OpenMed/multicare-articles huggingface dataset:
Case report: A case of anti-laminin 332 mucous membrane pemphigoid associated with severe pharyngolaryngeal involvement
Authors: Eleonora Quattri, Martina Zussino, Wanda Lauro, Emilio Berti, Angelo Valerio Marzano, Giovanni Genovese
Journal: Front Med (Lausanne) (2022)
Keywords: epiligrin, laminin 332, laminin 5, mucous membrane pemphigoid, paraneoplastic, pharyngolaryngeal involvement
MeSH terms: Case Reports

A 74-year-old woman presented with a 30-day history of blisters and erosions in the oral cavity, trunk, and left eye conjunctival mucosa, also reporting a weight loss of 15 kg in the last 3 months. Histopathological examination showed subepidermal blisters and lymphocytic infiltrates with rare eosinophils in the superficial dermis. Direct immunofluorescence showed linear deposits of IgG and C3 along the dermal-epidermal junction and salt-split skin indirect immunofluorescence confirmed the presence of linear deposits of IgG along the blister floor. Indirect immunofluorescence revealed antibodies against laminin 332 using recombinant laminin 332 expressed in human HEK293 cells, and commercial ELISA kits (Euroimmun, Padova, Italy) did not reveal antibodies against BP230 and BP180 antigens. Anti-laminin 332 mucous membrane pemphigoid (MMP), a condition often associated with a hidden neoplasm, was diagnosed. In our case, the paraneoplastic nature of MMP was excluded. Thus, topical treatment with triamcinolone acetonide 0.1% in orabase once daily for 30 days, oral prednisone 0.75 mg/kg/day and rituximab were started to relieve symptoms. Conjunctival, nasal and oral erosions improved, as well as skin lesions, but later the patient was tracheotomized due to respiratory distress linked to the appearance of pharyngolaryngeal synechiae.
An Adverse Drug Reaction to Trimethoprim-Sulfamethoxazole Revealing Primary HIV: A Case Report and Literature Review
Authors: Charles Meyer, Nicole Behm, Emily Brown, Nathanial K Copeland, Marvin J Sklar
Journal: Case Rep Infect Dis (2015)

Adverse drug reactions (ADRs) to antibiotics complicate the management of any infection, particularly opportunistic infections in advanced HIV as some ADRs are potentiated by HIV. Trimethoprim-sulfamethoxazole (TMP-SMX) causes ADRs in 40-80% of HIV infected individuals, compared to 3-5% in the general population. The incidence and severity of ADRs among HIV infected individuals appear to increase as they progress from latent infection to AIDS. We present a single case report of a 55-year-old African American male found to have an otherwise asymptomatic acute HIV infection who developed an ADR to TMP-SMX, despite having previously tolerating the medication. The proposed mechanisms for the increased incidence of sulfa hypersensitivity reactions among HIV infected individuals focus on either (1) HIV-induced changes in the immune function driven by falling levels of CD4 cells or (2) other HIV-specific factors correlated with rising viral load. To our knowledge this is the first reported case of new sulfa hypersensitivity in primary HIV and may provide clinical evidence to support the correlation between viral load and ADRs to TMP-SMX without a severely diminished CD4 count, though further research is necessary. This case also demonstrates a rare and easily overlooked presentation of HIV that may aid in early diagnosis.
Acute Q Fever in an Ankylosing Spondyloarthritis Patient Treated with Etanercept
Authors: A Guiga, D Khalifa, W Ben Yahia, N El Amri, A Atig, N Ghannouchi
Journal: Case Rep Rheumatol (2021)
MeSH terms: Case Reports

