OpenMed/multicare-articles huggingface dataset:
Endovascular management of hemosuccus pancreaticus, a rare case report of gastrointestinal bleeding
Authors: Hye Ryoung Sul, Hyun Woong Lee, Jeong Wook Kim, Sung Jae Cha, Yoo Shin Choi, Gi Hyeon Kim, Byung Kook Kwak
Journal: BMC Gastroenterol (2016)
MeSH terms: Ampulla of Vater / blood supply, Aneurysm, Ruptured / therapy, Angioplasty, Balloon / methods, Gastrointestinal Hemorrhage / therapy, Pancreatic Diseases / therapy, Splenic Artery / diagnostic imaging, Case Reports, Aneurysm, Ruptured / complications, Diagnosis, Differential, Endoscopy, Gastrointestinal, Gastrointestinal Hemorrhage / etiology, Humans, Male, Middle Aged, Pancreatic Diseases / complications, Pancreatic Ducts / diagnostic imaging, Radiography, Stents

Background:
Hemorrhage from the pancreatic duct, or hemosuccus pancreaticus (HP), is an unusual cause of intermittent gastrointestinal bleeding. HP is most often diagnosed in patients with chronic pancreatitis, and is usually due to the rupture of an aneurysm in the splenic artery. The traditional treatment for HP is surgery, although most cases can be managed by angioembolization.
Case presentation:
We present a case of HP in a patient with no history or evidence of chronic pancreatitis. Repeated endoscopy revealed fresh bleeding from the papilla of Vater. Angiography revealed an aneurysm of the splenic artery, which was the suspected cause of the intermittent bleeding from the pancreatic duct. Angiography demonstrated extravasation of contrast from the aneurysm. A peripheral Jostent stent-graft was hand-mounted on an angioplasty balloon and then inserted into the aneurysm. Arteriography revealed successful occlusion of the aneurysm with the stent-graft. No recurrent gastrointestinal bleeding was observed during the five years follow-up periods.
Conclusion:
HP should be included in the differential diagnosis of intermittent gastrointestinal bleeding in patients with histories of chronic alcoholism, even when they do not have a history of chronic pancreatitis. We recommend an interventional procedure with a metal stent for the initial treatment of HP.
An avoidable cause of thymoglobulin anaphylaxis
Authors: S Brabant, A Facon, F Provôt, M Labalette, B Wallaert, C Chenivesse
Journal: Allergy Asthma Clin Immunol (2017)
Keywords: anaphylactic allergic reaction, rabbit proteins, thymoglobulin
MeSH terms: Case Reports

Background:
Thymoglobulin® (anti-thymocyte globulin [rabbit]) is a purified pasteurised, gamma immune globulin obtained by immunisation of rabbits with human thymocytes. Anaphylactic allergic reactions to a first injection of thymoglobulin are rare.
Case presentation:
We report a case of serious anaphylactic reaction occurring after a first intraoperative injection of thymoglobulin during renal transplantation in a patient with undiagnosed respiratory allergy to rabbit allergens.
Conclusions:
This case report reinforces the importance of identifying rabbit allergy by a simple combination of clinical interview followed by confirmatory skin testing or blood tests of all patients prior to injection of thymoglobulin, which is formally contraindicated in patients with a history of hypersensitivity to rabbit proteins.
Prurigo pigmentosa clinically and immunologically mimicking autoimmune bullous disease: A case report
Authors: Kanako Kita, Ichiro Kurokawa, Daisuke Hayashi, Takashi Hashimoto
Journal: Front Med (Lausanne) (2022)
Keywords: autoantibodies, autoimmune bullous diseases, bullous pemphigoid, immunoblotting, prurigo pigmentosa
MeSH terms: Case Reports

A 15-year-old Japanese male noticed brown macules on his back 9 months ago. Initial examination revealed reticulated infiltrative erythema and pigmentation with blisters on the erythema of the back. Histopathology showed blisters with eosinophil infiltration in the epidermis, and direct immunofluorescence showed negative results for immunoglobulin (Ig) G, Ig A, Ig M, and C3 in the epidermal basement membrane zone. Immuno-serological tests revealed the presence of IgG antibodies against BP180, linear IgA disease antigen 1 (LAD-1), and laminin α3. The autoimmune bullous disease was suspected, and prednisolone at a concentration of 20 mg/day (0.3 mg/kg/day) was started. When the prednisolone dose was reduced to 10 mg/day, erythema and blisters recurred. The patient was diagnosed with prurigo pigmentosa based on clinical features and was treated successfully with oral doxycycline hydrochloride hydrate and topical tacrolimus ointment. This is the first case of prurigo pigmentosa with blisters in which autoantibodies to the epidermal basement membrane zone were found, which might be secondary non-pathogenic antibodies.
Chromobacterium violaceum causing disseminated soft tissue and pulmonary abscesses in a traveller returning from the Azores
Authors: Melissa Chowdhury, Nathaniel Lee, Emmanuel Q Wey
Journal: Access Microbiol (2021)
Keywords: antimicrobials, clinical microbiology, epidemiology, soft tissue infections, tropical diseases
MeSH terms: Case Reports

