OpenMed/multicare-articles huggingface dataset:
A Rare Case of Duodenal Adenocarcinoma Presenting as a Subepithelial Lesion in a Patient Undergoing Investigation for Iron Deficiency Anaemia
Authors: Xinxin Hu, Karina Aivazian, Catriona McKenzie, May Wong, Arthur Kaffes, Payal Saxena
Journal: Case Rep Gastrointest Med (2019)
MeSH terms: Case Reports

Introduction:
Adenocarcinomas account for approximately 40% of small bowel cancers. They are typically mucosal lesions with distinctive features on endoscopy. We describe a rare case of duodenal adenocarcinoma presenting as a subepithelial lesion which posed a diagnostic challenge.
Case:
An 85-year-old male patient presented for investigation of iron deficiency anaemia. Initial upper endoscopy found a subepithelial duodenal lesion with central depression but otherwise normal appearing mucosa. Superficial biopsies of the duodenal lesion were unremarkable. Subsequent antegrade single balloon enteroscopy revealed active bleeding from the lesion which was refractory to endoscopic treatment. A complete local excision of the lesion via laparotomy was necessary to achieve haemostasis. Histopathology from the lesion showed a moderately differentiated duodenal adenocarcinoma with invasion into the submucosa but no evidence of lymphovascular spread.
Conclusion:
Duodenal adenocarcinomas are rare gastrointestinal tumours associated with a poor prognosis. This case report outlines a rare presentation of duodenal adenocarcinoma and highlights the importance of judicious assessment of lesions found on endoscopy. Advances in endoscopic diagnostic modalities could facilitate early diagnosis and improve therapeutic outcomes.
Symptomatic Patent Foramen Ovale with Hemidiaphragm Paralysis
Authors: Hussain Ibrahim, Adnan Khan, Shawn P Nishi, Ken Fujise, Syed Gilani
Journal: Case Rep Pulmonol (2017)
MeSH terms: Case Reports

Dyspnea accounts for more than one-fourth of the hospital admissions from Emergency Department. Chronic conditions such as Chronic Obstructive Pulmonary Disease, Congestive Heart Failure, and Asthma are being common etiologies. Less common etiologies include conditions such as valvular heart disease, pulmonary embolism, and right-to-left shunt (RLS) from patent foramen ovale (PFO). PFO is present in estimated 20-30% of the population, mostly a benign condition. RLS via PFO usually occurs when right atrium pressure exceeds left atrium pressure. RLS can also occur in absence of higher right atrium pressure. We report one such case that highlights the importance of high clinical suspicion, thorough evaluation, and percutaneous closure of the PFO leading to significant improvement in the symptoms.
Nosocomial Myiasis Caused by Lucilia sericata (Diptera: Calliphoridae) and Neonatal Myiasis by Sarcophaga spp. (Diptera: Sarcophagidae) in Mexico
Authors: Hugo Martínez-Rojano, Julio C Noguez, Herón Huerta
Journal: Case Rep Infect Dis (2018)
MeSH terms: Case Reports

The presence of nosocomial myiasis reflects a lack of adequate medical attention, due to the physical facilities and/or the health care personnel. Patients requiring special attention are more susceptible, such as those with a loss of consciousness, assisted mechanical ventilation, tracheal tubes, or nasogastric probes. Nosocomial myiasis is a rare event that has a greater occurrence in the hospitals of poor and developing countries. The two cases herein described represent the first report of nosocomial myiasis in Mexico. The causal agents were found to be Lucilia sericata and Sarcophaga spp. The taxonomical identification of the larvae of the second and third instar was based on the morphology of the cephaloskeleton, anterior spiracles, and peritreme plaques.
Non-recurrent inferior laryngeal nerve: case report and review of the literature
Authors: R Iorgulescu, I Bistriceanu, D Badanoiu, C Calin, C Capatana, N Iordache
Journal: J Med Life (2014)
Keywords: inferior laryngeal nerve, non-recurrent, total thyroidectomy
MeSH terms: Recurrent Laryngeal Nerve / surgery, Case Reports, Review, Female, Goiter / surgery, Humans, Middle Aged, Thyroidectomy

