OpenMed/multicare-articles huggingface dataset:
Late-Onset OCD as a Potential Harbinger of Dementia With Lewy Bodies: A Report of Two Cases
Authors: Solène Frileux, Bruno Millet, Philippe Fossati
Journal: Front Psychiatry (2020)
Keywords: behavioral psychological symptoms of dementia, dementia with lewy bodies, late-onset, neuropsychiatric disorders, obsessive-compulsive disorder
MeSH terms: Case Reports

Objectives:
Obsessive-compulsive disorder usually begins in adolescence or young adulthood. OCD cases appearing after the age of 50 years are rare, most often associated with inflammatory, brain lesions, or neurodegenerative comorbidities. We describe two cases of late-onset obsessive compulsive disorder followed by the development of Dementia with Lewy Bodies and review the links between these two disorders.
Methods and results:
We describe the clinical history of two patients that first showed OCD symptoms at an atypical age (>60 years). After several failed treatment attempts, they were hospitalized in our unit. Both presented severe sensitivity to antipsychotic agents that led to a diagnosis of Dementia with Lewy Bodies. Administration of cholinesterase inhibitors was associated with decrease of psychiatric symptoms in both cases. In addition to those clinical observations, a systematic review of the literature suggests that, beyond prefrontal cortex, temporal lobe and putamen have important roles in OCD pathophysiology. Based on these findings, we discuss four hypotheses to explain the sequential appearance of OCD and DLB symptoms. First, we considered the possibility that comorbidity of OCD with DLB was coincidental. Second, we propose to interpret OCD symptoms as motor stereotypies. Third, we hypothesize that late-onset OCD might be a symptom of late-onset depression. Four, we hypothesize that through early deterioration of basal ganglia, DLB caused the onset of OCD.
Conclusion:
In conclusion, we recommend that cases of late-onset treatment-resistant OCD should be carefully tested for possible organic etiologies, and for DLB in particular.
Functional Treatment of a Child with Extracapsular Mandibular Fracture
Authors: Diana Cassi, Marisabel Magnifico, Chiara Di Blasio, Mauro Gandolfini, Alberto Di Blasio
Journal: Case Rep Dent (2017)
MeSH terms: Case Reports

Condylar fractures are among the most frequent fractures in the context of traumatic lesions of the face. The management of condylar fractures is still controversial, especially when fractures occur in children: if overlooked or inappropriately treated, these lesions may lead to severe sequelae, both cosmetic and functional. The therapy must be careful because severe long-term complications can occur. In this case report, the authors present a case of mandibular fracture in which the decision between surgical therapy and functional therapeutic regimen may be controversial due to the particular anatomy of the fracture line and the age of the patient.
Persistent Hypoglossal Artery as a Potential Risk Factor for Simultaneous Carotid and Vertebrobasilar Infarcts
Authors: Xingyi Jin, Libo Sun, Zheng Feng, Xiaodong Li, Hongyan Zhang, Ke Meng, Weidong Yu, Chao Fu
Journal: Front Neurol (2018)
Keywords: atherosclerosis, carotid artery, ischemia, persistent hypoglossal artery, risk factor, vertebrobasilar artery
MeSH terms: Case Reports

Persistent hypoglossal artery (PHA), a rare embryological carotid-basilar anastomosis, is usually accompanied by hypoplastic vertebral and posterior communicating arteries, and thereby such vascular anomaly serves as the main feeder supplying the vertebrobasilar territory. Although rarely reported, simultaneous anterior and posterior territory infarcts related to PHA and carotid atherosclerosis can occur. To date, as far as we know, only 4 such cases have been previously reported in the literature. Here, we present the case of a 65-year-old female with a PHA and carotid atherosclerotic plaques, who developed acute multiterritorial infarcts involving the left carotid and vertebrobasilar territories. This case highlights that such a persistent anastomosis should be considered when multiple infarcts involving the anterior and posterior territories are encountered, and should be kept in mind when dealing with carotid atherosclerotic lesion.
A Case of Pelvic Abscess Caused by Edwardsiella tarda followed by Laparoscopic Resection of a Hematoma Derived from Caesarean Section
Authors: Koji Yamanoi, Koji Yasumoto, Jumpei Ogura, Takahiro Hirayama, Koh Suginami
Journal: Case Rep Infect Dis (2018)
MeSH terms: Case Reports

