OpenMed/multicare-articles huggingface dataset:
Oral flora meningoencephalitis diagnosis by next-generation DNA sequencing
Authors: Eric Heintz, Matthew A Pettengill, Mohamed Azhar Gangat, Dwight J Hardy, William Bonnez, Mohammed Mahdee Sobhanie
Journal: Access Microbiol (2019)
Keywords: brain abscess, meningitis, meningoencephalitis, oral flora, sequencing
MeSH terms: Case Reports

Introduction:
Standard culture methods may fail to detect the causative agents of bacterial infection for various reasons including specimen collection after antibiotic administration, or when standard techniques or environmental conditions are not appropriate for growth of the microorganisms. Conventional 16S rRNA gene sequencing is sometimes a useful alternative technique for identification of bacteria, but is confounded by polymicrobial infection. We present a case of a patient who developed a serious neurological infection for which causative oral flora organisms were observed by microscopy, failed to culture but were identified by next-generation DNA sequencing.
Case presentation:
A male in his forties developed sinus pain and congestion, followed by facial and eye pain, and several weeks later acute-onset confusion and neck stiffness. Cerebrospinal fluid examination revealed pleocytosis and several bacterial morphologies, which were subsequently identified by next-generation sequencing as oral flora constituents Porphyromonas endodontalis , Fusobacterium nucleatum , Streptococcus constellatus , Prevotella species and Parvimonas micra .
Conclusion:
Oral flora can cause meningoencephalitis and brain abscess formation if translocation occurs by injury or surgical procedures. Next-generation sequencing is often not available at healthcare facilities, or when available may not have been validated for a wide spectrum of specimen sources, but is available at reference laboratories and should be considered when routine methods fail to provide a diagnosis for serious infections.
Severe Malaria with a Rare Tetrad of Blackwater Fever, Acute Renal Failure, Disseminated Intravascular Coagulopathy, and Acute Acalculous Cholecystitis
Authors: Hira Hanif, Biraj Shrestha, Salina Munankami, Manish Shrestha, Bidhya Poudel, Roopika Reddy, Syed Jaleel, Debra Powell
Journal: Case Rep Infect Dis (2023)
MeSH terms: Case Reports

Background:
Blackwater fever (BWF) is a severe clinical syndrome occurring as a complication of malarial infection characterized by intravascular hemolysis, hemoglobinuria, and acute renal failure in people exposed to Plasmodium falciparum and, to some extent, in people who were exposed to medications like quinine and mefloquine. The exact pathogenesis of classic BWF remains unclear. The mechanism leading to damage to the red blood cells (RBCs) can be immunologic nonimmunologic, leading to massive intravascular hemolysis. Case Presentation. We present a case of classic blackwater fever in a 24-year-old otherwise previously healthy male without any history of antimalarial prophylaxis use, returning from recent travel to Sierra Leone. He was detected to have P. falciparum malaria in the peripheral smear test. He was treated with artemether/lumefantrine combination therapy. Unfortunately, his presentation was complicated by renal failure and was managed with plasmapheresis and renal replacement therapy.
Conclusion:
Malaria continues to be a parasitic disease that can have devastating effects and continues to be a challenge globally. Although cases of malaria in the United States are rare and cases of severe malaria, mainly attributed to P. falciparum, are even more uncommon. Care should be taken to retain a high level of suspicion to consider the diagnosis, especially in returning travelers from endemic areas.
Influence of hemodialysis on pramipexole pharmacokinetics: Lessons from two cases and literature review
Authors: Nicolas Hanset, Philippe Hantson, Franck Saint-Marcoux, Arnaud Devresse, Michel Jadoul, Laura Labriola
Journal: Clin Nephrol Case Stud (2019)
Keywords: hemodialysis, pharmacokinetics, pramipexole
MeSH terms: Case Reports

