OpenMed/multicare-articles huggingface dataset:
Case report: anaplastic lymphoma kinase ( ALK) rearranged adenocarcinoma with high level of microsatellite instability response to pembrolizumab
Authors: Naoko Shigeta, Shuji Murakami, Tomoyuki Yokose, Yohei Miyagi, Haruhiro Saito
Journal: Front Oncol (2023)
Keywords: adenocarcinoma, advanced lung adenocarcinoma, anaplastic lymphoma kinase rearrangement, case report, immune checkpoint inhibitor, microsatellite instability, non-small cell lung cancer, programmed death ligand (pd-l) 1
MeSH terms: Case Reports

The presence of anaplastic lymphoma kinase (ALK) rearrangement is reported to be related to the lack of efficacy of immune checkpoint inhibitors (ICIs). High levels of microsatellite instability (MSI-high) are important biomarkers of ICIs, particularly in colorectal cancer. The therapeutic effect of ICIs for MSI-high NSCLC is uncertain because of the rarity of these tumors. Here we report a case of ALK rearranged NSCLC with MSI-high. A 48-year-old male was diagnosed with lung adenocarcinoma, cT4N3M1a, stage IVA with ALK rearrangement, high PD-L1 expression with a tumor proportion score (TPS) of 100%, and MSI-high. The patient was treated with alectinib as the first-line therapy but progressed at five months with left atrial invasion re-expansion. The patient discontinued alectinib and was switched to pembrolizumab monotherapy. After two months, left atrial invasion significantly decreased. The patient continued pembrolizumab for a year without noticeable adverse events, and tumor shrinkage persisted. This case supports the efficacy of ICIs for MSI-high NSCLC, even in the presence of ALK rearrangement.
Sinus venosus atrial septal defect presenting with brain abscess in a 33-year-old man
Authors: Roghayeh Pourkia, Seyed Habibollah Hassani, Simin Mouodi
Journal: J Cardiovasc Thorac Res (2019)
Keywords: atrial septal defect, brain abscess, echocardiography, transesophageal
MeSH terms: Case Reports

This study aimed to present a case of 33-year old man who was admitted with a history of one week headache and acute diplopia. No important finding was reported in his past medical history. Brain CT-scan revealed a large mass lesion in left parieto-occipital area with prominent vasogenic edema and midline shift. Brain magnetic resonance imaging (MRI) showed a mass with size of 5*4*5 centimeter with ring enhancement. After cranial surgery and removing the mass, transthoracic and transesophageal echocardiography (TEE) were conducted to find the source of brain abscess. Right ventricular (RV) and right atrial (RA) enlargement, significant left to right shunt, normal left ventricular (LV) and RV function, bidirectional shunt in addition to moderate size superior sinus venosus type atrial septal defect (ASD) were detected. Considering that most of brain abscesses have hematogenous source, a complete cardiac evaluation including TEE with contrast study is suggested for evaluation of patients with brain abscess.
Conservative management of spontaneous coronary artery dissection: a case report
Authors: Hind Regragui, Badre El Boussaadani, Lamyae Sasbou, Hanae Bouhdadi, Hicham Wazaren, Mohammed Cherti
Journal: Pan Afr Med J (2020)
Keywords: spontaneous coronary artery dissection, acute coronary syndromes, case report, conservative management
MeSH terms: Conservative Treatment / methods, Coronary Vessel Anomalies / therapy, Vascular Diseases / congenital, Case Reports, Adrenergic beta-Antagonists / therapeutic use, Adult, Aspirin / therapeutic use, Computed Tomography Angiography, Coronary Angiography, Coronary Vessel Anomalies / complications, Coronary Vessel Anomalies / diagnosis, Echocardiography, Female, Humans, Non-ST Elevated Myocardial Infarction / diagnosis, Non-ST Elevated Myocardial Infarction / therapy, Platelet Aggregation Inhibitors / therapeutic use, Vascular Diseases / complications, Vascular Diseases / diagnosis, Vascular Diseases / therapy, Adrenergic beta-Antagonists, Platelet Aggregation Inhibitors, Aspirin, Coronary Artery Dissection, Spontaneous

