OpenMed/multicare-articles huggingface dataset:
Biperiden dependence: case report and literature review
Authors: Fernando Espi Martinez, Fernando Espi Forcen, Arlenne Shapov, Amparo Martinez Moya
Journal: Case Rep Psychiatry (2012)
MeSH terms: Case Reports

Anticholinergic drugs are frequently used in psychiatry for the prophylaxis and treatment of extrapiramidal symptoms caused by neuroleptics. Abuse of anticholinergic agents has been reported in patients with psychotic disorders, on treatment with neuroleptics, and polysubstance use disorders. We are reporting the case of a patient who presented with hypoactive delirium as a consequence of biperiden dependence. The clinician must pay special attention to detect anticholinergic misuse in patients presenting with delirium of unknown cause.
Alexander Disease
Authors: Laura Hartog, Sven Dekeyzer, Stephanie Vanden Bossche
Journal: J Belg Soc Radiol (2021)
Keywords: alexander disease, canavan disease, leukodystrophy, macrocephaly, megalencephalic leukoencephalopathy with subcortical cysts
MeSH terms: Case Reports

Main teaching point: The main differential diagnosis of leukodystrophy associated with macrocephaly consists of Alexander disease, Canavan disease, and megalencephalic leukodystrophy with subcortical cysts. Distinguishing imaging characteristics of Alexander disease are an apicoposterior gradient of white matter involvement and a periventricular T2-hypointense rim.
Primary Carnitine Deficiency: A Rare, Reversible Metabolic Cardiomyopathy
Authors: Stephen Tomlinson, John Atherton, Sandhir Prasad
Journal: Case Rep Cardiol (2018)
MeSH terms: Case Reports

A 24-year-old female with a diagnosis of primary carnitine deficiency, a rare inherited metabolic disorder predominantly described in the paediatric literature that causes cardiomyopathy, presented for evaluation after three months of nonadherence with prescribed carnitine therapy. Initial echocardiography demonstrated severe left ventricular dilation (104 ml/m2) (normal < 76 ml/m2) with moderate systolic dysfunction (ejection fraction 40%) and severe right ventricular dilation with mild systolic dysfunction. Carnitine replacement was commenced, and a cardiac magnetic resonance imaging (MRI) performed five days later demonstrated dramatic improvement in biventricular function with normalization of left and right ventricular systolic function. To our knowledge, this is only the second case describing the rapid reversal of cardiomyopathy in an adult patient with this rare condition.
Amyloid and tau PET in cerebral amyloid angiopathy-related inflammation two case reports and literature review
Authors: Jhih-Yong Yang, Yung-Tsai Chu, Hsin-Hsi Tsai, Jiann-Shing Jeng
Journal: Front Neurol (2023)
Keywords: amyloid positron emission tomography (pet), cerebral amyloid angiopathy (caa), cerebral amyloid angiopathy-related inflammation, magnetic resonance imaging, microbleed
MeSH terms: Case Reports

