OpenMed/multicare-articles huggingface dataset:
Native aortic valve pneumococcal endocarditis--fulminant presentation
Authors: Kevin Domingues, Liliana Marta, Isabel Monteiro, Margarida Leal
Journal: Rev Bras Ter Intensiva (2016)
MeSH terms: Aortic Valve Insufficiency / diagnosis, Endocarditis, Bacterial / diagnosis, Heart Valve Diseases / diagnosis, Pneumococcal Infections / diagnosis, Case Reports, Aortic Valve / microbiology, Aortic Valve / pathology, Aortic Valve / surgery, Aortic Valve Insufficiency / microbiology, Aortic Valve Insufficiency / surgery, Echocardiography, Transesophageal, Endocarditis, Bacterial / microbiology, Female, Heart Valve Diseases / microbiology, Heart Valve Diseases / surgery, Humans, Middle Aged, Pneumococcal Infections / microbiology, Shock, Septic / physiopathology, Streptococcus pneumoniae / isolation & purification

Pneumococcal endocarditis is a rare entity, corresponding to 1 to 3% of native valve endocarditis cases. It has a typically adverse prognosis, with high mortality. There is a reported predilection for the aortic valve; thus, a common presentation is acute left heart failure. We present a case of a 60-year-old woman with a history of sinusitis, who was admitted with the diagnosis of pneumonia. She rapidly deteriorated with signs of septic shock and was transferred to the critical care unit. The transesophageal echocardiogram revealed severe aortic regurgitation due to valve vegetations. Blood cultures were positive for Streptococcus pneumoniae. She underwent cardiac surgery and had multiple postoperative complications. Nonetheless, the patient made a slow and complete recovery. Infectious endocarditis should be ruled out if any suspicion arises, and echocardiography should be performed in an early stage in patients with poor response to vasopressors and inotropes. Patients with pneumococcal endocarditis benefit from an aggressive approach, with performance of early surgery.
Right ventricular functional assessment by three-dimensional transesophageal echocardiography is useful for withdrawal from a right ventricular assist device: a case report
Authors: Hiroki Taenaka, Tatsuyuki Imada, Ryuichiro Abe, Akinori Uchiyama, Yuji Fujino
Journal: JA Clin Rep (2017)
Keywords: right ventricular assist device, right ventricular function, three-dimensional transesophageal echocardiography

Right ventricular assist device (RVAD) implantation is one type of surgical treatment used for right heart failure. It is important to assess right ventricular (RV) function precisely when RVAD withdrawal is considered. Although assessment of RV function is difficult due to its complicated shape and contraction pattern, the volumetric analysis method of three-dimensional (3D) transesophageal echocardiography (TEE) has been developed and is useful for this task. We report the case of a 79-year-old man who successfully underwent RVAD withdrawal and evaluation using 3D TEE. 3D TEE had an important role in determining the timing of withdrawal from RVAD in this case.
Multiple myeloma presenting as acute tubulointerstitial nephritis
Authors: Ying Long, Abed A Aljamal, Hisham F Bahmad, Niharika Yedla, Guillermo A Herrera, Michael A Schwartz, Ayman Layka
Journal: Autops Case Rep (2021)
Keywords: case reports, microscopy, electron, multiple myeloma, nephritis, interstitial
MeSH terms: Case Reports

