OpenMed/multicare-articles huggingface dataset:
Secondary oral syphilis presenting as a tumor-like lesion on the lower lip
Authors: Norberto Sugaya, Dante Migliari
Journal: Rev Inst Med Trop Sao Paulo (2024)
MeSH terms: Mouth Diseases / diagnosis, Mouth Diseases / pathology, Syphilis / diagnosis, Case Reports, Diagnosis, Differential, Humans, Lip / pathology, Syphilis, secondary

This study presents a case of atypical manifestation of secondary syphilis. Diagnosis was initiated prompted by the patient's complaint of a lower lip lesion, present for three months, resembling a malignant neoplasm. The lesion, a 3 cm (diameter) ulcerated nodule, arising from conjunctive tissue, raised concern. However, further physical examination revealed additional clinical features, including cervical micropolyadenopathy and erythematous skin lesions, prompting a reevaluation of the diagnosis, most likely secondary syphilis. These findings led to a serological investigation, which, ultimately, confirmed the diagnosis of syphilis. The case underscores the importance of recognizing syphilis as a formidable imitator, posing challenges in establishing differential diagnoses of mucocutaneous diseases.
A Rare Variant of Gastric Adenocarcinoma Presenting as a Symptomatic Early-Stage Submucosal Tumor in the Gastric Antral Primary
Authors: Hema Narlapati, Brendan R Martino, Pedro Manibusan
Journal: Cureus (2024)
Keywords: confocal laser endomicroscopy, endoscopic ultrasound (eus), gastric malignancy, locally advanced, rare gastric tumor, submucosal gastric adenocarcinoma
MeSH terms: Case Reports

Gastric adenocarcinomas are a well-known malignancy, with the vast majority presenting as primary mucosal invasions. However, a rare form of this cancer presents from the submucosal layer and mimics submucosal tumors (SMTs). This variant of gastric adenocarcinoma is not only rare, but it is also frequently misdiagnosed as other conditions such as gastrointestinal stromal tumors, lymphoma, or sarcoma. This case report describes a unique case of early gastric adenocarcinoma that presented as a submucosal tumor without invasion into the muscularis propria or primary involvement from the gastric mucosa. Additionally, this raises an important clinical question of whether this variant of gastric adenocarcinoma behaves differently from mucosal-origin cancers in terms of invasion and metastasis. This case highlights the diagnostic challenges and the importance of early detection and accurate diagnosis of this rare presentation of gastric adenocarcinoma. This case also provides valuable insights into the clinical variability of submucosal gastric adenocarcinomas and the need for further research to optimize its management and improve patient outcomes.
Adrenal insufficiency following cerebellar intracranial hemorrhage: a case report
Authors: Yu-Yang Lu, Chien-Ming Lin, Shang-Lin Chiang
Journal: Front Neurol (2024)
Keywords: adrenal insufficiency, case report, cerebellar hemorrhage, corticosteroids, rehabilitation
MeSH terms: Case Reports

This report presents a case of a previously healthy 58 years-old man who had suffered from persistent weakness and dizziness after a cerebellar intracranial hemorrhage (ICH). Endocrine function tests revealed low levels of plasma cortisol (3.05 μg/dL; normal range: 5-25 μg/dL) and adrenocorticotropic hormone (ACTH) (6.0 pg/mL; normal range: 10-60 pg/mL). The subsequent ACTH stimulation test suggested partial or recent hypopituitarism, resulting in adrenal gland atrophy and a subnormal cortisol response. Ultimately, the dizziness was found to be caused by undiagnosed adrenal insufficiency, which was detected when a hypotensive fainting incident occurred during rehabilitation. The symptoms improved significantly with oral prednisone supplementation. Notably, the duration of impaired hypothalamic-pituitary-adrenal axis may last as long as a year. This case highlights that adrenal insufficiency can easily be overlooked since its symptoms are similar to those commonly seen with cerebellar stroke alone. Physicians must be aware of the symptoms of adrenal insufficiency in patients with brain insults and conduct the appropriate endocrine tests to clarify the underlying comorbidity.
Case Report: Durable therapy response to Osimertinib in rare EGFR Exon 18 mutated NSCLC
Authors: Michael Cekay, Philipp F Arndt, Rio Dumitrascu, Rajkumar Savai, Andreas Braeuninger, Stefan Gattenloehner, Dagmar Steiner, Fritz Roller, Khodr Tello, Katja Hattar, Werner Seeger, Ulf Sibelius, Friedrich Grimminger, Bastian Eul
Journal: Front Oncol (2023)
Keywords: egfr exon 18 insertion, egfr mutation, osimertinib, non-small cell lung cancer, tyrosine kinase inhibitors (tkis)
MeSH terms: Case Reports

