OpenMed/multicare-articles huggingface dataset:
A Challenging Case of Acute Mercury Toxicity
Authors: Ali Nayfeh, Thamer Kassim, Noor Addasi, Faysal Alghoula, Christopher Holewinski, Zachary Depew
Journal: Case Rep Med (2018)
MeSH terms: Case Reports

Background:
Mercury exists in multiple forms: elemental, organic, and inorganic. Its toxic manifestations depend on the type and magnitude of exposure. The role of colonoscopic decompression in acute mercury toxicity is still unclear. We present a case of acute elemental mercury toxicity secondary to mercury ingestion, which markedly improved with colonoscopic decompression.
Clinical case:
A 54-year-old male presented to the ED five days after ingesting five ounces (148 cubic centimeters) of elemental mercury. Examination was only significant for a distended abdomen. Labs showed elevated serum and urine mercury levels. An abdominal radiograph showed radiopaque material throughout the colon. Succimer and laxatives were initiated. The patient had recurrent bowel movements, and serial radiographs showed interval decrease of mercury in the descending colon with interval increase in the cecum and ascending colon. Colonoscopic decompression was done successfully. The colon was evacuated, and a repeat radiograph showed decreased hyperdense material in the colon. Three months later, a repeat radiograph showed no hyperdense material in the colon.
Conclusion:
Ingested elemental mercury can be retained in the colon. Although there are no established guidelines for colonoscopic decompression, our patient showed significant improvement. We believe further studies on this subject are needed to guide management practices.
Peno-scrotal limphedema with giant hydrocele--surgical treatment particularities
Authors: Dan Mischianu, Ioan Florescu, Victor Madan, Cristian Iatagan, Ovidiu Bratu, Anca Oporan, C Giublea
Journal: J Med Life (2009)
MeSH terms: Lymphedema / surgery, Testicular Hydrocele / surgery, Case Reports, Adult, Humans, Lymphangioma / complications, Lymphedema / etiology, Male, Testicular Hydrocele / etiology, Urogenital Surgical Procedures / methods

Introduction:
The necessity for complex and multidisciplinary approach of "border" surgical pathology has unanimously been agreed upon for such a long period of time, its advantages becoming even more obvious in rare, particular cases.
Patients and methods:
We report the case of a 39 year-old man diagnosed with lymphangiomatosis back in his childhood. He is admitted with a giant pseudotumoral scrotal mass presenting an important scrotal enlargement (40/35 cm). Physical examination, blood tests, ultrasound, IVP, abdominal and chest CT, psychiatric and plastic surgery evaluation established the diagnosis: peno-scrotal lymphedema with gigantic hydrocele and depressive disorder. Taking into account the important enlargement of the scrotum associated with the alteration of the local skin, we decided to form a mixed surgical team: urology--plastic and reconstructive surgery. We performed bilateral surgical therapy of hydrocele with partial excision and eversion of sac edges, excision of penoscrotal skin and subcutaneous tissue surplus. At the end we made a reconstruction by using a partial-thickness graft from the normal skin of the left thigh.
Results:
Spinal anaesthesia was sufficient in order to perform a qualitative complex surgery. Intra and postoperative course was uneventful with minimal blood loss.
Conclusion:
Rare cases like this one clearly reveal the advantages of a multidisciplinary surgical team by combining usual surgical procedures from different specialities that could lead to spectacular results.
Isolated agenesis of the left pulmonary artery: A case report
Authors: M J Mpe, W van Aswegen
Journal: Afr J Thorac Crit Care Med (2021)
Keywords: agenesis, pulmonary artery, unilateral
MeSH terms: Case Reports

We present a case of a middle-aged patient followed up at the medical outpatient's department routinely over two years for hypertensive heart disease and tobacco-induced chronic obstructive pulmonary disease. The patient was found to have an additional problem of congenital absence of the left main pulmonary artery.
Late diagnosis of Lassa fever outbreak in endemic areas lead to high mortality, Kenema District, Sierra Leone, February - March 2019
Authors: Umaru Sesay, Leonard Hakizimana, Adel Hussein Elduma, Alden Henderson, Gebrekrstos Negash Gebru
Journal: Pan Afr Med J (2022)
Keywords: kenema, lassa fever, sierra leone, endemicity
MeSH terms: Lassa Fever / diagnosis, Lassa Fever / drug therapy, Lassa Fever / epidemiology, Case Reports, Child, Child, Preschool, Delayed Diagnosis, Disease Outbreaks, Female, Fever / epidemiology, Fever / etiology, Humans, Male, Sierra Leone / epidemiology

