OpenMed/multicare-articles huggingface dataset:
Merkel Cell Carcinoma of the Axilla and Adrenal Gland: A Case Report with Imaging and Pathologic Findings
Authors: Soo Heui Baek, Hyun Kyung Jung, WooGyeong Kim, Suk Jung Kim, Hye Jin Baek, Seung Ho Kim, Yedaun Lee, Young Mi Park
Journal: Case Rep Med (2015)

Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine carcinoma of the skin. MCC is characterized by a high incidence of locoregional recurrence, and distant metastasis, and often requires short-term follow-up after treatment. In this present paper, we describe a rare case of MCC, which presented as a palpable axillary mass and an incidental adrenal mass, and report on the ultrasonography, computed tomography, and (18)F-fluorodeoxyglucose-positron emission tomography findings. The patient underwent surgery and adjuvant radiation therapy. Seven months after the initial diagnosis, distant metastasis was detected during a follow-up examination.
Probable Levofloxacin-Induced Thrombocytopenia in a Patient Previously on Ciprofloxacin: A Case Report and Literature Review
Authors: A Justine Landi, Robert Burkes
Journal: Case Rep Med (2016)

Drug-induced thrombocytopenia is a poorly understood, yet common phenomenon widely encountered in clinical practice. We present a case of suspected levofloxacin-induced thrombocytopenia, a rare side effect of a ubiquitous antibiotic, in a patient without similar effect to ciprofloxacin. This report builds upon other isolated case reports of fluoroquinolone-induced thrombocytopenia and demonstrates our algorithmic approach to the issue as well as a literature review pertaining to fluoroquinolone-induced thrombocytopenia.
A Case of Lymphocytic Myocarditis with Eosinophilic Degranulation Successfully Treated with Steroid Therapy
Authors: Tomoko Inoue, Fusako Sera, Shunsuke Nishimura, Kei Nakamoto, Yasumasa Tsukamoto, Isamu Mizote, Tomohito Ohtani, Shungo Hikoso, Yoshihiko Ikeda, Yumiko Hori, Hatsue Ishibashi-Ueda, Eiichi Morii, Tetsuo Minamino, Yasushi Sakata
Journal: Case Rep Cardiol (2020)
MeSH terms: Case Reports

A 49-year-old woman was admitted with suspicion of acute myocarditis. On the next day after admission, her serum troponin I level continued to rise, indicating progression of myocardial damage. Moreover, her symptoms persisted, and left ventricular ejection fraction did not improve. Because of a predominant infiltration of lymphocytes in the myocardial specimens, lymphocytic myocarditis was diagnosed. However, a close observation of the specimens revealed eosinophil degranulation. Based on this finding, intravenous steroid therapy was initiated. High-dose methylprednisolone led to rapid and appreciable improvements in symptoms and left ventricular function within 12 hours after the first administration, which was followed by normalization of serum troponin I level. Steroid therapy was switched to oral administration and tapered carefully. There was no recurrence of left ventricular dysfunction or elevation of serum troponin I level. In eosinophilic myocarditis, eosinophil degranulation has been recognized as an important finding associated with progression of inflammation and myocardial damage. However, no attention has been paid to the presence and clinical implications of eosinophil degranulation in lymphocytic myocarditis. This case indicates that eosinophil degranulation in lymphocytic myocarditis may be an important finding associated with a high therapeutic response to steroid therapy.
How can school help victims of violence? Evaluation of online training for European schools' staff from a multidisciplinary approach
Authors: Ana M Greco, Carla González-Pío, Marina Bartolomé, Noemí Pereda, SAVE Project Team
Journal: PLoS One (2022)
MeSH terms: Child Abuse, Crime Victims, Sex Offenses / prevention & control, Case Reports, Research Support, Non-U.S. Gov't, Adult, Child, Female, Humans, Peer Group, Schools, Violence / prevention & control