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndromes (ACS) that mainly occurs in young women with no risk factors and no coronary atherosclerosis. Diagnosis is made by invasive coronary angiography (CA), computed tomography coronary angiography (CTCA), intravascular ultrasound (IVUS) and optical coherence tomography (OCT). The rarity of this entity as well as the complications of invasive treatment make it difficult to choose therapy between conservative management, percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). We report a case of a 36-year-old woman presented with non ST elevation myocardial infarction (NSTEMI) related to spontaneous dissection of coronary arteries (left main trunk, left anterior descending artery and left circumflex artery) treated medically with spectacular results at 2 months, controlled by CTCA.
Pathological Correlation of a Cardiac Mass with Multimodality Imaging
Authors: Sumit Sohal, Farida A Tanko, Esad Vucic, Sergio Waxman, Suresh Gupta, Billie Fyfe-Kirschner
Journal: Case Rep Med (2023)
MeSH terms: Case Reports

Cardiac masses are rarely encountered in clinical practice and can lead to severe hemodynamic consequences. In addition to clinical cues, noninvasive modalities can play an important role in characterization of these masses and therefore their diagnosis and management planning. Here in this case report, we describe the use of various forms of noninvasive imaging techniques to narrow the differential diagnosis and form an operative plan for a cardiac mass later identified as a benign myxoma originating from the right ventricle on histological examination.
Disseminated lung cancer presenting as a rectal mass
Authors: Mia M Noergaard, Inger M H Stamp, Uffe Bodtger
Journal: Eur Clin Respir J (2016)
Keywords: diagnosis, endoscopy, histology, non-small cell lung cancer, rectum
MeSH terms: Case Reports

Primary lung cancer is the leading cause of cancer-related deaths globally, and approximately 50% had metastatic disease at the time of diagnosis. A rectal mass and unintended weight loss are common manifestations of rectal cancer. Our case presented with a rectal mass, but workup revealed a metastatic lesion from lung cancer. Lung cancer metastases to the lower gastrointestinal tract imply reduced survival compared with the already poor mean survival of stage IV lung cancer. Despite relevant therapy, the patient died 5 months after referral.
Cobb Angle Reduction in a Nearly Skeletally Mature Adolescent (Risser 4) After Pattern-Specific Scoliosis Rehabilitation (PSSR)
Authors: Marc Moramarco, Kathryn Moramarco, Maja Fadzan
Journal: Open Orthop J (2017)
Keywords: adolescent idiopathic scoliosis, pattern-specific scoliosis rehabilitation, schroth best practice, schroth method, scoliosis-specific exercise
MeSH terms: Case Reports

Introduction:
It has long been said that exercise-based rehabilitation for scoliosis is ineffective, however, these reports studied general exercises. This case report is a prospective one-year follow-up of a nearly skeletally mature adolescent female (Risser 4) with idiopathic scoliosis treated with Pattern-Specific-Scoliosis Rehabilitation (PSSR).
Methods:
The 15-year old patient recommended for surgery (initial Cobb angle of 45°) completed a 16-hour scoliosis-specific back school (according to Schroth Best Practice®), over the course of five weeks. She continued with her program at home, and followed up with the lead author after 6 months and 1 year.
Results:
The patient achieved a 13° reduction in her primary thoracic Cobb angle. Postural improvement and reduction in trunk rotation (ATR) was also achieved (-4° in the thoracic spine, and -5° in the lumbar spine).
Conclusion:
Pattern-specific scoliosis rehabilitation (PSSR) works to reduce the asymmetrical load caused by scoliosis. PSSR is effective in stabilizing Cobb angle, and can, in some cases, reduce Cobb angle in adolescents. Patients recommended for surgery may be candidates for conservative treatment. This case suggests that the practice of discontinuing conservative treatment at Risser stage 4 should be re-evaluated.
Management of iatrogenic chloroform mucosal burn in the palate: a case report
Authors: Ali Taghavi Zenouz, Katayoun Katebi, Mohammad Ali Ghavimi, Farshad Javadzadeh, Maryam Hosseinpour Sarmadi
Journal: J Adv Periodontol Implant Dent (2022)
Keywords: chloroform, case report, chemical burn, iatrogenic disease
MeSH terms: Case Reports

Chloroform is used widely in endodontic treatments for solving gutta-percha points, but it can have destructive effects if it comes in to contact with oral mucosa. This article presents a case of necrotic ulcer of palatal and buccal mucosa due to injudicious use of chloroform in endodontic treatment, which has caused severe destruction in maxilla. A conservative treatment method of repeated curettage and irrigation was used and although the lesion healed completely, it had major effects on the patient's quality of life including loss of two teeth. It is important that dentist be aware of the devastating effects of imprudent application of various chemicals used in dentistry. The conservative treatment used for this case can be helpful option for similar cases.
Empyema Necessitans due to Interruption of Antituberculosis Treatment
Authors: H N Benaragama, J Pushpakumara, Kamani P Wanigasuriya
Journal: Case Rep Infect Dis (2019)
MeSH terms: Case Reports

