OpenMed/multicare-articles huggingface dataset:
Fatal Outcome of Disseminated Strongyloidiasis despite Detectable Plasma and Cerebrospinal Levels of Orally Administered Ivermectin
Authors: Charles E Rose, Christopher A Paciullo, David R Kelly, Mark J Dougherty, Lawrence L Fleckenstein
Journal: J Parasitol Res (2009)
MeSH terms: Case Reports

Strongyloides stercoralis affects over 100 million people worldwide. Those people most susceptible to infection are those with an immunocompromising condition, such as cancer or human immunodeficiency virus (HIV). Local disease may spread throughout the body of the host, causing a condition termed disseminated strongyloidiasis. Standard treatment for Strongyloides stercoralis infection is oral ivermectin. We describe a patient with chronic lymphocytic leukemia diagnosed with disseminated strongyloidiasis two weeks after initial presentation. After repeated dosing of oral ivermectin with no clinical response, serum and cerebral spinal fluid (CSF) concentrations of ivermectin were measured to assess absorption. The peak serum concentration of 49.3 ng/mL correlated with a CSF concentration of 0.14 ng/mL. Despite these concentrations, the patient eventually succumbed to multi-system organ failure. We discuss the reasons for treatment failure and explore the utility of measuring ivermectin concentrations.
Xanthogranulomatous Pyelonephritis: Synchronous Upper and Lower Gastrointestinal Bleed
Authors: Muhammad Usman Mirza, John Van Taunay, Muhammad Waleed, Shiva Shankar Vangimalla, Sharana Hegde, Muhamad Alhaj Moustafa
Journal: J Investig Med High Impact Case Rep (2019)
Keywords: gastrointestinal bleed, nephrectomy, reno-colic fistula, reno-gastric fistula, xanthogranulomatous pyelonephritis
MeSH terms: Gastrointestinal Hemorrhage / diagnostic imaging, Gastrointestinal Hemorrhage / surgery, Pyelonephritis, Xanthogranulomatous / diagnostic imaging, Pyelonephritis, Xanthogranulomatous / surgery, Case Reports, Diagnosis, Differential, Endoscopy, Gastrointestinal, Female, Humans, Intestinal Fistula / etiology, Laparotomy, Middle Aged, Nephrectomy, Splenectomy, Tomography, X-Ray Computed, Urinary Fistula / etiology

Xanthogranulomatous pyelonephritis (XGP) is a rare chronic granulomatous destructive process of the renal parenchyma. It is caused by a chronic inflammatory process due to recurrent urinary tract infections and/or obstructing renal calculi. Rarely, it presents with advanced complications including abscesses and fistula formations. In this article, we report a unique presentation of XGP with simultaneous upper and lower gastrointestinal bleeding in the setting of XGP with reno-gastric and reno-colic fistulas.
"Recurrent Papillary Necrosis and Nephrocalcinosis Induced by Nonsteroidal Anti-Inflammatory Drugs for Gouty Arthritis Associated with Congenital Chloride-Losing Diarrhea: A Major Risk for Kidney Loss"
Authors: Kamel El-Reshaid, Shaikha Al-Bader, Hossameldin Sallam
Journal: Case Rep Nephrol (2021)
MeSH terms: Case Reports

Congenital chloride-losing diarrhea (CCLD) is a rare genetic disorder due to autosomal recessive mutation in the SLC26A3 gene on chromosome 7. It is characterized with chronic watery diarrhea with high fecal chloride (Cl: >90 mmol/L), low potassium (K), and metabolic alkalosis with low urinary Cl and K. The overall long-term prognosis is favorable with optimal life-long salt and K supplementation. In this case report, we describe a man with progressive renal failure and small kidneys that showed nephrocalcinosis and papillary necrosis. His disease was diagnosed since birth and was confirmed by our tests. He was incompliant with therapy and had developed gout. The latter complication of his disease has led to excessive NSAID use over the past years. Reinstitution of diet, drug therapy, and allopurinol had stabilized his renal disease for 1 year of follow-up. In conclusion, excessive analgesic use is a risk factor for renal failure in CCLD.
Warfarin induced mesenteric and intestinal hematoma requiring surgical resection to relieve small bowel obstruction: A case report
Authors: Khuram Khan, Saqib Saeed, Sara Alothman, Farhana Iqbal, Alexius Ramcharan, Brian Donaldson
Journal: Int J Surg Case Rep (2018)
Keywords: abdominal pain, anticoagulant therapy, intramural hematoma, mesenteric, small bowel obstruction, warfarin

