestion of possibly contaminated food. The patient had a habit of eating Nile perch fish (Lates niloticus) every 4 weeks. We illustrated once more the possibility of a late onset L. garvieae related orthopedic periprosthetic joint infection by multiple comorbidities.
Multidrug resistance in the standardized treatment of colon cancer harboring a rare fibrosarcoma B-type (BRAF) p.N581I mutation: a case report
Authors: Xiaoyan Wang, Chenyi Zhao, Yang Gong, Ying Wang, Feng Guo
Journal: Front Oncol (2023)
Keywords: braf pn581i, anti-egfr monoclonal antibody, colorectal cancer metastasis, immunotherapy, multidrug resistance, targeted therapy
MeSH terms: Case Reports

BRAF non-V600 mutations are a distinct molecular subset of colorectal cancer (CRC) that has little to no clinical similarity to the BRAF V600 mutations. It is generally considered that the BRAF non-V600 mutations correlate with better survival of CRC patients. In this report, we present an unusual case of that a midlife female patient who was initially diagnosed with stage IIIC colon cancer, and multiple metastases were found 25 months after radical surgery. Next-generation sequencing (NGS) revealed the BRAF p.N581I (c.1742A>T) mutation. She received chemotherapy, targeted therapy, and immunotherapy. However, the disease progressed rapidly with rare metastasis of the bone and cerebellum. This case highlights that the BRAF non-V600 mutations, such as BRAF p.N581I mutant, may lead to resistance to epidermal growth factor receptor (EGFR) inhibitors and result in a rapid course in colorectal cancer. The role of BRAF p.N581I mutation in colorectal cancer demands more attention.
Transjugular retrieval of a knotted peripherally inserted central venous catheter (Epicutaneo-Cava catheter) in a neonate
Authors: Lindsay Zhou, Mathievathaniy Muthucumaru, Kenneth Tan, Kenneth Lau
Journal: BJR Case Rep (2016)
MeSH terms: Case Reports

Knotting of intravascular catheters has been well described, and all such cases documented in the literature have occurred during catheter insertion. Knot formation has not been reported during the removal of a peripherally inserted central venous line (Epicutaneo-Cava 2 French 24 gauge) in a neonate. The mechanism of knotting in our case is not fully understood. This case emphasizes the value of plain radiography in detecting the presence of a knot in the line, and is being presented to raise the awareness about knot formation if undue resistance is felt during line removal. Early recognition of this rare but serious complication may avoid line fracture and potential fragment embolization.
New-Onset Bullous Pemphigoid in a COVID-19 Patient
Authors: Natalie Olson, David Eckhardt, Angela Delano
Journal: Case Rep Dermatol Med (2021)
MeSH terms: Case Reports

This manuscript presents a report of bullous pemphigoid rash associated with COVID-19 for the first time. The objective of this manuscript is to present a unique dermatological case in the setting of a COVID-19-positive infection to further recognize the virus symptomatology. A 37-year-old female with a past medical history of class III obesity, type II diabetes mellitus, and hypertension presented to the emergency department in September 2020 with inpatient and outpatient follow-up through to November 2020. The patient denied any personal or family history of skin disorders. The patient tested positive for COVID-19 prior to hospitalization and presented to the hospital with severe, persistent, pruritic rash meeting dermatopathological, serologic, and clinical criteria for bullous pemphigoid diagnosis. Histopathology H&E punch biopsy from her left flexor wrist demonstrated epidermal keratinocyte necrosis, subepidermal vesiculation with eosinophils, gossamer stranding of the papillary dermis, and subepidermal edema. Direct immunofluorescence punch biopsy from her left flexor wrist demonstrated strong linear IgG staining at the dermoepidermal junction, with weaker and focal linear C3 staining. Antigen-specific serology was consistent with bullous pemphigoid. There was no previously reported cutaneous association of COVID-19 infection with bullous pemphigoid making this case an important addition to the body of evidence helping to identify bullous pemphigoid in the setting of viral infection.
A First Report on Experience in Managing Infants with Congenital Toxoplasmosis in Ethiopia: Case Reports and a Review of Evaluation and Treatment
Authors: Tinsae Alemayehu, Selamawit Assefa, Solomie Jebessa Deribessa, Semienew Ambachew
Journal: Case Rep Infect Dis (2021)
MeSH terms: Case Reports

Background. Congenital toxoplasmosis is a major sequela of untreated primary maternal infection. With or without symptoms, untreated infections eventually lead to multiple neurologic complications. Despite the high Toxoplasma gondii seroprevalence in the Ethiopian population, there are no reports of newborns diagnosed and treated for congenital toxoplasmosis. Presentation of Cases. The clinical presentation, evaluation, and management of three infants with congenital toxoplasmosis are described. Two were symptomatic at birth. All three had confirmed diagnoses using Toxoplasma serologic tests. Two completed their treatment with one infant developing complications of strabismus and seizure disorder. Discussion and Conclusions. There is little experience in managing congenital toxoplasmosis in Ethiopia due to constraints in diagnostics and therapy. The description of this first such report underscores the need for risk assessment and evaluation during antenatal care to obtain favorable fetal outcomes.
The Discrepancies of COVID-19 Clinical Spectrum Between Infancy and Adolescence - Two Case Reports and a Review of the Literature
Authors: Cristina Oana Mǎrginean, Lorena Elena Meliţ, Maria Oana Sǎsǎran
Journal: Front Pediatr (2020)
Keywords: covid-19 infection, atypical cases, children, lack of symptoms, peculiarities
MeSH terms: Case Reports

