OpenMed/multicare-articles huggingface dataset:
Long-Term Remission of Acquired Von-Willebrand's Disease and Platelet Dysfunction after High-Dose Melphalan in a Patient with Multiple Myeloma
Authors: Jan Stratmann, Stefan Gundermann, Christof Geisen, Alexandra Dukat, Wolfgang Miesbach
Journal: Int J Hematol Oncol Stem Cell Res (2019)
Keywords: acquired von-willebrand's disease, autologous stem cell transplantation, immunoglobulin, multiple myeloma, platelet dysfunction
MeSH terms: Case Reports

Background: Autologous stem cell transplantation is considered a standard of care treatment in eligible patients with multiple myeloma, but puts the patient at high risk for infections and bleeding complications. Acquired von-Willebrand's disease (AVWD) and acquired platelet dysfunction are rare bleeding disorders that are associated with lymphoproliferative disorders such as multiple myeloma. Patients with acquired bleeding disorders who are planned for ASCT to treat the underlying condition are considered at highest risk for bleeding complications, and optimal treatment strategies are not known. Materials and Methods: We summarized the diagnostic and therapeutic approach to a patient affected by AVWD and acquired platelet disorder related to multiple myeloma. The patient who was planned for ASCT presented with moderate to severe bleeding symptoms. Results: Acute bleeding episodes were successfully controlled and prevented during induction and consolidation therapy with immunoglobulins, whereas replacement of plasma-derived VW factor showed no clinical improvement. High-dose melphalan-based consolidation therapy supported with autologous stem-cell transplantation led to an immediate and sustainable rise of von-Willebrand antigen and activity and a subsequent normalization of platelet aggregation activity. After a follow-up of 40 weeks, the patient maintained normalized VW levels and platelet aggregation capacity. There were no further signs or symptoms of bleeding. Conclusion: This case report highlights the necessity for combined supportive and causal treatment in patients with AVWD and paraproteinemic PD. High-dose melphalan with autologous stem cell support may function as a treatment option in patients with myeloma-related AVWD.
Imatinib Resistance in Chronic Myeloid Leukemia Associated with a D363G BCR::ABL1 Kinase Domain Mutation
Authors: Stephen E Langabeer, Stuart Macleod, Úna Bhreathnach, Kamal Fadalla
Journal: Case Rep Hematol (2023)
MeSH terms: Case Reports

Acquired resistance to tyrosine kinase inhibitors (TKIs) remains a therapeutic challenge in the treatment of chronic myeloid leukemia (CML). The most studied reason for TKI resistance is the acquisition of mutations within the BCR::ABL1 tyrosine kinase domain (KDM) and of which the majority of which occur at seven codons within this region. A case of CML is described in which presence of a rare D363G BCR::ABL1 KDM resulted in a suboptimal response to frontline imatinib. Switching to dasatinib resulted in achieving a sustained major molecular response that was maintained after a subsequent switch to bosutinib due to the side effects. Reporting of such cases is important for the future management of any CML patients with this rare mutation.
A Midgut Duplication Cyst Lined by Respiratory Epithelium
Authors: Balaji Mahendran, Tim Bracey, Rajesh T Kochupapy
Journal: Case Rep Surg (2018)
MeSH terms: Case Reports

Duplication cysts are an uncommon finding. Majority of these cases are found in the region of the midgut, and many have been reported in literature. However, there has been only one previous case of a midgut duplication cyst lined by respiratory epithelium. This is a rare pathology, of which very little is known about. The pathophysiology of these cases is also difficult to explain. We aim to present a case of a midgut duplication cyst in a paediatric patient, who had other abnormalities as well. We also aim to offer a hypothesis for this case.
Posteclampsia Sudden Cardiac Arrest (SCA): A Rare Etiology
Authors: Nissar Shaikh, Shoaib Nawaz, Arshad Chanda, Seema Nahid, Muhmmad Zubair, Firdous Ummunnisa
Journal: Case Rep Obstet Gynecol (2020)
MeSH terms: Case Reports