Up to 20% of all non-small cell lung cancer patients harbor tumor specific driver mutations that are effectively treated with tyrosine kinase inhibitors. However, for the rare EGFR deletion-insertion mutation of exon 18, there is very little evidence regarding the effectiveness of tyrosine kinase inhibitors. A particular challenge for clinicians in applying tyrosine kinase inhibitors is not only diagnosing a mutation but also interpreting rare mutations with unclear therapeutic significance. Thus, we present the case of a 65-year-old Caucasian male lung adenocarcinoma patient with an EGFR Exon 18 p.Glu709_Thr710delinsAsp mutation of uncertain therapeutic relevance. This patient initially received two cycles of standard platinum-based chemotherapy without any therapeutic response. After administration of Osimertinib as second line therapy, the patient showed a lasting partial remission for 12 months. Therapy related toxicities were limited to mild thrombocytopenia, which ceased after dose reduction of Osimertinib. To our knowledge, this is the first report of effective treatment of this particular mutation with Osimertinib. Hence, we would like to discuss Osimertinib as a viable treatment option in EGFR Exon 18 p.Glu709_Thr710delinsAsp mutated lung adenocarcinoma.
Lithium Induced Amenorrhea: A First Case Report
Authors: Balakumar Ke, Vandana Tayal, Vidhya Egambarame, Vandana Roy
Journal: Acta Med Litu (2024)
Keywords: female health, lithium, psychiatry
MeSH terms: Case Reports

A 19-year-old female, known case of bipolar disorder had history of amenorrhea (absence of menstruation) for three years. While other causes of amenorrhea such as CNS, pregnancy, other medications, and thyroid issues were ruled out, she was found to have hyper-prolactinemia. Although antipsychotic medications are known to cause amenorrhea due to dopamine receptor blockade, which may result in hyperprolactinemia, the patient's symptoms began before she started these medications. Only drug that she was on for long period is lithium. Current literature shows mixed evidence about lithium's impact on prolactin levels, which can affect menstruation. This case may represent the first report of lithium causing amenorrhea through elevated prolactin levels. Clinicians should be aware of this potential side effect and monitor patients accordingly. Further studies are needed to confirm and understand this potential link.
Clinical and immunological features of laryngeal cryptococcosis
Authors: Vítor Falcão de Oliveira, Mariane Taborda, Mateus Bach Santa Catarina, Wdson Luis Lima Kruschewsky, Marjorie Marini Rapozo, Thais Queiroz da Rocha, Carla Pagliari, Adriana Satie Gonçalves Kono Magri, Marcello Mihailenko Chaves Magri, Miriam Nacagami Soto
Journal: Rev Inst Med Trop Sao Paulo (2024)
MeSH terms: Cryptococcosis / immunology, Laryngeal Diseases / immunology, Laryngeal Diseases / microbiology, Case Reports, Humans

