OpenMed/multicare-articles huggingface dataset:
Tibial Tuberosity Fracture in an Elderly Gentleman: An Unusual Injury Pattern
Authors: Emma Brown, Mohammad Taaha Sohail, Jonathan West, Benjamin Davies, Georgios Mamarelis, Mohammad Zain Sohail
Journal: Case Rep Orthop (2020)
MeSH terms: Case Reports

Avulsion fracture of the tibial tuberosity is an infrequent injury in adolescents and an extremely rare occurrence in adults. We describe the case of an 86-year-old gentleman presenting after a fall, sustaining injury to the left knee. Radiographs of the left knee showed avulsion fracture of the tibial tuberosity. The purpose of this study was to present a rare case of tibial tuberosity avulsion fracture in an adult, the treatment performed, and the challenges faced. The case is discussed with the review of the literature.
Case Report: Acute Myocarditis Due to PD-L1 Inhibitor Durvalumab Monotherapy in a Patient With Lung Squamous Cell Carcinoma
Authors: Bo Zhou, Manxiang Li, Tianjun Chen, Jianqing She
Journal: Front Med (Lausanne) (2022)
Keywords: pd-l1 inhibitor, durvalumab, empyema, lung squamous cell carcinoma, myocarditis
MeSH terms: Case Reports

Background:
Durvalumab, as a PD-L1 inhibitor, is commonly used for the treatment of various cancers. Adverse events associated with the therapy include hepatitis, nephritis, dermatitis, and myocarditis. Especially, myocarditis as an adverse event after PD-L1 inhibitor therapy is characterized for its low incidence and high mortality.
Case summary:
Here we present a rare case of a 67-year-old male with lung squamous cell carcinoma complicated with empyema who experienced myocarditis after only PD-L1 inhibitor durvalumab monotherapy. He presented with markedly decrease left ventricular ejection fraction, elevated Natriuretic peptide BNP, Troponin T, Troponin I, ESR, CRP and interleukin-6. The electrocardiogram showed sinus tachycardia, low voltage of limb leads, T wave inversion in anterior waves and V1-V3 QS type. Myocardial injury occurred in a short period and quickly returned to normal after glucocorticoids therapy.
Conclusion:
This case report is of clinical value for the treatment of PD-L1 related myocarditis.
Invasive Infection With emm3/ST15 Streptococcus pyogenes: The First Case Report From China and Complete Genome Analysis
Authors: Xinli Mu, Yanfei Wang, Lu Sun, Shanshan Zhao, Xi Jin, Junli Zhang, Yunsong Yu, Xueqing Wu
Journal: Front Med (Lausanne) (2022)
Keywords: m type, streptococcus pyogenes, emm3/st15, invasive infection, whole-genome sequencing (wgs)
MeSH terms: Case Reports

Streptococcus pyogenes (GAS) may cause severe invasive disease with a high fatality rate, especially M3-type strains, which are less common in China. Here, we report the first emm3/ST15 invasive GAS infection case in China. The patient was diagnosed with severe skin and soft tissue infection (SSTI) and septicaemia caused by one GAS strain. Antibiotic susceptibility tests showed that the isolate was susceptible to all tested drugs. Antimicrobial therapy was then applied, and the patient fully recovered and was discharged from the hospital on Day 43. Whole-genome sequencing was carried out using the Illumina and Oxford Nanopore platforms and revealed this to be the first emm3/ST15-type GAS invasive infection in China. The closely related emm3/ST15-type GAS strains are MGAS315 from the United States and M3-b from Japan. Our finding is a warning that we should pay attention to invasive M3-type GAS infections in China and indicates the global spread of the highly virulent emm3/ST15 GAS strain.
Two Cases of Sarcoma Arising in Giant Cell Tumor of Bone Treated with Denosumab
Authors: Cory Julian Broehm, Erika L Garbrecht, Jeff Wood, Therese Bocklage
Journal: Case Rep Med (2015)

