OpenMed/multicare-articles huggingface dataset:
Malingering of Psychotic Symptoms in Psychiatric Settings: Theoretical Aspects and Clinical Considerations
Authors: Val Bellman, Anisha Chinthalapally, Ethan Johnston, Nina Russell, Jared Bruce, Shazia Saleem
Journal: Psychiatry J (2022)
MeSH terms: Review

Malingering is the intentional production of false or grossly exaggerated physical or psychological symptoms motivated by external incentives. Although the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) does not list malingering in its diagnostic section and therefore does not identify it as a formal mental disorder, malingering and verified mental illness commonly coexist. Some subtypes of feigning behaviors, such as partial or pure malingering, dissimulation, and false imputation, can be suspected when patients have marked discrepancies between reported stressors and objective findings. The article discusses these three theoretical concepts with their possible clinical aspects, illustrating each phenomenon by clinical case with self-reported and/or observed psychotic symptoms. We summarized relevant findings and provided a review of clinical considerations that physicians can use to aid in the evaluation of psychotic symptoms in the context of those three concepts.
The Molecular Signature More Than the Site of Localization Defines the Origin of the Malignancy
Authors: Antonio Matrone, Liborio Torregrossa, Elisa Sensi, Daniele Cappellani, Walter Baronti, Raffaele Ciampi, Eleonora Molinaro, Clara Ugolini, Aleksandr Aghababyan, Luigi De Napoli, Francesco Latrofa, Gabriele Materazzi, Fulvio Basolo, Paolo Vitti, Rossella Elisei
Journal: Front Oncol (2019)
Keywords: cancer, lung cancer, molecular oncology, mutation—genetics, thyroid cancer
MeSH terms: Case Reports

The diagnosis of the primary origin of metastases to the thyroid gland is not easy, in particular in case of concomitant lung adenocarcinoma which shares several immunophenotypical features. Although rare, these tumors should be completely characterized in order to set up specific therapies. This is the case of a 64-years-old woman referred to our institution for a very advanced neoplastic disease diagnosed both as poorly differentiated/anaplastic thyroid cancer (PDTC/ATC) for the huge involvement of the neck and concomitant lung adenocarcinoma (LA). Neither the clinical features and the imaging evaluation nor the tumor markers allowed a well-defined diagnosis. Moreover, the histologic features of the thyroid and lung biopsies confirmed the synchronous occurrence of two different tumors. The molecular analysis showed a c.34G>T (p.G12C) mutation in the codon 12 of K-RAS gene, in both tissues. Since, this mutation is highly prevalent in LA and virtually absent in PDTC/ATC the lung origin of the malignancy was assumed, and the patient was addressed to the correct therapeutic strategy.
Sevelamer Carbonate Crystal-Induced Colitis
Authors: T Lai, A Frugoli, B Barrows, M Salehpour
Journal: Case Rep Gastrointest Med (2020)
MeSH terms: Case Reports

Hyperphosphatemia is a common and well-described complication of end-stage renal disease. Despite strict dietary constraints and compliance, phosphate binders such as calcium acetate and/or sevelamer carbonate are also needed to treat secondary hyperparathyroidism. This case vignette describes an underrecognized adverse effect of a phosphate binder, sevelamer carbonate, inducing colitis in a 47-year-old male with insulin-dependent diabetes complicated by end-stage renal disease. He presented for recurrent abdominal pain with associated nausea and was found to have multiple circumferential lesions on computed tomography including distal ascending, transverse, and proximal descending colon. Colonoscopy demonstrated nearly obstructing lesions worrisome for colonic ischemia or inflammatory bowel disease. Pathological review of histology demonstrated ragged colonic mucosa with ulcerative debris and nonpolarizing crystalline material at the sites of ulceration, morphologically consistent with the phosphate binder, sevelamer carbonate. Sevelamer carbonate was discontinued, and the patient was transitioned to calcium carbonate with strict dietary restrictions. His symptoms improved with the cessation of sevelamer, and he was subsequently discharged home. He eventually underwent renal transplant without redevelopment of symptoms. Recognition of this underreported complication of sevelamer carbonate, phosphate binder, is of utmost importance in directing appropriate therapy with cessation of this medication in the setting of gastrointestinal complaints or more specifically enteritis and colitis. Clinicians providing care to end-stage renal patients taking either sevelamer and/or sodium polystyrene sulfonate should have increased awareness of the possible gastrointestinal side effects.
Herpes Simplex Proctitis Mimicking Inflammatory Bowel Disease in a Teenaged Male
Authors: Kristen E Sandgren, Nathan B Price, Warren P Bishop, Patrick J McCarthy
Journal: Case Rep Pediatr (2017)
MeSH terms: Case Reports