Background:
Restless legs syndrome (RLS) is not a rare condition in patients on long-term dialysis. Pramipexole is a small molecule used in the treatment of idiopathic and uremic RLS. Although some information concerning the efficacy and safety of pramipexole in uremic patients is available, data concerning the pharmacokinetics of pramipexole in hemodialysis (HD) are lacking. Following the occurrence of accidental pramipexole intoxication in a chronic HD patient, we were concerned about the efficacy of HD in removing pramipexole. Our aim was thus to assess plasma pramipexole concentrations and pramipexole clearance in a stable chronic HD patient without any residual kidney function.
Materials and methods:
Our patient was a 63-year-old man on chronic HD for 5 years who had been treated uneventfully with oral pramipexole for uremic RLS since then. During a routine 4-hour high-flux HD session, blood, ultrafiltrate, and dialysate samples were collected every hour to determine pramipexole concentrations over time.
Results:
Pramipexole blood concentrations ranged from 12.1 to 23.9 µg/L. Pramipexole reduction ratio was 32.5%. Mean dialytic clearance of pramipexole was 76.8 mL/min. Postdialysis rebound was 5.6%.
Conclusion:
In the absence of any side effect, pramipexole blood concentrations at steady state were 2- to 4-fold higher than those observed in subjects with normal kidney function. Like other drugs with a high volume of distribution, pramipexole was poorly removed by HD. Therefore, HD is not recommended as a treatment option for pramipexole intoxication in patients with a glomerular filtration rate superior to 30 mL/min/1.73m².
Non-iatrogenic esophageal injury: a retrospective analysis from the National Trauma Data Bank
Authors: Alberto Aiolfi, Kenji Inaba, Gustavo Recinos, Desmond Khor, Elizabeth R Benjamin, Lydia Lam, Aaron Strumwasser, Emanuele Asti, Luigi Bonavina, Demetrios Demetriades
Journal: World J Emerg Surg (2017)
Keywords: esophageal trauma, non-iatrogenic esophageal injury, outcomes, primary suture
MeSH terms: Esophageal Diseases / etiology, Registries / statistics & numerical data, Wounds and Injuries / complications, Adult, Comorbidity, Esophageal Diseases / epidemiology, Female, Humans, Injury Severity Score, Logistic Models, Male, Middle Aged, Retrospective Studies, Risk Factors, Treatment Outcome, Wounds and Injuries / epidemiology

Background:
Traumatic, non-iatrogenic esophageal injuries, despite their rarity, are associated with significant morbidity and mortality. The optimal management of these esophageal perforations remains largely debated. To date, only a few small case series are available with contrasting results. The purpose of this study was to examine a large contemporary experience with traumatic esophageal injury management and to analyze risk factors associated with mortality.
Methods:
This National Trauma Data Bank (NTDB) database study included patients with non-iatrogenic esophageal injuries. Variables abstracted were demographics, comorbidities, mechanism of injury, Abbreviated Injury Scale (AIS), esophageal Organ Injury Scale (OIS), Injury Severity Score (ISS), level of injury, vital signs, and treatment. Multivariate analysis was used to identify independent predictors for mortality and overall complications.
Results:
A total of 944 patients with non-iatrogenic esophageal injury were included in the final analysis. The cervical segment of the esophagus was injured in 331 (35%) patients. The unadjusted 24-h mortality (8.2 vs. 14%, p = 0.008), 30-day mortality (4.2 vs. 9.3%, p = 0.005), and overall mortality (7.9 vs. 13.5%, p = 0.009) were significantly lower in the group of patients with a cervical injury. The overall complication rate was also lower in the cervical group (19.8 vs. 27.1%, p = 0.024). Multilogistic regression analysis identified age >50, thoracic injury, high-grade esophageal injury (OIS IV-V), hypotension on admission, and GCS <9 as independent risk factors associated with increased mortality. Treatment within the first 24 h was found to be protective (OR 0.284; 95% CI, 0.148-0.546; p < 0.001). Injury to the thoracic esophagus was also an independent risk factor for overall complications (OR 1.637; 95% CI, 1.06-2.53; p = 0.026).
Conclusions:
Despite improvements in surgical technique and critical care support, the overall mortality for traumatic esophageal injury remains high. The presence of a thoracic esophageal injury and extensive esophageal damage are the major independent risk factors for mortality. Early surgical treatment, within the first 24 h of admission, is associated with improved survival.
Trial registration:
iStar, HS-16-00883.
Hemorrhagic stroke in children caused by Bothrops marajoensis envenoming: a case report
Authors: Pedro Pereira de Oliveira Pardal, Augusto Cezar Jennings da Silva Pinheiro, Cristiane Tarcis Cunha Silva, Paulo Roberto Silva Garcez Santos, Maria Apolônia da Costa Gadelha
Journal: J Venom Anim Toxins Incl Trop Dis (2015)
Keywords: bothrops marajoensis, hemorrhagic stroke, marajó island, sequel
MeSH terms: Case Reports

