OpenMed/multicare-articles huggingface dataset:
Methimazole-Induced Pleural Effusion in the Setting of Graves' Disease
Authors: Le Yu Khine, Dong Won Kim, Omolola Olajide, Chelsey White, Yousef Shweihat, Henry Driscoll
Journal: Case Rep Endocrinol (2019)
MeSH terms: Case Reports

Methimazole is a thionamide drug that inhibits the synthesis of thyroid hormones by blocking the oxidation of iodine in the thyroid gland. We report a case of methimazole-induced recurrent pleural effusion. A 67-year-old female with recently diagnosed Graves' disease on methimazole 20mg daily was admitted with dyspnea and new onset atrial fibrillation with rapid ventricular rate. Chest X-ray revealed a unilateral right pleural effusion, which was consistent with a transudate on thoracocentesis. She was managed as a case of congestive heart failure and methimazole dose was increased to 30 mg daily. She was readmitted twice with recurrent right pleural effusion. The fluid revealed an exudative process on repeat thoracocentesis. CT scan of the chest with contrast showed mediastinal lymphadenopathy and a diffuse ground glass process involving the right lower lobe suggestive of pneumonitis. Bronchoalveolar lavage showed neutrophil predominant fluid, and cytology and adenosine deaminase were negative. Patient also had an endobronchial ultrasound guided biopsy of the lymph nodes (EBUS). She was treated empirically with steroids 40 mg for 10 days and the methimazole was also discontinued. The antinuclear antibodies (ANA) came back positive with a speckled pattern; antineutrophil cytoplasmic antibody (c-ANCA) and antimyeloperoxidase were also positive. The effusion resolved but recurred on rechallenge with methimazole. She was referred for urgent thyroidectomy. The patient's repeat chest X-ray showed complete resolution of the pleural effusion after stopping the methimazole. Few weeks later, repeat ANCA and antimyeloperoxidase antibody were both negative. Our case report highlights the importance of the recognition of a rare side effect of methimazole. Timely diagnosis would ensure that appropriate treatment is given.
Complex Regional Pain Syndrome: Is There a Role for Capsaicin?
Authors: Ana Raquel S Cruz, Filipa R Sales, Filipa Maldonado, Joana Torres
Journal: Cureus (2023)
Keywords: capsaicin, chronic pain, complex regional pain syndrome, pain medicine, trauma
MeSH terms: Case Reports

Complex regional pain syndrome (CRPS) is a challenging disorder occurring in patients most often after trauma or surgery. Its treatment is very complex, and even then, no treatment is fully effective. Capsaicin is a well-accepted treatment for neuropathic pain. However, its use in CRPS is controversial, with few studies having been published on it. In this case report, we describe the case of a female patient with CPRS type II, whose treatment with topical capsaicin resulted in great functional improvement. The patient was referred to the Pain Medicine Unit due to a CRPS type II due to trauma in her right wrist. She complained of severe pain in the median nerve territory of her dominant hand, associated with hyperalgesia, allodynia, burning, and electric shock sensation, resulting in functional disability. Electromyography was compatible with severe axonal injury of the right median nerve of the wrist. After conventional therapies were tried with no improvement, treatment with a capsaicin 8% patch was proposed. A functional improvement was observed after two applications of the capsaicin treatment, allowing the patient to regain activity in her hand. This shows that although evidence for capsaicin use in CRPS treatment is scarce, it can be a viable alternative for some patients.
Incidental Discovery of Multiorgan Extramedullary Plasmacytomas in the Setting of Newly Diagnosed Multiple Myeloma and Delayed Hemolytic Transfusion Reaction
Authors: Joselle Cook, Steven Song, Anthony Ventimiglia, Carol Luhrs
Journal: Case Rep Hematol (2017)
MeSH terms: Case Reports

Extramedullary plasmacytomas (EMPs) are defined by the presence of clonal plasma cell proliferation outside of the bone marrow, portending an overall poor prognosis. This case highlights extramedullary plasmacytomas as an unusual presenting manifestation of multiple myeloma. Through incidental discovery during a delayed hemolytic transfusion reaction workup, EMPs were found in the liver, spleen, and possibly the lung. Though rare at presentation, this case emphasizes that the presence of EMPs should be considered at the outset as it not only impacts the treatment regimen for such patients but also considerably affects prognosis.
Case series: Four fatal rabbit hemorrhagic disease virus infections in urban pet rabbits
Authors: Filipe Fontes Pinto, Joana Abrantes, Paula Gomes Ferreira, Mário Nóbrega, Ricardo Marcos
Journal: Front Vet Sci (2023)
Keywords: rhd, rhdv, case series, rabbit hemorrhagic disease, rabbit hemorrhagic disease virus

