OpenMed/multicare-articles huggingface dataset:
An indolent case of isolated cerebral mucormycosis: an uncommon presentation
Authors: David J Montgomery, Randi S Goldstein, Dontre' M Douse, Jerome Tuitt, Michael Sinnott
Journal: Access Microbiol (2019)
Keywords: atypical mucormycosis presentation, intracerebral mucormycosis, intracranial mucormycosis, isolated mucormycosis, mucormycosis
MeSH terms: Case Reports

Introduction:
This case is a presentation of isolated central nervous system (CNS) Mucormycosis in an immunocompetent patient. This case is unique in its demonstration of isolated CNS involvement while lacking clear evidence elucidating an entry point.
Case presentation:
The patient is a 36-year-old man without a pertinent past medical history, who initially presented with altered mental status and a 5-day history of progressively slurred speech. His social history is significant for intravenous drug use and outdoor pest control work. The patient's head computed tomography (CT) scan without contrast demonstrated the presence of possible bilateral infarcts or masses involving the basal ganglia and periventricular white matter. The patient then progressed to facial diplegia with new onset hemiplegia. High-dose steroids were initiated due to concern for neurosarcoidosis. A lumbar puncture was ordered due to minimal improvement and suggested an inflammatory process. A stereotactic brain biopsy was then performed, demonstrating non-caseating granulomatous inflammation with giant cells. Liposomal amphotericin B was added to cover possible fungal etiology. The pathology report was consistent with an isolated cerebral mucormycosis infection. The etiology remained elusive with clear paranasal sinuses and no cutaneous manifestations. Due to extensive gray matter involvement, the patient was not a candidate for surgery.
Conclusion:
This is a report of mucormycosis in a seemingly immunocompetent patient with either isolated CNS involvement or disseminated mucormycosis without an identifiable source. Although this patient did have two risk factors including intravenous drug use and outdoor working history, his lack of peripheral involvement demonstrates an uncommon presentation.
Left Main Compression by a Giant Aneurysm of the Left Sinus of Valsalva: An Extremely Rare Reason for Myocardial Infarction and Cardiogenic Shock
Authors: Bruno L R Faillace, Micheli Z Galon, Marcos Danillo P Oliveira, Guy F A Prado Jr, Adriano A M Truffa, Expedito E Ribeiro, Pedro A Lemos
Journal: Case Rep Cardiol (2015)

Aneurysms of the sinus of Valsalva are very rare and mostly located in the right coronary sinus. They might course with dyspnea, fatigue, and acute coronary syndromes. We present herein an extremely rare case report of a 61-year-old woman diagnosed with external left main coronary compression by a giant aneurysm of the left sinus of Valsalva, which was successfully managed with percutaneous coronary intervention.
Giant thyroid abscess related to postpartum Brucella infection
Authors: Zülküf Akdemir, Erbil Karaman, Hüseyin Akdeniz, Cem Alptekin, Harun Arslan
Journal: Case Rep Infect Dis (2015)

Thyroid gland infection, although rare, may be a life threatening disease. Thyroid abscess, arising from acute suppurative thyroiditis (AST), is a rare clinic condition depending on widespread use of antibiotics. Infection may involve one or both lobes and abscess formation may not be apparent until late stage of the progress of illness. Thyroid left lobe is more often affected than the right one. Brucellosis, especially obvious in endemic areas, is a widely seen zoonosis around the world. Although brucella infection can affect many organs through various complications, thyroid gland infection is rare. We aimed to present ultrasonography (USG) and magnetic resonance images (MRI) of a case with an acute thyroiditis which rapidly developed and grew fast on the left half of the neck during the first postpartum month. As far as we know from literature reviewing, our case is the first case report of a thyroid abscess arising from brucella infection which is developed in first postpartum period with images of ultrasonography and MRI.
Helicopter EMS: Research Endpoints and Potential Benefits
Authors: Stephen H Thomas, Annette O Arthur
Journal: Emerg Med Int (2012)

