OpenMed/multicare-articles huggingface dataset:
An Unusual Instigator of Spontaneous Bacterial Peritonitis: Salmonella typhimurium
Authors: Madhulika L Mahashabde, Yash R Bhimani, Gaurav A Chaudhary
Journal: Cureus (2024)
Keywords: hemorrhagic ascitis, portal vein thrombosis, salmonella typhimurium, spontaneous bacterial peritonitis, unusual case
MeSH terms: Case Reports

Salmonella is an unusual cause of spontaneous bacterial peritonitis (SBP). It is commonly seen in asymptomatic patients with normal or high ascitic fluid protein levels and an immunocompromised state such as AIDS and hematological and solid organ malignancies other than liver. SBP from non-typhoidal Salmonella species should be considered, even in the absence of underlying immunosuppression. Our patient presented with a history of high-grade fever and frequent loose stools with decompensated alcoholic liver cirrhosis. While evaluating the SBP etiology, ascitic fluid turned out positive for the non-typhoidal Salmonella species, which was red, turbid, and hemorrhagic due to portal vein and superior mesenteric vein thrombosis. We thus report an extremely rare case of SBP caused by Salmonella typhimurium in our patient.
Case Report: Pulsed field ablation for epicardial right-sided accessory pathway
Authors: Jana Haskova, Petr Peichl, Eva Borisincova, Josef Kautzner
Journal: Front Cardiovasc Med (2024)
Keywords: accessory pathway, electroanatomical mapping, intracardiac echocardiography, pulsed field ablation, radiofrequency ablation
MeSH terms: Case Reports

We present a case of a 32-year-old male with a history of palpitations and preexcitation on ECG who underwent altogether four failed catheter ablations using different approaches in the two other electrophysiology centers within two years. ECG showed overt preexcitation with a positive delta wave in lead I and negative in leads V1-V3, suggesting a right free wall accessory pathway. During the electrophysiological study, the accessory pathway was localized on the free lateral wall. However, the electrograms and mapping during atrial and ventricular pacing suggested the presence of true epicardial accessory pathway. Repeated radiofrequency energy delivery with the support of the steerable sheath and excellent contact (as assessed by intracardiac echocardiography) at the earliest ventricular activation was not successful. Therefore, the Farawave catheter (Boston Scientific, Inc) was used, and a flower configuration with the intention to cover the entire atrial attachment of the pathway during ventricular pacing was selected. Application of pulsed field resulted in interruption of accessory pathway conduction. An electrophysiological study one year later confirmed the persistent effect of ablation. This case illustrates the potential utility of pulsed field energy for the ablation of atrial insertion of the accessory pathway with an epicardial course. Such an approach can avoid epicardial mapping and access and may improve the safety of the procedure.
The use of extended-release tacrolimus twice a day might be beneficial for selected kidney transplant recipients: a case report
Authors: Louise Füessl, Lena Kreuzer, Kajetan Nierychlewski, Tobias Seibt, Manfred Johannes Stangl, Dionysios Koliogiannis, Bruno Meiser, Markus Schwarz, Michael Fischereder, Stephan Kemmner
Journal: Front Med (Lausanne) (2024)
Keywords: calcineurin inhibitor toxicity, extended-release tacrolimus, kidney transplantation, prolonged-release tacrolimus, tacrolimus
MeSH terms: Case Reports

The calcineurin inhibitor tacrolimus, which is available as an immediate- or extended-release formulation, is the standard-of-care immunosuppression after kidney transplantation with low rejection rates, especially in the first year after transplantation. However, its highly variable metabolism rate, narrow therapeutic window, and nephrotoxic side effects require close drug monitoring and individual dosing. Here, we describe first the application of extended-release tacrolimus (ER-Tac) twice daily with beneficial effects in a kidney transplant recipient under extensive therapeutic drug monitoring. A 47-year-old female kidney transplant recipient, who was identified as a fast metabolizer for tacrolimus, presented with declining allograft function and low tacrolimus through levels over time and 8 years after a second kidney transplantation despite the administration of high doses of ER-Tac once daily. Therefore, the area under the concentration-time curve (AUC) showed exceedingly high blood levels of ER-Tac. The latest biopsy of the kidney transplant showed arteriolar hyalinosis with pole vessel stenosis as a sign of chronic transplant vasculopathy and transplant glomerulopathy as a sign of chronic humoral rejection. After the exclusion of other options for immunosuppressive therapy due to the patient's high immunological risk, the patient was switched from ER-Tac once daily to ER-Tac twice daily. After switching to ER-Tac twice daily, the AUC for oral tacrolimus decreased and the transplant function improved despite higher tacrolimus trough levels and a lower total dose administered. This case highlights the importance of careful therapeutic drug monitoring with the performance of an AUC in the follow-up management of kidney transplant recipients.
Patterns of C-reactive protein trends during clozapine titration and the onset of clozapine-induced inflammation: a case series of weekly and daily C-reactive protein monitoring
Authors: Yuki Kikuchi, Hiroaki Tanifuji, Sota Ueno, Yoshifumi Onuma, Masatomo Goto, Masato Ishihara, Takeshi Toraiwa, Hiroshi Komatsu, Hiroaki Tomita
Journal: Front Psychiatry (2024)
Keywords: c-reactive protein, dress, fever, myocarditis, pneumonia

