OpenMed/multicare-articles huggingface dataset:
Acromegaloid facial appearance: case report and literature review
Authors: Adline Ghazi, Shikha Khosla, Kenneth Becker
Journal: Case Rep Endocrinol (2013)

Pseudoacromegaly is characterized by an acromegalic appearance without any abnormality of growth hormone function. It may be caused by several congenital and acquired conditions. One such condition is the acromegaloid facial appearance (AFA) syndrome. This condition has been described in approximately eight cases/families. It encompasses a spectrum of acromegaloid physical findings, normal growth hormone (GH) and insulin-like growth factor one (IGF-1) levels, and variable mode of inheritance. The most common physical findings are coarse facies, bulbous nose, and thickened lips. We present a case and a review of the literature on this illness. The patient is a 57-year-old woman who was referred to the endocrinology division for evaluation of suspected acromegaly. She had an acromegaloid appearance since birth as well as a terminal hypertrichosis. Her endocrine laboratory evaluation and chromosomal analyses were normal. AFA needs to be considered when evaluating any patient with pseudoacromegaly. Additional cases/families need to be identified in order to better understand the clinical spectrum, clinical implications, and mode of inheritance of AFA.
The effect of systematic exercise training on skeletal muscle strength in a patient with advanced inclusion body myositis: A case study
Authors: C D'Alton, R Johnstone, C du Plessis, A Pursad, T A Kohn
Journal: S Afr J Sports Med (2022)
Keywords: autoimmune disease, muscle weakness, myopathy, resistance training
MeSH terms: Case Reports

Inclusion body myositis (IBM) is an inflammatory and degenerative autoimmune disease that targets specific muscle groups, causing severe muscle weakness. Exercise training is often contraindicated in myopathies as it may aggravate muscle damage and inflammation. Although some reported positive outcomes in muscle strength of early diagnosed IBM patients undergoing resistance training, there remains uncertainty as to whether exercise could be beneficial and safe in advanced stage IBM. Thus the aims of this research were to evaluate the safety and response of 16-weeks supervised resistance training on the health and muscle performance of an elderly participant diagnosed with advanced stage IBM. It was shown that the training had no adverse effects on the health of the patient. Muscle strength measured at eight weeks and on completion of the intervention, remained the same as at baseline. In conclusion, the exercise programme was found to be safe and seemed to maintain muscle strength in a patient with advanced stage IBM.
Synchronous Bone Metastasis From Multiple Myeloma and Prostate Adenocarcinoma as Initial Presentation of Coexistent Malignancies
Authors: Diego Andres Adrianzen Herrera, Shlomit Goldberg-Stein, Alexander Sankin, Judy Sarungbam, Janaki Sharma, Benjamin A Gartrell
Journal: Front Oncol (2018)
Keywords: bone metastasis, multiple myeloma, prostate cancer, radiographic imaging, synchronous malignancies
MeSH terms: Case Reports

The radiographic appearance of bone metastases is usually determined by tumor histology and can be osteolytic, osteoblastic, or mixed. We present a patient with coexistent bone metastasis from multiple myeloma and prostate adenocarcinoma who exhibited synchronous bone involvement of both histologies within the same bone lesion, a rare phenomenon that has not been previously reported and led to atypical radiographic findings. The radiograph of a 71-year-old man with thigh swelling and pain demonstrated a lytic femoral lesion. Magnetic resonance imaging (MRI) confirmed a destructive process, but showed coexistent metaphyseal sclerosis. Multiple myeloma was suspected by demonstration of monoclonal gammopathy and confirmed by computed tomography (CT)-guided biopsy. Incidentally, CT demonstrated areas of sclerosis corresponding to T2 hypointensity on MRI. Further studies revealed osteoblastic spinal metastasis, prostate enhancement on CT and prostate-specific antigen (PSA) level of 90 ng/mL, concerning for concomitant prostate neoplasm. After endoprosthetic reconstruction, pathology of the femur identified both plasma cell neoplasm and metastatic prostate adenocarcinoma. An association between prostate cancer and multiple myeloma is hypothesized due to tumor microenvironment similarities and possible common genetic variations, however, coexisting bone metastases have never been reported. This unusual finding explains the discrepant imaging features in our patient and is evidenced that certain clinical situations merit contemplation of atypical presentations of common malignancies even if this leads to additional testing.
Case report: Experience with the Cube Navigation System in complex access routes during CT-guided lumbosacral infiltration therapy
Authors: Michael Diepers, Philipp Gruber, Luca Remonda, Jatta Berberat
Journal: Front Surg (2023)
Keywords: computer tomography, infiltration, navigation, pain, therapy
MeSH terms: Case Reports