Background:
Cerebral amyloid angiopathy-related inflammation (CAA-ri) is a clinical syndrome characterized by MRI findings of amyloid-related imaging abnormalities-edema (ARIA-E) suggestive of autoimmune and inflammatory reaction and hemorrhagic evidence of cerebral amyloid angiopathy. The longitudinal variation of amyloid PET and its imaging association with CAA-ri are undetermined. Moreover, tau PET in CAA-ri has been rarely investigated.
Method:
We retrospectively described two cases of CAA-ri. We provided the temporal change of amyloid and tau PET in the first case, and the cross-sectional finding of amyloid and tau PET in the second case. We also performed a literature review of the imaging features of amyloid PET in reported cases of CAA-ri.
Results:
In the first case, an 88-year-old male presented with progressive consciousness and gait disturbances over 2 months. MRI showed disseminated cortical superficial siderosis. Amyloid PET prior to and after the CAA-ri revealed focally decreased amyloid load in the region of ARIA-E. In the second case, a 72-year-old male was initially suspected to have central nervous system cryptococcosis but later diagnosed with CAA-ri because of the characteristic MRI features and good response to corticosteroid treatment; a subsequent amyloid scan revealed positive amyloid deposition of the brain. Neither case suggested an association between the region of ARIA-E and higher amyloid uptake on PET before or after onset of CAA-ri. Our literature review revealed variable findings related to amyloid burden in post-inflammatory regions in previously reported CAA-ri cases with available amyloid PET. Our case is the first report of longitudinal changes on amyloid PET and show focal decreases in amyloid load after the inflammatory process.
Conclusion:
This case series highlights the need to better explore the potential of longitudinal amyloid PET in the understanding of the mechanisms of CAA-ri.
Renal Replacement Therapy in Acute Kidney Failure due to Rhabdomyolysis
Authors: G Maggi, F Quinteros Hinojosa, M J Villagran, E Guasch Arévalo, F Gilsanz Rodríguez
Journal: Case Rep Crit Care (2012)
MeSH terms: Case Reports

Rhabdomyolysis is a syndrome caused by skeletal muscle cells destruction which can occur for many reasons, including prolonged immobilization. The main complication of the syndrome is the development of acute renal failure. Rhabdomyolysis and myoglobinuria are responsible for approximately 5% of all causes of acute renal failure in the USA. The cause of rhabdomyolysis is often multifactorial, and approximately 8-20% of such patients develop myoglobinuric acute renal failure.
A case of fitness to work in a worker with COPD using the exercise stress test
Authors: Yewon Kim, Kyungyong Jung, Ji Young Ryu, Dae Hwan Kim, Sangyoon Lee
Journal: Ann Occup Environ Med (2015)
Keywords: chronic obstructive pulmonary disease, exercise stress test, fitness to work
MeSH terms: Case Reports

Background:
Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disease characterized by persistent airflow limitation. Therefore, both work ability and workday length may be affected in individuals with this disease. We studied a worker with suspected COPD and assessed fitness to work using post-bronchodilator spirometry, symptom assessment scales, and the exercise stress test.
Case report:
The patient was a 58-year-old man due to work as a field supervisor in the ship construction sector. He had a 40 pack-year smoking history and experienced occasional dyspnea when climbing stairs. He visited this hospital to receive cardiopulmonary function tests and to determine his ability to work. Post-bronchodilator spirometry revealed severe irreversible airway obstruction corresponding to a modified Medical Research Council grade of 2 on the dyspnea scale. His COPD Assessment Test score was 12, placing him in patient group D (high risk, more symptoms) based on the Global Initiative for Chronic Obstructive Lung Disease classification system. His maximum oxygen uptake (VO2max) was determined to be 19.16 ml/kg/min, as measured by the exercise stress test, and his acceptable workload for 8 h of physical work was calculated to be 6.51 ml/kg/min. His work tasks required an oxygen demand of 6.89 ml/kg/min, which exceeded the acceptable workload calculated. Accordingly, he was advised to adjust the work tasks that were deemed inappropriate for his exercise capacity.
Conclusion:
As COPD incidence is expected to rise, early COPD diagnosis and determination of fitness to work is becoming increasingly important. Performing the exercise stress test, to evaluate the functional capacity of workers with COPD, is considered an acceptable solution.
Porphyria Cutanea Tarda Associated With Acute Hemorrhagic Pancreatitis
Authors: Manasi Singh, Ashley Duckett, Marc Heincelman
Journal: J Investig Med High Impact Case Rep (2019)
Keywords: acute hemorrhagic pancreatitis, porphyria cutanea tarda
MeSH terms: Blister / pathology, Pancreatitis, Acute Hemorrhagic / etiology, Porphyria Cutanea Tarda / complications, Porphyria Cutanea Tarda / diagnosis, Case Reports, Humans, Male, Middle Aged, Pancreatitis, Acute Hemorrhagic / diagnosis, Porphyria Cutanea Tarda / physiopathology, Risk Factors