Background:
International guidelines for clozapine titration recommend measuring C-reactive protein (CRP) weekly for 4 weeks after clozapine initiation to prevent fatal inflammatory adverse events, including myocarditis. However, limited evidence exists regarding whether weekly CRP monitoring can prevent clozapine-induced inflammation.
Aims:
We examined the relationship between CRP trends and the development of clozapine-induced inflammation. We also explored the usefulness and limitations of CRP monitoring during clozapine titration.
Method:
This study presents 17 and 4 cases of weekly and daily CRP monitoring during clozapine initiation, respectively.
Results:
Among 17 patients with weekly CRP measurements, 7 had fever. Elevated CRP levels were detected before the onset of fever in two of the seven patients. Of the five remaining patients, the CRP levels on a previous test had been low; however, the fever developed suddenly. Of the 10 patients with no fever under weekly CRP monitoring, three had elevated CRP levels >3.0 mg/dL. Refraining from increasing the clozapine dose may have prevented fever in these patients. Among four patients with daily CRP measurements, two became febrile. In both cases, CRP levels increased almost simultaneously with the onset of fever.
Conclusion:
Weekly and daily CRP monitoring during clozapine titration is valuable for preventing clozapine-induced inflammation, assessing its severity, and guiding clozapine dose adjustments. Weekly CRP monitoring may not adequately predict clozapine-induced inflammation in some cases. Consequently, clinicians should be aware of the sudden onset of clozapine-induced inflammation, even if CRP levels are low. Daily CRP monitoring is better for detecting clozapine-induced inflammation.
A Case of Metastatic Vulvar Choriocarcinoma Misdiagnosed as Vulvar Abscess: A Case Report
Authors: Alita Mrema, Prudence H Kiwia, Shaban J Shaban, Anwar Z Mohamed, Latifa Rajab Abdallah, Rajabu Kiaratu, John Mahoyogo, Agapiti Chuwa, David H Mvunta
Journal: Case Rep Obstet Gynecol (2024)
Keywords: case report, choriocarcinoma, gestational trophoblastic disease, gestational trophoblastic neoplasia
MeSH terms: Case Reports

Background: Metastatic vulvar choriocarcinoma, a rare ectopic gestational trophoblastic neoplasia (GTN), often presents a diagnostic challenge due to its mimicry of other conditions, particularly in resource-limited settings. Its primary symptom is abnormal vaginal bleeding without a clear cause. Consequently, diagnosing and managing it poses difficulties for many low-resource health facilities, as evidenced by the current case. Case Presentation: We present the case of a 25-year-old, P2+2+2L2, who had a large painless, bleeding vulva mass for nearly 5 months. This followed a spontaneous abortion the month prior. The mass gradually increased in size and was accompanied by fever, pus discharge, and weight loss. Despite being treated at multiple health facilities for a vulvar abscess, there was no improvement. A diagnosis was finally made at a tertiary facility where elevated quantitative serum beta-human chorionic gonadotropin (hCG) (β-hCG) was noted. Due to uncontrollable vulva bleeding, she was referred to another tertiary facility for emergency radiotherapy. Following stabilization, chemotherapy was administered using the EMA-CO protocol. Conclusion: The report highlights the difficulty in diagnosing vulvar choriocarcinoma, underscoring the importance of a high index of suspicion. Clinical tests such as serum (β-hCG) and imaging studies are crucial for diagnosis. In resource-limited settings, a simple strip-based urine pregnancy test with serial dilutions can be sufficient for diagnosing and managing vulvar choriocarcinoma.
Identification and Management of Persistent Stimulation-Induced Dyskinesia Associated with STN DBS: The See-Saw Dilemma
Authors: Matthew A Remz, Joshua K Wong, Justin D Hilliard, Tracy Tholanikunnel, Ashley E Rawls, Michael S Okun
Journal: Tremor Other Hyperkinet Mov (N Y) (2023)
Keywords: dbs, parkinson’s disease, stn, dyskinesia, stimulation-induced dyskinesia
MeSH terms: Dyskinesias, Parkinson Disease / complications, Parkinson Disease / therapy, Subthalamic Nucleus, Case Reports, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Aged, Female, Humans, Tremor