The literature holds few descriptions on immune response findings for laryngeal cryptococcosis. Immunology has been more extensively described in cases involving the central nervous system and the lungs, although many of these studies were conducted in animal models. We aimed to analyze the clinical and immunological characteristics of three patients with laryngeal cryptococcosis. We observed a weak participation of the innate immune response, whereas adaptive immunity showed the predominance of a Th2-type response over a Th1-type response. Most cases occur in male older adults with immunosuppressive conditions, of which HIV infection was absent. Hoarseness configured the main symptom. We found a disease that was restricted to the larynx and possibly the lungs by contiguity. Patients with hoarseness and lesions in nasal endoscopy should be investigated for cryptococcosis by a biopsy of the larynx, including with negative serum cryptococcal antigen. The immunological aspects of our findings of laryngeal involvement resembled those in the most commonly affected systems.
A Unique Case of Prostate Carcinoma Presenting as Retroperitoneal Lymphadenopathy With Normal Levels of Prostate-Specific Antigen and a Prostate of Normal Size: A Case Report
Authors: Swapnil Patil, Mayank Mundada, Pradnya M Diggikar, Raju Hansini Reddy, Sree Vidya Yekkaluru
Journal: Cureus (2024)
Keywords: conglomerated lymph node mass, metastatic prostate carcinoma, normal prostate size, prostate biopsy, prostate-specific antigen (psa), retroperitoneal lymphadenopathy
MeSH terms: Case Reports

Despite the significant advancements in prostate-specific antigen (PSA) screening and the diverse array of available treatments, prostate cancer (PCa) still significantly contributes to cancer-related illness. The most prevalent sites for metastases are bones, distant lymph nodes, and abdominal organs. Nevertheless, metastasis to the renal and retroperitoneal regions originating from prostate cancer constitutes an exceptionally uncommon clinical occurrence. Metastatic PCa commonly presents with elevated serum PSA levels, a hallmark of its diagnostic profile. However, there are instances where patients exhibit atypical metastatic patterns or maintain normal PSA levels. In the case under consideration, the patient exhibited a periureteral tumor with an indeterminate primary origin, subsequently confirmed to be metastatic prostate cancer. This case underscores the importance of recognizing the varied and sometimes elusive presentations of metastatic PCa. Despite its rarity, the occurrence of renal and retroperitoneal metastasis emphasizes the need for vigilance and a comprehensive understanding of the diverse manifestations of advanced PCa for timely and accurate diagnosis, which is paramount in optimizing patient care and outcomes.
Case Report: Enhancing lead extraction techniques: a novel approach using a loop formed by an ablation catheter and a gooseneck snare
Authors: Jun Li, Lei Wang, Xiaofang Li, Na Li, Xin Shao, Anxin Zhang, Yan Shu, Haixiong Wang
Journal: Front Cardiovasc Med (2024)
Keywords: catheter, infection, lead extraction, loop, pacemaker, very old lead
MeSH terms: Case Reports

The difficulty and complexity of lead extraction procedures increase with the age of the lead to be extracted. The extraction of old (>20 years) leads is more time-consuming and requires advanced tools and a complex technique. In this case, we retrieved a very old (>30 years) lead using a loop formed by a catheter and a gooseneck snare. The catheter was rotated to remove the lead-bound sites. The lead was successfully retrieved using a Needle's Eye Snare.
A Case Report of Necrotizing Pneumonia Due to Burkholderia cepacia Syndrome
Authors: Antoine S Hedary, Nikki L DeBord, Diahann Marshall
Journal: Cureus (2024)
Keywords: antibiotic-resistant bacteria, burkholderia cepacia complex, immunocompetent patients, necrotizing peumonia, severe sepsis
MeSH terms: Case Reports

