OpenMed/multicare-articles huggingface dataset:
Radiation Therapy for Breast Cancer With Oligometastatic Cervical Lymph Nodes: A Case Report
Authors: Hiroshi Burioka, Unta Yamamori, Natsuko Nagano, Atsushi Ue, Yukihisa Tamaki
Journal: Cureus (2024)
Keywords: breast cancer, cervical lymph node, multimodality treatment, oligometastases, radiation therapy
MeSH terms: Case Reports

Stage IV breast cancer is difficult to cure and is mainly treated with systemic therapy. However, when distant metastasis is oligometastatic, proactive treatment including local therapies for the primary lesion and distant metastases has been reported to improve prognosis. We encountered a patient who had left breast cancer with ipsilateral cervical lymph node metastases. The metastases were oligometastatic, and we treated them curatively. The patient was a female in her 50s who had been aware of a lump in the lower inner quadrant of the left breast for a few years. A biopsy was performed and left breast cancer was diagnosed pathologically. Radiological examination showed metastasis to ipsilateral axillary and cervical lymph nodes. The cervical lymph node metastases were oligometastatic, suggesting possible improvement in prognosis by multimodality treatment including local therapy. The multimodality treatment in this case comprised mastectomy with levels I and II axillary lymph node dissection, systemic therapy (including chemotherapy, endocrine therapy, and molecular targeted therapy), and postmastectomy radiation therapy. The left chest wall and left supraclavicular lymph node region were irradiated. Furthermore, following the postmastectomy radiation therapy, the cervical lymph node metastases were treated with radical radiation therapy. The cure was achieved, with recurrence-free status maintained for two years and four months after the completion of radiation therapy. This case suggests that, for breast cancer with oligometastatic involvement of cervical lymph nodes, locally treating these distant metastatic lesions with radical radiation therapy as part of multimodality treatment is beneficial.
Case report: A case of widespread soft tissue infection and multiple abscesses secondary to hidradenitis suppurativa inducing septic shock caused by Lawsonella clevelandensis in China
Authors: Zhi Lijia, Qi Jia Chao, Li Li, Deng Shikun, Gao Peiyang
Journal: Front Med (Lausanne) (2024)
Keywords: lawsonella clevelandensis, hidradenitis suppurativa, multiple abscesses, next generation sequencing, widespread soft tissue infection
MeSH terms: Case Reports

Lawsonella clevelandensis is rare to associated with human infection, which may cause abscesses in abdominal cavity, liver, breast, and spine. Lawsonella clevelandensis is very difficult to be cultivated in regular manner; detection of 16S rRNA sequence is the main evidence for L. clevelandensis infection. The clinical manifestations of L. clevelandensis infection resemble other agents of Nocardia, Tuberculosis and non-tuberculous Mycobacterium (NTM) due to their morphologic similarities. Hidradenitis suppurativa (HS) is a chronic inflammatory disorder, which affects the intertriginous skin and is associated with numerous systemic comorbidities. HS eventually leads to severe pain, multiple abscesses, pus discharge, and irreversible tissue destruction. Lawsonella clevelandensis has not been reported to cause HS and systemic comorbidities. We presented the case of a 33-year-old male with widespread soft tissue infection and multiple abscesses secondary to HS (Hurley stage III) inducing septic shock caused by L. clevelandensis in China. He was diagnosed as HS and treated with intravenous antibiotic empirically. He developed multiple abscesses including lung and scrota. Bacterial and fungal cultures on blood and secretions from multiple skin lesions were all negative. Due to the misdiagnosis and progression of disease, the patient was transferred to intensive care unit, and he underwent drainage of the chest and right hemothorax removal under thoracoscopic. During the hospitalization, the patient developed septic shock and received mechanical ventilation. Computerized tomography (CT) scans revealed mediastinal emphysema, multiple subcutaneous emphysema, and severe pneumonia. Gene analysis of samples of incision and drainage of pus at the skin showed the rare infection of L. clevelandensis. Finally, the patients with recurrent soft tissue infections and multiple abscesses with negative microbiological culture results recovered after effective abscess drainage and antibiotic therapy. We suggested that NGS is a crucial supplementary diagnostic tool in individuals with recurrent skin infections and multiple abscesses, especially when conventional diagnostic methods are inconclusive.
Nanopore sequencing elucidates in vivo development of meropenem resistance by insertion of a mobile genetic element in the porin gene ompC in E. coli
Authors: Sébastien Matamoros, Jarne van Hattem
Journal: Access Microbiol (2024)
Keywords: antimicrobial resistance, insertion sequence, mobile genetic elements, whole genome sequencing
MeSH terms: Case Reports

