OpenMed/multicare-articles huggingface dataset:
Right Ventricular Compression Mimicking Brugada-Like Electrocardiogram in a Patient with Recurrent Pectus Excavatum
Authors: Jinhee Ahn, Jong-Il Choi, Jaemin Shim, Sung Ho Lee, Young-Hoon Kim
Journal: Case Rep Cardiol (2017)
MeSH terms: Case Reports

Pectus excavatum (PE), the most common skeletal anomaly of chest wall, sometimes requires a surgical correction but recurrent PE is not uncommon. PE usually has a benign course; however, this chest deformity may be associated with symptomatic tachyarrhythmias due to mechanical compression. We report a case of a patient with recurrent PE after surgical correction presenting with palpitation and electrocardiogram (ECG) showing ST-segment elevation on the right precordial leads, which could be mistaken for a Brugada syndrome (BrS).
Chronic, Recreational Chloroform-Induced Liver Injury
Authors: Emily A Minor, Mackenzie S Newman, Justin T Kupec
Journal: Case Reports Hepatol (2018)
MeSH terms: Case Reports

Historically used as an anesthetic, chloroform is a halogenated hydrocarbon that is associated with central nervous system depression, arrhythmias, and hepatotoxicity. It is no longer used clinically, but accidental and intentional poisonings still occur. We report a case of chronic chloroform abuse leading to severe hepatotoxicity in a 26-year-old male graduate student. The patient presented to the emergency department with a three-day history of abdominal pain, dehydration, and scleral icterus. He drank several beers the night before the onset of symptoms, but denied taking acetaminophen, ibuprofen, or other drugs. An extensive work-up revealed an aspartate aminotransferase (AST) of 13,527 U/L and alanine aminotransferase (ALT) of 8,745 U/L, but the cause of his liver injury could not be determined. It was not until many months later that the patient admitted to inhaling chloroform in the weeks leading up to his illness.
Thoracic Synovial Cyst at the Th2-3 Level Causing Myelopathy
Authors: Martin M Sundskarð, Shahin Gaini
Journal: Case Rep Neurol Med (2017)
MeSH terms: Case Reports

Intraspinal synovial cyst is a rare cause of myelopathy. These cysts present most often in the lumbar and cervical parts of the spine but are more infrequent in the thoracic spine. We present a case of a 73-year-old man with an intraspinal, extradural synovial cyst at the Th2-3 level causing paraesthesia and weakness in the legs. A laminectomy and excision of the cyst were performed and the patient recovered fully. In the thoracic spine, synovial cysts are almost exclusively found in the lower part. Laminectomy, with excision, is the treatment of choice, although steroid injections have been described.
Case report: Acquired neurotrophic tyrosine receptor kinase inhibitor resistance in a patient with pancreatic neuroendocrine carcinoma receiving entrectinib
Authors: Wen-Chi Wu, Ming-Huang Chen
Journal: Front Oncol (2023)
Keywords: entrectinib, liquid biopsy, neurotrophic tropomyosin receptor kinase (ntrk), pancreatic neuroendocrine carcinoma (pannec), repotrectinib
MeSH terms: Case Reports

Pancreatic neuroendocrine carcinoma (panNEC) is a rare disease. The rearrangements of neurotrophic tropomyosin receptor kinase (NTRK) genes are oncogenic. And in the existed literatures, the prevalence of NTRK3 was only 0.1% in neuroendocrine tumors. NTRK inhibitor was approved for refractory and recurrence NTRK fusion-positive solid tumors did not respond to standard treatment. We described a patient with panNEC who was confirmed to have ETV6-NTRK3 fusion gene by liquid biopsy. The patient initially responded well to entrectinib, a first-generation NTRK inhibitor, but developed resistance with two acquired NTRK3-G623R and NTRK3-G623E mutations detected by a second liquid biopsy. Kirsten rat sarcoma vial oncogene (KRAS) K117N mutation was found initially but became undetectable after resistance. This was the first report demonstrating the novel agent, entrectinib, used for the NTRK3-fusion gene found by the liquid biopsy in panNEC. Our report provides evidence of not only the effectiveness but also the acquired resistance of entrectinib. Also, we highlighted the potential role of genomic sequencing after entrectinib failure. Furthermore, liquid biopsy should be considered if acquiring tissue from the patient is challenging. Further studies regarding NTRK inhibitors in panNEC were needed.
Valley fever, mimicker of malignancy
Authors: Raffi Gharakhanian, Ai Ohno, Debra Craig, Sharon Wang
Journal: Heliyon (2023)
Keywords: coccidioides, disseminated coccidiomycosis
MeSH terms: Case Reports