Q fever is a rare zoonotic infection caused by Coxiella burnetii. Tumor necrosis factor-alpha (TNF-α) has an important role in the early control of this infection. However, TNF-α blockers increase the risk of infectious diseases. We present herein a patient who developed acute Q fever under anti-TNF-α who had a good evolution after anti-TNF stoppage and treatment with doxycycline.
Lead Poisoning Can Be Easily Misdiagnosed as Acute Porphyria and Nonspecific Abdominal Pain
Authors: Ming-Ta Tsai, Shi-Yu Huang, Shih-Yu Cheng
Journal: Case Rep Emerg Med (2017)
MeSH terms: Case Reports

Lead poisoning (LP) is less commonly encountered in emergency departments (ED). However, lead exposure still occurs, and new sources of poisoning have emerged. LP often goes unrecognized due to a low index of suspicion and nonspecific symptoms. We present a case of a 48-year-old man who had recurring abdominal pain with anemia that was misdiagnosed. His condition was initially diagnosed as nonspecific abdominal pain and acute porphyria. Acute porphyria-like symptoms with a positive urine porphyrin test result led to the misdiagnosis; testing for heme precursors in urine is the key to the differential diagnosis between LP and acute porphyria. The final definitive diagnosis of lead toxicity was confirmed based on high blood lead levels after detailed medical history taking. The lead poisoning was caused by traditional Chinese herbal pills. The abdominal pain disappeared after a course of chelating treatment. The triad for the diagnosis of lead poisoning should be a history of medicine intake, anemia with basophilic stippling, and recurrent abdominal pain.
Retinal toxicity after facial laser epilation
Authors: Ioan Alexandru Plăcintă, Rodríguez Angélica De Freitas, Miriam Rahhal-Ortuño, Patricia Udaondo
Journal: Rom J Ophthalmol (2020)
Keywords: nd
MeSH terms: Eye Injuries / etiology, Hair Removal / methods, Hirsutism / surgery, Laser Therapy / adverse effects, Lasers, Solid-State / adverse effects, Retina / injuries, Retinal Diseases / etiology, Case Reports, Adult, Eye Injuries / diagnostic imaging, Eye Injuries / physiopathology, Humans, Male, Retina / diagnostic imaging, Retina / physiopathology, Retinal Diseases / diagnostic imaging, Retinal Diseases / physiopathology, Tomography, Optical Coherence, Visual Acuity / physiology

A 39-year-old man presented to the ophthalmology emergency room complaining of decreased visual acuity and metamorphopsia on his left eye after undergoing Nd:YAG facial hair epilation without wearing proper eye protection. Fluorescein angiography showed a foveal staining initially, with an increase in foveal leakage over late phases. On optical coherence tomography, a subfoveal retinal pigment epithelial detachment with associated subretinal fluid and no signs of choroidal neovascularization or cystoid macular edema was observed. Observation with monthly follow-ups was adopted. By the fourth month, the subretinal fluid had already disappeared and visual acuity had returned to 20/20. Over one-year follow-up, the retinal pigment epithelial detachment experienced a decrease in its size. Conservative management may be a valid option in assessing accidental foveal photocoagulation when choroidal neovascularization or cystoid macular edema is absent. The use of wavelength specific goggles is mandatory for the patient and the aesthetician operating the cosmetic laser, especially when operating on the face or around the eyes. Abbreviations: Nd:YAG = neodymium-doped yttrium aluminium garnet, OCT = optical coherence tomography, PED = pigment epithelial detachment, CME = cystoid macular edema.
A Case of Treatment Resistant Depression and Alcohol Abuse in a Person with Mental Retardation: Response to Aripiprazole and Fluvoxamine Therapy upon Consideration of a Bipolar Diathesis after Repetitive Failure to Respond to Multiple Antidepressant Trials
Authors: Michele Fornaro, Giovanni Ciampa, Nicola Mosti, Alessandra Del Carlo, Giuseppe Ceraudo, Salvatore Colicchio
Journal: Case Rep Med (2010)
MeSH terms: Case Reports

