OpenMed/multicare-articles huggingface dataset:
Drug-Drug-Induced Akathisia: Two Case Reports
Authors: Grace Owusu Aboagye, Daniel Ankrah
Journal: Case Rep Psychiatry (2020)
MeSH terms: Case Reports

Extrapyramidal side effects of psychotropic medicines are usually experienced by patients in the first few weeks of initiating therapy. Patients stabilized on these medications who present with distressing complaints akin to akathisia may be triggered by other factors. This report presents two cases of drug-drug-induced akathisia. Case A is a patient with schizophrenia who was being managed with risperidone 2 mg tablet daily for the past 3 years. She fell ill and reported to a nearby clinic where she was prescribed ciprofloxacin and artemether/lumefantrine tablets for the treatment of an infection and malaria. She presented 7 days later to her psychiatrist with complaints of restlessness, tremor, palpitations, insomnia, and resurgence of obsessive thoughts. Case B is a patient who was diagnosed with first-episode psychotic depression and admitted for 10 days. Her medications on admission were fluphenazine decanoate 25 mg depot injection once, olanzapine 10 mg tablet daily, and fluoxetine 20 mg capsule daily. On discharge, ciprofloxacin 500 mg tablet every 12 hours for 5 days and fluconazole 150 mg capsule once were added to her medications for the treatment of a urinary tract infection. She reported back to the hospital a day after discharge with complaints of restlessness, "seizures," tremor, abdominal discomfort, and weight gain. Both patients were diagnosed with akathisia using ICD-10 classification and the Barnes akathisia rating scale and managed with anticholinergics, benzodiazepines, and beta blockers. Other measures employed in managing the akathisia included reducing the dose of the antipsychotic and/or switching antipsychotics. Despite these management measures, the symptoms of akathisia persisted and only resolved after 4weeks. Upon the resolution of symptoms, Case A continued treatment on olanzapine 5 mg tablet daily and fluoxetine 20 mg capsule daily while Case B continued treatment on risperidone 2 mg tablet daily and fluoxetine 20 mg capsule daily. Using Naranjo's adverse drug reaction causality assessment scale, Medscape drug interaction checker, and literature review, a possible and probable case of drug-drug-induced akathisia was made for Case A and Case B. This report is to create more awareness about psychotropic-antimicrobial-induced akathisia. The information underpins the need for health professionals to consider adverse drug-drug interactions as the probable cause of extrapyramidal side effects experienced by patients on antipsychotics.
Jejunal Ulcer Caused by Schistosoma japonicum
Authors: Daniela Jaqueline Rivadeneira, Hesheng Luo
Journal: Case Rep Gastrointest Med (2019)
MeSH terms: Case Reports

Intestinal schistosomiasis can be caused by the trematodes Schistosoma japonicum that mainly exists in East Asia or the S. mansoni in Africa and South America. The adult worms of S. japonicum live in the mesenteric veins and excrete eggs that circulate to the liver and colon; the eggs migrate through the intestinal wall and pass out with the stool. Here, we report a case of jejunal ulcer caused by the infection of Schistosoma japonicum. A 63-year-old woman from Wuhan, China, was admitted with left quadrant abdominal pain and weight loss for more than 6 months. The patient's computerized tomography reported cirrhotic liver changes, jejunal wall edema, and narrowed lumen; the upper enteroscopy corroborated these findings with the presence of several jejunal ulcers and edema. The pathology report showed chronic inflammation with ulcerative changes and S. japonicum eggs deposition. Schistosomiasis is one of the neglected tropical diseases that affect the poorest. Although a great improvement has been made to control it, there is a lot of work that remains to be fulfilled.
Diagnostic pitfall: primary myoepithelial carcinoma of the lacrimal gland, case report and literature review
Authors: Youssef Mahdi, Mohamed Amine Azami, Rajae Daoudi, Nadia Cherradi
Journal: BMC Clin Pathol (2018)
Keywords: immunohistochemistry, lacrimal gland, myoepithelial carcinoma
MeSH terms: Case Reports