Patients, EMS systems, and healthcare regions benefit from Helicopter EMS (HEMS) utilization. This article discusses these benefits in terms of specific endpoints utilized in research projects. The endpoint of interest, be it primary, secondary, or surrogate, is important to understand in the deployment of HEMS resources or in planning further HEMS outcomes research. The most important outcomes are those which show potential benefits to the patients, such as functional survival, pain relief, and earlier ALS care. Case reports are also important "outcomes" publications. The benefits of HEMS in the rural setting is the ability to provide timely access to Level I or Level II trauma centers and in nontrauma, interfacility transport of cardiac, stroke, and even sepsis patients. Many HEMS crews have pharmacologic and procedural capabilities that bring a different level of care to a trauma scene or small referring hospital, especially in the rural setting. Regional healthcare and EMS system's benefit from HEMS by their capability to extend the advanced level of care throughout a region, provide a "backup" for areas with limited ALS coverage, minimize transport times, make available direct transport to specialized centers, and offer flexibility of transport in overloaded hospital systems.
Rupture of a splenic artery aneurysm in a previously healthy 53-year-old male
Authors: A Papadomichelakis, D Anyfantakis, M Kastanakis, P Karona, E Bobolakis
Journal: J Med Life (2014)
Keywords: splenic artery aneurysm, diagnosis, rupture
MeSH terms: Aneurysm, Ruptured / diagnosis, Splenic Artery, Case Reports, Aneurysm, Ruptured / surgery, Diagnosis, Differential, Humans, Male, Middle Aged, Splenectomy

Splenic artery aneurysms are unusual clinical conditions that may be ruptured resulting into adverse health outcomes. Pregnancy, portal hypertension and atherosclerosis are conditions that predispose to the formation of splenic artery aneurysms. A rare case of a previously healthy man referred to our department by his general practitioner complaining of acute abdominal pain is presented. During the hospital stay, the patient presented hemodynamic instability. Abdominal computed tomography disclosed perihepatic and perisplenic fluid accumulation. A diagnosis of ruptured splenic artery aneurysm was performed and the patient was operated successfully with splenectomy and ligation of the splenic artery. Although the condition is rare, physicians have to be aware of the high mortality rates caused by a ruptured splenic artery aneurysm and include this in the differential diagnosis when they encounter patients with acute abdominal pain and hemodynamic instability.
Molecular Basis of Hyperammonemic Encephalopathy in Fibrolamellar Hepatocellular Carcinoma
Authors: Rodrigo Cañada T Surjan, Thais M de Lima, Heraldo P de Souza, Marcel Cerqueira C Machado, José C Ardengh
Journal: Cureus (2023)
Keywords: encephalopathy, fibrolamellar hepatocellular carcinoma, hyperammonemia-encephalopathy, metabolic encephalopathy, physiopathology
MeSH terms: Case Reports

Hyperammonemic encephalopathy is a potentially fatal condition associated with fibrolamellar hepatocellular carcinoma. The mechanism involved in hyperammonemia in patients with fibrolamellar carcinoma was unclear until a possible physiopathological pathway was recently proposed. An ornithine transcarboxylase dysfunction was suggested as a result of increased ornithine decarboxylase activity induced by c-Myc overexpression. This c-Myc overexpression resulted from Aurora kinase A overexpression derived from the activity of a chimeric kinase that is the final transcript of a deletion in chromosome 19, common to all fibrolamellar carcinomas. We performed the analysis of the expression of all enzymes involved and tested for the mutation in chromosome 19 in fresh frozen samples of fibrolamellar hepatocellular carcinoma, non-tumor liver, and hepatic adenomatosis. The specific DNAJB-PRKACA fusion protein that results from the recurrent mutation on chromosome 19 common to all fibrolamellar carcinoma was detected only in the fibrolamellar carcinoma sample. Fibrolamellar carcinoma and adenomyomatosis samples presented increased expression of Aurora kinase A, c-MYC, and ornithine decarboxylase when compared to normal liver, while ornithine transcarbamylase was decreased. The proposed physiopathological pathway is correct and that overexpression of c-Myc may also be responsible for hyperammonemia in patients with other types of rapidly growing hepatomas. This gives further evidence to apply new and adequate treatment to this severe complication.
Vancomycin hypersensitivity diagnosed by lymphocyte blast transformation
Authors: Nguyen P Tran, Jeremy Katcher, Erin Rohman, Mary Francis Hall, Christie F Michael, Isao Miyairi, D Betty Lew
Journal: Case Rep Pediatr (2011)
MeSH terms: Case Reports

A 15-year-old male admitted for Pott's puffy tumor developed recurrent episodes of fever, diffuse morbilliform rash, eosinophilia, and tubulointerstitial nephritis while on multiple antibiotics. Lymphocyte blast transformation (LBT), a method of detecting cellular immune response by measuring levels of interferon-γ (IFN-γ), was used to diagnose vancomycin hypersensitivity and guide antibiotic selection.
Case Report: Post-operative Angioedema After a Laryngeal Mask Airway Application
Authors: Suren Soghomonyan, Qian Fleming, Sujatha P Bhandary
Journal: Front Med (Lausanne) (2021)
Keywords: anesthesia complications, angioedema, laryngeal mask airway, lisinopril, quincke's edema
MeSH terms: Case Reports

