OpenMed/multicare-articles huggingface dataset:
Corneal Cross-Linking Window Absorption (CXL-WA) as an Adjuvant Therapy in the Management of Aspergillus niger Keratitis
Authors: Pietro Rosetta, Emanuela F Legrottaglie, Luca Pagano, Paolo Vinciguerra
Journal: Case Rep Ophthalmol Med (2018)
MeSH terms: Case Reports

Purpose:
To evaluate the effectiveness of corneal cross-linking window absorption (CXL-WA) as an adjuvant therapy for Aspergillus keratitis.
Methods:
A 90-year-old male came to our clinic complaining of hyperemic conjunctivitis and progressive visual loss in the right eye. Slit-lamp examination showed keratic precipitates, severe corneal opacity, and stromal edema. Corneal scraping culture was positive for Aspergillus niger. Because the clinical condition did not sufficiently improve with antifungal therapy, the patient underwent CXL-WA as an adjuvant therapy.
Results:
During the first week after treatment, the Tyndall effect, corneal edema, and signs of ocular inflammation progressively lessened. At the third postoperative month, the cornea was stable without signs of fungal keratitis. However, after this period, a descemetocele appeared in the cornea (2 × 2 mm in diameter), so the patient underwent a corneal penetrating keratoplasty. Histological evaluation of the removed corneal tissue revealed the presence of hyphae and fungal infection.
Conclusions:
We reported a case of in vivo CXL-WA used as an adjuvant therapy for deep stromal Aspergillus keratitis. CXL did not completely eradicate the fungal infection which caused perforation 4 months after treatment and it still cannot be considered a definitive solution to mycotic keratitis, which maintains a poor long-term prognosis.
To avoid operating on pseudo tumoral pulmonary infarctions mimicking lung cancer
Authors: Alexis Lacout, Pierre Yves Marcy, Mostafa El Hajjam
Journal: Pan Afr Med J (2012)
Keywords: ct-scan, pulmonary embolism, follow up, infarction
MeSH terms: Lung Neoplasms / diagnosis, Pulmonary Infarction / diagnosis, Case Reports, Aged, Diagnosis, Differential, Humans, Lung Neoplasms / surgery, Male, Pulmonary Infarction / surgery

Pulmonary infarction usually appears as a hump-shaped triangular opacity with its base applied to a pleural surface. In some cases, pulmonary infarctions may appear as a pseudo tumoral opacity mimicking lung cancer. Thoracotomy could be prevented by repeating CT scan in properly selected patients.
Intracortical intraosseous lipoma
Authors: Michael Khoo, Ian Pressney, Rikin Hargunani, Paul O'Donnell
Journal: BJR Case Rep (2016)
MeSH terms: Case Reports

Intraosseous lipomas are very uncommon, benign primary bone lesions with an incidence of <1%. The overwhelming majority occur within the intramedullary canal. We present an uncommon intracortical intraosseous lipoma with 3 T MRI findings to help differentiate this from other differential diagnoses.
Death following bilateral complete Achilles tendon rupture in a patient on fluoroquinolone therapy: a case report
Authors: Andrew W Gottschalk, John W Bachman
Journal: J Med Case Rep (2009)

Introduction:
Risk of tendon rupture, especially of the Achilles tendon, is one of the many potential side-effects of fluoroquinolone therapy. Achilles tendon rupture may be painful, debilitating or, as seen in our patient, devastating. While fluoroquinolone-induced tendon rupture typically accompanies other comorbidities (for example renal impairment) or concurrent steroid therapy, our case represents a medical 'first' in that there were no such comorbidities and no steroid therapy. Furthermore, our case is remarkable in that tendon rupture was bilateral, complete, and resulted in a devastating outcome.
Case presentation:
A healthy 91-year-old Caucasian man was placed on fluoroquinolone (levofloxacin) therapy for a presumed bacterial pneumonitis. Subsequently, he developed bilateral heel pain, edema, and ecchymoses leading to a diagnosis of bilateral complete Achilles tendon rupture. This drug's side-effect was directly responsible for his subsequent physical and psychologic decline and unfortunate death.
Conclusion:
Fluoroquinolones are a powerful and potent tool in the fight against bacterial infection. As a class, they are employed by primary care physicians as well as by subspecialty physicians in all areas of medical practice. However, as this case illustrates, the use of these drugs is not without risk. Attention must be paid to potential side-effects when prescribing any medication, and close follow-up with patients is a medical necessity to evaluate for these adverse reactions, especially with fluoroquinolones.
Rapid Response in a Patient with Relapsed/Refractory Multiple Myeloma Treated with BRAF/MEK Inhibitors
Authors: Steve Biko Otieno, Syed Nasir, Alva Weir, Robert Johnson
Journal: Case Rep Hematol (2020)
MeSH terms: Case Reports