Mental Retardation (MR) is a developmental disability characterized by impairments in adaptive daily life skills and difficulties in social and interpersonal functioning. Since multiple causes may contribute to MR, associated clinical pictures may vary accordingly. Nevertheless, when psychiatric disorders as Treatment Resistant Depression (TRD) and/or alcohol abuse co-exist, their proper detection and management is often troublesome, essentially due to a limited vocabulary MR people could use to describe their symptoms, feelings and concerns, and the lack of reliable screening tools. Furthermore, MR people are among the most medicated subjects, with (over) prescription of antidepressants and/or typical antipsychotics being the rule rather than exception. Thus, treatment resistance or even worsening of depression, constitute frequent occurrences. This report describes the case of a person with MR who failed to respond to repetitive trials of antidepressant monotherapies, finally recovering using aripiprazole to fluvoxamine augmentation upon consideration of a putative bipolar diathesis for "agitated" TRD. Although further controlled investigations are needed to assess a putative bipolar diathesis in some cases of MR associated to TRD, prudence is advised in the long-term prescription of antidepressant monotherapies in such conditions.
Monoclonal Gammopathy of Renal Significance: Clinical and Histological Efficacy of a Bortezomib-Based Regimen
Authors: Giacomo Quattrocchio, Antonella Barreca, Antonella Vaccarino, Giulio Del Vecchio, Emanuele De Simone, Roberta Fenoglio, Michela Ferro, Maria Pagliaro, Massimo Pini, Massimo Manes, Dario Roccatello
Journal: Front Med (Lausanne) (2020)
Keywords: c3 glomerulonephritis (c3gn), immunotactoid glomerulonephritis, bortezomib, glomerulonephritis, monoclonal gammopathy of renal significance (mgrs)
MeSH terms: Case Reports

Monoclonal Gammopathy of Renal Significance (MGRS) is a group of heterogeneous disorders characterized by renal dysfunction secondary to the production of a monoclonal immunoglobulin by a nonmalignant B cell or plasma cell clone. We report the clinical and histological outcomes of two patients with biopsy-proven MGRS: one patient showed membranoproliferative glomerulonephritis with monoclonal k-light chain and C3 deposits, the second patient showed immunotactoid glomerulopathy. Both patients were treated with a 9-month chemotherapy protocol including bortezomib, cyclophosphamide, and dexamethasone. Renal biospy was repeated after 1 year. The estimated glomerular filtration rate (eGFR) increased from 22.5 (baseline) to 40 ml/min per 1.73 m2 after 12 months, then to 51.5 ml/min per 1.73 m2 after 24 months; proteinuria decreased from 4.85 (baseline) to 0.17 g/day after 12 months, then to 0.14 g/day after 24 months. Repeat renal biopsies showed a dramatic improvement of the glomerular proliferative lesions and near complete disappearance of the immune deposits. A bortezomib-based treatment proved very effective and was well-tolerated in the two patients presenting with clinically and histologically aggressive MGRS.
Numerical Processing Impairment in 22q11.2 (LCR22-4 to LCR22-5) Microdeletion: A Cognitive-Neuropsychological Case Study
Authors: Lívia de Fátima Silva Oliveira, Annelise Júlio-Costa, Fernanda Caroline Dos Santos, Maria Raquel Santos Carvalho, Vitor Geraldi Haase
Journal: Front Psychol (2018)
Keywords: 22q112ds (lcr22-4 to lcr22-5), weber fraction, approximate number system, cognitive phenotype, developmental dyscalculia, math learning difficulties

