OpenMed/multicare-articles huggingface dataset:
Sickle Cell Trait Presenting as Unilateral Proliferative Retinopathy and Macular Thinning in a Pregnant Woman
Authors: Sepideh Ghods, Elias Khalili Pour, Hooshang Faghihi, Golnaz Gharehbaghi, Ahmad Mirshahi, Fariba Ghassemi, Bahman Inanloo, Hamid Riazi-Esfahani
Journal: Case Rep Ophthalmol Med (2021)
MeSH terms: Case Reports

Background:
To report a case of a pregnant woman with sickle cell trait (SCT) who presented with unilateral proliferative sickle cell retinopathy. Case Presentation. A 26-year-old otherwise healthy pregnant woman presented with the complaint of visual loss in her left eye. The funduscopic examination showed vitreous hemorrhage, sea fan neovascularization, and pale optic disc. Optical coherence tomography revealed macular inner retinal layer thinning and foveal splaying (saucerization of the foveal pit). The investigations, including hemoglobin electrophoresis, verified the diagnosis of sickle cell trait. Blood pressure, fasting blood glucose tests, and tuberculin skin tests were normal. We treated the patient by peripheral retinal photocoagulation over the area of nonperfusion.
Conclusion:
Even though the sickle cell trait is generally considered as a milder form of sickle cell disease without severe retinal manifestations, pregnancy should be considered as a trigger that can induce proliferative changes and foveal splaying in this group of patients.
Response of Pembrolizumab Alone for Non-small Cell Lung Cancer With Brain Metastasis: A Case Report and Literature Review
Authors: Eric A Marvin, Kimberley L Furrow, Ayesha Kar, Joshua A Cuoco
Journal: Front Oncol (2020)
Keywords: brain metastases (bm), central nervous system metastases, immunotherapy, non-small cell lung cancer, pembrolizumab
MeSH terms: Case Reports

Treatment of brain metastases often includes surgical resection, chemotherapeutics and radiotherapy. Given the difficulty in obtaining therapeutic levels of medications within the immune-privileged central nervous system, chemotherapy as a stand-alone treatment modality for brain metastases is an uncommon option. However, there is a growing body of evidence to suggest that immunomodulatory agents can induce a robust immune response in the central nervous system. Here, we describe a 68-year old male who presented with radiographic evidence of new and enlarging lung nodules with mediastinal adenopathy. Lung biopsy was consistent with adenocarcinoma. Immunohistochemical staining demonstrated high expression of programmed cell death protein 1 with a tumor proportion score of 100%. Surveillance magnetic resonance imaging of the brain demonstrated a single enhancing 11 × 7 × 12 mm lesion along the mesial surface of the right frontal lobe. The patient deferred surgical resection as well as stereotactic radiosurgery but agreed to treatment with pembrolizumab. Repeat magnetic resonance imaging at 3-months after initiation of treatment demonstrated complete radiographic resolution of the brain lesion. To our knowledge, this is one of only a few reports in the current literature to document complete resolution of non-small cell lung cancer brain metastasis with pembrolizumab alone. We discuss the emerging literature regarding the efficacy of pembrolizumab in the treatment of brain metastases, central nervous system penetration, and emerging new treatment paradigms involving novel immunotherapy agents.
Optical Coherence Tomography Angiography (OCT-A) in a Patient with Occult Retinal Dysfunction
Authors: Juliana Wons, Jana Dinges, Matthias D Becker, Stephan Michels
Journal: Case Rep Ophthalmol Med (2019)
MeSH terms: Case Reports

Multimodal imaging techniques were performed in a patient with a newly emerged visual field defect; a missing retinal lesion on fundus examination made the diagnosis challenging but infrared imaging showed a larger area of retinal abnormality temporal to the fovea. Indocyanine green angiography (IA) showed late hypofluorescence and there was mild hyperautofluorescence which is known from acute zonal occult outer retinopathy (AZOOR). Despite normal fluorescein angiography (FA) results, a perfusion loss in the outer retinal layer was detected by OCT-A. Similar OCT-A findings were recently described in patients with acute macular neuroretinopathy (AMN). Methods. The methods included FA and IA, spectral domain optical coherence tomography (SD-OCT), near infrared imaging, and autofluorescence imaging (AF), as well as OCT-A. Patient. A 36-year-old patient who suffered from acute symptoms of photopsia and scotoma on her left eye. She had an influenza-like illness two weeks earlier. The scotoma could be verified by visual field testing. Results. The affected retinal zone showed mild fading of external limiting membrane (ELM) and a disorganisation of the ellipsoid zone (EZ) on SD-OCT. OCT-A revealed a large area of reduced perfusion in the outer retinal vascular layer. Conclusion. OCT-A can help to detect reduced capillary network in patients with visual field defects and no visible fundus changes. This case seems to have features of different occult retinal disorders such as AZOOR and AMN.
Borderline Clear Cell Adenofibroma of the Ovary
Authors: Pilaiwan Kleebkaow, Apiwat Aue-Aungkul, Amornrat Temtanakitpaisan, Chumnan Kietpeerakool
Journal: Case Rep Pathol (2017)
MeSH terms: Case Reports