We report the case of a 17-year-old male who was initially assessed for pain with defecation, bloody rectal discharge, and diarrhea, consistent with proctitis. Though proctitis is most commonly due to inflammatory bowel disease (IBD), infectious etiologies must also be considered, including sexually transmitted causes of infectious proctitis. In discussion of his sexual history, he identified as homosexual and acknowledged engaging in receptive anal intercourse. Rectal biopsies obtained via colonoscopy were culture-positive for herpes simplex virus (HSV), leading to a diagnosis of HSV proctitis and treatment with an appropriate antiviral medication. HSV proctitis is more common in individuals with high-risk sexual practices, including men who have sex with men. While this may be an uncommon diagnosis for pediatricians to make in practice, a high clinical index of suspicion for sexually transmitted infectious proctitis in those with risk factors must be maintained in order to facilitate appropriate testing, treatment, and counseling of affected individuals.
Unusual Cause of Acute Scrotal Pain-Inflammatory Noncommunicating Hydrocele: A Pediatric Case Report
Authors: Yoshinobu Moritoki, Kentaro Mizuno, Taiki Kato, Takahiro Yasui, Yutaro Hayashi
Journal: Case Rep Med (2018)
MeSH terms: Case Reports

The etiology of scrotal pain is clinically classified in terms of the necessity for emergency surgery. Lately, color Doppler ultrasonography has reduced unnecessary surgeries, but there are still some cases that require immediate exploration because of an uncertain diagnosis. Here, we describe the case of a 14-month-old boy, who could not deliver his complaint accurately, presenting with a grumpy mood and a red swollen scrotum. Emergency surgery revealed that the cause was intense inflammation of the hydrocele wall, which typically does not cause acute scrotum. We also reviewed rare etiologies of scrotal pain for general physicians to develop the differential diagnosis.
Postoperative hemicrania continua-like headache - a case series
Authors: Andreas R Gantenbein, Hakan Sarikaya, Franz Riederer, Peter J Goadsby
Journal: J Headache Pain (2015)
MeSH terms: Indomethacin / therapeutic use, Migraine Disorders / etiology, Neurosurgical Procedures / adverse effects, Case Reports, Adult, Female, Headache Disorders / physiopathology, Humans, Male, Middle Aged, Migraine Disorders / drug therapy, Indomethacin

Background:
Hemicrania continua (HC) is a rare chronic headache disorder, typically accompanied by cranial autonomic features and responding to therapeutic doses of indomethacin. The pathophysiology of hemicrania continua is not fully understood.
Findings:
We report a series of three patients who developed a continuous hemicranial headache after cranial surgery. Each case presented a similar phenotype of continuous half-sided headache, cranial autonomic symptoms with exacerbations (2/3), and a response to indomethacin.
Conclusion:
The biology of hemicrania continua may be activated post-craniotomy just as can be seen with other primary headache disorders.
A New MEN2 Syndrome with Clinical Features of Both MEN2A and MEN2B Associated with a New RET Germline Deletion
Authors: Carlotta Giani, Teresa Ramone, Cristina Romei, Raffaele Ciampi, Alessia Tacito, Laura Valerio, Laura Agate, Clara Ugolini, Michele Marinò, Fulvio Basolo, Alessandro Franchi, Simona Borsari, Angela Michelucci, Cesare Selli, Gabriele Materazzi, Filomena Cetani, Rossella Elisei
Journal: Case Rep Endocrinol (2020)
MeSH terms: Case Reports