Purpose:
Computed tomography (CT)-guided infiltrations are a mainstay in the treatment of lower back pain. Needle placement is usually performed using the free-hand method, where the translation from the planned needle angle to the actual needle insertion angle is estimated. However, the free-hand method is especially challenging in cases where a double-oblique access route (out-of-plane) rather than an in-plane route is necessary. In this case series, we report our experience with the patient-mounted Cube Navigation System to guide needle placement for complex access routes in lumbar pain therapy.
Research design and methods:
We retrospectively analyzed the cases of five patients in whom a double-oblique access route was necessary for CT-guided lumbar infiltration pain treatment. Each of those procedures was done using the Cube Navigation System to provide navigational guidance. The mean patient age was 69 ± 13 years (range 58-82 years; all females). Technical success, procedure time, and number of control scans were determined retrospectively.
Results:
Technical success (i.e., positioning and accuracy) was obtained in all cases. Mean procedure time was 15 ± 7 min (10-22 min); on average, 2 ± 1 CT control scans were performed. There were no complications or material failures reported in the present study.
Conclusion:
Double-oblique punctures with the Cube Navigation System in this initial case series of complex access routes at the lumbar spine were accurate and the procedure was time efficient. In the authors' view, the Cube Navigation System has the potential to improve needle guidance for complex access routes, especially considering the ease of use of the device.
Radiation-Associated Pemphigus Vulgaris in a Patient With Preceding Malignancy: Treatment With Rituximab as a Valuable Option
Authors: Franziska Schauer, Norito Ishii, Maja Mockenhaupt, Leena Bruckner-Tuderman, Takashi Hashimoto, Dimitra Kiritsi
Journal: Front Immunol (2020)
Keywords: autoimmune blistering disorder, desmoglein, desmosomal adhesion, desmosome, radiation therapy
MeSH terms: Laryngeal Neoplasms / radiotherapy, Laryngomalacia / radiotherapy, Pemphigus / drug therapy, Pemphigus / etiology, Radiotherapy / adverse effects, Rituximab / administration & dosage, Case Reports, Drug Therapy, Combination, Humans, Male, Middle Aged, Prednisolone / administration & dosage, Rituximab, Prednisolone

Pemphigus is a chronic autoimmune blistering disorder, characterized by (muco-)cutaneous erosions due to autoantibodies against desmoglein 3 and/or 1. Pemphigus induction might be associated with drugs, malignancy or radiation therapy (RT); the latter being only rarely described. A rigorous literature review revealed around 30 cases of RT-associated pemphigus, which had been primarily treated with topical and/or systemic steroids, in some cases also dapsone or few other immunosuppressive agents were given. The most common underlying cancer type was breast cancer. We here present a 63-year-old male patient, who was pre-treated with adjuvant RT for larynx carcinoma 3 months before admission. He developed extensive cutaneous, ocular, and oral erosions. Despite the clinical picture comparable to a paraneoplastic pemphigus, the diagnosis of pemphigus vulgaris of mucocutaneous type was established based on the direct immunofluorescence, showing positive cell surface IgG and discrete C3 deposits, with matching cell surface IgG pattern on monkey esophagus. Serum autoantibodies to desmoglein 1 and 3 were highly positive. No further autoantibodies were found, thus paraneoplastic pemphigus was excluded. The patient was treated with high dose prednisolone, partially given intravenously up to 2 mg/kg per day, as well as topical disinfectants and class IV steroid cream. To stabilize the disease rituximab 2 × 1,000 mg was given, leading to clinical and serological remission for up to 2 years now. We show that rituximab represents a good treatment option for the frequently treatment-refractory RT-associated pemphigus, a clinically and immunologically specific RT-induced skin disorder, resulting in long-term clinical, and serological remission.
Undiagnosed uterus didelphys with unicavitary twin gestation in a district hospital in Ghana: a case report
Authors: Kofi Effah, Lawrencia Serwaa Manu, Emilia Asuquo Udofia, Nana Owusu Essel
Journal: Pan Afr Med J (2023)
Keywords: mullerian duct abnormality, uterus didelphys, case report, pre-eclampsia, twin gestation
MeSH terms: Cesarean Section, Hospitals, District, Case Reports, Adult, Female, Ghana, Humans, Pregnancy, Pregnancy, Multiple, Uterus / abnormalities, Young Adult, Uterine Anomalies