Empyema necessitans is a rare presentation of tuberculous infection, commonly encountered in immunocompromised patients. The diagnosis can be challenging due to the paucibacillary nature of the condition and nonspecific symptoms. Identifying the organism in culture is the gold standard method of diagnosis. We describe a patient with chronic kidney disease, who developed empyema necessitans due to interruption of antituberculous therapy. Initially, he was started on antituberculous therapy based on a clinical diagnosis of smear-negative pulmonary tuberculous infection; this resulted in Stevens-Johnson syndrome needing a long course of steroid therapy. He later presented with a painful chest lump and was diagnosed as empyema necessitans. Finding the etiology for this rare presentation lead to a diagnostic dilemma, finally confirming the TB infection from the culture. This case highlights the importance of being aware of unusual complications of tuberculous infection in immunocompromised settings.
A case report and literature review of myocardial infarction with nonobstructive coronary arteries (MINOCA) possibly due to acute coronary vasospasm induced by misoprostol
Authors: Nguyen Viet Hau, Luu Thi Kim Han, Le Huu Nhat Minh, Nguyen Anh Kiet, Tang Tuan Phong, Nguyen Khanh Duong, Phan Thi Hoang Yen, Nguyen Xuan Vinh, Nguyen Quan Nhu Hao, Nguyen Nguyen, Thien Tan Tri Tai Truyen, Nguyen Quoc Khanh Le
Journal: Front Cardiovasc Med (2023)
Keywords: minoca, acute myocardial infarction, coronary vasospasm, myocardial infarction in the absence of obstructive coronary artery disease, prostaglandin e1 analogue
MeSH terms: Case Reports

Coronary artery vasospasm (CVS), an uncommon cause of acute chest pain, can be provoked by vasoconstriction-induced medications. Misoprostol, a prostaglandin analog, is a safe medication to terminate a pregnancy. However, misoprostol can cause coronary artery vasospasm due to vasoconstrictor properties, leading to acute myocardial infarction with nonobstructive coronary arteries (MINOCA), especially in patients with a high risk for cardiovascular disease. We report a case of a 42-year-old female with a past medical history of hypertension who presented with ST-elevation myocardial infarction following the administration of a high-dose Misoprostol. The fact that coronary angiogram and intravascular ultrasound revealed normal coronary arteries suggested transient coronary vasospasm. CVS is a severe but rare cardiac adverse effect associated with high-dose misoprostol. This medication should be prescribed with caution and close monitoring, especially in those with pre-existing heart disease or cardiovascular risk factors. Our case raises awareness of severe cardiovascular complications that can be related to using misoprostol in high-risk patients.
Refractory Epistaxis due to Severe Factor V Deficiency with Inhibitor
Authors: Elizabeth S John, Minesh D Patel, Julio Hajdenberg
Journal: Case Rep Hematol (2015)

Factor V deficiency secondary to inhibitors is extremely rare and can be caused by a wide collection of exposures such as bovine thrombin and beta lactamase antibiotics. The management of factor V deficiency with inhibitor is a condition treated based on case reports due to the rarity of this condition. We describe a complicated case of an elderly patient with severe factor V deficiency with high inhibitor titer refractory to FEIBA (anti-inhibitor coagulation complex) treated with NovoSeven concurrently with cyclosporine immunosuppression and Rituxan. Given that there are no consensus guidelines on treatment, this case offers important insight into the therapeutic approaches that can be used to treat such patients.
Advanced Renal-Cell Carcinoma Pseudoprogression After Combined Immunotherapy: Case Report and Literature Review
Authors: Xiaojie Zhang, Hao Huang, Lu Han, Tiepeng Li, Zibing Wang, Quanli Gao
Journal: Front Oncol (2021)
Keywords: pd-1, cytokine-induced killer (cik) cells, immunotherapy, pseudoprogression, renal-cell carcinoma
MeSH terms: Case Reports

Treatment with a combination of programmed cell death-1 (PD-1) blocker and cytokine-induced killer (CIK) cells has improved outcome in cancer patients but is also associated with various patterns of responses. Pseudoprogression is a unique and uncommon phenomenon with no clear criteria for rapid diagnosis. Although some reports of pseudoprogression during immunotherapy exist, there are few reports of pseudoprogression occurring twice in the same patient. Here, we report the case of 51-year-old female patient with advanced renal cell carcinoma, who received a combination treatment of PD-1 blocker and CIK cells, and where pseudoprogression of lung and brain tumors occurred successively during treatment.
An unusual presentation of a massive pulmonary embolism with misleading investigation results treated with tenecteplase
Authors: David Migneault, Zachary Levine, François de Champlain
Journal: Case Rep Emerg Med (2015)