Porphyria cutanea tarda (PCT) is a condition of dysregulated heme synthesis that leads to accumulation of photosensitizing precursors with resultant fragility and blistering of the skin. It can be hereditary or acquired and has been known to be associated with hepatic C virus, alcohol, HIV, and estrogen. In this article, we report an unusual presentation of PCT associated with acute hemorrhagic pancreatitis in a 57-year-old man. He presented initially to a community hospital with acute onset of epigastric abdominal pain and new-onset ascites. Lipase was elevated. Diagnostic paracentesis was grossly bloody. He was then transferred to our institution for concern for acute hemorrhagic pancreatitis. On arrival, physical examination demonstrated vesicles and bullae with erythematous bases, in different stages of healing seen over the dorsal aspects of both hands with scaling, scarring, and hypopigmentation and hyperpigmentation of the skin. Laboratory evaluation and skin biopsy confirmed the diagnosis of PCT. Search for an underlying etiology failed to reveal typical predisposing factors. This report illustrates that acute hemorrhagic pancreatitis may be an underlying etiology for PCT.
Ossification of transverse ligament of atlas causing cervical myelopathy: a case report and review of the literature
Authors: Tatsuro Sasaji, Chikashi Kawahara, Fujio Matsumoto
Journal: Case Rep Med (2011)
MeSH terms: Case Reports

A case of ossification of transverse ligament of atlas (TLA) is reported. A 76-year-old female suffered from a transverse type myelopathy was successfully treated by posterior decompression. Dynamic lateral plain radiographs showed irreducible atlantoaxial subluxation (AAS). A computed tomogram revealed ossified mass compatible to ossification of TLA. Coalition of the atlantooccipital joints and osteoarthritis of the atlantoaxial joints with degenerated dens was also revealed. Magnetic resonance imaging showed compressed spinal cord at C1 level by the ossification of TLA and AAS. We suggest a mechanism of ossification of TLA as follows: hypertrophied dens and stress to the atlantoaxial joints caused by coalition of atlantooccipital joints could make forward shift of atlas leading to irreducible AAS, and continuous tension given to TLA from irreducible AAS would result in hypertrophied and ossification of TLA.
Effective Treatment of Glioblastoma Multiforme With Oncolytic Virotherapy: A Case-Series
Authors: Benjamin Gesundheit, Eliel Ben-David, Yehudit Posen, Ronald Ellis, Guido Wollmann, E Marion Schneider, Karl Aigner, Lars Brauns, Thomas Nesselhut, Ingrid Ackva, Christine Weisslein, Arno Thaller
Journal: Front Oncol (2020)
Keywords: newcastle disease virus (ndv), biological therapy, glioblastoma, immunotherapy, oncolytic virotherapy

Glioblastoma multiforme (GBM) remains an incurable condition, associated with a median survival time of 15 months with best standard of care and 5-year survival rate of <10%. We report on four GBM patients on combination treatment regimens that included oncolytic virus (OV) immunotherapy, who achieved clinical and radiological responses with long-term survival, thus far, of up to 14 years, and good quality of life. We discuss the radiological findings that provide new insights into this treatment, the scientific rationale of this innovative and promising therapy, and considerations for future research.
Hyperkalemic Periodic Paralysis: Case Report with a SCNA4 Gene Mutation and Literature Review
Authors: Manuela Quiroga-Carrillo, Cristian Correa-Arrieta, Fernando Ortiz-Corredor, Fernando Suarez-Obando
Journal: Case Rep Genet (2020)
MeSH terms: Case Reports