Background:
Acute tubulointerstitial nephritis (ATIN) is a very rare paraneoplastic manifestation in patients with multiple myeloma (MM). It is an uncommon pattern of renal disease in such patients.
Case presentation:
We report a case of an 82-year-old male who was admitted with acute kidney injury. Renal biopsy showed typical findings of light chain-associated ATIN with scattered inflammatory cells in the interstitium and associated active tubulitis. No other common manifestations of MM were present at the time of presentation, including hypercalcemia, hyperuricemia, proteinuria, bone pain or lytic bone lesions. Subsequent immunoassays revealed significant serum lambda light chain burden and Bence Jones protein in urine. Immunofluorescence demonstrated linear tubular basement membranes with positive staining for lambda light chain (3+). Electron microscopy (EM) further showed interstitial edema and inflammation. All the aforementioned findings are consistent with ATIN and supported the diagnosis of MM.
Conclusions:
In conclusion, light chain-associated ATIN should be considered in the differential diagnosis of acute interstitial nephritis. Henceforth, serum free light chains as well as serum and urine protein electrophoresis should be included in the workup of such patients.
Endobronchial localization of Hodgkin's disease
Authors: Lamyae Amro, Siham Jridi, Hafsa Sajiai, Hind Serhane, Salma Aït Batahar
Journal: Pan Afr Med J (2017)
Keywords: hodgkin´s disease, bronchoscopy, diagnosis, endobronchial
MeSH terms: Antineoplastic Combined Chemotherapy Protocols / therapeutic use, Bronchial Neoplasms / diagnosis, Hodgkin Disease / diagnosis, Case Reports, Adolescent, Biopsy, Bleomycin / therapeutic use, Bronchial Neoplasms / drug therapy, Bronchial Neoplasms / pathology, Dacarbazine / therapeutic use, Doxorubicin / therapeutic use, Female, Follow-Up Studies, Hodgkin Disease / drug therapy, Hodgkin Disease / pathology, Humans, Lymph Nodes / pathology, Tomography, X-Ray Computed, Vinblastine / therapeutic use, Bleomycin, Vinblastine, Dacarbazine, Doxorubicin, ABVD protocol

The endobronchial localization of Hodgkin's disease is a rare entity which is often confused with endobronchial tuberculosis in our setting. We report the case of a 16 years old female who presented with 6 months history of dry cough, hemoptysis, dyspnea, dysphagia and dysphonia. The chest radiography showed a mediastinal and pulmonary opacity. The chest CT scan found enlarged mediastinal lymph nodes. The bronchial biopsy and peripheral lymph node biopsy confirmed Hodgkin's disease with endobronchial localization. The patient received chemotherapy (ABVD protocol) and radiotherapy with a favorable follow up.
The Spectrum of Acute Disseminated Encephalomyelitis and Mild Encephalopathy with Reversible Splenial Lesion
Authors: Michel Sáenz-Farret, Mariana Aurora Cansino-Torres, Valeria Sandoval-Rodríguez, Rigoberto Navarro-Ibarra, Carlos Zúñiga-Ramírez
Journal: Case Rep Neurol Med (2019)
MeSH terms: Case Reports

Background:
Acute disseminated encephalomyelitis and mild encephalopathy with reversible splenial lesion are autoimmune demyelinating disorders of central nervous system. Diagnosis remains clinical, aided by neuroimaging confirmation and excluding other causes. In the absence of a biological marker, the diagnosis of these entities based on clinical and imaging criteria could overlap.
Methods:
We describe a 22-year-old woman developing mild neurological signs after an upper tract infection, a brain magnetic resonance image revealed confluent, symmetrical white matter lesions with corpus callosum involvement; after extensive ancillary testing that ruled out secondary causes we concluded that this subject had a post infectious encephalitis sharing clinical and imaging criteria for acute disseminated encephalomyelitis. However, mild encephalopathy with reversible splenial lesion could be an alternate diagnosis for this subject. Treatment with methylprednisolone completely solved both the clinical and image abnormalities without relapsing for more than 3 years of follow-up.
Conclusion:
Both acute disseminated encephalomyelitis and mild encephalopathy with reversible splenial lesion share clinical and radiological features. A biological marker is needed to differentiate among these entities, since overlap is seen according to current criteria.
Delayed cerebral radiation necrosis after neutron beam radiation of a parotid adenocarcinoma: a case report and review of the literature
Authors: Christopher S Hong, Hamza N Gokozan, José J Otero, Michael Guiou, J Bradley Elder
Journal: Case Rep Neurol Med (2014)