This case report describes a 30-year-old male patient presenting with Chromobacterium violaceum cutaneous lesions who develops a subsequent bacteraemia, complicated by soft tissue and pulmonary abscesses. C. violaceum disease is a rare infection that can manifest in a spectrum from cutaneous lesions to disseminated disease and sepsis, the latter associated with high mortality. Although in the available literature there is a recommendation for a prolonged antibiotic course, we describe effective management with a shorter course of antibiotics. This case highlights the importance of not only considering a diagnosis of C. violaceum if there has been a high risk and appropriate exposure, but to also consider the changing epidemiology of the organism due to certain geographical areas becoming warmer due to climate change.
Coinfection with Rickettsia helvetica and Herpes Simplex Virus 2 in a Young Woman with Meningoencephalitis
Authors: Kenneth Nilsson, Katarina Wallménius, Carl Påhlson
Journal: Case Rep Infect Dis (2011)
MeSH terms: Case Reports

Herpes virus type 2 DNA was detected by PCR in the cerebrospinal fluid in a young woman presenting with headache, stiff neck and pleocytosis, and serological findings consistent with reactivation. Since she was exposed to ticks, Lyme disease and tick-borne encephalitis were excluded. Further investigation in an ongoing project, using PCR and sequencing of the amplified products, showed the presence of Rickettsia helvetica in the cerebrospinal fluid. The bacteria were also isolated in Vero cell culture, and microimmunofluorescence confirmed the development of antibodies against Rickettsia spp. with predominance of IgM reactivity consistent with recent infection. She was treated with antibiotics and improved rapidly. The patient could easily have been judged to have isolated herpes meningitis. Because Sweden and other European countries are endemic areas for rickettsioses, the paper reaffirms the importance of investigating for the presence of rickettsial infections in endemic areas in cases of meningitis of uncertain aetiology.
Intravesical Migration of Missed Intrauterine Device Associated with Stone Formation: A Case Report and Review of the Literature
Authors: Mücahit Kart, Turgay Gülecen, Murat Üstüner, Seyfettin Çiftçi, Ufuk Yavuz, Cüneyd Özkürkçügil
Journal: Case Rep Urol (2015)

Intrauterine device is the most widely used method of reversible contraception. It may cause various complications including perforation of uterus. In this case, 44-year-old woman was presented with lower urinary tract symptoms after six years of insertion. Patient has no remarkable physical or laboratory finding but abdominal ultrasound revealed a 27 mm hyperechogenicity, suggestive of foreign body or calculus on the posterior bladder wall which was removed endoscopically. This case highlights the need of immediate and periodic evaluation of women with intrauterine device to avoid missing serious complications.
Clinicopathologic features of Good's syndrome: Two cases and literature review
Authors: Yi-Dan Chen, Zhong-Hui Wen, Bing Wei, Shu-Yuan Xiao, Yu-Fang Wang
Journal: Open Med (Wars) (2021)
Keywords: good’s syndrome, common variable immunodeficiency, diarrhea, immunodeficiency disease, opportunistic infection, thymoma
MeSH terms: Case Reports