Background. There is no foolproof strategy to identify a pulmonary embolism (PE) in the emergency department, and atypical presentations are common. Negative test results may mislead physicians away from the diagnosis of PE. Objectives. The current report aims to raise awareness of an unusual presentation of massive PE and its diagnosis and management, in the face of limited evidence in the scientific literature. Case Reports. We report the case of a patient with a negative D-Dimer and a negative Computed Tomography contrast angiography of the chest who was diagnosed twenty-seven hours later with a massive PE, as suggested by a bedside echocardiography. The patient was successfully treated with tenecteplase (TNK). Conclusions/Summary. Pulmonary embolism frequently presents atypically and is often a diagnostic challenge. There is limited literature about the treatment of massive PE. Further research on bedside echocardiography for diagnosing PE in unstable patients is warranted. In addition, further study into new thrombolytic agents like tenecteplase in the context of massive and submassive PE is warranted.
Fibrous tumor of the breast: case report of an underrecognized entity
Authors: Nilotpal Chowdhury, Ramachandra V Bhat, Partho Protim Barman
Journal: Patholog Res Int (2011)
MeSH terms: Case Reports

Fibrous tumor of the breast is an underappreciated, distinctive, benign, nonrecurrent lesion of the breast. The cytological features of this condition are not well characterized. We present a case report of a 30-year-old female presenting with a hard mass in her right breast. Fine needle aspiration showed smears of low cellularity showing a few clusters and sheets of mostly uniform benign epithelial cells, some of which were lined by myoepithelial cells. Scattered bipolar bare nuclei or stromal fragments were not seen. Excision with subsequent histopathological examination revealed a well-circumscribed, heavily collagenous tumor with atrophy and replacement of the epithelial and ductal elements of the breast, and diagnosed as fibrous tumor. Being nonrecurrent, it is important to distinguish this lesion from fibromatosis of the breast.
Association of Direct Oral Anticoagulants (DOACs) and Warfarin With Haemorrhagic Risk by Applying Correspondence Analysis to Data From the Italian Pharmacovigilance Database - A Case Study
Authors: Mario Gaio, Carmen Ferrajolo, Alessia Zinzi, Consiglia Riccardi, Pasquale Di Filippo, Ludovica Carangelo, Gorizio Pieretti, Francesco Rossi, Giovanni Francesco Nicoletti, Annalisa Capuano
Journal: Front Pharmacol (2021)
Keywords: adverse event, anticoagulants, correspondence analysis, drug safety, pharmacovigilance, spontaneous reporting system

Introduction: Post-marketing data on the risks associated with direct oral anticoagulants (DOACs) are conflicting and only few studies evaluated a comparison between each different DOAC. Real-world data from pharmacovigilance databases can help to better define the safety profile of each DOAC and warfarin. However, Correspondence Analysis (CA) could represent a useful tool in this context. Objective: In the attempt to assess the usefulness of CA as a signal detection pharmacovigilance tool, we applied this method to the Italian Pharmacovigilance Database (RNF, Rete Nazionale di Farmacovigilanza), by comparing with disproportionality analysis on warfarin and DOACs. Methods: Study based on AEs sent to RNF by Campania Region from 2008 to 2021, in which warfarin, dabigatran, apixaban, edoxaban or rivaroxaban were reported as suspected drug. AEs were clustered into three Standardized MedDRA Queries (SMQs): Central Nervous System Haemorrhages and Conditions (CNSH), GastroIntestinal Perforation, Ulceration, Obstruction or Haemorrhages (GIPUOH) and other Haemorrhages (HH). Non-haemorrhagic AEs were included in a fourth cluster (nHH). Results: We retrieved 1,161 reports: 41.5% are associated to warfarin, 21.0% to dabigatran, 17.8% to rivaroxaban, 13.9% to apixaban and 5.8% to edoxaban. No significant differences in age distribution were observed. Results of CA showed that dabigatran and warfarin have the highest contribution (44.910 and 47.656, respectively) to the inertia of Dimension 1 as well as apixaban and dabigatran to the inertia of Dimension 2 (53.768 and 30.488, respectively). Edoxaban and rivaroxaban showed a negligible total contribution. CA biplot showed positive associations between warfarin and HH, apixaban and CNSH and dabigatran and nHH. Conclusion: Results seem to confirm that DOACs are not interchangeable. Apixaban was surprisingly associated with a higher risk of cerebral haemorrhage. As expected, our data support the better safety profile of DOACs than warfarin in terms of skin and respiratory tract hemorrhagic risks. Finally, we showed how CA could play a complementary role in analyzing data from pharmacovigilance databases.
The Role of Dexmedetomidine in Pediatric Patients Presenting with an Anticholinergic Toxidrome
Authors: Mitchell Zekhtser, Erin Carroll, Molly Boyd, Shashikanth Ambati
Journal: Case Rep Crit Care (2021)
MeSH terms: Case Reports