Background:
In lacrimal gland, lymphomas and inflammatory lesions predominate. Primary epithelial tumours represent less than 30% of lacrimal gland lesions. Myoepithelial carcinoma of lacrimal gland is rare. To the best of our knowledge, only nine cases have been reported in the literature. This lesion presents diagnostic difficulties: non-specific clinical and radiological findings and histological polymorphism. This is well illustrated by the diagnostic pathology errors described in the literature.We report a new case of lacrimal myoepithelial carcinoma with a review of others published cases to try to assess clinico-pathological features and outcome whenever possible of this rare tumour.
Case presentation:
An 80-year-old Arabian female presented with a 2-month history of swelling over the right eyebrow, pain, proptosis of the right eye and diplopia. Computed tomography demonstrated an ill-defined, homogeneous, contrast-enhancing mass attached to the medial rectus. A biopsy was performed. Microscopic examination showed malignant spindle cells tumour, most consistently to sarcoma or sarcomatoid carcinoma. Immunohistochemical study was not possible because neoplastic material has been exhausted. Subsequently, total exenteration of the right orbit was performed. Immunohistochemical study revealed diffuse positive staining for pancytokeratin AE1/AE3, epithelial membrane antigen (EMA) and smooth muscle actin (SMA) and focal positivity for S100 protein. The lesion was immunonegative for desmin, h-cladesmon, CD34, Melan-A and HMB-45. The tumour was extending to the surgical margins. The patient was lost to follow-up until she developed local tumour progression 3 months after removal. The patient was again lost to follow-up and therefore did not receive any other treatment in our hospital.
Conclusion:
We present this rare tumour with an unusual location. The use of a complete immunohistochemical panel with epithelial and myoepithelial markers positivity helped us for classification of this poorly differentiated tumour.
Acute Cholecystitis in a Gastric Bypass Patient Complicated by Takotsubo Cardiomyopathy
Authors: Muhammad Jawaid, Tarek El-Sherif, Aaron George, Hugo J R Bonatti
Journal: Case Rep Surg (2022)
MeSH terms: Case Reports

Background:
Gallbladder disease is a common condition after gastric bypass surgery. Even after weight loss, many bariatric patients continue to suffer from comorbid conditions. Takotsubo cardiomyopathy is a rare condition that mimics acute cardiac ischemia but seems to be caused by a catecholamine storm triggered by intense stress. Case Report. A 62-year-old female presented with acute right upper quadrant (RUQ) pain to the ER. She had a history of laparoscopic gastric bypass 5 years ago and had been noncompliant for 2 years. This noncompliance included missing follow-up appointments, gaining weight which caused poorly controlled DM, and not taking her vitamin supplements. Upon presentation, her WBC was elevated, her LFTs were normal, and imaging showed acute calculous cholecystitis. She was admitted and started on antibiotics with plans for laparoscopic cholecystectomy. The next day, she developed acute chest pain, and troponins were elevated with ST changes on EKG. Echocardiography showed a ballooned left ventricle indicative for Takotsubo cardiomyopathy. Symptomatic treatment including antibiotics, betablocker, and thiamine infusion was initiated. At three-month follow-up, ejection fraction had improved from <20% to >50%. The patient underwent interval laparoscopic cholecystectomy, which was technically very challenging due to severe ongoing acute and chronic cholecystitis. There were no cardiac issues, but the patient developed an abscess in the gallbladder fossa, which was successfully treated with oral antibiotics.
Conclusions:
Takotsubo cardiomyopathy complicating acute cholecystitis has thus far not been reported. Our patient had a history of gastric bypass and was noncompliant with vitamin supplementation. Thiamine deficiency may have contributed to the cardiac condition (wet beriberi).
Bilateral Spontaneous Pneumothorax in a COVID-19 and HIV-Positive Patient: A Case Report
Authors: Young Min Cho, Sara Guevara, Judith Aronsohn, James M Mumford, Linda Shore-Lesserson, Santiago J Miyara, Martin Herrera, Claudia Kirsch, Christine N Metz, Stefanos Zafeiropoulos, Dimitrios Giannis, Alexia McCann-Molmenti, Kei Hayashida, Koichiro Shinozaki, Muhammad Shoaib, Rishabh C Choudhary, Gabriel I Aranalde, Lance B Becker, Ernesto P Molmenti, James Kruer, Anthony Hatoum
Journal: Front Med (Lausanne) (2021)
Keywords: covid-19, haart, hiv/aids, sars-cov-2, bilateral pneumothorax, spontaneous pneumothorax, tension pneumothorax
MeSH terms: Case Reports

