OpenMed/multicare-articles huggingface dataset:
Adrenocorticotropic Hormone Secreting Pheochromocytoma Underlying Glucocorticoid Induced Pheochromocytoma Crisis
Authors: Gil A Geva, David J Gross, Haggi Mazeh, Karine Atlan, Iddo Z Ben-Dov, Matan Fischer
Journal: Case Rep Endocrinol (2018)
MeSH terms: Case Reports

Context:
Pheochromocytomas are hormone secreting tumors of the medulla of the adrenal glands found in 0.1-0.5% of patients with hypertension. The vast majority of pheochromocytomas secrete catecholamines, but they have been occasionally shown to also secrete interleukins, calcitonin, testosterone, and in rare cases adrenocorticotropic hormone. Pheochromocytoma crisis is a life threatening event in which high levels of catecholamines cause a systemic reaction leading to organ failure.
Case description:
A 70-year-old man was admitted with acute myocardial ischemia following glucocorticoid administration as part of an endocrine workup for an adrenal mass. Cardiac catheterization disclosed patent coronary arteries and he was discharged. A year later he returned with similar angina-like chest pain. During hospitalization, he suffered additional events of chest pain, shortness of breath, and palpitations following administration of glucocorticoids as preparation for intravenous contrast administration. Throughout his admission, the patient demonstrated both signs of Cushing's syndrome and high catecholamine levels. Following stabilization of vital parameters and serum electrolytes, the adrenal mass was resected surgically and was found to harbor an adrenocorticotropic hormone secreting pheochromocytoma. This is the first documented case of adrenocorticotropic hormone secreting pheochromocytoma complicated by glucocorticoid induced pheochromocytoma crisis.
Conclusion:
Care should be taken when administering high doses of glucocorticoids to patients with suspected pheochromocytoma, even in a patient with concomitant Cushing's syndrome.
Recurrent Lobar Hemorrhages and Multiple Cortical Superficial Siderosis in a Patient of Alzheimer's Disease With Homozygous APOE ε2 Allele Presenting Hypobetalipoproteinemia and Pathological Findings of 18F-THK5351 Positron Emission Tomography: A Case Report
Authors: Masaki Ikeda, Koichi Okamoto, Keiji Suzuki, Eriko Takai, Hiroo Kasahara, Natsumi Furuta, Minori Furuta, Yuichi Tashiro, Chisato Shimizu, Shin Takatama, Isao Naito, Mie Sato, Yasujiro Sakai, Manabu Takahashi, Masakuni Amari, Masamitsu Takatama, Tetsuya Higuchi, Yoshito Tsushima, Hideaki Yokoo, Masahiko Kurabayashi, Shun Ishibashi, Kenji Ishii, Yoshio Ikeda
Journal: Front Neurol (2021)
Keywords: 11c-pib pet, 18f-thk5351 pet, alzheimer's disease, apolipoprotein ϵ allele, cerebral amyloid angiopathy, cortical superficial siderosis, hypobetalipoproteinemia, recurrent lobar brain hemorrhages
MeSH terms: Case Reports