A new pandemic caused by SARS-CoV-2 raised new challenges for the worldwide healthcare system, involving the pediatric field since children own certain peculiarities that caused a different reaction to this infection as compared to adults. We report two cases of COVID-19 in two pediatric patients, a 6-month-old male infant and a 15-year-old female teenager in order to underline the age-related differences in terms of clinical manifestations. Thus, the 6-month-old male infant was admitted in our clinic presenting fever, rhinorrhea and diarrhea for ~24 h. Taking into account that both parents presented respiratory manifestations, nasopharyngeal/oropharyngeal swab-based polymerase chain reaction tests for SARS-CoV-2 were performed, and the test came back positive for the parents and inconclusive for the infant. Nevertheless, the infection was confirmed also in the child by the second test. The symptoms resolved in the 2nd day of admission with symptomatic treatment. The 2nd case, a 15-year-old female teenager, presented to the emergency department with fever, cough and shortness of breath (O2 saturation 84%). The chest radiography pointed out multilobar impairment. The nasopharyngeal/oropharyngeal swab-based polymerase chain reaction test for SARS-CoV-2 infection was positive. She was admitted to the intensive care unit for 3 days, and the evolution was favorable with anti-viral therapy. The pediatrician's awareness regarding both asymptomatic and atypical cases is vital for decreasing the transmission of this novel life-threatening condition.
Primary follicular lymphoma of the duodenum with erosions as atypical macroscopic features
Authors: Keiko Takeuchi, Masaya Iwamuro, Atsushi Imagawa, Yoshitsugu Kubota, Katsuya Miyatani, Katsuyoshi Takata, Hiroyuki Okada
Journal: Case Rep Med (2012)
MeSH terms: Case Reports

A 52-year-old Japanese woman who was eventually diagnosed with primary follicular lymphoma of the duodenum showed atypical endoscopic features, namely, erosions with peripheral whitish edematous mucosa. Initial biopsy specimens taken from the erosions revealed insufficient numbers of lymphoma cells for histological diagnosis. Subsequent biopsy specimens from the peripheral mucosa containing the whitish enlarged villi showed infiltration of the lymphoma cells forming lymphoid follicles, which led us to the appropriate diagnosis. This case indicates that endoscopists should take biopsy samples from the peripheral mucosa with whitish enlarged villi rather than erosions in the rare instances that erosions appear as the main macroscopic feature of intestinal follicular lymphoma.
Robust and durable response to first-line treatment of pembrolizumab combined with chemotherapy in two patients with metastatic thymic squamous cell carcinoma: Case report
Authors: Cui Chen, Peng Sun, Jianting Long
Journal: Front Immunol (2022)
Keywords: case report, durable response, first-line treatment, metastatic thymic carcinoma, pembrolizumab
MeSH terms: Carcinoma, Squamous Cell / drug therapy, Thymoma / drug therapy, Thymus Neoplasms / drug therapy, Case Reports, Research Support, Non-U.S. Gov't, Antibodies, Monoclonal, Humanized, B7-H1 Antigen / metabolism, Humans, Neoplasm Recurrence, Local, Antibodies, Monoclonal, Humanized, B7-H1 Antigen, pembrolizumab

Thymic carcinoma is a rare and aggressive disease with poor outcome. There is no established treatment regimen for advanced thymic carcinoma. While the efficacy of pembrolizumab was proved to be promising, as a single agent, in patients with refractory/recurrent thymic carcinoma that progressed after chemotherapy, the efficacy and safety of combination of pembrolizumab and chemotherapy as front-line treatment in metastatic thymic carcinoma have not been explored yet. Herein, we report the first two cases of metastatic thymic squamous cell carcinoma receiving the combined approaches of pembrolizumab and chemotherapy as first-line treatment. Of the two patients, one had a complete radiological response of mediastinal masses with sustained remission over 3 years, and the other one with widespread disease had a good partial response over 20 months and achieved no evidence of disease radiologically after undergoing percutaneous radiofrequency ablation for residual liver metastases. Next-generation sequencing (NGS) showed low tumor mutation burden and MSS in both patients. Immunohistochemistry analysis of the tumor showed high PD-L1 expression in patient 1 and low PD-L1 expression in patient 2. Pembrolizumab combined with chemotherapy may be an attractive strategy for the first-line treatment of metastatic thymic carcinoma and thus warrants further evaluation.