OpenMed/multicare-articles huggingface dataset:
Lyme disease presenting as complete heart block in a young man: Case report and review of pathogenesis
Authors: Maria Chiara Carnazzo, Celine Scholin, Fnu Shweta, Andrew D Calvin
Journal: IDCases (2023)
Keywords: av block, cardiotropism, host factors, lyme carditis, lyme disease, pacemaker
MeSH terms: Case Reports

Lyme carditis is a serious complication of Lyme disease, the most common vector-borne infection in both the United States and Northern Europe. It is a rare manifestation of Lyme disease that primarily affects young adults with a marked 3:1 male-to-female predominance. The presentation of Lyme carditis is heterogenous and often non-specific, although the most common clinical manifestation is AV block, which can be acute in onset and can rapidly progress to complete heart block. We discuss the case of a young adult male with complete heart block as a complication of Lyme infection, presenting with two episodes of syncope without prodromal symptoms months after tick bites. There are several pathogen, host and environmental factors that can play an important role in the epidemiology and pathogenesis of this serious condition that is reversible if treated in a timely manner. It is important for clinicians to be familiar with the presentation and treatment of this infection that is now being observed in a wider geographic distribution so as to avoid serious long-term complications and unnecessary permanent pacemaking implantation.
Gastric Necrosis After Binge Eating in Bulimia: Recovery From Eating Disorder After Total Gastrectomy
Authors: Najate Achamrah, Sébastien Grigioni, Moïse Coëffier, Nadjib Ainseba, Pierre Déchelotte
Journal: Front Psychiatry (2020)
Keywords: binge eating, bulimia, eating disorders, gastrectomy, gastric necrosis
MeSH terms: Case Reports

Background:
Gastric necrosis following acute gastric dilatation is rare but more common in females with eating disorders, such as anorexia nervosa or bulimia, during which patients often alternate restriction and binge eating behaviors.
Case presentation:
A 37-year old female patient with a history of 15 years of bulimia nervosa was admitted to the emergency department 24 h after binge eating. Abdominal Computed Tomography imaging showed major gastric distension reaching the pelvis and compressing the digestive organs. Total gastrectomy was required because of gastric necrosis. The patient reported significant reduction in bulimic symptoms after gastrectomy.
Conclusion:
We discuss here the possible mechanisms underlying this recovery, including changes in gut-derived factors that could mediate eating behavior changes.
A Modified Technique for Laparoscopic Spleen Preserving Distal Pancreatectomy
Authors: Andreas Papatriantafyllou, Theodoros Mavromatis, Theano Demestiha, Dimitrios Filippou, Panagiotis Skandalakis
Journal: Case Rep Surg (2018)
MeSH terms: Case Reports

Spleen preserving laparoscopic distal pancreatectomy is considered as first choice operation for symptomatic benign or small malignant lesions located at the body or tail of the pancreas. The two main surgical techniques that have been proposed and widely adopted for spleen preserving laparoscopic distal pancreatectomy are the Warshaw and Kimura techniques. A novel modified approach for laparoscopic spleen preserving distal pancreatectomy is presented. The technique was initially performed in a 57-year-old female patient with mucinous cystadenoma. Following the surgical planes created by the fascia fusion and the organ rotation during embryogenesis (fascia of Toldt and renal fascia) with the patient in a right lateral decibutus position, the tumor was accessed retroperitoneally, without dividing the gastrocolic ligament and entering the lesser sac. The tail of the pancreas was mobilized anteriorly and medially, the lesion was visually identified and resected, and short gastric and left gastroepiploic vessels were preserved. We present the technical details and tips; we define the surgical anatomy of it and discuss the perioperative course of the patient as well as the possible benefits of the proposed technique. The proposed technique seems to be safe, easy to perform, and may present a promising alternative approach for patients with pancreatic disease that can be treated by laparoscopic pancreatectomy.
Myxedema Coma: A Life-Threatening Condition in Patients Using Pembrolizumab
Authors: Sangeetha Gummalla, Madhura Manjunath, Brian Phillips
Journal: Case Rep Endocrinol (2020)
MeSH terms: Case Reports

