OpenMed/multicare-articles huggingface dataset:
Cognitive Behavioral Therapy for Insomnia as Adjunctive Therapy to Antipsychotics in Schizophrenia: A Case Report
Authors: Muneto Izuhara, Hiroyuki Matsuda, Ami Saito, Maiko Hayashida, Syoko Miura, Arata Oh-Nishi, Ilhamuddin Abdul Azis, Rostia Arianna Abdullah, Keiko Tsuchie, Tomoko Araki, Arauchi Ryousuke, Misako Kanayama, Sadayuki Hashioka, Rei Wake, Tsuyoshi Miyaoka, Jun Horiguchi
Journal: Front Psychiatry (2018)
Keywords: cognitive behavioral therapy, cognitive behavioral therapy for insomnia(cbt-i), insomnia, long acting injectable antipsychotic(lai), schizophrenia
MeSH terms: Case Reports

The authors present the case of a 38-year-old man with schizophrenia and with severe insomnia, who attempted suicide twice during oral drug therapy with risperidone. The patient slept barely 2 or 3 h per night, and he frequently took half days off from work due to excessive daytime sleepiness. As a maladaptive behavior to insomnia, he progressively spent more time lying in bed without sleeping, and he repeatedly thought about his memories, which were reconstructed from his hallucinations. His relatives and friends frequently noticed that his memories were not correct. Consequently, the patient did not trust his memory, and he began to think that the hallucinations controlled his life. During his insomniac state, he did not take antipsychotic drugs regularly because of his irregular meal schedule due to his excessive daytime sleepiness. The authors started cognitive behavioral therapy for insomnia (CBT-i) with aripiprazole long acting injection (LAI). CBT-i is needed to be tailored to the patient's specific problems, as this case showed that the patient maladaptively use chlorpromazine as a painkiller, and he exercised in the middle of the night because he believed he can fall asleep soon after the exercise. During his CBT-i course, he learned how to evaluate and control his sleep. The patient, who originally wanted to be short sleeper, began to understand that adequate amounts of sleep would contribute to his quality of life. He finally stopped taking chlorpromazine and benzodiazepine as sleeping drugs while taking suvorexant 20 mg. Through CBT-i, he came to understand that poor sleep worsened his hallucinations, and consequently made his life miserable. He understood that good sleep eased his hallucinations, ameliorated his daytime sleepiness and improved his concentration during working hours. Thus, he was able to improve his self-esteem and self-efficacy by controlling his sleep. In this case report, the authors suggest that CBT-i can be an effective therapy for schizophrenia patients with insomnia to the same extent of other psychiatric and non-psychiatric patients.
Glandular odontogenic cyst of the maxilla: a case report and literature review
Authors: Nigel Roque Figueiredo, Ajit Dattatray Dinkar, Manisha Maruti Khorate
Journal: Pan Afr Med J (2016)
Keywords: jaw, maxilla, odontogenic cyst
MeSH terms: Epithelium / pathology, Maxillary Diseases / diagnosis, Odontogenic Cysts / diagnosis, Case Reports, Review, Female, Humans, India, Maxillary Diseases / pathology, Middle Aged, Odontogenic Cysts / pathology

Glandular Odontogenic Cyst is a relatively rare cyst of odontogenic origin, which shows glandular or salivary features that are thought to indicate the pluripotentiality of odontogenic epithelium. It is seen in middle-aged adults, and commonly involves the anterior region of the jaws, especially the mandible. It shows non-specific clinico-radiographic findings which may resemble other lesions, but has characteristic histopathologic features which help in its diagnosis. This paper reports an unusual presentation of a glandular odontogenic cyst which was diagnosed in a 64-year old female in the posterior maxilla, along with a literature review of this cyst, especially the cases reported in India in the past.
Atypical Focal Choroidal Excavation with Macular Hole in a Patient with Alagille Syndrome
Authors: Manami Misawa, Hironobu Tampo, Shinji Makino
Journal: Case Rep Ophthalmol Med (2022)
MeSH terms: Case Reports

