OpenMed/multicare-articles huggingface dataset:
Thrombotic microangiopathy following chimeric antigen receptor T-cell therapy
Authors: Matthew S Wu, Abbal Koirala
Journal: Clin Nephrol Case Stud (2023)
Keywords: car-t, endothelium, thrombotic microangiopathy, transplant
MeSH terms: Case Reports

Introduction:
Thrombotic microangiopathy (TMA) is characterized by microangiopathic hemolytic anemia and is associated with a variety of conditions and following hematopoietic stem cell transplantation. Chimeric antigen receptor T-cell (CAR-T) therapy is a novel immunotherapeutic approach using genetically modified autologous T cells. CAR-T therapy has been linked with injuries to vascular endothelium, but a direct association between CAR-T and TMA has not been reported.
Case reports:
Two cases of TMAs following CAR-T treatment are reported here. In each case, clinical evidence of kidney injury, thrombocytopenia, and hemolytic anemia became apparent 2 - 3 months following CAR-T infusion. We describe the clinical course, management, and outcome of these experiences.
Discussion/conclusion:
CAR-T cell therapy-associated TMA (CAR-T TMA) appear to be an entity that shares overlapping clinical features with transplant-associated TMA (TA-TMA). Based on our preliminary clinical observations, we discuss the best clinical diagnosis/classification criteria, underlying pathophysiology, and the implication of the apparently self-limiting course. With increasing use of CAR-T cell treatment in hematologic malignancies, systematic studies will be necessary to improve management of CAR-T TMA.
Expert Opinion on Three Clinical Cases with a Common Urgent Problem: Urge Urinary Incontinence
Authors: Andrea Tubaro, John Heesakkers, Jean Nicolas Cornu, Dudley Robinson
Journal: Case Rep Urol (2018)
MeSH terms: Case Reports

Urgency is the cornerstone symptom of overactive bladder (OAB) syndrome, which is associated with reduced health-related quality of life (HRQoL) and affects patients with different profiles. We report here three clinical pictures of OAB: a male patient with mixed lower urinary tract symptoms (LUTS), a young woman with comorbidities, and an elderly woman with mixed urinary incontinence. The aim is to analyze the specificities of these real cases, to discuss what would be the most appropriate management, and how treatment with fesoterodine, an antimuscarinic agent with key pharmacological properties, might meet the patients' expectations. Relevant and constructive messages are drawn: urgency, the cornerstone symptom, should be given special attention; fesoterodine is effective and well tolerated in the elderly; before switching to another medication consider increasing the dosage of fesoterodine; the major goal of initial therapy is to meet patient expectations; and involving the patient in the treatment plan increases her/his adherence.
Exertional Dyspnea Incidentally Diagnosed as Sarcoidosis: A Teaching Hospital Experience
Authors: Melvina Nartey, Kofi Ulzen-Appiah
Journal: Case Rep Pulmonol (2023)
MeSH terms: Case Reports

Background:
Sarcoidosis is a complex disease with nonspecific etiology and clinical presentation. Its diagnosis is often delayed due to the absence of a single specific investigation modality. A multidisciplinary approach is necessary for its diagnosis. Report. A 49-year-old male presented with recurrent dyspnea on exertion, easy fatigue, and chest pain after several visits to different health facilities over 5 months. A diagnosis of pulmonary sarcoidosis was made after a series of laboratory and imaging investigations were done revealing bilateral reticonodular opacifications, noncaseating granulomata, elevated serum ACE and calcium levels consistent with sarcoidosis.
Conclusion:
Sarcoidosis, although a rare presentation in our setting, may easily be overlooked or misdiagnosed if a holistic or multidisciplinary approach is not employed in its diagnosis. Nonspecificity of symptoms contributes to the delayed diagnosis.
Life-quality of orthognathic surgery patients: the search for an integral diagnosis
Authors: José Augusto Mendes Miguel, Nathália Barbosa Palomares, Daniela Feu
Journal: Dental Press J Orthod (2014)
Keywords: orthodontics, orthognathic surgery, quality of life
MeSH terms: Malocclusion / psychology, Orthognathic Surgical Procedures / psychology, Patient Care Planning, Quality of Life, Case Reports, Review, Activities of Daily Living, Adult, Esthetics, Dental, Humans, Interpersonal Relations, Male, Malocclusion / surgery, Malocclusion, Angle Class II / psychology, Malocclusion, Angle Class II / surgery, Malocclusion, Angle Class III / psychology, Malocclusion, Angle Class III / surgery, Motivation, Oral Health, Patient Satisfaction, Self Concept, Surveys and Questionnaires, Treatment Outcome, Young Adult