Patients with relapsed and refractory multiple myeloma have a poor prognosis. The mitogen-activated protein kinase (MAPK) pathway has been implicated in the pathogenesis of multiple myeloma. Several mutations in this pathway can lead to its constitutive activation leading to oncogenesis. One such mutation is BRAFV600E which is a therapeutic target in the treatment of melanoma, lung cancer, colon cancer, thyroid cancer, and hairy cell leukemia. BRAFV600E-directed therapy currently does not have approval in multiple myeloma. It has been proposed that this mutation leads to proteasome inhibitor resistance. About 4-10% of multiple myeloma cases harbor the BRAFV600E mutation. Herein, we report a case of a patient with relapsed and refractory multiple myeloma who had a progression-free survival (PFS) of 8.5 months on BRAF-targeted therapy.
Severe Anxiety Post-COVID-19 Infection
Authors: Maggie Driscoll, Jason Gu
Journal: Case Rep Psychiatry (2021)
MeSH terms: Case Reports

COVID-19 infection is linked to increased risk of neuropsychiatric symptoms such as psychosis and suicidal ideation/behavior. After further review of the literature, there is not a large body of data on anxiety following COVID-19 infection. Most literature found is related to fear/anxiety of contracting and dying from COVID-19. We illustrate a case of a 27-year-old male with no previous psychiatric treatment history or symptomology, who developed severe anxiety with intrusive thoughts of self-harm via firearm after COVID-19 infection. Given the severe nature of the anxiety and intrusive thoughts, the patient feared for his safety and sought acute inpatient admission. The patient was effectively treated with group therapy and psychotropic medications and was able to be discharged in a timely manner with outpatient psychiatric follow-up. Much is still unknown of COVID-19. With this case report, we discuss a potential relationship between anxiety and COVID-19 infection.
Identifying key challenges and needs in digital mental health moderation practices supporting users exhibiting risk behaviours to develop responsible AI tools: the case study of Kooth
Authors: Elena Nichele, Anita Lavorgna, Stuart E Middleton
Journal: SN Soc Sci (2022)
Keywords: digital counselling, digital moderation, mental health and wellbeing, responsible ai, risk behaviours

Digital platforms for mental health and wellbeing purposes have become increasingly common to help users exhibiting risk behaviours (e.g. self-harming, eating-related disorders) across all ages, opening new frontiers in supporting vulnerable users. This study stems from a larger project, which explores how responsible AI solutions can up-scale existing manual moderation approaches and better target interventions for young people who ask for help or engage in risk behaviours online. This research aims to better understand the challenges and needs of moderators and digital counsellors, i.e. the 'behind the scenes'. Through this case study, the authors intend to contribute to the development of responsible AI tools that are fit for purpose and better understand the challenges. The key focus lies on Kooth.com, the UK's leading free online confidential service offering counselling and emotional wellbeing support to young people in the UK through its online web-based and pseudo-anonymous digital platform.
Spare-part fillet cross-finger flaps: A series of two cases
Authors: M M Al-Qattan, S A Al Mohrij
Journal: Int J Surg Case Rep (2019)
Keywords: cross-finger flaps, fillet flap, spare-part flaps

Introduction:
The concept of 'spare-part' flaps in hand reconstruction is most commonly applied using finger fillet flaps to cover dorsal or volar hand defects. In this paper, we introduce the concept of utilization of spare-part finger fillet flaps in a cross-finger fashion.
Case reports:
The technique is demonstrated in two case reports. In both cases, there was one finger that was severely crushed requiring amputation. The bones from that finger were removed and the fillet finger flap was utilized to reconstruct a complex defect in an adjacent digit. Immediate post-operative physiotherapy was employed and flap division was done 17-18 days later. Both patients were satisfied with the outcome and returned back to work as manual workers.
Discussion:
Differences between previous techniques / types of cross-finger flaps and the current spare-part fillet cross-finger flap technique are discussed.
Conclusion:
We introduce the concept of utilization of spare-part finger fillet flaps in a cross-finger fashion.
Uterine Rupture after Laparoscopic Myomectomy in Two Cases: Real Complication or Malpractice?
Authors: Antonella Vimercati, Vittoria Del Vecchio, Annarosa Chincoli, Antonio Malvasi, Ettore Cicinelli
Journal: Case Rep Obstet Gynecol (2017)
MeSH terms: Case Reports