Borderline clear cell tumors are extremely rare, and few cases have been reported in the literature. Herein, we present a case of borderline clear cell adenofibroma of the ovary in a 58-year-old woman who presented with a pelvic mass and constipation. Physical examination revealed a 10 cm solid midline pelvic mass. Computed tomography showed an 8 cm heterogeneous enhancing mass attached to the left posterolateral wall of the uterus. The patient's serum CA 125 levels were slightly elevated (80.9 U/ml). The patient was given a total abdominal hysterectomy with bilateral salpingooophorectomy. On gross examination, it was found that the left ovarian tumor was an 8.0 × 7.5 × 8.0 cm solid multilobulated mass containing tiny cysts. Histologically, the tumor was composed of small glands in dense fibrous and myxoid stroma. The glands were lined with cuboidal cells with clear cytoplasm and mild to moderate nuclear atypia. No stromal invasion was observed. The pathological diagnosis was borderline clear cell adenofibroma of the left ovary. There was no reoccurrence 36 months post operation.
Considerations on surgery invasiveness and response and toxicity patterns in classic palliative radiotherapy for acrometastases of the hand: a hint for a potential role of stereotactic body radiation therapy? A case report and literature review
Authors: Gianluca Ferini, Valentina Zagardo, Anna Viola, Marco Maria Aiello, Mandara Muralidhar Harikar, Tejas Venkataram, Paolo Palmisciano, Salvatore Ivan Illari, Vito Valenti, Giuseppe Emmanuele Umana
Journal: Front Oncol (2023)
Keywords: acrometastases, hand metastases, metastatic lung adenocarcinoma, palliative radiation therapy, stereotactic body radiotherapy (sbrt)
MeSH terms: Case Reports

Background:
The rarity of hand acrometastases hampers the consensus-building for their optimal management among the involved oncology professionals. In the current literature, demolitive surgery overcomes the use of palliative radiotherapy, which proved to be ineffective in more than 30% of cases treated with classic palliative dose schemes, carrying also a not negligible radiation-related adverse event rate. Against this background, stereotactic body radiation therapy (SBRT) could emerge as a well-balanced therapeutic option.
Case summary:
Here we describe the methods and outcomes of a SBRT treatment of a painful and function-limiting hand acrometastasis in a patient with a history of stage IIIB lung adenocarcinoma. We delivered a total dose of 30 Gy in five daily fractions to a soft-tissue metastasis abutting the fifth metacarpal bone through the SBRT protocol generally used for intracranial treatments. A few weeks later, the patient reported a clinical complete response with acrometastasis and pain disappearance, function recovery, and no significant toxicity. The acrometastasis was the first sign of an atypical cancer progression.
Conclusions:
SBRT for hand acrometastases is feasible and might have the best therapeutic profile among the currently available treatment options for this rare clinical scenario. Larger investigations are needed to confirm the present single-case experience.
Transient jejuno-jejunal intussusception in an anabolic steroid user-A case report
Authors: Marie Shella De Robles, Robert Sean O'Neill, Christopher J Young
Journal: Int J Surg Case Rep (2020)
Keywords: case report, intestinal obstruction, intussusception, jejunum, steroids
MeSH terms: Case Reports