Angioedema with macroglossia is a rare complication of anesthesia. We present a clinical case of post-operative development of angioedema presenting as macroglossia in a patient receiving chronic therapy with lisinopril, who developed symptoms in the early post-operative period following surgery in a lateral position, when a laryngeal mask airway was used. Possible mechanisms of angioedema and macroglossia development in our patient are discussed along with potential underlying predisposing mechanisms and available therapeutic approaches.
Testicular Signet-Ring Cell Metastasis from a Carcinoma of Unknown Primary Site: A Case Report and Literature Review
Authors: Aristomenes Kollas, George Zarkavelis, Anna Goussia, Aikaterini Kafantari, Anna Batistatou, Zoi Evangelou, Eva Sintou, Nicholas Pavlidis
Journal: Case Rep Oncol Med (2016)

Signet-ring cell carcinoma is a highly malignant adenocarcinoma consisting of cells characterized as cytoplasmic vacuoles filled with mucin. The most common primary location of this type of cancer is the stomach, but it may also be found in other organs such as prostate, testis, bladder, ovaries, or colon. To date, metastatic signet-ring cell carcinoma of unknown primary (CUP) site to the testis is an extremely rare entity in daily practice. Reviewing the literature, we have been able to detect only three cases of testicular metastases from CUP, two with histological diagnosis of a signet-ring cell carcinoma and one with an adenocarcinoma. In this short paper, we report a case of a 56-year-old man who presented to our Department with testicular mass and ascites. Following a standard diagnostic approach no primary tumor could be identified. CUP was the final clinical diagnosis, histologically characterized as poorly differentiated adenocarcinoma with signet-ring cells involving the peritoneum and the testicular structures.
Case report: Reoperative parathyroidectomy for large ectopic hyperplastic parathyroid in the mediastinum of a patient with recurrent secondary hyperparathyroidism
Authors: Yong Lv, Qiuyuan Wang, Ling Zhang, Qing Zhou, Zhiyu Mi, Yi Wu, Jingning Cheng
Journal: Front Surg (2022)
Keywords: ipth, chronic renal failure (crf), hemodialysis, hypocalcemia, reoperative parathyroidectomy, secondary hyperparathyroidism
MeSH terms: Case Reports

Introduction:
Secondary hyperparathyroidism (SHPT) is a common complication in hemodialysis patients with chronic renal failure uremia. For severe SHPT, parathyroidectomy is effective. Owing to the variability in parathyroid anatomy, surgical parathyroidectomy can be complex and many patients experience recurrent SHPT, which may require repeated surgery. These cases pose significant challenges to surgeons.
Case description:
An elderly woman with recurrent severe SHPT was admitted to our hospital. Preoperative methoxyisobutylisonitrile (MIBI) examination found a large ectopic parathyroid gland in the superior mediastinum, and she underwent reoperative parathyroidectomy. A large parathyroid gland in the right anterior mediastinum and another parathyroid gland in the left lingual lobe of the thymus were removed. The patient had postoperative hypocalcemia that was successfully corrected with calcium supplementation via femoral vein catheterization. During the 1-year postoperative follow-up, the patient's iPTH was well controlled and her blood calcium was within the normal range.
Conclusion:
We report a case of parathyroidectomy to remove multifocal ectopic hyperplastic parathyroid tissue in the mediastinum. Preoperative MIBI accurately detected the lesions. Calcium supplementation via femoral vein catheterization successfully corrected postoperative hypocalcemia. Postoperative follow-up for 1 year indicated that the surgery was successful.
Giant extra-hepatic thrombosed portal vein aneurysm: a case report and review of the literature
Authors: Ismaïl Labgaa, Yann Lachenal, Pierre Allemann, Nicolas Demartines, Markus Schäfer
Journal: World J Emerg Surg (2014)
Keywords: aneurysm, portal vein, thrombosis
MeSH terms: Review