Giant cell tumor (GCT) of bone is a generally benign, but often locally aggressive, neoplasm of bone, with a propensity for recurrence. Sarcomatous transformation is rare and typically occurs with a history of recurrences and radiation treatment. Denosumab, an inhibitor of the RANK ligand involved in bone resorption in GCT, is increasingly used in treatment of recurrent or unresectable giant cell tumor of bone. We report two cases of sarcomatous transformation of GCT to osteosarcoma in patients receiving denosumab. One was a 59-year-old male with a 12-year history of GCT and multiple recurrences taking denosumab for 2.5 years. The second case was in a 56-year-old male with a seven-year history of GCT taking denosumab for six months. Review of the literature shows one case report of malignant transformation of GCT in a patient being treated with denosumab. As the use of denosumab for treatment of GCT will likely increase, larger, controlled studies are needed to ascertain whether denosumab may play a role in malignant transformation of giant cell tumor of bone.
A Rare Form of Brucella Bursitis with Negative Serology: A Case Report and Literature Review
Authors: F M Almajid
Journal: Case Rep Infect Dis (2017)
MeSH terms: Case Reports

Brucellosis is still endemic in certain parts of the world including the Mediterranean, the Middle East, Latin America, and African regions. Osteoarticular manifestations are common presenting features. Brucellosis presenting as prepatellar bursitis has already been reported. We present a case of seronegative olecranon bursitis with positive blood and aspirate cultures. The patient improved remarkably by treatment with streptomycin and doxycycline with no evidence or relapse.
Development of Fulminant Type 1 Diabetes Mellitus in a Patient with DRESS Syndrome
Authors: Pedro Perez, Wilson Sze, Daniel Lozeau, Dipa Avichal, Joshua Miller
Journal: Case Rep Endocrinol (2020)
MeSH terms: Case Reports

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, also known as drug-induced hypersensitivity syndrome, is a serious, sometimes lethal, immunological reaction to drug metabolites involving multiple organ systems. Some of the common causative agents of DRESS include allopurinol, minocycline, sulfasalazine, azathioprine, antiepileptic drugs, and hydroxychloroquine. DRESS is often misdiagnosed and challenging to clinically manage due to the disease's myriad presentations, acute complications, and long-term sequela after initial resolution. We present the case of a 39-year-old female patient that developed type 1 diabetes as a sequela of DRESS. The patient originally presented to the emergency department with three days of fevers and a pruritic erythematous maculopapular rash that began two weeks prior. She had recently started an antibiotic course and had also been on a long-term antiepileptic drug regimen. Following a thorough clinical examination, the patient was diagnosed with DRESS and treated accordingly. Over the next four months, she went on to have multiple hospitalizations with several admissions to the medical intensive care unit. She had numerous complications including significant facial edema, seizures, bacterial pneumonia, sepsis, hypovolemic shock, acute respiratory distress syndrome, diabetic ketoacidosis, nonalcoholic steatohepatitis, liver failure, and recurring DRESS rashes despite treatment with high-dose intravenous steroids and immunosuppressants. During this time, the patient developed a rare form of uncontrolled type 1 diabetes mellitus not explained by autoantibody production or continued high-dose steroid use. Fulminant type 1 diabetes mellitus is a sequela of DRESS that is poorly understood and rarely reported. When it occurs, it significantly and negatively affects patient prognosis and requires careful monitoring to assure proper glycemic control.
A case report of simultaneous PML-IRIS during corticosteroids tapering in a patient with an anti-synthetase syndrome
Authors: Guillaume Martin-Blondel, David Brassat, Hervé Dumas, Emmanuelle Uro-Coste, Daniel Adoue, Hans Lassmann, Michel Clanet
Journal: F1000Res (2013)