Introduction:
Mesenteric and Intramural Hematoma leading to small bowel obstruction is a rare, but a fatal complication of anticoagulant therapy.
Presentation of case:
We present this unique case of 61 year old male with non traumatic mesenteric and intramural hematoma secondary to warfarin leading to small bowel obstruction requiring surgical resection.
Discussion:
Although there have been few cases reported in literature about intramural small bowel hematoma, however, associated with small bowel obstruction secondary to warfarin therapy are less frequently seen. Diagnosis of intramural hematoma can be made with Computed Tomography (CT) of abdomen. The most effective treatment approach is conservative management after excluding any signs of small bowel obstructions, peritonitis and bowel necrosis.
Conclusion:
Therefore, early diagnosis is vitally essential to avoid morbidity in patients with these symptoms. Physician should have a higher index of suspicion to recognize and diagnose this complication is essential for early treatment intervention to prevent morbidity.
Heterotopic Triplet Pregnancy After Clomiphene Citrate
Authors: James J Morong, Jennifer Janssen, Jessica C Morgan, Sophia M Rodriguez
Journal: Ochsner J (2021)
Keywords: pregnancy–heterotopic, reproductive techniques–assisted, superfetation
MeSH terms: Case Reports

Background: Heterotopic pregnancy is an exceedingly rare condition in which an intrauterine and extrauterine pregnancy coexist. Superfetation refers to the coexistence of 2 or more fetuses of different gestational ages as a result of ovulation, fertilization, and implantation during an ongoing pregnancy. We present a case of heterotopic triplet pregnancy with a difference in gestational age by crown rump length of more than 1 week between the twin intrauterine pregnancy and the singleton tubal ectopic. Case Report: A 31-year-old gravida 3, para 2002 presented to the emergency department with abdominal pain at 9 weeks 2 days' gestation dated by last menstrual period, consistent with ultrasound. She was discharged home with a diagnosis of ruptured hemorrhagic cyst but returned 4 days later with ruptured tubal ectopic pregnancy measuring 9 weeks' gestation and ongoing twin gestation measuring 10 weeks 1 day. She was taken to the operating room for laparoscopic salpingectomy, and ectopic pregnancy was confirmed on tissue diagnosis. Conclusion: Heterotopic pregnancy presents a diagnostic challenge for obstetricians/gynecologists. Superfetation has never been demonstrably proven in humans but has been suggested in the literature. This report adds to the literature that perhaps superfetation can be artificially induced in humans in the presence of assisted reproductive technologies.
Genetic Drivers of Pancreatic Cancer Are Identical Between the Primary Tumor and a Secondary Lesion in a Long-Term (>5 Years) Survivor After a Whipple Procedure
Authors: Tyler M Bauer, Teena Dhir, Adam Strickland, Henry Thomsett, Austin B Goetz, Shawnna Cannaday, Jonathan R Brody, Michael J Pishvaian, Charles J Yeo
Journal: J Pancreat Cancer (2018)
Keywords: kras, myc, whipple procedure, metachronous, pancreatic ductal adenocarcinoma, pancreaticoduodenectomy
MeSH terms: Review

Background: A new mass in the remnant pancreas of a patient with previously resected pancreatic ductal adenocarcinoma (PDA) typically represents either a recurrence of the initial primary tumor or a second primary tumor. Recent advances in next-generation sequencing (NGS) strategies allow us to compare the genetic makeup of primary and secondary lesions. Case presentation: A 50-year-old Caucasian female presented for a surgical evaluation of a new biopsy-proven PDA at the junction of the body and tail of the pancreas. Six years prior, in 2011, the patient was found to have a T3N0M0 PDA of the pancreatic head, which was surgically resected with a classic Whipple procedure and concurrent hemicolectomy. Pathology showed pancreatic intraepithelial neoplasia grade 2 and PDA with negative surgical margins, positive perineural spread, and negative lymphovascular spread, and the patient received adjuvant chemotherapy and local radiation. In 2017, she was diagnosed with a new PDA lesion in the remaining pancreatic body far from the previous anastomosis site and was taken to surgery for a completion pancreatectomy and revision of the gastrojejunostomy. NGS was performed on both specimens. Both lesions shared identical mutations in KRAS, TP53, and CDKN2A genes. Amplifications of MYC and mutant KRAS were identified in the 2017 tumor and an ACVR1B mutation was identified in the 2011 tumor, but was not found in the 2017 tumor. Conclusions: This case demonstrates the ability to evaluate similarities between key genetic drivers from a resected primary tumor and a PDA lesion that presented in the same patient 6 years later. Histological analysis and NGS can be used to understand potential differences and similarities between lesions and may be useful in future studies as predictive markers or to provide insight into resistance mechanisms (e.g., MYC amplification).
Case Report: A case report of unstable Hangman fracture in a eighty year old male
Authors: Sunil Munakomi, Binod Bhattarai
Journal: F1000Res (2015)
Keywords: hangman’s fracture, management, unstable