An ESBL-producing E. coli isolate recovered from a patient undergoing long-term treatment developed resistance to meropenem without acquiring carbapenem-hydrolysing enzymes. We performed Nanopore and Illumina sequencing and subsequent full hybrid genome assembly of this isolate and the meropenem-susceptible isolate recovered almost 8 weeks prior. Whole genome MLST patterns did not differ between isolates. However, we found the insertion of an IS5-like element in the sequence of the ompC gene and an increase in the number of copies of the CTX-M-15 gene in the resistant isolate. These results show that E. coli can develop meropenem resistance under antibiotic pressure by mutations in ompC genes and increasing the copy number of ESBL genes, and the value of next generation sequencing to reveal resistance mechanisms not detected by conventional PCR.
Total Thickness Bilateral Rupture of the Rectus Abdominis: A Case Report and Literature Review
Authors: Dernas Suhail, Olivia Smith, Philip Lim, Srinivas Chintapatla
Journal: Case Rep Surg (2024)
MeSH terms: Case Reports

Rupture of the rectus abdominis is a rare condition. We describe the case of a young male trainee paratrooper who presented with sudden onset severe lower abdominal pain that occurred during military training. Magnetic resonance imaging revealed full-thickness bilateral rupture of the rectus abdominis. Our management involved injecting botulinum toxin into the rectus muscles preoperatively, reconstructing the rectus muscles, and placing a supportive biosynthetic mesh. Postoperatively, our patient could walk pain-free at 3 weeks, jog pain-free at 10 weeks, and run up to 2 miles at 25 weeks. As there is no consensus on the management of this rare injury, we conducted a literature review on all cases reporting rupture of the rectus abdominis from the year 2000. After comparing the outcomes of conservatively versus surgically managed patients, we can conclude that generally, management of such defects is dependent on size, severity, and patient factors; however, surgical treatment yields comparable results to conservative treatment.
Case report: The effect of second-line vebreltinib treatment on a patient with advanced NSCLC harboring the MET exon 14 skipping mutation after tepotinib treatment
Authors: Siyuan Huang, Linlin Li, Ningning Yan, Huixian Zhang, Qianqian Guo, Sanxing Guo, Di Geng, Xincheng Liu, Xingya Li
Journal: Front Oncol (2024)
Keywords: metex14 skipping mutation, case report, non-small cell lung cancer, treatment resistance, vebreltinib
MeSH terms: Case Reports

Background:
Highly selective type Ib mesenchymal-epithelial transition gene (MET) tyrosine kinase inhibitors (TKIs) are the standard-of-care (SOC) therapy for previously untreated non-small cell lung cancer (NSCLC) harboring MET exon 14 (METex14) skipping mutations. However, there are rare reports describing effective regimens for patients who fail SOC without identifying resistant mutations or tissue transformation.
Case report:
We report the first case of a 74-year-old woman with lung adenocarcinoma (cT1cNxM0) harboring METex14 splice region mutation, which was identified by a next-generation sequencing (NGS)-based assay. The patient was administered two treatments, including first-line tepotinib and second-line vebreltinib. The patient achieved progression-free survival (PFS) of 7.6 months, and then disease progression of tepotinib was observed. A re-biopsy was performed for NGS, which revealed the same mutations as before, with no new gene mutations detected. The woman received subsequent vebreltinib therapy and experienced durable clinical benefits. In the first 6.8 months, chest computed tomography demonstrated stable disease. Then, she achieved partial response (PR). The durable PR lasted for more than 13 months, and the PFS is currently over 20 months, exceeding the prior treatment.
Conclusion:
This case highlights the importance of considering re-biopsy and reanalysis of genetic profiles in NSCLC patients harboring METex14 skipping mutations after progressive disease in MET TKI treatment. This raises the possibility that vebreltinib may have long-term survival benefits for patients without mutations conferring resistance (funded by Beijing Pearl Biotechnology Co., Ltd; ClinicalTrials.gov number, NCT04258033).
Case report: Clitoral adenocarcinoma in a mixed-breed female dog
Authors: Christina Moss, Nicole Sugai, Rebecca Persons, Brittany Ciepluch, Kevin Lahmers, Julie Cecere
Journal: Front Vet Sci (2023)
Keywords: adenocarcinoma, canine, clitoris, hypercalcemia, neoplasia, prolapse, vulva
MeSH terms: Case Reports