The decision on whether starting an orthosurgical treatment depends on the negative esthetic, functional and social impact the dentofacial deformity has on the quality of life of each patient. The objective of this article is to demonstrate the importance of assessing the quality of life of these individuals by means of applying specific questionnaires before treatment onset in order to increase the success rate of orthosurgical treatment. These questionnaires assess not only the esthetic factor, but also the functional conditions that may be affected as well as the psychological issues related to self-esteem and sociability, all of which must be assessed in order to enable the development of an individual treatment plan that meets patient's expectations. Thus, a more predictable level of satisfaction can be achieved at treatment completion, not only from a normative standpoint stated by professionals, but also from a subjective standpoint stated by patients. Although not enough comparable data is available in the literature for us to assess the extent of improvements produced by orthosurgical treatment, a few recent reports conducted by different universities around the world reveal a good response from the majority of patients after surgery, demonstrating great satisfaction with regard to esthetic, functional and psychosocial factors. Therefore, it is reasonable to conclude that the current objective of orthodontic treatment associated with orthognathic surgery consists not only in treating the esthetic functional components of dentofacial deformities, but also in considering patients' psychological factor.
Endometrial carcinoma in a young subfertile woman with polycystic ovarian syndrome
Authors: K Jayakrishnan, R Anupama, Aby Koshy, R Raju
Journal: J Hum Reprod Sci (2010)
Keywords: endometrial adenocarcinoma, infertility, polycystic ovaries
MeSH terms: Case Reports

Adenocarcinoma of the endometrium is a morbid condition in women under 40 years of age with an incidence of 25%. However, patients with anovulatory polycystic ovarian syndrome are at risk of developing endometrial carcinoma. The disease is often advanced when diagnosed, thereby depriving the woman of the option for fertility sparing conservative approach. In young women with menstrual abnormalities and polycystic ovarian disease and/or infertility, an endometrial evaluation should be performed. Carcinoma endometrium should be kept in mind while evaluating young women with polycystic ovary syndrome for abnormal uterine bleeding. Only strictly selected patients should, therefore, be indicated for long-term progestogen treatment and careful evaluation before and after treatment should be performed.
Segmental Pigmentation Disorder: A Case Report of Hypopigmented Patch
Authors: Ammar Bakhsh, Khalid Al Hawsawi, Ola Y Bahadur, Ruba Z Alotaibi, Mohammed F Bondagji, Sarah M Fageeh
Journal: Cureus (2023)
Keywords: early childhood, mosaicism, segmental pigmentation disorder, segmental vitiligo, vitiligo
MeSH terms: Case Reports

A segmental pigmentation disorder (SPD) is a form of pigmentary mosaicism. SPD is a hypo- or hyperpigmented patch that has a segmental pattern. A 16-year-old male with an insignificant past medical history presented with symptomless, slowly progressive skin lesions since early childhood. Skin examination revealed well-demarcated, non-scaling, hypopigmented patches on the right upper extremity. A similar spot was located on his right shoulder. Wood's lamp examination showed no enhancement. Differential diagnoses included segmental pigmentation disorder and segmental vitiligo (SV). A skin biopsy was obtained, which revealed normal findings. Based on the above clinicopathological findings, a diagnosis of segmental pigmentation disorder was made. The patient did not receive any treatment but was reassured that he did not have vitiligo.
Primary Signet-Ring Cell Carcinoma of the Urinary Bladder Successfully Managed with Radical Cystectomy in a Young Patient
Authors: Farzad Allameh, Morteza Fallah Karkan, Yalda Nilipour, Azadeh Rakhshan
Journal: Case Rep Urol (2017)
MeSH terms: Case Reports