Background:
Multiple endocrine neoplasia type 2 (MEN2) is a hereditary cancer syndrome caused by RET proto-oncogene mutation. Two different clinical variants of MEN2 are known (MEN2A and MEN2B): medullary thyroid carcinoma (MTC) almost always present and associated with pheochromocytoma (Pheo), and primary hyperparathyroidism (HPTH) in MEN2A and with Pheo and other nonendocrine diseases in MEN2B. Case Report. A 7-year-old girl, previously treated for a pelvic plexiform neurofibroma, arrived at our observation with a peculiar MEN2B syndrome and with HPTH. The neck ultrasound showed bilateral thyroid nodules, local lymph node lesions, and a suspicious left hyperplastic parathyroid. The CT scan showed a megacolon and described the persistence of the pelvic tumor. A new RET germline deletion in exon 11 (c.1892_1899delCGAGCT; p.Glu632_Leu633del) was found. She underwent total thyroidectomy, central compartment and latero-cervical lymph node dissection, and neck exploration for primary HPTH. The histology confirmed bilateral MTC, multiple lymph node metastases, a hyperplastic parathyroid, and a parathyroid adenoma.
Conclusions:
This is the first case of a complex syndrome characterized by peculiar features of MEN2B, without Pheo but with a pelvic plexiform neurofibroma and with HPTH, which is typical of MEN2A. A "de novo" new germline RET deletion located in exon 11 was found.
Primary Cutaneous Diffuse Large B-Cell Lymphoma of the Upper Limb: Double Hit/Double Expressor with CNS Involvement: From Hospice to Remission
Authors: Brenda S Castillo, Maria L Rodriguez, Ju-Hsien John Chao, Behyar Zoghi
Journal: Case Rep Hematol (2019)
MeSH terms: Case Reports

We report a patient with diffuse large B-cell lymphoma of skin, nongerminal center type double hit double expressor, with an initial presentation as a left forearm mass. The patient underwent chemotherapy after initial diagnosis. After chemotherapy regimen, she developed a second mass, followed by CNS involvement with neurological defects. At this time, a three line of chemotherapy was used with minimal effects. The patient was deemed terminal and was recommended hospice care. The patient decided to continue with skin and crainospinal radiotherapy and intrathecal chemotherapy; she achieved complete remission. After achieving complete remission, the patient underwent an autologous stem cell transplant with minimal transplant-related toxicity.
Ventricular septal defect: the three-dimensional point of view
Authors: V Parisi, E Ratto, C Silvestri, F Pastore
Journal: Transl Med UniSa (2013)
Keywords: aortic regurgitation, congenital heart defects, three dimensional transthoracic echocardiography
MeSH terms: Case Reports

This case highlights the clinical usefulness of three-dimensional (3D) echocardiography. The diagnosis of inter-ventricular septal defect associated with aortic regurgitation has been performed in a 50-year-old man using 3D echocardiography. This advanced echocardiography could accurately reproduce the anatomy of the defect and provide further insights in the mechanisms of aortic regurgitation showing an unusual non-coronary cusp prolapse. The routinely use of 3D echocardiography in clinics might allow a better characterization of cardiac anatomy, especially of aortic valve disorders.
Testing rTMS-Induced Neuroplasticity: A Single Case Study of Focal Hand Dystonia
Authors: Sonia Betti, Andrea Spoto, Umberto Castiello, Luisa Sartori
Journal: Neural Plast (2018)
MeSH terms: Dystonic Disorders / therapy, Motor Cortex / physiopathology, Neuronal Plasticity, Transcranial Magnetic Stimulation, Case Reports, Research Support, Non-U.S. Gov't, Biomechanical Phenomena, Dystonic Disorders / physiopathology, Fingers, Humans, Male, Middle Aged, Motor Activity, Recovery of Function, Treatment Outcome, Dystonia, Focal, Task-Specific