Uterus didelphys is a congenital anomaly of the female reproductive tract which arises from the abnormal fusion of the Mullerian ducts. We present, the first case to the best of our knowledge, of uterus didelphys with a unicavitary twin gestation to be documented in Ghana, a low-middle income country. A 24-year-old woman, gravida 3, para 0+2 miscarriages, was seen and admitted to our maternity ward due to elevated blood pressure with ++ proteinuria at 36 weeks of gestation. She attended an antenatal clinic regularly during the pregnancy but was mainly seen by midwives. Apart from multiple pregnancy, two 2D ultrasound examinations (one at 25 weeks gestation and another during admission) did not reveal any uterine malformations. At 37 weeks+2 days, she underwent emergency cesarean section on account of pre-eclampsia and a twin pregnancy with the leading twin in breech presentation. After delivering both babies and the placenta, the uterus was exteriorized and inspected, during which a non-gravid bulky left uterus was first found. Each uterus had a normal ovary and fallopian tube on its lateral end. Further postoperative examination revealed a normal-looking vulva, two vaginas, and two cervices. Both babies weighed 1.9 kg, each below the fifth percentile of weight for age. The elevated blood settled postoperatively and the postoperative period was uneventful. The patient and twins were found in a stable condition on review two weeks after delivery and the twins were healthy at 5 years. Despite being a rare presentation, we wish to create awareness among health workers in rural and low-resource settings of such cases and highlight the need to improve prenatal diagnostic capabilities, as this is key to determining the mode of delivery and achieving favorable maternal and fetal outcomes.
Symptomatic Coronary Anomalies and Ischemia in Teenagers - Rare but Real
Authors: Julia Borns, Christoph Gräni, Alexander Kadner, Martin Gloeckler, Jean-Pierre Pfammatter
Journal: Front Cardiovasc Med (2020)
Keywords: aaoca, angina pectoris, anomalous aortic origin of the coronary arteries, chest pain, coronary artery anomaly, interarterial, teenager
MeSH terms: Case Reports

Three cases of teenagers with anomalous aortic origin of the coronary arteries (AAOCA) are presented with typical exercise induced symptoms (chest pain, syncope or dizziness). Using multimodal imaging, diagnoses was confirmed showing interarterial and/or intramural course of the coronary artery explaining the ischemia induced symptoms. Successful surgical correction with unroofing of the AAOCA was performed in all three cases with a favorable outcome. Even though AAOCA are rare, some variants may be relevant and potentially life threatening, therefore treating physicians should be aware of correctly diagnosing and treating these individuals.
Fibrous dysplasia: an overview of disease process, indications for surgical management, and a case report
Authors: Oluwaseun A Adetayo, Samuel E Salcedo, Vedant Borad, Sara S Richards, Adrienne D Workman, Andrea O Ray
Journal: Eplasty (2015)
Keywords: peek implant, craniofacial fibrous dysplasia, craniofacial reconstruction, fibrous dysplasia, von recklinghausen