The interventions used to prevent or treat violence against children, particularly sexual abuse, tend to only consider the target audience as their main source of data. We tested the effect of an online training for school staff members in Europe through three studies. In Study I, we interviewed 5 adult women (Mage = 49.2, SD = 5.81) who were victims of sexual abuse during childhood to assess what school could have done during that time to protect them. Through Study II, we collected data on 66 school staff members to assess feasibility (based on quantitative indicators) and to explore the changes they would make to their everyday practice due to the training course (using qualitative analysis). In Study III, we used network analysis to assess to what extent the actions described by school staff in Study II met the needs expressed by the victims in Study I. Findings of Study I revealed new proposals from the victims' perspective, such as working with the perpetrators. Study II showed the feasibility of training and identified five types of action that school staff members will include in their everyday working dynamics due to the training: detection (e.g., Greater attention to relationships with peers), reporting (e.g., Now I know that suspecting a case of child abuse is enough to report), everyday practices (e.g., Introducing a calming space), changes at school level (e.g., Propose the training course to the school management team) or practices that could belong to more than one category (e.g., Greater awareness of the activities undertaken by the school). Study III provided evidence that some of these changes (e.g., reporting without looking for proof) were in line with some of the victims' expectations (e.g., listen to the children). We also identified gaps that need to be further developed.
Microperimetric Biofeedback Training Improved Visual Acuity after Successful Macular Hole Surgery
Authors: Tomoko Ueda-Consolvo, Mitsuya Otsuka, Yumiko Hayashi, Masaaki Ishida, Atsushi Hayashi
Journal: J Ophthalmol (2015)

Purpose. To evaluate the efficacy of setting a preferred retinal locus relocation target (PRT) and performing Macular Integrity Assessment (MAIA) biofeedback training in patients showing insufficient recovery of best corrected visual acuity (BCVA) despite successful closure of an idiopathic macular hole (MH). Methods. Retrospective interventional case series. Nine eyes of 9 consecutive patients with the decimal BCVA of less than 0.6 at more than 3 months after successful MH surgery were included. A PRT was chosen based on MAIA microperimetry and the patients underwent MAIA biofeedback training. BCVA, reading speed, fixation stability, and 63% bivariate contour ellipse area (BCEA) were evaluated before and after the training. Statistical analysis was carried out using paired Student's t-test. Results. PRT was chosen on the nasal side of the closed MH fovea in 8 patients. After the MAIA training, BCVA improved in all patients. The mean logMAR value of BCVA significantly improved from 0.33 to 0.12 (p = 0.007). Reading speed improved in all patients (p = 0.29), fixation stability improved in 5 patients (p = 0.70), and 63% BCEA improved in 7 patients (p = 0.21), although these improvements were not statistically significant. Conclusion. MAIA biofeedback training improved visual acuity in patients with insufficient recovery of BCVA after successful MH surgery.
Gamma knife radiosurgery treatment for metastatic melanoma of the trigeminal nerve and brainstem: a case report and a review of the literature
Authors: Halloran E Peterson, Erik W Larson, Robert K Fairbanks, Wayne T Lamoreaux, Alexander R Mackay, Jason A Call, John J Demakas, Barton S Cooke, Christopher M Lee
Journal: Case Rep Neurol Med (2013)

Objective and Importance. Brainstem metastases (BSMs) are uncommon but serious complications of some cancers. They cause significant neurological deficit, and options for treatment are limited. Stereotactic radiosurgery (SRS) has been shown to be a safe and effective treatment for BSMs that prolongs survival and can preserve or in some cases improve neurological function. This case illustrates the use of repeated SRS, specifically Gamma Knife radiosurgery (GKRS) for management of a unique brainstem metastasis. Clinical Presentation. This patient presented 5 years after the removal of a lentigo maligna melanoma from her left cheek with left sided facial numbness and paresthesias with no reported facial weakness. Initial MRI revealed a mass on the left trigeminal nerve that appeared to be a trigeminal schwannoma. Intervention. After only limited response to the first GKRS treatment, a biopsy of the tumor revealed it to be metastatic melanoma, not schwannoma. Over the next two years, the patient would receive 3 more GKRS treatments. These procedures were effective in controlling growth in the treated areas, and the patient has maintained a good quality of life. Conclusion. GKRS has proven in this case to be effective in limiting the growth of this metastatic melanoma without acute adverse effects.
Erythrodermic mycosis fungoides with hypereosinophilic syndrome: a rare presentation
Authors: Savita Chaudhary, Cherry Bansal, Upasna Ranga, Kk Singh
Journal: Ecancermedicalscience (2013)
Keywords: cutaneous t-cell lymphomas, hypereosinophilic syndrome, mycosis fungoides
MeSH terms: Case Reports