The advent of immune checkpoint inhibitors has significantly improved the prognosis of patients with advanced malignancies. As we begin to understand these medications, multiple immune-related adverse effects (irAEs) have been found with these drugs, including endocrinopathies. Understanding the treatment-related adverse events of these medications is critical for clinical practice. Thyroid-related adverse effects usually occur within the first three months of treatment and rarely after eight months. It can manifest as an early onset of thyrotoxicosis, which is largely asymptomatic, followed by a rapid transition to hypothyroidism, requiring long-term levothyroxine substitution. We present a case in which our patient was found unresponsive, hypothermic, and with respiratory failure almost after completing a year of treatment with pembrolizumab. He had an initial mild elevation in thyroid-stimulating hormone (TSH) of 6.52, although with normal free thyroxine (T4) of 1.06, in his first three months of starting treatment which then rapidly progressed to a true myxedema coma. The infrequency with which this occurs makes it a diagnostic challenge.
Complement-Amplifying Conditions in Atypical Hemolytic Uremic Syndrome: A Canadian Case Series
Authors: Christopher J Patriquin, Katerina Pavenski, Jocelyn Garland, Louis-Philippe Girard, Paul Isenring
Journal: Can J Kidney Health Dis (2022)
Keywords: complement pathway, hemolytic uremic syndrome, organ dysfunction, thrombotic microangiopathy, thrombotic thrombocytopenic purpura

Rationale:
Thrombotic microangiopathies (TMAs) are systemic disorders that often affect the kidneys and encompass a heterogeneous group of conditions, including atypical hemolytic uremic syndrome (aHUS). The complement pathway is thought to play a crucial role in the pathogenesis of aHUS, and a favorable response can be obtained through complement C5 inhibition. There is emerging evidence to suggest that the same is also true for several other forms of TMA.
Objective:
The purpose of this series is to report cases of aHUS in which both an innate defect of the alternative complement pathway and a complement-amplifying condition were suspected.
Methods:
This case series describes 8 patients who were managed in Canadian tertiary centers for aHUS and who presented initially with complement-amplifying conditions.
Results:
In all cases, aHUS was associated with organ dysfunction and in some, with an innate defect of the alternative complement pathway. The complement-amplifying conditions identified were diverse including immune disorders, pregnancy, and a Shiga toxin infection. Patients improved rapidly when treated with eculizumab or plasma exchange.
Conclusions:
These observations illustrate the seriousness of secondary aHUS. They also add to existing lines of evidence that the complement pathway is potentially involved in this condition and that it should be considered as a therapeutic target of interest under such circumstances.
Case report: Hyperosmolar hyperglycemic syndrome secondary to PEG-asparaginase-induced hypertriglyceridemia and pancreatitis
Authors: Todd William Mudd Jr, Ashley Danielle Fox, Mark Ghaly, Amany Keruakous
Journal: Front Oncol (2023)
Keywords: all, peg-asparaginase, hyperosmolar hyperglycemic syndrome, pancreatitis, toxicity
MeSH terms: Case Reports

Pegylated (PEG)-asparaginase is an established treatment for acute lymphoblastic leukemias that exhibits an antitumor effect by depleting asparagine, an amino acid essential for leukemia cell protein synthesis. Pancreatitis with hypertriglyceridemia is a well-established toxidrome associated with PEG-asparaginase. However, impaired pancreatic synthetic function and hormone release have rarely been reported as a result of PEG-asparaginase pancreatitis. In this report, we present a 22-year-old woman recently diagnosed with T-acute lymphoblastic leukemia (T-ALL), who presented to the hospital with progressive weakness, confusion, blurry vision, hallucinations, and abdominal pain after induction treatment with daunorubicin, vincristine, PEG-asparaginase, and dexamethasone following the AYA protocol. She was found to have hypertriglyceridemia, acute pancreatitis, and hyperosmolar hyperglycemic syndrome. While pancreatitis and hypertriglyceridemia are commonly reported side effects of PEG-asparaginase, HHS related to these conditions has been sparsely reported. Providers should maintain awareness of this association and consider routine serial glucose monitoring of patients receiving PEG-asparaginase.
Solitary Colorectal Cancer Metastasis to the Pancreas
Authors: M Karageorgou, D Myoteri, T Kotsis, G Polymeneas, E Bournakis, D Dellaportas
Journal: Case Rep Surg (2019)
MeSH terms: Case Reports

