OpenMed/multicare-articles huggingface dataset:
Efficacy of switching to dolutegravir plus rilpivirine, the small-tablet regimen, in patients with dysphagia: two case reports
Authors: Takefumi Suzuki, Nobuko Hara, Morichika Osa, Kazuhisa Misawa, Kazuo Imai, Yuji Fujikura, Takuya Maeda, Wataru Sonehara, Akihiko Kawana
Journal: J Pharm Health Care Sci (2017)
Keywords: dolutegravir, dysphagia, nrti-sparing, rilpivirine
MeSH terms: Case Reports

Background:
The advent of well-tolerated and effective anti-retroviral drugs against human immunodeficiency virus-1 (HIV-1) infection has been a major step forward that has achieved long-term survival in recent years. The number of HIV-1 infected patients who experience difficulty in swallowing tablets is expected to increase as the HIV-infected population advances in age or develops comorbidities or treatment sequelae affecting the central nervous system.
Case presentation:
Here, we describe two HIV-1-infected patients who experienced progressive dysphagia leading to inability to swallow the antiretroviral tablets included in the standard regimen. Both patients had a plasma viral load < 40 copies/mL while receiving anti-retroviral therapy with the recommended combination antiretroviral therapy (cART) regimen, but the dysphagia necessitated a switch. By switching to much smaller sized combined regimen of dolutegravir (DTG) plus rilpivirine (RPV) tablets, both of our patients were able to successfully continue treatment and maintain adherence without the need for crushing tablets or preparing an oral suspension. Additionally, switching from the recommended cART regimen to DTG plus RPV successfully maintained viral suppression. At the last available follow-up (12 months after switching to DTG/RPV), HIV-1 viral load remained below the lower limit of quantification.
Conclusions:
An alternative therapeutic option that takes tablet size into consideration could not only contribute to improved patient adherence, but also a reduced care burden for HIV-infected patients with dysphagia. Thus, switching to the "small-tablet regimen" of DTG plus RPV has the potential to improve the survival and well-being of patients with dysphagia.
A Rare Case of Acute Pancreatitis Due to Very Severe Hypertriglyceridemia (>10 000 mg/dL) Successfully Resolved With Insulin Therapy Alone: A Case Report and Literature Review
Authors: Vijay Gayam, Amrendra Kumar Mandal, Arshpal Gill, Mazin Khalid, Ruby Sangha, Mowyad Khalid, Pavani Garlapati, Bikash Bhattarai
Journal: J Investig Med High Impact Case Rep (2018)
Keywords: acute pancreatitis, hypertriglyceridemia

A 48-year-old male presented to the psychiatric emergency room for dysmorphic mood. He was admitted to medical service for the management of hyponatremia, which was discovered in his initial laboratory workup. After the first day of admission, he developed abdominal pain and fever, and subsequent laboratory work revealed a triglyceride level of 10 612 mg/dL (reference range = 0-194 mg/dL). Computed tomography scan of the abdomen and pelvis revealed a hypodense lesion in the pancreas surrounded by a moderate amount of peripancreatic fluid suggestive of hemorrhagic pancreatitis. Based on the laboratory findings and imaging, we diagnosed acute pancreatitis (AP) secondary to hypertriglyceridemia. The patient was initiated on intravenous fluids and insulin to help decrease the triglyceride level with the plan to initiate apheresis. However, the patient improved on insulin therapy alone, which negated the need for apheresis, and the patient was discharged with fenofibrate with no further complications. While elevated triglycerides are a well-known cause of AP, we sought to assess various treatment options in management, especially considering a severely elevated triglyceride level of >10 000 mg/dL. Along with supportive care in AP, there are additional options in hypertriglyceridemia AP, including heparin, insulin, apheresis, antioxidants, and fibrates. Currently, there are no clear guidelines favoring one therapeutic option over the other.
A rare case of poorly differentiated thyroid carcinoma probably arising from a nodular goiter
Authors: Hironao Yasuoka, Yasushi Nakamura, Mitsuyoshi Hirokawa, Ken-Ichi Yoshida, Kana Anno, Masayuki Tori, Masahiko Tsujimoto
Journal: BMC Clin Pathol (2017)
Keywords: nodular goiter, poorly differentiated thyroid carcinoma, ras mutation
MeSH terms: Case Reports