Background:
Good's syndrome (GS) is an immunodeficiency disease, causing thymoma, low or absent B-cells, hypogammaglobulinemia, and defects in cell-mediated immunity. The most common clinical presentation is recurrent infection, followed by refractory diarrhea, due to the immunodeficiency. However, there are only few reports on intestinal endoscopy and pathology.
Case summary:
We report here two typical GS cases with diarrhea as the prominent manifestation. Both cases presented with thymoma combined with immunodeficiency, characterized by hypogammaglobulinemia, low or absent B lymphocytes, and decreased T-cells with inverted CD4+/CD8+ T-cell ratio, while two GS patients were evaluated by endoscopy revealed mucosal edema and fine-granular or nodular appearance changes in the small intestine. Histological examination showed chronic inflammation and villous atrophy. A very interesting finding is that the inflammatory cell infiltration in the two GS cases was different. In one case, predominantly CD138+ plasma cells with only scattered CD3+ T-cells infiltration were revealed, while in another, it showed predominantly T-cells infiltration without plasma cells in the lamina propria. Although GS cases shared various clinical characteristics with common variable immunodeficiency (CVID) cases, they still differed from CVID cases in terms of its late onset, lack of familial clusters, low or absent peripheral blood B lymphocytes, absence of lymphoid hyperplasia, and plasma cells infiltration in the lamina propria in some patients. Although both patients had been diagnosed previously with recurrent diarrhea, respiratory infection, and thymoma, the association between these conditions and the possibility of GS was not recognized. The patients had remained misdiagnosed for 2 and 4 years, respectively, even after receiving the diagnosis of thymoma. The rarity of GS was likely the primary cause for the lack of disease recognition. Reporting of these cases will help to alert clinicians and raise awareness of this disease.
Conclusion:
GS should be considered among the differential diagnoses for patients with unexplained recurrent diarrhea and opportunistic infection. Although it was regarded as a subset of CVID with thymoma, GS had a different clinical-pathological feature from CVID.
Deletion 9p23 to 9p11.1 as sole additional abnormality in a Philadelphia positive chronic myeloid leukemia in blast crisis: a rare event
Authors: Abdulsamad Wafa, Manar Asa'ad, Adnan Ikhtiar, Thomas Liehr, Walid Al-Achkar
Journal: Mol Cytogenet (2015)
Keywords: cdkn2a gene, chronic myeloid leukemia, philadelphia chromosome, prognostic factors, del(9)(p24p12)
MeSH terms: Case Reports

Background:
Chronic myeloid leukemia (CML) is a myeloproliferative disorder characterized by the presence of a derivative chromosome 22 [der(22)] commonly called Philadelphia chromosome (Ph). The Ph chromosome is a product of the reciprocal translocation t(9;22)(q34.1;q11.2). Additional genetic changes occur in less than 10 % of CML cases at the time of diagnosis and other genetic changes are seen in 60-80 % of the cases in advanced disease. Even though deletions in chromosome 9 are not rare findings in advanced phase-CML, del(9)(p23p11.1) as sole additional abnormality detected by fluorescence in situ hybridization (FISH) technique, to our knowledge has not been described in the literature.
Results:
A complete cytogenetic and molecular cytogenetic analysis, molecular biology method (reverse transcription polymerase chain reaction (RT-PCR)), and immunophenotype confirmed to be a CML case in blast crisis (BC). It revealed del(9)(p23p11.1) as sole abnormality detected by FISH technique besides Ph chromosome, which leads to monoallely of tumor suppressor gene CDKN2A (cyclin-dependent kinase inhibitor 2A) before Imatinib mesylate (IM) treatment.
Conclusions:
The patient did not demonstrate a good response to IM treatment. The underlying mechanisms and prognostic implications of these cytogenetic abnormalities are discussed.
Successful Management of a Young Patient Suffering From Pyoderma Gangrenosum Following Gastric Bypass Surgery: A Case Report
Authors: Abdulqader M Albeladi, Zaki Busbaih, Ali A Almohammed Saleh, Abdullah Q AlAlwan, Mohammed A Aljughayman, Almunthir S Alhamed, Abdulmohsen Alsuwaigh, Abdulmohsen Aleasa, Tayseer Alali, Mohammad S AlGhadeer, Sajedah A Albeladi
Journal: Cureus (2023)
Keywords: biologic treatment, debridement tissue, idiopathic pyoderma gangrenosum, pyoderma gangrenosum, successful outcome
MeSH terms: Case Reports

Pyoderma gangrenosum (PG) is a pathogenetically ill-defined neutrophilic dermatosis frequently characterized by severely painful ulcerations with no identifiable infective pathogens. There are no diagnostic criteria for PG, nor specific gold standard management, which may complicate the process of dealing with patients suffering from this disease. Here, we report a case of a 27-year-old male patient, with a history of gastric bypass surgery three years ago, who presented with a left leg non-healing ulcer diagnosed as a PG by the clinical presentation and biopsy of the ulcer. He was managed by the administration of systemic immunomodulators, a surgical debridement procedure, and the application of a vacuum. The patient was discharged with vitamin B complex and vitamin D supplements as well as zinc sulfate and folic acid. Also, multiple doses of Infliximab intravenously and vitamin B 12 intramuscularly result in a satisfactory healing process of the ulcer. Since PG is a diagnosis of exclusion, clinicians must be aware of the need for highly specific history-taking, previous surgical history, laboratory investigations, and histopathological workup in order to reach the diagnosis.
Chronic Invasive Fungal Granuloma-A Diagnostic Dilemma in an Immunocompetent Host
Authors: Shrinivas S Chavan, K S Bhople, Sunil D Deshmukh, Prateek V Jain, Mangala Sonavani
Journal: Iran J Otorhinolaryngol (2016)
Keywords: chronic invasive granulomatous fungal sinusitis, immunocompetent host, tuberculoma and chronic granulomatous disease
MeSH terms: Case Reports