Introduction:
Adult intussusception (AI) is both a challenging and rare diagnosis, with predisposing factors including malignancy, surgery and infection to name a few. Transient jejunal intussusception is a subset of AI which is usually diagnosed radiologically, with diagnostic laparoscopy utilised to determine whether a malignant cause is identifiable and subsequently treatable.
Presenting case:
We present the case of a previously healthy 36-year-old male diagnosed with transient jejunal intussusception on computed tomography after presenting with abdominal pain. Blood tests on admission were normal apart from polycythaemia. His only significant history was that of chronic anabolic steroid use. He had a subsequent normal gastroscopy and colonoscopy with diagnostic laparoscopy demonstrating thickening of the small bowel. Histopathological analysis of the intraoperative specimen was normal. The patient improved and was discharged with no further complications.
Conclusion:
This case highlights the potential association between anabolic steroid use resulting in polycythaemia, and AI or transient jejunal intussusception, along with further validating a conservative approach in the management of AI in patients deemed to be low risk of malignancy on pre-operative evaluation.
Infiltrating ductal carcinoma breast, metastatic to ipsilateral axillary lymph nodes harbouring primary tuberculous lymphadenitis: a case report
Authors: Pinki Pandey, Alok Dixit, Aparna Tanwar, N C Mahajan
Journal: Pan Afr Med J (2014)
Keywords: ductal carcinoma, breast, lymph node, tuberculous
MeSH terms: Breast Neoplasms / pathology, Carcinoma, Ductal, Breast / pathology, Tuberculosis, Lymph Node / diagnosis, Case Reports, Axilla, Female, Humans, Lymphatic Metastasis, Middle Aged, Tuberculosis, Lymph Node / pathology

The coexistence of breast cancer and tuberculosis has been described in over 100 cases; however its coexistence in the axillary lymph node is rare with only a handful cases have been reported in the literature. We report a case of infiltrating ductal carcinoma of the left breast, metastatic to ipsilateral axillary lymph nodes harbouring tuberculous lymphadenitis without primary mammary or pulmonary tuberculosis. The case is presented for its rarity and illustrates that the simultaneous occurrence of tuberculosis and carcinoma can create a dilemma in the diagnosis and treatment, so surgeons and pathologists should keep such a combination on the back of their mind, especially in endemic areas.
Case report: Antiplatelet therapy on metastatic paraganglioma-associated cutaneous vascular disease and literature review
Authors: Yinjie Gao, Yunying Cui, Zhonghui Hu, Yu Wang, Tianyi Li, Yuehua Liu, Anli Tong
Journal: Front Med (Lausanne) (2022)
Keywords: antiplatelet therapy, diffuse erythema, hypercoagulability, pheochromocytoma/paraganglioma, tumor-associated cutaneous vascular disorders
MeSH terms: Case Reports

Context:
Tumor-associated cutaneous vascular disorder induced by PPGL was extremely rare, and the cutaneous manifestations could disappear after removal of the tumors. However, the definite pathological diagnosis and the potential mechanism remained unidentified. We presented a severe cutaneous vascular lesion manifested as diffuse erythema with ulceration and necrosis over the limbs in a female patient with metastatic paraganglioma. Skin biopsy was performed on her for defining the pathological diagnosis and potential mechanism. The patient was diagnosed as vascular disease according to the obvious angioectasia in dermis on cutaneous pathology, which might be caused by PPGL-induced hypercoagulability. We used the antiplatelet therapy with aspirin to treat the PPGL-associated cutaneous vascular disease for the first time, and the cutaneous lesions were relieved and healed gradually, further supporting the diagnosis of vascular disease.
Conclusion:
For metastatic PPGL patients like the case we reported, the definite diagnosis by skin biopsy and the early antiplatelet therapy might be effective to the cutaneous lesions caused by the hypercoagulable state of PPGL.
A Case Report about Glycogenic Hepatopathy
Authors: L Plaza Enriquez, N Konindala, H Yeh, P Khatiwada, M Sanchez Valenzuela, K Askari
Journal: Case Rep Endocrinol (2022)
MeSH terms: Case Reports

