OpenMed/multicare-articles huggingface dataset:
A 45-year old man with recurrent syncope: an unusual presentation of coronary artery disease
Authors: Abiodun Moshood Adeoye, Aina Nnodim Adekunle, Adewole Adesoji Adebiyi, Ajit Mullassari, Subban Vijayakumar, Chibuike Eze Nwafor
Journal: Pan Afr Med J (2013)
Keywords: percutaneous transluminal coronary angioplasty, syncope, angiogram, coronary artery disease
MeSH terms: Coronary Artery Disease / complications, Coronary Artery Disease / diagnosis, Syncope / etiology, Case Reports, Humans, Male, Middle Aged, Recurrence

A 45-year old normotensive, euglycaemic, non-smoker was referred from a peripheral hospital to the Cardiology unit of the University College Hospital, Nigeria for evaluation of recurrent exercise induced syncope. Initial 12-lead electrocardiogram (ECG), 24-hr ambulatory ECG, trans-thoracic echocardiogram and electroencephalogram (EEG) were normal. A repeat episode of syncope warranted further investigation. Immediate post syncope ECG showed deeply inverted symmetrical T waves in the anterior leads. He underwent coronary angiogram which revealed distal left main disease and 70-80% stenosis of the proximal Left Anterior Descending Artery (LAD). The Circumflex artery was non dominant with normal Right Coronary artery. He subsequently had Percutaneous Transluminal Coronary Angioplasty (PTCA) of the LAD. Post-revascularisation course has been satisfactory with no recurrence of syncope. In view of the rising trend of cardiac death in the country, there is the need for high index of suspicion in making diagnosis of coronary artery disease in patients with syncope.
Prolonged leptospira urinary shedding in a 10-year-old girl
Authors: Emilie Chow, Jaime Deville, Jarlath Nally, Michael Lovett, Karin Nielsen-Saines
Journal: Case Rep Pediatr (2012)
MeSH terms: Case Reports

We present a case of leptospirosis in a previously healthy girl following a trip to Costa Rica. While she was clinically asymptomatic, she had spirochetes cultured from her urine six weeks following her trip. Prolonged urinary shedding following infection with Leptospira is possible in humans and often has subtle manifestations in children.
Usefulness of Stereotactic Radiotherapy Using CyberKnife for Recurrent Lymph Node Metastasis of Differentiated Thyroid Cancer
Authors: Joji Kawabe, Shigeaki Higashiyama, Mitsuharu Sougawa, Atsushi Yoshida, Kohei Kotani, Susumu Shiomi
Journal: Case Rep Endocrinol (2017)
MeSH terms: Case Reports

A woman in her 60s presented with a recurrent lymph node metastasis from a papillary thyroid carcinoma in the right parapharyngeal space. She had already undergone total thyroidectomy, five resections for cervical lymph node metastases, and right carotid rebuilding. Surgical resection of the current metastasis was impossible. 131I-radioiodine therapy (RIT) with 3.7 GBq 131I was not effective; therefore, stereotactic radiation therapy (SRT) using a CyberKnife radiotherapy system was scheduled. The prescription dose was 21 Gy, and a dose covering 95% of the planning target volume (PTV) in three fractions was administered. The PTV was 4,790 mm3. Follow-up magnetic resonance imaging conducted 3 and 12 months after the SRT demonstrated a remarkable and gradual reduction of the recurrent lymph node metastasis in the right parapharyngeal space and no evidence of recurrence. For multidisciplinary therapy of unresectable and/or RIT unresponsive locoregional lymph node metastases and recurrences of DTC, SRT using the CyberKnife system should be considered.
Intravenous thrombolysis in ischemic stroke patients with intracranial neoplasms: two cases and a literature review
Authors: William Neil, Bruce Ovbiagele
Journal: Case Rep Med (2011)
MeSH terms: Case Reports