Introduction:
the Kenema District Surveillance team in Sierra Leone received notifications of patients with suspected Lassa fever on February 20th and March 2nd, 2019. On that day, an investigation started to confirm the diagnosis and search for additional cases.
Methods:
we used the Lassa fever surveillance case definition and collected demographic and exposure information from suspected cases through interviews and clinical records. Blood samples were collected from the cases to confirm the diagnosis. Active case finding was conducted in the community and health facility.
Results:
on February 10, 2019, an eight-year-old male developed a fever (>39.5°C) and a sore throat. On February 18, 2019, he was admitted to a hospital and treated for malaria and pneumonia. On February 20, 2019, Lassa fever was suspected because the patient was bleeding from orifices and testing. On February 15, a 5-year-old female developed fever and headache and was treated with anti-malarial drugs. On February 26th the high fever re-emerged with severe bleeding from the orifices. She was admitted and treated with antibiotics, confirmed for Lassa fever, and died on March 2, 2019.
Conclusion:
the two children had Lassa fever, and no additional cases were identified. We sensitized clinicians on suspicion of Lassa fever to improve early detection and treatment.
Presumptive Zoonotic Kerion by Nannizzia gypsea: Case Report
Authors: Deborah Cruciani, Manuela Papini, Sayra Broccatelli, Francesco Agnetti, Sara Spina, Ylenia Natalini, Silvia Crotti
Journal: Front Vet Sci (2021)
Keywords: nannizzia gypsea, case report, child, dog, kerion
MeSH terms: Case Reports

Nannizzia gypsea (formerly Microsporum gypseum) belongs to geophilic dermatophytes, fungi involved in keratin degradation in the soil; however, they are also found in dogs and cats. Transmission to humans can occur directly by contact with soil, but indirect transmission via domestic animals is reported too. The exact source of the infection is usually difficult to assess and in most cases only hypothesised and rarely investigated. This case report describes a kerion caused by N. gypsea in a 2-year-old boy, where the contagion was probably secondary to domestic healthy carrier dogs. A "One-Health" approach involving human dermatologists and veterinarians, combined with the use of conventional and molecular-based techniques, allowed tracing of the epidemiological chain and managing of not only the treatment but also the prevention of a recurrence. The child's lesion began to regress after about 8 weeks of treatment with both systemic and topical therapy, while the dogs were given chlorhexidine and miconazole baths. No recurrences nor new infections occurred, demonstrating the effectiveness of the strategies used.
Beneficial Effect of Systemic Allogeneic Adipose Derived Mesenchymal Cells on the Clinical, Inflammatory and Immunologic Status of a Patient With Recessive Dystrophic Epidermolysis Bullosa: A Case Report
Authors: Rocío Maseda, Lucía Martínez-Santamaría, Rosa Sacedón, Nora Butta, María Del Carmen de Arriba, Sara García-Barcenilla, Marta García, Nuria Illera, Isabel Pérez-Conde, Marta Carretero, Eva Jiménez, Gustavo Melen, Alberto M Borobia, Víctor Jiménez-Yuste, Ángeles Vicente, Marcela Del Río, Raúl de Lucas, María José Escámez
Journal: Front Med (Lausanne) (2020)
Keywords: adipose derived msc (admsc), case report, inflammation, mesenchymal stromal cells (msc), recessive dystrophic epidermolysis bullosa (rdeb), systemic cell therapy
MeSH terms: Case Reports

Recessive dystrophic epidermolysis bullosa (RDEB) is an incurable inherited mucocutaneous fragility disorder characterized by recurrent blisters, erosions, and wounds. Continuous blistering triggers overlapping cycles of never-ending healing and scarring commonly evolving to chronic systemic inflammation and fibrosis. The systemic treatment with allogeneic mesenchymal cells (MSC) from bone marrow has previously shown benefits in RDEB. MSC from adipose tissue (ADMSC) are easier to isolate. This is the first report on the use of systemic allogeneic ADMSC, correlating the clinical, inflammatory, and immunologic outcomes in RDEB indicating long-lasting benefits. We present the case of an RDEB patient harboring heterozygous biallelic COL7A1 gene mutations and with a diminished expression of C7. The patient presented with long-lasting refractory and painful oral ulcers distressing her quality of life. Histamine receptor antagonists, opioid analgesics, proton-pump inhibitors, and low-dose tricyclic antidepressants barely improved gastric symptoms, pain, and pruritus. Concomitantly, allogeneic ADMSC were provided as three separate intravenous injections of 106 cells/kg every 21 days. ADMSC treatment was well-tolerated. Improvements in wound healing, itch, pain and quality of life were observed, maximally at 6-9 months post-treatment, with the relief of symptoms still noticeable for up to 2 years. Remarkably, significant modifications in PBL participating in both the innate and adaptive responses, alongside regulation of levels of profibrotic factors, MCP-1/CCL2 and TGF-β, correlated with the health improvement. This treatment might represent an alternative for non-responding patients to conventional management. It seems critical to elucidate the paracrine modulation of the immune system by MSC for their rational use in regenerative/immunoregulatory therapies.
Case report: Saccadic ping-pong gaze in progressive supranuclear palsy with predominant postural instability
Authors: Hikari Nunomura, Taketoshi Kasahara, Taku Hatano, Hitoshi Shimada, Yuhei Takado, Hironobu Endo, Ayako Inoshita, Atsuko Inomata, Toshihisa Murofushi, Shihoko Misawa, Yutaka Machida, Hisamasa Imai
Journal: Front Neurol (2023)
Keywords: case report, macro square wave jerks, ping-pong gaze, postural instability, progressive supranuclear palsy, saccadic ping-pong gaze, the movement disorder society criteria, transitory alternating saccades
MeSH terms: Case Reports