Cerebral radiation necrosis (CRN) is a well described possible complication of radiation for treatment of intracranial pathology. However, CRN as sequelae of radiation to extracranial sites is rare. Neutron beam radiation is a highly potent form of radiotherapy that may be used to treat malignant tumors of the salivary glands. This report describes a patient who underwent neutron beam radiation for a parotid adenocarcinoma and who developed biopsy-confirmed temporal lobe radiation necrosis thirty months later. This represents the longest time interval described to date, from initial neutron radiation for extracranial pathology to development of CRN. Two other detailed case studies exist in the literature and are described in this report. These reports as well as our patient's case are reviewed, and additional recommendations are made to minimize the development of CRN after extracranial neutron beam radiation. Physicians should include the possible diagnosis of CRN in any patient with new neurologic signs or symptoms and a history of head and neck radiation that included planned fields extending to the base of the skull. Counseling of patients prior to neutron beam radiation should include potential neurologic complications associated with CRN and risks of treatment for CRN including neurosurgical intervention.
Acute pyelonephritis including an overlooked renal cell carcinoma
Authors: Soo Kyeong Song, Ji Soo Song, Hong Pil Hwang, Sik Lee
Journal: Clin Nephrol Case Stud (2013)
Keywords: pyelonephritis, renal cell carcinoma
MeSH terms: Case Reports

Hidden renal mass is not evident during severe inflammation such as acute pyelonephritis, pyonephrosis, or renal abscess. Deceptive inflammatory presentations that can occur in aggressive synchronous renal malignancies can significantly delay the diagnosis of cancer. Herein, we report a case of acute pyelonephritis involving overlooked renal cell carcinoma.
Cutaneous leiomyosarcoma on the trunk: An unusual presentation with an aggressive course - Case report and review of literature
Authors: Lina Hmida, Feryel Letaief, Raoudha Doghri, Khedija Meddeb, Khalil Mahjoubi, Amina Mokrani, Yosra Yahiaoui, Azza Gabsi, Nesrine Cheraiet, Henda Rais, Mouna Ayadi, Amel Mezlini
Journal: Pan Afr Med J (2018)
Keywords: leiomyosarcoma cutaneous, chemotherapy, surgery
MeSH terms: Leiomyosarcoma / diagnosis, Skin Neoplasms / diagnosis, Case Reports, Review, Adult, Bone Neoplasms / secondary, Follow-Up Studies, Humans, Leiomyosarcoma / pathology, Leiomyosarcoma / surgery, Lung Neoplasms / secondary, Male, Retroperitoneal Neoplasms / secondary, Skin Neoplasms / pathology, Skin Neoplasms / surgery, Time Factors, Torso / pathology

Primary cutaneous leiomyosarcoma (PCL) are soft-tissue sarcoma, arising in the dermis, with or without extension into the subcutis. They are thought to have an indolent course compared to their subcutaneous counterparts, they may recur but rarely metastases. We report the case of a patient with a PCL arising in the anterior trunk wall who developed pulmonary, bone and retroperitoneal metastases 6 years after wide surgical excision of the primary tumor.
Persistent Tachycardia in a Patient on Clozapine
Authors: Samuel Adeyemo, Oluwole Jegede, Peterson Rabel, Saad Ahmed, Terence Tumenta, Oluwatoyin Oladeji, Khanderker Taher
Journal: Case Rep Psychiatry (2020)
MeSH terms: Case Reports