According to the World Health Organization, snakebites are considered neglected diseases. Bothrops, the genus most frequently implicated in envenomations in Brazil, includes the species B. marajoensis Hoge, 1966, part of the complex B. atrox, which is found in the savannas of Marajó Island, Pará state, Brazil, a region that presents scarce epidemiological data. This work reports the first case of hemorrhagic stroke in a child, attributed to delayed medical care after snakebite envenoming by Bothrops marajoensis in Anajás city, Marajó Island, Pará, Brazil, which led to permanent hemiplegia as a sequela.
Sarcoidosis and spondyloarthritis: A coincidence or common etiopathogenesis?
Authors: Hamdi Wafa, Miladi Saoussen, Kaffel Dhia, Zouch Imen, Kchir Mohamed Montacer
Journal: Caspian J Intern Med (2018)
Keywords: ankylosing spondylarthritis, sarcoidosis, tumor necrosis factor alpha
MeSH terms: Case Reports

Background:
Sarcoidosis is a multisystem granulomatous disease. Co-existence with spondyloarthritis (SA) has been more described as an adverse effect of anti-TNF α therapy than an association. We report herein a case of a typical sarcoidosis confirmed by histological proofs and an advanced SA with a bamboo column.
Case presentation:
A 48-years-old woman presented with inflammatory back pain for 5 years and ankle swelling for 1 year. On physical examination, she had an exaggerated dorsal kyphosis and disappearance of lumbar lordosis with limitation in motion of the cervical and lumbar spine. Laboratory tests did not show an inflammatory syndrome or hypercalcemia. Plain radiographies of the spine and pelvic revealed a triple ray appearance with sacroiliitis grade 4. Chest radiography and CT confirmed the presence of bilateral hilar lymph nodes and parenchymal nodes. Bronchoscopy and biopsies were performed showing non-calcified granulomatous reaction without cell necrosis. The diagnosis of SA was performed based on 9 points of Amor criteria associated with pulmonary sarcoidosis. She was treated with 15 mg per week of methotrexate and 1mg/kg/day of prednisone for pulmonary disease with good outcomes.
Conclusions:
Sarcoidosis may be associated to SA besides paradoxical drug effect. The same physio pathological pathways mediate by TNF α are arguments for association than hazardous coincidence.
A Case of C5 Vertebral Chordoma in a 73-Year-Old Patient with More Than 8 Years of Follow-Up after Total Piecemeal Spondylectomy
Authors: Keigo Tanaka, Harutoshi Sakakima, Kazutoshi Hida, Kanako Hatanaka, Kosei Ijiri
Journal: Case Rep Orthop (2017)
MeSH terms: Case Reports

Chordoma arising from the cervical spine is rare and the traditional long-term prognosis is typically poor. Total en bloc spondylectomy with a wide margin is generally accepted to be the most appropriate management for thoracic and lumbar malignant tumors. However, this method is still challenging for the cervical spine because of the proximity of the tumor to the vertebral arteries and neural elements. Here, we report a 73-year-old man with a C5 vertebral chordoma treated with total piecemeal spondylectomy. Histological examination revealed pathognomonic physaliphorous cells with mucus-filled cytoplasm in the tumor, and the ratio of Ki-67-positive cells within the tumor was high (19.0%), showing active proliferation rate. Local recurrences were found at 9 months, 4 years and 2 months, and 6 years after the initial surgery. All the recurrences were encapsulated and isolated and treated with an additional en bloc resection successfully at each stage. Eight years after the initial total piecemeal spondylectomy, the patient maintained his intact neurological status without local recurrence or metastasis. The prognosis of cervical chordoma depends on the patient's age, surgical procedures, and histological features. In this report, we present that piecemeal spondylectomy is an alternative management for aged patients with cervical chordoma, even for those with high MIB-1 index.
Transient splenial lesion syndrome in bipolar-II disorder: a case report highlighting reversible brain changes during hypomanic episodes
Authors: Jingyuan Zhou, Yuan Cao, Gaoju Deng, Jinbo Fang, Changjian Qiu
Journal: Front Psychiatry (2023)
Keywords: bipolar disorder type 2, case report, corpus callosum, hypomanic episodes, reversible splenial lesion syndrome
MeSH terms: Case Reports