Coccidioidomycosis rates in endemic areas such as California and Arizona have been increasing in recent years. Most common manifestations in symptomatic individuals involve the lungs. Disseminated disease occurs when the infection spreads beyond the lungs. Disseminated disease occurs in about 1% of all coccidiomycosis cases. Diagnosis in classically non-endemic regions can be difficult as coccidiomycosis can mimic a variety of other illnesses which can lead to delays in initiating appropriate therapy. We report a case of severe disseminated coccidiomycosis involving the soft tissue, bone, and intra-abdominal organs in a previously healthy individual that was initially thought to be a malignancy. With climate change possibly altering the traditional endemic regions and expanding Coccidioides to new territories, this case reinforces the importance of maintaining a broad differential as well as awareness of disease manifestations for healthcare providers who do not regularly treat Coccidioides.
Unpredicted Sudden Death due to Recurrent Infratentorial Hemangiopericytoma Presenting as Massive Intratumoral Hemorrhage: A Case Report and Review of the Literature
Authors: Toshihide Tanaka, Naoki Kato, Yuzuru Hasegawa, Yuichi Murayama
Journal: Case Rep Neurol Med (2014)

Unpredicted sudden death arising from hemangiopericytoma with massive intracranial hemorrhage is quite rare. We encountered a patient with recurrent infratentorial hemangiopericytoma presenting as life-threatening massive intracerebral hemorrhage. A 43-year-old man who had undergone craniotomy for total resection of an infratentorial hemangiopericytoma 17 months earlier presented with morning headache and generalized convulsions. Computed tomography revealed a massive hematoma in the right infratentorial region causing tonsillar herniation and emergency surgery was performed to evacuate the hematoma. Histological findings revealed hemangiopericytoma with hemorrhage. Neurological status remained unimproved and brain death was confirmed postoperatively. Hemangiopericytoma presenting as massive hemorrhage is quite rare. Since the risk of life-threatening massive hemorrhage should be considered, careful postoperative long-term follow-up is very important to identify tumor recurrences, particularly in the posterior cranial fossa, even if the tumor is completely removed.
Pancreatic neuroendocrine carcinoma with unique morphological features mimicking intraductal papillary mucinous carcinoma: A case report
Authors: Hidekazu Tanaka, Kosuke Minaga, Yasuo Otsuka, Yasuhiro Masuta, Ken Kamata, Kentaro Yamao, Mamoru Takenaka, Tomoko Hyodo, Masatomo Kimura, Tomohiro Watanabe, Masatoshi Kudo
Journal: Front Med (Lausanne) (2022)
Keywords: neuroendocrine carcinoma, neuroendocrine neoplasm, pancreatic neuroendocrine carcinoma, pancreatoscopy, per-oral pancreatoscopy
MeSH terms: Case Reports

Background:
Pancreatic neuroendocrine carcinoma (PanNEC) is a rare disease entity with rapid progression and poor prognosis. Here, we report a PanNEC case with unique morphological features mimicking intraductal papillary mucinous carcinoma.
Case presentation:
A 69-year-old Japanese man was referred to our hospital for further evaluation of weight loss and deterioration of diabetes mellitus. Contrast-enhanced computed tomography showed a solid and cystic mass with hypo-enhancement at the tail of the pancreas. The main pancreatic duct (MPD) was diffusely dilated without obstruction, accompanied by marked parenchymal atrophy. Multiple peritoneal and omental nodules were observed, suggesting tumor dissemination. Endoscopic retrograde cholangiopancreatography revealed that the mass correlated with the dilated MPD. During pancreatography, a large amount of mucus was extruded from the pancreatic orifice of the ampulla. Based on these imaging findings, intraductal papillary mucinous carcinoma was suspected. Per-oral pancreatoscopy (POPS)-guided tumor biopsies were conducted for the lesion's solid components. Histopathological examination of the biopsied material confirmed small-cell-type PanNEC with a Ki-67 labeling index of 90%. Due to his condition's rapid decline, the patient was given the best supportive care and died 28 days after diagnosis.
Conclusion:
Although rare, PanNEC, which correlates with the MPD and is accompanied by marked dilation of the MPD, does exist as one phenotype. In such cases, POPS-guided biopsy could be a useful diagnostic modality.
Meningococcemia complicated by myocarditis in a 16-year-old young man: a case report
Authors: Rania Bouneb, Manel Mellouli, Haifa Regaieg, Senda Majdoub, Imed Chouchène, Mohamed Boussarsar
Journal: Pan Afr Med J (2018)
Keywords: neisseria meningitidis, myocarditis, recovery, shock
MeSH terms: Bacteremia / diagnosis, Meningococcal Infections / diagnosis, Myocarditis / diagnosis, Neisseria meningitidis / isolation & purification, Case Reports, Adolescent, Anti-Bacterial Agents / administration & dosage, Bacteremia / drug therapy, Bacteremia / microbiology, Ceftriaxone / administration & dosage, Diuretics / administration & dosage, Female, Fever / etiology, Furosemide / administration & dosage, Humans, Male, Meningococcal Infections / drug therapy, Meningococcal Infections / microbiology, Myocarditis / drug therapy, Myocarditis / etiology, Norepinephrine / administration & dosage, Treatment Outcome, Anti-Bacterial Agents, Diuretics, Ceftriaxone, Furosemide, Norepinephrine