Introduction:
Invasive fungal sinusitis, though considered to be rare entity, is nowadays frequently encountered, not only in immunocompromised patients but also in immunocompetent patients. The changing prevalence towards immunocompetent hosts is due to the indiscriminate usage of broad spectrum antibiotics, steroids, and immunosuppressive drugs. Diagnosing invasive fungal sinusitis should not pose any difficulty to both the clinician [a whitish colour secretion in elderly Diabetics, and CT Scan PNS showing concretion in the sinus along with destruction of the surrounding bone] and to the pathologist; however, when the invasive fungal sinus infection presents in a form of a granuloma then its diagnosis imposes a challenge to medical professionals.
Case report:
We are presenting a case study,which consists of 3 cases of chronic invasive fungal sinus infection.Two patients were treated for tuberculoma and had completed a course of Anti Koch's Treatment and one patient was given a trial of broad spectrum antibiotics and steroids.Eventually all cases were diagnosed as a chronic invasive form of fungal granuloma (CIFG).
Conclusion:
CIFG of the paranasal sinuses is seen in immunocompetent hosts, especially those that are in the 2nd and 3rd decades of their lives. Gradually progressive proptosis is the primary presenting symptom. MRI scanning is a better imaging modality compared to CT scanning. Routine H&E staining may prove inadequate and special stains such as the GMS stain should be employed in the slightest doubt of a fungal aetiology. A team approach towards patients is paramount for early diagnosis and timely medical and surgical intervention.
Eosinophilic gastroenteritis in small intestine in a child in a remote medical centre required surgery
Authors: Ameer Kakaje, Noha Hedar, Najat Alali Alahmad
Journal: Int J Surg Case Rep (2020)
Keywords: emergency medicine, eosinophilic gastroenteritis, middle east, paediatric, public health, remote area
MeSH terms: Case Reports

Introduction:
Eosinophilic gastroenteritis (EGE) is an extremely rare disease of unknown aetiology that can occur at any age, but rarely in children. It usually presents with ambiguous abdominal pain and the symptoms can occur for years before diagnosis. It needs a high suspicion and therefore misdiagnosis can occur.
Presentation of case:
We present a case of three-and-a-half year old girl who had a complicated EGE but was misdiagnosed as no proper consult was available as she presented in a remote medical centre. She had 50 cm from her small intestine dissected as micro abscesses and a necrotic mass of 3.5*2.5 cm were observed.
Discussion:
EGE is usually managed medically. However, the patient's condition was complicated and surgery was indicated. However, if proper diagnosis was made, conservative surgery would be the proper management as this case tends to improve with steroids.
Conclusions:
Medical centres in remote areas should have a way to discuss atypical cases with a skilled consultant even when urgent as surgery indication can completely differ. This is the first case reported in the region with EGE in a child which can justify the difficulty in diagnosis as it is quite rare and have not been reported previously in the region which can lead to futuristic misdiagnosis.
Multiple endocrine neoplasia 2a presenting with pheochromocytoma and pituitary macroadenoma
Authors: Jonathan E Heinlen, David D Buethe, Daniel J Culkin, Gennady Slobodov
Journal: ISRN Oncol (2011)
MeSH terms: Case Reports

Multiple Endocrine Neoplasia type 2A (MEN-2a) is a rare disease associated with tumors of endocrine organs. Presentation most commonly is with medullary thyroid cancer and infrequently with other complaints. Pituitary adenoma has been seen coincidentally with this disease very rarely. Presented is a case of coincident MEN-2a with a symptomatic pituitary adenoma and an asymptomatic pheochromocytoma. A brief review is also provided.
Clinically undiagnosed prostate carcinoma metastatic to renal oncocytoma
Authors: Adam J Horn, Bari E Fritz, Chad A Lagrange, William W West, Subodh M Lele
Journal: Case Rep Urol (2012)
MeSH terms: Case Reports