Introduction:
Glycogenic hepatopathy is a rare complication of uncontrolled diabetes mellitus that presents with hepatomegaly and transient elevation in serum aminotransferase enzymes. The underlying pathophysiology involves excessive accumulation of intrahepatic glycogen. Glycogenic hepatopathy is usually underdiagnosed because it is difficult to differentiate from other entities, such as the nonalcoholic fatty liver. The gold standard for diagnosis is liver biopsy. Glycogenic hepatopathy can be reversed by the achievement of adequate glycemic control. Case description. A 19-year-old female patient with a history of poorly controlled type 1 diabetes mellitus that resulted in several episodes of diabetes ketoacidosis requiring hospital admissions. The patient presented to the emergency room with generalized weakness and fatigue found to have diabetic ketoacidosis. Blood tests revealed abnormal liver function with aspartate aminotransferase 1129 U/L (13-37 U/L), alanine aminotransferase 766 U/L (13-56 U/L), alkaline phosphatase 216 U/L (45-117 U/L), total bilirubin 1.0 mg/dL (0.2-1.3 mg/dL), albumin 3.8 g/dL (3.4-5.0 g/dL), partial thromboplastin time < 20 s (23-31 s), prothrombin time 11.8 s (9.5-11.5 s), and international normalized ratio 1.1. Acute hepatitis serologies were negative. Epstein-Barr virus and cytomegalovirus were ruled out. Extensive autoimmune hepatitis tests were negative. Primary biliary cirrhosis was also ruled out. A liver biopsy was obtained, which was diagnostic of glycogenic hepatopathy.
Conclusion:
Glycogenic hepatopathy must be suspected in patients with uncontrolled type 1 diabetes mellitus who present with elevated liver enzymes and hepatomegaly. Treating this rare condition requires a timely diagnosis with liver biopsy and strict glycemic control.
Advancing the state-level tracking of evidence-based practices: a case study
Authors: Sarah Cusworth Walker, Georganna Sedlar, Lucy Berliner, Felix I Rodriguez, Paul A Davis, Savannah Johnson, Jessica Leith
Journal: Int J Ment Health Syst (2019)
Keywords: children’s mental health, common elements, evidence-based policymaking, evidence-based practice, implementation, learning system, state policy

Background:
Despite a sustained focus by policymakers and researchers on improving the standard of clinical care in public mental health services, the use of evidence-based practice remains low. Among other challenges, this reflects the difficulty of translating clinical research into useable policy that can be feasibly funded and monitored by state or large healthcare systems.
Case presentation:
In this paper we present a case study of Washington State's strategy for monitoring the use of clinical elements at the session level for all Medicaid-funded children's mental health services. The implementation of this strategy reflects policy actions to promote effective practice while also actively influencing multiple other levels of the implementation ecology. The approach is informed by the Policy Ecology Framework, the Consolidated Framework for Implementation Research, the evidence-based policymaking literature, and common ontology and clinical elements models.
Conclusions:
We found the strategy developed in Washington State to be a feasible method of collecting session level information about the use of effective clinical mental health practices. In addition, the approach appears to be having influence on multiple layers of the implementation ecology that could be explored through further study.
Isolated myeloid sarcoma of the temporal bone: As the first clinical manifestation of acute myeloid leukemia in a patient of down's syndrome
Authors: Nisha Marwah, Namita Bhutani, Archana Budhwar, Rajeev Sen
Journal: Int J Surg Case Rep (2019)
Keywords: acute myeloid leukemia, down syndrome, extramedullary, granulocytic sarcoma, myeloid sarcoma

Introduction:
Leukemia is the most common malignancy of childhood but myeloid sarcoma is a rare presentation of underlying leukemic disorder. Myeloid sarcoma (MS) is a rare tumor composed of proliferation of myeloid precursors at extramedullary sites.
Presentation of case:
We report an unusual case of myeloid sarcoma involving the temporal bone in a young male child who presented with a large mass involving the left temporal region. This lesion was the initial presentation which led to further diagnosis of acute myeloid leukemia in our case. This case report brings awareness to the diverse extramedullary manifestations of isolated myeloid sarcoma, as well as the importance and difficulties that are associated with establishing a rapid diagnosis and initiating treatment.
Discussion:
They can arise de novo or in association with hematological malignancies, most commonly acute myeloid leukemia (AML-M2). Clinically, it can masquerade as an abscess, cutaneous ulcer, or as a mass lesion. Morphologically, MS can mimic a variety of small round cell tumors including lymphomas, neuroblatoma and rhabdomyosarcoma. The occurrence of this tumor usually heralds AML or the onset of the blastic phase of chronic myeloid leukemia. Early recognition of this rare entity is important, because early aggressive chemotherapy and focal irradiation can cause regression of the tumor and thus improve patient longevity.
Conclusion:
The possibility of MS should be considered when dealing with unusual lymphoma like neoplasms that cannot be categorized as any of the Non-Hodgkin lymphoma subtypes and small blue round cell tumors.
A Rare Cause of Cough: Tracheobronchial Myxoid Spindle Cell Lipoma
Authors: Jose A Rodriguez, Christopher R Weil, Jose F Ramirez
Journal: Case Rep Pulmonol (2020)
MeSH terms: Case Reports