Background:
Extrahepatic Portal vein aneurysm (EPVA) is a rare finding that may be associated with different complications, e.g. thrombosis, rupture, portal hypertension and compression of adjacent structures. It is being diagnosed more frequently with the advent of modern cross-sectional imaging. Our review of the English literature disclosed 13 cases of thrombosed EPVA.
Case presentation:
A 50-years-old woman presented with acute abdominal pain but no other symptom. She had no relevant medical history. Palpation of the right upper quadrant showed tenderness. Laboratory tests were unremarkable. A computed tomography showed portal vein aneurysm measuring 88 × 65 mm with thrombosis extending to the superior mesenteric and splenic vein. The patient was treated conservatively with anticoagulation therapy. She was released after two weeks and followed on an outpatient basis. At two months, she reported decreased abdominal pain and her physical examination was normal. A computed tomography was performed showing a decreased thrombosis size and extent, measuring 80 × 55 mm.
Conclusions:
Although rare, surgeons should be made aware of this entity. Complications are various. Conservative therapy should be chosen in first intent in most cases. We reported the case of the second largest thrombosed extra-hepatic PVA described in the literature, treated by anticoagulation therapy with a good clinical and radiological response.
Sarcoidosis incidentally diagnosed: a case report
Authors: Besir Kesici, Ahmet Burak Toros, Levent Bayraktar, Adem Dervisoglu
Journal: Case Rep Pulmonol (2014)

Sarcoidosis is a chronic, granulomatous condition with unknown cause. Because most of the patients are free of clinical symptoms, sarcoidosis should be considered in differential diagnosis if noncaseous granuloma is noted in biopsies, performed for other reasons. With no clinical symptoms, our patient was diagnosed with sarcoidosis upon identifying noncaseous granuloma in the lymph node biopsy material collected during the laparoscopic operation, performed for gallbladder polyp.
Diagnosis and Surgical Management of Nonsyndromic Nine Supernumerary Teeth and Leong's Tubercle
Authors: Christiane V Cruz, Andrea L Soares, David N Braga, Marcelo C Costa
Journal: Case Rep Dent (2016)

Nonsyndromic multiple supernumerary teeth (ST) and Leong's tubercle are a condition with a very low prevalence and a multidisciplinary approach is required to restore function and aesthetics. So, this case report aimed at presenting a rare case of nonsyndromic nine supernumerary teeth and Leong's tubercle in a pediatric patient, without any evident familial history, showing its diagnosis and surgical management.
Outpatient Tubeless Percutaneous Nephrolithotomy Performed in a Freestanding Ambulatory Surgery Center
Authors: Joel E Abbott, Julio G Davalos
Journal: J Endourol Case Rep (2018)
Keywords: percutaneous nephrolithotomy, percutaneous renal surgery, renal stone, urolithiasis
MeSH terms: Case Reports

Background: Percutaneous nephrolithotomy (PNL) is a procedure that has traditionally been performed in an inpatient or hospital setting. Many surgical procedures have evolved over time from an inpatient/hospital setting to outpatient procedures performed in surgical centers. Outpatient PNL has become an accepted standard in select patients, but to date, the procedure has not been performed in an outpatient surgical center. Case Presentation: We describe our initial experience managing large renal stone burden with PNL performed completely outpatient in a freestanding ambulatory surgery center. The patient was carefully selected as a young, healthy, thin patient with straightforward renal stone burden and favorable anatomy per CT. Access was achieved with a combination of fluoroscopic and endoscopic needle guidance. The procedure was performed with several modifying factors to enable an effective outpatient discharge. Conclusion: Our experience reinforces the outpatient feasibility of PNL and incites the possibility of transitioning the procedure to an ambulatory surgical center in select patients to provide healthcare savings and an improved patient experience.
A case report of pulmonary tumor thrombotic microangiopathy (PTTM) caused by esophageal squamous cell carcinoma
Authors: Takeshi Fujishiro, Kiyohiko Shuto, Toru Shiratori, Tuguaki Kono, Yasunori Akutsu, Masaya Uesato, Isamu Hoshino, Kentaro Murakami, Shunsuke Imanishi, Toru Tochigi, Yoko Yonemori, Hisahiro Matsubara
Journal: Esophagus (2013)
Keywords: esophageal squamous cell carcinoma, pttm, pulmonary tumor thrombotic microangiopathy