Background:
Some poorly differentiated thyroid carcinomas (PDTC) arise from pre-existing, well-differentiated carcinomas of follicular cell origin; however, others most likely arise de novo. The case of a PDTC adjacent to a pre-existing nodular goiter is very rare.
Case presentation:
A patient had a PDTC, a widely invasive, cellular tumor with cells that lacked the nuclear features of a papillary thyroid carcinoma. Carcinoma cells were arranged in trabecular, solid, and microfollicular histological patterns and displayed high mitotic activity. A nodule partially encapsulated in a thick fibrous capsule was found adjacent to the PDTC. The nodule was composed of small or dilated follicles, without papillary carcinoma-like nuclear features, that were consistent with a nodular goiter. The PDTC showed a high Ki-67 labeling index and an NRAS gene mutation (codon 61, Q61K).
Conclusion:
These results support our diagnosis of a PDTC, probably arising from a nodular goiter.
A Triple Obstetric Challenge of Thoracopagus-Type Conjoined Twins, Eclampsia, and Obstructed Labor: A Case Report from Sub-Saharan Africa
Authors: Mariatu Binta Leigh, Valerie John-Cole, Mike Kamara, Alimamy Philip Koroma, Michael Momoh Koroma, Edward Ejiro Emuveyan, Peter Bramlage, Ivo Buschmann
Journal: Case Rep Obstet Gynecol (2017)
MeSH terms: Case Reports

Conjoined twins are very rarely seen. We present a case of thoracopagus that was undiagnosed prior to delivery and combined with eclampsia and obstructed labor in a low-resource setting in sub-Saharan Africa. A 27-year-old pregnant woman was presented to the maternity emergency unit of Princess Christian Maternity Hospital (PCMH) in Freetown at term in labor. Upon admission, the patient was awake and orientated and presented a blood pressure of 180/120 mmHg and a protein value of 3+ on urine dipstick test. Clinical examination-ultrasound was not available-led to the admission diagnosis: obstructed labor with intrauterine fetal death and preeclampsia. Application of Hydralazine 5 mg (i.v.) under close blood pressure monitoring was performed. Under spontaneous progression of labor, one head of the yet unknown conjoined twin was born. The patient developed eclamptic fits. Ceasing of seizures was achieved after implementing the loading dose of the MgSO4 protocol. A vaginal examination led to the unexpected diagnosis of conjoined twins. An emergency cesarean section under general anesthesia via a longitudinal midline incision was performed immediately. The born head was repositioned vaginally. The stillborn conjoined twins presented a female thoracopagus type that seemed to involve the heart. After 8 weeks, the woman was clinically fully recovered.
Acute Hypertensive Retinochoroidopathy Secondary to an Anti-cancer Drug (apatinib): The First Case Report
Authors: Bangtao Yao, Gang Liu, Bei Wang, Qian Cao
Journal: Front Med (Lausanne) (2021)
Keywords: brb, rpe, srd, apatinib, elschnig spots, hypertensive retinochoroidopathy
MeSH terms: Case Reports

Background: Acute hypertensive retinochoroidopathy is a rare, severe ocular disease, characterized by retinal and choroidal ischaemia. Untreated cases are associated with high mortality and poor visual outcomes. Patients subjected to treatment with the anti-neoplasic drug apatinib may trigger this disease. The purpose of this article is to describe in detail an acute hypertensive retinochoroidopathy in a young Chinese woman treated with apatinib. Case Presentation: A 40-year-old young Chinese woman presented a sudden but painless reduction of visual acuity in both eyes. She was previously diagnosed with gastric cancer and metastatic ovarian adenocarcinoma. The treatment consisted radical gastrectomy, transabdominal hysterectomy, bilateral adnexectomy, and 250 mg oral apatinib per day. After 58 days of apatinib administration, the patient immediately sought consult for a sudden decrease in vision. Her blood pressure was 208/136 mmHg and, based on the clinical manifestations, the patient was diagnosed with acute hypertensive retinochoroidopathy. Conclusions: This is the first case report of an apatinib-related acute hypertensive retinochoroidopathy diagnosed using fundal photograph, fundus fluorescein angiography, and spectral-domain optical coherence tomography simultaneously. It is crucial to develop a suitable strategy for management and prevention of this adverse event.
Aggressive Acute Marjolin's Ulcer Arising in a Burn Scar
Authors: Adela Alvarez Rio, Josep Oriol Roca Mas, Daniel Navarro Sanchez, Ivan Monge Castresana, Gonzalo Joaquin Soroa Moreno, Jaime Estrada Cuxart
Journal: Case Rep Dermatol Med (2022)
MeSH terms: Case Reports