Herein we discuss a rare variant of hangman's fracture in an eighty year old male with good Karnofsky performance score. We performed X-ray and magnetic resonance imaging (MRI) of the cervical spine to confirm the diagnosis. The patient was placed on a gentle cervical traction which showed good reduction. Despite being on a resource limited setup, we performed posterior occipitocervical fusion with bone graft fusion followed by early mobilization. A postoperative scan showed good reduction and purchase of the screws. This case highlights the importance of choosing the correct therapeutic attitude for the management of the geriatric population especially in those who do not have any significant co-morbid conditions.
Longer Duration of SARS-CoV-2 Infection in a Case of Mild COVID-19 With Weak Production of the Specific IgM and IgG Antibodies
Authors: Xuemin Guo, Lizhu Zeng, Zhen Huang, Yongjun He, Zhuojin Zhang, Zhixiong Zhong
Journal: Front Immunol (2020)
Keywords: sars-cov-2, case report, mild covid-19, persistent infection, virus-specific antibody response
MeSH terms: Antibodies, Viral / immunology, Betacoronavirus / immunology, Coronavirus Infections / immunology, Immunoglobulin G / immunology, Immunoglobulin M / immunology, Pneumonia, Viral / immunology, Case Reports, Research Support, Non-U.S. Gov't, Adult, Betacoronavirus / genetics, COVID-19, Coronavirus Infections / transmission, Coronavirus Infections / virology, Humans, Male, Pandemics, Patient Discharge, Patient Readmission, Pneumonia, Viral / transmission, Pneumonia, Viral / virology, Quarantine / methods, RNA, Viral / analysis, SARS-CoV-2, Virus Shedding, Antibodies, Viral, Immunoglobulin G, Immunoglobulin M, RNA, Viral

Background: The relationship between SARS-CoV-2-carrying time and specific antibody production has not yet been reported in re-admitted COVID-19 patients. We reported a case of mild COVID-19 with long virus-carrying time, weak production of virus-specific IgG and IgM antibodies, and recurrence of positive SARS-CoV-2 RNA in stool specimens after discharge. Case Presentation: A 27-year-old male was diagnosed as COVID-19 after returning to Meizhou from Wuhan. Despite extremely mild symptoms, the patient was hospitalized for 24 days because of persistent positive SARS-CoV-2 RNA detection. Three days after recovery discharge, he was hospitalized again for 7 days due to a recurrence of the positive SARS-CoV-2 RNA result, while in a good physical condition. Serological assay, using a fluorescent immunochromatography detection kit specific to SARS-CoV-2, showed that SARS-CoV-2-specific IgM antibodies were undetectable and IgG antibodies were very low on day 8 after onset; both of the antibodies seemingly reached top concentrations on day 15 (just a 6-fold increase of the IgG titer), and then decreased, remaining relatively stable from day 25 after onset until discharge. The production of the IgM and IgG targeting SARS-CoV-2 in this very mild case was much lower than that in a severe case of COVID-19 during the same hospitalizing period, and the latter was used as a control. Conclusion: Mild COVID-19 patients could carry SARS-CoV-2 for a long time, which may be related to the weak production of the virus-specific IgG and IgM. Recurrence of positive SARS-CoV-2 RNA could occur in mild COVID-19 possibly due to intermittent virus shedding, so strict quarantine and health surveillance should be taken for all discharged COVID-19 patients to prevent a potential virus spread.
Acupuncture in the Treatment of a Female Patient Suffering from Chronic Schizophrenia and Sleep Disorders
Authors: Peggy Bosch, Sabina Lim, Sujung Yeo, Sook-Hyun Lee, Heike Staudte, Maurits van den Noort
Journal: Case Rep Psychiatry (2016)
MeSH terms: Case Reports

