OpenMed/multicare-articles huggingface dataset:
The Diagnostic Dilemma of "The Great Imitator": Heart and Cerebral Involvement of Lupus Manifesting as Bilateral Upper and Lower Extremity Weakness
Authors: Alexander Santos, Catrina Kure, Cesar Sanchez, Phillip Gross
Journal: Case Rep Rheumatol (2023)
MeSH terms: Case Reports

Background:
Systemic lupus erythematous (SLE) is an autoimmune condition which can cause complex, multiorgan dysfunction. This autoimmune disease is caused by the production of antinuclear antibodies which allows this disease to target virtually any organ in the human body. When a patient experiences an unpredictable worsening of disease activity, it is generally considered a lupus flare. Organ dysfunction due to a lupus flare tends to manifest as separate events in the literature and rarely do we witness multiple compounding organ failures during a lupus flare. If we do witness organ dysfunction and failure, rarely do we see cardiac and cerebral involvement. Typically, patients take immunosuppressants for a long term to avoid the patient's disease process from worsening and to provide prophylaxis from a flare to occur. Despite the availability in preventive strategies, some patients will have increased disease activity multiple times throughout their lifetime and will need increases in their medication doses or changes to their regimen. Some flares can be managed in the clinic, but more severe ones may be life-threatening that they require intravenous medications and hospitalization to achieve remission. In the following case, we see a patient with a past medical history of SLE on multiple immunosuppressants who arrived at the hospital with acute, bilateral weakness of the upper and lower extremities. It was later determined via various imaging and laboratory testing that she was having an SLE flare that was directly causing myocarditis which progressed to global ischemia of the brain via myocardial hypoperfusion. She experienced substantial recovery from her flare with treatment with high-dose, intravenous corticosteroids. Case Report. A 27-year-old female with a 2-year history of lupus and a 1-week history of paroxysmal atrial fibrillation presented with three days of bilateral focal neurological deficits in the arms and legs. She was found to have ischemic cardiac and neurologic manifestations during her hospital stay.
Conclusion:
Our patient presented with reversible focal neurological deficits, elevated high-sensitive troponin levels, and high lupus serum antibodies who showed significant improvement after the introduction of high-dose steroids. This case recommends keeping a large differential and to not discount patients' past comorbidities for causing atypical symptomatology.
Diabetes Insipidus due to Metastases of Undiagnosed Lung Cancer: A Case Report from Syria
Authors: Ibrahim Alali, Alaa Al-Sarraj, Younes Kabalan
Journal: Case Rep Endocrinol (2023)
MeSH terms: Case Reports

Pituitary metastases (PM) are extremely uncommon, accounting for less than 1% of all intracranial metastases. PM of an undiagnosed malignancy can commonly present with symptoms of hormonal deficiencies, central diabetes insipidus, and/or visual symptoms. Lung and breast malignancies are the most common cancers associated with PM. Despite advances in diagnostic and therapeutic options, the prognosis remains poor and is influenced by primary malignancy and treatment methods. We report a case of a patient with PM from lung cancer who had polyuria, polydipsia, and nonspecific symptoms. A full evaluation confirmed central diabetes insipidus, hypogonadism, and metastatic lung cancer. We also discuss the current literature on PM diagnosis and management, emphasizing the need for a comprehensive evaluation of all available data. This is the first case of PM reported from Syria, to our knowledge.
Primary gastrinoma of the gallbladder: a case report and review of the literature
Authors: Yao-Ge Liu, Shi-Tao Jiang, Yang Zhou, Jun-Wei Zhang, Xin-Ting Sang, Lei Zhang, Xin Lu, Yi-Yao Xu
Journal: Front Oncol (2024)
Keywords: zollinger-ellison syndrome, case report, gallbladder, gastrinoma, neuroendocrine neoplasm
MeSH terms: Case Reports