Mycosis fungoides (MF) is the most common variant of primary cutaneous T-cell lymphoma (CTCL). It is generally associated with an indolent clinical course and characterised by well-defined clinicopathological features. Although rare, CTCLs constitute 65% of all cutaneous lymphoid malignancies, of which 50% are patients with MF. The erythrodermic variants of MF, a malignancy of mature, skin homing and clonal T lymphocytes, usually present in mid to late adulthood. Association with hypereosinophilia is important in prognosis. We report a case of erythrodermic MF with hypereosinophilic syndrome in a 22-year-old female presenting with gradually progressive intractable erythroderma with intensely pruritic multiple papules, plaques, and nodules involving more than 90% of body surface area. Diagnosis was confirmed by histopathological examination and immunophenotyping from multiple skin biopsies.
Presumptive thrombotic thrombocytopenic purpura following a hump-nosed viper (Hypnale hypnale) bite: a case report
Authors: Milinda Withana, Chaturaka Rodrigo, Ariaranee Gnanathasan, Lallindra Gooneratne
Journal: J Venom Anim Toxins Incl Trop Dis (2014)
Keywords: hemolytic uremic syndrome, hump-nosed viper, snakebite, thrombotic microangiopathy, thrombotic thrombocytopenic purpura
MeSH terms: Case Reports

Hump-nosed viper bites are frequent in southern India and Sri Lanka. However, the published literature on this snakebite is limited and its venom composition is not well characterized. In this case, we report a patient with thrombotic thrombocytopenic purpura-like syndrome following envenoming which, to the best of our knowledge, has not been reported in the literature before. A 55-year-old woman from southern Sri Lanka presented to the local hospital 12 hours after a hump-nosed viper (Hypnale hypnale) bite. Five days later, she developed a syndrome that was characteristic of thrombotic thrombocytopenic purpura with fever, thrombocytopenia, microangiopathic hemolysis, renal impairment and neurological dysfunction in the form of confusion and coma. Her clinical syndrome and relevant laboratory parameters improved after she was treated with therapeutic plasma exchange. We compared our observations on this patient with the current literature and concluded that thrombotic thrombocytopenic purpura is a theoretically plausible yet unreported manifestation of hump-nosed viper bite up to this moment. This study also provides an important message for clinicians to look out for this complication in hump-nosed viper bites since timely treatment can be lifesaving.
Eculizumab discontinuation in a patient with atypical hemolytic uremic syndrome after ChAdOx1 nCoV-19 vaccination
Authors: Marisa Roldão, Francisco Ferrer, Karina Lopes
Journal: Clin Nephrol Case Stud (2023)
Keywords: chadox1 ncov-19 vaccine, atypical hus, eculizumab, maintenance therapy discontinuation
MeSH terms: Case Reports

Eculizumab has proven to be effective in patients with atypical hemolytic uremic syndrome (aHUS) in clinical trials and in the real world, but the optimal duration of therapy remains unknown. Standard maintenance treatment is often life-long, but the possibility of discontinuation has not yet been systematically tested. We describe a case of aHUS after ChAdOx1 nCoV-19 vaccination in a patient with homozygous CFHR3/CFHR1 gene deletion who discontinued eculizumab maintenance therapy 24 weeks after achieving disease remission. We report the safety of discontinuing eculizumab treatment with the aim of minimizing the risk of adverse reactions, reducing the risk of meningitis, improving quality of life, and reducing the considerable treatment costs.
Spontaneous choledochoduodenal fistula with tuberculous duodenal ulceration
Authors: V S Karthikeyan, S C Sistla, D Ram, S M Ali, N Rajkumar, G Balasubramaniam, M S Sanker
Journal: Ann R Coll Surg Engl (2014)
MeSH terms: Biliary Fistula / microbiology, Duodenal Diseases / microbiology, Duodenal Ulcer / microbiology, Intestinal Fistula / microbiology, Tuberculosis, Gastrointestinal / diagnosis, Case Reports, Biliary Fistula / surgery, Duodenal Diseases / surgery, Duodenal Ulcer / surgery, Endoscopy, Digestive System / methods, Humans, Intestinal Fistula / surgery, Male, Middle Aged