Background. The use of acupuncture in the treatment of sleep disorders in patients with chronic schizophrenia is investigated. Case Presentation. We report the case of a 44-year-old female outpatient of German origin who had been suffering from long-term schizophrenia and sleep disorders. The patient was treated with manual acupuncture weekly for 12 weeks, and a psychological assessment was performed before, immediately after, and three months after the acupuncture treatment period. In addition, actiwatch data were collected for 14 days both before and after the acupuncture treatment period. Conclusion. Acupuncture treatment led to a decrease in general psychopathology, less severe sleep problems, and markedly improved cognitive functioning (working memory) in the patient; however, the positive and the negative symptoms remained stable. The actiwatch data revealed a beneficial effect of acupuncture, showing better sleep latency, a trend towards better sleep efficiency, and a decrease in the number of minutes that the patient was awake during the night after acupuncture treatment. In sum, this study showed that acupuncture might be beneficial in the treatment of sleep disorders in patients suffering from chronic schizophrenia, but future, large, randomized (placebo), controlled, clinical trials are needed in order to replicate the present preliminary findings.
Case Report: MSS colorectal extrahepatic (non-liver) metastases as the dominant population for immunotherapy combined with multi-target tyrosine kinase inhibitors
Authors: Jiayin Liu, Dan Li, Jing Han, Yin Zhang, Xue Zhang, Zhisong Fan, Li Feng, Long Wang, Hui Jin, Jing Zuo, Yudong Wang
Journal: Front Oncol (2023)
Keywords: mss, dominant population, extrahepatic (non-liver) metastases, immunotherapy combined, multi-target tyrosine kinase inhibitors
MeSH terms: Case Reports

Background:
The microsatellite stability(MSS) subtype of Colorectal Cancer(CRC) represents approximately 95% of mCRC cases. Immunotherapy was not as encouraging as the data for MSS mCRC cancer. We report the treatment of a series of patients with extrahepatic metastasis of MSS colorectal cancer, which can provide reference and guidance for the treatment of non-hepatic metastasis of MSS colorectal.
Case presentation:
This report describes 8 typical cases of successful MSS treatment with lung metastases of CRC. We systematically reviewed the clinical data and detailed medical history of one of these patients with extrahepatic metastasis from MSS colorectal cancer, and reviewed the literature to analyze and discuss the related epidemiological features, mechanisms and recent research findings of the special subgroup of the population.
Conclusions:
Although MSS colon rectal cancer is still known as a cold tumor in the industry, immunotherapy combined with multi-targeted anti-vascular tyrosine kinase inhibitors had brought clinical benefits to patients with non-hepatic metastases from MSS colorectal cancer.
A rare collision tumor composed of follicular lymphoma and adenocarcinoma in the ampulla of vater: a case report
Authors: Shioto Suzuki, Fumihiko Tanioka, Keisuke Inaba, Shingo Takatori, Hideto Ochiai, Shohachi Suzuki
Journal: Case Rep Pathol (2014)

The duodenum is infrequently affected by malignant lymphoma, and follicular lymphomas of the duodenum are rare histological subtypes. There are no reported cases of collision of follicular lymphoma and other tumors in the ampulla of Vater. A 57-year-old Japanese man presented with jaundice, and abdominal computed tomography revealed a tumor of the ampulla of Vater invading the pancreatic head with biliary dilatation and a thickened duodenal wall. The patient underwent subtotal stomach-preserving pancreaticoduodenectomy. Histopathology of the resected specimen revealed lymphoid follicular formations with small-to-medium-sized centrocyte-like cells and some centroblast-like cells. The atypical lymphoid cells were immunohistochemically positive for CD10, CD20, and CD79a but negative for CD5 and cyclin D1. BCL2 protein was highly expressed in the follicle centers. The diagnosis was duodenal follicular lymphoma, Grade 1. The follicular lymphoma, 40 mm in diameter, involved duodenal submucosa and regional lymph nodes without distant metastasis. This duodenal follicular lymphoma was partially overlapped by adenocarcinoma of the ampulla of Vater, measuring 25 × 20 mm, which involved the lower common bile duct, pancreas, and duodenum. We report the first case of a surgically treated collision tumor composed of a rare mass-forming follicular lymphoma and adenocarcinoma of the ampulla of Vater.
Thrombosis of the right iliac, femoral, popliteal, and tibial arteries in a post-COVID-19 in adolescent
Authors: Mariana Orate Menezes da Silva, Henrique Amorim Santos, Amanda Fernandes Vidal da Silva, Guilherme Marum, Jose Maria Pereira de Godoy
Journal: Ann Pediatr Surg (2021)
Keywords: adolescent, arteries, covid-19, femoral, iliac, popliteal, thrombosis, tibial