Background:
Primary gallbladder gastrinoma is an exceptionally uncommon tumor and is a rare form of neuroendocrine neoplasm. Until now, no cases of primary gallbladder gastrinoma and rare cases of primary gastrinoma from the biliary system have been reported.
Case presentation:
We report a case of a 50-year-old woman with watery diarrhea who intermittently received proton pump inhibitors (PPIs) as treatment. A serum gastrin level of 711 pg/ml was recorded after the withdrawal of PPI over 1 week. Enhanced computed tomography (CT) imaging and octreotide imaging uncovered a solitary tumor at the hepatic hilar region. During the laparoscopic surgery, it was determined that the tumor had its origin in the wall of the gallbladder neck, prompting the implementation of a laparoscopic cholecystectomy. Histological analysis revealed a primary neuroendocrine tumor from the neck of the gallbladder. The patient's symptoms disappeared after the surgery with a follow-up of 6 months.
Conclusions:
This case confirmed that primary gallbladder gastrinoma represents a distinct nosological entity. Immunohistochemical analysis plays a pivotal role in the diagnostic process. Given the limited understanding of primary gallbladder gastrinoma, our objective is to offer novel insights into this rare disease by delivering distinctive information and highlighting the therapeutic significance of surgical intervention.
Major depression associated with a levonorgestrel-releasing intrauterine system mimicking frontotemporal dementia: a case report
Authors: Valeria Valencia-Cifuentes, Carlos A Cañas, Juan Carlos Rivas
Journal: Front Psychiatry (2023)
Keywords: adverse event, anxiety, contraception, depressive cognitive disorder, hormonal contraceptive, progestin-only contraceptive
MeSH terms: Case Reports

This case illustrates the adverse cognitive and affective effects associated with the use of an intrauterine hormonal contraceptive, which could be confused with symptoms of early onset dementia. We present a case of a 42-year-old woman diagnosed with seronegative spondyloarthropathy who subsequently developed anxiety and depressive symptoms after the implantation of a Levonorgestrel-Releasing Intrauterine System (LNG-IUS). Three years later, she began to experience memory and attentional failures, refractory pain, and severe depression. The progression of psychiatric symptoms led to a diagnosis of bipolar affective disorder and treatment with antidepressants and anxiolytics. Due to cognitive and psychiatric symptoms, autoimmune encephalitis was considered, but no improvement was shown with treatment. Early onset dementia was suspected, and a brain PET scan revealed frontal lobe hypometabolism. An adverse effect of LNG-IUS was considered; after its removal, mood and cognitive function improvements were observed. This case report emphasizes the importance of considering organic causes of unexplained psychiatric manifestations and highlights the potential impact of hormonal interventions on mental health.
Acromegaly, Herniation of Cerebellar Tonsils, and Arnold-Chiari 1 Malformation: The Importance of Right Definitions
Authors: Alessandro Ciarloni, Gianmaria Salvio
Journal: Case Rep Endocrinol (2024)
MeSH terms: Case Reports

We present a case of acromegaly associated with Arnold-Chiari 1 malformation and a literature review regarding this association, mainly focusing on the importance of a clear distinction between Chiari malformation and herniation of cerebellar tonsils (CTH). Indeed, in many clinical cases, this distinction has not been properly made and a better description of the radiological findings could be important for the clinical management of these patients. In fact, Arnold-Chiari 1 malformation, as a congenital disease, is not caused by acquired growth hormone (GH) excess, but the latter could worsen pre-existing CTH or even induce it ex novo. Therefore, awareness of this condition in the clinical management of acromegaly appears crucial.
Impact of Focal Muscle Vibration on Flaccid Upper Limb Motor Paralysis following Acute Brain Disease: A Case Study
Authors: Hirotaka Saito, Haruka Kobayashi, Kodai Oba, Yosuke Hamaya
Journal: Case Rep Neurol Med (2024)
MeSH terms: Case Reports