Edwardsiella tarda (E. tarda) infections are rare and can be fatal. We report a case of an E. tarda abscess which developed in the hematoma originally derived from a caesarean section. A 24-year-old gravida 1 woman was admitted to our hospital with a complaint of abdominal pain. Approximately one month before her admission, pelvic hematoma had developed derived from caesarean section. Followed by the failure of conservative management, she underwent laparoscopic surgery to remove the hematoma 6 days before her admission. On computed tomography examination, we found that the abscess with a diameter of 9 cm was located in the right pelvic space. We punctured the abscess and identified E. tarda in the abscess. We continued administering antibiotics, but her symptoms, including fever and abdominal pain, became worse, and the abscess enlarged. We performed laparotomy drainage and ileocecal resection on the 10th posthospitalization day. After drainage surgery, the patient's condition improved gradually, and the patient was discharged uneventfully. There are no reports in patients of E. tarda infection during the perinatal period. E. tarda infection can be a life-threatening illness even in immunocompetent patients. In the case of E. tarda infection, intensive care and surgical procedures should be considered.
Traumatic rupture of a non-parasitic simple hepatic cyst presenting as an acute surgical abdomen: Case report
Authors: Jinyoung Park
Journal: Int J Surg Case Rep (2019)
Keywords: deroofing, nonparasitic simple hepatic cyst, rupture

Introduction:
Non-parasitic simple hepatic cyst is a very common type of benign liver disease, occurring in approximately 1-5% of the general population. These cysts are usually asymptomatic and are conservatively followed up without treatment. Some of these cysts, however, are associated with complications, including infection, hemorrhage, obstructive jaundice, portal hypertension, and rupture.
Presentation of case:
A 74-year-old woman was transferred to our trauma center with epigastric pain after being knocked down by a cultivator. An abdominal computed tomography (CT) scan showed fluid collection and cystic lesion around the caudate lobe of the liver. Operative exploration showed that she had a ruptured hepatic cyst that originated from the caudate lobe of the liver. The cyst was deroofed to the margins of the liver parenchyma, and the internal surfaces of the cyst walls was subjected to electrocoagulator ablation.
Discussion:
Open or laparoscopic cyst deroofing is a safe and effective treatment for non-parasitic simple hepatic cysts. Laparoscopic deroofing may also be difficult following rupture of non-parasitic simple hepatic cysts associated with infection or hemorrhage, as these cysts may collapse and the line of resection may be unclear. Laparoscopic ultrasound is a useful adjunct to delineate the boundaries of the cyst.
Conclusion:
Traumatic rupture of a non-parasitic simple hepatic cyst is a very rare complication, but can lead to acute abdomen. In patients who are known to have non-parasitic simple hepatic cyst, rupture of cyst could be included in the differential diagnosis of acute abdomen.
Case Report: Monitoring Vancomycin Concentrations and Pharmacokinetic Parameters in Continuous Veno-Venous Hemofiltration Patients to Guide Individualized Dosage Regimens: A Case Analysis
Authors: Jihui Chen, Xiaohui Huang, Zhiyan Lin, Chao Li, Haoshu Ding, Junming Du, Lixia Li
Journal: Front Pharmacol (2021)
Keywords: area under the curve, continuous renal replacement therapy, kidney failure, therapeutic drug monitoring, vancomycin
MeSH terms: Case Reports

There are limited pharmacokinetic (PK) studies on vancomycin in patients treated with continuous renal replacement therapy (CRRT), and the results have been inconsistent. Because of individual differences, proposing a definite recommendation for the clinical regimen is not possible. Rapidly reaching target vancomycin concentrations will facilitate effective treatment for critically ill patients treated with CRRT. In this study, to understand the dynamic change in drug clearance rates in vivo, analyze the effect of PK changes on drug concentrations, and recommend loading and maintenance dosage regimens, we monitored the blood concentrations of vancomycin and calculated the area under the curve in two critically ill patients treated with vancomycin and continuous veno-venous hemofiltration (CVVH). On the basis of real-time therapeutic drug monitoring results and PK parameters, an individualized vancomycin regimen was developed for patients with CVVH. Good clinical efficacy was achieved, which provided support and reference for empirical vancomycin therapy in these patients.
Liquid Biopsy Detects Relapse Five Months Earlier than Regular Clinical Follow-Up and Guides Targeted Treatment in Breast Cancer
Authors: Fiona Tsui-Fen Cheng, Nina Lapke, Chin-Chu Wu, Yen-Jung Lu, Shu-Jen Chen, Pei-Ning Yu, Yen-Ting Liu, Kien Thiam Tan
Journal: Case Rep Oncol Med (2019)
MeSH terms: Case Reports