Tachycardia emergent from clozapine treatment is usually transient, often missed, unreported, and therefore frequently goes untreated resulting in possible premature discontinuation of an otherwise effective treatment. Clozapine-induced tachycardia results from direct effects on the sympathetic nervous system including the blockade of cardiac muscarinic M2 receptors, presynaptic α 2 adrenoceptors, and indirect activation of the β adrenoceptors. Unfortunately, there are no clear guidelines for monitoring or treating tachycardia induced by clozapine. We present a case of a 55-year-old man with treatment-resistant schizophrenia initiated on clozapine who developed persistent tachycardia and right bundle branch block in the course of treatment. Tachycardia persisted despite treatment with metoprolol and necessitated a transfer to the intensive care unit. A reduction in clozapine dose with the addition of adjunctive antipsychotic(lurasidone) stabilized the patient's heart rate. This case highlights the need for consistent physical examination and a multidisciplinary-based treatment approach for patients on clozapine. The case also suggests that clozapine dose reduction and combination antipsychotic treatments may preclude the need to discontinue clozapine in patients with persistent tachycardia.
Fatal Systemic Vasoconstriction in a Case of Metastatic Small-Intestinal NET
Authors: Jochen Stenzel, Sebastian Noe, Konstantin Holzapfel, Franziska Erlmeier, Florian Eyer
Journal: Case Rep Gastrointest Med (2017)
MeSH terms: Case Reports

An increased release of serotonin secreted by ileal NETs is thought to be the major factor causing the carcinoid syndrome. However, in acutely arising carcinoid crisis also other vasoactive factors may lead to hazardous fluctuations in blood pressure and bronchial constriction. In rare cases, systemic vasoconstriction can be observed, probably caused by catecholamines or similar acting substances. Here, we report a fatal case of fulminant systemic vasoconstriction possibly caused by catecholamines in a patient with metastasized ileal NET. The vasospasm was detected by CT-angiography, and hemodynamic monitoring revealed a high systemic vascular resistance. Epinephrine, norepinephrine, and chromogranin A levels in plasma were elevated as was the urinary 5-hydroxyindoleacetic acid (5-HIAA). The cause of death was heart failure due to severe circulatory insufficiency. The progression of the tumor disease was confirmed by autopsy.
Case report: Osteo-oto-hepato-enteric syndrome caused by UNC45A deficiency
Authors: Ruixue Wang, Yizhong Wang, Ronghua Yu, Wuhen Xu, Ting Zhang, Yongmei Xiao
Journal: Front Genet (2023)
Keywords: o2he, unc45a, case report, cholestasis, compound heterozygote variants
MeSH terms: Case Reports

Background: Recently, UNC45 myosin chaperone A (UNC45A) deficiency was identified as a cause of osteo-oto-hepato-enteric syndrome (O2HE) characterized by congenital diarrhea, neonatal cholestasis, deafness, and bone fragility. To date, only a few O2HE cases have been reported in the literature. Case presentation: Here, we present a child from China diagnosed with O2HE with novel compound heterozygous variants in UNC45A. The patient suffered with neonatal jaundice, cholestasis, and intractable diarrhea after birth. Laboratory tests revealed highly elevated levels of total serum bilirubin (TB), direct bilirubin (DB), and total bile acid (TBA). The patient was managed with ursodeoxycholic acid (UDCA)-based treatments, and the clinical symptoms and abnormal liver functions were significantly relieved. The patient's hearing was normal, and no sign of bone fragility was observed. Exome sequencing (ES) identified novel compound heterozygote variants c.292C>T (p.Arg98Trp)/c.2534-2545del (p.Leu845-Met848del) in UNC45A, which were inherited from her mother and father, respectively. Both variants are predicted to be deleterious by in silico predictors. Conclusion: We present an O2HE child from China with novel compound heterozygous variants in UNC45A. Our patient's clinical manifestations were less severe than those of the previous reported cases, which expands the clinical spectrum of O2HE.
Acute Pancreatitis Causing Descending Colonic Stricture: A Rare Sequelae
Authors: Amrendra Kumar Mandal, Paritosh Kafle, Pradip Puri, Baikuntha Chaulagai, Muhammad Hassan, Bikash Bhattarai, Rajan Kanth, Vijay Gayam
Journal: J Investig Med High Impact Case Rep (2019)
Keywords: crohn’s disease, acute pancreatitis, colon stricture
MeSH terms: Colonic Diseases / etiology, Constriction, Pathologic / etiology, Pancreatitis / complications, Case Reports, Acute Disease, Adult, Colon / pathology, Colonic Diseases / pathology, Colonoscopy, Humans, Male, Tomography, X-Ray Computed