Eclampsia is associated with high maternal and fetal morbidity and mortality. The mortality in eclampsia is reported to be secondary to cerebrovascular accidents, neurogenic pulmonary edema, or acute kidney injury leading to cardiac arrest. A rarely reported etiology is sudden cardiac arrest (SCA) immediately after the seizure activity. We report a case of morbidly obese multigravida, complicated into postnatal eclampsia developing postseizure SCA due to apnea. Case. A 35-year-old woman in 38 weeks of gestation presented to the women's hospital emergency with hypertension and proteinuria and had lower section caesarean section under epidural anesthesia and required labetalol infusion. She developed convulsions in the 1st postoperative day, and she was started on magnesium sulphate therapy. After a few minutes, the patient had a 2nd episode of convulsions, apnea, cyanosis, and cardiac asystole requiring cardiopulmonary resuscitation and spontaneous circulation returned in 3 minutes. Her endotracheal intubation was difficult, but we succeeded in the 2nd attempt. She was sedated, ventilated, and required noradrenaline to maintain hemodynamics. Her ECG, echocardiogram, cardiac biomarkers, CT chest/brain, and serum magnesium levels were within normal range. The patient was weaned from vasopressor and ventilator by day 2 and extubated. She became awake; labetalol and magnesium sulphate infusions were stopped by day 3. The patient was transferred to the ward on day 5; from there she was discharged home on day 8 on oral labetalol. She was followed up in an outpatient clinic after 4 weeks and remained comfortable, and blood pressure was controlled with tablet labetalol and repeat echocardiogram was normal. Conclusion. Eclampsia patients can have apnea after seizures, progressing to SCA.
An Incidental Diagnosis of Rheumatic Mitral Stenosis and Secundum Atrial Septal Defect (Lutembacher's Syndrome) in a Young Woman
Authors: Md Mashiul Alam, Md Fakhrul Islam Khaled
Journal: Case Rep Cardiol (2019)
MeSH terms: Case Reports

Lutembacher's syndrome is a rare cardiovascular defect comprising of mitral stenosis and atrial septal defect. A combination of acquired mitral stenosis and congenital atrial septal defect is the most well-recognized pattern. As atrial septal defect acts as a pressure relieving gateway, signs and symptoms of mitral stenosis may be attenuated and/or delayed in such patients. We have presented a case with Lutembacher's syndrome that was incidentally diagnosed as having such defect during outpatient check-up for upper respiratory infection.
Ingested metallic foreign body impacted in the vermiform appendix presenting as acute appendicitis: Case report
Authors: Ayad Ahmad Mohammed, Dezhwar Yahya Ghazi, Sardar Hassan Arif
Journal: Int J Surg Case Rep (2019)
Keywords: appendicectomy, appendicitis, foreign body appendicitis, vermiform appendix

Introduction:
Ingestion of foreign bodies and their impaction at the lumen of the appendix is a very rare finding and only few cases have been reported all over the world. A variety of metallic foreign bodies when ingested may be lodged in the lumen of the appendix such as screws, bird shots, and needles. This is called in most literatures as foreign body appendicitis.
Case presentation:
A 4-year-old boy with history of an accidental ingestion of a metallic nail presented to the emergency department one week later with right iliac fossa pain and one attack of vomiting. During abdominal examination there was tenderness and rebound tenderness at the right iliac fossa. Plain abdominal X-ray showed the metallic nail in the region of the right iliac fossa. Ultrasound examination was normal apart from tenderness of putting the probe on the right lilac fossa. The white blood cell counts were 14,000 cell per microliter. During surgery the nail was found to be impacted inside the lumen of the vermiform appendix causing inflammation of the appendix. Appendicectomy done and the patient discharged on the third day in a good general condition.
Conclusion:
Acute appendicitis may be caused by a variety of causes including ingested foreign bodies if impacted in its lumen. When the patient has signs of generalized peritonitis it is important to exclude bowel perforation. The surgery can be done by the open surgery or laparoscopically.
Pericardial injury from chest compression: a case report of incidental release of cardiac tamponade
Authors: Shigeaki Aoyagi, Tomokazu Kosuga, Kumiko Wada, Shin-Ichi Nata, Hiroshi Yasunaga
Journal: J Intensive Care (2018)
Keywords: aortic dissection, cardiac tamponade, cardiopulmonary arrest, cardiopulmonary resuscitation, chest compression, pericardial injury
MeSH terms: Case Reports