This case report describes a 60 year-old Black-American male with a past medical history of human immunodeficiency virus (HIV) infection and hyperthyroidism, who suffered a bilateral spontaneous pneumothorax (SP) in the setting of coronavirus disease 2019 (COVID-19) pneumonia. SP is a well-established complication in HIV-positive patients and only recently has been associated with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. While HIV and COVID-19 infections have been independently linked with increased risk of SP development, it is unknown if both infections interact in a synergistic fashion to exacerbate SP risk. According to the Centers for Disease Control and Prevention (CDC), patients living with HIV have a higher risk of developing severe COVID-19 infection and the mechanism remains to be elucidated. To the best of our knowledge, this is the first report of a HIV-positive patient, who in the setting of SARS-CoV-2 infection, developed bilateral apical spontaneous pneumothorax and was later found to have a left lower lobe tension pneumothorax. This case highlights the importance of considering SP on the differential diagnosis when HIV-positive patients suddenly develop respiratory distress in the setting of SARS-CoV-2 infection.
Neuroendoscopic Removal of Acute Subdural Hematoma with Contusion: Advantages for Elderly Patients
Authors: Ryota Tamura, Yoshiaki Kuroshima, Yoshiki Nakamura
Journal: Case Rep Neurol Med (2016)

Background. Large craniotomy for acute subdural hematoma is sometimes too invasive. We report good outcomes for two cases of neuroendoscopic evacuation of hematoma and contusion by 1 burr hole surgery. Case Presentation. Both patients arrived by ambulance at our hospital with disturbed consciousness after falling. Case 1 was an 81-year-old man who took antiplatelet drugs for brain infarction. Case 2 was a 73-year-old alcoholic woman. CT scanning showed acute subdural hematoma and frontal contusion in both cases. In the acute stage, glycerol was administered to reduce edema; CTs after 48 and 72 hours showed an increase of subdural hematoma and massive contusion of the frontal lobe. Disturbed consciousness steadily deteriorated. The subdural hematoma and contusion were removed as soon as possible by neuroendoscopy under local anesthesia, because neither patient was a good candidate for large craniotomy considering age and past history. 40%~70% of the hematoma was removed, and the consciousness level improved. Conclusion. Neuroendoscopic removal of acute subdural hematoma and contusion has advantages and disadvantages. For patients with underlying medical issues or other risk factors, it is likely to be effective.
Case Report: Consecutive Adrenal Cushing's Syndrome and Cushing's Disease in a Patient With Somatic CTNNB1, USP8, and NR3C1 Mutations
Authors: Mario Detomas, Barbara Altieri, Wiebke Schlötelburg, Silke Appenzeller, Sven Schlaffer, Roland Coras, Andreas Schirbel, Vanessa Wild, Matthias Kroiss, Silviu Sbiera, Martin Fassnacht, Timo Deutschbein
Journal: Front Endocrinol (Lausanne) (2021)
Keywords: ctnnb1, cushing’s disease, cushing’s syndrome, nr3c1, usp8, glucocorticoid excess, hypercortisolism
MeSH terms: Cushing Syndrome / genetics, Endopeptidases / genetics, Endosomal Sorting Complexes Required for Transport / genetics, Pituitary ACTH Hypersecretion / genetics, Receptors, Glucocorticoid / genetics, Ubiquitin Thiolesterase / genetics, beta Catenin / genetics, Case Reports, Research Support, Non-U.S. Gov't, Adenoma / diagnosis, Adenoma / genetics, Adenoma / surgery, Adrenal Cortex Neoplasms / diagnosis, Adrenal Cortex Neoplasms / genetics, Adrenal Cortex Neoplasms / surgery, Adrenalectomy / adverse effects, Cushing Syndrome / complications, Cushing Syndrome / diagnosis, Female, Germany, Humans, Middle Aged, Mutation, Pituitary ACTH Hypersecretion / complications, Pituitary ACTH Hypersecretion / diagnosis, CTNNB1 protein, human, Endosomal Sorting Complexes Required for Transport, NR3C1 protein, human, Receptors, Glucocorticoid, beta Catenin, Endopeptidases, USP8 protein, human, Ubiquitin Thiolesterase