Primary signet-ring cell adenocarcinoma of bladder is a rare neoplasm, usually seen in middle age adults. We report the case of an 18-year-old man who presented with intermittent gross hematuria. Computed tomography imaging showed multifilling defects in the bladder. The patient underwent a transurethral resection of the bladder tumor. Histological findings were consistent with poorly differentiated mixed mucinous and signet-ring cell adenocarcinoma. We ruled out other possible origins of tumor by gastrointestinal endoscopy and colonoscopy. The patient was treated with radical cystectomy with prostate and seminal vesicle sparing technique and orthotopic diversion using "W" ileum pouch with pelvic lymphadenectomy to the bifurcation of the aorta was done. Six-month follow-up of patient showed normal conditions without metastatic spread or any recurrence.
Case Report: Clinical benefit from multi-target tyrosine kinase inhibitor and PARP inhibitor in a patient with cancer of unknown primary with BRCA1 large genomic rearrangement
Authors: Ling Yu, Jietao Lin, Hanhan Li, Lingling Sun, Shubo Wang, Yaoxu Chen, Hanrui Chen, Lizhu Lin
Journal: Front Pharmacol (2023)
Keywords: brca1, anlotinib, cancer of unknown primary, large genomic rearrangement, olaparib
MeSH terms: Case Reports

Background: Cancer of unknown primary (CUP), which accounts for 3%-5% of new cancer cases every year, involves the presence of a type of histologically confirmed metastatic tumors whose primary site cannot be confirmed by conventional diagnostic methods. This difficulty in identifying the primary site means that CUP patients fail to receive precisely targeted therapy. Most patients are treated with empiric chemotherapy, with a median survival of 6 months and even poorer prognosis within an unfavorable subset of CUP. Case report: An 80-year-old woman presented with masses in the abdomen. Following comprehensive imagological and immunohistochemical examinations, she was diagnosed with CUP. She emphatically declined chemotherapy; thus, anlotinib has been administered with patient consent since 02/07/2019, and stable disease (SD) was observed for 2 years. During subsequent treatment, a large genomic rearrangement in BRCA1 was identified in the patient via NGS, and SD was observed for a further 6 months following olaparib treatment. The type of LGR identified in this patient was discovered to be BRCA1 exon 17-18 inversion (inv), which has never been previously reported. Conclusion: For CUP patients, a chemo-free regimen seems to be acceptable as a first-line treatment, and NGS-guided targeted treatment could improve patient outcomes.
Case report: A disconjugate pattern in video head impulse testing hints toward a central cause of acute vertigo
Authors: Vincent G Wettstein, Bertram Feil, Marie-Luise Mono
Journal: Front Neurol (2023)
Keywords: ino, binocular, disconjugate, internuclear ophthalmoplegia, neurosarcoidosis, video head impulse test (vhit)
MeSH terms: Case Reports

When acute vertigo occurs, the challenge for the medical practitioner lies in the focused assessment to find the cause of its symptoms. Especially in the case of central pathology, a fast diagnosis is essential for therapy. The head impulse, nystagmus, test of skew (HINTS) protocol and the additional video head impulse test (VHIT) can distinguish between central and peripheral vestibular causes in the acute setting and thus help to set the right path for further evaluation and treatment. In this case, a patient with acute onset of vertigo presented with an unusual pattern in the VHIT. Binocular eye tracking showed a disconjugate horizontal vestibulo-ocular reflex (VOR) with severe loss or gain for the adducting eye yet with a lack of corrective saccades. The abducting eye produced a pattern of mild VOR gain loss yet with pronounced corrective saccades. Together with clinical findings that were compatible with internuclear ophthalmoplegia, a probable central lesion in the medial longitudinal fasciculus (MLF) region was suspected. The patient was sent to a tertiary hospital, where the initial MRI was negative, but due to additional neurological symptoms occurring later, multiple lesions in the cervical spine and cerebellum were detected. The hypothesis of an inflammatory demyelinating disease of the central nervous system (CNS) was made. A further workup led to the final diagnosis of neurosarcoidosis. In a retrospective neuroradiologic assessment, an alteration compatible with a non-active demyelinating lesion in the MLF was detected on secondary imaging as a probable cause of the initial pathophysiologic finding. In this report, we aimed to highlight the unusual case of a disconjugate VOR as a distinctive VHIT pattern hinting toward a central cause of acute vertigo that clinicians should be aware of.
Sudden Cardiac Death due to Coronary Artery Vasculitis in a Patient with Relapsing Polychondritis
Authors: Heather Bukiri, Steven M Ruhoy, Jane H Buckner
Journal: Case Rep Rheumatol (2020)
MeSH terms: Case Reports