Focal hand dystonia in musicians is a neurological motor disorder in which aberrant plasticity is caused by excessive repetitive use. This work's purposes were to induce plasticity changes in a dystonic musician through five daily thirty-minute sessions of 1 Hz repetitive transcranial magnetic stimulation (rTMS) applied to the left M1 by using neuronavigated stimulation and to reliably measure the effect of these changes. To this aim, the relationship between neuroplasticity changes and motor recovery was investigated using fine-grained kinematic analysis. Our results suggest a statistically significant improvement in motor coordination both in a task resembling the dystonic-inducing symptoms and in a reach-to-grasp task. This single case study supports the safe and effective use of noninvasive brain stimulation in neurologic patients and highlights the importance of evaluating outcomes in measurable ways. This issue is a key aspect to focus on to classify the clinical expression of dystonia. These preliminary results promote the adoption of kinematic analysis as a valuable diagnostic tool.
Hyperdense Basal Ganglia on Brain CT in Non-Ketotic Hyperglycemia Associated with Hemichorea
Authors: Bjorn Valgaeren, Elyn Van Snick, Jan Hendrickx
Journal: J Belg Soc Radiol (2022)
Keywords: brain ct, caudate nucleus, diabetes mellitus, hemichorea, lentiform nucleus, non-ketotic hyperglycemia
MeSH terms: Case Reports

Teaching Point: Unilateral choreiform movements combined with contralateral hyperdense lentiform and/or caudate nucleus on computed tomography is suggestive for non-ketotic hyperglycemia, warranting further metabolic workup.
Managing Major Postpartum Haemorrhage following Acute Uterine Inversion with Rusch Balloon Catheter
Authors: Remon Keriakos, Smriti Ray Chaudhuri
Journal: Case Rep Crit Care (2011)
MeSH terms: Case Reports

Acute postpartum uterine inversion is a relatively rare complication. The uterus inverts and the uterine fundus prolapses to or through the dilated cervix. It is associated with major postpartum haemorrhage with or without shock. Shock is sometimes out of proportion to the haemorrhage. Minimal maternal morbidity and mortality can be achieved when uterine inversion is promptly and aggressively managed. We present this report of three cases of acute uterine inversion complicated with major postpartum haemorrhage and managed with Rusch balloon. The paper highlights the importance of early recognition and the safety of the use of intrauterine balloon to manage major postpartum haemorrhage in these cases.
Safety and efficacy of plasma exchange therapy for Kawasaki disease in children in intensive care unit: case series
Authors: Satoko Noguchi, Junichi Saito, Tomoyuki Kudo, Eiji Hashiba, Kazuyoshi Hirota
Journal: JA Clin Rep (2018)
Keywords: kawasaki disease, pediatric intensive care, plasma exchange therapy

Background:
We have reviewed four cases of Kawasaki disease treated with plasma exchange with 5% albumin in electrolyte-balanced solution, according to the recommended guidelines for Kawasaki disease in the intensive care unit, as their responses to intravenous immunoglobulin therapy were poor.
Case presentation:
The four cases were aged between 5 months and 3 years and weighted between 6.4 and 15.6 kg. The plasma levels of C-reactive protein were significantly decreased after plasma exchange (p < 0.05). The dilatations of the coronary artery were found in two cases, but both of them were ameliorated until 1 month after the onset and the other cases recovered without any complications. However, we recognized that one case showed marked decreases in coagulation factors, especially in fibrinogen after each plasma exchange even with a transfusion of fresh frozen plasma.
Conclusions:
Plasma exchange with 5% albumin was effective for refractory Kawasaki disease. However, as there was a possibility of coagulation disorder, attention should be given to changes in coagulation factors like fibrinogen, especially in small patients who need frequent plasma exchange.
Stenotrophomonas maltophilia periprosthetic joint infection after reverse total shoulder arthroplasty
Authors: Michael E Hantes, Fotios Papageorgiou, George A Komnos
Journal: IDCases (2020)
MeSH terms: Case Reports