Focal muscle vibration (FMV) is increasingly being recognized as a rehabilitative therapy for enhancing motor function in central nervous system (CNS) diseases, particularly in patients with fine motor control deficits stemming from CNS damage. Brain lesions from these diseases disrupt the motor networks, necessitating novel rehabilitation strategies. By applying vibrations to muscles, FMV stimulates sensory fibers to induce cortical activity and kinesthetic illusions. While initial studies have highlighted FMV's role in reducing spasticity, recent evidence points to its potential in treating motor paralysis. However, prior research has been limited by the lack of acute-phase studies and a focus on patients with minimal muscle contraction capability. This report aimed to explore FMV's efficacy on upper limb motor function in patients with flaccid motor paralysis immediately after acute CNS diseases. We report the case of a septuagenarian male with a brain abscess in the right parietal lobe, leading to flaccid motor paralysis. Rehabilitation included 28 sessions of occupational and physical therapy that incorporated FMV. Significant improvements were observed in upper extremity function, with moderate to very large effect sizes, while lower limb function showed lesser improvement without adverse effects. This case suggests the utility of FMV in enhancing upper-limb motor function after acute CNS injuries, potentially serving as a supplementary therapy for spontaneous recovery. This report contributes to emerging evidence on FMV's benefits in acute flaccid motor paralysis, expanding the documented therapeutic scope.
Cutaneous Neuroendocrine Metastases of Visceral Origin Responsive to Surgical Resection and Targeted Radionuclide Therapy
Authors: Eleanor Tung-Hahn, Ghassan El-Haddad, Jonathan Strosberg
Journal: Case Rep Dermatol Med (2024)
MeSH terms: Case Reports

Neuroendocrine neoplasms (NENs) encompass a diverse range of biologically and behaviorally distinct epithelial malignancies that derive from neuroendocrine cells. These neoplasms are able to secrete a variety of bioactive amines or peptide hormones. The majority of NENs are well-differentiated and are defined as neuroendocrine tumors (NETs). While NETs are known to frequently metastasize to lymph nodes, liver, and lungs, spread to the skin is extremely rare and is often a late finding. Because cutaneous metastasis from a visceral site represents distant tumor dissemination, prompt histologic diagnosis is critical in terms of selecting further treatment options and ultimately impacts subsequent prognosis. This report presents a man with painful cutaneous NET metastases initially on the face then scalp. He had a prior history of longstanding and progressive stage IV visceral disease. Multimodal therapy with initial surgical resection of the larger facial lesion and radionuclide infusion therapy was undertaken. Excision fully removed the temple lesion and resolved pain. Peptide receptor radionuclide therapy (PRRT) with 177Lu-DOTATATE, a radiolabeled somatostatin analog that targets somatostatin receptors on NETs, was given along with maintenance lanreotide therapy, which resolved the scalp lesion, prevented recurrence of prior lesions and development of new cutaneous metastases, and controlled his visceral disease. PRRT has not been previously described in the management of cutaneous NET metastases. Due to the rare nature of cutaneous NET metastases, there is no consensus regarding optimal management. As such, we propose novel multimodal therapy involving excision and targeted radionuclide therapy as a possible effective option.
A challenging differential diagnosis - Leber's Hereditary Optic Neuropathy
Authors: Raluca Eugenia Iorga, Răzvana Sorina Munteanu-Dănulescu, Ciprian Danielescu
Journal: Rom J Ophthalmol (2024)
Keywords: leber’s hereditary optic neuropathy, idebenone, optic atrophy, optic coherence tomography, retinal ganglion cell layer
MeSH terms: Optic Atrophy, Hereditary, Leber / diagnosis, Optic Atrophy, Hereditary, Leber / genetics, Optic Nerve Diseases, Case Reports, Adult, Child, DNA, Mitochondrial / genetics, Diagnosis, Differential, Evoked Potentials, Visual, Humans, Male, DNA, Mitochondrial

Leber's hereditary optic neuropathy (LHON) is the most common maternally inherited disease linked to mitochondrial DNA (mtDNA). The patients present with subacute asymmetric bilateral vision loss. Approximately 95% of the LHON cases are caused by m.3460G>A (MTND1), m.11778G>A (MTND4), and m.14484T>C (MTND6) mutations. The hallmark of hereditary optic neuropathies determined by mitochondrial dysfunction is the vulnerability and degeneration of retinal ganglion cells (RGC). We present the case of a 28-year-old man who came to our clinic complaining of a subacute decrease in visual acuity of his left eye. From his medical history, we found out that one month before he had the same symptoms in the right eye. From the family history, we noted that an uncle has had vision problems since childhood. We carried out complete blood tests, including specific antibodies for autoimmune and infectious diseases. Laboratory tests and MRI were within normal limits. A blood test of the mtDNA showed the presence of 11778 G>A mutation on the mtND6 gene. The medical history, the fundus appearance, the OCT, and the paraclinical investigations, made us diagnose our patient with Leber's hereditary optic neuropathy. As soon as possible, we began the treatment with systemic idebenone, 900 mg/day. We examined the patient 2, 6, and 10 weeks after initiating the treatment. Abbreviations: LHON = Leber's Hereditary Optic Neuropathy, mtDNA = mitochondrial DNA, VA = visual acuity, RE = right eye, LE = left eye, OCT = Optical coherence tomography, pRNFL = peripapillary retinal nerve fiber layer, GCL = retinal ganglion cells layer, MRI = magnetic resonance imaging, VEP = visual evoked potentials, VEP IT = VEP implicit time, VEP A = VEP amplitude.
Case Report: Giant left atrial cystic tumor: myxoma or intracardiac blood cyst?
Authors: Weizhang Xiao, Jing Qin, Jia Feng, Feng Jiang, Xinming Chen, Xiang Cao, Qun Xue, Jiahai Shi
Journal: Front Cardiovasc Med (2024)
Keywords: cardiac surgery, cardiac tumor, case report, intracardiac blood cyst, myxoma
MeSH terms: Case Reports