Introduction:
First described by Von Recklinghausen in 1891, fibrous dysplasia is a developmental defect of osseous tissue such that bone is produced with an abnormally thin cortex and marrow is replaced with fibrous tissue that demonstrates characteristic ground-glass appearance on x-ray examination. The underlying defect in fibrous dysplasia is a mutation of the GNAS1 gene, which leads to constitutive activation of gene products that preclude the maturation of osteoprogenitor cells and lead to development of abnormal bone matrix, trabeculae, and collagen, produced by undifferentiated mesenchymal cells. There exists a mainly self-limiting form of fibrous dysplasia classified as monostotic, which is characterized by dysplastic bone in a single location that remains relatively stable throughout life and a polyostotic form, which can exhibit aggressive growth placing adjacent structures at risk for compressive sequelae.
Methods:
We present the surgical management of an unusual case of monostotic fibrous dysplasia, which exhibited aggressive growth with mass effect, and late presentation, both uncharacteristic features for the monostotic form. The authors also performed a comprehensive review of the literature and discuss the disease process, management options, and indications for surgical treatment.
Results:
An overview of the disease process and management options is presented. The authors also present details of reconstruction in an unusual form of symptomatic monostotic fibrous dysplasia.
Conclusion:
Conservative management is usually the mainstay of therapy in asymptomatic cases of fibrous dysplasia. In patients fulfilling criteria for surgical management, craniofacial reconstruction offers a viable option in the surgeon's armamentarium, providing good functional and cosmetic outcomes.
Beneficial Treatment Outcomes of Severe COVID-19 Patients Treated Entirely in Primary Care Settings With Dexamethasone Including Regimen-Case Series Report
Authors: Damir Vukoja, Andrea Jurić, Zdravka Erkapić, Tomislav Pejić, Željko Zovko, Josipa Juričić, Jelena Pejić, Matea Ćorluka
Journal: Front Pharmacol (2021)
Keywords: covid-19, sars-cov-2, coronavirus, corticosteroids, dexamethasone, primary health care, treatment
MeSH terms: Case Reports

Even in 2021, coronavirus disease 2019 (COVID-19) remains a major global health concern, especially in developing countries. The burden of this disease, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which affects not only primary respiratory but also other organ systems, keeps rising as the pandemic continues. Primary health care centers are the first line where COVID-19 patients are managed and should be able to manage the vast majority of them successfully. In this paper, we present a case series and concept of beneficial management of even deteriorating and severe patients treated entirely in our primary health center. The management is based on well-timed and rational dexamethasone use, as well as on various other pharmacological and nonpharmacological treatments and interventions, and is supported by provided statistical data. According to the presented experience and positive outcomes achieved, it seems that even deteriorating and severe COVID-19 patients can be treated successfully to some extent or even completely in primary care settings. This kind of approach could be particularly beneficial in conditions of overload of higher-level health care institutions.
Extra-abdominal fibromatosis (desmoid tumor): a rare tumor of the lower extremity arising from the popliteal fossa
Authors: Mehmet Ali Kaygin, Ozgur Dag, Bilgehan Erkut, Azman Ates, Refik Cetin Kayaoglu, Hakan Kadioglu
Journal: Case Rep Vasc Med (2011)
MeSH terms: Case Reports

Aggressive fibromatosis is a rare soft tissue tumor. Although it lacks metastatic potential, it can grow aggressively in a locally infiltrating pattern. The tumors frequently recur after surgical excision, which remains the treatment of choice. Optional combinations of radiotherapy and/or chemotherapy have been used postoperatively for recurrent disease and/or inoperable cases. A palpable mass was detected in the popliteal fossa of the right lower extremity in a 48-year-old man. Magnetic resonance imaging showed a contrast-enhancing noncalcified lesion initially felt to represent a vascular tumor. An invasive mass adherent to the surrounding tissue was visualized intraoperatively and extensively debulked. The patient's postoperative course was uneventful. Histologic examination of the surgical specimen was consistent with an extra-abdominal desmoid tumor. After appropriate recognition, wide local excision may be the most appropriate treatment for fibromatosis of the extremity. However, the rarity of this tumor and the difficulty inherent in distinguishing it from similar-appearing tumors are necessitating histologic confirmation of the diagnosis.
Management of Meningitis Caused by Multi Drug-Resistant Acinetobacter Baumannii: Clinical, Microbiological and Pharmacokinetic Results in a Patient Treated with Colistin Methanesulfonate
Authors: Elisabetta Schiaroli, Maria Bruna Pasticci, Maria Iris Cassetta, Stefania Fallani, Corrado Castrioto, Matteo Pirro, Andrea Novelli, Lucia Henrici De Angelis, Marco Maria D'Andrea, Maria Lina Mezzatesta, Franco Baldelli, Antonella Mencacci
Journal: Mediterr J Hematol Infect Dis (2015)
MeSH terms: Case Reports