We report a 63-year-old female patient with progressive supranuclear palsy (PSP). She presented predominant postural instability and "saccadic ping-pong gaze" (SPPG). She had unprovoked falls recurrently within a year from the onset of gait disturbance. She tended to fall backward with eye closure but had no freezing of gait on examination. She showed no signs of nuchal dystonia, limb tremor, rigidity, spasticity, or ataxia. The dopaminergic response was negative. On the initial examination, her vertical eye movements were normal, but frequent macro square wave jerks and SPPG were observed. SPPG consisted of short-cycle, horizontal conjugate irregular pendular oscillations of the eye position from the midpoint with superimposed small saccades. SPPG was observed usually in the dark, not in the daylight, and with eye closure by using electrooculogram and infrared charge-coupled device imaging. One and a half years after the first examination, she was diagnosed as probable PSP with vertical supranuclear gaze palsy. SPPG was first described in patients who are unconscious by Johkura in 1998 as a "saccadic" variant of "ping-pong gaze (PPG)." PPG, short-cycle periodic alternating gaze, has been described in comatose patients since 1967. On the other hand, abnormal eye movement, which looks the same as SPPG in coma, has been described in conscious patients with PSP or spinocerebellar degeneration (SCD) in Japanese literature since 1975. However, it has been called "transient alternating saccades (TAS)." Nowadays, we believe it is more appropriate to call this abnormal eye movement "SPPG" instead of TAS. Here, we propose that PSP, a neuro-degenerative disease, should be added as one of the etiologies of SPPG. We discuss the differences between PPG/SPPG in coma and SPPG in PSP and the possible pathophysiological mechanism of SPPG in relation to cerebellar oculomotor dysfunctions.
Pharmacogenomics and Opioid Analgesics: Clinical Implications
Authors: Eugenia Yiannakopoulou
Journal: Int J Genomics (2015)
MeSH terms: Review

Variation exists in patient response on analgesic treatment in terms of efficacy and safety. This variation may be in part explained by pharmacogenomics. This paper aimed to review data on pharmacogenomics of opioid analgesics focusing on the effect of genetic variation on the efficacy and safety of these agents. Current evidence suggests that pharmacogenomics contribute to variation in efficacy and safety of opioids. However, most data come from case control studies and case reports. In addition, a recognized drawback in the field of pharmacogenomics is the common occurrence of false positive association between polymorphisms and the investigated outcome. Prospective studies are needed to further elucidate the clinical implications of available data as well as to define the guidelines for the clinical application of pharmacogenomic data. Furthermore, basic research should focus on the identification of biologically meaningful polymorphisms enabling a hypothesis with biological plausibility driven research in the field of pharmacogenomics of analgesics. Moreover, the publication of relevant negative results should be favoured.
Spinal Dural Arteriovenous Fistula and Cecal Arteriovenous Malformation in a Boy
Authors: Vimlesh Soni, Pankaj C Vaidya, Jitendra Kumar Sahu, Mukesh Yadav, Pratibha Singhi
Journal: APSP J Case Rep (2017)
Keywords: cecum - arteriovenous malformation, dural - arteriovenous fistula
MeSH terms: Case Reports