A 9-year-old, spayed female, mixed-breed dog was initially presented for evaluation of chronic dermatitis on the nasal planum, where a clitoral mass was discovered as an incidental finding during the exam. No further investigation of the clitoral mass was undertaken due to other significant dermal lesions and the lack of clinical significance of the mass at the time. However, ~1 month later, the dog was presented to the Emergency Service for bleeding from the vulva. The clitoral mass was found to have prolapsed; the mass was manually reduced back into a position within the vulvar folds and maintained with a purse-string suture. The dog was referred to the Theriogenology Service for further investigation and removal. On follow-up evaluation, the mass was noted to be multi-lobulated, ulcerated, cystic, and involving the clitoris but not the urethra. The urethra was easily catheterized, and no urinary abnormalities were found. No evidence of lymph node metastasis or hypercalcemia was noted prior to surgery. Ultrasonographic evaluation of the anal sacs was normal. The mass was removed, and histopathologic evaluation revealed a primary clitoral adenocarcinoma. On recheck evaluation, after 1 month, no evidence of metastasis or local recurrence was observed. Clitoral adenocarcinoma is a rarely reported neoplasm of the canine genital tract that shares many clinical, histopathological, and immunohistochemical features with canine apocrine gland anal sac adenocarcinoma. This case adds to the available knowledge on the condition, specifically regarding the frequency of complications such as hypercalcemia and metastasis, as previous reports suggest that these are present at least 50% of the time.
Case Report: A case of TAFRO syndrome with severe and prolonged thrombocytopenia: diagnostic pitfalls
Authors: Hironori Sato, Atsuhiro Kanno, Minato Sato, Akari Endo, Hiroki Ito, Takahiro Ohara, Yuko Shirota, Kazuhiro Sumitomo, Takefumi Mori, Katsutoshi Furukawa
Journal: Front Immunol (2023)
Keywords: tafro syndrome, acute kidney injury, disseminated intravascular coagulation, immune thrombocytopenia, thrombotic microangiopathy
MeSH terms: Disseminated Intravascular Coagulation / diagnosis, Disseminated Intravascular Coagulation / etiology, Sepsis, Thrombotic Microangiopathies, Case Reports, Edema / diagnosis, Edema / drug therapy, Edema / etiology, Fever / drug therapy, Humans, Infant, Male, Multi-centric Castleman's Disease

Thrombocytopenia, anasarca, myelofibrosis, renal dysfunction, and organomegaly (TAFRO) syndrome is a rare condition with diverse clinical and pathological characteristics related to multi-organ damage. We report a case of TAFRO syndrome complicated by immune thrombocytopenia with prolonged fever and thrombocytopenia for several weeks. A 61-year-old man was transferred with sepsis caused by Enterococcus faecalis, and developed disseminated intravascular coagulation. Antibiotics treatment was initiated: however, low-grade fever and thrombocytopenia persisted despite the adequate antimicrobial treatment. Systemic edema, pleural effusion, and ascites had developed before hospitalization, and renal and liver function had deteriorated, resulting in progressive multi-organ damage. Prednisolone 40 mg/day was initiated based on the assumption of a condition in which excessive production of inflammatory cytokines would lead to systemic deterioration and fatal organ damage. Subsequently, the fever resolved, and renal function began to normalize. However, thrombocytopenia did not show much recovery trend after Helicobacter pylori eradication therapy and initiation of thrombopoietin receptor agonists. Bone marrow biopsy results showed normal bone marrow with no malignant findings. Alternatively, significant clinical signs met the diagnostic criteria for TAFRO syndrome, and a renal biopsy revealed thrombotic microangiopathy, which is also reasonable for renal involvement in TAFRO syndrome. The use of cyclosporine remarkably corrected the thrombocytopenia. We considered this a case of TAFRO syndrome that developed after sepsis with disseminated intravascular coagulation and performed the differential diagnosis of prolonged thrombocytopenia and excluded it. Although TAFRO syndrome is a unique disease concept, diagnostic criteria may consist of nonspecific elements such as generalized edema, thrombocytopenia, persistent fever, and elevated inflammatory response, and there are many differential conditions to exclude, requiring caution in diagnosing TAFRO syndrome.
Tuberculosis patients with special clinical conditions treated with contezolid: three case reports and a literature review
Authors: Jun Wang, Liping Ma
Journal: Front Med (Lausanne) (2023)
Keywords: adverse reaction, contezolid, linezolid, oxazolidinone, tuberculosis
MeSH terms: Case Reports