Background:
Although chest compression is a standard technique in cardiopulmonary resuscitation, it is well recognized that manual chest compression causes various internal injuries, of which major injuries are often fatal. Similarly, when cardiac tamponade occurs in patients with type A acute aortic dissection, many patients die before reaching the hospital. We report a rare case in which chest compressions caused pericardial laceration that may have inadvertently played a life-saving role in releasing cardiac tamponade induced by acute aortic dissection.
Case presentation:
A 67-year-old woman developed cardiac arrest soon after complaining of epigastric pain, and after successful resuscitation by manual chest compression, she was transferred to our hospital. On arrival, the patient was 14 on the Glasgow Coma Scale. An ECG showed a normal sinus rhythm, and no arrhythmias or signs of myocardial ischemia were observed. A chest X-ray revealed left pleural effusion, while cardiomegaly and pneumothorax were not identified. Computed tomography revealed type A aortic dissection, mild pericardial effusion, and massive left pleural effusion. No pulmonary embolus was found on the CT. After drainage of bloody effusion from the left pleural space, an emergency operation was begun. During surgery, a pericardial laceration with communication to the left pleural space and a hemothorax were found; however, no cardiac injury was identified. No other intra-thoracic injuries or rupture of the aortic dissection causing the hemothorax were detected. Hemiarch replacement was performed without difficulty, but the patient died of multi-organ failure 30 days after surgery.
Conclusions:
We report a case of pericardial injury without skeletal fracture caused by chest compression. The pericardial laceration may have inadvertently served to release the cardiac tamponade induced by the acute aortic dissection, resulting in the hemothorax, and provided time to receive surgery.
Case report: Unusual viral evolutions following antiviral therapies in a patient with concurrent hepatitis B virus and hepatitis C virus infection
Authors: Yi-Tse Su, Ming-Ling Chang, Yun-Fan Liaw
Journal: Front Med (Lausanne) (2023)
Keywords: chronic hepatitis b, chronic hepatitis c, co-infection, entecavir, reactivation
MeSH terms: Case Reports

Concurrent hepatitis B virus (HBV) and hepatitis C virus (HCV) infection is not uncommon as the two viruses shared the similar transmission routes. HCV is usually the dominant virus to suppress HBV, and HBV reactivation may occur during or after the course of anti-HCV treatment. By contrast, HCV reactivation after anti-HBV therapy in the concurrent HBV- and HCV-infected patients was rarely noted. Here, we reported the unusual viral evolutions of a patient with concurrent HBV and HCV infection, in whom HCV reactivation occurred during the entecavir therapy to rescue the severe HBV flare, while the following anti-HCV combination therapy with pegylated interferon and ribavirin elicited the second HBV flare despite sustained virological response to HCV infection, and further entecavir therapy healed the flare.
An aggravated return-to-work case of organic solvent induced chronic toxic encephalopathy
Authors: Sangyun Seo, Jungwon Kim
Journal: Ann Occup Environ Med (2018)
Keywords: neurotoxicity syndromes, occupational diseases, return to work, solvents, toxic encephalopathy
MeSH terms: Case Reports

Background:
Organic solvent-induced chronic toxic encephalopathy (CTE) is known as a non-progressive disorder that does not progress after diagnosis. The authors present a case those symptoms worsened after continued exposure to organic solvent after returning to work. Because such a case has not been reported in South Korea to the best of our knowledge, we intend to report this case along with literature review.
Case presentation:
A 59-year-old man, who performed painting job at a large shipyard for 20 years, was receiving hospital treatment mainly for depression. During the inpatient treatment, severe cognitive impairment was identified, and he visited the occupational and environmental medicine outpatient clinic for assessing work relatedness. In 1984, at the age of 27, he began performing touch-up and spray painting as a shipyard painter. Before that he had not been exposure to any neurotoxic substances. In 2001, at the age of 44, after 15 years of exposure to mixed solvents including toluene, xylene and others, he was diagnosed with CTE International Solvent Workshop (ISW) type 2A. After 7 years of sick leave, he returned to work in 2006. And he repeated return-to-work and sick leave in the same job due to worsening of depressive symptoms. He had worked four times (2006-2010, 2011-2011, 2011-2011, 2016-2017) for a total of 5 years as a shipyard painter after first compensation. During the return-to-work period, the mean values of the mixed solvent index ranged from 0.57 to 2.15, and except for a one semiannual period, all mean values were above the standard value of 1. We excluded other diseases that can cause cognitive impairment like central nervous system diseases, brain injury, psychological diseases and metabolic diseases with physical examinations, laboratory tests, and brain image analysis. And finally, throughout neuropsychological tests, an overall deterioration in cognitive function was identified compared to 2002, and the deterioration types was similar to that often shown in the case of CTE; thus a diagnosis of CTE (ISW) type 3 was made.
Conclusion:
This case is showing that CTE can go on with continued exposure to mixed solvents. Appropriate "fitness to work" should be taken to prevent disease deterioration especially for the sick leave workers.
Tocilizumab for the treatment of rheumatoid arthritis and other systemic autoimmune diseases: current perspectives and future directions
Authors: Atsushi Ogata, Toshio Tanaka
Journal: Int J Rheumatol (2012)