We report a case of simultaneous progressive multifocal leukoencephalopathy-associated immune reconstitution inflammatory syndrome (PML-IRIS) during corticosteroid tapering in a patient with an anti-synthetase syndrome. We describe the challenges associated with the diagnosis and the management of this emerging inflammatory neurological condition in this immunocompromised patient with a severe rheumatic disease. We highlight that, in the setting of IRIS, the low-level of the JC virus viral load requires a sensitive PCR assay before excluding PML.
Dermatomyositis With Dual Positive Anti-melanoma Differentiation-Associated Gene 5 and Anti-Sjogren Syndrome-Related Antigen 52 kD Antibodies: A Case Report and Literature Review on Clinical Characteristics
Authors: Guru Prasad Parthiban, Sowbharnika Arivazhagan, Shiva Charan Anaji, Aaron Williams
Journal: Cureus (2023)
Keywords: anti-mda5 amyopathic dermatomyositis, anti-ssa antibody, dermatomyositis, idiopathic inflammatory myopathies, rapid progressive interstitial lung disease
MeSH terms: Case Reports

Anti-melanoma differentiation-associated gene 5 (MDA 5) is one of the subtypes of dermatomyositis associated with rapidly progressive lung disease. MDA 5 carries a high mortality risk due to respiratory failure. The exact pathophysiology is unclear, but it is linked to genetic predisposition and viral triggers with the associated innate response and cytokine production like interleukins IL-1,6,18, tumor necrosis factor-alpha, and interferons. It is usually treated with anti-cytokines, high-dose steroids, immunosuppressants, and plasma exchange. Due to the atypical presentation and rapidity of the disease course, the diagnosis is often delayed. We report a 39-year-old female presenting with rapidly progressive lung disease secondary to an aggressive form of dermatomyositis.
Acute Low-Dose Hydralazine-Induced Lupus Pneumonitis
Authors: Sarah K Holman, Donique Parris, Sarah Meyers, Jason Ramirez
Journal: Case Rep Pulmonol (2017)
MeSH terms: Case Reports

A 35-year-old female was started on hydralazine 10 mg orally three times a day for treatment of postpartum hypertension. Three months later, after multiple unsuccessful courses of prednisone and antibiotics for presumed pneumonia and asthma exacerbations, her respiratory symptoms progressed in severity and she developed resting hypoxia. Previous diagnostic work-up included spirometry with a restrictive pattern, chest CT showing bilateral basilar consolidation, negative BAL, and nonspecific findings on lung biopsy of mild inflammatory cells. Review of systems was positive for arthralgia, lymphadenopathy, paresthesia, and fatigue that began four weeks after starting hydralazine. A clinical diagnosis of hydralazine-induced lupus (HIL) with pneumonitis was made. Antihistone antibodies were positive supporting a diagnosis of HIL. Management included cessation of hydralazine and a prolonged steroid taper. Within days, patient began improving symptomatically. Six weeks later, CT chest showed complete resolution of infiltrates. Genetic testing revealed she was heterozygous for N-acetyltransferase 2 (intermediate acetylator). Drug-induced lupus should be considered in patients with lupus-like symptoms taking medications with a known association. While the majority of HIL cases occur with high doses and prolonged treatment, cases of low-dose HIL have been reported in patients who are slow acetylators.
Case report: Uncommon multiple metastases from occult breast cancer revealed by 68Ga-DOTATATE PET/CT
Authors: Tianyuan Hu, Rongqin Zhang, Bing Zhang, Shanzhen He, Lian Liu, Yan Zou, Junhao Huang, Bing Wang, Ping Hu, Zhanwen Zhang
Journal: Front Oncol (2023)
Keywords: 18f-fdg, 68ga-dotatate, pet/ct, lymph node metastases, occult breast cancer
MeSH terms: Case Reports