Introduction:
Secondary pancreatic metastasis from other solid organ malignancy is rare and accounts for less than 2% of all pancreatic tumors. The aim of this study is to highlight that colorectal metastatic disease in the pancreas could be in selected cases an indication for surgery rather than for palliative chemotherapy.
Case presentation:
We present a case of a 62-year-old Caucasian female with a history of rectal adenocarcinoma. Four years ago, the patient underwent low anterior resection of the rectosigmoid, post neoadjuvant chemoradiotherapy, with adjuvant chemotherapy. During her follow-up, imaging examinations revealed a lesion in the pancreatic neck with features indicating primary pancreatic cancer. Near-total distal pancreatectomy with en bloc splenectomy was performed. Histopathology revealed metastatic disease compatible with colorectal adenocarcinoma as the primary cancer. Second-line chemotherapy was decided from the institutional tumor board. The patient remains disease free one year later.
Conclusion:
Pancreatic lesions in patients with a history of extrapancreatic malignancy should raise suspicions of metastatic disease. Surgical intervention is a legitimate treatment option for these pancreatic lesions, since they represent solitary disease deposits and of course in the context of multidisciplinary meeting decisions, and after proper and extensive staging investigations.
Ruptured Large Gastrointestinal Stromal Tumor: A Case Report and Review of Literature
Authors: Javereeya Abdul Jabbar, Amr Elmekresh, Yousif Eltayeb
Journal: Case Rep Surg (2023)
MeSH terms: Case Reports

Gastrointestinal stromal tumors (GIST) account for the majority of non-epithelial, mesenchymal tumors occurring in the gastrointestinal tract. Usually, the tumor measures a few centimeters, and cases larger than 15 cm are rare. Here, we report a rare case of a previously healthy 50-year-old woman, with generalized abdominal pain and increased abdominal girth for over nine months. Imaging showed a very large cystic lesion (21 cm × 15 cm × 24 cm) arising from the greater curvature of the stomach with rupture of the lesion into the intraperitoneal space. The patient was taken for exploratory laparotomy, which revealed a ruptured large cystic mass (21 cm × 15 cm × 24 cm) occupying the upper abdomen and encompassing the greater curvature of the stomach, body, and tail of the pancreas, as well as part of the spleen.
Burkitt-Like Lymphoma with 11q Aberration: A Case Report and Review of a Rare Entity
Authors: Sepideh N Asadbeigi, Chelsey D Deel
Journal: Case Rep Hematol (2020)
MeSH terms: Case Reports

Burkitt-like lymphoma with 11q aberration is a rare diagnostic entity commonly occurring in children and young adults with a nodal presentation. This entity shares many similar morphologic and immunophenotypic features with conventional Burkitt lymphoma and other aggressive B-cell lymphomas, making its recognition challenging. However, the presence of its characteristic 11q gain/loss pattern is helpful in the diagnosis. We report a case of Burkitt-like lymphoma presenting as a right neck mass in a 17-year-old female patient that demonstrated no improvement with antibiotic therapy. The neoplasm displayed a diffuse proliferation of intermediate-sized atypical lymphoid cells with prominent nucleoli in a background of apoptotic debris, morphologically raising concern for conventional Burkitt lymphoma. Subsequent immunohistochemical and cytogenetic studies established the most likely diagnosis of Burkitt-like lymphoma with 11q aberration. Though rare, Burkitt-like lymphoma exhibits significant morphologic overlap with other high-grade B-cell lymphomas, making it an important entity to consider on the differential diagnosis of these lesions.
Herb-induced hepatitis secondary to artemisinin: A case report
Authors: Jiwei Zhan, Meilin Ding, Jin Li, Lei Su
Journal: Front Med (Lausanne) (2022)
Keywords: artemisinin, cholestatic hepatitis, drug-induced liver injury, jaundice, plasma exchange (pe)
MeSH terms: Case Reports

This report describes a rare case of severe liver injury secondary to a herbal supplement containing artemisinin. The patient received plasma exchange with bilirubin filtration adsorption therapy. The case is unique in its severe cholestasis. Bilirubin decreased to baseline after 62 days. This will help to improve clinicians' awareness of the diagnosis and treatment of drug-induced liver injury.
Oncocytoma of the Parotid Gland with Facial Nerve Paralysis
Authors: Seijiro Hamada, Keishi Fujiwara, Hiromitsu Hatakeyama, Akihiro Homma
Journal: Case Rep Otolaryngol (2018)
MeSH terms: Case Reports