Interleukin (IL)-6 is a cytokine featuring redundancy and pleiotropic activity. While IL-6, when transiently produced, contributes to host defense against acute environmental stress, continuous dysregulated IL-6 production plays a significant pathological role in several systemic autoimmune diseases. In response to the expectation that IL-6 blockade would constitute a novel therapeutic strategy for the treatment of these diseases, tocilizumab, a humanized anti-IL-6 receptor antibody, was developed. Clinical trials have verified the efficacy and the safety of tocilizumab for patients with rheumatoid arthritis, resulting in approval of this innovative biologic for the treatment of rheumatoid arthritis in more than 90 countries worldwide. Pathological analyses of the effect of IL-6 on the development of autoimmune diseases and a considerable number of case reports and pilot studies have also indicated the beneficial effects of this antibody on other systemic autoimmune diseases, including systemic lupus erythematosus, systemic sclerosis, polymyositis, and large-vessel vasculitis.
Obstructive-Type Jaundice without Bile Duct Dilatation in Generalized Peritonitis Is a Specific Sign of Spontaneous Gall Bladder Perforation
Authors: Vicky Sumarki Budipramana, Maria Meilita
Journal: Case Rep Med (2020)
MeSH terms: Case Reports

Generalized peritonitis caused by spontaneous gall bladder perforation is rare and difficult to diagnose preoperatively. The increased absorption of the spilling conjugated bile from the gall bladder by the inflamed peritoneum causes jaundice and direct hyperbilirubinemia. A 56-year-old male patient with septic generalized peritonitis and obstructive-type hyperbilirubinemia came to our hospital. The blood examination showed that total, direct, and indirect bilirubin were 6.20, 5.38, and 0.82 mg/dl. The gall bladder perforation was not detected on USG, CT scan, and MRCP. On laparotomy, we found a 0.5 cm perforation on the fundus of the gall bladder and 2500 cc of bilious fluid in the peritoneal cavity. Cholecystectomy was performed, and the patient completely recovered after the surgery. Preoperative diagnosis of spontaneous gall bladder perforation is difficult even by using ultrasonography, CT scan, and MRCP. The inflammatory reaction of the peritoneum in bile peritonitis increases the absorption of the spilled conjugated bile from the peritoneal cavity. The obstructive-type hyperbilirubinemia without dilatation of the bile duct on imaging examination was the sign of bile leakage into the peritoneal cavity. In septic condition, the preoperative diagnosis of the spontaneous gall bladder perforation is important to establish so that the surgeon can make only a minimal procedure in reducing the morbidity. Therefore, it could be concluded that the presently occurring obstructive-type jaundice without dilatation of the bile duct in the case of generalized peritonitis is a specific sign of spontaneous gall bladder perforation.
Patients with Hypocortisolism Treated with Continuous Subcutaneous Hydrocortisone Infusion (CSHI): An Option for Poorly Controlled Patients
Authors: Malene Lyder Mortensen, Marie Juul Ornstrup, Claus H Gravholt
Journal: Int J Endocrinol (2023)

Objective:
Despite appropriate oral glucocorticoid replacement therapy, patients with hypocortisolism often suffer from impaired health and frequent hospitalizations. Continuous subcutaneous hydrocortisone infusion (CSHI) has been developed as an attempt to improve the health status of these patients. The objective of this study was to compare the effects of CSHI to conventional oral treatment on hospitalizations, glucocorticoid doses, and subjective health status. Patients. Nine Danish patients (males: 4 and females: 5) with adrenal insufficiency (AI) were included, with a median age of 48 years, due to Addison (n = 4), congenital adrenal hyperplasia (n = 1), steroid induced secondary adrenal insufficiency (n = 2), morphine induced secondary adrenal insufficiency (n = 1), and Sheehan's syndrome (n = 1). Only patients with severe symptoms of cortisol deficit on oral treatment were selected for CSHI. Their usual oral hydrocortisone doses varied from 25-80 mg per day. The duration of follow-up depended on when the treatment was changed. The first patient started CSHI in 2009 and the last in 2021.
Design:
A retrospective case series comparing hospitalizations and glucocorticoid doses before and after treatment with CSHI. In addition, patients were retrospectively interviewed about their health-related quality of life (HRQoL) after the change of treatment modality.
Results:
Patients significantly reduced their daily dose of glucocorticoids by 16.1 mg (p = 0.02) after changing to CSHI. The number of hospital admission due to adrenal crisis decreased by 1.3 per year on CSHI, which was a 50% reduction (p = 0.04). All patients found it easier to handle an adrenal crisis with CSHI, and almost all patients found it easier to overcome everyday activities and had fewer symptoms of cortisol deficit such as abdominal pain and nausea (7-8 out of 9 patients).
Conclusions:
The change of treatment from conventional oral hydrocortisone to CSHI resulted in a reduced daily dose of glucocorticoids and a reduced number of hospitalizations. Patients reported regain of energy, achievement of better disease control, and better handling of adrenal crisis.
The treatment of PTSD in an older adult Norwegian woman using narrative exposure therapy: a case report
Authors: Nina Mørkved, Steven R Thorp
Journal: Eur J Psychotraumatol (2018)
Keywords: psychotherapy, complex trauma, emotional abuse, sexual abuse, trauma narratives, • ptsd due to single or multiple traumatic events can occur at any age and persist over years• the majority of research on ptsd treatments is focused on younger and middle-aged adults• there is a need for research on how these treatment-protocols might be generalizable to older adults• this case report illustrates that narrative exposure therapy was effective in treating ptsd and depressive symptoms in an older adult
MeSH terms: Case Reports