We describe two cases of uterine rupture in pregnancy after laparoscopic myomectomy and analyze all the aetiological factors involved in this circumstance according to the recent literature, focusing above all on the surgical procedures and the characteristics of the excised myomas. The two cases of uterine rupture in pregnancy following laparoscopic myomectomy occurred at 36 and 18 weeks of gestation, respectively. Both women had undergone laparoscopic multiple myomectomy and uterine rupture occurred along the isthmic myomectomy scars, despite the fact that compliance with all the recent technical surgical recommendations for the previous laparoscopic multiple myomectomy had been fully observed. In our cases we identified the isthmic localization, size of the excised myomas (≥4 cm), and individual characteristics of the healing process as possible risk factors for "a real complication." Larger studies and robust case-control analyses are needed to draw reliable conclusions; special care should be paid when performing laparoscopic myomectomy in women planning a later pregnancy.
A Case of a Stafne Bone Defect Associated with Sublingual Glands in the Lingual Side of the Mandible
Authors: Kamichika Hayashi, Takeshi Onda, Takahiro Iwasaki, Mitsuru Takata, Kiyotaka Mori, Hiroyuki Matsuda, Shinya Watanabe, Hidetoshi Tamura, Takahiko Shibahara, Masayuki Takano
Journal: Case Rep Dent (2020)
MeSH terms: Case Reports

A Stafne bone defect from the mandibular anterior to the premolar region is an extremely rare case. A case of a Stafne bone defect extending from the mandibular anterior to the premolar region was presented. Computed tomography (CT) and magnetic resonance imaging (MRI) suggested that salivary gland tissue connected to the sublingual glands was involved in the formation of the cavity. The patient was a 68-year-old man who was examined at our hospital's emergency outpatient department after a traffic accident. He was referred to our department for the treatment of contusions of the lips and oral cavity. A bone defect in the lingual side of the mandible from the right anterior to the right premolar region was incidentally detected on CT. CT showed a rounded cavity in the lingual side of the mandible that had a lingual opening, was monocystic, and had a cortical margin. The margin of the cavity was relatively dull and regular. MRI showed that the tissue filling the cavity in the lingual side of the mandible had similar signal intensity as the sublingual glands and was contiguous with the normal sublingual glands. Based on these findings, the bone defect was diagnosed as a Stafne bone defect filled with salivary gland tissue connected to the sublingual gland tissue.
Idiopathic aggressive myositis ossificans of the hand infiltrating the flexor sheath/checkrein ligament, obliterating the common digital artery, and attenuating the digital nerve: A case report
Authors: Maha Arafah, Mohammad M Al-Qattan
Journal: Int J Surg Case Rep (2018)
Keywords: hand, infiltrating tumor, myositis ossificans

Introduction:
Myositis ossificans of the hand is extremely rare and tumors do not usually infiltrate adjacent structures. We present a very unusual case with a tumor infiltrating adjacent structures.
Report of a case:
A 30-year-old female presented with a 5-week history of a painful rapidly-growing mass over the proximal phalanx of the right ring finger. The mass infiltrated the entire flexor sheath over the proximal phalanx as well as the checkrein ligament of the proximal interphalangeal joint. The common digital artery of the 3rd web space was obliterated by the tumor. The radial digital nerve of the ring finger was stretched and attenuated. Total excision was done and histology confirmed the diagnosis of myositis ossificans. No recurrence was seen at the one-year follow-up.
Discussion:
Myositis ossificans of the hand is extremely rare. We report our case to document the unique feature of tumor infiltration of adjacent structures. We also document that excision is curative despite the infiltrative nature of the tumor.
Conclusion:
Our case is unique because of the infiltrative nature of tumor. There is no indication for amputation even for infiltrative tumors. We demonstrate that complete excision is curative with good regain of function even in infiltrative lesions.
Peripheral T-Cell Lymphoma with Aberrant Expression of CD19, CD20, and CD79a: Case Report and Literature Review
Authors: Rahul G Matnani, Rachel L Stewart, Joseph Pulliam, Chester D Jennings, Melissa Kesler
Journal: Case Rep Hematol (2013)