Occult breast cancer is an uncommon type of breast cancer and its diagnosis is challenging. It is usually invisible on multiple imaging examines. Metastases to the rectum and inguinal lymph nodes from occult breast lobular cancer are even rarer. 68Ga-DOTA peptides can image neuroendocrine tumors by targeting specific somatostatin receptors. Besides, other tumors, including breast cancer, have been shown to express somatostatin receptors. In this case, we presented a 63-year-old woman who underwent both 18F-FDG and 68Ga-DOTATATE PET/CT due to a rectal polyp. An endoscopic excision biopsy confirmed metastatic carcinoma of suspected breast origin, but subsequent ultrasound and MRI showed no signs of malignancy in the breast and adnexa uteri. PET/CT showed obvious 68Ga-DOTATATE activity in bilateral axillary and right inguinal lymph nodes with mild 18F-FDG uptake. Final histopathology at the left axillary, right inguinal lymph nodes, and rectum indicated metastases from breast cancer while the origin remained radiologically occult. Additionally, one uterine fibroids was found with positive uptake of 68Ga-DOTATATE and negative uptake of 18F-FDG. This case suggested that 68Ga-DOTATAE PET/CT may be an effective supplement in diagnosing OBC lymph node metastases with mild 18F-FDG uptake, and it may provide a new technology for the clinical diagnosis of occult breast cancer.
Vitrectomy with complete posterior hyaloid removal for ischemic central retinal vein occlusion: series of cases
Authors: Carlos Leizaola-Fernández, Luis Suárez-Tatá, Hugo Quiroz-Mercado, Juner Colina-Luquez, J Fromow-Guerra, Juan M Jiménez-Sierra, Jose L Guerrero-Naranjo, Virgilio Morales-Cantón
Journal: BMC Ophthalmol (2005)
MeSH terms: Ischemia / surgery, Retinal Vein Occlusion / surgery, Retinal Vessels, Vitrectomy, Vitreous Body / surgery, Case Reports, Comparative Study, Aged, Basement Membrane / surgery, Electroretinography, Female, Fluorescein Angiography, Follow-Up Studies, Humans, Intraocular Pressure / physiology, Ischemia / physiopathology, Male, Middle Aged, Prospective Studies, Retinal Vein Occlusion / physiopathology, Tomography, Optical Coherence, Visual Acuity / physiology

Background:
Central retinal vein occlusion (CRVO) is a common retinal vascular disorder with potentially complications: (1) persistent macular edema and (2) neovascular glaucoma. No safe treatment exists that promotes the return of lost vision. Eyes with CRVO may be predisposed to vitreous degeneration. It has been suggested that if the vitreous remains attached to the macula owing to a firm vitreomacular adhesion, the resultant vitreous traction can cause inflammation with retinal capillary dilation, leakage and subsequent edema6. The roll of vitrectomy in ischemic CRVO surgical procedures has not been evaluated.
Case presentation:
This is a non comparative, prospective, longitudinal, experimental and descriptive series of cases. Ten eyes with ischemic CRVO. Vitrectomy with complete posterior hyaloid removal was performed. VA, rubeosis, intraocular pressure (IOP), and macular edema were evaluated clinically. Multifocal ERG (m-ERG), fluorescein angiography (FAG) and optic coherence tomography (OCT) were performed. Follow-up was at least 6 months. Moderate improvement of visual acuity was observed in 60% eyes and stabilized in 40%. IOP changed from 15.7 +/- 3.05 mmHg to 14.9 +/- 2.69 mmHg post-operative and macular edema from 976 +/- 196 microm to 640 +/- 191 microm to six month. The P1 wave amplitude changed from 25.46 +/- 12.4 mV to 20.54 +/- 11.2 mV.
Conclusion:
A solo PPV with posterior hyaloid removal may help to improve anatomic and functional retina conditions in some cases. These results should be considered when analyzing other surgical maneuvers.
Papillary cystadenoma of the epididymis
Authors: Olga Lopez, Hisham F Bahmad, Ruben Delgado, Billy H Cordon, Robert Poppiti, Lydia Howard
Journal: Autops Case Rep (2022)
Keywords: case reports, cystadenoma, papillary, epididymis, von hippel-lindau disease
MeSH terms: Case Reports