This study is aimed at reporting a rare and unusual focal choroidal excavation with a macular hole in a patient with Alagille syndrome (AGS). A 21-year-old woman with an established early-life AGS diagnosis was referred to our hospital prior to liver transplantation. Examination revealed best-corrected visual acuity of 16/20 and 20/20 in the right and left eye, respectively. Slit-lamp examination was positive for posterior embryotoxon in both eyes. Fundoscopy revealed diffuse choroidal hypopigmentation with increased visibility of the choroidal blood vessels and circumferential chorioretinal atrophy in the mid-peripheral and peripheral retina in both eyes. A full-thickness macular hole with underlying focal choroidal excavation was observed in the right eye. Optical coherence tomography through the macula confirmed choroidal excavation with a full-thickness macular hole in the right eye. To our knowledge, this is the first report describing focal choroidal excavation with a macular hole in an AGS patient.
Case report: Effectiveness of sirolimus in a de novo FAS mutation leading to autoimmune lymphoproliferative syndrome-FAS and elevated DNT/Treg ratio
Authors: Hao Gu, Zhenping Chen, Jie Ma, Jingyao Ma, Lingling Fu, Rui Zhang, Tianyou Wang, Runhui Wu
Journal: Front Pediatr (2022)
Keywords: alps (autoimmune lymphoproliferative syndrome), dnt, fas (apo-1/cd95), treg - regulatory t-cell, sirolimus (rapamycin)
MeSH terms: Case Reports

Background:
The autoimmune lymphoproliferative syndrome (ALPS) is a rare disease characterized by defective function of the FAS death receptor, which results in chronic, non-malignant lymphoproliferation and autoimmunity accompanied by elevated numbers of double-negative (DN) T cells (T-cell receptor α/β + CD4-CD8-) and an increased risk of developing malignancies later in life.
Case description:
Here, we report a patient with a de novo FAS mutation with a severe phenotype of ALPS-FAS. The FAS gene identified as a novel spontaneous germline heterozygous missense mutation (c.857G > A, p.G286E) in exon 9, causing an amino acid exchange and difference in hydrogen bond formation. Consequently, the treatment with sirolimus was initiated. Subsequently, the patient's clinical condition improved rapidly. Moreover, DNT ratio continuously decreased during sirolimus application.
Conclusion:
We described a novel germline FAS mutation (c.857G > A, p.G286E) associated with a severe clinical phenotype of ALPS-FAS. Sirolimus effectively improved the patient clinical manifestations with obvious reduction of the DNT ratio.
Metastatic Inflammatory Myofibroblastic Tumor of the Spleen: A Case Report and Review of the Literature
Authors: Luca Koechlin, Andreas Zettl, Dieter Koeberle, Markus von Flüe, Martin Bolli
Journal: Case Rep Surg (2016)

Introduction. Inflammatory myofibroblastic tumors (IMT) of the spleen are rare neoplasms and only little is known about the origin and behavior of these tumors. Here we report the case of a 37-year-old woman with an atypical spindle cell neoplasm showing features strongly suggesting an IMT of the spleen with hepatic metastasis. Methods. A 37-year-old patient had been complaining about pain in the left upper abdomen for the last two months. A CT scan revealed a tumor mass in her spleen and liver. After complete staging, a splenectomy and atypical liver resection of segments VII and VIII were performed. Literature was screened for similar cases and existing further literature. Results. A R0 resection was achieved. Histological analysis showed a multinodular infiltration of the spleen by an atypical mesenchymal neoplasia. Immunohistochemically there was an expression of histiocytic markers (CD4, CD68) as well as smooth muscle cell markers (SMA, H-Caldesmon) in the tumor cells. A diagnosis of an atypical spindle cell neoplasm showing features most suggestive of an IMT was rendered. Conclusion. Synchronous hepatic metastasis of an IMT of the spleen is a rarity. Therefore no experience in the treatment of these tumors exists. Fibroblastic reticular cell tumor is a differential diagnosis, but differentiation of these two entities is difficult.
Wilson's Disease: Diagnosis of Wilson's Disease in Ethiopian Young Sisters
Authors: Nebiyu Bekele, Frew Ewnetu, Tigest Hailu, Zerubabel Tegegne, Abilo Tadesse
Journal: Case Rep Med (2020)
MeSH terms: Case Reports