Although progress has been made, the cognitive, biological and, particularly, the genetic underpinnings of math learning difficulties (MD) remain largely unknown. This difficulty stems from the heterogeneity of MD and from the large contribution of environmental factors to its etiology. Understanding endophenotypes, e.g., the role of the Approximate Number System (ANS), may help understanding the nature of MD. MD associated with ANS impairments has been described in some genetic conditions, e.g., 22q11.2 deletion syndrome (22q11.2DS or Velocardiofacial syndrome, VCFS). Recently, a girl with MD was identified in a school population screening. She has a new syndrome resulting from a microdeletion in 22q11.2 (LCR22-4 to LCR22-5), a region adjacent to but not overlapping with region 22q11.2 (LCR22-2 to LCR22-4), typically deleted in VCFS. Here, we describe her cognitive-neuropsychological and numerical-cognitive profiles. The girl was assessed twice, at 8 and 11 years. Her numerical-cognitive performance at both times was compared to demographically similar girls with normal intelligence in a single-case, quasi-experimental study. Neuropsychological assessment was normal, except for relatively minor impairments in executive functions. She presented severe and persistent difficulties in the simplest single-digit calculations. Difficulties in commutative operations improved from the first to the second assessment. Difficulties in subtraction persisted and were severe. No difficulties were observed in Arabic number writing. Difficulties in single-digit calculation co-occurred with basic numerical processing impairments in symbolic and non-symbolic (single-digit comparison, dot sets size comparison and estimation) tasks. Her difficulties suggest ANS impairment. No difficulties were detected in visuospatial/visuoconstructional and in phonological processing tasks. The main contributions of the present study are: (a) this is the first characterization of the neuropsychological phenotype in 22q11.2DS (LCR22-4 to LCR22.5) with normal intelligence; (b) mild forms of specific genetic conditions contribute to persistent MD in otherwise typical persons; (c) heterogeneity of neurogenetic underpinnings of MD is suggested by poor performance in non-symbolic numerical processing, dissociated from visuospatial/visuoconstructional and phonological impairments; (d) similar to what happens in 22q11.2DS (LCR22-2 to LCR22-4), ANS impairments may also characterize 22q11.2DS (LCR22-4 to LCR22-5).
Breast metastasis of cervical cancer: A case report and systematic literature review
Authors: Zhang Jian-Yong, Zeng Guang-Ping, Wang Xue, Zhang Shi-Min, Zhao Zhen-Guo
Journal: Front Oncol (2022)
Keywords: breast metastases, cervical cancer, immunohistochemical, interstitial brachytherapy, systemic chemotherapy
MeSH terms: Case Reports

It has been reported that extramammary malignant tumors metastasize to the breast, but cervical cancer metastasis to the breast is very rare. At present, there are only dozens of reports about cervical cancer metastasis to breast in the world. It is difficult to distinguish between primary breast cancer and metastatic breast cancer. We report a 44-year-old woman who underwent surgery, chemotherapy, and radiotherapy for cervical cancer 5 years ago. Then, she was hospitalized for finding a left breast mass measured 2.9 × 2.7 cm in chest CT. Pathological examination combined with immunohistochemical staining showed that the mass came from the cervix. Then, the patient received systematic chemotherapy and interstitial brachytherapy (IB) for the breast mass and got a great result. Cervical cancer rarely metastasizes to the breast. In this case, we confirmed the diagnosis of breast mass by histopathological examination and immunohistochemistry. IB achieved a good result in the treatment of the breast mass. We hope to provide reference of prognosis and treatment when facing this situation by presenting this case.
Successful Pregnancy following Mixed Double Embryo Transfer in a Patient with Variable Window of Implantation
Authors: Georgi Stamenov Stamenov, Dimitar Angelov Parvanov, Todor Angelov Chaushev
Journal: Case Rep Obstet Gynecol (2018)
MeSH terms: Case Reports