A 67-year-old male was referred to our hospital after being diagnosed with esophageal squamous cell carcinoma of the middle thoracic esophagus. The clinical stage was T1b(sm)N4M1 cStage IVb, so he was admitted to our hospital for systemic chemotherapy. He had sustained fever and a dry cough. Chest computed tomography showed the presence of irregular shadows, and unidentified respiratory insufficiency had progressed. A transbronchial lung biopsy revealed a pulmonary artery tumor embolus of esophageal squamous cell carcinoma. He developed DIC and died of respiratory failure on the 19th hospital day. The postmortem autopsy detected pulmonary tumor thrombotic microangiopathy accompanied by esophageal squamous cell carcinoma.
Late resistance to imatinib therapy in a metastatic gastrointestinal stromal tumour is associated with a second KIT mutation
Authors: T Wakai, T Kanda, S Hirota, A Ohashi, Y Shirai, K Hatakeyama
Journal: Br J Cancer (2004)
MeSH terms: Antineoplastic Agents / pharmacology, Gastrointestinal Neoplasms / drug therapy, Gastrointestinal Neoplasms / genetics, Proto-Oncogene Proteins c-kit / genetics, Case Reports, Benzamides, DNA Mutational Analysis, Drug Resistance, Neoplasm / genetics, Gastrointestinal Neoplasms / pathology, Humans, Imatinib Mesylate, Male, Middle Aged, Piperazines / pharmacology, Pyrimidines / pharmacology, Stromal Cells, Antineoplastic Agents, Benzamides, Piperazines, Pyrimidines, Imatinib Mesylate, Proto-Oncogene Proteins c-kit

Currently, there are no data on the secondary resistance of gastrointestinal stromal tumours to imatinib. Here, we report a case of metastatic gastrointestinal stromal tumour that relapsed during imatinib therapy. Mutation analysis showed that the imatinib-resistant liver tumour contained two c-kit mutations.
A Posteriorly Displaced Distal Metaphyseal Clavicular Fracture (Type IV AC Joint Dislocation-Like) in Children: A Case Report and Literature Review Study
Authors: Ahmed Kotb, Taylor Yong, Amr Abdelgawad
Journal: Case Rep Orthop (2016)

Fractures of the lateral end of the clavicle are common in pediatric patients; most of these fractures occur at the physeal level representing Salter Harris injuries. The vast majority of fractures of the lateral end of the clavicle are managed nonoperatively. In this report, we describe a unique type of fracture of the distal end of the clavicle in the pediatric patients in which the fracture occurs in the metaphyseal lateral clavicle with the proximal edge of the fracture displaced posteriorly through the trapezius muscle causing obvious deformity. It is similar in pathology to type IV AC joint dislocation. In this study we report this injury in eleven-year-old boy. Literature review showed that similar injuries were described before three times (two of them in pediatric patients). Due to the significant clinical deformity of this category with entrapment of the bone through the trapezius muscle, reduction (open or closed) of the fracture is the recommended treatment.
Clostridium difficile Peritonitis: An Emerging Infection in Peritoneal Dialysis Patients
Authors: Saira Chaughtai, Bhavika Gandhi, Zeeshan Chaughtai, Dana Tarina, Mohammad A Hossain, Arif Asif
Journal: Case Rep Med (2018)
MeSH terms: Case Reports

Recently, the incidence of Clostridium difficile- (C. difficile-) associated infection has increased significantly in hospital and ambulatory care settings in parallel to the increasing use of inappropriate antibiotics. According to the CDC, approximately 83,000 patients who developed C. difficile experienced at least one recurrence and 29,000 died within 30 days of the initial diagnosis. Patients on dialysis (particularly peritoneal dialysis) are predisposed to this infection due to an inherent immunocompromised state and transmural translocation of the bacteria due to the close association of gastrointestinal tract and peritoneal cavity. C. difficile infection in peritoneal dialysis patients is problematic from two aspects: (1) because dialysis patients are immunocompromised, the infection can be devastating and (2) infection directly interferes with their renal replacement therapy. In this article, we present a case of peritoneal dialysis (PD)-related peritonitis caused by C. difficile-associated diarrhea and colitis. In this patient, the peritonitis was caused by transmural translocation of the enteric bacteria. While the peritoneal fluid culture did not grow the organism (possibly because of prior empiric broad-spectrum antibiotics use), the positive PCR on stool analysis suggested C. difficile-related peritonitis, along with the rapid clinical improvement induced by C. difficile-directed therapy (metronidazole) and discontinuation of broad-spectrum antibiotics. The patient was successfully treated with metronidazole without PD catheter removal. C. difficile infection is common and frequently internists are the first contact with such patients. This article highlights C. difficile infection in a PD patient and raises awareness of this infection in dialysis patients.