Parotid gland tumor with facial nerve paralysis is strongly suggestive of a malignant tumor. However, several case reports have documented benign tumors of the parotid gland with facial nerve paralysis. Here, we report a case of oncocytoma of the parotid gland with facial nerve paralysis. A 61-year-old male presented with pain in his right parotid gland. Physical examination demonstrated the presence of a right parotid gland tumor and ipsilateral facial nerve paralysis of House-Brackmann (HB) grade III. Due to the facial nerve paralysis, a malignant tumor of the parotid gland was suspected and right parotidectomy was performed. Oncocytoma was confirmed histopathologically. The facial nerve paralysis was resolved 2 months after surgery. During the follow-up period (one and a half years), no recurrence was observed. As the tumor showed a distinctive dumbbell shape and increased somewhat due to inflammation (i.e., infection), the facial nerve was pinched by the enlarged tumor. Ischemia and strangulation of the nerve were considered to be the cause of the facial nerve paralysis associated with the benign tumor in this case.
Thrombotic events following tocilizumab therapy in critically ill COVID-19 patients: a Façade for prognostic markers
Authors: Bassam Atallah, Wasim El Nekidy, Saad I Mallah, Antoine Cherfan, Laila AbdelWareth, Jihad Mallat, Fadi Hamed
Journal: Thromb J (2020)
Keywords: covid-19, d-dimers, prognostic markers, thrombosis, tocilizumab
MeSH terms: Case Reports

Background:
Hospitals in the Middle East Gulf region have experienced an influx of COVID-19 patients to their medical wards and intensive care units. The hypercoagulability of these patients has been widely reported on a global scale. However, many of the experimental treatments used to manage the various complications of COVID-19 have not been widely studied in this context. The effect of the current treatment protocols on patients' diagnostic and prognostic biomarkers may thus impact the validity of the algorithms adopted.
Case presentation:
In this case series, we report four cases of venous thromboembolism and 1 case of arterial thrombotic event, in patients treated with standard or intensified prophylactic doses of unfractionated heparin or low molecular weight heparin at our institution. Tocilizumab has been utilized as an add-on therapy to the standard of care to treat patients with SARS-CoV-2 associated acute respiratory distress syndrome, in order to dampen the hyperinflammatory response. It is imperative to be aware that this drug may be masking the inflammatory markers (e.g. IL6, CRP, fibrinogen, and ferritin), without reducing the risk of thrombotic events in this population, creating instead a façade of an improved prognostic outcome. However, the D-dimer levels remained prognostically reliable in these cases, as they were not affected by the drug and continued to be at the highest level until event occurrence.
Conclusions:
In the setting of tocilizumab therapy, traditional prognostic markers of worsening infection and inflammation, and thus potential risk of acute thrombosis, should be weighed carefully as they may not be reliable for prognosis and may create a façade of an improved prognostic outcome insteasd. Additionally, the fact that thrombotic events continued to be observed despite decrease in inflammatory markers and the proactive anticoagulative approach adopted, raises more questions about the coagulative mechanisms at play in COVID-19, and the appropriate management strategy.
Case reports: orthotic treatment of adult scoliosis patients with chronic back pain
Authors: Dino Gallo
Journal: Scoliosis (2014)
Keywords: alignment, body, chronic back pain, customized trunk orthoses, sagittal line, scoliosis, spine deformity
MeSH terms: Case Reports

Orthotic treatment of patients with degenerative deformations of the spine is a complex endeavor. It is a great orthopedic technical challenge to effectively reduce the accompanying pain and to help patients regain and keep their mobility. Due to difficult therapies and poor compliance, a surgical intervention to brace the spine is usually the first therapeutic choice. This article presents two cases in which individualized torso orthoses were successfully used to treat patients with degenerative diseases and disorders of the sagittal line as well as three dimensional deformities of the spine. Using torso orthoses allows treatment of these patients with as few invasive measures as possible without losing maximal functionality.
Antenatal Diagnosis of a Rare Neural Tube Defect: Sincipital Encephalocele
Authors: Mehdi Kehila, Sana Ghades, Hassine Saber Abouda, Aida Masmoudi, Mohamed Badis Chanoufi
Journal: Case Rep Obstet Gynecol (2015)