Relapsing polychondritis (RP) is a systemic autoimmune disease characterized by relapsing and remitting inflammation of the cartilaginous structures of the ears, nose, tracheobronchial tree, and joints. Diagnosis is challenging due to the heterogeneity of clinical manifestations, the relapsing and remitting nature of the disease, the presence of coexistent diseases in at least one-third of patients, and the lack of a diagnostic blood test. Although RP-associated cardiac disease is the second most common cause of death behind tracheobronchial complications, coronary artery vasculitis is rare. This report describes a case of sudden cardiac death due to vasculitis affecting the coronary arteries in a patient with RP. The pathologic findings included obliterative coronary arteritis with plasma cells and storiform fibrosis, features suggesting that IgG4-related disease (IgG4-RD) may have contributed to the patient's cardiac disease. The literature on vasculitis and cardiac disease in RP and the possible role of IgG4-RD in this setting is also reviewed. The primary take-home message from this case report is the importance of frequent screening for cardiac disease, regardless of symptoms, in patients with RP. In addition, considering the diagnosis of IgG4-RD in some cases thought to be RP may also be warranted.
An unusual case of myonecrosis
Authors: P Mukhopadhyay, R Barai, C A Philips, J Ghosh, S Saha
Journal: Case Rep Endocrinol (2011)
MeSH terms: Case Reports

Diabetic Myonecrosis is a rare complication of long-standing Diabetes Mellitus Type 1 and 2. The most likely affected areas are of proximal lower limbs, mostly the quadriceps muscle. The presenting features are myriad and a diagnostic conundrum for the physician. There has been previously mentioned, through few case reports, the classical presentation of diabetes-related muscle infarction. Here we present a patient of diabetic myonecrosis, in whom the initial presentation of diabetes mellitus was that of bilateral symmetric proximal upper limb predominant muscle infarction, which has never been reported before.
Arthroscopic Excision for Intra-Articular Osteoid Osteoma of the Olecranon Fossa: A Case Report and Literature Review
Authors: Koichi Yano, Yasunori Kaneshiro, Hideki Sakanaka
Journal: Case Rep Orthop (2020)
MeSH terms: Case Reports

Intra-articular osteoid osteoma (OO) of the elbow is rare. We report a 26-year-old man who presented with pain, swelling, and limited elbow range of motion. Plain computed tomography (CT) showed a radiolucent round lesion at the distal humerus and reactive bone in the olecranon fossa. Conservative treatment with salicylate failed under the suspicion of OO. During elbow arthroscopy, a red solitary lesion was noted after resection of the white reactive bone in the olecranon fossa and was excised en bloc using a bony chisel. Histological examination showed OO. The patient's symptoms resolved the day after surgery. The patient remained asymptomatic 2 years postoperatively. This case report shows the successful clinical results of an arthroscopic procedure for intra-articular OO based on two primary goals: precise location of the lesion indicated by reactive bone on preoperative CT and histological verification using bony chisel.
Successful treatment of a child with vascular pythiosis
Authors: Tavitiya Sudjaritruk, Virat Sirisanthana
Journal: BMC Infect Dis (2011)
MeSH terms: Iliac Artery / surgery, Leg / blood supply, Pythiosis / surgery, Case Reports, Amputation, Surgical, Child, Humans, Iliac Artery / parasitology, Leg / parasitology, Leg / surgery, Male, Pythiosis / parasitology, Pythium / isolation & purification, Pythium / physiology