Fulminant meningococcemia is a relatively rare life-threatening disease caused by Neisseria meningitidis. The clinical presentation is varied, but, when associated with myocarditis, it carries a particularly poor prognosis. We report a case of a patient with fulminant meningococcemia who subsequently developed severe myocardial dysfunction and successfully recovered within a period of 7 days of hospitalization. A 15-year-old girl presented with headache, fever, body ache for 1 day and few ecchymotic rash over her body for 3 hours. Blood cultures confirmed infection with N. meningitidis. After 2 days in the hospital, the patient developed dyspnea, elevated jugular venous pressure and shock. The patient was managed with intravenous ceftriaxone, furosemide and norepinephrine. Over the next 4 days the patient rapidly improved. Meningococcemia complicated by myocarditis has an extremely poor prognosis with high mortality. Our case suggests that recovery from a severe myocardial dysfunction can occur rapidly within a few days. Prompt recognition and management in this case might have contributed to the patient's rapid recovery from myocarditis.
Mucormycosis in the COVID-19 Environment: A Multifaceted Complication
Authors: Rohit Sharma, Praveen Kumar, Abdur Rauf, Ashun Chaudhary, Pradeep Kumar Prajapati, Talha Bin Emran, Clara Mariana Gonçalves Lima, Carlos Adam Conte-Junior
Journal: Front Cell Infect Microbiol (2022)
Keywords: covid-19, grp78, sars-cov-2, amphotericin-b, diabetes, hepcidin, mucormycosis, steroids
MeSH terms: COVID-19 / complications, Diabetes Mellitus, Mucormycosis / diagnosis, Mucormycosis / drug therapy, Mucormycosis / epidemiology, Review, Research Support, Non-U.S. Gov't, Humans, Immunocompromised Host, India / epidemiology

The second wave of coronavirus disease 2019 (COVID-19) caused severe infections with high mortality. An increase in the cases of COVID-19-associated mucormycosis (CAM) was reported predominantly in India. Commonly present in immunocompromised individuals, mucormycosis is often a life-threatening condition. Confounding factors and molecular mechanisms associated with CAM are still not well understood, and there is a need for careful research in this direction. In this review, a brief account of the diagnosis, management, and advancement in drug discovery for mucormycosis has been provided. Here, we summarize major factors that dictate the occurrence of mucormycosis in COVID-19 patients through the analysis of published literature and case reports. Major predisposing factors to mucormycosis appear to be uncontrolled diabetes, steroid therapy, and certain cancers. At the molecular level, increased levels of iron in COVID-19 might contribute to mucormycosis. We have also discussed the potential role and regulation of iron metabolism in COVID-19 patients in establishing fungal growth. Other factors including diabetes prevalence and fungal spore burden in India as contributing factors have also been discussed.
Case report: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL) as a risk factor for central serous chorioretinopathy
Authors: Alberto Pazzaglia, Nicola Valsecchi, Matteo Belletti, Fabio Guaraldi, Michela Fresina, Luigi Fontana
Journal: Front Neurol (2022)
Keywords: cadasil, atypical case, case report, central serous chorioretinopathy, choriocapillaris ischemia, transfoveal subthreshold micropulse yellow laser
MeSH terms: Case Reports