Four pet rabbits (Oryctolagus cuniculus cuniculus) diagnosed with a fatal infection by rabbit hemorrhagic disease virus (RHDV GI.2) were identified in the same week and further investigated. All animals lived in an urban environment (Lisbon, Portugal), were between 8 months and 2 years old and none had been vaccinated against RHDV2 (GI.2). Three animals arrived at the clinic and died shortly afterward and it was only possible to collect material for RT-qPCR (RHDV) test. These rabbits tested positive for RHDV2, with high viral loads. In the fourth case, additional clinical and post-mortem gross and histological evaluations were performed. This 8 month old intact female indoor pet rabbit was presented with apathy, tachypnea and tachycardia. Radiographic projections revealed no clinical revealed no clinical abnormalities. Serum biochemistry revealed a significant increase in AST and ALT with a small hypoglycemia. Abdominal ultrasound revealed an acute hepatitis. Despite hospitalization support, after 30 h of admission, the rabbit lost consciousness and developed anorexia and pyrexia in the last minutes before death. Post-mortem analysis and molecular testing by RT-qPCR, confirmed the diagnosis of RHDV2 (GI.2) infection also with high viral load. In conclusion, this paper reports a case series that demonstrates the severe infectious ability and the high mortality associated with RHDV even in rabbits from urban environments. Furthermore, it highlights the importance of always considering rabbit hemorrhagic disease (RHD) as a differential diagnosis in pet rabbits with non-specific clinical signs, and should warn veterinarians that pet rabbits living indoors can also be infected with a fatal outcome.
Hyperkalemia masking left ventricular hypertrophy in electrocardiogram in a patient with end-stage renal disease
Authors: V V Sai Naresh, V Ramakrishna, P Ramakrishna, V Siva Kumar
Journal: Indian J Nephrol (2008)
Keywords: electrocardiography, end stage renal disease, hyperkalemia, left ventricular enlargement
MeSH terms: Case Reports

A patient of severe chronic renal failure presented with hyperkalemic electrocardiographic (ECG) changes and hyperkalemia. Following a session of hemodialysis, when he reverted to normokalemia, the repeat ECG revealed left ventricular hypertrophy (LVH). Thus we confronted with a situation of hyperkalemia, masking the LVH on ECG initially and when the hyperkalemia was corrected with dialysis the LVH showed in ECG. The plausible explanation for this electrophysiological behaviour was offered.
A case report of vasa previa incidentally discovered
Authors: Salahiddine Saghir, Jaouad Kouach, Aomar Agadr
Journal: Pan Afr Med J (2015)
Keywords: benckiser′s haemorrhage, vasa previa, fetal bleeding
MeSH terms: Cesarean Section, Ultrasonography, Prenatal / methods, Vasa Previa / diagnosis, Case Reports, Adult, Female, Humans, Infant, Newborn, Male, Placenta / diagnostic imaging, Pregnancy, Vasa Previa / diagnostic imaging

Vasa previa is a rare but clinically important obstetrical complication that can be associated with a low-lying placenta or placenta previa. We aim to present one case of vasa previa diagnosed during the placenta examination after the caesarean indicated for triple uterus scar. A 26-year-old female was referred to our hospital at 30 weeks of gestation to provide a scheduled caesarean. Trans-abdominal ultrasound was performed; the placenta was positioned in the posterior side of the fundus. Fetal growth was found to be appropriate for gestational age. A healthy male infant weighing was successfully delivered via cesarean section at 38 weeks of gestation. This operation helped to prevent complications due to acute fetal bleeding. The identification and exclusion of vasa previa using trans-vaginal ultrasound are essential to ensure appropriate and timely treatment.
Intravascular Large B-Cell Lymphoma Presenting with Diffuse Gallbladder Wall Thickening: A Case Report and Literature Review
Authors: Sayf Al-Katib, Robert Colvin, Farnoosh Sokhandon
Journal: Case Rep Radiol (2018)
MeSH terms: Case Reports