A case of lymphoma of T-cell derivation with aberrant expression of three B-cell lineage markers (CD19, CD20, and CD79a), which was diagnosed on a left axillary excision, is described. Immunohistochemical studies and flow cytometry analysis demonstrated neoplastic cells expressing CD3, CD19, CD20, and CD79a with absence of CD4, CD8, CD10, CD30, CD34, CD56, CD68, TDT, MPO, PAX-5, and surface immunoglobulin. Gene rearrangement studies performed on paraffin blocks demonstrated monoclonal T-cell receptor gamma chain rearrangement with no evidence of clonal heavy chain rearrangement. The neoplastic cells were negative for Epstein-Barr virus (EBV) or Human Herpes Virus 8 (HHV-8). At the time of diagnosis, the PET scan demonstrated hypermetabolic neoplastic cells involving the left axilla, bilateral internal jugular areas, mediastinum, right hilum, bilateral lungs, and spleen. However, bone marrow biopsy performed for hemolytic anemia revealed normocellular bone marrow with trilineage maturation. The patient had no evidence of immunodeficiency or infection with EBV or HHV-8. This is the first reported case of a mature T-cell lymphoma with aberrant expression of three B-cell lineage markers. The current report also highlights the need for molecular gene rearrangement studies to determine the precise lineage of ambiguous neoplastic clones.
Case report: Constrictive pericarditis after coronary artery perforation during percutaneous coronary intervention
Authors: Kyung An Kim, Kwan Yong Lee, Byung-Hee Hwang, Do Yeon Kim, Chan Beom Park
Journal: Front Cardiovasc Med (2023)
Keywords: constrictive pericarditis, coronary artery perforation, echocardiography, percutaneous coronary intervention, pericardiectomy
MeSH terms: Case Reports

A 77-year-old man underwent percutaneous coronary intervention (PCI) at the right coronary artery, which was complicated by coronary artery perforation (CAP). After prolonged balloon tamponade proximal to the CAP there was no more contrast extravasation, and the CAP was thought to have resolved. Computed tomography (CT) and echocardiography the following day did not find evidence of continued bleeding, and the patient was discharged. Echocardiograms and chest CT scans obtained one week and two months after PCI detected no remarkable interval change. The patient complained of progressive dyspnea and abdominal distension seven months after PCI however, and echocardiography found an increased amount of pericardial effusion and constrictive physiology. The patient underwent pericardiectomy due to congestive hepatopathy, and progressive dyspnea. The pericardium was thickened and adhesive, and a dark bloody effusion was found. Pathology was unremarkable except for thick fibrosis. After the operation the patient made full recovery, and is stable three years after surgery.
Diagnosis and Management of Atypical Chronic Myeloid Leukemia with a t(2;13)(q33;q12) Translocation
Authors: John S Wang, Omar Elghawy, Brett R Kurpiel, Michael G Douvas
Journal: Case Rep Hematol (2022)
MeSH terms: Case Reports

Atypical chronic myeloid leukemia (aCML) is a rare myeloproliferative disorder that shares clinical features with chronic myeloid leukemia but lacks the classic t(9;22) BCR-ABL1 translocation and features prominent dysgranulopoiesis and granulocytic dysplasia. Challenges of this diagnosis include clinical and biologic heterogeneity, the high risk of transformation to acute myeloid leukemia, and the lack of standard treatment options. Allogeneic hematopoietic stem cell transplant is likely the preferred treatment, but this can be limited by patient psychosocial support, age, concomitant medical conditions, and availability of an appropriate donor. We report the case of a 61-year-old male with no significant past medical history diagnosed with aCML with a rare t(2;13)(q33;q12). He presented with weight loss, night sweats, splenomegaly, hyperleukocytosis, a leukoerythroblastic differential with a predominant neutrophilia, anemia, and thrombocytopenia. Subsequent peripheral blood and bone marrow studies lead to the diagnosis of aCML. He was recommended to undergo an allogeneic stem cell transplant evaluation and declined. He was initially treated with hydroxyurea and imatinib to which he responded for approximately three years. After clinical progression, he was treated with sorafenib, a multiprotein kinase inhibitor more commonly used in the treatment of hepatocellular and renal cell carcinoma due to its off target FLT3 inhibition. The patient achieved complete hematologic response which has been sustained for 7 years with tolerable side effects.
Disrupting arrhythmia in a professional male wrestler athlete after rapid weight loss and high-intensity training-Case report
Authors: Aleksandra Milovančev, Tatjana Miljković, Aleksandra Ilić, Anastazija Stojšić Milosavljević, Milovan Petrović, Roberto Roklicer, Nemanja Lakičević, Tatjana Trivić, Patrik Drid
Journal: Front Cardiovasc Med (2023)
Keywords: arrhythmia, case report, combat athletes, heart, rapid weight loss, wrestling
MeSH terms: Case Reports