Hyperkalemic periodic paralysis is a rare musculoskeletal disorder characterized by episodic muscle weakness associated with hyperkalemia. It is a channelopathy associated with point mutations in the SCNA4 gene, with an autosomal dominant pattern of inheritance. We report the case of a 39-year-old patient with a picture with onset at six years of age, consisting of episodes of weakness caused by physical activity and intercurrent infectious processes, in whom a point mutation was found in the SCNA4 gene, not previously reported in the literature.
Efficacy of Transcranial Direct-Current Stimulation in Catatonia: A Review and Case Series
Authors: Alexandre Haroche, Nolwenn Giraud, Fabien Vinckier, Ali Amad, Jonathan Rogers, Mylène Moyal, Laetitia Canivet, Lucie Berkovitch, Raphaël Gaillard, David Attali, Marion Plaze
Journal: Front Psychiatry (2022)
Keywords: brain stimulation, case series, catatonia, schizophrenia, transcranial direct-current stimulation

Catatonia is a severe neuropsychiatric syndrome, usually treated by benzodiazepines and electroconvulsive therapy. However, therapeutic alternatives are limited, which is particularly critical in situations of treatment resistance or when electroconvulsive therapy is not available. Transcranial direct-current stimulation (tDCS) is a promising non-invasive neuromodulatory technique that has shown efficacy in other psychiatric conditions. We present the largest case series of tDCS use in catatonia, consisting of eight patients in whom tDCS targeting the left dorsolateral prefrontal cortex and temporoparietal junction was employed. We used a General Linear Mixed Model to isolate the effect of tDCS from other confounding factors such as time (spontaneous evolution) or co-prescriptions. The results indicate that tDCS, in addition to symptomatic pharmacotherapies such as lorazepam, seems to effectively reduce catatonic symptoms. These results corroborate a synthesis of five previous case reports of catatonia treated by tDCS in the literature. However, the specific efficacy of tDCS in catatonia remains to be demonstrated in a randomized controlled trial. The development of therapeutic alternatives in catatonia is of paramount importance.
Coronary Artery Bypass Grafting in a Patient with Dextrocardia with Situs Inversus
Authors: Kaitlin E Woods, J W Awori Hayanga, Daniel Sloyer, Roy E Henrickson, Lawrence M Wei, Heather K Hayanga
Journal: Case Rep Anesthesiol (2020)
MeSH terms: Case Reports

Dextrocardia involves embryologic malformations leading to a right hemithorax heart with rightward apex. Situs inversus encompasses all viscera in mirrored position. A 76-year-old male with dextrocardia with situs inversus presented for coronary artery bypass grafting due to a non-ST elevation myocardial infarction. Management was altered accordingly. Electrocardiography leads and defibrillator pads were reversed. A left internal jugular vein central venous catheter provided direct access to the right atrium. Transesophageal echocardiography confirmation of aortic and venous cannulation required turning the probe right for the right-sided aorta and left for liver visualization, respectively. Proactive surgical and anesthetic management was imperative for the successful and uneventful outcome for this patient.
Mirror Syndrome in Monochorionic Twin Pregnancy with Acardiac Fetus
Authors: Luiz Felipe Lessa Ortiz, Julio Elito Júnior, Edward Araujo Júnior, Alberto Borges Peixoto, Nelson Sass, Antonio Fernandes Moron
Journal: Case Rep Obstet Gynecol (2018)
MeSH terms: Case Reports

We report the case of a 20-year-old patient, primigravida, with twin monochorionic pregnancy, with a weight gain of 6 kg in one week and increased blood pressure. During the ultrasound diagnostic investigation, placental edema and hydrops were identified in both fetuses, which, in association with maternal anasarca and pressure control, constitute the triad for mirror syndrome, also known as triple edema. In addition to being hydropic, one of the twins was an acardiac fetus, which is a rare combination of events. Gestation was terminated at 22 weeks and five days because of high maternal risk. The patient progressed with clinical and laboratory improvement. Our study is relevant in that it documents an extremely rare case and discusses relevant aspects of the symptoms and diagnosis of mirror syndrome. It also systematically reviews the condition.
Successful Antimicrobial Treatment of Phlegmonous Gastritis: A Case Report and Literature Review
Authors: Madiha Iqbal, Rabia Saleem, Salman Ahmed, Prachi Jani, Salvador Alvarez, Han W Tun
Journal: Case Rep Hematol (2018)
MeSH terms: Case Reports