Background:
We report two pediatric cases of anticholinergic toxidrome, including the youngest reported to date, in which standard therapeutic strategies were either contraindicated or ineffective, while treatment with dexmedetomidine was rapidly efficacious with no adverse effects. Moreover, with the recent shortage of physostigmine, we highlight an alternative treatment in this clinical setting. Case Summaries. In case 1, a two-year-old had an overdose presenting with an anticholinergic toxidrome. However, his hypopnea precluded the use of benzodiazepines due to the high likelihood of intubation. In case 2, a 14-year-old had a polypharmacy overdose inducing agitated delirium that was refractory to high-dose benzodiazepines. Due to the unknown ingestion, physostigmine was avoided. In both cases, dexmedetomidine helped the patient remain calm and metabolize the ingestions.
Conclusion:
Our experience suggests that dexmedetomidine may be a useful adjunct in anticholinergic presentations in the setting of polypharmacy, when standard therapy is proven ineffective, contraindicated, or unavailable.
Descending thoracic aortic aneurysm revealing metastasis of a soft tissue fibrosarcoma: a case report and review of the literature
Authors: Clotilde Delerce, Olivia Bailly, Amine Bouhamama, Sophie Couchon, Frank Pilleul, Arnaud Thivolet, Charles Mastier
Journal: Clin Sarcoma Res (2018)
Keywords: aortic aneurysm, aortic metastasis, soft tissue sarcoma
MeSH terms: Case Reports

Background:
Review of the first documented case of aortic wall metastasis from a limb sarcoma.
Case presentation:
In a 56-year-old woman with a diagnosis of a high-grade limb fibrosarcoma, an aortic metastasis was revealed by a fast growing aneurysm of the descending thoracic aorta. This was managed with an endoprosthesis.
Conclusion:
The presence of an aneurysm in a patient with a sarcoma with a high potential for metastasis and poor cardiovascular risk factors should alert physicians.
Uremic leontiasis ossea due to secondary hyperparathyroidism complicated by vitamin C deficiency in a non-adherent chronic hemodialysis patient: A case report
Authors: David Massicotte-Azarniouch, Laurie McLean, Pierre Antoine Brown
Journal: Clin Nephrol Case Stud (2019)
Keywords: end-stage kidney disease, hyperparathyroidism, leontiasis ossea, non-adherence, renal osteodystrophy, vitamin c deficiency
MeSH terms: Case Reports

Non-adherence to medical therapy in patients with end-stage kidney disease (ESKD) can lead to severe metabolic derangements rarely seen in the current medical era. Such complications may take the form of secondary hyperparathyroidism (HPT) leading to rare manifestations of bone mineral disease, and profound vitamin C deficiency from poor nutrition combined with removal of water-soluble vitamins during dialysis. Secondary HPT causes renal osteodystrophy which can lead to diffuse enlargement of the facial skeleton and morphological changes suggestive of leontiasis ossea. We report a 36-year-old, non-adherent woman on chronic dialysis for over 10 years who developed progressive, diffuse facial bone enlargement in the context of years of extreme HPT and newly diagnosed severe vitamin C deficiency. Imaging revealed diffuse hypertrophy of the maxillary and mandibular bones. Histopathology showed extensive fibro-osseous proliferation without evidence of Brown tumor, suggestive of uremic leontiasis ossea. In this report, we discuss the orofacial manifestations of secondary HPT and the possible potentiating role of vitamin C deficiency on the development of renal osteodystrophy through altered vitamin D metabolism. Non-adherent patients on chronic dialysis should be evaluated for vitamin C deficiency, and the development of uremic leontiasis ossea should be considered when such patients present with distortion of facial features in the context of severe secondary HPT.