Burkholderia cepacia ​​​​​​(B. cepacia) complex is a highly resistant gram-negative pathogen known to cause lung infection in cystic fibrosis, chronic granulomatous disease, and immunocompromised patients. However, it may rarely infect immunocompetent patients as well. Here, we present the case of a 30-year-old male patient who was treated for B. cepacia pneumonia in the hospital, discharged with oral antibiotics, and returned two months later with recurring B. cepacia pneumonia and bacteremia. The patient rapidly declined over the next 24 hours and expired in the intensive care unit. This case is significant as it is one of very few published cases of cepacia syndrome in a patient with no evidence of immunodeficiency. In conclusion, cases of B. cepacia pneumonia must be monitored vigilantly for progression to cepacia syndrome, even in immunocompetent patients. Additional studies regarding optimized antibiotic regimens and effective treatment modalities for B. cepacia infection are warranted.
Case report: Identification of Hepatitis B Virus in the cerebrospinal fluid of neuromyelitis optica spectrum disorders and successful treatment with ofatumumab and inebilizumab
Authors: Linjun Cai, Xu Liu, Hongyu Zhou, Jinmei Li, Dong Zhou, Zhen Hong
Journal: Front Immunol (2024)
Keywords: case report, hepatitis b virus, inebilizumab, neuromyelitis optica spectrum disorders, ofatumumab
MeSH terms: Antibodies, Monoclonal, Humanized, Neuromyelitis Optica / diagnosis, Neuromyelitis Optica / drug therapy, Case Reports, Research Support, Non-U.S. Gov't, Adult, Aquaporin 4, Female, Hepatitis B virus / genetics, Humans, ofatumumab, inebilizumab, Aquaporin 4, Antibodies, Monoclonal, Humanized

Neuromyelitis optica spectrum disorder (NMOSD) is a rare demyelinating disease of the central nervous system primarily affecting the optic nerves, spinal cord, and brainstem. Viral infection may trigger NMOSD. Here, we report the case of a 34-year-old female presenting with a range of symptoms including nausea, vomiting, dysphagia, choking, and fatigue with unsteady gait, diplopia, hearing loss, left-sided facial paralysis, breathing difficulties, and hoarseness of voice. Her HBV DNA concentration, as determined by quantitative PCR analysis, exceeded 5×107 IU/ml in serum and 4.48×102 IU/ml in CSF. Next-generation sequencing of CSF revealed 1,528 HBV sequences in DNA analysis and 6 sequences in RNA analysis. Serum aquaporin-4 antibody (AQP4-Ab) titer was 1:10, and the CSF titer was 1:3.2. Brain magnetic resonance imaging showed high signal intensities in the brain stem, medulla oblongata, and left middle cerebellar peduncle with mild restricted-diffusion. The patient received antiviral and hepatoprotective medications before the high-dose methylprednisolone pulse therapy. However, the patient did not respond well to the first-line treatment. Subsequently, the patient received ofatumumab and inebilizumab. Throughout the follow-up period, there was a gradual improvement in her neurological symptoms, with no reactivation of hepatitis B or deterioration of liver function observed. Thereby, to the best of our knowledge, we report the first case of successful treatment with ofatumumab and inebilizumab in a patient with NMOSD concurrent with HBV infection.
Intensifying the Hormonal and Radiation Treatment in Prostate Cancer Presenting With Bulky Pelvic Lymph Nodes: An Opportunity for a New Paradigm
Authors: Agha H Khan, Nadeem Pervez, Muhammad S Usmani, Houda S Almusalhi, Munjid Al Harthy, Layth Mula-Hussain
Journal: Cureus (2024)
Keywords: bulky lymph nodes, duo hormonal therapy, hypofractionated rt, intensity-modulated radiation therapy (imrt), locally advanced, prostate cancer, psma scan, radical treatment, radiotherapy
MeSH terms: Case Reports