Intravascular large B-cell lymphoma is a rare subtype of extranodal diffuse B-cell lymphoma characterized by proliferation of neoplastic cells within the lumen of small and medium sized vessels. Clinical and imaging findings are nebulous as the intravascular subtype of lymphoma can involve a multitude of organs. Involvement of the gallbladder is extremely uncommon, and imaging findings can be easily confused for more prevalent pathologies. We report a case of intravascular large B-cell lymphoma in an 83-year-old male and review clinical presentation and imaging findings on CT, ultrasound, hepatobiliary iminodiacetic acid (HIDA) scan, and MRI. It is important for the radiologist to know about this disease as the imaging findings are atypical of other types of lymphoma, and this may lead to a delay in diagnosis and treatment.
Traumatic subgaleal hematoma drainage in an adolescent: a case report and review of the literature
Authors: Blandine Aubert, Manon Cadoux, Cyril Sahyoun
Journal: Front Pediatr (2023)
Keywords: drainage, head trauma, pediatric, subgaleal hematoma, trauma
MeSH terms: Case Reports

Background:
Subgaleal hematoma is a well-known life-threatening complication of instrumentation at birth. Even though most cases of subgaleal hematomas occur in the neonatal period, older children and adults are also at risk for subgaleal hematomas and their complications, following head trauma.
Objective:
We hereby report the case of a 14-year-old boy who presented with a traumatic subgaleal hematoma requiring drainage and review the relevant literature regarding potential complications and indications for surgical intervention.
Results:
Infection, airway compression, orbital compartment syndrome and anemia requiring transfusion are potential complications of subgaleal hematomas. Although rare, surgical drainage and embolization are occasionally required interventions.
Conclusion:
Subgaleal hematomas following head trauma can occur in children beyond the neonatal period. Large hematomas may require drainage to relieve pain or when compressive or infectious complications are suspected. Although usually not life-threatening, physicians taking care of children must be cognizant of this entity when caring for a patient with a large hematoma following head trauma and in severe cases, consider a multidisciplinary approach.
A Wide Complex Tachycardia in a Structurally Normal Heart: What is the Mechanism? Where to Ablate?
Authors: Yash Lokhandwala, Aniruddha Vyas
Journal: J Innov Card Rhythm Manag (2019)
Keywords: antedromic tachycardia, mahaim pathway, distal ablation in atriofascicular mahaim pathway, pre-excited atrial fibrillation via mahaim pathway
MeSH terms: Case Reports

We present a case of wide complex tachycardia (left bundle branch block, superior axis) in a 30-year-old female with a structurally normal heart and no baseline preexcitation on electrocardiogram. Tachycardia initiation and atrial pacing confirmed the existence and participation of a right-sided atriofascicular decrementally conducting Mahaim pathway. Tachycardia mechanism validation by atrial pacing maneuvers was documented as well as was a response to adenosine and preexcited Mahaim atrial fibrillation. The usual ablation site did not record a Mahaim potential; hence, ablation was performed at a site other than the usual one.
Artifactual Hypoglycaemia in Systemic Sclerosis and Raynaud's Phenomenon: A Clinical Case Report and Short Review
Authors: R H Bishay, A Suryawanshi
Journal: Case Rep Endocrinol (2016)
MeSH terms: Case Reports

Background. Artifactual hypoglycaemia, defined as a discrepancy between glucometer (capillary) and plasma glucose levels, may lead to overtreatment and costly investigations. It is not infrequently observed in patients with Raynaud's phenomenon due to vascular capillary distortion, yet this is clinically underappreciated. Case Report. We report a 76-year-old woman with systemic sclerosis and Raynaud's phenomenon, who presented with upper gastrointestinal bleeding and found to have concomitant persistent hypoglycaemia (1.0-2.7mmol/L) on a point-of-care glucometer in the absence hypoglycaemic symptoms. She underwent a 2-week hospital admission, repeated glucose monitoring, hydrocortisone replacement and dextrose infusions, with consequent hyperglycaemia on plasma measurements. Clinically, she did not satisfy Whipple's triad and radiological investigations failed to identify pituitary or pancreatic pathology. A 72-hour fast was negative for hyperinsulinaemia or exogenous insulin use and her sulphonylurea metabolite urinary screen was negative. Discussion. Treatment of low capillary blood glucose is usually met with clinical impetus to treat, even when hypoglycaemic symptoms are lacking. The correct diagnosis may have been achieved had there been an observation of her cold hands, scleroderma facies, and consideration of the likely distorted peripheral microvasculature. Early identification of this presumably rare clinical scenario may have prevented overtreatment, altered methods of monitoring, and avoided unnecessary investigations.
Coexistence of Cervical Leiomyosarcoma and Gastric-Type Adenocarcinoma In Situ with Extensive Extension to the Endometrium and Fallopian Tube
Authors: Ayako Ura, Kanako Ogura, Asumi Sakaguchi, Hiroko Onagi, Daiki Ogishima, Yayoi Sugimori, Kensuke Hamamura, Masaharu Fukunaga, Toshiharu Matsumoto
Journal: Case Rep Pathol (2018)
MeSH terms: Case Reports