In Alzheimer's disease, the apolipoprotein E gene (APOE) ε2 allele is a protective genetic factor, whereas the APOE ε4 allele is a genetic risk factor. However, both the APOE ε2 and the APOE ε4 alleles are genetic risk factors for lobar intracerebral hemorrhage. The reasons for the high prevalence of lobar intracerebral hemorrhage and the low prevalence of Alzheimer's disease with the APOE ε2 allele remains unknown. Here, we describe the case of a 79-year-old Japanese female with Alzheimer's disease, homozygous for the APOE ε2 allele. This patient presented with recurrent lobar hemorrhages and multiple cortical superficial siderosis. The findings on the 11C-labeled Pittsburgh Compound B-positron emission tomography (PET) were characteristic of Alzheimer's disease. 18F-THK5351 PET revealed that the accumulation of 18F-THK 5351 in the right pyramidal tract at the pontine level, the cerebral peduncle of the midbrain, and the internal capsule, reflecting the lesions of the previous lobar intracerebral hemorrhage in the right frontal lobe. Moreover, 18F-THK5351 accumulated in the bilateral globus pallidum, amygdala, caudate nuclei, and the substantia nigra of the midbrain, which were probably off-target reaction, by binding to monoamine oxidase B (MAO-B). 18F-THK5351 were also detected in the periphery of prior lobar hemorrhages and a cortical subarachnoid hemorrhage, as well as in some, but not all, areas affected by cortical siderosis. Besides, 18F-THK5351 retentions were observed in the bilateral medial temporal cortices and several cortical areas without cerebral amyloid angiopathy or prior hemorrhages, possibly where tau might accumulate. This is the first report of a patient with Alzheimer's disease, carrying homozygous APOE ε2 allele and presenting with recurrent lobar hemorrhages, multiple cortical superficial siderosis, and immunohistochemically vascular amyloid β. The 18F-THK5351 PET findings suggested MAO-B concentrated regions, astroglial activation, Waller degeneration of the pyramidal tract, neuroinflammation due to CAA related hemorrhages, and possible tau accumulation.
Case Report: Gut and spleen anomalies associated with DYRK1A syndrome
Authors: I Infantino, F Tocchioni, M Ghionzoli, R Coletta, F Morini, A Morabito
Journal: Front Pediatr (2023)
Keywords: dyrk1a, gut abnormalities, intestinal obstruction, spleen abnormalities, splenectomy
MeSH terms: Case Reports

DYRK1A syndrome has been extensively studied primarily with regard to neurologic and other phenotypic features such as skeleton and craniofacial alterations. In the present paper, we aim to highlight unusual anomalies associated with a DYRK1A mutation: a 17-year-old female patient with language and cognitive delay, microcephaly, and an autistic disorder, who was operated upon for spleen torsion with anomalous gut fixation.
Hemoperitoneum caused by spontaneous rupture of hepatocellular carcinoma in noncirrhotic liver. A case report and systematic review
Authors: Nicola Tartaglia, Alessandra Di Lascia, Pasquale Cianci, Alberto Fersini, Mario Pacilli, Giovanna Pavone, Antonio Ambrosi
Journal: Open Med (Wars) (2020)
Keywords: hemoperitoneum, hepatocellular carcinoma, noncirrhotic liver, staged hepatectomy, transcatheter arterial embolization
MeSH terms: Review

Introduction:
Hepatocellular carcinoma (HCC) is the sixth most common cancer. Spontaneous rupture of HCC is an acute complication with a high mortality rate. The HCC principally arises in the background of chronic liver disease and cirrhosis of the liver. In the last few years, the rising incidence of HCC in noncirrhotic liver suggests the presence of other factors that may play a role in liver carcinogenesis.
Methods:
We reviewed all cases treated at the University Surgical Department of Ospedali Riuniti of Foggia from 2009 to 2018. Only a single case of hemoperitoneum caused by spontaneous rupture of HCC in noncirrhotic liver was found. An extensive search of the relevant literature was carried out using MEDLINE, and a total of 58 published studies were screened from the sources listed.
Conclusions:
The management of this devastating emergency should be carefully analyzed, with stabilization of vital signs as soon as possible. Patient with ruptured HCC and hemoperitoneum without a prior history of cirrhosis and viral infections benefited from the role of transcatheter arterial embolization (TAE) as the preliminary treatment in order to have a more precise diagnosis and an optimal stabilization of the patient. Delayed or staged hepatectomy after TAE represents the definitive treatment.
Recurrent subacute visual loss presenting in a 52-year-old Caucasian woman with chronic relapsing inflammatory optic neuropathy: a case report
Authors: Amrit Samra, Jason Ramtahal
Journal: J Med Case Rep (2012)