The process of embryo implantation is carried out during the receptive stage of the endometrium in the midluteal phase of the menstrual cycle, known as window of implantation (WOI). It has been assumed that the WOI is not a constant variable in all women and the determination of its displacement is of crucial importance, especially for patients with recurrent implantation failure (RIF). Furthermore, in rare cases it could have different duration and position in the menstrual cycle even in the same woman but during different periods. Here, we report a 37-year-old woman with RIF, who was previously classified as idiopathic but has now been diagnosed as having a variable WOI. This interpretation was done after the performance of immunohistochemical and histomorphological analyses of endometrial biopsies taken in the midluteal phase during three sequential menstrual cycles. In order to solve the problem with pinpointing a variable WOI, a specific type of embryo transfer, called mixed double embryo transfer (MDET), was done where one Day 3 and one Day 5 good quality embryos were transferred simultaneously 7 days after ovulation. A viable single pregnancy was confirmed by ultrasound scan and a healthy girl was born. This case showed a unique approach in overcoming the problem in RIF patients with variable WOI.
Empyema Necessitans in the Setting of Methicillin-Susceptible Staphylococcus aureus Causing Pneumonia and Bacteremia
Authors: Sindhura Bandaru, Sukesh Manthri, Vidya Sundareshan, Vidhya Prakash
Journal: Case Rep Infect Dis (2018)
MeSH terms: Case Reports

Empyema necessitans (EN) is a rare phenomenon that refers to an insidious extension of the empyema through parietal pleura and subsequent dissection into subcutaneous tissue of the chest wall. A 29-year-old man presented to the hospital with fever and chills a few days after an inadvertent needle stick while injecting heroin. His left forearm was warm with an area of fluctuance. He underwent incision and drainage of the left forearm abscess with fluid submitted for Gram stain and culture. His condition rapidly deteriorated due to sepsis, and he required transfer to the intensive care unit. A new 4 × 3 cm area over the left pectoralis muscle had become increasingly indurated, fluctuant, and erythematous. CT of the chest demonstrated extensive cavitary lung lesions and a large loculated left-sided pleural effusion with extension through the chest wall. TEE revealed a 3 cm complex lesion on the superior septal leaflet of the tricuspid valve. The patient underwent incision and drainage of the pectoralis major EN with placement of a drain. Blood and sputum cultures grew methicillin-susceptible Staphylococcus aureus (MSSA) at which time antibiotic therapy was tailored to oxacillin. Our case highlights a rare occurrence of EN due to MSSA in a patient with intravenous drug use (IDU) and underscores the importance of prompt diagnosis and treatment.
Kikuchi-Fujimoto Disease in an Iranian Woman; a Rare but Important Cause of Lymphadenopathy
Authors: Mana Baziboroun, Masomeh Bayani, Ghodsieh Kamrani, Shahab Saeedi, Majid Sharbatdaran
Journal: Arch Acad Emerg Med (2019)
Keywords: fever, histiocytic necrotizing lymphadenitis, lymphadenopathy
MeSH terms: Case Reports

Kikuchi-Fujimoto Disease (KFD), is a rare and self-limited condition of histiocytic necrotizing lymphadenitis, which typically presents as fever and lymphadenopathy. We describe a case of KFD in an Iranian woman. Due to low incidence and high importance, awareness of this disease is necessary for clinicians for early diagnosis and appropriate treatment. A 26-year-old woman was admitted to our hospital with a 3-week history of fever and lymphadenopathy. On physical examination, she had three separate enlarged lymph nodes on the right side of her neck. In laboratory tests that were carried out, she had mild anemia and an increase in C-reactive protein (CRP) level, erythrocyte sedimentation rate (ESR) and lactate dehydrogenase (LDH) level, while other tests were normal. Ultasound (U/S) guided core needle lymph node biopsy was performed and based on the histological finding, diagnosis of Kikuchi-Fujimoto disease was made. The patient was managed supportively and with prednisolone. She symptomatically improved and was discharged with no follow up. Although the incidence of KFD is rare, it must be considered as a differential diagnosis of lymphadenopathy especially in tuberculosis-endemic areas like our country-Iran. Moreover, it is necessary that physicians are aware of this disease in order to minimize unnecessary evaluation and toxic treatment.
Impacted ureteric stone causing iliofemoral vein thrombosis: The first reported case
Authors: Mohammed Abed Al Kadum Hassan, Rawa Hama Ghareeb Ali, Okba Fathy Ahmed, Fahmi H Kakamad, Hewa Mahmood Toffeq
Journal: Int J Surg Case Rep (2018)
Keywords: case report, deep vein thrombosis, ureteric stone, ureteroscopy