Clinical vignette:
A 73-year-old woman with Parkinson's disease (PD) underwent implantation of bilateral subthalamic nucleus deep brain stimulators (STN-DBS) to address bilateral upper extremity medication-refractory tremor. Post-operatively, she experienced a "see-saw effect" where small increases in stimulation resulted in improvement in one symptom (tremor) with concurrent worsening in another (dyskinesia).
Clinical dilemma:
SID is usually considered a positive predictor of DBS outcome. However, there are cases where SID cannot be optimized. Lead location and pre-operative characteristics may contribute to this adverse effect. If the combination of programming and medication adjustments fails to resolve SID, what can be done to "rescue" the outcome?
Clinical solution:
Management of SID requires a gradual and steadfast programming approach. Post-operative lead localization can guide advanced programming and decision-making. Rescue surgical interventions may be considered.
Gap in knowledge:
In cases where SID is persistent despite deploying persistent optimization strategies, there is limited guidance on next steps.
Exploring the relationship of supernumerary recurrent renal calculi formation and tick-borne infections: a case report
Authors: Dean C Paz, Abigael C Gunther, Michael C Higham, Lynne G Stephenson, Anthony J Laporta, K Dean Gubler, Rebecca J Ryznar
Journal: Front Cell Infect Microbiol (2024)
Keywords: babesia, bartonella, borrelia, cacchi-ricci disease, medullary sponge kidney, nephrolithiasis, renal calculi, tick-borne infections
MeSH terms: Kidney Calculi / complications, Kidney Calculi / diagnosis, Medullary Sponge Kidney / complications, Tick-Borne Diseases / complications, Tick-Borne Diseases / diagnosis, Case Reports, Humans, Kidney, Male, Middle Aged

A 51-year-old male with a history of Cacchi-Ricci disease and long-standing infection with various species of Borrelia, Babesia, and Bartonella presented with recurrent symptoms of right-sided flank pain. Numerous renal calculi were identified on imaging. The etiology of the calculi had not been previously elucidated. Symptoms intermittently date back to 2002 when uric acid stones were identified. Subsequent calculi analysis revealed calcium oxalate stones. Despite the commonality of nephrolithiasis in patients with Cacchi-Ricci disease, the extreme number of calculi and recurrent presentation of symptoms persisted despite a plethora of medical evaluations, dietary changes, and hereditary testing. This case raises questions of etiology including possible immune deficiency and whether his uncommon microbial history contributes to recurrent stone formation.
An Atypical 15q11.2 Microdeletion Not Involving SNORD116 Resulting in Prader-Willi Syndrome
Authors: Molly M Crenshaw, Sharon L Graw, Dobromir Slavov, Theresa A Boyle, Daniel G Piqué, Matthew Taylor, Peter Baker 2nd
Journal: Case Rep Genet (2023)
MeSH terms: Case Reports

Loss of expression of paternally imprinted genes in the 15q11.2-q13 chromosomal region leads to the neurodevelopmental disorder Prader-Willi Syndrome (PWS). The PWS critical region contains four paternally expressed protein-coding genes along with small nucleolar RNA (snoRNA) genes under the control of the SNURF-SNRPN promoter, including the SNORD116 snoRNA gene cluster that is implicated in the PWS disease etiology. A 5-7 Mb deletion, maternal uniparental disomy, or an imprinting defect of chromosome 15q affect multiple genes in the PWS critical region, causing PWS. However, the individual contributions of these genes to the PWS phenotype remain elusive. Reports of smaller, atypical deletions may refine the boundaries of the PWS critical region or suggest additional disease-causing mechanisms. We describe an adult female with a classic PWS phenotype due to a 78 kb microdeletion that includes only exons 2 and 3 of SNURF-SNRPN with apparently preserved expression of SNORD116.
Non-invasive cardiac activation mapping and identification of severity of epicardial substrate in Brugada Syndrome: a case report
Authors: Saverio Iacopino, Paolo Sorrenti, Giuseppe Campagna, Gennaro Fabiano, Emmanuel Fabiano, Jacopo Colella
Journal: Front Cardiovasc Med (2024)
Keywords: brugada syndrome, brugada syndrome ecg type-2 pattern, case report, epicardial substrate, non-invasive cardiac imaging
MeSH terms: Case Reports