Background:
Papillary cystadenoma is a rare benign neoplasm of the epididymis. It may occur sporadically or in association with von Hippel-Lindau disease (VHLD). Papillary cystadenoma of the epididymis (PCE) is a benign mimic of metastatic clear cell renal cell carcinoma (CCRCC) given their histologic similarities.
Case presentation:
Herein, we present the case of a 40-year-old man with a four-year history of microhematuria and a recently detected right paratesticular mass. A testicular sonogram revealed a hypoechoic, hypervascular solid mass in the right epididymal head treated by surgical excision. Histopathological examination demonstrated a 1.1 cm papillary cystadenoma of the epididymis. Genetic testing performed later showed no signs of VHLD. However, heterozygous mutations in three genes - CASR, POT1, and RAD51D - were found which have never been reported in PCE before.
Conclusions:
Papillary cystadenoma of the epididymis should always be considered in the differential diagnosis of epididymal lesions, especially those that are cystic. The mainstay of treatment remains surgical excision, which provides an excellent prognosis.
Acute cholecystitis as a rare presentation of metastatic breast carcinoma of the gallbladder: A case report and review of the literature
Authors: Belhachmi Abdelilah, Ouazni Mohamed, Rajae Yamoul, Imane Elkhiyat, A Al Bouzidi, Sifeddine Alkandry, Eheirchou Abdelkader
Journal: Pan Afr Med J (2014)
Keywords: acute cholecystitis, gallbladder, lobular breast carcinoma, metastatic breast cancer
MeSH terms: Breast Neoplasms / pathology, Carcinoma, Lobular / pathology, Cholecystitis, Acute / etiology, Gallbladder Neoplasms / diagnosis, Case Reports, Review, Breast Neoplasms / therapy, Carcinoma, Lobular / therapy, Cholecystectomy / methods, Cholecystitis, Acute / diagnosis, Cholecystitis, Acute / surgery, Female, Gallbladder Neoplasms / pathology, Gallbladder Neoplasms / secondary, Humans, Mastectomy / methods, Middle Aged

Breast cancer is usually associated with metastases to lungs, bones and liver. Breast carcinoma metastasizing to the gallbladder is very rare. We report the case of 45-year-old female with clinical presentation of acute Cholecystitis, who underwent cholecystectomy in emergency. The Gallbladder showed a nodule on the Gallbladder wall. Histological examination disclosed a metastasis from a lobular breast carcinoma with positive hormone receptors. The patient had received three months previously a right mastectomy with axillar dissection followed by chemotherapy and radiotherapyfor lobular breast cancer stage III, PT3N1M0, showing hormone receptors. We present a rare case of acute cholecystitis from metastatic breast cancer three months after management of primary cancer.
Case Report: Uniportal Video-Assisted Thoracoscopic Parenchymal Sparing Secondary Carinal Resection and Reconstruction for the Treatment of Tracheobronchial Mucoepidermoid Carcinoma
Authors: Yan Hu, Xiaofeng Chen, Siying Ren, Chao Zeng, Li Wang, Peng Xiao, Fenglei Yu, Wenliang Liu
Journal: Front Surg (2022)
Keywords: parenchymal sparing procedure, secondary carinal reconstruction, tracheobronchial mucoepidermoid carcinoma, uniportal, video-assisted thoracoscopic surgery
MeSH terms: Case Reports