Context. Fetal sincipital encephalocele is one of the most serious congenital neural tube defects with a high risk of mortality and neonatal morbidity. Prenatal diagnosis of this malformation is important in fetal medicine. Case Report. We report a case of prenatal diagnosis of sincipital encephalocele using ultrasound and MRI imaging. The diagnosis was done at 25 weeks of gestation by identifying an anterior cephalic protrusion through a defect in the skull. Conclusion. Through this case, we discuss the differential diagnosis, management, and prognosis of such lesions.
Case Report: The importance of examining colon and rectum in patients with appendiceal cancer
Authors: Hugin Reistrup, Siv Fonnes, Jacob Rosenberg, Kristoffer Andresen
Journal: F1000Res (2021)
Keywords: appendicitis, appendiceal cancer, appendix cancer, case report, digital rectal examination, rectal cancer, rectum cancer, synchronous
MeSH terms: Appendiceal Neoplasms / diagnosis, Appendiceal Neoplasms / pathology, Appendiceal Neoplasms / surgery, Appendicitis / diagnosis, Appendicitis / etiology, Appendicitis / surgery, Case Reports, Acute Disease, Appendectomy / adverse effects, Appendectomy / methods, Colon / pathology, Humans, Male, Middle Aged, Rectum / pathology

Appendiceal cancer is rare and is often diagnosed incidentally in patients undergoing appendectomy for acute appendicitis. However, patients with appendiceal cancer are at increased risk of synchronous malignancy. In this case report, we present a 58-year-old man initially diagnosed with acute appendicitis after presenting to the emergency department with abdominal pain. He had an appendectomy and was discharged the following day. Unexpectedly, the postoperative histopathologic examination showed a primary adenocarcinoma in the appendix. A computed tomography scan showed rectal wall thickening and the patient was referred to colonoscopy where an experienced endoscopist found a rectal tumor during the digital rectal examination prior to the colonoscopy. The tumor was initially missed by the newly qualified doctor who examined the patient during his first admittance to hospital. The patient's two primary cancers were treated with a laparoscopic right hemicolectomy for the appendiceal cancer and a low anterior resection for the rectal cancer. This case supports the importance of a full colorectal workup in patients with appendiceal cancer. It also emphasizes the value of a thorough digital rectal examination and the need for improved focus on teaching and practice of the procedure.
Case Report: Single-Cell Transcriptomic Analysis of an Anaplastic Oligodendroglioma Post Immunotherapy
Authors: Guangyang Yu, Madison K Butler, Abdalla Abdelmaksoud, Ying Pang, Yu-Ting Su, Zachary Rae, Kimia Dadkhah, Michael C Kelly, Young K Song, Jun S Wei, Masaki Terabe, Ramya Atony, Kelly Mentges, Brett J Theeler, Marta Penas-Prado, John Butman, Kevin Camphausen, Kareem A Zaghloul, Edjah Nduom, Martha Quezado, Kenneth Aldape, Terri S Armstrong, Mark R Gilbert, James L Gulley, Javed Khan, Jing Wu
Journal: Front Oncol (2021)
Keywords: glioma, immunotherapy, pseudo-progression, single-cell rna sequencing, tumor microenvironment
MeSH terms: Case Reports

Glioma is the most common primary malignant brain tumor with a poor prognosis. Immune checkpoint inhibitors have been of great interest in investigation of glioma treatments. Here, we report single-cell transcriptomic analyses of two tumor areas from an oligodendroglioma taken from a patient who had multiple tumor recurrences, following several chemotherapies and radiation treatments. The patient subsequently received nivolumab and was considered have disease progression based on conventional diagnostic imaging after two cycles of treatment. He underwent a debulking surgical resection and pathological diagnosis was recurrent disease. During the surgery, tumor tissues were also collected from the enhancing and non-enhancing areas for a scRNAseq analysis to investigate the tumor microenvironment of these radiographically divergent areas. The scRNAseq analysis reveals a plethora of immune cells, suggesting that the increased mass observed on MRI may be partially a result of immune cell infiltration. The patient continued to receive immunotherapy after a short course of palliative radiation and remained free of disease progression for at least 12 months after the last surgery, suggesting a sustained response to immunotherapy. The scRNAseq analysis indicated that the radiological progression was in large part due to immune cell infiltrate and continued immunotherapy led to a positive clinical outcome in a patient who would have otherwise been admitted to hospice care with halting of immunotherapy. Our study demonstrates the potential of scRNAseq analyses in understanding the tumor microenvironment, which may assist the clinical decision-making process for challenging glioma cases following immunotherapy.