Introduction:
It has recently been shown that electrocardiographic imaging (ECGi) can be employed in individuals undergoing an ajmaline test who have Brugada Syndrome (BrS), to evaluate the extent of substrate-involved arrhythmia in the right ventricular overflow tract (RVOT). For the first time, we stratify the risk of sudden cardiac death (SCD) in BrS during ajmaline testing using the dST-Tiso interval (a robust predictor of the inducibility of ventricular arrhythmias (VAs) in the presence of drug-induced BrS type-1 pattern) in combination with ECGi technology.
Case presentation:
We studied a 48-year-old man with BrS ECG type-2 pattern and presence of J-wave without a family history of SCD but with a previous syncope. Transthoracic echocardiography and cardiac magnetic resonance imaging were performed, showing normal results. The ECG was performed to assess the novel ECG marker "dST-Tiso interval." The 3D epicardial mapping of the RVOT surface was performed with the support of a non-contact cardiac mapping system in sinus rhythm during ajmaline infusion. The examination of the propagation map unveiled the presence of multiple conduction blocks in this pathologic epicardial region, and the conduction blocks were identified within the central part and/or near the boundary separating the normal and slow conduction areas.
Conclusion:
The dST-Tiso interval, which lies between the onset and termination of the coved ST-segment elevation and serves as a robust predictor of VA inducibility in cases of drug-induced BrS type-1 pattern, was utilized in conjunction with ECGi technology (employed for the non-invasive confirmation and identification of the pathological substrate area). This combined approach was applied to stratify the risk of SCD in BrS during ajmaline testing, alongside clinical scores.
Neonatal hypertrophic cardiomyopathy with dyspnoea as the first symptom: a case report
Authors: Xiaoxia Li, Shu-Jun Hong, Hui Hong, Zhi-Qun Zhang, Jing Li
Journal: Front Pediatr (2023)
Keywords: case report, genetic diagnosis, hypertrophic cardiomyopathy, myosinopathy, neonate
MeSH terms: Case Reports

Neonatal hypertrophic cardiomyopathy (HCM) is an idiopathic disease characterised by myocardial hypertrophy with normal or small ventricular chambers, a systolic hyperdynamic state and diastolic dysfunction. The etiology, pathogenesis and clinical manifestations of HCM are diverse, and it is likely to progress to sudden cardiac death. The highly heterogeneous nature of this disease determines the difficulty of its diagnosis, and it is especially rare to report that can be diagnosed conclusively in the neonatal period. However, when it does occur, the younger the age of onset is, the higher the mortality rate and the worse the prognosis. The genetic variants and diagnostic timing can affect the life course of the patient. This case report describes a neonate with a family history of HCM who was diagnosed with hypertrophic non-obstructive cardiomyopathy by echocardiography shortly after birth. At 4 years of age, the patient presented with slow weight gain, feeding difficulties, tachypnoea and diaphoresis, and cardiac ultrasound findings suggesting progression to severe hypertrophic obstructive cardiomyopathy, with a high likelihood of arrhythmias, heart failure, pulmonary hypertension, syncope and even sudden death. Neonatal congenital hypertrophic cardiomyopathy is extremely rare and difficult to diagnose before the onset of symptoms. Echocardiography has a definite diagnostic value in hypertrophic cardiomyopathy and helps in early detection and treatment. At the time of clinical diagnosis, children with hypertrophic cardiomyopathy should be asked about their family history and, if necessary, a survey of family members should be conducted for the early detection of mildly ill patients and gene carriers to enable timely intervention and treatment, which remains the focus of our research and efforts.
Recurrent lipoma: an uncommon presentation in the wrist after incomplete excision
Authors: Marc D Mazur, Tinatin Natroshvili, Sandra J M Jongen, Marius A Kemler
Journal: Case Reports Plast Surg Hand Surg (2024)
Keywords: lipoma, carpal tunnel, guyon canal, hand, recurrence, reoperation, surgery
MeSH terms: Case Reports