Total thyroidectomy is nowadays the operation of choice in the majority of endocrine surgery centers, whether the pathology is benign or malignant. To obtain good results, a thorough knowledge of local anatomy and a profound respect for hemostasis are necessary. Routine, at least visual, identification of the inferior laryngeal nerve (ILN) is considered gold standard and is strongly recommended. Surgeons are generally aware of the variations the nerve can have, especially on the right side. Although very rare, one such variation, with possible great impact on outcomes, is the non-recurrent route of the nerve. We present the case of a middle-aged woman with a multinodular goiter scheduled for elective surgery. During total thyroidectomy, on the right side, we were not able to find the inferior laryngeal nerve in its usual position, using the customary anatomical landmarks. Instead, we encountered it emerging directly from the right vagus nerve, at a rather right angle and entering the larynx as a unique non-bifurcating nerve. Thus, it could be spared from any injury and protected, although it could have been easily confounded with a vascular structure, given its transverse course.We think it is never overmuch to repeat that the routine identification and exposure of the inferior laryngeal nerve is a must for the thyroid surgeon in order to safely preserve its integrity.
Surgically induced necrotizing scleritis after retinal detachment surgery masquerading as scleral abscess
Authors: V G Madanagopalan, Narayana Shivananda, Thiruvengadakrishnan Krishnan
Journal: GMS Ophthalmol Cases (2019)
Keywords: retinal detachment surgery, sclerotomy, surgically induced necrotizing scleritis, vitrectomy
MeSH terms: Case Reports

Scleral necrosis is a rare occurrence after many ocular procedures. In the absence of infection or use of surgical adjuncts such as antimetabolites or radiation, the necrosis is presumed to be directly related to surgical trauma and is hence termed surgically induced necrotizing scleritis (SINS). A high index of suspicion is required for an early diagnosis of SINS and its differentiation from infective scleritis is important as the treatment modalities of these two related conditions are different. We report a case of SINS at sclerotomy site following 23-gauge transconjunctival retinal detachment surgery that was initially suspected to be a scleral abscess. Prompt recognition and institution of topical and systemic steroid therapy helped in limiting the extent of scleral damage.
Venetoclax in Combination with Decitabine for Relapsed T-Cell Acute Lymphoblastic Leukemia after Allogeneic Hematopoietic Cell Transplant
Authors: Leena T Rahmat, Anna Nguyen, Haifaa Abdulhaq, Sonam Prakash, Aaron C Logan, Gabriel N Mannis
Journal: Case Rep Hematol (2018)
MeSH terms: Case Reports

Long-term disease-free survival in adults with T-cell acute lymphoblastic leukemia (T-ALL) remains poor, particularly after relapse, with few available salvage options. Preclinical data suggest that inhibition of the antiapoptotic protein BCL-2 (B-cell lymphoma 2) either alone or in combination with other agents, may be a unique therapeutic approach for the treatment of T-ALL. We present a case of a young male with T-ALL, relapsed after allogeneic hematopoietic stem cell transplant, who achieved a second complete remission following salvage therapy with combined venetoclax and decitabine. Assessment of measurable residual disease by next generation sequencing showed no evidence of residual disease of a sensitivity of 1 × 10-6. While the combination of venetoclax and hypomethylating agents has shown promise in the treatment of relapsed/refractory AML, and to our knowledge, this is the first report of this combination demonstrating clinical activity in relapsed/refractory T-ALL.
Borderline paratubal cyst: a case report
Authors: Fatima Zohra Fdili Alaoui, Hinde El Fatemi, Hekmat Chaara, Molay Abdilah Melhouf, Afaf Amarti
Journal: Pan Afr Med J (2012)
Keywords: paratubal cyst, borderline, torsion, treatment
MeSH terms: Parovarian Cyst / diagnosis, Precancerous Conditions / diagnosis, Case Reports, Adult, Female, Humans, Laparotomy, Ovarian Cysts / complications, Ovarian Cysts / diagnosis, Ovarian Cysts / surgery, Parovarian Cyst / complications, Parovarian Cyst / surgery, Precancerous Conditions / surgery

Borderline para-ovarian cysts (PCs) are rare entities. They are commonly present in the third decade. Borderline PCs are often discovered fortuitously on routine ultrasound examination or they are common incidental findings during a laparotomy. They must be differentiated from simple ovarian cysts, peritoneal inclusion cysts and hydrosalpinges on ultrasound sonography. Papillary projections on the cyst wall should be searched carefully to suggest diagnosis. The treatment is surgical including fertility -sparing operation or more radical surgery depending on the case. The prognosis is good because borderline PCs are usually early-stage at diagnosis. Here is a report of a 38- year old woman with a borderline paratubal cyst. Adnexal torsion of hydrosalpinx was suspected; thus, she underwent an urgent surgery. Cystectomy was performed without rupture. The final diagnosis revealed a borderline PC. The patient underwent a radical surgery. Currently, she has had no evidence of disease recurrence.
Opana ER (Oxymorphone)-Induced Thrombotic Microangiopathy: An Atypical Presentation in a Patient With Hepatitis C
Authors: Hassan Mehmood, Muzammil Khan, Asghar Marwat, Medha Joshi, Varun Malhotra
Journal: J Investig Med High Impact Case Rep (2018)
Keywords: adamts-13, opana er, hepatitis c, kidney biopsy, thrombotic microangiopathy