Purpose:
To describe an atypical case of central serous chorioretinopathy (CSC) in a patient with cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL).
Methods:
A retrospective case report.
Results:
A 43-year-old white man with a genetic diagnosis of CADASIL was referred to our hospital because of reduced visual acuity in his right eye (20/30). In the previous 2 months, he developed CSC with subretinal fluid (SRF) and damage to the retinal pigmented epithelium without pachychoroid and pachyvessels or known risk factors for CSC. The patient was treated with transfoveal subthreshold micropulse yellow laser (577 nm) therapy. One month later, there were no signs of SRF, and visual acuity improved to 20/20.
Conclusions:
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL) is a genetic condition that primarily affects vascular smooth cells in small cerebral vessels and retinal arterioles. However, we hypothesize that CADASIL could also be responsible for an alteration of the vascular smooth cells in the choroidal arterioles, leading to choriocapillaris ischemia and CSC, even in the absence of a pachychoroid spectrum.
Emergency surgery due to diaphragmatic hernia: case series and review
Authors: Mario Testini, Antonia Girardi, Roberta Maria Isernia, Angela De Palma, Giovanni Catalano, Angela Pezzolla, Angela Gurrado
Journal: World J Emerg Surg (2017)
Keywords: congenital diaphragmatic hernia, diaphragmatic rupture, emergency surgery, laparotomy, mesh, thoracotomy
MeSH terms: Hernia, Diaphragmatic, Traumatic / complications, Hernias, Diaphragmatic, Congenital / complications, Rupture / surgery, Review, Aged, Barium Sulfate / therapeutic use, Diaphragm / injuries, Diaphragm / surgery, Female, Hernia, Diaphragmatic, Traumatic / surgery, Hernias, Diaphragmatic, Congenital / surgery, Humans, Intestinal Obstruction / complications, Male, Middle Aged, Radiography / methods, Rupture / diagnostic imaging, Tomography, X-Ray Computed / methods, Barium Sulfate

Background:
Congenital diaphragmatic hernia (CDH) is a congenital abnormality, rare in adults with a frequency of 0.17-6%. Diaphragmatic rupture is an infrequent consequence of trauma, occurring in about 5% of severe closed thoraco-abdominal injuries. Clinical presentation ranges from asymptomatic cases to serious respiratory or gastrointestinal symptoms. Diagnosis depends on anamnesis, clinical signs and radiological investigations.
Methods:
From May 2013 to June 2016, six cases (four females, two males; mean age 58 years) of diaphragmatic hernia were admitted to our Academic Department of General Surgery with respiratory and abdominal symptoms. Chest X-ray, barium studies and CT scan were performed.
Results:
Case 1 presented left diaphragmatic hernia containing transverse and descending colon. Case 2 showed left CDH which allowed passage of stomach, spleen and colon. Case 3 and 6 showed stomach in left hemithorax. Case 4 presented left diaphragmatic hernia which allowed passage of the spleen, left lobe of liver and transverse colon. Case 5 had stomach and spleen herniated into the chest. Emergency surgery was always performed. The hernia contents were reduced and defect was closed with primary repair or mesh. In all cases, post-operative courses were uneventful.
Conclusion:
Overlapping abdominal and respiratory symptoms lead to diagnosis of diaphragmatic hernia, in patients with or without an history of trauma. Chest X-ray, CT scan and barium studies should be done to evaluate diaphragmatic defect, size, location and contents. Emergency surgical approach is mandatory reducing morbidity and mortality.
On a Boat: A Case in Australia of Endophthalmitis and Pyogenic Liver, Prostatic, and Lung Abscesses in a Previously Well Patient due to Klebsiella pneumoniae
Authors: Alecia Vandevelde, Bojana Stepanovic
Journal: Case Rep Infect Dis (2014)

This is a case report about a patient who arrived in our emergency department in Western Australia to the care of the urologists having just gotten off a ship with a bacterial infection that would result in a 44-day stay in hospital and have quite devastating lasting effects for the young male. His story was in fact reflective of an emerging global phenomenon. Once thought to generally be a bacterium of threat only to the elderly and alcoholics, causing pneumonia and urinary tract infections, this case report describes the potentially devastating consequences of what is now becoming recognized as a hypervirulent form of Klebsiella pneumoniae with the potential to spread throughout the system rapidly seeding abscesses and causing significant morbidity in nonimmunocompromised patients. Initially noticed in Asia increasingly case reports are emerging in Western countries suggesting a global spread.
Emergency Obstetric Hysterectomy after Conservative Management of Placenta Accreta
Authors: T Loukopoulos, A Zikopoulos, M Plachoura, A Galani, K Zikopoulos, E Kolibianakis
Journal: Case Rep Obstet Gynecol (2023)
MeSH terms: Case Reports