The occurrence of different subtypes of endogenous Cushing's syndrome (CS) in single individuals is extremely rare. We here present the case of a female patient who was successfully cured from adrenal CS 4 years before being diagnosed with Cushing's disease (CD). The patient was diagnosed at the age of 50 with ACTH-independent CS and a left-sided adrenal adenoma, in January 2015. After adrenalectomy and histopathological confirmation of a cortisol-producing adrenocortical adenoma, biochemical hypercortisolism and clinical symptoms significantly improved. However, starting from 2018, the patient again developed signs and symptoms of recurrent CS. Subsequent biochemical and radiological workup suggested the presence of ACTH-dependent CS along with a pituitary microadenoma. The patient underwent successful transsphenoidal adenomectomy, and both postoperative adrenal insufficiency and histopathological workup confirmed the diagnosis of CD. Exome sequencing excluded a causative germline mutation but showed somatic mutations of the β-catenin protein gene (CTNNB1) in the adrenal adenoma, and of both the ubiquitin specific peptidase 8 (USP8) and the glucocorticoid receptor (NR3C1) genes in the pituitary adenoma. In conclusion, our case illustrates that both ACTH-independent and ACTH-dependent CS may develop in a single individual even without evidence for a common genetic background.
Malignant Prolactinoma With Liver Metastases Masquerading as Metastatic Gastrointestinal Stromal Tumor: A Case Report and Literature Review
Authors: A Ram Hong, Jee Hee Yoon, Hee Kyung Kim, Ho-Cheol Kang
Journal: Front Endocrinol (Lausanne) (2020)
Keywords: dopamine agonist, gastrointestinal stromal tumor, metastasis, pituitary carcinoma, prolactinoma
MeSH terms: Gastrointestinal Neoplasms / pathology, Gastrointestinal Stromal Tumors / pathology, Liver Neoplasms / secondary, Pituitary Neoplasms / complications, Prolactinoma / complications, Case Reports, Review, Female, Gastrointestinal Neoplasms / drug therapy, Gastrointestinal Neoplasms / etiology, Gastrointestinal Stromal Tumors / drug therapy, Gastrointestinal Stromal Tumors / etiology, Humans, Liver Neoplasms / drug therapy, Liver Neoplasms / etiology, Middle Aged, Prognosis, Prolactin / blood, Prolactin