Oxymorphone is a semisynthetic extended release opiate used to treat moderate to severe chronic pain. The Food and Drug Administration approved the oral form of oxymorphone available as Opana and Opana ER (extended release) since 2006. The Food and Drug Administration and the Centers for Disease Control and Prevention issued warning against intravenous use of Opana ER. We are presenting a case report of a 37-year-old female with a history of active intravenous drug abuse who presented to our hospital with acute kidney injury. Urinalysis showed red blood cell sediments, many dysmorphic red blood cell casts along with nephrotic range proteinuria of 12 g/deal per day. Kidney biopsy showed microscopic thrombotic microangiopathy (TMA) involving glomeruli and vessels. Further workup was undertaken for TMA, and apart from mildly elevated lactate dehydrogenase of 380 (normal <243), active hepatitis C, and slightly low ADAMTS-13 (55%), there was no other laboratory evidence of TMA. On literature search, we found that intravenous injection of chronic Opana ER has been reported to cause TMA resulting in chronic kidney disease. Our patient also admitted to use of intravenous Opana ER abuse for the past 5 years. She had a normal platelet count and an absence of schistocytes, which makes it an atypical presentation of TMA resulting in chronic kidney disease in an opiate user. We strongly urge physicians to avoid prescribing opiates for chronic pain, especially Opana ER, which if injected intravenously for recreational purposes can lead to serious side effects like TMA. Treatment is mainly supportive and avoidance of drug in future.
Circummandibular wiring of symphysis fracture in a five-year-old child
Authors: Krishna Priya Vellore, Srinivas Gadipelly, Brahmananda Dutta, Vijay Bhaskar Reddy, Sri Ram, Arun Parsa
Journal: Case Rep Dent (2013)

The treatment of pediatric maxillofacial fractures is unique due to the psychological, physiological, developmental, and anatomical characteristics of children. Method. This case report describes the management of symphysis fracture of mandible in a 5-year-old boy. The fracture was treated by acrylic splint with circummandibular wiring. Results. The splint was removed after 3 weeks. The patient had no complaints, and radiograph revealed a healed fracture. Conclusion. The clinical outcome in the present case indicates the management of mandibular fractures in pediatric patients using acrylic splint with circummandibular wiring.
An Intensive Care Unit Outbreak of Acute Respiratory Distress Syndrome due to Human Metapneumo Virus Infection
Authors: Ankur Sinha, Vignesh Ponnusamy, Sushilkumar S Gupta, Hitesh Raheja, Ravikaran Patti, Parita Soni, Namrita Malhan, Yu Shia Lin, Yizhak Kupfer
Journal: J Investig Med High Impact Case Rep (2019)
Keywords: acute respiratory distress syndrome, extracorporeal membrane oxygenation, intensive care unit, metapneumo virus
MeSH terms: Extracorporeal Membrane Oxygenation, Metapneumovirus, Paramyxoviridae Infections / complications, Respiratory Distress Syndrome / therapy, Respiratory Distress Syndrome / virology, Case Reports, Adolescent, Adult, Aged, Aged, 80 and over, Disease Outbreaks, Female, Humans, Intensive Care Units, Middle Aged, Paramyxoviridae Infections / virology, Tertiary Care Centers

Human metapneumo virus is an emerging cause of upper and lower respiratory tract illness with increasing reports of a varied spectrum of disease over all age groups. We report an outbreak of 6 cases of human metapneumo virus infection in the intensive care unit of a metropolitan tertiary care center over 6 weeks, leading to severe acute respiratory distress syndrome. We report the subsequent favorable outcomes due to the institution of extracorporeal membrane oxygenation.
An uncommon spontaneous right distal tubal pregnancy post bilateral laparoscopic sterilization: A case report
Authors: Ching-Min Lin, Yu-Lun Ku, Yu-Tzu Cheng, Ngo Yeh Giin, Yu-Che Ou, Meng-Chih Lee, Chung-Yuan Lee
Journal: Medicine (Baltimore) (2019)
MeSH terms: Laparoscopy / adverse effects, Postoperative Complications / etiology, Pregnancy, Tubal / etiology, Sterilization, Tubal / adverse effects, Case Reports, Adult, Female, Humans, Laparoscopy / methods, Postoperative Complications / surgery, Pregnancy, Pregnancy, Tubal / surgery, Salpingectomy / methods, Sterilization, Tubal / methods