Background:
Wilson's disease is an inherited autosomal recessive disorder of copper metabolism. Clinical signs, biochemical parameters, histologic findings, and/or ATP7B genetic testing are required to diagnose Wilson's disease. Case Presentation. 25-year-old and 22-year-old young women (siblings) presented to the University of Gondar Hospital, Northwest Ethiopia, with difficulty of keeping balance of 3-year duration and progressive extremity weakness of 5-year duration, respectively. Both siblings had visible ocular Kayser-Fleischer rings, low serum ceruloplasmin level and increased urinary copper content, ultrasound-evidenced cirrhotic liver disease, and axial T2-weighted MRI hyperintensities in basal ganglia, thalamus, and brainstem (midbrain and pons). Diagnosis of Wilson's disease was established in both patients using a diagnostic scoring system proposed by "8th International Meeting on Wilson Disease and Menkes Disease, Leipzig (2001)." Treatment with D-penicillamine as a chelator and zinc sulphate as a metalothionein-inductor was started. Screening of their family members was recommended.
Conclusion:
Wilson's disease, declared to be an orphan disease, requires clinical acumen of physicians and expensive investigation modalities for prompt recognition and is inaccessible as required, lifelong drugs for treatment.
Dermatitis Artefacta: A Challenging Case Report
Authors: Lena Basfar, Ahmed Almadfaa, Bashayr A Nazer, Khalid Al Hawsawi, Shahad T Khayyat
Journal: Cureus (2023)
Keywords: dermatitis artefacta, excoriations, factitious disorder, rare, self-inflicted injury
MeSH terms: Case Reports

We report a 31-year-old female presented with a history of recurrent skin and oral lesions for 10 years. She brought a histopathology report confirming the diagnosis of pemphigus vulgaris (PV), which was found to be faked with no patient information and lacked letterhead. Skin and oral examination only reveal multiple linear upper lip erosions. We believed the patient had a preliminary diagnosis of PV, and we asked the patient to continue her medications. Based on the conflicting history and occurrence of contradictory issues, a diagnosis of dermatitis artefacta was made. The patient improved after four sessions of dialectical therapy.
Should we investigate mitochondrial disorders in progressive adult-onset undetermined ataxias?
Authors: José Luiz Pedroso, Wladimir Bocca Vieira de Rezende Pinto, Orlando Graziani Povoas Barsottini, Acary Souza Bulle Oliveira
Journal: Cerebellum Ataxias (2020)
Keywords: ataxia, cerebellar ataxia, merrf syndrome, mitochondrial diseases
MeSH terms: Case Reports

Background:
Despite the broad development of next-generation sequencing approaches recently, such as whole-exome sequencing, diagnostic workup of adult-onset progressive cerebellar ataxias without remarkable family history and with negative genetic panel testing for SCAs remains a complex and expensive clinical challenge.
Case presentation:
In this article, we report a Brazilian man with adult-onset slowly progressive pure cerebellar ataxia, which developed neuropathy and hearing loss after fifteen years of ataxia onset, in which a primary mitochondrial DNA defect (MERRF syndrome - myoclonus epilepsy with ragged-red fibers) was confirmed through muscle biopsy evaluation and whole-exome sequencing.
Conclusions:
Mitochondrial disorders are a clinically and genetically complex and heterogenous group of metabolic diseases, resulting from pathogenic variants in the mitochondrial DNA or nuclear DNA. In our case, a correlation with histopathological changes identified on muscle biopsy helped to clarify the definitive diagnosis. Moreover, in neurodegenerative and neurogenetic disorders, some symptoms may be evinced later during disease course. We suggest that late-onset and adult pure undetermined ataxias should be considered and investigated for mitochondrial disorders, particularly MERRF syndrome and other primary mitochondrial DNA defects, together with other more commonly known nuclear genes.
Anlotinib combined with TAS-102 as the third-line treatment for a patient with metastatic colon cancer: A case report
Authors: Qizheng Li, Xia Zhang, Buqun Fan, Yudie Yang, Xiaonan Cui, Jie Zhang, Kaiteng Jiang, Chunxia Zhang, Bin Zhang
Journal: Front Oncol (2022)
Keywords: tas-102, anlotinib, case report, mcrc, metastatic colon cancer, third-line
MeSH terms: Case Reports