Introduction:
Chronic relapsing inflammatory optic neuropathy is a recently described form of recurrent isolated subacute optic neuropathy. The condition is highly responsive to systemic steroid treatment and prone to relapse on steroid withdrawal. A complete work up for demyelination, autoimmune disease and sarcoidosis must be made before considering chronic relapsing inflammatory optic neuropathy.
Case presentation:
We describe the case of a 52-year-old Caucasian woman who presented with isolated subacute optic neuropathy. There was no evidence of demyelination, autoimmunity or sarcoidosis. There was an abrupt and prompt response to systemic corticosteroids and a relapse of the condition on steroid withdrawal.
Conclusions:
Chronic relapsing inflammatory optic neuropathy requires careful consideration and differentiation from demyelinating optic neuritis and ischemic optic neuropathy since the treatment is different and the outcome without treatment is likely to be poor. The importance of identifying these patients has considerable clinical implications as the condition is highly responsive to steroids.
A noval approach of altered cast technique in bilateral partial maxillectomy patient with severely restricted mouth opening
Authors: Shuchi Tripathi, Pooran Chand, Raghuwar D Singh, Ramashankar Siddharth, Balendra P Singh
Journal: ISRN Dent (2011)
MeSH terms: Case Reports

Patients with extensive head and neck injuries due to trauma and/or extensive surgical procedures often exhibit a severely limited ability to open the mouth. For the dentist involved in prosthodontic treatment of such patients, restricted mouth opening commonly leads to compromised impressions and prostheses especially in cases where both hard and soft palatal parts have been resected. In prosthodontic treatment, the loaded impression tray is the largest item requiring intraoral placement. During impression procedures, wide mouth opening is required for proper tray insertion and alignment. This is not possible in patients with restricted mouth opening, so a modification of the standard impression procedure is often necessary to accomplish this fundamental step in the fabrication of a successful prosthesis. An alteration in the final impression procedure was made using altered cast technique for fabricating an obturator prosthesis with soft palate extension, and the result obtained was quite satisfactory.
Neurological symptoms in a patient with isolated adrenocorticotropin deficiency: case report and literature review
Authors: Yukihiro Goto, Kazunori Tatsuzawa, Kazuyasu Aita, Yuichi Furuno, Takuya Kawabe, Kei Ohwada, Hiroyasu Sasajima, Katsuyoshi Mineura
Journal: BMC Endocr Disord (2016)
MeSH terms: Adrenocorticotropic Hormone / deficiency, Endocrine System Diseases / complications, Genetic Diseases, Inborn / complications, Hypoglycemia / complications, Nervous System Diseases / etiology, Case Reports, Review, Aged, Diagnosis, Differential, Endocrine System Diseases / diagnosis, Endocrine System Diseases / psychology, Female, Gait Disorders, Neurologic / diagnosis, Gait Disorders, Neurologic / etiology, Genetic Diseases, Inborn / diagnosis, Genetic Diseases, Inborn / psychology, Humans, Hydrocephalus, Normal Pressure / diagnosis, Hydrocephalus, Normal Pressure / etiology, Hypoglycemia / diagnosis, Hypoglycemia / psychology, Magnetic Resonance Imaging, Nervous System Diseases / diagnosis, Adrenocorticotropic Hormone, ACTH Deficiency, Isolated