The bulk of the literature on effective treatments for posttraumatic stress disorder (PTSD) has focused on children, adolescents, and young adults. The evidence on treatments for older adults is sparse. This case report presents the application of narrative exposure therapy (NET) for a 70-year-old Norwegian woman suffering from PTSD as a result of multiple childhood and late life traumatic events. NET is a manualized, short-term, cognitive-behavioural therapy for PTSD, originally developed to meet the needs of survivors of war and organized violence. Some aspects of NET may be a good fit for older adults, including its brevity, simplicity, and concrete nature. The course of therapy included psychoeducation, a lifeline exercise, imaginal exposure, and the creation of a coherent narrative. Symptoms of depression and posttraumatic stress showed improvement over the course of therapy and at follow-up. This suggests that NET may have potential as a trauma treatment for older adults.
Giant desmoid tumor of the anterior abdominal wall in a young female: a case report
Authors: Mahim Koshariya, Samir Shukla, Zuber Khan, Vaibhav Vikas, Avinash Pratap Singh, Puspendra Baghel, Varun Pendro, Vishal Kirti Jain, Shrikant Jagdish Jai, Sanjeev Kumar, M C Songra
Journal: Case Rep Surg (2013)

Desmoid tumors (also called desmoids fibromatosis) are rare slow growing benign and musculoaponeurotic tumors. Although these tumors have a propensity to invade surrounding tissues, they are not malignant. These tumors are associated with women of fertile age, especially during and after pregnancy. We report a young female patient with a giant desmoid tumor of the anterior abdominal wall who underwent primary resection. The patient had no history of an earlier abdominal surgery. Preoperative evaluation included abdominal ultrasound, computed tomography, and magnetic resonance imaging. The histology revealed a desmoid tumor. Primary surgical resection with immediate reconstruction of abdominal defect is the best management of this rarity. To the best of our knowledge and PubMed search, this is the first case ever reported in the medical literature of such a giant desmoid tumor arising from anterior abdominal wall weighing 6.5 kg treated surgically with successful outcome.
Retroperitoneal Ectopic Pregnancy: Diagnosis and Therapeutic Challenges
Authors: Salma Ouassour, Abdelhai Adib Filali, Mohamed Raiss, Rachid Bezad, Zakia Tazi, Mohamed Hassan Alami, Jihane Bennani, Rachida Dafiri
Journal: Case Rep Surg (2017)
MeSH terms: Case Reports

Background:
Retroperitoneal ectopic pregnancy is extremely rare. This unusual location represents a great challenge for clinicians due to the difficulties of diagnosis and high risk of life-threatening complications.
Case report:
We report the case of a spontaneous early pregnancy of undetermined location in a patient with a history of previous laparoscopic surgery. Diagnosis steps using clinical examination, ultrasound, and magnetic resonance imaging led to the localization of the pregnancy, in the left side of the para-aortic region, in the retroperitoneal space.
Conclusion:
Retroperitoneal ectopic pregnancy is an uncommon entity with rather complex pathogenesis. Clinicians should carefully interpret clinical signs, biological findings, and imaging features and be aware of unusual locations such as the retroperitoneum for ectopic pregnancies. Early diagnosis and appropriate management strategy are conditio sine qua non for successful treatment outcomes.