Background:
Reversible splenial lesion syndrome (RESLES) is a rare neurological condition characterized by temporary abnormalities in the splenium of the corpus callosum, which has been reported in mental disorders. Previous studies on bipolar disorder (BD) primarily focused on aspects such as brain structure and function, neurochemical changes, and genetics. However, there have been no studies reporting the occurrence of this syndrome during hypomanic episodes and its disappearance during the remission phase in bipolar disorder type 2 (BD-II).
Case presentation:
We present a case report of a 30 years-old female patient with BD-II who exhibited symptoms of RESLES during a hypomanic episode. The patient, with a 12 years psychiatric history, has experienced recurrent depressive episodes initially, with the first hypomanic episode occurring 8 years ago. During this period, this patient made several visits to the outpatient clinic to have her medications adjusted due to repeated suicide attempts. This time, she was admitted to our hospital with a second hypomanic episode due to drug withdrawal during pregnancy. The RESLES was observed on her brain magnetic resonance image, and it was alleviated after treatment with lithium carbonate and quetiapine until achieving remission.
Conclusion:
We present the first report of identifying RESLES in BD-II with hypomanic episodes, which subsequently disappears during the remission phase. Our case report highlights a potential association between BD and RESLES, emphasizing the need for future studies to explore the underlying mechanisms connecting these two conditions in greater depth.
Internal Hernia Masquerading As Necrotizing Enterocolitis
Authors: Ranjit I Kylat
Journal: Front Pediatr (2017)
Keywords: acute abdomen, exploratory laparotomy, extreme preterm infant, internal hernias, necrotizing enterocolitis
MeSH terms: Case Reports

In extremely preterm infants, acute abdominal emergencies are fortunately less common with improving care. Spontaneous intestinal perforation and necrotizing enterocolitis are conditions where emergency surgery is most often needed. Conservative medical management and placement of temporary drain are often used in the initial management. Internal hernia (IH) is an uncommon cause of bowel obstruction in neonates, is difficult to diagnose and unfortunately are found only at autopsy. The presentation in preterm infants, distinction between these conditions, and the need for early diagnosis of IH are discussed.
Orthostatic Dysregulation during Postural Change on the Dental Chair and Intraoperative Monitoring by Heart Rate Variability Analysis
Authors: Yukihiro Momota, Shigemasa Tomioka, Mayuko Furukita, Kenji Fujisawa, Hideyuki Takano, Masayuki Azuma
Journal: Case Rep Dent (2014)

This is the first case report of orthostatic dysregulation (OD) manifested during postural change on the dental chair and intraoperatively monitored by heart rate variability (HRV) analysis. OD-associated autonomic dysfunction is induced by postural changes and easily leads to disturbance in circulatory dynamics; however, most dental practices have not yet realized the importance of managing OD. We measured autonomic activity in a patient with OD during dental therapy and assessed the clinical significance of HRV analysis for OD. The patient was a 17-year-old Japanese female. She was diagnosed with impacted wisdom teeth and had no previous history of a distinct systemic disease. A surgical procedure to extract the teeth was safely performed under both local anesthesia and sedation with nitrous oxide and midazolam. After the surgery, her postural change to sitting induced orthostatic hypotension. HRV variables showed parasympathetic dominance due to the upright position. Subsequently, her posture was returned to supine, and atropine sulfate administration for the immediate treatment of OD returned her blood pressure to normal levels. HRV variables showed relative sympathetic dominance due to an atropine-derived parasympathetic blockade. HRV analysis revealed OD-associated autonomic dysfunction and should become a standard tool for safe and secure dental management of OD.
A Rare Case of Bilateral Posterior Tibial Artery Aneurysm Presenting as Unilateral Acute Limb Ischemia
Authors: Andrew T Hattam, Mayur Krishnaswamy
Journal: Case Rep Vasc Med (2019)
MeSH terms: Case Reports

True aneurysms of the tibial arteries are extremely rare. Of the few previously described tibial artery aneurysms, there are scant reports of isolated true aneurysms of the posterior tibial artery (PTA). In this report, we describe the second documented case of bilateral true PTA aneurysms. Unique aspects of this case are that the aneurysmal PTA were the only patent tibial arteries bilaterally, the aneurysms were degenerative in nature, and initial patient presentation was due to aneurysm thrombosis causing acute foot ischemia. The clinical and radiological features of this case, as well as surgical decision making and management, are discussed.
Blinding bilateral hyperviscosity retinopathy in a 43-year-old nigerian male with lymphoplasmacytic lymphoma: a case report and management challenges
Authors: Abdulkabir A Ayanniyi, Uchenna Godswill Ejikeme, Yohanna Tanko, Rilwan C Muhammad, Obiageli E Nnodu
Journal: Case Rep Oncol Med (2014)