Based on exclusion criteria in the landmark NINDS-rtPA trial, current expert consensus guidelines preclude the use of intravenous recombinant tissue plasminogen activator (IV rtPA) in acute ischemic stroke (AIS) patients with intracranial neoplasm. There are only 3 published cases of administration of IV rtPA to AIS patients with intracranial neoplasms in the literature. Two of these published cases involved malignant brain parenchymal lesions discovered only after rtPA was inadvertently given, and one of these cases was associated with hemorrhage within the tumor. In this paper, we report two cases of administration of IV rtPA in AIS patients with intracranial neoplasms observed on neuroimaging prior to IV rtPA administration. In both cases, the tumor was outside of the brain parenchyma. The first case was an acoustic schwannoma and the second a falcine meningioma. Neither case was associated with intratumoral hemorrhage as of at least one week following IV rtPA treatment. More published cases are definitely warranted, but our experience with these two cases suggests that administration of IV rtPA to AIS patients in the presence of extraparenchymal brain tumors may not necessarily precipitate intra-tumoral bleeding and thereby worsen clinical outcomes.
Massive Ascites Following Robot-Assisted Radical Prostatectomy and Extended Pelvic Lymph Node Dissection: A Case Report
Authors: Shyaw Ahmed, Greg Shaw, Omar AlKadhi
Journal: J Endourol Case Rep (2019)
Keywords: lipidiol lymphangiogram, massive ascites, robot-assisted radical prostatectomy
MeSH terms: Case Reports

Background: Lymph leakage is regarded as one of the rare complications of major abdominal, pelvic, and thoracic surgeries. Lymphangiogram seems to be the principal diagnostic modality. Management strategies that have been shown in the literature range from conservative measures to surgical exploration. However, the rarity and diversity in the presentation of this complication have attributed to the lack of consensus and guideline on its management. Case Presentation: A 49-year-old obese man with prostate-specific antigen of 10 and preoperative Gleason score of 8 prostate cancer and initial staging of T3N0M0 has undergone robot-assisted radical prostatectomy and extended pelvic lymph node dissection with unilateral nerve sparing. Our patient was admitted with significant ascites on day 14 postoperative, which was confirmed on CT abdomen and initially managed with nutritional support and percutaneous drainage. A lipidiol lymphangiogram demonstrated lymphatic leakage near the right external iliac vein. While he was awaiting elective surgical exploration, he has had two further successive admissions with massive ascites, anemia and raised C-reactive protein with acute kidney injury. A laparoscopic exploration was performed with interventional radiology assistance to direct dissection to the site of leak. An abscess cavity was found and excised. The lymphatic leak tailed off to insignificance rapidly thereafter. Conclusion: Each case of lymphatic leakage seems to require an individualized approach according to the nature and severity of the lymphatic leak and patient condition. Although it is possible that the collection was infected lymphatic fluid, the position of the abscess cavity in proximity to the site where the lipidiol was seen to leak from the lymphatics suggests that it is possible that the lipidiol was the nidus for infection. Either way what is interesting is that the presence of the abscess caused prolonged and profuse lymphatic leakage.
Ultrasound-guided multiple peripheral nerve blocks in a superobese patient
Authors: Alper Kilicaslan, Ahmet Topal, Atilla Erol, Hale Borazan, Onur Bilge, Seref Otelcioglu
Journal: Case Rep Anesthesiol (2014)

The number of obese patients has increased dramatically worldwide. Morbid obesity is associated with an increased incidence of medical comorbidities and restricts the application choices in anesthesiology. We report a successfully performed combined ultrasound-guided blockade of the femoral, tibial, and common peroneal nerve in a superobese patient. We present a case report of a 31-year-old, ASA-PS II, super obese man (190 kg, 180 cm, BMI: 58 kg/m(2)) admitted to the emergency department with a type II segmental tibia shaft fracture and ankle dislocation after a vehicle accident. After two failed spinal anesthesia attempts, we decided to apply a femoral block combined with a sciatic block. Femoral blocks were successfully performed with US guided in-plane technique. Separate blocks of the tibial and common peroneal nerves were planned after the sciatic nerve could not be located due to the thick subcutaneous tissue. We performed a tibial nerve block at 2 cm above the popliteal crease and common peroneal nerve at the level of the fibular head with US guided in-plane technique. The blocks were successful and no block-related complications were noted. Ultrasound guidance allows new approaches for multiple peripheral nerve blocks with low local anesthetic doses in obese patients.
Mirizzi syndrome: from ultrasound diagnosis to surgery-a case report
Authors: Dario Pariani, Giorgio Zetti, Fausto Galli, Ferdinando Cortese
Journal: Case Rep Surg (2013)

The Mirizzi syndrome is a rare disorder that usually presents with jaundice and cholangitis; its lack of recognition in the diagnostic path could have serious consequences for the patient undergoing cholecystectomy. Here we describe the clinical case of a jaundiced patient from the ultrasound suspect of Mirizzi syndrome to the surgical treatment.
Management of Pulmonary Hemorrhage Complicating Pulmonary Thromboendarterectomy
Authors: Adam A Dalia, Scott Streckenbach, Mike Andrawes, Richard Channick, Cameron Wright, Michael Fitzsimons
Journal: Front Med (Lausanne) (2018)
Keywords: cteph, airway management, cardiac anesthesia, chronic thromboembolic pulmonary hypertension, double lumen tube, pulmonary hemorrhage, thromboendarterectomy