Background:
Viral infection into lung, muscular, and endothelial cells results in inflammatory response, including edema, degeneration, and necrotic alterations. The involvement of the major arteries in adolescent with COVID-19 has been infrequently reported in the literature. The aim of the present study is to report thrombosis of the right iliac, femoral and tibial arteries and stenosis of left iliac artery in an adolescent with COVID-19 and to discuss the pathophysiological hypotheses.
Case presentation:
We report the case of a 17-year-old female patient with COVID-19 infection. She was seen at the physician specialized general medicine in her hometown, was diagnosed with COVID-19 but did not require hospitalization. After 15 days, she had sudden pain in the left leg that has limited her ability to walk more than 10 met, associated with extremity cyanosis and coldness. Angiotomography revealed thrombosis of a portion of the iliac and popliteal arteries. Na emergency embolectomy was successfully performed, followed by full-dose heparinization with unfractionated heparin.
Conclusion:
Arterial thrombosis of large arteries may be associated with chronic inflammatory syndrome secondary to COVID-19 infection and the treatment with a late embolectomy was successful, even in a thrombotic event.
Bilateral Vocal Fold Paralysis in Myasthenia Gravis: A Case Report and Literature Review
Authors: Christopher Nelke, Bendix Labeit, Sven G Meuth, Tobias Warnecke, Rainer Dziewas, Tobias Ruck
Journal: Front Neurol (2020)
Keywords: bilateral vocal fold paralysis, case report, literature review, myasthenia gravis, myasthenic crisis
MeSH terms: Case Reports

To prevent severe and potentially life-threatening consequences of bilateral vocal fold paralysis (BVFP), the identification and management of reversible causes is pivotal. Myasthenia gravis (MG) presenting with BVFP is rarely reported and remains incompletely understood. Although symptom control is achievable for most MG patients with sufficient therapy, atypical clinical presentation such as BVFP might preclude diagnosis and thus effective treatment. Here, we present a case of BVFP as leading manifestation of MG successfully treated with plasmapheresis. Moreover, we performed a literature review of the few existing cases reported between 1980 and 2020 indicating that elderly patients are particularly at risk for MG presenting with severe BVFP and that edrophonium testing with fiber optic endoscopic evaluation of swallowing (FEES) might be valuable for establishing the diagnosis. We conclude that clinicians should consider MG as possible and reversible cause for BVFP.
Surgical Repair of the Postoperative Lung Hernia by Combining Mesh Interposition and Chest Wall Stabilization by Using Synthes Plates: A Novel Technique
Authors: Dragan Subotic, Mark Wiese, Aljaz Hojski, Didier Lardinois
Journal: Case Rep Surg (2019)
MeSH terms: Case Reports

Several technical points for postoperative lung hernia repair are still not fully elucidated. We present an original technical solution to deal with this complication. In a 68-year-old female, the lung hernia was confirmed 5 months after the partial left-sided chest wall and scapula angle resection with primary Mersilene mesh reconstruction for elastofibroma. The patient refused the proposed surgical correction, being only slightly limited in daily activities. The symptoms persisted under analgetic therapy till the moment when patient's daily activities became critically limited, 22 months after surgery. The repeated chest CT showed a slight increase in hernia size with no signs of tumour recurrence, so that reoperation was planned. After the exposure of the mesh region, a lung protrusion (4 × 3 cm) along the anterolateral edge of the mesh was confirmed. By careful dissection, the mesh was separated from a firmly adherent lung and removed. After adhaesiolysis and complete lung liberation, a wedge resection of the afunctional lung tissue of the lingula was done, just in the region of contact with the mesh. After the chest tube insertion, the chest wall defect was reconstructed by using a Mersilene mesh, and the final chest wall stabilization was done by the fixation of two Synthes plates (DePuy Synthes J&J) over the 5th and 6th ribs. The postoperative course was uneventful. One year after the operation, the patient was in good general condition, without the need for analgesics. To the best of our knowledge, the described technique is the original way of dealing with postoperative lung hernia. We find it efficient as a prevention of potential serious hernia-related complications.