Genetic alterations in circulating tumor DNA (ctDNA) are an emerging biomarker for the early detection of relapse and have the potential to guide targeted treatment. ctDNA analysis is often performed by droplet digital PCR; however, next-generation sequencing (NGS) allows multigene testing without having to access a tumor sample to identify target alterations. Here, we report the case of a stage III hormone receptor-positive breast cancer patient who remained symptomless after receiving surgery and adjuvant chemotherapy. Liquid biopsy analysis by NGS revealed the presence of a ctDNA PIK3CA N345K mutation five months before the detection of relapse with multiple liver metastases by regular clinical follow-up. To date, clinical implications of the PIK3CA N345K variant remain insufficiently investigated; however, everolimus treatment resulted in the shrinkage of tumor lesions and decreased the levels of tumor markers. Four months after treatment initiation, a second ctDNA analysis suggested a relapse, and the patient clinically progressed after five months of everolimus therapy. This case report demonstrates the value of ctDNA analysis by NGS for the early detection of relapse in breast cancer patients. The study further indicates its usefulness for the choice of targeted treatments, suggesting that the variant PIK3CA N345K might be associated with everolimus sensitivity.
Percutaneous Cava Stenting in a Dog with Symptomatic Azygos Continuation of the Caudal Vena Cava
Authors: Giovanna Bertolini, Marco Caldin
Journal: Case Rep Vet Med (2020)
MeSH terms: Case Reports

This report describes the successful placement of a nitinol stent within the azygos continuation of the caudal vena cava in a 2-year-old, neutered female, English Bulldog with clinical and imaging signs related to venous return chronic obstruction, renal venous thrombi, and chronic renal insufficiency. This noninvasive, interventional radiology procedure was safe and clinically effective for the patient. The clinical signs were rapidly eliminated, and three years later, the patient is still in good clinical condition, with normal renal function. Venous stenting appears to be a useful, new, minimally invasive treatment option for symptomatic cavo-azygos vascular connection.
Case Report: Enhanced Diazepam Elimination With the Molecular Adsorbents Recirculating System (MARS) in Severe Autointoxication: A Survival Case Report
Authors: Anna Dobisova, Peter Vavrinec, Diana Vavrincova-Yaghi, Andrea Gebhardtova, Robert H Henning, Aktham Yaghi
Journal: Front Med (Lausanne) (2021)
Keywords: autointoxication, diazepam, elimination, mars, pharmacokinetics
MeSH terms: Case Reports

Objective: Due to the extensive use of diazepam worldwide, self-induced intoxication is very common, yet rarely fatal. Nevertheless, the management of intoxication caused by extremely high doses of diazepam is not known, as well as the effectiveness of flumazenil, a specific benzodiazepine (BDZ) antagonist. Here we present the first report on the enhanced elimination (clearance) of diazepam using the Molecular Adsorbents Recirculating System (MARS) following autointoxication with an extremely high dose as part of a suicide attempt. Case: A 44-year-old male patient was admitted to the ICU because of impaired consciousness following the ingestion of 20 g of diazepam. Blood and urine samples revealed high benzodiazepine levels. Repeated doses of flumazenil were without effect on consciousness. Following deterioration of the patient's clinical condition, including unconsciousness, hypoventilation, and decreased SpO2 (88%), the patient was intubated and mechanically ventilated. On the fourth day after admission, the patient was unresponsive, with no attempt to breath spontaneously. The plasma level of benzodiazepines was 1,772 μg/l. The elimination of benzodiazepines by MARS was attempted, continuing for 5 days, with one session per day. Five sessions of MARS effectively enhanced benzodiazepine elimination. After the first MARS treatment, the plasma level of benzodiazepines dropped from 1,772 to 780 μg/l. After the final MARS treatment on the eighth day, the patient was weaned from mechanical ventilation and extubated. Two days later, the patient was discharged to the internal medicine department and subsequently to the psychiatry department. Conclusions: To the best of our knowledge, this is the first case reporting successful treatment of diazepam intoxication using MARS. In severe cases of diazepam intoxication, with prolonged unconsciousness and the necessity of mechanical ventilation, we suggest considering the use of MARS elimination therapy together with the monitoring of the BDZ plasma level.
Metagenomic Next-Generation Sequencing in the Diagnosis of HHV-1 Reactivation in a Critically Ill COVID-19 Patient: A Case Report
Authors: Lei Shi, Han Xia, Matthew D Moore, Chao Deng, Na Li, Hui Ren, Yunru Chen, Jinfeng Liu, Fenjing Du, Gezhi Zheng, Jing Li, Qunying Han, Wanhu Fan, Feng Ye, Shumei Lin, Zhengwen Liu, Hongjuan Liu, Yawen Wang, Jian Yang, Qingguang Liu, Yingren Zhao, Tianyan Chen
Journal: Front Med (Lausanne) (2021)
Keywords: covid-19, hhv-1, case report, diagnosis, metagenomic next-generation sequencing (mngs)
MeSH terms: Case Reports