Surgical resection is currently the mainstay of treatment for tracheobronchial mucoepidermoid carcinoma (TMEC). The parenchymal sparing secondary carinal resection and reconstruction for TMEC under the uniportal thoracoscopic approach has seldomly been reported in the literature. Here, we report a case of a 42-year-old male patient complaining of the incidental finding of a 1.5 × 1.2 cm neoplasm at the opening of the right bronchus intermedius and a 5.1 × 3.1 cm patchy lesion located at the left upper lobe by chest CT scans in February 2021. This patient successively underwent fiberoptic bronchoscopic biopsy of the bronchial neoplasm and CT-guided biopsy of the left upper lobe lesion. Pathological examination confirmed the diagnosis of the endobronchial mass in the right bronchus intermedius as low-grade mucoepidermoid carcinoma and left upper lobe lesion as tuberculosis. This patient successfully underwent uniportal thoracoscopic parenchymal sparing tumor resection, reconstruction of the secondary carina and lymphadenectomy at our center. Intraoperative frozen section showed no residual cancer at any bronchial stumps. Postoperative pathology indicated that no metastases were seen in any of the resected lymph nodes. The patient recovered well after surgery. He received a 9-month course of anti-tuberculosis treatment postoperatively. He did not complain of any special discomfort and there was no local recurrence at the 9-month postoperative follow-up. Although technical demanding, this case highlights that uniportal video-assisted thoracoscopic parenchymal sparing secondary carinal resection and reconstruction for TMEC is safe and feasible with the preservation of lung function and excellent outcomes.
Genomic and transcriptomic analysis of MSI-H colorectal cancer patients with targetable alterations identifies clinical implications for immunotherapy
Authors: Hanju Hua, Wenguang He, Nan Chen, Yinjun He, Guosheng Wu, Feng Ye, Xile Zhou, Yandong Li, Yongfeng Ding, Weixiang Zhong, Lisong Teng, Weiqin Jiang, Qinsong Sheng
Journal: Front Immunol (2023)
Keywords: gep, msi-h cancer, tme (tumor microenvironment), immunotherapy, targetable alterations
MeSH terms: Colonic Neoplasms, Transcriptome, Research Support, Non-U.S. Gov't, Female, Gene Expression Profiling, Genomics, Humans, Immunotherapy / methods, Microsatellite Instability, Retrospective Studies, Tumor Microenvironment / genetics

Introduction:
Targetable alterations such as BRAFV600E mutation and NTRK fusion are enriched in microsatellite instability-high (MSI-H) colorectal cancer (CRC). MSI-H with targetable alterations (MSI-H altered) might present unique opportunities for both targeted therapy and immunotherapy. We systematically evaluated the molecular characteristics and immune-related features of MSI-H altered and MSI-H without targetable alterations (MSI-H wt) CRC patients in our study.
Methods:
Among 1938 continuously enrolled CRC patients, 126 patients with MSI-H status (6.50%) were included in this retrospective study. Genomic and transcriptomic data were investigated by next-generation sequencing (NGS) and gene expression profiling (GEP), respectively.
Results:
BRAFV600E, NTRK1, and FGFR2 mutations were the most frequent targetable alterations in MSI-H CRC patients. The MSI-H altered phenotype was significantly associated with older age (p< 0.001), right side (p=0.024) and females (p= 0.036). No lynch syndrome (LS) patients were identified in MSI-H altered group. The tumor mutational burden (TMB), and tumor neoantigen burden (TNB) of MSI-H altered and wt subgroups were comparable (p<0.05). Subsequently, transcriptomic study analysis further revealed MSI-H altered CRC patients were linked to an immune-active tumor microenvironment with higher levels of Teff IFN-gamma, CYT, and MERCK 18 signatures, and lower levels of the IPRES gene signature, EMT and TGF Beta signatures. In addition, case study supported MSI-H CRC patient harboring targetable alterations might also achieved a long-term disease-free survival benefit from immunotherapy.
Discussion:
Our study preliminary revealed MSI-H altered as a novel subtype of MSI-H CRC patients with unique molecular signatures and immune-active tumor microenvironment. Given the accessibility of immune checkpoint inhibitors (ICIs) treatment, our results might provide clinical evidence for immunotherapy in MSI-H CRC patients with targetable alterations.