Phlegmonous gastritis is an uncommon acute bacterial infection of the stomach that carries a fatal prognosis in spite of the advent of antibiotics. A high index of suspicion is required in patients with risk factors. An immunocompromised state is identified as one of the most important risk factors. We hereby report a case of successful antimicrobial treatment of phlegmonous gastritis in a patient who was receiving intensive chemotherapy for acute myelogenous leukemia. We have also carried out a review of literature over the past ten years. Streptococcus pyogenes is identified as the most common causative organism, and patient presentation is usually nonspecific. Conservative treatment with prompt institution of antibiotics can lead to rapid resolution in the majority of patients.
Intra-Abdominal Bleeding during Pregnancy, Preterm Delivery, and Placental Polyp in a Long-Term Survivor of Neuroblastoma: A Case Report
Authors: Noriyoshi Watanabe, Junna Tsutsui, Satsuki Kakiuchi, Seung Chik Jwa, Hironori Takahashi, Naomi Kato, Nobuaki Ozawa, Haruhiko Sago, Michihiro Kitagawa
Journal: Obstet Gynecol Int (2009)
MeSH terms: Case Reports

Background. There are few reports of pregnancies in long-term survivors of pelvic neuroblastoma. Case. A 30-year-old Japanese woman with a history of pelvic neuroblastoma in her childhood, which was treated with surgical resection, chemotherapy, and radiation. Her pregnancy continued with conservative management, but she delivered a 510 g female infant at 23 weeks of gestation due to sudden onset of labor pain. She also had a placental polyp and developed massive postpartum bleeding. Conclusion. Cancer treatment, especially radiation therapy, in childhood may cause adverse outcomes during pregnancy in long-term survivors of neuroblastoma.
Patiromer Acetate Induced Hypercalcemia: An Unreported Adverse Effect
Authors: Shreeyukta Bhattarai, Stephen Pupillo, Gulshan Man Singh Dangol, Erdal Sarac
Journal: Case Rep Nephrol (2019)
MeSH terms: Case Reports

Hyperkalemia, a potential life threating condition, is a commonly encountered problem in chronic kidney disease (CKD) patients. Patiromer acetate, a nonabsorbable cation exchange polymer, is a gastrointestinal agent for chronic therapy in patients with persistent hyperkalemia. Patiromer is generally well tolerated in patients; common side effects are gastrointestinal, such as diarrhea, constipation, flatulence, and vomiting. Hypercalcemia, although a theoretical possibility, has not been reported in any major clinical trials. We present a case of hypercalcemia associated with patiromer acetate used for treatment of hyperkalemia in a stage IV CKD patient. Clinicians should be aware of the possibility of hypercalcemia while taking patiromer.
Ticagrelor is more effective than clopidogrel in carrier of nonfunctional CYP2C19 allele who has diabetes and acute coronary syndrome - case report and literature review
Authors: Rahel Tekeste, Gregorio Garza, Song Han, Jianli Dong
Journal: AIMS Mol Sci (2022)
Keywords: acs, cyp2c19, mace, p2ry12, pci, clopidogrel, intermediate cyp2c19 metabolizer, pharmacogenetics