Locally advanced prostate cancer may rarely present with bulky pelvic lymph nodes without distant metastasis. Patients may be treated with curative intent. Dual hormonal therapy including luteinizing hormone-releasing hormone agonist in combination with abiraterone or enzalutamide can be utilized neoadjuvantly to shrink bulky disease. This can be followed by radical doses of radiotherapy. This intensified treatment is tolerable. Prostate-specific membrane antigen scan can be utilized to assess staging and treatment response. Here, we present a case of a non-metastatic locally advanced prostate cancer with bulky pelvic lymph nodes. The patient was treated neoadjuvantly with dual hormonal therapy followed by radical doses of radiotherapy. The patient tolerated the treatment well and had a promising early response.
Surgical management of a locally advanced jejunal stromal tumor: A case report of a challenging condition
Authors: Anis Hasnaoui, Racem Trigui, Nizar Khedhiri, Imen Helal, Haithem Zaafouri, Anis Ben Maamer
Journal: Int J Surg Case Rep (2024)
Keywords: case report, gastrointestinal stromal tumors, jejunal neoplasms, locally advanced, protein kinase inhibitors
MeSH terms: Case Reports

Introduction and importance:
Locally advanced jejunal stromal tumors stand as a captivating and relatively rare entity, garnering attention for several reasons. Their inaccessible location by conventional endoscopy poses a diagnostic challenge. Further, treatment decisions necessitate a multidisciplinary approach, compounded by the absence of high-level evidence studies.
Case presentation:
A 54-year-old patient was admitted to our surgical department with abdominal pain and chronic anemia. Abdominal CT imaging confirmed the presence of a non-metastatic sizable jejunal tumor. The patient underwent laparotomy, revealing a locally advanced jejunal tumor contracting the ileum and the ascending colon. A monobloc oncological resection was performed, followed by the restoration of digestive continuity. Anatomopathological analysis delineated a locally advanced Stromal Tumor with a high risk of recurrence. The patient underwent a course of tyrosine kinase inhibitors for 3 years, with no reported recurrence during the subsequent 3-year follow-up.
Discussion:
Locally advanced jejunal stromal tumors are rare. Most patients present with unspecific symptoms. Diagnosis remains challenging due to their intricate anatomical location. Decisions regarding management must be deliberated within a multidisciplinary framework, tailored to each patient's unique characteristics. While combined therapeutic modalities have demonstrated efficacy in recent studies, prudence is advised given the heightened incidence of both short and long-term complications.
Conclusion:
In the absence of randomized controlled trials, the management of locally advanced jejunal stromal tumors underscores the imperative of multidisciplinary collaboration in treatment deliberations. A wide, sometimes mutilating excision is only permissible if it is complete.
Isolated Central Nervous System Involvement after Brentuximab Vedotin Treatment for HIV-Positive ALK-Negative Anaplastic Large Cell Lymphoma
Authors: Takuya Suyama, Kumiko Matsui, Kosuke Makihara, Masatoshi Tsuru
Journal: Case Rep Hematol (2024)
MeSH terms: Case Reports

Human immunodeficiency virus (HIV)-associated lymphoma poses a high mortality risk despite antiretroviral therapy (ART). Although intermediate- or high-grade B-cell lymphomas are common, anaplastic large-cell lymphomas (ALCLs) are rare and seldom affect the central nervous system (CNS). Herein, we present a case of HIV-associated ALCL with isolated CNS involvement that occurred following the discontinuation of ART that was administered after treatment with brentuximab vedotin (BV)-which does not cross the blood-brain barrier. At the time of CNS recurrence, the patient's CD4 count was 9 cells/mm3. This is the first report of CNS recurrence in HIV-associated ALCL. Considering the high risk of CNS relapse, we suggest initiating CNS prophylaxis in cases of HIV-associated ALCL, particularly in patients receiving CNS-impermeable agents such as BV.
Expanding treatment options for patients with HER2+ metastatic breast cancer with margetuximab plus chemotherapy: a case report series
Authors: Reshma Mahtani, Natasha Harpalani, Fengting Yan, Kristen Phiel, Iuliia Kovalenko
Journal: Front Oncol (2024)
Keywords: her2+, case report, later-line treatment, margetuximab, metastatic breast cancer
MeSH terms: Case Reports