An isolated descending colonic stricture is an unlikely complication of acute pancreatitis, with the nonspecific symptoms of colonic stricture making the overall diagnosis difficult. Crohn's disease (CD) and tuberculosis (TB) are the two common etiologies of an isolated colonic stricture and may present similarly to colonic stricture related to acute pancreatitis. Unfortunately, colonoscopy and biopsy often cannot determine the etiology, and surgical resection may be needed to provide both symptomatic relief and confirm the diagnosis. As a result, descending colonic stricture may produce a diagnostic dilemma with CD and TB as all 3 conditions may be radiologically and endoscopically indistinguishable. We describe a young male with weight loss and abdominal pain. TB testing was negative, with radiography and ELISA (enzyme-linked immunosorbent assay) testing supporting a diagnosis of the CD. The patient was initiated on sulfasalazine but worsened over the next month. Further investigations revealed that the patient had descending colonic stricture without CD. Therefore, the stricture's etiology was most likely related to an episode of acute pancreatitis the patient had 2 months before admission and was found to have left colonic segment adherent to the pancreas eventually requiring segmentectomy. Although the pathophysiology of colonic stricture after pancreatitis is unclear, we speculate that inflammatory injury to the colon is an important component. Finally, we emphasize that colonic stricture is a rare complication of pancreatitis.
Sutureless Approach for Gastroschisis Patients in Palestine
Authors: Yousef S Abuzneid, Sadi A Abukhalaf, Duha Rabi, Abdelrahman Rabee, Safwan Mashhour, Radwan Abukarsh
Journal: Case Rep Surg (2020)
MeSH terms: Case Reports

Gastroschisis is a ventral abdominal wall congenital defect with bowel herniation outside the abdominal cavity. Gastroschisis traditional management is the primary operative closure surgery (POCS), but the sutureless silo approach (SSA), a novel alternative, gains wide acceptance in the developed countries and across nations. This study describes the first-ever gastroschisis patient managed with the sutureless silo approach in Palestine. In addition, we shall use this case as the very first nucleus for the upcoming gastroschisis management in our referral hospital because the SSA yields a reduced hospital stay which is fundamental to our institution due to the limited number of beds and lower management costs to the hospital and families.
Successful Treatment by Surgery and Lenvatinib of a Patient with Adrenal Metastasis of Papillary Thyroid Cancer
Authors: Hajime Nakamura, Kohichi Takada, Kazuyuki Murase, Hiroki Sakamoto, Naotaka Hayasaka, Kazuma Ishikawa, Yuki Ikeda, Makoto Yoshida, Satoshi Iyama, Ko Kobayashi, Tetsuya Shindo, Shintaro Sugita, Koji Miyanishi, Masayoshi Kobune, Naoya Masumori, Junji Kato
Journal: Case Rep Oncol Med (2020)
MeSH terms: Case Reports

Papillary thyroid cancer (PTC) is considered an indolent cancer, but some PTC patients do present with distant metastases and treatment strategies for such patients are not well established. Recently, lenvatinib, an inhibitor of multiple tyrosine kinases, has been introduced to treat patients with advanced PTC but carries a risk of serious adverse events such as hemorrhage. Here, we report a PTC patient with a left adrenal metastasis and lenvatinib-induced hemorrhage who underwent successful surgical resection and was subsequently treated with a lower dose of lenvatinib. The patient has now been in a stable state with no adverse events for nearly two years. This case highlights the importance of surgical resection of metastatic PTC and subsequent lenvatinib therapy, even when the tumor is at an advanced stage.
Liver transplantation and aortic valve replacement
Authors: H R Davari, S A Malek-Hosseini, H Salahi, A Bahador, S Nikeghbalian, M H Nemati, M A Sanjarian, M B Khosravi, S Shahbazi, M Saberfiruzi, S M Dehghani, K Kazemi
Journal: Int J Organ Transplant Med (2011)
Keywords: artic valve replacement, cirrhosis, orthotopic liver transplantation, severe aortic insufficiency
MeSH terms: Case Reports