Clopidogrel is a purinergic receptor P2Y12 (P2RY12)-blocking pro-drug used to inhibit platelet aggregation in patients at risk for major adverse cardiac events (MACE), such as coronary artery disease and stroke. Despite clopidogrel therapy, some patients may still present with recurrent cardiovascular events. One possible cause of recurrence are variants in the cytochrome P450 2C19 (CYP2C19) gene. CYP2C19 is responsible for the metabolism of many drugs including clopidogrel. Recent studies have associated pharmacogenetics testing of CYP2C19 variants to guide clopidogrel therapy with a decreased risk of certain recurrent MACEs. Through a different mechanism, diabetes mellitus (DM) and obesity are also associated with clopidogrel treatment failure. We describe the case of a 64-year-old Caucasian woman with a history of acute coronary syndrome (ACS) and percutaneous coronary intervention (PCI), and DM/obesity, who presented to University of Texas Medical Branch (UTMB) in 2019 with a transient ischemic attack (TIA) while on clopidogrel/aspirin dual anti-platelet therapy. After CYP2C19 genetic testing revealed that she was an intermediate metabolizer with a heterozygous *2 genotype, ticagrelor replaced the clopidogrel treatment regimen. No future MACEs were documented in the two-year patient follow-up. Thus, ACS patients with DM/obesity who have undergone PCI and are intermediate CYP2C19 metabolizers may yield better treatment outcomes if prescribed ticagrelor instead of clopidogrel. Whether this improvement was due to genotype-guided therapy or the differing interactions of clopidogrel/ticagrelor in DM/obese patients is unknown based on available data. Regardless, CYP2C19 genotype-guided treatment of ACS/PCI patients, with consideration of DM/obesity status, may provide effective individualized therapy compared to standard treatment. The inclusion of DM/obesity in this study is clinically relevant because DM/obesity has become a major health issue in the United States and worldwide.
Late Onset Cobalamin Disorder and Hemolytic Uremic Syndrome: A Rare Cause of Nephrotic Syndrome
Authors: Gianluigi Ardissino, Michela Perrone, Francesca Tel, Sara Testa, Amelia Morrone, Ilaria Possenti, Francesco Tagliaferri, Robertino Dilena, Francesca Menni
Journal: Case Rep Pediatr (2017)
MeSH terms: Case Reports

Hemolytic uremic syndrome (HUS) is an unrare and severe thrombotic microangiopathy (TMA) caused by several pathogenetic mechanisms among which Shiga toxin-producing Escherichia coli infections and complement dysregulation are the most common. However, very rarely and particularly in neonates and infants, disorders of cobalamin metabolism (CblC) can present with or be complicated by TMA. Herein we describe a case of atypical HUS (aHUS) related to CblC disease which first presented in a previously healthy boy at age of 13.6 years. The clinical picture was initially dominated by nephrotic range proteinuria and severe hypertension followed by renal failure. The specific treatment with high dose of hydroxycobalamin rapidly obtained the remission of TMA and the complete recovery of renal function. We conclude that plasma homocysteine and methionine determinations together with urine organic acid analysis should be included in the diagnostic work-up of any patient with TMA and/or nephrotic syndrome regardless of age.
Serum fluoxetine and norfluoxetine levels support the safety of fluoxetine in overdose
Authors: Stephanie Pope, Solomon G Zaraa
Journal: Ann Gen Psychiatry (2016)
MeSH terms: Case Reports

Background:
Previous literature has found fluoxetine to be relatively safe in overdose. This study hopes to examine this idea along with support from published pharmacokinetic information including serum fluoxetine and norfluoxetine levels based on information from a clinical case series.
Methods:
Four cases are presented along with vital abnormalities, electrocardiogram abnormalities, and physical exam abnormalities along with amount of overdose and resulting serum fluoxetine and norfluoxetine levels.
Case presentation:
In these four cases, serum fluoxetine and norfluoxetine days after overdose were found to be in a range believed to be within the treatment range. No abnormalities were found on electrocardiogram but some patients (3) were found to have slight elevations in heart rate.
Conclusion:
Fluoxetine is relatively safe in overdose. This study supports previous literature. Future directives for research can be directed towards when serotonergic, including fluoxetine, medications can be introduced or restarted in patients who have overdosed. Research could also focus on if the introduction of another medication, such as carbamazepine, to induce metabolism of a medication, such as fluoxetine, after an overdose.