Stenotrophomonas maltophilia is a well-known opportunistic Gram-negative bacterium causing mainly hospital-acquired infections, which rarely affects the musculoskeletal system. We report the first case, to our knowledge, of a periprosthetic infection caused by this pathogen in an artificial joint. Stenotrophomonas maltophilia has the ability to form biofilm, and subsequently should not be excluded in the investigation of prosthetic joint infections. Management in the establishment of such an infection demands aggressive operative treatment in conjunction with the proper antibacterial administration.
Immune Alterations in a Patient With Hyperornithinemia-Hyperammonemia-Homocitrullinuria Syndrome: A Case Report
Authors: Silene M Silvera-Ruiz, Corinne Gemperle, Natalia Peano, Valentina Olivero, Adriana Becerra, Johannes Häberle, Adriana Gruppi, Laura E Larovere, Ruben D Motrich
Journal: Front Immunol (2022)
Keywords: b cells, hhh syndrome, t cells, case report, hyperammonemia, immunodeficiency, infection, urea cycle defects
MeSH terms: Hyperammonemia / complications, Hyperammonemia / diagnosis, Urea Cycle Disorders, Inborn / complications, Urea Cycle Disorders, Inborn / diagnosis, Urea Cycle Disorders, Inborn / genetics, Case Reports, Research Support, Non-U.S. Gov't, Amino Acid Transport Systems, Basic / genetics, Child, Preschool, Female, Humans, Mitochondrial Membrane Transport Proteins, Ornithine / deficiency, Quality of Life, Amino Acid Transport Systems, Basic, Mitochondrial Membrane Transport Proteins, Ornithine, HHH syndrome

The hyperornithinemia-hyperammonemia-homocitrullinuria (HHH) syndrome is a rare autosomal recessive inborn error of the urea cycle caused by mutations in the SLC25A15 gene. Besides the well-known metabolic complications, patients often present intercurrent infections associated with acute hyperammonemia and metabolic decompensation. However, it is currently unknown whether intercurrent infections are associated with immunological alterations besides the known metabolic imbalances. Herein, we describe the case of a 3-years-old girl affected by the HHH syndrome caused by two novel SLC25A15 gene mutations associated with immune phenotypic and functional alterations. She was admitted to the hospital with an episode of recurrent otitis, somnolence, confusion, and lethargy. Laboratory tests revealed severe hyperammonemia, elevated serum levels of liver transaminases, hemostasis alterations, hyperglutaminemia and strikingly increased orotic aciduria. Noteworthy, serum protein electrophoresis showed a reduction in the gamma globulin fraction. Direct sequencing of the SLC25A15 gene revealed two heterozygous non-conservative substitutions in the exon 5: c.649G>A (p.Gly217Arg) and c.706A>G (p.Arg236Gly). In silico analysis indicated that both mutations significantly impair protein structure and function and are consistent with the patient clinical status confirming the diagnosis of HHH syndrome. In addition, the immune analysis revealed reduced levels of serum IgG and striking phenotypic and functional alterations in the T and B cell immune compartments. Our study has identified two non-previously described mutations in the SLC25A15 gene underlying the HHH syndrome. Moreover, we are reporting for the first time functional and phenotypic immunologic alterations in this rare inborn error of metabolism that would render the patient immunocompromised and might be related to the high frequency of intercurrent infections observed in patients bearing urea cycle disorders. Our results point out the importance of a comprehensive analysis to gain further insights into the underlying pathophysiology of the disease that would allow better patient care and quality of life.
Vibrio cholerae O6 gastroenteritis in a patient with lupus nephritis - a report from coastal Karnataka, South India
Authors: Mamatha Ballal, Vignesh Shetty, Sohan Rodney Bangera, Asish Mukhopadhyay, Goutam Chowdhury, Prosenjit Samanta, Akshata Prabhu, H C Anusha
Journal: JMM Case Rep (2018)
Keywords: vibrio cholerae o6, acute gastroenteritis, ciprofloxacin, fever, lupus nephritis, non-o1/non-o139 vibrios, non-agglutinating vibrios
MeSH terms: Case Reports