Background: Secondary infections pose tremendous challenges in Coronavirus disease 2019 (COVID-19) treatment and are associated with higher mortality rates. Clinicians face of the challenge of diagnosing viral infections because of low sensitivity of available laboratory tests. Case Presentation: A 66-year-old woman initially manifested fever and shortness of breath. She was diagnosed as critically ill with COVID-19 using quantitative reverse transcription PCR (RT-qPCR) and treated with antiviral therapy, ventilator and extracorporeal membrane oxygenation (ECMO). However, after the condition was relatively stabled for a few days, the patient deteriorated with fever, frequent cough, increased airway secretions, and increased exudative lesions in the lower right lung on chest X-rays, showing the possibility of a newly acquired infection, though sputum bacterial and fungal cultures and smears showed negative results. Using metagenomic next-generation sequencing (mNGS), we identified a reactivation of latent human herpes virus type 1 (HHV-1) in the respiratory tract, blood and gastrointestinal tract, resulting in a worsened clinical course in a critically ill COVID-19 patient on ECMO. Anti-HHV-1 therapy guided by these sequencing results effectively decreased HHV-1 levels, and improved the patient's clinical condition. After 49 days on ECMO and 67 days on the ventilator, the 66-year-old patient recovered and was discharged. Conclusions: This case report demonstrates the potential value of mNGS for evidence-based treatment, and suggests that potential reactivation of latent viruses should be considered in critically ill COVID-19 patients.
High-Throughput Sequencing Reveals the Loss-of-Function Mutations in GALT Cause Recessive Classical Galactosemia
Authors: Lulu Li, Li Ma, Min Sun, Jiancheng Jiao, Yudong Zhang, Yue Tang, Nan Yang, Yuanyuan Kong
Journal: Front Pediatr (2020)
Keywords: chinese patient, gatl, autosomal recessive (ar), classical galactosemia (cg), gene mutation, hepatomegaly, high-throughput sequencing, mutation spectrum
MeSH terms: Case Reports

Background: Classical Galactosemia (CG) is a rare autosomal recessive metabolic disease caused by mutations in the galactose-1-phosphate uridyl transferase (GALT) gene. This study aim to identify pathogenic mutations underlying classic galactosemia in two Chinese families. Methods: We collected blood samples from two Chinese families and extracted genomic DNA. High-throughput sequencing, sanger sequencing, and bioinformatics analysis were used to investigate the molecular cause of manifestations in the two Chinese families. Results: We found compound heterozygous mutations (c.396C>G; p.His132Gln and c.974C>T; p.Pro325Leu) in family 1 and a homozygous missense variant (c.974C>T; p.Pro325Leu) in family 2. Bioinformatics and Sanger sequencing were performed to verify the identified variants. Conclusion: The present study identified the GALT mutations as a genetic etiology in the two Chinese families with classic galactosemia and expanded the phenotypic and mutational spectrum of GALT. Our findings could be useful in providing evidence for prenatal interventions and more precise pharmacological treatments to patients. High-throughput sequencing conducted in our study is a convenient and useful tool for clinical diagnosis of galactosemia and other associated genetic disorders.
Cutaneous candidiasis mimicking acute generalized exanthematous pustulosis: A case report
Authors: Emily Seale, Alison Spurr, Iris Teo, Steven J Glassman
Journal: SAGE Open Med Case Rep (2023)
Keywords: candidiasis, drug eruption, immunosuppression, pustulosis
MeSH terms: Case Reports