Pituitary carcinomas are rare diseases defined as pituitary tumors with metastases. In this report, we describe a case of malignant prolactinoma with liver metastases masquerading as metastatic gastrointestinal stromal tumor (GIST). A 54-years-old woman received dopamine agonists for macroprolactinoma for 2 years, followed by transsphenoidal surgery due to a poor response to medical therapy. Despite the continuation of dopamine agonist after surgery, serum prolactin level progressively increased to above 8,000 ng/ml in 5 years. There was no evidence of disease recurrence on sella magnetic resonance imaging (MRI). She stopped medical therapy. Meanwhile, she was diagnosed with GIST accompanied by liver and peritoneal metastases. After a 2-months treatment with imatinib, she suddenly presented with headache and visual impairment. Sella MRI showed a 3.3-cm sized pituitary mass, and serum prolactin levels were still high. For the recurred mass, she underwent a second surgery followed by radiation therapy. During the imatinib treatment for GIST, main mass and peritoneal metastases were dramatically decreased, but liver metastases were markedly aggravated. Liver masses were eventually confirmed as metastases from prolactin-producing pituitary carcinoma and not from GIST by percutaneous biopsy. Unfortunately, she died 6 months after the second surgery due to acute renal failure and sepsis. This case suggests that highly sustained serum prolactin levels during the dopamine agonist may indicate prolactin-producing pituitary carcinomas with hidden metastases.
Endoscopic Nasogallbladder Drainage Combined with Laparoscopic Surgery for Type I Mirizzi Syndrome with Acute Cholecystitis: A Case Series Report
Authors: Wei Han, Qing Yue, Kai Liu, Jian-Ji Ke, Ling-Yu Meng, Ya-Hui Liu
Journal: Gastroenterol Res Pract (2020)

Objective:
To investigate the safety and feasibility of endoscopic nasogallbladder drainage (ENGBD) combined with laparoscopic surgery for Mirizzi syndrome type I with acute cholecystitis.
Methods:
An analysis of 4 patients with type I Mirizzi syndrome with acute cholecystitis admitted to the First Hospital of Jilin University.
Results:
The patients underwent ENGBD, and laparoscopic surgery was evaluated postoperatively. All four patients successfully recovered from this combined surgical approach.
Conclusion:
The combination of ENGBD and laparoscopic surgery is safe and feasible for the treatment of patients with type I Mirizzi syndrome accompanied by acute cholecystitis. This approach may reduce the traumatic stress on patients and is worthy of widespread implementation.
External flail chest stabilization; The simple, low-cost way
Authors: Efstratios Apostolakis, Nikolaos A Papakonstantinou, Alexandra Liakopoulou, Serafeim Chlapoutakis
Journal: J Cardiovasc Thorac Res (2021)
Keywords: external stabilization, flail chest, respiratory insufficiency, thoracic trauma
MeSH terms: Case Reports

Flail chest is a life-threatening clinical entity which can be complicated by respiratory insufficiency. Paradoxical motion of a part of chest wall is the basic cause to put the blame on. Consequently, stabilization of the chest wall is occasionally of paramount importance to achieve early extubation in a patient with post-trauma respiratory insufficiency. Hereby, a simple, low cost, harmless and effective approach of external stabilization is presented.
A novel GUCY2D mutation in a Chinese family with dominant cone dystrophy
Authors: Xin Zhao, Yanfan Ren, Xiaohui Zhang, Changxi Chen, Bing Dong, Yang Li
Journal: Mol Vis (2013)
MeSH terms: Asian People / genetics, Genes, Dominant / genetics, Genetic Predisposition to Disease, Guanylate Cyclase / genetics, Mutation / genetics, Receptors, Cell Surface / genetics, Retinitis Pigmentosa / genetics, Case Reports, Research Support, Non-U.S. Gov't, Adult, Amino Acid Sequence, Base Sequence, China, Computational Biology, DNA Mutational Analysis, Electroretinography, Family, Female, Guanylate Cyclase / chemistry, Humans, Male, Middle Aged, Molecular Sequence Data, Pedigree, Receptors, Cell Surface / chemistry, Retinitis Pigmentosa / physiopathology, Tomography, Optical Coherence, Young Adult, Receptors, Cell Surface, guanylate cyclase 1, Guanylate Cyclase