Marjolin's ulcer is one of the clinical variants of squamous-cell carcinoma. It is a highly aggressive disease that develops from chronic wounds. Almost 65% of these lesions have been diagnosed on underlying burn scars. Although the mean latency time between the primary lesion and the apparition of the ulcer is around 25 years, some cases with an early debut have been described. Squamous-cell carcinomas arising in chronic wounds are typically aggressive and are related with a poor prognosis due to their late diagnosis. Therefore, it is important to recognize symptoms that indicate malignant degeneration of chronic wounds, allowing the clinician to make an early diagnosis in order not to delay the surgical treatment that is required to improve the global survival of the patient. The time elapsed between our patient's burn and the appearance of Marjolin's ulcer was only 7 months, drawing attention to its fast and aggressive progression.
Twice perforated stump appendicitis: a case report
Authors: Pueya Rashid Nashidengo, Francis William Quayson, John Tabiri Abebrese, Rejoice Tjipetekera, Sharifa Sushmita Seibes
Journal: Pan Afr Med J (2022)
Keywords: appendicitis, case report, exploratory laparotomy, stump appendicitis
MeSH terms: Appendicitis / diagnosis, Appendicitis / etiology, Appendicitis / surgery, Appendix / surgery, Fecal Impaction, Case Reports, Abdominal Pain / complications, Adult, Appendectomy / adverse effects, Humans, Inflammation, Male

Stump appendicitis is an acute inflammation of the residual appendix and one of the rare complications after appendectomy. Stump appendicitis is an under-reported and poorly defined condition related to obstruction and inflammation of the residual appendix after an appendectomy, usually by a fecolith. It remains a clinical challenge because of delayed diagnosis and subsequent treatment with increased morbidity or mortality. Herein, we describe the case of a 42-year-old male who presented with periumbilical pain with progression to generalized abdominal pain and signs of peritonitis 14 months post appendectomy. An exploratory laparotomy revealed an inflamed, non-gangrenous perforated appendices stump. We discuss the challenges in the diagnosis and management thereof.
A Rare Case of Chronic Myelogenous Leukemia Presenting as T-Cell Lymphoblastic Crisis
Authors: Parikshit Padhi, Margarita Topalovski, Radwa El Behery, Eduardo S Cantu, Ramadevi Medavarapu
Journal: Case Rep Oncol Med (2018)
MeSH terms: Case Reports

Chronic Myelogenous Leukemia in blast crisis can manifest as either myeloid (more common) or lymphoid blast crisis. Most lymphoblastic crises are of B-cell lineage. T-cell blast crisis is extremely rare, with only a few reported cases. We present a case of a middle-aged man who was diagnosed with CML on peripheral blood and bone marrow biopsy. Because of a generalized lymphadenopathy noted at the time of diagnosis, a lymph node biopsy was also performed, which revealed a T-cell lymphoblastic leukemia/lymphoma, BCR/ABL1 positive, with clonal evolution. This is a very rare manifestation of CML in blast crisis with no standard treatment and with poor outcomes despite chemotherapy or allogeneic stem cell transplant. Given its rarity, it would be difficult to develop standard chemotherapy protocols. We believe the treatment for this condition should be similar to any lymphoid blast crisis. The patient was treated with induction chemotherapy (hyper-CVAD regimen) plus dasatinib for 3 cycles followed by sibling-donor allogeneic stem cell transplant and is currently on maintenance dasatinib and has minimal residual disease at this time.
Mycobacterium fortuitum abdominal wall abscesses following liposuction
Authors: Hussam Al Soub, Eman Al-Maslamani, Mona Al-Maslamani
Journal: Indian J Plast Surg (2008)
Keywords: atypical mycobacteria, mycobacterium fortuitum, liposuction
MeSH terms: Case Reports

We describe here a case of abdominal abscesses due to Mycobacterium fortuitum following liposuction. The abscesses developed three months after the procedure and diagnosis was delayed for five months. The clues for diagnosis were persistent pus discharge in spite of broad spectrum antibiotics and failure to grow any organisms on routine culture. This condition has been rarely reported; however, the increasing number of liposuction procedures done and awareness among physicians will probably result in the identification of more cases. Combination antibiotic therapy with surgical drainage in more extensive diseases is essential for cure.
Case Report: Evolution of a Severe Vascular Refractory Form of ECD Requiring Liver Transplantation Correlated With the Change in the Monocyte Subset Analysis
Authors: Jérôme Razanamahery, Anne Roggy, Jean-François Emile, Alexandre Malakhia, Zaher Lakkis, Francine Garnache-Ottou, Thibaud Soumagne, Fleur Cohen-Aubart, Julien Haroche, Bernard Bonnotte
Journal: Front Immunol (2021)
Keywords: erdheim–chester disease, histiocytosis, monocyte, transplantation, vascular diagnosis
MeSH terms: Erdheim-Chester Disease / pathology, Liver Failure, Acute / etiology, Liver Transplantation, Monocytes / immunology, Monocytes / pathology, Case Reports, Adult, Erdheim-Chester Disease / complications, Erdheim-Chester Disease / immunology, Fatal Outcome, Female, Humans, Immunophenotyping, Liver Failure, Acute / pathology, Liver Failure, Acute / surgery