Background:
Contezolid is a novel oxazolidinone antibacterial agent, but there have been no reports of any pertinent clinical studies for the treatment of tuberculosis (TB). This was the first report of three TB patients who were successfully treated with contezolid.
Case presentation:
Case 1 was TB complicated by myelosuppression syndrome. Case 2 was drug-resistant TB complicated by cirrhosis and anemia. Case 3 was drug-resistant TB complicated by liver transplantation that developed severe anemia after linezolid treatment. Following contezolid therapy, the three patients' symptoms improved significantly, and no adverse reactions were observed. The chest computed tomography (CT) examination also indicated that the therapeutic effect of this anti-TB regimen was as expected.
Conclusion:
Contezolid showed good efficacy and fewer side effects in the treatment of TB. It may be a promising TB treatment.
Distal end of a ureteral double-J stent displaced into the contralateral ureter after percutaneous nephrolithotripsy: a case report
Authors: Junyong Chen, Tao Xie, Ya Xu, Jian Deng, Jie Zhang, Yumo Zhu, Guiyuan Li
Journal: Front Med (Lausanne) (2023)
Keywords: pcnl, case report, contralateral ureter, displacement, distal end, ureteral double-j stent
MeSH terms: Case Reports

We report displacement of the distal end of a ureteral double-J stent into the contralateral ureter after percutaneous nephrolithotripsy (PCNL) in a 71-year-old man with a history of left kidney stones. Postoperative computed tomography imaging showed that the distal end of the left ureteral double-J stent was displaced into the right ureter, which resulted in persistent right renal colic when the nephrostomy tube was clipped and continuous urine leakage from the nephrostomy opening after the nephrostomy tube was removed. After the cystoscopic adjustment of the ureteral stent, the patient recovered uneventfully and was discharged home the next day.
Dose-dependent, non-pigmenting fixed drug eruption with eczematous lesions induced by bosutinib: case report
Authors: Joohyung Youh, Yasuyuki Yamaguchi, Tsugumichi Kawamura, Daichi Hoshina
Journal: Pan Afr Med J (2023)
Keywords: bosutinib, dose-dependent, fixed drug eruption, non-pigmenting fixed drug eruption
MeSH terms: Drug Eruptions / diagnosis, Drug Eruptions / etiology, Drug Eruptions / pathology, Quinolines, Case Reports, Aniline Compounds / adverse effects, Humans, Nitriles / adverse effects, bosutinib, Quinolines, Aniline Compounds, Nitriles

Bosutinib, widely used as a primary treatment for chronic myeloid leukemia (CML), is known to frequently cause cutaneous drug eruptions. Fixed Drug Eruption (FDE) is common, typically presenting as recurrent lesions that heal with residual hyperpigmentation. Diagnosing FDE, especially Non-Pigmenting Fixed Drug Eruption (NPFDE), is often challenging. A correlation exists between the dosage of certain medications, such as levetiracetam, and the emergence of drug eruptions. This report details a unique case of dose-dependent NPFDE caused by bosutinib. In managing cutaneous drug eruptions, particularly when the causative drug is crucial for treatment, a strategy of tapering the dosage should be considered.
Use of Botulinum Toxin A to Manage Hamstring-Induced Flexion Contracture Following Total Knee Arthroplasty: A Case Series
Authors: Quincy T Cheesman, Danielle Y Ponzio, Hope E Thalody, Vincent W Lau, Zachary D Post, Alvin Ong
Journal: Cureus (2024)
Keywords: botox, botulinum toxin a, flexion contracture, hamstring, range of motion, total knee arthroplasty

Introduction Flexion contractures following total knee arthroplasty (TKA) greatly affect patient function and satisfaction. Botulinum toxin A (BTX) has been described in the literature as a means of addressing post-operative flexion contractures due to hamstring muscle rigidity. Methods We retrospectively report a case series of eight patients with range of motion (ROM) who developed a flexion contracture status post-TKA and were managed with the use of physical therapy, diagnostic hamstring lidocaine injections, and therapeutic hamstring BTX injections. Results All patients had an improvement in extension ROM following diagnostic lidocaine hamstring injections and were therefore considered candidates for therapeutic hamstring BTX injections. Prior to therapeutic hamstring BTX injections, patients had an average flexion contracture of 19° (range: 15°-22°). All patients had an improvement in extension ROM two to four weeks following the therapeutic hamstring BTX injection, with an average improvement in ROM of 7° (range: 2°-19°). At the final follow-up, all patients continued to sustain an improvement in extension ROM with an average deficit of 9° (range: 0°-17°). Conclusion Our case series highlights the use of diagnostic hamstring lidocaine injections to confirm hamstring rigidity as an etiology for flexion contracture following TKA. In addition, we showed a persistent improvement in flexion contracture for all patients after hamstring BTX injections. Therefore, when the appropriate patient is selected, BTX may provide an additional treatment option for a flexion contracture following TKA.
Bilateral Transankle Intervention as a Critical Determinant of Successful Revascularisation in Complex Peripheral Arterial Disease
Authors: Tetsuya Nomura, Naotoshi Wada, Kenshi Ono, Keisuke Shoji
Journal: EJVES Vasc Forum (2024)
Keywords: critical limb threatening ischaemia, endovascular treatment, intravascular ultrasound, parallel wiring, transankle intervention
MeSH terms: Case Reports