Background:
Endobronchial lipomas are a particularly rare form of benign lung neoplasms, with an incidence of 0.1-0.4%. They are often clinically silent, though present with nonspecific symptoms that can result in extensive workup or significant delay prior to diagnosis, as presented in this case. Case Presentation. A 61-year-old male presented with chronic productive cough and occasional dyspnea and a 10-year history of clinically diagnosis of intermittent, exercise-induced asthma, nonresponsive to bronchodilators, and with normal pulmonary function tests. A chest ray showed a band-like opacity in the right middle lobe of the lung and a CT of the chest showed right lung atelectasis with a soft tissue mass in the right main bronchus. The patient underwent bronchoscopy with biopsy, which demonstrated an endobronchial myxoid spindle cell lipoma. The lesion was subsequently removed by a bronchoscopic snare. The patient's asthmatic-like symptomatology resolved after the mass was excised.
Conclusion:
Though rare, endobronchial lipomas characteristically present with nonspecific signs and symptoms and thus can be easily mistaken for other medical conditions, delaying diagnosis and prolonging symptoms.
Hypocalcemic cardiomyopathy: A case report
Authors: Yi Wen, Xiaolin Luo
Journal: Front Cardiovasc Med (2022)
Keywords: heart failure, hypocalcemia, hypocalcemic cardiomyopathy, hypoparathyroidism, thyroidectomy
MeSH terms: Case Reports

Hypocalcemia and its related symptoms are common manifestations in postsurgical hypoparathyroidism, but patients with hypocalcemia manifested as heart failure is rare and few cases are reported in the literature. Here we reported a 58-year-old female with hypoparathyroidism and uncontrolled hypocalcemia after thyroidectomy, presented with acute heart failure, accompanied with enlargement and reduced ejection fraction of left ventricle. She was refractory to guideline-directed medical therapy for heart failure including digitalis and diuretics. However, her symptoms resolved and cardiac function improved dramatically after normalization of serum calcium level. This rare case highlights the pivotal role of calcium in maintaining cardiac function and the importance of treating underlying reversible causes of heart failure. For patients with hypoparathyroidism, it is essential to get standard treatment to avoid development of heart failure and hypocalcemia related syndromes.
Direct Percutaneous Embolization of Peristomal Ileostomy Varices in an Emergency Setting
Authors: William Ryan, Farouk Dako, Gary Cohen, David Pryluck, Joseph Panaro, Emily Cuthbertson, Dmitry Niman
Journal: Case Rep Radiol (2018)
MeSH terms: Case Reports

Patients with liver disease and portal hypertension who have had surgical formation of an abdominal stoma are at risk of developing peristomal varices. These varices have a predilection for bleeding. Ideally, portal decompression via TIPS procedure is performed, with or without direct embolization of the bleeding varix. When TIPS is not an appropriate option due to significant liver disease and hepatic encephalopathy there are other approaches to treat peristomal variceal hemorrhage. We report the embolization of such a varix via direct percutaneous puncture under ultrasound guidance when portal decompression was not an appropriate option.
Coverage Root after Removing Peripheral Ossifying Fibroma: 5-Year Follow-Up Case Report
Authors: Paulo S G Henriques, Luciana S Okajima, Marcelo P Nunes, Victor A M Montalli
Journal: Case Rep Dent (2016)

When lesions in soft tissue reach the gingival margin, they can produce aesthetic defects during its permanence and after its removal. Periodontal plastic surgery allows the correction of the gingival contour using different techniques. This paper is a case report of a peripheral ossifying fibroma removal in the interproximal area of teeth 21 and 22 in addition to root coverage of the affected area through two surgical phases: keratinized gingival tissue augmentation surgery with free gingival graft concurrent with removal of the lesion and, in a second stage, root coverage by performing coronally advanced flap technique with a follow-up of five years. The initial results achieved, which were root coverage of 100% after 6 months, promoted an adequate gingival contour and prevented the development of a mucogingival defect or a root exposure with its functional and aesthetic consequences. After five years, the results showed long term success of the techniques, where the margin remained stable with complete root coverage and tissues were stable and harmonic in color.