Erdheim-Chester disease is a rare histiocytosis characterized by iconic features associated with compatible histology. Most patients have somatic mutations in the MAP-kinase pathway gene, and the mutations occur in CD14+ monocytes. Differentiation of the myeloid lineage plays a central role in the pathogenesis of histiocytosis. Monocytes are myeloid-derived white blood cells, divided into three subsets, but only the CD14++CD16- "classical monocyte" can differentiate into dendritic cells and tissue macrophages. Since most mutations occur in CD14+ cells and since ECD patients have a particular monocytic phenotype resembling CMML, we studied the correlation between disease activity and monocytic subset distribution during the course of a severe vascular form of ECD requiring liver transplantation. During early follow-up, increased CD14++CD16- "classical monocyte" associated with decreased CD14lowCD16++ "non-classical monocyte" correlated with disease activity. Further studies are needed to confirm the use of monocyte as a marker of disease activity in patients with ECD.
Iodine Content and Distribution in Thyroid Specimens from Two Patients with Graves' Disease Pretreated with Either Propylthiouracil or Stable Iodine: Analysis Using X-Ray Fluorescence and Time-of-Flight Secondary Ion Mass Spectrometry
Authors: Marie Hansson, Helena Filipsson Nyström, Svante Jansson, Jukka Lausmaa, Gertrud Berg
Journal: Case Rep Endocrinol (2012)
MeSH terms: Case Reports

Patients with Graves' disease can be medically prepared before surgery in different ways, which may have various effects on iodine stores. Thyroid specimens were collected at surgery from two patients pretreated with propylthiouracil (PTU) and stable iodine, respectively. A quantitative analysis of iodine content was performed using X-ray fluorescence (XRF) in frozen tissue and a qualitative analysis of aldehyde-fixed material with Time-of-Flight Secondary Ion Mass Spectrometry (TOF-SIMS). Iodine concentrations were 0.9 mg/mL and 0.5 mg/mL in the thyroid tissue from the patients treated with PTU and stable iodine respectively. TOF-SIMS showed iodine in the follicle lumina in both. However, in the PTU case, iodine was also seen within the thyrocytes indicating accumulation of iodinated compounds from uninhibited hormone release. XRF and TOF-SIMS can be used to follow iodine distribution within the thyroid and the intricate processes following the different medical treatment alternatives in Graves' disease.
Atypical Case of Combined Types I and II Scleredema Mimicking Morphea on Histopathology
Authors: Sarah A Alhunaif, Abeer Alsarheed, Raghad Almutairi, Ghaida Almutairi
Journal: Cureus (2023)
Keywords: atypical presentation, scleredema, scleredema of buschke, type 1 scleredema, type 2 scleredema
MeSH terms: Case Reports

Scleredema is a rare sclerotic skin disorder that typically develops in conjunction with diabetes, monoclonal gammopathy, or infection and commonly involves the neck, back, trunk, and arms. Scleredema can be categorized into three types according to its cause. The local examination of the lesion is characterized by non-pitting induration that follows a symmetrical spread with sparing of the hands and feet. We present a case of a 19-year-old female patient that presented to the outpatient clinic complaining of facial skin lesions that have been progressive for four years. The skin lesions were found to involve the neck, back, trunk and both arms sparing the hands and there was no systemic involvement of the disease. The patient is non-diabetic but reported frequent attacks of tonsillitis over the past months. Initially, punch biopsy showed no signs of scleredema; however, repeated biopsy at follow-up confirmed the presence of mucin deposits which are suggestive features of scleredema. Due to the similarities with various other diseases, the diagnosis requires clinical and histopathological exclusion which makes the diagnosis quite challenging. It almost always starts in the neck but can present initially in rare cases from the face spreading symmetrically. Close follow-up and continuous monitoring are necessary for systemic organ involvement.
Perrault Syndrome Diagnosis in a Patient Presenting to Her Primary Care Provider with Secondary Amenorrhea
Authors: Leah May Roberts, Bruce Carnivale
Journal: Case Rep Obstet Gynecol (2019)
MeSH terms: Case Reports