Spontaneous choledochoduodenal fistulas (CDFs) are rare. The most common aetiology is penetrating duodenal ulcers, observed in 80% of cases. Even in areas where acid peptic disease is common, tuberculosis should be considered as a cause, especially in developing countries like India, where tuberculosis is common. The management of CDF due to acid peptic disease is predominantly surgical while healing of tuberculous CDF has been reported with antitubercular treatment. A preoperative diagnosis of tuberculous CDF by endoscopic biopsy from the duodenal ulcer or image guided fine needle aspiration if abdominal lymph nodes are present can eliminate the need for surgery and achieve a cure with antitubercular treatment. The CDF in this case was due to caseation of periduodenal lymph nodes rupturing into the duodenum and the bile duct.
Single-Incision Laparoscopy Surgery Excision of an Infected Urachal Cyst: Description of the Technique
Authors: Juan D Garisto, Katherine Henriquez, Edwin E Pimentel M
Journal: J Endourol Case Rep (2017)
Keywords: infection, minimal invasive, urachal cyst
MeSH terms: Case Reports

Background: Urachal cysts (UCs) are secondary to incomplete obliteration of the embryonic urachal duct and may become symptomatic when infected. Treatment is primarily surgical to excise the infected cyst. Surgical approaches include a lower midline laparotomy or minimally invasive (MI) techniques. Case: We present a case of a young male with an infected UC that was treated with a single-incision laparoscopy surgery. The operative technique is described. Conclusion: This approach is a safe and feasible option for the MI management of UCs.
Surgical Management of Primary Bone Lymphoma of the Hip: A Case Report and Review of the Literature
Authors: Grace Kennedy, Phil Weir, Kevin Johnston, Patrick Elder
Journal: Case Rep Orthop (2019)
MeSH terms: Case Reports

Introduction:
Primary bone lymphoma (PBL) is a rare bone malignancy which may present with atraumatic pain, swelling, or pathological fracture. Whilst the femur is the most commonly affected site, any bone may be involved. PBL should be distinguished from other bone lesions to determine clinical management.
Case report:
We report the case of an 89-year-old gentleman who presented to the local emergency department with atraumatic hip pain and inability to weight-bear. Multimodal imaging showed evidence of a tumor involving the proximal femur and adjacent acetabulum with an associated pathological intertrochanteric fracture. Biopsy specimens demonstrated this to be PBL of the diffuse large B-cell subtype. No other disease foci or nodal involvement was identified. The patient underwent proximal femoral replacement and acetabular reconstruction prior to commencing R-Mini-CHOP chemotherapy, during which time he has been permitted to fully weight-bear.
Conclusion:
To our knowledge, this is the first reported case of a patient having PBL with both femoral and acetabular involvements. Due to its infrequent occurrence, evidence remains limited to advise therapeutic guidelines. Our practice concurs with literature suggesting that surgery be reserved for cases of pathological fracture. However, the merits of undergoing surgical fixation prior to chemoradiation treatment have been considered.
Mass-Forming Ischemic Colitis: A Potential Mimicker of Malignancy
Authors: Alexandra M Danakas, Bushra G Fazili, Aaron R Huber
Journal: Case Rep Pathol (2019)
MeSH terms: Case Reports

Ischemic colitis (IC) results from reduced colonic vascular perfusion, accounting for 50-60% of all gastrointestinal ischemic episodes. IC leads to mucosal damage with clinical symptom severity developing based on the duration and extent of colonic injury. In rare cases IC may form a mass-like lesion mimicking malignancy. Here we present the case of a 55-year-old female with hematochezia and diarrhea, who on workup was found to have a mass-like lesion at the ileocecal valve. Multiple biopsies demonstrated ischemic change and mucosal injury without evidence of dysplasia or carcinoma. Two months later on follow-up imaging, after supportive treatment the lesion was completely resolved. It is critical for gastroenterologists and pathologists to be aware of this variant of IC to avoid unnecessary surgical procedures and treatment of patients.
Sámi reindeer herders' perspective on herbivory of subarctic mountain birch forests by geometrid moths and reindeer: a case study from northernmost Finland
Authors: Terhi Vuojala-Magga, Minna T Turunen
Journal: Springerplus (2015)
Keywords: autumnal moth, betula pubescens ssp czerepanovii, climate change, global warming, indigenous knowledge (ik), mountain birch destruction, niche construction theory (nct), professional knowledge, reindeer herding, winter moth