Chemotherapy combined with targeted therapy is a first-line and second-line treatment for metastatic colorectal cancer(mCRC), which has brought survival benefits to mCRC patients, however, disease progression is inevitable. More than 60% of patients still needed third-line treatment after the progress of second-line treatment. After the failure of second-line chemotherapy, treatment compliance and the physical tolerance of patients both decrease. Therefore, choosing an appropriate third-line treatment regimen is key to prolonging survival and improving quality of life. As a novel cytotoxic antitumor drug, trifluridine/tipiracil (TAS-102) is composed of trifluridine (FTD) and tipiracil hydrochloride (TPI). FTD can directly bind to the DNA of cancer cells to cause DNA dysfunction, thereby exerting antitumor effects. TPI can inhibit the degradation of FTD, thereby increasing its cytotoxicity. The few side effects of TAS-102 has become an important reason why clinicians present it as a treatment option to the patient for consideration, clinical trial data for progression free survival are lacking. The exploration of third-line treatment regimens with drug combinations has attracted much attention. This article reports a case of metastatic colon cancer (RAS/BRAF wild type, pMMR/Non-MSI-H), after failure of first-line and second-line therapies, the patient was eventually treated with anlotinib combined with TAS-102 as the third-line treatment. The treatment has shown good efficacy, with a long PFS benefit for more than 20 months and mild adverse reactions. This case reports demonstrates that anlotinib combined with TAS-102 is a promising third-line treatment regimen for refractory mCRC, and provides proof-of-concept for the clinical exploration of optimal third-line combination treatment regimens.
COVID-19 Pneumonia in Asymptomatic Trauma Patients; Report of 8 Cases
Authors: Majid Samsami, Javad Zebarjadi Bagherpour, Behzad Nematihonar, Hamed Tahmasbi
Journal: Arch Acad Emerg Med (2020)
Keywords: covid-19, pneumonia, injuries
MeSH terms: Case Reports

We are currently involved in the novel coronavirus 2019 (COVID-19) pandemic. A considerable number of COVID-19 infected cases are asymptomatic but they can transmit the disease to others, especially healthcare workers. In this study, we reported 8 incidentally detected cases of COVID-19 pneumonia in chest computed tomography (CT) scan of patients referred to emergency department following multiple trauma without any respiratory symptoms.
When a doctor becomes a patient with a mystery illness: a case report
Authors: Brit Haver
Journal: Case Rep Med (2010)
MeSH terms: Case Reports

Symptoms presenting as mental disorders may represent epileptic discharges, especially from the temporal lobe. Both mental and somatic symptoms are common in temporal lobe epilepsy, which may confuse doctors, leading to extensive medical examinations and tests, false diagnoses, and ineffective treatment. Also, the episodic nature and variety of symptoms between as well as in individual cases hinder correct diagnosis. Since epileptic discharges may be visible on EEG only during an epileptic fit-and may need highly specialized equipment to detect-many cases are undiagnosed or treated under false diagnoses. The author believes that undetected temporal lobe epilepsy falsely labelled as psychiatric disorders are common. Specific and effective treatment exists for temporal lobe epilepsy, making correct diagnosis important. This history-based on the author's personal experience-also illustrates aspects of the physician-patients' problems and resources, as well as the gap between somatic and psychiatric medicine concerning this rather common neuropsychiatric disorder.
Adenocarcinoma in bladder diverticulum, metastatic from gastric cancer
Authors: Nobuhisa Matsuhashi, Kazuya Yamaguchi, Taiso Tamura, Kuniyasu Shimokawa, Yasuyuki Sugiyama, Yosuke Adachi
Journal: World J Surg Oncol (2005)

Background:
Metastasis to the urinary bladder from gastric cancer is rare. Metastasis to a diverticulum of the bladder from gastric cancer is extremely rare. We report a case of isolated bladder metastasis from gastric cancer and invasion localized to the muscularis propria of the primary site (stomach).
Case presentation:
A 90-year-old female presented with nausea and vomiting that was diagnosed as gastric cancer, the patient also had intermittent hematuria. Pelvic computed tomography identified an abnormally thickened area in the bladder wall that was diagnosed as a diverticulum of the bladder. A biopsy of the bladder wall revealed well differentiated tubular adenocarcinoma metastatic from gastric carcinoma.
Conclusion:
Almost all cases of bladder metastasis from gastric cancer had peritoneal dissemination. This particular presentation of bladder metastasis from gastric cancer, to the best of our knowledge, has not been previously reported.
Deep Neck Infection: Atypical Presentation of Papillary Thyroid Cancer
Authors: Apichana Mahattanapreut, Rangsima Aroonroch, Chalermchai Chintrakarn, Chutintorn Sriphrapradang
Journal: Case Rep Otolaryngol (2021)
MeSH terms: Case Reports