Cervical leiomyosarcoma is known to be rare from the previous reviews of a large number of malignant cervical tumors. The patient was a 66-year-old woman with irregular vaginal bleeding. She underwent modified radical hysterectomy and bilateral salpingooophorectomy. Histopathologically, we diagnosed the coexistence of uterine cervical leiomyosarcoma and cervical gastric-type adenocarcinoma in situ with endometrial lesions that had continuous and skip patterns and fallopian tubal lesions with a partial lesion. To the best of our knowledge, cases of synchronous leiomyosarcoma and cancers have not often been reported; only two cases of synchronous cervical leiomyosarcoma and cervical squamous cell carcinoma have been published. This case is the first presentation of coincidental primary cervical leiomyosarcoma and cervical gastric-type adenocarcinoma in situ. Additionally, we considered cervical gastric-type adenocarcinoma in situ with continuous lesions on the endometrium and skip lesions on the left fallopian tube.
New Parameter for In-Office Dental Bleaching
Authors: Cristina Dupim Presoto, Janaina Freitas Bortolatto, Priscila Petrucelli Freire de Carvalho, Tamara Carolina Trevisan, Michael Christopher Floros, Osmir Batista de Oliveira Junior
Journal: Case Rep Dent (2016)

Dental bleaching is considered a conservative and biologically safe treatment for discolored teeth. Despite this, one of the major undesirable effects of bleaching is dentin sensitivity which may occur during and after treatment. To address these sensitivity issues, new dental bleaching preparations with lower concentrations of hydrogen peroxide (H2O2) have recently been introduced to the market. This paper presents a clinical case report of a 20-year-old female patient admitted to the Araraquara Dental School, UNESP, Brazil. The patient underwent dental bleaching using one of the new products with reduced hydrogen peroxide concentration, Lase Peroxide Lite 6%, a 6% H2O2 gel containing titanium oxide nanoparticles doped with nitrogen (6% H2O2/N-doped TiO2).
Case Report: Delayed treatment of tuberculosis of the elbow joint
Authors: Desdiani Desdiani, Hidayat Rizal, Anindita Basuki, Fadilah Fadilah
Journal: F1000Res (2021)
Keywords: arthritis, delayed treatment, elbow, tuberculosis
MeSH terms: Elbow Joint, Mycobacterium tuberculosis, Tuberculosis / diagnosis, Tuberculosis / drug therapy, Case Reports, Adult, Humans, Male, Pain, Time-to-Treatment, Young Adult

Extrapulmonary tuberculosis (TB) is known to occur in the musculoskeletal system, including the elbow joints. These cases are rarely found because the signs and symptoms are not specific to extrapulmonary TB or other diseases. We report a case of a 24-year-old male, who complained about pain in his left elbow and noticed swelling. Initially, he complained about pain all over his left arm, after several reflexology massages to alleviate his toothache. However, instead of seeking medical treatment, he visited a traditional massage therapist every week without improvement in his left arm pain including his left elbow for almost one year. Examination showed skin perforation with discharge. He also had fever during the first few days when the elbow became swollen. Weight loss and a decreased appetite were also noticed by the patient. The patient went to the orthopedic department and underwent surgery. Radiological examination indicated bone erosion on the left humerus and radius, while posteroanterior chest X-ray did not show any abnormality. Histopathological examinations from biopsy and fluid aspiration showed granulomas and datia Langhans cells. Mycobacterium tuberculosis was found on acid-fast bacteria smear and culture. The patient was administered multidrug tuberculosis therapy, which consisted of two months of an intensive phase and seven months of a continuation phase, in accordance with the World Health Organization's guidelines for extrapulmonary tuberculosis treatment. He has currently undergone the continuation phase of the treatment and his condition has improved. Early detection of tuberculosis of the elbow can prevent damage to joint structure and impairment of joint function.
Whole-Exome Sequencing Enables the Diagnosis of Variant-Type Xeroderma Pigmentosum
Authors: Xiaokai Fang, Yonghu Sun
Journal: Front Genet (2019)
Keywords: dna polymerase eta (polh) gene, novel mutation, psoriasis, whole-exome sequencing, xeroderma pigmentosum (xp)