Perrault syndrome is a rare autosomal recessive genetic disorder characterized by sensorineural hearing loss and female gonadic eukaryotic dysgenesis. Here, we report the case of a 20-year-old female that presented to her internal medicine physician after suffering from secondary amenorrhea. After multiple negative pregnancy tests done with primary care physicians, a further evaluation by an internal medicine specialist showed an elevated FSH and LH as well as a small uterus and streak ovaries on transabdominal and transvaginal ultrasound. She was referred to the OB-GYN service, gonadal dysgenesis was diagnosed, and proper treatment was initiated. We intend to highlight this presentation of ovarian dysfunction and provide guidance for the proper diagnosis and management of the said disorder.
Warning: This may be as dangerous as firearm injuries;"grease-gun injury": A case report
Authors: Oguz Eroglu, Elif Sari, Sevilay Vural, Figen Coskun
Journal: Pan Afr Med J (2015)
Keywords: grease-gun, amputation, firearm injuries
MeSH terms: Accidents, Occupational, Hand Injuries / pathology, Manufacturing Industry / instrumentation, Wounds, Penetrating / pathology, Case Reports, Adult, Debridement, Firearms, Hand Injuries / etiology, Humans, Injections / instrumentation, Male, Wounds, Gunshot / pathology, Wounds, Penetrating / etiology

High-pressure injection gun (Grease-gun) injuries mainly occur with industrial labourers. Injuries associated with high pressure grease guns are very rare and frequently involve the hand and chest. The non-dominant hand is generally injured since the grease gun is usually held in the dominant hand. Even if high-pressure injection injury causes only a small lesion in the skin, it is still characterized by severe damage to subcutaneous tissue. Since initial presentation may be deceptive, treatment is frequently delayed. The characteristics of the material injected need to be known as a priority, and systemic intoxication must be ruled out. The risk of amputation is 16-55%. With solvents it goes up to 50-80%. Surgical treatment must be performed immediately, under general anesthesia or plexus block. Foreign material and necrotic tissue must be early debrided with wide microsurgical exploration. Positive outcomes in reacquisition of hand functions can be obtained with long-term and early physiotherapy.
Case Report: Chronic hepatitis E virus Infection in an individual without evidence for immune deficiency
Authors: Dong Ying, Wenxia Niu, Yanling Chen, Yingbin Wang, Weikun Tian, Xiaoping Zhang, Chang Liu, Siling Wang, Zihao Chen, Yajie Lin, Shaoqi Guo, Zihao Yu, Xiuting Chen, Mujin Fang, Hongsheng Qiang, Yifan Yin, Zimin Tang, Zizheng Zheng, Lijuan Fu, Ningshao Xia
Journal: Front Immunol (2023)
Keywords: chronic hepatitis b, chronic hepatitis e, hepatitis e virus, immunocompetent, travel-related
MeSH terms: Hepatitis E virus / genetics, Hepatitis E / diagnosis, Hepatitis E / drug therapy, Immunologic Deficiency Syndromes / complications, Case Reports, Research Support, Non-U.S. Gov't, CD4-CD8 Ratio, CD4-Positive T-Lymphocytes, CD8-Positive T-Lymphocytes, Humans

Chronic hepatitis E virus (HEV) infection occurs mainly in immunosuppressed populations. We describe an investigation of chronic HEV infection of genotype 3a in an individual without evidence for immune deficiency who presented hepatitis with significant HEV viremia and viral shedding. We monitored HEV RNA in plasma and stools, and assessed anti-HEV specific immune responses. The patient was without apparent immunodeficiency based on quantified results of white blood cell, lymphocyte, neutrophilic granulocyte, CD3+ T cell, CD4+ T cell, and CD8+ T cell counts and CD4/CD8 ratio, as well as total serum IgG, IgM, and IgA, which were in the normal range. Despite HEV specific cellular response and strong humoral immunity being observed, viral shedding persisted up to 109 IU/mL. After treatment with ribavirin combined with interferon, the indicators of liver function in the patient returned to normal, accompanied by complete suppression and clearance of HEV. These results indicate that HEV chronicity can also occur in individuals without evidence of immunodeficiency.
Recurrent Dermatofibrosarcoma Protuberance and its Management with Radical Excision and Interval Skin Grafting: A Case Report
Authors: Imran Ahmad, Mohd Altaf Mir, Lalit Mohan Bariar, Nishat Afroz
Journal: World J Plast Surg (2016)
Keywords: dermatofibrosarcoma protuberans, interval skin graft, radical excision
MeSH terms: Case Reports

Dermatofibrosarcoma protuberans (DFSP) is very rare tumor of dermis layer of skin with the incidence of only 1 case per million per year. DFSP rarely leads to a metastasis (Less than 5% have metastasis), but DFSP can recur locally. We publish a rare case of a recurrent dermatofibrosarcoma protuberans and its management with radical excision and interval skin grafting.