Introduction:
Establishing optimal vascular access sites is important for the procedural success of endovascular treatment (EVT) and the patient's comfort afterwards. Among the variety of vascular access sites, the transankle intervention (TAI) has been used more recently; however, there have been no reports of complex lower extremity arterial disease lesions treated with the TAI manoeuvre.
Report:
An 82 year old man with chronic limb threatening ischaemia in both lower extremities underwent EVT for bilateral long segment occlusion from the iliac arteries to the superficial femoral artery (SFA). The right posterior tibial artery was punctured under extravascular ultrasound guidance and a Parent Select 5082 guide sheath was inserted. The guidewire was manipulated under intravascular ultrasound (IVUS) guidance. When the first guidewire entered the subintimal space, the second guidewire was manipulated to advance through the intraplaque route, while monitoring it using IVUS. The intraluminal space of the right common iliac artery was reached by repeating these procedures. A self expandable stent was deployed in the external iliac artery and drug coated balloons were inflated from the common femoral artery to the SFA; good vascular patency and favourable blood flow were confirmed. Subsequently, a similar TAI procedure was performed from the left dorsalis pedis artery, and successful revascularisation was achieved from the left common iliac artery to the SFA. After revascularisation, the persistent pain disappeared in the right lower limb and the wound healed favourably in the left lower limb.
Conclusion:
In this case of complex chronic limb threatening ischaemia, the TAI strategy worked favourably for successful revascularisation. Transankle intervention can provide various advantages for successful EVT.
Radiopacity of Sodium Zirconium Cyclosilicate in Computed Tomography: a case of a patient with Hyperkalemia and kidney disease
Authors: Andrea Angioi, Matteo Floris, Nicola Lepori, Gianfranca Cabiddu, Antonello Pani
Journal: Ren Fail (2023)
Keywords: chronic kidney disease (ckd), computed tomography (ct) imaging, sodium zirconium cyclosilicate, diagnostic imaging, hyperkalemia, radiopacity
MeSH terms: Hyperkalemia / etiology, Kidney Diseases / complications, Case Reports, Adult, Humans, Male, Potassium, Tomography / adverse effects, sodium zirconium cyclosilicate, Potassium

Sodium Zirconium Cyclosilicate (SZC) is commonly used for treating hyperkalemia because it sequesters gastrointestinal potassium ions, thereby reducing serum potassium levels. However, a less-discussed aspect of SZC is its radiopacity on x-ray-based imaging techniques. The European Medicines Agency (EMA) has only vaguely addressed this issue. Radiopaque substances like SZC can interfere with diagnostic imaging, creating challenges for clinicians and radiologists. We present the case of a 34-year-old Italian male to illustrate these concerns.
Successful Management of Folliculitis Decalvans
Authors: Yash Kashikar, Vikrant Saoji, Bhushan Madke, Meenakshi S Chandak, Soham Meghe
Journal: Cureus (2024)
Keywords: antibiotics therapy, cicatricial alopecia, oral doxycycline, scalp nodule, staphylococcus aureus
MeSH terms: Case Reports

Folliculitis decalvans (FD) is a rare disease that causes inflammation on the scalp, leading to scarring alopecia. It commonly affects young and middle-aged men and is characterized by pustules, papules, scarring, hemorrhagic crusts, and erosions. The exact cause of FD is not fully understood, but it is believed that Staphylococcus aureus may play a role in its development. The condition is thought to be influenced by a combination of genetic, allergic, infectious, and immunological factors. This report describes a 20-year-old male patient who experienced painful pustules on his scalp for six months. The pustules first appeared on the occipital region and then spread to the crown. The patient was diagnosed with FD after a thorough clinical and pus culture examination. Treatment involved a month-long prescription of doxycycline (100 mg BD) and topical ozenoxacin (2%), which led to successful remission of the lesions.