Background:
Xeroderma pigmentosum (XP) is a rare autosomal, recessive, inherited disease. XP patients exhibit high sensitivity to sunlight and increased incidence of skin cancer. The different XP subtypes, which are caused by mutations of eight distinct genes, show some specific clinical manifestations. XP variant (XPV) is caused by mutations in the gene encoding DNA polymerase eta (POLH).
Case presentation:
We report a family that included two XP patients whose parents were first cousins. The proband is a 36-year-old male who developed a large number of pigmented freckle-like lesions starting at 4 years of age; later, he displayed typical psoriasis manifestation, abnormal renal function and hyperglycaemia. He was suspected as suffering from dyschromatosis symmetrica hereditaria (DSH), but negative results were obtained in candidate gene analyses. Whole-exome sequencing was performed in four subjects, including the two patients and two controls, and a new pathogenic homozygous nonsense mutation (c.353dupA, p. Y118_V119delinsX) of the POLH gene, which was identified in all nine family members by Sanger sequencing, was detected in the patients.
Conclusion:
A novel XPV pathogenic homozygous nonsense mutation in the POLH gene was identified. Our case proves that next-generation sequencing is an effective method for the rapid diagnosis and determination of XP genetic etiology.
"Real-Time" High-Throughput Drug and Synergy Testing for Multidrug-Resistant Bacterial Infection: A Case Report
Authors: Wei Sun, Shayla Hesse, Miao Xu, Richard W Childs, Wei Zheng, Peter R Williamson
Journal: Front Med (Lausanne) (2018)
Keywords: klebsiella pneumoniae, antibiotic combination therapy, drug repurposing screen, multidrug-resistant organisms, real-time drug test
MeSH terms: Case Reports

Antibiotic management of infections with multidrug-resistant organisms (MDRO) represents a complex clinical challenge. We report here the first patient with a severe MDRO infection managed with assistance of a novel "real-time" 3-day high-throughput screen (HTS) that allowed screening of 9 drugs in 14 combinations in 2,304 total samplings. Identified synergies were used to modify patient therapy with the goal of reducing drug-induced toxicity. The desired clinical outcome was achieved on the HTS-informed therapeutic regimen, supporting the utility of HTS technology to expand standard antimicrobial susceptibility testing.
Two cases of unusual airway pathology, in which a careful history contributed to a successful diagnosis
Authors: S T Hlophe, R Masekela
Journal: Afr J Thorac Crit Care Med (2018)
Keywords: intensive care unit, wheezing
MeSH terms: Case Reports

Lower airway obstruction commonly presents with wheezing but is not always caused by asthma. Considering the case history and course of illness is of utmost importance in determining the cause of wheezing. We present two cases admitted to the paediatric intensive care unit, in which a double aortic arch was found to be the cause of wheezing. The cases illustrate the importance of a systematic approach when investigating a patient with persistent wheeze, especially when there is a poor response to conventional therapy.
Cytomegalovirus pneumonia in a patient with T-lymphoblastic leukemia/lymphoma after allogeneic hematopoietic stem cell transplantation: A case report
Authors: Qiuyu Li, Kai Wang, Wei Guo, Ming Lu
Journal: Medicine (Baltimore) (2019)
MeSH terms: Cytomegalovirus Infections / virology, Cytomegalovirus, Hematopoietic Stem Cell Transplantation / adverse effects, Pneumonia, Viral / virology, Postoperative Complications / virology, Precursor T-Cell Lymphoblastic Leukemia-Lymphoma / surgery, Case Reports, Adult, Antiviral Agents / therapeutic use, Cytomegalovirus Infections / drug therapy, Fatal Outcome, Ganciclovir / therapeutic use, Hematopoietic Stem Cell Transplantation / methods, Humans, Male, Pneumonia, Viral / drug therapy, Transplantation, Homologous / adverse effects, Transplantation, Homologous / methods, Antiviral Agents, Ganciclovir

Rationale:
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is an important treatment for hematological malignancies. Common complications are opportunistic infections and graft-versus-host disease (GVHD). Cytomegalovirus (CMV) is one of the most common causes of opportunistic infections.
Patient concerns:
A 30-year-old male was diagnosed with T-cell lymphoma after persistent cough and lymphadenopathy. Fever, abdominal pain, diarrhea, rash, and dyspnea occurred after HSCT.
Diagnosis:
The young man developed severe CMV infection with CMV detected in the bronchoalveolar lavage fluid and gastrointestinal tract.
Interventions:
Intravenous ganciclovir and high-dose glucocorticoids were administered after the patient was diagnosed with CMV pneumonia and enteritis.
Outcomes:
After 3 weeks, the young man died from respiratory failure and infectious toxic shock caused by severe CMV infection.
Lessons:
Patients after HSCT should be closely monitored CMV-DNA in blood and other specimen, and treated first if necessary, so as to avoid the occurrence of severe infections such as CMV gastroenteritis and pneumonia.