Background:
Human epidermal growth factor receptor 2 protein (HER2)-positive (+) metastatic breast cancer (MBC) is an aggressive disease and patients often undergo multiple lines of therapy following HER2 targeted therapies. The most recent National Comprehensive Cancer Network (NCCN) guidelines recommend margetuximab plus chemotherapy as fourth-line or later therapy for HER2+/hormone receptor (HR) + or negative (-) MBC. The aim of this case series is to provide information regarding margetuximab utilization in clinical practice as later-line therapy in women with HER2+ MBC.
Case summaries:
Margetuximab plus chemotherapy was used as fourth- or later-line treatment in patients who had received multiple HER2-targeted agents, including trastuzumab, pertuzumab, ado-trastuzumab emtansine, trastuzumab deruxtecan, tucatinib, and neratinib. Patients responded to margetuximab plus chemotherapy with real-world progression-free survival (PFS) of 3, 4, and 7 months.
Conclusion:
Clinical outcomes from three heavily pretreated patients with metastatic HER2+/HR+ MBC demonstrated that margetuximab plus chemotherapy resulted in real-world PFS comparable to that reported in the controlled pivotal clinical trial and support use of this targeted therapy option in appropriately identified patients.
Undercover Peripheral Arterial Disease
Authors: Catarina Costa, Beatriz Riquito, Sofia Perdigão, Rita Cunha, Victor Paz
Journal: Cureus (2024)
Keywords: atherosclerosis, cardiovascular risk, cerebrovascular disease, multidisciplinary work, peripheral arterial disease, polyvascular disease, stroke
MeSH terms: Case Reports

Peripheral arterial disease is a frequently underdiagnosed disease that can severely affect the quality of life. We present a clinical case of a 62-year-old smoker post-menopause woman with a mild stroke. Further investigation revealed a severe disseminated arterial disease. Due to multidisciplinary and timely interventions, peripheral ischemia was prevented successfully. In fact, this patient had polyvascular disease. Despite its worst prognosis than either coronary artery disease, cerebrovascular disease, or peripheral arterial disease alone, polyvascular disease is still underdiagnosed. Atherosclerosis and cardiovascular risk should be regarded as multisystemic and managed as such in multidisciplinary teams. A proper and timely intervention is essential to diminish its morbidity and mortality.
Reversible Vagal Nerve Stimulation-Induced Vocal Cord Paralysis and Intractable Neck Pain Following a Syncopal Fall: A Case Report
Authors: Ethan J Houskamp, James M Mossner, S Katie Bandt
Journal: Cureus (2024)
Keywords: case report, epilepsy, pain, vagus nerve stimulation, vocal cord paralysis
MeSH terms: Case Reports

Vagal nerve stimulation (VNS) is a well-tolerated procedure for patients with medication-resistant and non-focal epilepsy. It does, however, have potential complications (e.g., hoarseness and cough) thought to be from vagus nerve irritation. These arise postoperatively and generally improve without intervention. If these symptoms present later or do not improve, it suggests a more insidious etiology. Herein we report the case of a patient in their 50s with medication-resistant epilepsy, who subsequently underwent VNS electrode array and pulse generator implantation to aid seizure management. Three years after the initial implantation, the patient experienced vocal cord paralysis and neck pain following a syncopal fall. The pain radiated to their jaw and chest and was eliminated when their VNS was turned off. The patient was taken to the OR for removal and replacement of their entire VNS system. Their original electrodes were unable to be removed secondary to being scarred in place. The patient's preoperative pain symptoms completely resolved after the removal of their old VNS and implantable pulse generator (IPG) and replacement with a new system 14 days postoperatively. While short-term postoperative sequelae and lead fractures/displacements have been reported in the literature, this is the first case to our knowledge of a patient experiencing a likely symptomatic traction injury without displacement of the VNS coils or obvious vagus nerve injury. Furthermore, the removal and replacement of the entire VNS system led to complete relief of their presenting symptoms.