Concurrent spinal dural arteriovenous fistula (AVF) and cecal arteriovenous malformation (AVM) are very rare. A 6-year old boy presented with lower limb paresis after trauma. On imaging work-up spinal dural AVF was found. It was managed with endovascular glue embolization. After two years, the boy presented with severe anemia and occult gastrointestinal tract (GIT) bleed. Cecal AVM was diagnosed and managed with embolization.
Case Report: Discovery a Novel SARS-CoV-2 Variant in a Six-Months Long-Term Swab Positive Female Suffering From Non-Hodgkin Lymphoma
Authors: Ettore Capoluongo, Carmela Nardelli, Maria Valeria Esposito, Antonio Riccardo Buonomo, Monica Gelzo, Biagio Pinchera, Emanuela Zappulo, Giulio Viceconte, Giuseppe Portella, Mario Setaro, Ivan Gentile, Giuseppe Castaldo
Journal: Front Oncol (2021)
Keywords: orf3a, sars-cov-2, long-term infection, non-hodgkin lymphoma, novel variant, whole genome sequencing
MeSH terms: Case Reports

Background:
We report the case of a woman with non-Hodgkin lymphoma who remained positive on the molecular assay for SARS-CoV-2 for six months: she has never experienced a severe form of COVID-19 although in absence of seroconversion.
Methods:
The whole SARS-CoV-2 genome analysis was performed by the CleanPlex SARS-CoV-2 Research and Surveillance NGS Panel (PARAGON GENOMICS, Hayward, USA).
Results:
We found twenty-two mutations in SARS-CoV-2 genome and a novel deleterious ORF3a frameshift c.766_769del corresponding to a unique and novel lineage. The region affected by this frameshift variant is reported as being important in determining SARS-CoV-2 immunogenicity. Patient's immunophenotype showed the absence of B lymphocytes and significantly reduced T-cell count. Only after the treatment with hyperimmune plasma she finally became negative on the swab.
Conclusions:
Our findings could be helpful in the management of patients with immunodeficiency, particularly when novel variants, potentially altering the virus immune response, are present.
Acute on chronic bilateral renal vein thrombosis in the setting of remission of class V lupus nephritis: A case report and literature review
Authors: Christopher El Mouhayyar, Christine Segal, Bertrand L Jaber, Vaidyanathapuram S Balakrishnan
Journal: Clin Nephrol Case Stud (2023)
Keywords: acute, chronic, lupus nephritis, membranous nephropathy, renal vein thrombosis
MeSH terms: Case Reports

Renal vein thrombosis (RVT), defined as the presence of a thrombus in the major renal vein or one of its tributaries, can present acutely or go unnoticed resulting in acute kidney injury or chronic kidney disease. RVT is associated with multiple etiologies, including nephrotic syndrome, thrombophilia, autoimmune disorders, and malignancy. Patients with systemic lupus erythematosus (SLE), a multiorgan autoimmune disorder, are predisposed to coagulopathy and thus are at a higher risk of venous and arterial thromboembolism. We describe the case of a 41-year-old man with SLE and biopsy-proven membranous glomerulonephritis (WHO class V lupus nephritis) in clinical remission with no evidence of nephrotic range proteinuria who presented with macroscopic hematuria and was diagnosed with acute-on-chronic bilateral RVT. We discuss the different causes of RVT and compare the clinical presentation, diagnostic imaging findings, and management of acute and chronic RVT.
Metastatic prostate cancer mimicking polymyalgia rheumatica
Authors: Charles T Randazzo, Aaron W Bernard, Douglas A Rund
Journal: Case Rep Emerg Med (2011)
MeSH terms: Case Reports

A 59-year-old male presented to the emergency department with a four-month progressive history of proximal muscle pain and weakness with elevated erythrocyte sedimentation rate and C-reactive protein. He was initially diagnosed with polymyalgia rheumatica (PMR) and admitted to the hospital. During his hospitalization he was found to have metastatic prostate cancer, which was thought to be responsible for his PMR-like syndrome. By recognizing the resemblance between metastatic malignancy and rheumatologic diseases, the emergency physician can improve diagnostic accuracy.
Calcific panniculitis and nasopharyngeal cancer-associated adult-onset dermatomyositis: a case report and literature review
Authors: Manasmon Chairatchaneeboon, Kanokvalai Kulthanan, Araya Manapajon
Journal: Springerplus (2015)
Keywords: adult, calcinosis, dermatomyositis, nasopharyngeal neoplasm, panniculitis