Tumors-to-tumor metastasis is an uncommon occurrence and can be a source of great diagnostic difficulty, especially when the donor tumor is undiagnosed. Here we report a case of a kidney resected for a primary neoplasm (oncocytoma) that harbored metastases from a clinically undiagnosed prostatic adenocarcinoma. The presence of the poorly differentiated metastasis within an otherwise typical oncocytoma in the absence of metastases in the surrounding nonneoplastic renal parenchyma resulted in a diagnostic dilemma. To our knowledge, this is the first report of a case in the English literature of a clinically undiagnosed prostatic adenocarcinoma metastatic to a renal oncocytoma identified on examination of the resected renal neoplasm.
Dabigatran-induced esophagitis with full circumferential blue pigmentation
Authors: Tomonori Araki, Kohei Hayashi, Yuki Sonoda, Takuya Honda, Yoshifumi Imamura, Yuji Koide, Hisayuki Hamada, Kazuhiko Nakao
Journal: DEN Open (2023)
Keywords: atrial fibrillation, dabigatran, drug‐related side effects and adverse reactions, esophagitis, pigmentation disorders
MeSH terms: Case Reports

Dabigatran is a useful and widely used drug for stroke prevention in patients with atrial fibrillation. However, it has been reported to cause esophagitis. Herein, we report the case of a 77-year-old man with dabigatran-induced esophagitis with blue pigmentation, which is known to be a rare adverse effect. The patient presented to our hospital with a tightness of the chest and anorexia. Computed tomography revealed a thickening of the entire esophageal wall, with an upper esophageal predominance. Esophagogastroduodenoscopy was performed, which showed that the cervical and upper thoracic esophagus had blue pigmentation with edematous changes, partial narrowing, and longitudinal sloping. We replaced dabigatran with edoxaban, a similar anticoagulation medication. The patient was closely monitored for 1 month after switching to edoxaban. The follow-up esophagogastroduodenoscopy showed marked improvements, revealing resolution of the bluish discoloration and edematous changes, and the patient's complaints regarding the tightness of the chest and anorexia were also resolved. It is important to recognize that such side effects can occur with dabigatran, a drug that is frequently used in daily practice. Considering the fact that strong edematous changes can cause indigo carmine pigmentation associated with dabigatran stagnation, we recommend switching to another anticoagulant if esophagitis occurs during dabigatran administration.
A Rare Case of Glycogen Storage Disease Type 1a Presenting with Hemophagocytic Lymphohistiocytosis (HLH)
Authors: Hedyeh Saneifard, Bibishahin Shamsian, Marjan Shakiba, Simin Karizi Zarea, Ali Sheikhy
Journal: Case Rep Pediatr (2020)
MeSH terms: Case Reports

Background:
Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening hyperinflammatory syndrome characterized by fever, respiratory distress, massive hepatomegaly, and bicytopenia. It is classified into primary (congenital) and secondary (acquired) types. There are many diseases associated with secondary HLH, but glycogen storage disease is a novel cause of secondary HLH. Case Presentation. In this case, we present a five-month-old female infant with recurrent fever, poor feeding, pallor, and prolonged diarrhea for two months. With a diagnosis of HLH, the patient was treated with IVIG and prednisolone. After treatment was initiated, the patient's general condition improved. All metabolic workup was normal. We did whole-exome sequencing that confirmed glycogen storage disease (GSD) type 1.
Conclusion:
Metabolic diseases are one of the severe causes of secondary HLH in infants; hence, complete metabolic assessment is mandatory in these patients, and GSD must be included in the differential diagnosis of HLH metabolic causes.
Postoperative Thrombotic Thrombocytopenic Purpura after Total Hip Arthroplasty: A Case Report and Review of the Literature
Authors: Nick N Patel, Jason A Shah, Christopher K Sadlack
Journal: Case Rep Orthop (2018)
MeSH terms: Case Reports

Thrombotic thrombocytopenic purpura (TTP) is an uncommon and potentially lethal microangiopathy that carries a >90% mortality rate if not treated urgently and appropriately. Postoperative TTP after orthopaedic procedures is particularly rare with only four case reports existing in the literature. We present the case of postoperative TTP in a 57-year-old female who underwent elective total hip arthroplasty. We believe this case adds to the limited literature surrounding the topic. While rare, TTP after orthopaedic procedures poses a real and potentially fatal condition if not managed appropriately. Therefore, it is essential for orthopaedic surgeons to be cognizant of postoperative TTP for timely diagnosis and treatment.