Lymphoplasmacytic lymphomas are rare and may present with uncommon and devastating symptoms. We report a case of a 43-year-old male who presented with bleeding gums and sudden onset of bilateral blindness but was not on anticoagulants and had no family history of bleeding disorder. He had bilateral hyperpigmented infraorbital skin lesions, visual acuities (VA) of hand motion in both eyes (blindness), round and sluggish pupils, and bilateral diffuse and extensive retinal haemorrhages obliterating the retinal details with central visual field defects. The optical coherence tomography revealed retinal haemorrhage, oedema, detachment, and diffuse photoreceptors damage. Investigations revealed elevated ESR and β 2 microglobulin, monoclonal peak on serum protein electrophoresis, high IG with lambda restriction on serum, and urine immunofixation with increased lymphocytes and plasma cells in the bone marrow. A diagnosis of lymphoplasmacytic lymphoma complicated by blinding hyperviscosity retinopathy was made. In the absence of an aphaeresis machine, he received four cycles of manual exchange blood transfusion (EBT) and commenced with chlorambucil/prednisolone due to difficulty in obtaining blood for continued EBT. His general condition and VA has improved and he is stable for more than six months into treatment.
Dramatic decreases of all haemorrhagic coagulation factors by acquired inhibitors after extended left lobectomy
Authors: Yuhki Sakuraoka, Takashi Suzuki, Takatsugu Mtsumoto, Genki Tanaka, Takayuki Shimizu, Takayuki Shiraki, Park Kyongha, Shozo Mori, Yukihiro Iso, Masato Kato, Taku Aoki, Keiichi Kubota
Journal: Int J Surg Case Rep (2019)
Keywords: acquired inhibitors of coagulation factors, liver resection

Introduction:
Acquired inhibition of coagulation factors is a rare disease, and the diagnosis is often difficult and delayed. We experienced a deficiency in all coagulation factors after hepatobiliary surgery.
Case presentation:
Extended left liver resection was undertaken and hepaticojejunostomy was performed in a 70-year-old man. He had suffered from a high fever caused by cholangitis for 35 days. The major cause was a narrowing of the hepaticojejunostomy, and reconstruction was carried out. Twenty-four days later, there was a sudden massive bleed from his nose and the surgical site. Steroid pulse therapy was used as a treatment because cross mixing and some blood tests revealed the patient was experiencing an inhibition of all coagulation factors, and consequently the levels of coagulation factors dramatically recovered.
Discussion:
We considered malignancy and surgical damages to be the underlying cause. The reported treatment and examination will help clinicians explore additional reasons for massive bleeding after a severe physical injury.
Conclusion:
We have described the first case of acquired inhibition of all coagulation factors associated with extended left lobectomy.
False-Positive Human Immunodeficiency Virus Results in COVID-19 Patients
Authors: Narek Hakobyan, Ruchi Yadav, Khaled Abaza, Adam Friedman
Journal: Cureus (2023)
Keywords: covid-19, enzyme linked immunosorbent assay (elisa), fourth generation hiv screening test, human immunodeficiency virus infection, sars-cov-2
MeSH terms: Case Reports

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, which causes coronavirus disease 2019 (COVID-19) disease, was first described in 2019 and became a pandemic in 2020. Although it is possible for two viruses to co-infect together, a rarer phenomenon of false-positive results due to cross-reactivity between viruses is also possible. Herein, we present two cases of the false-positive human immunodeficiency virus (HIV) results in those infected with COVID-19. Both patients were screened for HIV and were initially found to be positive with the fourth-generation test. A subsequent blood test revealed no viral load, and an enzyme-linked immunosorbent assays (ELISA) test indicated no reactivity to HIV, thus the false initial screening test. SARS-CoV-2 is an enveloped RNA virus with its outer surface containing a spike-like glycoprotein, which allows it to recognize host cells and invade. HIV-1 gp41 and SARS-CoV-2 share several structural sequences and motifs. These similarities could explain cross-reactivity and false-positive results when screening for HIV in the presence of COVID. The presence of HIV must be confirmed through more specific laboratory tests such as ELISA.
Gingival Bleeding in a Child with Fanconi Anemia: A Case Report and Literature Review
Authors: Dorsaf Touil, Rahma Bouhouch, Raoua Belkacem Chebil, Lamia Oualha, Nabiha Douki
Journal: Case Rep Dent (2020)
MeSH terms: Case Reports

Fanconi anemia (FA) is a rare autosomal recessive disorder characterized by multiple congenital abnormalities, bone marrow failure, and higher susceptibility to malignancies, especially to head and neck carcinomas. Only few reports about the oral manifestations of FA are available. The main reported oral conditions associated with FA are microdontia and advanced periodontitis. The aim of this paper was to report a case of a 10-year-old patient with FA presenting severe spontaneous gingival bleeding, as well as to discuss the role of the dentist in the management and treatment of this condition.