This paper reports on a 71- year-old Caucasian male who underwent neurosurgery for an oligodendroglioma, followed by a cranial-sinus fistula and cerebrospinal fluid rhinorrhea. The clinical course was complicated due to an extensively drug-resistant Acinetobacter baumannii meningitis. The patient was treated with colistin methanesulfonate, intrathecal for 24 days and intravenous for 46 days. In addition, the patient received meropenem and teicoplanin to treat a urinary tract infection and a bacterial aspiration pneumonia. Cerebrospinal fluid trough colistin levels resulted above the MIC of A. baumannii. Colistin cerebrospinal fluid concentration did not increase over the treatment period. Meningitis was cured and A. baumannii eradicated. No side effects from the antimicrobial therapy were observed. In conclusion, this case highlights the issues in treating infections caused by resistant Gram negative bacteria and supports previous findings on the efficacy, pharmacokinetic and tolerability of intravenous and intrathecal colistin treatments.
First ever case report of co-occurrence of hobnail variant of papillary thyroid carcinoma and intrathyroid parathyroid adenoma in the same thyroid lobe
Authors: Omer Al-Yahri, Abdelrahman Abdelaal, Walid El Ansari, Hanan Farghaly, Khaled Murshed, Mahmoud A Zirie, Mohamed S Al Hassan
Journal: Int J Surg Case Rep (2020)
Keywords: braf(v600e) mutation, hobnail papillary thyroid carcinoma, molecular profile, neck mass, parathyroid adenoma
MeSH terms: Case Reports

Introduction:
The hobnail variant of papillary thyroid cancer (PTC) is rare. Intrathyroid parathyroid adenoma (ITPA) is also rare. Co-ocurrence of PTC and ITPA in the same thyroid lobe is extremely rare. Likewise, primary hyperparathyroidism with such non-medullary thyroid carcinoma is rare. The specific molecular profile of hobnail PTC (HPTC) is different from the classic, poorly differentiated and anaplastic variants and may contribute to its aggressive behavior. HPTC's genetic profile remains unclear.
Presentation of case:
A 61-year-old woman presented to our endocrine clinic with generalized aches, bone pain, polyuria, and right neck swelling of a few months' duration. Laboratory findings revealed hypercalcemia and hyperparathyroidism. Ultrasound of the neck showed 4.6 cm complex nodule within the right thyroid lobe. Sestamibi scan suggested parathyroid adenoma in the right thyroid lobe. Fine-needle aspiration (FNA) revealed atypical follicular lesion of undetermined significance. She underwent right lobectomy, which normalized the intraoperative intact parathyroid hormone levels. Final pathology with immunohistochemical stains demonstrated HPTC and IPTA (2 cm each). Next-generation sequencing investigated the mutation spectrum of HPTC and detected BRAFV600E mutation.
Conclusions:
A parathyroid adenoma should not exclude the diagnosis of thyroid carcinoma. Thyroid evaluation is needed for patients with primary hyperparathyroidism to prevent missing concurrent thyroid cancers. Cytomorphologic features to distinguish thyroid from parathyroid cells on FNA cytology must be considered. Immunohistochemical stains are important. BRAFV600E is the most common mutation in HPTC. This is possibly the first reported case of HPTC and ITPA co-occurring within the same thyroid lobe. Studies that define other molecular abnormalities may be useful as therapeutic targets.
Disruption of Cesarean Scar with Uterovesical Space Hematocele Mimicking an Endometrioma
Authors: Sujata Datta, Ritisha Basu
Journal: Womens Health Rep (New Rochelle) (2022)
Keywords: cesarean complication, cesarean scar defect, endometrioma
MeSH terms: Case Reports

Our case highlights an extreme form of cesarean scar defect with diagnostic and surgical challenges. The unusual presentation of a large extrauterine-encapsulated collection of altered blood and hemosiderin behind the posterior bladder wall that communicated with the endometrial cavity, through a full thickness myometrial discontinuity, at the site of a previous cesarean section, mimicked an endometrioma in an unusual location. This case report not only highlights the diagnostic challenge involved in this case but also highlights the surgical steps involved in the laparoscopic management of this extreme end of the spectrum of cesarean scar defects. We have attached a video of the laparoscopic surgery with step-wise description to shed more light on the management of this rare complication.