Rationale:
Tubal sterilization as a contraception method has a high success rate; however, it also carries a low risk of incidental pregnancy. A majority of these pregnancies are ectopic. In this study, we report a rare case of spontaneous right distal tubal pregnancy after bilateral laparoscopic tubal sterilization.
Patient concerns:
A 36-year-old woman who had undergone bilateral laparoscopic tubal sterilization presented with abdominal pain and a positive test for pregnancy.
Diagnosis:
Ectopic pregnancy was suspected based on absence of gestational sac in the uterine cavity on ultrasound and elevated beta-human chorionic gonadotropin (β-hCG) level.
Intervention:
Since the patient had unstable vitals, emergency laparoscopic surgery was performed, which revealed a right distal fallopian tube pregnancy. We performed a complete bilateral residual tubal stump excision.
Outcomes:
The patient recovered well after surgery, with a reduction in β-hCG level, and was discharged after 3 days.
Lessons:
To ensure complete sterilization, the gap at the excised end needs to be adequately widened and enhanced with electro-destruction to prevent formation of a fistula.
Xanthogranulomatous pyelonephritis with calculus migration into the psoas abscess: an unusual complication
Authors: Manpreet Singh, Dillibabu Ethiraj, Venkatraman Indiran, Niranjan Dhanaji Kanase, Prabakaran Maduraimuthu
Journal: Autops Case Rep (2020)
Keywords: escherichia coli, pyelonephritis, xanthogranulomatous, urinary tract infections
MeSH terms: Case Reports

Xanthogranulomatous pyelonephritis (XGP) is a rare variant of chronic pyelonephritis. It is characterized by progressive parenchymal destruction caused by chronic renal obstruction due to calculus, stricture, or rarely tumor, resulting in kidney function loss. Herein, we describe the case of a 36-year-old female who presented with left loin pain, left lower limb pain, and dysuria. On contrast-enhanced computed tomography (CECT), multiple abscesses and an obstructive staghorn calculus were depicted in the left kidney with the classical appearance of "Bear Paw Sign." An abscess with calculi was also present within the left psoas muscle. Though psoas muscle abscess in association with XGP was described, a ureteric fistula and calculi within the psoas muscle have not yet been reported in the literature. Left nephrostomy was performed, which came out to be positive for E. coli on culture. The patient underwent left nephrectomy, and the histopathological report of the surgical specimen confirmed XGP.
Replantation of an avulsed maxillary incisor after 12 hours: three-year follow-up
Authors: Hamid Moradian, Samaneh Badakhsh, Mehran Rahimi, Somayeh Hekmatfar
Journal: Iran Endod J (2013)
Keywords: media, milk, replantation, tooth avulsion, trauma
MeSH terms: Case Reports

Tooth avulsion is defined as the complete displacement of the tooth out of its alveolar socket. The treatment of choice is immediate replantation or if that is not possible, placement of the tooth in an appropriate storage media. This report presents replantation of an avulsed maxillary central incisor after 12 hours of storage in milk. The tooth was replanted and splinted. One week later, it was treated endodontically and calcium hydroxide dressing was placed for 1 month; subsequently, the tooth was obturated with gutta-percha. During three years of follow-up, no evidence of ankylosis or inflammatory resorption was observed. After three years, the tooth was stable and remained functional and esthetically acceptable.
Brugada-type electrocardiographic pattern induced by electrocution
Authors: R Rangaraj, Nagaraja Moorthy, Shivanand S Patil, Cn Manjunath
Journal: Indian Pacing Electrophysiol J (2009)
Keywords: brugada syndrome, electrocution, early repolarisation, sudden cardiac death, ventricular fibrillation

Heart is one of the most frequently affected organs in electrocution. Electrical injury can cause life-threatening cardiac complications such as asystole, ventricular fibrillation, and myocardial rupture. In this case report, we describe a 22-yr-old male patient who sustained electric burn injury and presented with electrocardiogram showing transient Brugada type pattern.
Dual Coronary-Pulmonary Artery Fistula in a Patient with Severe Bicuspid Aortic Valve Stenosis
Authors: Rody G Bou Chaaya, Yasser Sammour, Samarthkumar Thakkar, Ziad Jaradat, William J Gill, Omar Batal
Journal: Methodist Debakey Cardiovasc J (2023)
Keywords: aortic stenosis, bicuspid aortic valve, coronary artery, fistula, pulmonary artery
MeSH terms: Aortic Valve Stenosis / complications, Aortic Valve Stenosis / diagnostic imaging, Bicuspid Aortic Valve Disease, Coronary Artery Disease, Fistula, Heart Defects, Congenital, Case Reports, Aortic Valve / diagnostic imaging, Aortic Valve / surgery, Constriction, Pathologic, Humans, Male, Middle Aged, Pulmonary Artery / diagnostic imaging