Introduction:
Geometrid moths and semi-domesticated reindeer are both herbivores which feed on birch leaves in the subarctic mountain birch forests in northern Fennoscandia. The caterpillars of autumnal and winter moths have episodic outbreaks, which can occasionally lead to extensive defoliation of birch forests. Earlier studies have shown that reindeer have a negative effect on the regeneration of defoliated birches by grazing and browsing their seedlings and sprouts.
Case description:
We interviewed 15 reindeer herders in the Kaldoaivi and Paistunturi herding co-operative in northernmost Finland in order to analyse their past, present and future views on the behaviour of moths and the growth of mountain birches. We investigate the behaviour of the two herbivores by combining the indigenous knowledge (IK) of Sámi herders with the results of relevant studies in biology and anthropology, applying niche construction theory (NCT) in doing so.
Discussion and evaluation:
In the first stage, the niche constructors (moths, reindeer, herders, mountain birch and other organisms) are looked upon as "equal constructors" of a shared niche. As changes unfold in their niche, their role changes from that of constructor to key constructor. The role and importance of niche constructors were different when nomadic pasture rotation was used than they are today under the herding co-operative system. Niche construction faced its most radical and permanent negative changes during the border closures that took place over the latter half of the 19(th) century. The large-scale nomadic life among the Sámi herders, who migrated between Finland and Norway, came to an end. This phase was followed by stationary herding, which diminished the possibilities of reindeer to look for various environmental affordances. Difficult snow conditions or birch defoliation caused by moth outbreaks made the situation worse than before. Eventually reindeer became key constructors, together with moth larvae, leading to negative ecological inheritance that forced herders to use new, adaptive herding practices.
Conclusions:
Both the scientific data and the IK of herders highlight the roles of reindeer and herders as continuous key constructors of the focal niche, one which stands to be modified in more heterogenic ways than earlier due to global warming and hence will result in new ecological inheritance.
Trisomy 8 Associated Clonal Cytopenia Featured With Acquired Auto-Inflammation and Its Response to JAK Inhibitors
Authors: Yakai Fu, Wanlong Wu, Zhiwei Chen, Liyang Gu, Xiaodong Wang, Shuang Ye
Journal: Front Med (Lausanne) (2022)
Keywords: janus kinase inhibitor, auto-inflammation, clonal hematopoiesis, myelodysplasia, trisomy 8

Objects:
It has been recognized the nexus between trisomy 8 and auto-inflammatory features in myelodysplasia syndrome (MDS). Recent research about VEXAS syndrome proved clonal hematopoiesis could interfere with innate immune system far before occurrence of hematological malignancies. We reported a case series of clonal cytopenia with auto-inflammatory features in trisomy 8 patients.
Methods:
A total of six patients with isolated trisomy 8 excluded from MDS was retrospectively collected from the Department of Rheumatology, Renji Hospital, Shanghai. The clinical presentations and treatment outcomes were presented.
Results:
We report patients with trisomy 8 shared the auto-inflammatory features of recurrent fever, arthralgia, gastrointestinal involvement, and elevated inflammatory markers, especially hyperferritinemia, in addition to hematological findings such as macrocytic anemia and cytopenia of other lineages but without myelodysplasia. The symptoms of this disorder responded to the treatment of glucocorticoids but difficult to taper. JAK inhibitors were introduced to four patients with enhanced response along with glucocorticoids sparing effect and good tolerance.
Conclusion:
Clonal cytopenia harboring trisomy 8 presenting with auto-inflammatory features was identified. JAK inhibitor may be a promising anti-inflammatory option.
Cutis Marmorata Telangiectatica Congenita Associated with Hemiatrophy
Authors: Alexander K C Leung, Joseph M Lam, Kin Fon Leong
Journal: Case Rep Pediatr (2020)
MeSH terms: Case Reports

Cutis marmorata telangiectatica congenita is characterized by the presence of a bluish-purple reticulated cutaneous vascular network on the skin intermixed with telangiectasia and occasionally prominent veins at birth. Areas of the skin within the reticulated cutaneous vascular network may be normal, erythematous, atrophic, and, at times, ulcerated. Areas of ulcerations and focal cutaneous and subcutaneous atrophy occasionally occur resulting in body asymmetry. On the other hand, cutaneous and subcutaneous atrophy, extensive and severe enough leading to hemiatrophy, of the entire limb is rare. A search of the English literature revealed only eight documented cases to which we are adding two more cases.