Background:
Isolated adrenocorticotropic hormone (ACTH) deficiency is a pituitary disorder characterized by reduction only in the secretion of ACTH. Although the underlying mechanism remains to be elucidated, numbers of cases with this entity have been increasing. We experienced a case presenting with gait disturbance necessitating differential diagnosis from idiopathic normal pressure hydrocephalus (iNPH).
Case presentation:
A 69-year-old female with a complaint of difficulty walking and suspected to have iNPH at a prior hospital was referred to our department. For the prior three years, she had suffered from a progressive gait disturbance. Magnetic resonance imaging (MRI) revealed global ventricular dilatation. The typical features of the gait in iNPH cases were all identifiable. Neuropsychological dementia scale tests showed deterioration. However, the major feature of a disproportionately enlarged subarachnoid-space on MRI was not obvious. The patient developed progressively worsening fatigue during hospitalization. Her symptoms resembled those of hypothalamic-pituitary tumor patients. Serum ACTH and cortisol levels were low. While corticotrophin releasing hormone stress tests showed no response, other stress tests using thyrotropin releasing hormone, luteinizing hormone releasing hormone, and growth hormone releasing hormone yielded normal responses, indicating a diagnosis of isolated ACTH deficiency. We initiated corticosteroid therapy, and her gait disturbance improved promptly.
Conclusion:
Isolated ACTH deficiency may have major significance to the differential diagnosis of iNPH. Early consideration of this entity is anticipated to facilitate making an early diagnosis.
CASE REPORT Temporomandibular Joint Arthroplasty With Human Amniotic Membrane: A Case Report
Authors: Florian Bauer, Lukas M Hingsammer, Klaus-Dietrich Wolff, Marco R Kesting
Journal: Eplasty (2013)

This case reports the usage of human amniotic membrane combined with a costochondral graft as an interpositional material in temporomandibular joint reconstruction for the first time in humans. Because of the favorable outcome 20 months postoperatively, it has to be considered as an approach bringing to light the antiadhesive potential of amniotic membrane. This case report must be regarded as initial spadework and should motivate other institutions to intensify their clinical research in this field. Because of the fact that currently used interpositional materials do not prevent the recurrence of temporomandibular joint ankylosis sufficiently, it is of great interest to establish a proper therapeutic intervention fulfilling these demands. Furthermore, the demonstrated antiadhesive properties of amniotic membrane highlight its multifaceted field of application. Nevertheless, further studies have to prove the findings reported in our case.
Esophageal perforation by tilapia fish bone ingestion - A case report
Authors: Radisnay Guzman Lambert, Seth Kwadjo Angmorterh, Manuel Betancourt Benjamin, Mariuska Rodriguez Gonzalez, Sonia Aboagye, Eric Kwasi Ofori
Journal: Int J Surg Case Rep (2020)
Keywords: case report, esophageal perforation, minimally invasive, tilapia fish bone, ultrasound, x-ray
MeSH terms: Case Reports

Introduction:
Esophageal perforation (EP) is a rare, severe and challenging surgical emergency which can be caused by several factors. This report presents the case of a patient with EP caused by ingestion of a Tilapia fish bone.
Presentation of case:
A 41-year-old male patient presented with a six-day history of painful right-sided neck swelling, associated with a progressive dysphagia, regurgitation, fever and chills. Physical examination revealed an axillary temperature of 39 °C and a subcutaneous emphysema in the neck. Cervical spine x-ray and ultrasound scan revealed a neck foreign body with abscess. The case was managed by a right cervicotomy.
Discussion:
Despite over 20-years of clinical experience in Ghana, this was the first case of EP caused by a 2 cm long Tilapia fish bone, to be treated by the authors. This is significant because tilapia consumption is very popular in Ghana and it would be predicted that such cases would be more common. It is suggested that such cases do occur more frequently but are not reported to hospitals due to cultural-spiritual beliefs.
Conclusion:
Ingestion of Tilapia fish bones can cause significant damage to the esophagus and Tilapia should be consumed with care. Ultrasound is a very useful tool with high diagnostic accuracy for EP. Further studies are needed to establish the prevalence of EP from fish bone ingestion in Ghana and the factors accounting for the mismatch between the high consumption of Tilapia across the population and the low occurrence of patients presenting with EP from fish bone ingestion.
Multiple Myeloma Breast Involvement: A Case Report
Authors: Heba O E Ali, Zafar Nasir, Ahmed M S M Marzouk
Journal: Case Rep Radiol (2019)
MeSH terms: Case Reports