Introduction:

Vibrio cholerae O1 strains are responsible for pandemics of cholera and major epidemics in the world. All the remaining V. cholerae non-O1/non-O139 strains are less virulent and are responsible for sporadic cases of gastroenteritis. These non-O1/non-O139 serogroups have more than 200 somatic antigens, and mostly lack cholera toxin and toxin co-regulated pilus encoding genes. Toxigenic and non-toxigenic non-O1/non-O139 V. cholerae have caused several diarrhoeal outbreaks in India and other countries. Acute gastroenteritis is the typical clinical sign and symptom of non-O1/non-O139 V. cholerae infection for both periodical and outbreak cases; in contrast, these V. cholerae are rarely associated with extraintestinal infections.
Case presentation:
Here, we present a case of a 27-year-old female with underlying kidney disease (lupus nephritis) presenting with loose stools, vomiting and fever. V. cholerae O6 was isolated from a faecal sample, which was positive for hlyA and the type III secretion system. The present case is, to the best of our knowledge, the first such case to be reported from South India.
Conclusion:
The V. cholerae O6 associated with autoimmune disease in the present study demonstrates the role of this pathogen in acute gastroenteritis, and if it is left undiagnosed it can lead to septicaemia and other complications. The pathogenic mechanisms of non-O1/non-O139 V. cholerae are multivariate, virulence factors being naturally present in these strains. Therefore, further epidemiological studies are necessary to determine the virulence factors and their pathogenic mechanisms. Non-O1/non-O139 V. cholerae can undoubtedly be the cause of diarrhoea and it would be important to extend bacteriological identification in this line as well as in all cases of gastroenteritis of unknown aetiology.
Systemic lupus erythematous revealed by cytomegalovirus infection
Authors: Rezgui Amel, Karmani Monia, Mzabi Anis, Ben Fredj Fatma, Laouani Chadia
Journal: Pan Afr Med J (2016)
Keywords: systemic lupus erythematous, cerebral vasculitis, cytomegalovirus infection
MeSH terms: Cytomegalovirus Infections / diagnosis, Lupus Erythematosus, Systemic / diagnosis, Lupus Nephritis / diagnosis, Case Reports, Acute Disease, Adrenal Cortex Hormones / therapeutic use, Antiviral Agents / therapeutic use, Cytomegalovirus Infections / drug therapy, Female, Humans, Young Adult, Adrenal Cortex Hormones, Antiviral Agents

Cytomegalovirus (CMV) infection have been described as exacerbing systemic lupus erythematous (SLE). The role of CMV in starting off SLE remains object of debate. We report a severe presentation of SLE revealed by CMV infection with hemophogocytic syndrome. A 22 old women without a history of systemic disease developed a cutaneous eruption with fever and myalgia persistant for 2 weeks. Laboratory studies revealed a CMV serology supporting acute CMV infection, with positive antinuclear antidody, anti ds DNA, elevated liver functions tests, pancytopenia. Further exams revealed an hemophagocytic syndrome and a lupus nephritis. While receiving antiviral and corticosteroid therapy, the patient developed seizures related to a cerebral vasculitis. The outcome was favorable when intravenous immunoglobulins were associated. This observation showed that CMV infection in patients with SLE is often serious and difficult to diagnose and to treat, especially when SLE is not yet recognized. So we suggest all patients with recent SLE have routine testing for CMV immunity.