Patient:
Female, 58-year-old.
Final diagnosis:
Benign recurrent lipoma following incomplete surgical removal.
Symptoms:
Discomfort, Aesthetic Dissatisfaction.
Clinical procedure:
Surgical Revision-Excision-Exploration with Lipoma Extraction.
Specialty:
Plastic Surgery (Hand Surgery).
Objective:
Unusual Clinical Presentation and Course.
Background:
Lipoma is a usually painless tumor composed of adipocytes, of fat cells, arising from mesenchymal tissue. It manifests itself in locations in the body where adipocytes are and has circumscribed growth. Its incidence in the hand is relatively low (1%-4.9%). Despite most lipomas being benign and usually asymptomatic, the location of lipoma can lead to nerve compression symptoms. We report a case of an unusual recurrence of lipoma in the wrist after incomplete excision.
Case report:
A 58-year-old female presented with a large, soft mass located on the volar side of the wrist, which recurred during the first week following the initial excision. While the patient did not exhibit symptoms of nerve compression, she reported experiencing swelling and pain at the surgical site postoperatively. The patient underwent surgical re-excision of the lesion, and the excised tissue was sent for histological examination. The subsequent histological analysis confirmed the diagnosis of a benign lipoma. The patient expressed satisfaction with the surgical revision, postoperative care, and outcomes, reporting high levels of contentment in pain relief, functional improvement, and cosmetic results.
Conclusions:
Lipomas often remain asymptomatic for extended periods, only becoming a source of discomfort or concern once they increase in size or impact one's appearance. Although most lipomas are benign and pose little risk to overall health, certain malignant variants exist. Recurrence of lipoma is uncommon and typically suggests an incomplete initial excision. In anatomically complex regions like the hand or wrist, meticulous planning and preoperative imaging are essential to prevent compression, exclude malignancy, and preserve function.
Long COVID-19 syndrome associated with Omicron XBB.1.5 infection: a case report
Authors: Otávio Espíndola, Paola C Resende, Lusiele Guaraldo, Guilherme Amaral Calvet, Trevon L Fuller, Stephanie Lema Suarez Penetra, Heloisa Ferreira Pinto Santos, Anielle Pina-Costa, Michele Fernanda Borges da Silva, Isabella Campos Vargas Moraes, Fernando Medeiros, Jimmy Whitworth, Christopher Smith, Karin Nielsen-Saines, Marilda M Siqueira, Patrícia Brasil
Journal: Mem Inst Oswaldo Cruz (2023)
MeSH terms: COVID-19 / complications, Case Reports, Aged, Brazil, Chromosome Mapping, Female, Humans, Post-Acute COVID-19 Syndrome, SARS-CoV-2

Background:
There is interest in lingering non-specific symptoms after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, referred to as Long coronavirus disease 2019 (Long COVID-19). It remains unknown whether the risk of Long COVID-19 is associated with pre-existing comorbidities or initial COVID-19 severity, including infections due to new Omicron lineages which predominated in 2023.
Objectives:
The aim of this case report was to characterize the clinical features of acute XBB.1.5 infection followed by Long COVID-19.
Methods:
We followed a 73-year old female resident of Rio de Janeiro with laboratory-confirmed SARS-CoV-2 during acute infection and subsequent months. The SARS-CoV-2 lineage was determined by genome sequencing.
Findings:
The participant denied comorbidities and had completed a two-dose vaccination schedule followed by two booster doses eight months prior to SARS-CoV-2 infection. Primary infection by viral lineage XBB.1.5. was clinically mild, but the participant subsequently reported persistent fatigue.
Main conclusions:
This case demonstrates that Long COVID-19 may develop even after mild disease due to SARS-CoV-2 in fully vaccinated and boosted individuals without comorbidities. Continued monitoring of new SARS-CoV-2 lineages and associated clinical outcomes is warranted. Measures to prevent infection should continue to be implemented including development of new vaccines and antivirals effective against novel variants.
Ctenocephalides felis (Siphonaptera, Pulicidae) parasitizing White-eared opossum (Didelphis albiventris) at Southern Brazil - Case report
Authors: Julia Somavilla Lignon, Diego Moscarelli Pinto, Silvia Gonzalez Monteiro, Gabrielle Torres Cotta de Mello, Natália Soares Martins, Tamires Silva Dos Santos, Felipe Geraldo Pappen, Fábio Raphael Pascoti Bruhn
Journal: Braz J Vet Med (2023)
Keywords: ectoparasites, fleas, marsupial, saruê, zoonosis
MeSH terms: Case Reports

Didelphis albiventris is a marsupial with synanthropic habits, whose contact with domestic animals and humans is increasing. They are considered potential disseminators of diseases, present as definitive hosts or reservoirs of various pathogenic agents. The present study aim to report, for the first time, the parasitism by Ctenocephalides felis in D. albiventris in Rio Grande, Southern Rio Grande do Sul state, Brazil. An adult female White-eared Opossum (D. albiventris), killed by being run over, was collected on the roads of the city of Rio Grande, Rio Grande do Sul, Brazil and sent to the laboratory for necropsy. During external inspection, a flea was found, which was stored in 70o alcohol until taxonomic identification, being classified as C. felis. This study reports the occurrence of parasitism by C. felis in D. albiventris for the first time in the location studied, demonstrating that these arthropods circulate between the wild and urban environments, and play an important role in the cycle of zoonotic pathogens among wild fauna, companion animals and humans.