Background:
Human pythiosis is an emerging and life-threatening infectious disease caused by Pythium insidiosum. It occurs primarily in tropical, subtropical and temperate areas of the world, including Thailand. The aim of this report is to present the first pediatric case of typical vascular pythiosis.
Case presentation:
A 10-year-old boy with underlying β-thalassemia presented with gangrenous ulcers and claudication of the right leg which were unresponsive to antibiotic therapy for 6 weeks. Computerized tomography angiography indicated chronic arterial occlusion involving the right distal external iliac artery and its branches. High-above-knee amputation was urgently done to remove infected arteries and tissues, and to stop disease progression. Antibody to P. insidiosum was detected in a serum sample by the immunoblot and the immunochromatography tests. Fungal culture followed by nucleic sequence analysis was positive for P. insidiosum in the resected iliac arterial tissue. Immunotherapeutic vaccine and antifungal agents were administered. The patient remained well and was discharged after 2 months hospitalization without recurrence of the disease. At the time of this communication he has been symptom-free for 2 years.
Conclusions:
The child presented with the classical manifestations of vascular pythiosis as seen in adult cases. However, because pediatricians were unfamiliar with the disease, diagnosis and surgical treatment were delayed. Both early diagnosis and appropriate surgical and medical treatments are crucial for good prognosis.
Novel double beta-lactam therapy for Granulicatella adiacens infective endocarditis
Authors: S Khan, C Urban, V Singh, D Liu, S Segal-Maurer, Y Parmar, J Yoon
Journal: IDCases (2021)
Keywords: double beta-lactam therapy, granulicatella adiacens, infective endocarditis, synergy
MeSH terms: Case Reports

Granulicatella adiacens, a nutritionally variant streptococci (NVS) is a well described organism associated with endocarditis. Previously communicated cases have documented the use of double beta-lactam therapy with ampicillin and ceftriaxone to treat patients with infective endocarditis due to Enterococcus faecalis and Streptocossus pneumoniae. We describe the first case of Granulicatella adiacens infective endocarditis in a patient successfully treated with the combination of intravenous ampicillin and ceftriaxone and document their synergistic activity.
Acute Interstitial Nephritis in a Patient with Non-Small Cell Lung Cancer under Immunotherapy with Nivolumab
Authors: Panagiotis I Georgianos, Vasilios Vaios, Eleni Leontaridou, Georgia Karayannopoulou, Triantafyllia Koletsa, Athanasios Sioulis, Elias V Balaskas, Pantelis E Zebekakis
Journal: Case Rep Nephrol (2019)
MeSH terms: Case Reports

Immune-checkpoint-inhibitors (ICPIs) represent a novel class of immunotherapy against several malignancies. These agents are associated with several "immune-mediated" adverse effects, but the reported renal toxicity of ICPIs is less well defined. We present the case of a 60-year-old man with a history of non-small cell lung cancer, who developed acute kidney injury (AKI) approximately 3.5 months after initiation of immunotherapy with nivolumab. Urinalysis revealed sterile pyuria, without microscopic hematuria or proteinuria. Immunological examination was negative. A renal biopsy showed severe interstitial inflammatory infiltration of T-cells, monocytes, and eosinophils without interstitial granulomas and normal appearance of glomeruli, indicating acute interstitial nephritis (AIN) as the cause of AKI. After a short-term course of corticosteroids and permanent nivolumab discontinuation, partial recovery of renal function was noted. AIN is a rare adverse effect of ICPIs that mandates the close monitoring of renal function in patients under immunotherapy with these agents.
Papillary Carcinoma Occurrence in a Thyroglossal Duct Cyst with Synchronous Papillary Thyroid Carcinoma without Cervical Lymph Node Metastasis: Two-Cases Report
Authors: F B Sobri, M Ramli, U N Sari, M Umar, D K Mudrick
Journal: Case Rep Surg (2015)

Background. We present two rare cases of papillary carcinomas which appeared in thyroglossal duct cysts. These cases highlight that thyroglossal duct cyst can serve as malignancy of thyroid gland. Methods. A retrospective case report was carried out on 2 patients at Cipto Mangunkusumo Hospital. Results. A 57-year-old man presented with enlarged right anterior and midline neck mass, which preoperatively were diagnosed as thyroglossal duct cyst (TDC) and nontoxic multinodular goiter. A total thyroidectomy and Sistrunk procedure were performed. In the second case, a 35-year-old woman presented with a lump which occurred at anterior neck region without palpable mass at the thyroid. Preoperatively, it was diagnosed as TDC. Sistrunk procedure was performed, followed by total thyroidectomy a month after the first operation. Histopathology showed papillary thyroid carcinoma in both patients. Conclusion. The occurrence of carcinoma in TDC is very rare but should always be considered as an option in making diagnosis for a neck mass.