Introduction:
Physiological heart adaptations may lead to increased susceptibility to arrhythmia in athletes. Furthermore, vigorous training and method like rapid weight loss (RWL) in combat sports could pose additional risks. This case represents how routine cardiovascular screening during high-risk methods like RWL and high-intensity training (HIT) reveal abrupt ventricular arrhythmias in a young athlete.
Case report:
We report a case of a 20-year-old male wrestler athlete who developed disrupting arrhythmia during RWL and HIT. The study included: a medical exam, 12 lead electrocardiograms (ECG), transthoracic echocardiogram (ECHO), and 24 h of continuous ECG monitoring in baseline, phase one (P1), (in which the athlete had to simulate RWL through vigorous training and dietary intervention and HIT) and phase two (P2), (with the same HIT protocol performed without the RWL procedure). Baseline laboratory analyses were without abnormalities, ECG showed sinus rhythm with one premature atrial contraction (PAC) and ECHO showed signs of concentric remodeling with preserved systolic, diastolic function, and global longitudinal strain. After P1 RWL simulation, he lost 5.15% of body weight in 3 days, which resulted in lower blood glucose levels, higher urea, creatinine, creatine kinase (CK), CK-MB levels, and slightly increased levels of NT pro-BNP, ECG revealed sinus rhythm with one ventricular premature beat (VPB), 24-h continuous electrocardiogram (ECG) revealed frequent ventricular premature beats (PVB) 2,150/ 24 h, with two couplets, and 8 PAC. After an advised 4-week period of de-training continuous 24 h, ECG monitoring was improved with only occasional PVB. The 24 h continuous ECG monitoring was repeated after HIT and revealed even more frequent PVB, 5% of all beats for 24 h, 4,205 in total, and almost all VPB were in bigeminy and trigeminy. The athlete was advised against RWL and extremely vigorous exercise and for regular, frequent checkups with occasional ECG monitoring during and after exercise.
Conclusion:
The short and long-term implication of abrupt ventricular arrhythmias provoked by intensive training and methods like RWL is unknown. We postulate that cardiovascular screening is necessitated, especially during high-risk methods like RWL and HIT, in helping us prevent adverse outcomes and come to individual-based clinical making decisions for each athlete.
Stable transmission of an unbalanced chromosome 21 derived from chromoanasynthesis in a patient with a SYNGAP1 likely pathogenic variant
Authors: Peter J B Sabatini, Resham Ejaz, Dimitri J Stavropoulos, Roberto Mendoza-Londono, Ann M Joseph-George
Journal: Mol Cytogenet (2018)
Keywords: chromoanagenesis, chromoanasynthesis, familial transmission, syngap1
MeSH terms: Case Reports

Background:
Complex genomic structural variations, involving chromoanagenesis, have been implicated in multiple congenital anomalies and abnormal neurodevelopment. Familial inheritance of complex chromosomal structural alteration resulting from germline chromoanagenesis-type mechanisms are limited.
Case presentation:
We report a two-year eleven-month old male presenting with epilepsy, ataxia and dysmorphic features of unknown etiology. Chromosomal microarray identified a complex unbalanced rearrangement involving chromosome 21. G-banding and FISH for targeted regions of chromosome 21 revealed that the copy number imbalances were limited to gains dispersed throughout the long arm of chromosome 21, characteristic of a chromosome derived from chromoanagenesis. Family studies showed that the unbalanced chromosome had been stably inherited, as it was present in both his healthy mother and maternal grandfather. Further molecular testing for non-syndromic intellectual disability genes found a likely pathogenic mutation in SYNGAP1 (NM_006772.2:c.3722_3723del).
Conclusions:
This study indicates that complex rearrangements involving an unbalanced chromosome derived from chromoanasynthesis can be familial and should be not be presumed pathogenic.