Multiple Myeloma involving the breast is very rare and the diagnosis is challenging because the clinical and radiological features of breast multiple myeloma are indistinguishable to other forms of breast disease whether primary or metastatic. In this article the authors report a case presented with breast masses, which were found to be extra osseous Multiple Myeloma. The patient was managed for multiple spinal lesions that were primarily thought to be metastasis from primary breast cancer.
Mycobacterium marinum infection: a case report
Authors: Christiane Salgado Sette, Patrick Alexander Wachholz, Paula Yoshiko Masuda, Renata Borges Fortes da Costa Figueira, Fernanda Rodrigues de Oliveira Mattar, Deise Godoy Ura
Journal: J Venom Anim Toxins Incl Trop Dis (2015)
Keywords: case report, granuloma, mycobacterium infections, mycobacterium marinum
MeSH terms: Case Reports

The infection by Mycobacterium marinum in humans is relatively uncommon. When it occurs, it mainly affects the skin, usually with a chronic, indolent and benign evolution. The diagnosis requires a high index of suspicion, and a significant delay may be observed between the first symptoms to the final diagnosis. This present case reports a M. marinum infection in an immunocompetent patient that had a chronic undiagnosed injury on the dominant hand for at least five years. The patient had several medical consultations, without proper suspicion, hampering adequate diagnostic investigation. Histopathology detected tuberculoid granulomas, but showed no acid-fast bacilli. The culture in appropriate medium and the polymerase chain reaction-restriction enzyme analysis (PRA)-hsp65 confirmed the diagnosis. Treatment with clarithromycin (1 g/day) for three months was effective. Although uncommon, this infection is a contact zoonosis. Therefore, it is important for clinicians to be aware of this diagnosis and properly guide preventable measures to professionals that are in risk group.
ANCA vasculitis: A manifestation of Post-Covid-19 Syndrome
Authors: Desiree Morris, Kushal Patel, Osman Rahimi, Omar Sanyurah, Alfredo Iardino, Nazia Khan
Journal: Respir Med Case Rep (2021)
Keywords: anca-associated vasculitis, covid-19, renal medicine, respiratory medicine
MeSH terms: Case Reports

The SARS-CoV-2 infection has been found to present with different degrees of response and variable levels of inflammation. Patients who have recovered from the initial infection can develop long-term symptomatology. We present a unique case of a middle aged-healthy man who developed complications of ANCA-associated vasculitis after recovering from a mild COVID-19 infection. A previously healthy 53-year-old male presented with hemoptysis and acute renal failure. One month prior, the patient tested positive for COVID-19; not requiring hospitalization. Physical exam findings included bilateral lower extremity petechiae. CT Chest showed bilateral diffuse patchy lung consolidations with cavitary lesions with urinalysis revealing erythrocytes, +1 protein. Hemodialysis and workup for pulmonary-renal syndromes were initiated. Infectious workup results included: negative COVID-19, negative MTB-PCR, respiratory culture revealing yeast. Additional workup revealed; elevated CRP, D-Dimer, and Fibrinogen. Notably, the patient had; decreased C3 and C4 levels; negative Anti-GBM antibody; negative Anti-streptolysin-O; and positive ANCA assay, Proteinase antibody, and mildly positive Myeloperoxidase antibody. Worsening coagulopathy and atrophic kidneys delayed renal biopsy for definitive diagnosis. The patient's respiratory status acutely worsened during hemodialysis with imaging showing markedly increased pulmonary infiltrates. Upon urgent intubation, active frank red bleeding was noted, and the patient sustained 2 cardiac arrests with eventual expiration. Much is to be learned from the Novel SARS-CoV-2 virus and suspected complications. This case highlights a unique complication of COVID-19 leading to a possible AAV and the importance of keeping a broad differential when treating patients who have recovered from the initial infection.
Enterococcal meningitis caused by Enterococcus casseliflavus. First case report
Authors: Chiara Iaria, Giovanna Stassi, Gaetano Bruno Costa, Rita Di Leo, Antonio Toscano, Antonio Cascio
Journal: BMC Infect Dis (2005)
MeSH terms: Cerebrospinal Fluid / microbiology, Enterococcus / isolation & purification, Gram-Positive Bacterial Infections / microbiology, Meningitis, Bacterial / microbiology, Sigmoid Diseases / complications, Case Reports, Aged, Ampicillin / administration & dosage, Anti-Bacterial Agents / administration & dosage, Enterococcus / drug effects, Female, Gram-Positive Bacterial Infections / drug therapy, Gram-Positive Bacterial Infections / etiology, Humans, Meningitis, Bacterial / drug therapy, Meningitis, Bacterial / etiology, Meropenem, Microbial Sensitivity Tests, Sulbactam / administration & dosage, Thienamycins / administration & dosage, Anti-Bacterial Agents, Thienamycins, sultamicillin, Ampicillin, Meropenem, Sulbactam