Panniculitis is an uncommon cutaneous manifestation in dermatomyositis. It not only occurs in idiopathic dermatomyositis, but also rarely occurs in the setting of malignancy-associated dermatomyositis. Calcinosis cutis is also less likely to be found in adult-onset dermatomyositis. In malignancy-associated dermatomyositis, panniculitis can precede, concur, or follow the diagnosis of malignancy. We report the case of a 26-year-old Thai female with calcific panniculitis in the setting of adult-onset dermatomyositis associated with nasopharyngeal cancer. The clinical course of calcific panniculitis in our case was not parallel to the course of malignancy. Calcific panniculitis can appear many years after, despite the remission of the cancer. A thorough review of the previously reported literature is also provided.
A Case of Type 2 Hypersensitivity to Rasburicase Diagnosed with a Natural Killer Cell Activation Assay
Authors: Sébastien Viel, Rémi Pescarmona, Alexandre Belot, Audrey Nosbaum, Christine Lombard, Thierry Walzer, Frédéric Bérard
Journal: Front Immunol (2018)
Keywords: adcc, antibody dependent cell cytotoxicity, natural killer cells, rasburicase, type 2 hypersensitivity
MeSH terms: Drug Hypersensitivity / diagnosis, Gout Suppressants / adverse effects, Killer Cells, Natural / immunology, Urate Oxidase / adverse effects, Case Reports, Research Support, Non-U.S. Gov't, Antibody-Dependent Cell Cytotoxicity / immunology, Biological Assay, Drug Hypersensitivity / immunology, Humans, Lymphocyte Activation, Male, Middle Aged, Gout Suppressants, rasburicase, Urate Oxidase

Drug hypersensitivity reactions can lead to different clinical pictures depending on the underlying immunological mechanism. Diagnosis tests are already available to assess the most frequent drugs hypersensitivity reactions, which are mediated by specific IgE or T cells. However, it remains challenging to diagnose type 2 hypersensitivity reactions (T2HR), which can lead to severe cytopenia and liver failure. Here, we describe a case of T2HR to rasburicase, an uricolytic agent used to prevent tumor lysis syndrome. In this patient, sensitization was associated with the production of specific IgG able to bind to leukocytes. We found that patient NK cells were specifically activated in the presence of rasburicase and autologous serum, which led to exocytosis of lytic granules. This antibody-dependent cell cytotoxicity mechanism may lead to cytopenia observed in the patient. Moreover, this NK cell activation assay could be used to improve the diagnosis of a T2HR to rasburicase and, by extent, to other drugs. These data also suggest that NK cells could play an important role in the pathophysiological mechanism of T2HR.
Zygomycosis in a renal allograft recipient
Authors: G Lakshminarayana, R Rajesh, G Kurian, V N Unni
Journal: Indian J Nephrol (2009)
Keywords: immunosuppression, renal transplantation, zygomycosis
MeSH terms: Case Reports

Invasive fungal infections can cause considerable morbidity and mortality in immunocompromised patients. Zygomycosis is a type of invasive fungal infection with a rapid course and grave prognosis. Renal transplant recipients with concomitant diabetes mellitus are most susceptible to this infection. We report here a case of disseminated zygomycosis (Rhizopus sp.) in a renal allograft recipient with posttransplant diabetes mellitus (PTDM). This is the first reported case of zygomycosis caused by Rhizopus species.
A case of EDTA-dependent pseudothrombocytopenia: simple recognition of an underdiagnosed and misleading phenomenon
Authors: Michael Nagler, Peter Keller, Daniel Siegrist, Lorenzo Alberio
Journal: BMC Clin Pathol (2014)
Keywords: hematology analyzers, laboratory hematology, thrombocytopenia
MeSH terms: Case Reports

Background:
EDTA-dependent pseudothrombocytopenia (EDTA-PTCP) is a common laboratory phenomenon with a prevalence ranging from 0.1-2% in hospitalized patients to 15-17% in outpatients evaluated for isolated thrombocytopenia. Despite its harmlessness, EDTA-PTCP frequently leads to time-consuming, costly and even invasive diagnostic investigations. EDTA-PTCP is often overlooked because blood smears are not evaluated visually in routine practice and histograms as well as warning flags of hematology analyzers are not interpreted correctly. Nonetheless, EDTA-PTCP may be diagnosed easily even by general practitioners without any experiences in blood film examinations. This is the first report illustrating the typical patterns of a platelet (PLT) and white blood cell (WBC) histograms of hematology analyzers.
Case presentation:
A 37-year-old female patient of Caucasian origin was referred with suspected acute leukemia and the crew of the emergency unit arranged extensive investigations for work-up. However, examination of EDTA blood sample revealed atypical lymphocytes and an isolated thrombocytopenia together with typical patterns of WBC and PLT histograms: a serrated curve of the platelet histogram and a peculiar peak on the left side of the WBC histogram. EDTA-PTCP was confirmed by a normal platelet count when examining citrated blood.
Conclusion:
Awareness of typical PLT and WBC patterns may alert to the presence of EDTA-PTCP in routine laboratory practice helping to avoid unnecessary investigations and over-treatment.