Deep neck infection is defined as an infectious process in the potential spaces and fascial plane of the neck which may result in a fatal complication. Prompt drainage and broad-spectrum antibiotics are the mainstays of treatment. Deep neck infection as the initial presentation of primary head and neck cancer is not common. Nevertheless, head and neck squamous cell carcinoma is the most common primary head and neck cancer, which could present with cervical metastasis and subsequently becomes infected. Papillary thyroid cancer has a naturally indolent course, and most patients present with a thyroid nodule. However, deep neck infection could be an uncommon presentation of papillary thyroid cancer which may obscure the diagnosis of underlying malignancy. This case report aims to present a rare presentation of papillary thyroid cancer which needs meticulous evaluation. Moreover, the pathological examination should be performed in all cases of deep neck infection for early detection and management of underlying papillary thyroid cancer.
Artificially Positive Crossmatches Not Leading to the Refusal of Kidney Donations due to the Usage of Adequate Diagnostic Tools
Authors: G Schlaf, B Pollok-Kopp, E Schabel, W Altermann
Journal: Case Rep Transplant (2013)

Allografting patients with human leukocyte antigens (HLA) which are recognized by preformed antibodies constitutes the main cause for hyper-acute or acute rejections. In order to select recipients without these donor-specific antibodies, the complement-dependent cytotoxicity crossmatch (CDC-CM) assay was developed as a standard procedure about forty years ago. The negative outcome of pretransplant crossmatching represents the most important requirement for a successful kidney graft survival. The artificially positive outcomes of CDC-based crossmatches due to the underlying disease Systemic Lupus Erythematosus (SLE), however, may lead to the unjustified refusal of adequate kidney grafts. Two prospective female recipients destined for a living as well as for a cadaver kidney donation, respectively, exhibited positive CDC-based crossmatch outcomes although for both patients no historical immunizing events were known. Furthermore, solid phase-based screening or antibody differentiation analyses never led to positive results. Immediate reruns of the CDC-based crossmatch assays using the alternative antibody monitoring system (AMS-)crossmatch ELISA resulted in unequivocally negative outcomes. Consequently both transplantations were performed without any immunological complications for the hitherto follow-up time of 25 and 28 months, respectively. We here show two case reports demonstrating an alternative methodical approach to circumvent CDC-based artefacts and point to the urgent need to substitute the CDC-based crossmatch procedure at least for special groups of patients.
Anti-Ma2-antibody-associated encephalitis: An atypical paraneoplastic neurologic syndrome
Authors: Bogna Targonska, Jamie Frost, Sanjay Prabhu
Journal: SA J Radiol (2018)
MeSH terms: Case Reports

Paraneoplastic syndromes are a heterogeneous group of conditions affecting cancer patients, where the signs and symptoms are not owing to the local effects of the tumour but instead owing to humoral or immunologic effects. We describe an unusual presentation of a paraneoplastic neurologic syndrome presenting with predominant involvement of the hypothalamus and deep grey nuclei secondary to an anterior mediastinal germinoma and associated with anti-Ma2 antibody.
Jejunal diverticulitis as a rare cause of abdominal pain: a case report
Authors: Amal Khsiba, Samir Bradai, Moufida Mahmoudi, Asma Ben Mohamed, Jawhar Bradai, Khaled Bouzaidi, Medhioub Mona, Lamine Hamzaoui, Mohamed Mousadek Azouz
Journal: Pan Afr Med J (2022)
Keywords: abdominal pain, antibiotic therapy, case report, jejunal diverticulitis
MeSH terms: Diverticulitis / complications, Diverticulitis / diagnosis, Diverticulitis / surgery, Jejunal Diseases / diagnosis, Jejunal Diseases / surgery, Peritonitis / etiology, Case Reports, Abdominal Pain / complications, Aged, Female, Humans, Jejunum

Jejunal diverticulitis is an uncommon and underdiagnosed condition. Due to the rarity of This disease, diagnosis is often difficult and delayed. Medical treatment is usually sufficient for jejunal diverticulitis without peritonitis. Surgery is required in case of generalized peritonitis or voluminous abscess complicating diverticulitis. We report the case of a 76-year-old woman who suffered from recent abdominal pain. Diagnosis of uncomplicated jejunal diverticulitis was based on computed tomography (CT) scan. The evolution was favorable after antibiotic treatment. Jejunal diverticulitis have to be evoked among the differential diagnosis of patients with abdominal pain especially in the elderly and it is important for clinicians and radiologists to have awareness about this disease.