Airway management during pulmonary thromboendarterectomy (PTE) can prove challenging, especially in the face of unexpected intraoperative pulmonary hemorrhage. Utilization of proper airway equipment on induction is crucial for the successful management of intraoperative pulmonary hemorrhage. Our case series describes the preoperative risk factors that can lead to intraoperative pulmonary hemorrhage, the preinduction airway equipment considerations for PTE, and the intraoperative management of pulmonary hemorrhage. We summarize the lessons learned at our institution from four cases of post perfusion pulmonary hemorrhage.
A Case of Polymicrobial Bacteremia in a Patient Undergoing Chemotherapy
Authors: Kyoko Arahata, Ryo Yamaguchi, Takeshi Terashima
Journal: Case Rep Infect Dis (2018)
MeSH terms: Case Reports

We report an aggressive case of polymicrobial bacteremia in a patient with renal pelvis carcinoma. A 76-year-old man developed watery diarrhea after undergoing chemotherapy. He became unconscious and went into shock. Laboratory data showed severe neutropenia, renal failure, and lactic acidosis. Chest radiography showed multiple opacities. He died despite aggressive fluid resuscitation, catecholamine administration, antibiotic treatment, and mechanical ventilation. Blood culture isolates included Escherichia coli, Klebsiella pneumoniae, Streptococcus pneumoniae, Acinetobacter baumannii, and Moraxella catarrhalis. The foci of bacteremia were the respiratory tract and the bowel. The two infection foci and polymicrobial bacteremia are thought to be associated with the patient's poor prognosis. Although polymicrobial bacteremia is rare, awareness of this condition and of the rare causative pathogens, such as A. baumannii and M. catarrhalis, especially in patients with comorbidities and immunosuppression will help treat the patients with bacteremia.
Perceptions of eating disorder diagnoses and body image issues in four male cases in Singapore
Authors: Evelyn Boon, Kelly Ann Zainal, Stephen W Touyz
Journal: J Eat Disord (2017)
Keywords: anorexia nervosa, binge eating disorder, body image, bulimia nervosa, case report, eating disorder, male
MeSH terms: Case Reports

Background:
Despite the increasing number of patients presenting for treatment, little is still known about male eating disorders cases. The current study presents four male eating disorder cases presented to our specialized treatment facility in Singapore.
Case presentation:
Cases 1, 2 and 3 are homosexual males in their twenties and thirties who presented with anorexia nervosa and bulimia nervosa. Case 4 is a heterosexual male in his twenties diagnosed with binge eating disorder. All four cases expressed body image dissatisfaction, fat phobia and fear of weight gain. Additionally, all of them sought treatment because of comorbid psychiatric conditions or parental wishes. Premorbid obesity and homosexual orientation may be potential risk factors for males in developing eating disorders.
Conclusions:
These findings suggest that more exploration needs to be done for males diagnosed with eating disorders, particularly in the Asian society. A deeper understanding into factors associated with symptom presentation and treatment-seeking behaviors would greatly assist in informing the direction and focus of treatment in the region.
Mediastinal esophageal leiomyosarcoma abutting a retroesophageal right subclavian artery: A case report
Authors: Erin M Corsini, Daniel Maoz-Metzl, Kyle G Mitchell, Robert D Rice, Boris Sepesi
Journal: Int J Surg Case Rep (2019)
Keywords: arteria lusora, case report, esophageal leiomyosarcoma, retroesophageal subclavian artery