Disseminated cutaneous candidiasis is a rare manifestation of candidiasis that arises most commonly from Candida albicans. It is described as a widespread erythematous papulopustular skin infection that typically affects premature newborns or immunocompromised patients. While candidal infections usually respond well to antifungal therapy, the clinical presentation of disseminated cutaneous candidiasis can often mimic a variety of other dermatologic conditions, that can lead to delayed diagnosis and treatment. We present a 67-year-old comorbid male patient with widespread erythema and superficial pustules resembling acute generalized exanthematous pustulosis (AGEP) that was actually an unexpected manifestation of disseminated cutaneous candidiasis. Prompt initiation of a topical and oral antifungal regimen contributed to marked improvement. Given the high frequency of drug eruptions in comorbid patients receiving multiple medications, alternate diagnoses like infections should be included in the differential diagnosis.
Sudden psychotic episode probably due to meningoencephalitis and Chlamydia pneumoniae acute infection
Authors: Miguel Xavier, Bernardo Correa, Marta Coromina, Nuno Canas, João Guimarães
Journal: Clin Pract Epidemiol Ment Health (2005)

Background:
Since 9% to 20% of all cases of acute psychosis presenting to an Emergency Department (ED) are due to a general medical condition, cautious medical workup should be mandatory in such patients. Differential diagnosis must consider conditions as diverse as renal failure or CNS infection. Acute Chlamydia pneumoniae infection usually causes a self-limited respiratory syndrome. Rarely, acute neurological complications occur, with acute meningoencephalitis most frequently reported. Diagnosis requires a high level of suspicion and is difficult to confirm.
Case report:
We describe a 22 year-old female Caucasian who, three days after a mild pharingitis, developed an acute psychosis with exuberant symptoms interspersed with periods of lucidity, in a background of normal consciousness and orientation. Initial medical and imagiological workup were inconclusive. After 20 days of unsuccessful treatment with antipsychotics she developed a high fever and was re-evaluated medically. Lumbar puncture revealed an inflammatory cerebrospinal fluid. MRI showed irregular thickening and nodularity of the lateral ventricles' lining. An anti-Chlamydia pneumoniae IgM antibody titter of 85 IU/ml was detected. All symptoms cleared after treatment with antibiotics and corticosteroids.
Conclusion:
This is, to our knowledge, the first reported case of acute CP-associated meningoencephalitis manifesting as an acute psychotic episode. It illustrates the principle that non-organic psychiatric syndromes must remain a diagnosis of exclusion in first-time acute psychosis.
Streptococcus canis Bacteremia in a Renal Transplant Recipient
Authors: Syed M H Zaidi, Ambika Eranki
Journal: J Investig Med High Impact Case Rep (2019)
Keywords: bacteremia, renal transplant
MeSH terms: Bacteremia / microbiology, Kidney Transplantation, Streptococcal Infections / diagnosis, Streptococcus / isolation & purification, Case Reports, Humans, Immunocompromised Host, Male, Middle Aged, Transplant Recipients, Streptococcus canis

A middle-aged man presented with fever and shortness of breath. He had significant history of congestive heart disease and received deceased donor renal transplant 2 years prior to presentation. He was febrile and found to have sepsis. His initial blood cultures grew Streptococcus canis. Streptococcus canis causes rare infection in humans, and this is most likely the first case in the renal transplant population.
Sources of metal pollution in the urban atmosphere (A case study: Tuzla, Istabul)
Authors: Abdullah Aksu
Journal: J Environ Health Sci Eng (2015)
Keywords: atmospheric pollution, enrichment factor (ef), metal, tuzla, i̇stanbul

In this study, İstanbul-Tuzla Region atmosphere was selected as the working area for atmospheric pollution. Although the study area seems too local, this region contains shipyards and shipyard-related side product industries. It is also surrounded by aluminum (ASSAN) and copper (SARKUYSAN) facilities and tannery organized industrial district. For determined the atmospheric inputs, the sample collection was carried out as monthly in 2010. Particulate matter was filtered from aerosols via a high volume air sampler. The collected 46 ambient air samples were analyzed for Cr, Fe, Cu, Zn, Cd, Pb and Al using Atomic Absorption Spectrometry (AAS), Flame unit. Additionally, the volume of the air was drawn and meteorological data recorded. Average individual heavy metal concentrations were found as Cd (0.06 ng/m(3)) < Cr (0.09 ng/m(3)) < Zn (0.21 ng/m(3)) < Pb (0.23 ng/m(3)) < Cu (0.48 ng/m(3)). The concentrations of crustal elements Fe and Al were changed between 5.48 ng/m(3), 74 ng/m(3) and 14 ng/m(3), 284 ng/m(3) respectively during the sampling period. Except Cr and Fe anthropogenic contribution was seen on the concentrations of Zn, Cu, Pb and Cd in an increasing order. While the crustal element Fe was not show an appreciable change in concentration, but the Al concentration was display an important change in concentration depending on the wind transportation.