Background:
Enterococcal meningitis is an uncommon disease usually caused by Enterococcus faecalis and Enterococcus faecium and is associated with a high mortality rate. Enterococcus casseliflavus has been implicated in a wide variety of infections in humans, but never in meningitis.
Case presentation:
A 77-year-old Italian female presented for evaluation of fever, stupor, diarrhea and vomiting of 3 days duration. There was no history of head injury nor of previous surgical procedures. She had been suffering from rheumatoid arthritis for 30 years, for which she was being treated with steroids and methotrexate. On admission, she was febrile, alert but not oriented to time and place. Her neck was stiff, and she had a positive Kernig's sign. The patient's cerebrospinal fluid was opalescent with a glucose concentration of 14 mg/dl, a protein level of 472 mg/dl, and a white cell count of 200/muL with 95% polymorphonuclear leukocytes and 5% lymphocytes. Gram staining of CSF revealed no organisms, culture yielded E. casseliflavus. The patient was successfully treated with meropenem and ampicillin-sulbactam.
Conclusions:
E. casseliflavus can be inserted among the etiologic agents of meningitis. Awareness of infection of central nervous system with Enterococcus species that possess an intrinsic vancomycin resistance should be increased.
An Unusual Case of Type 1 Narcolepsy in an Ethiopian Patient
Authors: Asefa Mekonnen, Gregory Stimac
Journal: Ethiop J Health Sci (2021)
Keywords: ethiopia, narcolepsy, polysomnogram, sleep disorders
MeSH terms: Cataplexy, Narcolepsy / diagnosis, Neuropeptides, Case Reports, Adult, Female, Humans, Intracellular Signaling Peptides and Proteins, Quality of Life, Intracellular Signaling Peptides and Proteins, Neuropeptides

Background:
Narcolepsy is a chronic disabling central neurological disorder of daytime hypersomnia. It is categorized into two subtypes-type 1 (N1) and type 2 (N2). Symptoms of N1 commonly include excessive daytime sleepiness (EDS), cataplexy, sleep paralysis, hypnogogic/hypnopompic hallucinations, and disturbed nighttime sleep. Ethnic differences have been observed, but they have not been reported in an Ethiopian patient to date.
Case detail:
We report a 39-year-old Ethiopian patient with type 1 narcolepsy whose diagnosis was delayed for three decades despite severe symptoms. Her quality of life was significantly impaired and included EDS, sleep fragmentation, and depression. The mean sleep latency (MSL) for five naps was 1.3 minutes. Sleep-onset rapid eye movement (REM) periods (SOREMPs) were present in all five nap periods. HLA-typing and a CSF hypocretin level testing were not performed. Modafinil 300mg was prescribed, which improved her quality of life.
Conclusion:
In developing countries where diagnostic studies are not available, practitioners should pay special attention to a detailed history and look for classic symptoms of narcolepsy to establish an early diagnosis and improve quality of life.