Introduction:
Esophageal leiomyosarcoma and arteria lusoria represent rare entities in thoracic disease. In the setting of arteria lusoria, careful surgical planning and preoperative imaging is essential.
Presentation of case:
A 53-year old male presented with a history of cough. Imaging demonstrated a 7-cm mediastinal mass at the level of the trachea and upper esophagus, abutting an incidentally found retroesophageal right subclavian artery. The right carotid artery originated from the aortic arch. Comprehensive evaluation demonstrated a mediastinal sarcoma. Given the tumor size and close association with vital structures, induction chemotherapy was given without response. He was therefore taken for resection, including possible esophagectomy. The mass was well-encapsulated, permitting mobilization off the surrounding structures, and was identified arising from the muscular layer of the esophagus. Postoperatively, he had a low-volume chyle leak, which resolved with conservative management. He was offered mediastinal adjuvant radiation due to close margins, but declined. The patient remained without evidence of disease for over two years, at which time a single pulmonary metastasis was noted and resected.
Discussion:
Esophageal leiomyosarcoma are an uncommon intrathoracic malignancy and may present with symptoms of mass effect. While patients with arteria lusoria are typically asymptomatic, they may suffer surgical morbidity if this entity is not identified preoperatively. In this case, the aberrant artery was intimately involved with the leiomyosarcoma, increasing complexity and rendering complete oncologic resection challenging.
Conclusion:
Herein we present a challenging surgical resection of esophageal leiomyosarcoma in the setting of arteria lusoria, which was successfully treated tumor enucleation.
Alternative drugs go global: possible lead and/ or mercury intoxication from imported natural health products and a need for scientifically evaluated poisoning monitoring from environmental exposures
Authors: Lygia Therese Budnik, Xaver Baur, Volker Harth, Axel Hahn
Journal: J Occup Med Toxicol (2016)
Keywords: dietary supplements, heavy metal intoxication, lead, mercury, monitoring, natural health products, prevention measures
MeSH terms: Case Reports

Background:
With increases in globalization, cultural remedies from Chinese, Ayurvedic, Arab and other traditions have become more available to international consumers, offering unfamiliar "Natural Health Products" (NHP), used as alternative medicine or supplementary medicine. Contamination with toxic ingredients including lead, mercury, arsenic, and other toxic elements has been documented in several of these products from various parts of the globe, particularly from some parts of Asia and the Orient.
Findings:
We have been following this development in the last 6 years and have analyzed n = 20 such products (60 analyses) from patients with intoxication symptoms in a pilot study, showing alarming high concentrations of mercury and/or lead (the first one in "therapeutic" doses). 82 % of the studied NHP contained lead concentrations above the EU limit for dietary supplements. 62 % of the samples exceeded the limit values for mercury. Elevated blood lead and mercury levels in patients along with clinical intoxication symptoms corroborate the causal assumption of intoxication (s). We present one detailed clinical case report of severe lead and mercury intoxications and give an overview about blood concentration related symptoms and signs of n = 41 case reports of mercury intoxications of the German monitoring BfR-DocCenter.
Conclusions:
For NHP there is evidence on a distinct toxicological risk with alarming low awareness for a possible intoxication which prevents potentially life-saving diagnostic steps in affected cases. In many cases patients do not communicate the events to their physicians or the local health authority so that case reports (e.g. the BfR-DocCentre) are missing. Thus, there is an urgent need to raise awareness and to initiate more suitable monitory systems (e.g. National Monitoring of Poisonings) and control practice protecting the public.
Evans Syndrome Associated with Pregnancy and COVID-19 Infection
Authors: Gayathri Vadlamudi, Leah Hong, Madhurima Keerthy
Journal: Case Rep Obstet Gynecol (2020)
MeSH terms: Case Reports

Background:
Evans syndrome (ES) is a chronic autoimmune disease characterized by autoimmune hemolytic anemia along with immune thrombocytopenic purpura. Few case reports of ES in pregnancy have been published, and ES may be difficult to distinguish from other diagnoses more common in pregnancy. Guidelines for treatment of ES are not well-defined.
Case:
A 23-year-old multigravid woman in active labor was found to have severe anemia and thrombocytopenia. She was diagnosed with ES and started on immunosuppressive treatments for persistent immune thrombocytopenic purpura. In the postpartum period, she was found to have coronavirus (COVID-19) infection and acute pulmonary embolism.
Conclusion:
Evans syndrome is a challenge to diagnose in pregnancy and poses important considerations for intrapartum and postpartum management.
Atypical Radiographic Presentation of Cryptococcus Pneumonia in a Newly Diagnosed HIV Patient
Authors: Arthur Cacacho, Umair Ashraf, Arsalan Rehmani, Masooma Niazi, Misbahuddin Khaja
Journal: Case Rep Infect Dis (2019)
MeSH terms: Case Reports

Background:

Cryptococcus infection is an opportunistic infection that occurs primarily among immunocompromised patients, and the morbidity and mortality of this infection is high if left unrecognized and untreated. There are no clinical or radiographic characteristics typical of cryptococcal pneumonia, and its clinical and radiological presentations often overlap with other diagnoses.
Case presentation:
We present a case of a 25-year-old man from Ghana admitted for an altered mental state, weight loss, neck pain, fever, and photophobia. He was diagnosed with Cryptococcus neoformans meningitis by cerebrospinal fluid culture and with disseminated cryptococcal infection by a positive Cryptococcus blood test. Diffuse micronodular opacities were found in a miliary pattern in the upper portions of both lungs upon imaging, which suggested miliary tuberculosis; thus, the patient was started on antituberculosis therapy. The patient underwent flexible fiber optic bronchoscopy, and transbronchial biopsy of the right lung showed bronchopneumonia with fungal spores consistent with filamentous Cryptococcus neoformans, which grew in tissue culture of the right lung. Interferon-gamma release assay, Mycobacterium tuberculosis PCR, and acid-fast bacilli staining of the bronchoalveolar lavage were negative for the M. tuberculosis complex.
Conclusion:
The similarities in clinical and imaging findings among patients with acute immunodeficiency syndrome with coinfections make diagnoses difficult; thus image-guided biopsies are essential to confirm diagnoses.
Ethical Implications of the Fecal Microbiota Transplantation: Disclosure of a False-Positive HIV Test
Authors: Caitlyn Hollingshead, Jacob Ciricillo, Joel Kammeyer
Journal: Case Rep Infect Dis (2021)
MeSH terms: Case Reports

Fecal microbiota transplantation (FMT) has gained popularity as an effective therapeutic option for Clostridioides difficile infection (CDI). Since its FDA recognition as a treatment modality for recurrent CDI in 2013, screening protocols for FMT donor stool have been in flux. However, extensive health questionnaires, in combination with serological and stool assays, have become mainstays in the donor screening process, although ethical implications are yet to be thoroughly considered. Herein, we present the case of a family member found to have a false-positive HIV test during the donor screening process and discuss potential ethical ramifications associated with FMT stool donation.
Congenital Tufting Enteropathy, a Rare Cause of Diarrhea and Malnourishment in Arab Child with Genetic and Histopathology Investigations
Authors: Shooq Alkhalifa, Aysha Darwish, Mohamed Awadh, Salman M Alkhalifa, Abdulla Darwish
Journal: Case Rep Pediatr (2023)
MeSH terms: Case Reports

Congenital tufting enteropathy (CTE), also known as intestinal epithelial dysplasia (IED), is a rare autosomal recessive disorder due to EPCAM gene mutation. It is a rare congenital enteropathy that presents in early infancy as an intractable diarrhea that is independent of breast formula feeding that requires life-long total parental nutrition (TPN) to acquire adequate calories and fluid intake or small bowel transplantation in severe cases. Here, we report a case of intestinal failure due to congenital tufting enteropathy in a 3-year-old girl who presented with loose stools and failure to thrive. This study aims to review the literature about CTE and discuss the clinicopathological aspects and to be able to distinguish it from other causes of congenital diarrheal disorders (CDDs).
Pseudotumoral hydatid cyst: report of a case
Authors: Ioannis E Petrakis, Evaggelia Grysbolaki, Stefanos Paraskakis, Theodore Lagoudis, Demetrios Filis, George Chalkiadakis
Journal: HPB Surg (2009)
MeSH terms: Echinococcosis, Hepatic / pathology, Case Reports, Abdominal Neoplasms / diagnosis, Adult, Diagnosis, Differential, Echinococcosis, Hepatic / diagnosis, Echinococcosis, Hepatic / surgery, Humans, Male, Tomography, X-Ray Computed

Hydatidosis due to Echinococcus granulosus is an endemic parasitic zoonosis characterized by worldwide distribution particularly in Mediterranean countries. The most commonly involved anatomical locations are the liver and lung. Occasionally the cyst may progressively increase in size, mimicking gross ascites or intrabdominal tumor. Herein, are reported a case of a 40-year-old patient with a giant exophytically expanded hepatic echinococcus cyst, misdiagnosed as an abdominal malignancy during formal investigation. The patient was admitted to the hospital complaining for mild diffuse abdominal tenderness, moderate abdominal pain, nausea, diarrhoea, and vomiting. A CT scan revealed the presence of a giant abdominal mass 25 x 21 x 14 cm, resembling a tumor, adherent to the liver edges and parietal peritoneum, displacing intestinal loops. During the ensuing days the patient's clinical condition worsened, and he became febrile. Exploratory laparotomy was performed, and an exophytically grown giant liver hydatid cyst was removed, despite the radiological findings and the preoperative clinical suspicion.