Background:
Primary cardiac tumors are uncommon, with the majority being benign myxomas. Cystic myxoma, a particularly rare type of benign cardiac tumor, demands cautious differential diagnosis from other cardiac tumors.
Case summary:
A 43-year-old male patient presenting with intermittent dyspnea was referred to our department for surgical evaluation. Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) unveiled an intra-left atrial cyst, which was subsequently found to be blood-filled during a video-assisted microinvasive heart surgery. Pathological examination depicted a cyst wall filled with small stellate and fat spindle cells, along with a mucoid matrix, indicating a diagnosis of cystic myxoma.
Conclusions:
We herein presented a rare case of an adult patient with cystic myxoma, initially misdiagnosed as an intracardiac blood cyst (CBC) prior to surgery, and ultimately verified via pathological findings.
Case report: successful response to bevacizumab combined with erlotinib for a novel FH gene mutation hereditary leiomyoma and renal cell carcinoma
Authors: Xiaoming Bai, Dan Xiang, Mengxi Huang, Yitian Chen
Journal: Front Pharmacol (2024)
Keywords: fh mutation, bevacizumab combined with erlotinib, hereditary leiomyoma and renal cell carcinoma, peripheral blood genetic testing, targeted therapy
MeSH terms: Case Reports

FH-deficient Renal Cell Carcinoma (FH-deficient RCC) are inherited tumors caused by mutations in the fumarate hydratase (FH) gene, which plays a role in the tricarboxylic acid cycle. These mutations often result in aggressive forms of renal cell carcinoma (RCC) and other tumors. Here, we present a case of FH-deficient RCC in a 43-year-old woman with a history of uterine fibroids. She exhibited a new heterozygous mutation in exon six of the FH gene (c.799_803del, c.781_796del). The patient had multiple bone metastases and small subcutaneous nodules in various areas such as the shoulders, back, and buttocks. Biopsy of a subcutaneous nodule on the right side revealed positive expression of 2-succinate-cysteine (2SC), and FH staining indicated FH expression deletion. The patient underwent treatment with a combination of erlotinib and bevacizumab, which resulted in significant efficacy with moderate side effects. This treatment combination may be recommended as a standard regimen. This case underscores the importance of genetic testing in patients with advanced renal cancer to enhance diagnostic accuracy. Furthermore, it provides insights into potential treatment approaches for FH-deficient RCC.
The dialectics of disaster: Considerations on hazards and vulnerability in the age of climate breakdown, with a brief case study of Khuzestan
Authors: Andreas Malm
Journal: Jamba (2023)
Keywords: marxism, climate breakdown, coastline, dialectics, vulnerability

In a historical moment inundated by disasters, understanding and conceptualising the phenomenon is a matter of some importance. No framework for doing so has been more productive than that developed by Wisner and his colleagues. But their so-called 'Progression of Vulnerability' (pressure and release [PAR] model) framework was conceived before the onset of the climate crisis. And that crisis, as the saying goes, changes everything.
Contribution:
What follows is an immanent critique of the framework, with an eye towards shifting some of its parameters in order to account for the process of climate breakdown now multiplying disasters across the globe.
Successful percutaneous coronary intervention of left main coronary artery dissection following mechanical aortic valve replacement surgery: a case report and literature review
Authors: Vu Hoang Vu, Hung Phi Truong, Hoa Tran, Khang Dang Cao, Bao Thien Duong, Thuy Thanh Thi Tran, Binh Quang Truong
Journal: Front Cardiovasc Med (2024)
Keywords: coronary artery bypass surgery, iatrogenic left main coronary artery dissection, intravascular ultrasound, mechanical aortic valve replacement surgery, percutaneous coronary intervention
MeSH terms: Case Reports