Surgical procedures involving heart and liver are rare and have been limited to either combined heart and liver transplantation or coronary artery bypass graft surgery (CABG) or aortic valve surgery and orthotopic liver transplantation (OLT). Aortic valve replacement (AVR) and pulmonary valve vegetectomy for bacterial endocarditis after OLT have also been reported. There are only five cases with aortic stenosis and cirrhosis reported to have combined AVR and liver transplantation. In the presence of cirrhosis, AVR has a significant risk for mortality because of bleeding from coagulopathy, renal failure, infection, and poor post-operative wound healing. Herein, we report on a case and management analysis of combined sequential AVR, and OLT in a 40-year-old cirrhotic man with Child and MELD score of C and 29, respectively. Echocardiography detected severe aortic insufficiency (AI) with enlarged left ventricle. Due to severe AI, the cardiologist recommended AVR prior to transplantation. The patient underwent metallic AVR. 4 months later, he received OLT. Both operations were successful and uneventful. Prioritizing AVR before OLT was successful in this patient. However, each patient must be evaluated individually and multiple factors should be assessed in pre-operation evaluation.
Case Report: Next-Generation Sequencing in Diagnosis of Pneumonia Due to Pneumocystis jirovecii and Cytomegalovirus in a Patient With HIV Infection
Authors: Yirui Xie, Bing Ruan, Lingxiao Jin, Biao Zhu
Journal: Front Med (Lausanne) (2021)
Keywords: hiv, pneumocystis jirovecii, bronchoalveolar lavage fluid, cytomegalovirus, next-generation sequencing, pneumonitis
MeSH terms: Case Reports

Background: Pulmonary infections remain a significant cause of morbidity and mortality in immunocompromised patients. The pathogens spectrum of pulmonary infection that can affect patients with human immunodeficiency virus (HIV) is wide such as bacterial, fungal, viral, parasitic organisms, and so on. The risk of multi-pathogenic pneumonia is higher in HIV-infected patients. However, the fast and accurate diagnosis of multi-pathogenic pneumonia is challenging because of the limitations of current conventional tests. Case Presentation: Here, we report a case of pneumonia due to Pneumocystis jirovecii and cytomegalovirus (CMV) in a 22-year-old male with newly diagnosed HIV infection. Blood tests revealed a low CD4 count, a chest computed tomography (CT) scan showed extensive ground-glass opacities in the bilateral lung with multiple cavity lesions in the left upper lung. Microscopic examination of stained sputum and bronchoalveolar lavage fluid (BALF) smear specimens did not find any pathogens. There was also no evidence of pathogens known to cause pneumonia in bacteria and fungi culture tests and virus antibodies such as EBV, CMV, and COVID-19. The nucleic acid of CMV in blood was reported by quantitative PCR. Next-generation sequencing (NGS) analysis of BALF specimens identified a large number of P. jirovecii and CMV reads, and confirmed the diagnosis of pneumonia due to P. jirovecii and CMV. Following the patient's treatment with anti-PCP and anti-CMV, the patient was cured and discharged. Conclusions: This case highlights the combined application of NGS in the clinical diagnosis of multi-pathogenic pneumonia in an HIV-infected patient. NGS is proposed as an important adjunctive diagnostic approach for identifying pathogens of multi-pathogenic pneumonia in HIV-infected patients.