A 62-year-old male presented to the emergency department with acute viral bronchitis and worsening of his chronic dyspnea on exertion. Incidentally, a murmur was detected on physical examination. Extensive work-up, including coronary computed tomography angiography, revealed a rare combination and potential association between severe bicuspid aortic valve stenosis and coronary-pulmonary artery fistulas.
Case report: Zanubrutinib-induced dermatological toxicities: A single-center experience and review
Authors: Lingling Wang, Jiao Tang, Jun Feng, Yongfen Huang, Yuexin Cheng, Hao Xu, Yuqing Miao
Journal: Front Oncol (2022)
Keywords: dermatological toxicity, epithelial growth factor receptor, maculopapule rash, papulopustular rash, skin infection, zanubrutinib
MeSH terms: Case Reports

Zanubrutinib, a next-generation non-covalent Bruton's tyrosine kinase (BTK) inhibitor, shows great efficacy in the treatment of B cell malignancies. Some patients may experience a series of side effects after the treatment of zanubrutinib. Grade 4 dermatological toxicities are rare, which present as severe rash and skin infection. Herein, we retrospectively reported the grade 4 dermatological toxicities of zanubrutinib in three consecutive patients. They were treated with zanubrutinib 160 mg twice daily orally. One patient was diagnosed with Primary Breast Diffuse Large B-cell Lymphoma(PB-DLBCL) and two patients were diagnosed with Chronic Lymphocytic Leukemia(CLL). Within one month after zanubrutinib treatment, all three patients developed grade 4 dermatological toxicities, including bruising, maculopapular rash, petechiae, ecchymosis, hemorrhagic blister, acne-Like rash, papulopustular rash, and skin infections. Zanubrutinib was discontinued in two patients due to unacceptable dermatological toxicities. Safety data from pre-licensing clinical trials showed that zanubrutinib-related side effects were frequent but well tolerated. To date, no severe dermatological toxicities were reported. The majority of patients can be relieved with symptomatic treatment, but a very small percentage of patients may face discontinuation of the drug.
A rare case of colon obstruction due to gastrointestinal basidiobolomycosis in a 36-year-old woman
Authors: Alaa Eid Aljohani, Bandar Alshemesi, Abdullatif Alshubaisheri, Abdulmajeed Alkraidis, Ali Alzahrani, Rami Sairafi
Journal: Int J Surg Case Rep (2020)
Keywords: basidiobolomycosis, basidiobolus ranarum, case report, entomophthorales, gastrointestinal basidiobolomycosis
MeSH terms: Case Reports

Introduction:
Gastrointestinal basidiobolomycosis (GIB) is an uncommon fungal infection caused byBasidiobolus ranarum, with less than 80 cases reported in the literature.
Presentation of case:
A 36-year-old woman presented with colicky upper abdominal pain for 2 months and inability to pass stool for 2 days. Computed tomography of the abdomen and colonoscopy both showed a mass in the transverse colon. Colonoscopic biopsy suggested a zygomycosis. Laparotomy revealed a perforated mass in the transverse colon; the mass also involved the small bowel and stomach. En bloc resection was performed, and the incision was closed for a second-look procedure. The patient was admitted to the intensive care unit and placed on a ventilator and inotropes; however, her condition deteriorated, and she died on day 24 post admission. The histopathology report (obtained after the patient's death) was consistent with GIB.
Discussion:
Gastrointestinal basidiobolomycosis presents with nonspecific signs and symptoms and so the diagnosis is easily missed or delayed. Timely, accurate diagnosis is crucially important, especially when there is intestinal obstruction and sepsis. Persistent severe abdominal pain in a patient with neutropenia should alert the physician to the possibility of a fungal infection. There are reports from several countries of basidiobolomycosis in immunocompetent hosts. The disease shows no age predilection, but males may be more susceptible. Treatment is with surgical debridement and antifungal drugs-ideally the lipid formulation of amphotericin B.
Conclusion:
Gastrointestinal basidiobolomycosis is a rare infection that can be fatal if not diagnosed and treated early.