Background:
Obstetric hemorrhage is a frequent and life-threatening complication of either vaginal or cesarean delivery. It can be due to many causes, one of which is placenta accreta, the abnormal invasion of the placenta into the myometrial wall of uterus. Ultrasonography is the first line diagnostic method that can lead to the diagnosis of placenta accreta although, the depth of penetration is estimated by magnetic resonance imaging. Placenta accreta is a life-threatening situation requiring an experienced health care team for its management. Hysterectomy is usually performed although, conservative management might be preferred in carefully selected cases. Case Presentation. A 32-year-old woman (G2, P0) who had an inconsistently monitored pregnancy appeared at a regional hospital with contractions at 39th week of gestation. In her first pregnancy, she was subjected to cesarean section due to delay in second stage of labor and unfortunately her child died due to sudden cardiac death. During C-section, placenta accreta was identified. Given her previous history and her desire to maintain fertility, conservative management was initially planned to preserve her uterus. However, due to persisting vaginal bleeding immediately after delivery an emergency hysterectomy was performed.
Conclusion:
Conservative management of placenta accreta can be considered in some special cases with the aim to spare fertility. However, if bleeding cannot be controlled during the immediate postpartum period, emergency hysterectomy is unavoidable. A specialized multidisciplinary medical team is required to optimize management.
Optimization of conditions for apnea testing in a hypoxemic brain dead patient
Authors: Bárbara Vieira Carneiro, Guilherme Henrique Garcia, Larissa Padrão Isensee, Bruno Adler Maccagnan Pinheiro Besen
Journal: Rev Bras Ter Intensiva (2019)
MeSH terms: Apnea / diagnosis, Brain Death / diagnosis, Hypoxia / complications, Pulmonary Atelectasis / complications, Case Reports, Continuous Positive Airway Pressure, Delayed Diagnosis, Humans, Male, Middle Aged, Oxygen / blood, Partial Pressure, Prone Position, Tidal Volume, Oxygen

We report the case of a patient in whom brain death was suspected and associated with atelectasis and moderate to severe hypoxemia even though the patient was subjected to protective ventilation, a closed tracheal suction system, positive end-expiratory pressure, and recruitment maneuvers. Faced with the failure to obtain an adequate partial pressure of oxygen for the apnea test, we elected to place the patient in a prone position, use higher positive end-expiratory pressure, perform a new recruitment maneuver, and ventilate with a higher tidal volume (8mL/kg) without exceeding the plateau pressure of 30cmH2O. The apnea test was performed with the patient in a prone position, with continuous positive airway pressure coupled with a T-piece. The delay in diagnosis was 10 hours, and organ donation was not possible due to circulatory arrest. This report demonstrates the difficulties in obtaining higher levels of the partial pressure of oxygen for the apnea test. The delays in the diagnosis of brain death and in the organ donation process are discussed, as well as potential strategies to optimize the partial pressure of oxygen to perform the apnea test according to the current recommendations.
Rare Presentation of Left Lower Lobe Pulmonary Artery Dissection
Authors: René Hako, Ján Fedačko, Štefan Tóth, Radoslav Morochovič, Pavol Kristian, Tímea Pekárová, Petri Tuomainen, Daniel Pella
Journal: Case Rep Med (2017)
MeSH terms: Case Reports

Background. Pulmonary arterial dissection with chronic pulmonary arterial hypertension as its major cause is a very rare but life-threatening condition. In most cases the main pulmonary trunk is the affected site usually without involvement of its branches. Segmental or lobar pulmonary artery dissection is extremely rare. Case Presentation. We report a unique case of left lower lobe pulmonary artery dissection in a 70-year-old male, with confirmed chronic pulmonary hypertension. To confirm dissection MDCT pulmonary angiography was used. Multiplanar reformation (MPR) images in sagittal, coronal, oblique sagittal, and curved projections were generated. This case report presents morphologic CT features of rare chronic left lobar pulmonary artery dissection associated with chronic pulmonary hypertension at a place of localised pulmonary artery calcification. CT pulmonary angiography excluded signs of thromboembolism and potential motion or flow artefacts. Conclusion. To the best of our knowledge, no case of lower lobe pulmonary artery dissection with flap calcification has been reported yet. CT imaging of the chest is a key diagnostic tool that is able to detect an intimal flap and a false lumen within the pulmonary arterial tree and is preferred in differential diagnosis of rare complications of sustained pulmonary arterial hypertension.