Introduction:
Extrinsic compression with resulting obstruction of the iliac veins is recognized as a crucial cause of deep vein thrombosis (DVT). We report a case of impacted ureteric stone causing DVT.
Case report:
A 65-year-old man presented with left lower limb swelling that diagnosed and treated as extensive DVT. Further evaluation revealed incidental left severe hydroureteronephrosis and impacted ureteric stone compressing iliac vessels. Immediate percutaneous nephrostomy done followed by left ureterolithotripsy 6 weeks later.
Discussion:
several iliofemoral venous thromboses have been reported due to extrinsic compression by various pathologies, but to best of our knowledge, this is the 1st report of the impacted ureteric stone causing life-threatening proximal DVT.
Conclusion:
Isolated unilateral iliofemoral DVT may raise the suspicion of pelvic pathology including ureteric stone.
Quantitative Visualization of Lanthanum Accumulation in Lanthanum Carbonate-Administered Human Stomach Tissues Using Mass Spectrometry Imaging
Authors: Shuichi Shimma, Yoshiki Makino, Kazuto Kojima, Takafumi Hirata
Journal: Mass Spectrom (Tokyo) (2020)
Keywords: la-icp-ms, lanthanum, macrophage, mass spectrometry imaging, toxicology

Platinum, a transition metal that is widely used in anti-cancer agents, also results in the development of nephropathy due to severe adverse reactions caused by platinum-induced nephrotoxicity. Reports on imaging with metals other than platinum remain are limited, even in preclinical studies. Furthermore, most of these are case reports, and the relationship between the distribution of the metal and clinical observations in human samples is not well understood. Here we report on visualizing lanthanum (139La), a component of Fosrenol, which is usually used for the treatment of hyperphosphatemia. Gastric inflammation, also known as hemorrhagic gastritis, is the main adverse event caused by Fosrenol. To conduct this study, 139La was visualized in gastric biopsy samples obtained from a patient using quantitative laser ablation-inductively coupled plasma-mass spectrometry (LA-ICP-MS). We also compared the distribution of 139La in tissue and histochemical results. The areas where 139La accumulated corresponded to the macrophage-positive areas observed in immunohistochemistry studies using an anti-CD68 antibody. In contrast, we observed a debris-like crystal morphology in hematoxylin and eosin staining tissues. The debris was also associated with 139La accumulation. The abnormal accumulation of 139La crystals caused the observed inflammation. This phenomenon was previously characterized, but this is the first report in which 139La distribution and histochemical results are compared using LA-ICP-MS.
Eculizumab for the Treatment of Severe Antibody-Mediated Rejection: A Case Report and Review of the Literature
Authors: Duy Tran, Anne Boucher, Suzon Collette, Alexis Payette, Virginie Royal, Lynne Senécal
Journal: Case Rep Transplant (2016)

In renal transplantation, treatment options for antibody-mediated rejection are limited. Here, we report a case of severe AMR treated with eculizumab. A 50-year-old woman known for end stage kidney disease secondary to IgA nephropathy received a kidney transplant from a 50-year-old deceased donor. At 5 months after transplantation, she presented with acute graft dysfunction and biopsy showed a severe antibody-mediated rejection associated with thrombotic microangiopathy. Despite an aggressive conventional immunosuppressive regimen, signs of rejection persisted and the patient was treated with 3 doses of eculizumab. Following the therapy, markers of TMA improved and graft function stabilized. However, ongoing signs of rejection remained in the repeated biopsy. In kidney transplantation, eculizumab is an expensive treatment and its role in the treatment of antibody-mediated rejection remains to be determined.