Purpose:
To describe the clinical and genetic findings in a Chinese family with autosomal dominant cone dystrophy (adCOD).
Methods:
One family was examined clinically, and genomic DNA was extracted from venous blood of all participants. Genotyping and haplotyping analysis was performed on the known genetic loci for adCOD and autosomal dominant cone-rod dystrophies (adCORD) with a panel of polymorphic markers in this family. All coding exons of the AIPL1, PTTPNM3, and GUCY2D gene were directly sequenced. Allele-specific PCR was used to validate a substitution in all available family members and 100 normal controls. Bioinformatics analysis was done using the Garnier-Osguthorpe-Robson method to predict the effect of the variants detected on the secondary structure of the GUCY2D protein.
Results:
Clinical examination and pedigree analysis revealed a three-generation family with four members diagnosed with adCOD. Through genotyping, the disease-causing genes were mapped to chromosomes 17p13.1-2 (AIPL1, PITPNM3, and GUCY2D gene). A novel A->G transition at position 2545 (p.T849A) of the cDNA sequence was identified in the GUCY2D gene. No mutation was detected in the AIPL1 and PITPNM3 genes. This missense mutation co-segregated with the disease phenotype of the family but was not found in the 100 normal controls.
Conclusions:
A novel missense mutation of the GUCY2D gene was identified in this study. Our results further confirm that the dimerization zone of RetGC-1 is the mutational hot region for COD and CORD.
Empyema necessitans due to aspergillus in a 3-year-old paediatric patient at a referral hospital in Nairobi, Kenya
Authors: Anne-Marie Macharia, Loice Achieng Ombajo, Abdirahman Hashi Farah, Edwin Oloo Walong, Gladys Nthambi Mwango, Dalton Wamalwa
Journal: Pan Afr Med J (2019)
Keywords: invasive aspergillosis, child, empyema
MeSH terms: Aspergillosis / diagnosis, Empyema / diagnosis, Tuberculosis, Pulmonary / diagnosis, Case Reports, Aspergillosis / pathology, Child, Preschool, Empyema / microbiology, Humans, Kenya, Male

We present a case of empyema necessitans due to aspergillus in a young child. The incidence of deep fungal mycoses in children, especially in developing countries is not known. There is paucity of data and access to diagnostics is usually limited. Our patient had received treatment for pulmonary tuberculosis which is endemic in Kenya for four months before diagnosis was made. We present this case to highlight the importance of considering alternative diagnosis when there is non-response to anti-tuberculous therapy.
COVID-19-Related Pneumonia in an Adolescent Patient with Allergic Asthma
Authors: Öner Özdemir, Muhammet Mesut Nezir Engin, Emine Aylin Yılmaz
Journal: Case Rep Med (2021)
MeSH terms: Case Reports

Background:
The latest coronavirus infection due to SARS-CoV-2, which started in China in December 2019, was announced as a pandemic by the World Health Organization (WHO) in March 2020. All epidemiological data so far show us that SARS-CoV-2 infection is less serious in children than in adults. Allergic asthma, the most common chronic disease in children, is usually not to be related to greater risk or severity for COVID-19 in pediatric populations. Although reports/research on asthma and COVID-19 in children have thus far been comforting, when coming across an asthma patient with any lower airway infection, attention should be given to evaluate their asthma control level and the possibility of SARS-CoV-2 infection. Case Report. Here, we report a rare adolescent case of COVID-19-related pneumonia development with underlying asthma. A 16-year-old male patient has been followed up by the pediatric allergy outpatient clinic with the diagnosis of asthma for the last 5 years. He was thought to have typical clinical and laboratory findings for SARS-CoV-2 infection combined with underlying pediatric (allergic) asthma. Pulmonary CT showed findings consistent with COVID-19-related pneumonia. He was discharged after 1 week when all his complaints regressed, his examination became normal, and 5-day favipiravir treatment was completed.
Conclusion:
When a physician comes across an asthma patient with any lower airway infection, attention should be given to evaluate their asthma control level and possibility of SARS-CoV-2 infection.