Background:
Iatrogenic left main coronary artery (LMCA) dissection resulting from cardiac surgery is a rare complication. Its early detection is challenging and often poses a significant threat to the patient's life. However, evidence regarding the most effective management strategy for this condition remains limited at present.
Case presentation:
We present a case of 65-year-old female patient who developed cardiogenic shock after mechanical aortic valve replacement surgery associated acute myocardial infraction. Despite concurrent coronary artery bypass graft (CABG) surgery, the patient's condition remained unimproved. Subsequent coronary angiography revealed extensive LMCA dissection involving the left circumflex (LCx) artery. Percutaneous coronary intervention (PCI) guided by intravascular ultrasound (IVUS) led to an immediate improvement in hemodynamic status. The patient was successfully discharged after 22 days of treatment.
Conclusions:
Iatrogenic LMCA dissection is an uncommon complication following cardiac surgery. It can manifest in a variety of ways, including as incidental findings, cardiogenic shock or sudden cardiac arrest. The precise prevalence rates of causes linked to cardiac surgery remain largely unknown due to the scarcity of reported cases and the absence of research on this issue. Currently, a definitive management strategy for this condition has not been established. However, previous reported clinical cases provide insight that CABG could be considered if coronary artery dissection is detected during cardiac surgery. Upon postoperative identification, diagnostic coronary angiography and PCI may be feasible alternatives.
Case report: A case of advanced gastric cancer with multiple skin metastases, with significant relief from immunotherapy
Authors: Wen Hao, Ruimin Chang, Jingxin Liu, Yibing Wang, Meijin Ren, Kai Xin, Baorui Liu, Jiaqi Xie, Yang Yang
Journal: Front Immunol (2024)
Keywords: pd-1, cutaneous metastasis, gastric cancer, genetic sequencing, immunotherapy
MeSH terms: Adenocarcinoma / pathology, Skin Neoplasms / drug therapy, Stomach Neoplasms / pathology, Case Reports, Research Support, Non-U.S. Gov't, Female, Humans, Immunotherapy

Gastric cancer is the fifth leading cause of cancer-related mortality worldwide, with a low 5-year survival rate in advanced stages. Cutaneous metastasis is rare in gastric cancer, with only 0.8-1% incidence. We reported a rare case of female gastric cancer. The patient had undergone subtotal gastrectomy and chemotherapy 13 years ago, followed by a subsequent surgery of residual stomach, partial jejunum, and partial colon resection 11 years later. The pathological examination revealed poorly differentiated stomach adenocarcinoma, Lauren classification: diffuse type. The patient received 2 cycles of SOX chemotherapy. Two years later, cauliflower-like skin nodules, which were surgically excised, appeared on the back. The histopathological examination showed a spindle cell tumor; no specific anti-tumor treatment was administered. Six months later, the skin lesions increased in size and number, spreading to the neck, chest, and abdomen, presenting as erythematous patches with some cauliflower-like elevations. A skin biopsy of a 1cm0.5cm0.3cm lesion on the left abdomen was performed, and based on the immunohistochemistry, clinical history, and the possibility of metastatic or infiltrating adenocarcinoma, the gastrointestinal origin was highly suspected. Genetic testing was performed on the gastric recurrence and skin lesions, revealing 103 shared genetic variations, further suggesting the skin metastasis originated from gastric cancer. Subsequently, the patient received 10 cycles of immunotherapy combined with intravenous chemotherapy (200mg Tislelizumab and 100mg albumin-bound paclitaxel). The treatment response was evaluated as partial remission, with significant improvement in the skin lesions compared to before. This case highlights the possibility of tumor metastasis in patients with extensive skin lesions in advanced gastric cancer. Early examination, diagnosis, skin biopsy, immunohistochemistry, and genetic sequencing are recommended.