OpenMed/multicare-articles huggingface dataset:
Erythrocytosis in congenital heart defects: hints for diagnosis and therapy from a clinical case
Authors: Oscar Borsani, Marzia Varettoni, Giacomo Riccaboni, Elisa Rumi
Journal: Front Med (Lausanne) (2024)
Keywords: eisenmenger, congenital, erythrocytosis, heart, syndrome
MeSH terms: Case Reports

Erythrocytosis is one of the most common abnormalities that clinical hematologists, general practitioners, and internal medicine specialists could have to face off in their routine clinical practice. While diagnostic criteria for primary erythrocytosis (i.e., polycythemia vera) are well known and characterized, there are several causes of secondary erythrocytosis that should be kept in mind to avoid misdiagnosis. Congenital heart defects are rarely cause of secondary erythrocytosis as they are normally recognized and treated at an early stage. Eisenmenger syndrome is a complex clinical syndrome that arise as consequence of an untreated congenital heart defect associated with large intracardiac shunt. The clinical picture of this syndrome usually includes a severe erythrocytosis that could tempt clinicians to start an intensive phlebotomy (or venesection) program. However, clinicians should be aware that erythrocytosis in Eisenmenger syndrome is a compensatory mechanism aimed at improving blood oxygen-carrying capacity; accordingly, phlebotomies should be reserved for those cases complaining hyperviscosity symptoms. Here we present a case of an adult female patient with Eisenmenger syndrome that has been evaluated because of severe and persistent erythrocytosis. In this case we present a step-by-step approach by which clinical hematologist could proceed to reach the definitive diagnosis. We will also provide some hints that could help clinicians when choosing the best treatment strategy to avoid unnecessary and potentially harmful procedures.
Rocky Mountain spotted fever contracted along a Canadian road trip: A case report
Authors: Aliyah King, Alison Spurr, Reetesh Bose
Journal: SAGE Open Med Case Rep (2024)
Keywords: rocky mountain spotted fever, case report, tick-borne disease
MeSH terms: Case Reports

Rocky Mountain spotted fever, a potentially fatal tick-borne disease thought to be confined to specific climates and geographic locations, is expanding its reach due to climate change. This is demonstrated by a 73-year-old woman who contracted Rocky Mountain spotted fever outside endemic areas during travel in Canada. Presenting with fevers, arthralgia, weakness, non-bloody diarrhea, conjunctivitis, mild cough, and a rash, this patient was initially started on moxifloxacin (400 mg PO/day) for suspected pneumonia. Treatment was changed to doxycycline (100 mg PO twice daily for 7 days) after dermatology was consulted, and Rocky Mountain spotted fever was thought to be higher on the differential. Rocky Mountain spotted fever was confirmed, and the patient responded well to antibiotics, improving by discharge. The disease's expansion into previously thought nonendemic areas is thought to be linked to milder winters and more extreme dry summers, facilitating pathogen development and tick lineage expansion.
Extensive Base of Skull Osteomyelitis: Why Does It Still Occur?
Authors: Siti Hajar Noordiana, Emilia Rosniza Mohammed Rusli, Zara Nasseri, Asma Abdullah
Journal: Cureus (2024)
Keywords: base of the skull, intracranial infection, malignant otitis externa, otorrhea, skull-base osteomyelitis
MeSH terms: Case Reports

Skull base osteomyelitis (SBO) is a rare yet serious intratemporal infection that often masquerades as a skull base malignancy. It is most common in diabetic and immunocompromised patients. We present a case of an elderly diabetic patient with end-stage renal disease with progressive malignant otitis externa. The disease progressed to involve the base of the skull, causing multiple cranial neuropathies. Early initiation of intravenous (IV) antibiotics, along with supportive treatment, may improve the long-term prognosis of the disease. This case highlights the importance of keeping a high index of diagnostic suspicion for SBO in patients with risk factors. Early diagnosis and prompt treatment can drastically decrease morbidity and mortality due to SBO.
Case report: Successful treatment of a patient undergoing haemodialysis with multifocal hepatocellular carcinoma using atezolizumab and bevacizumab
Authors: Shalin Abraham, Adel Samson
Journal: Front Oncol (2024)
Keywords: anti-angiogeneic therapy, atezolizumab, bevacizumab, end stage kidney disease (eskd), haemodialysis (hd), hepatocellar carcinoma (hcc), immune check inhibitor (ici), patient outcome
MeSH terms: Case Reports

In the last five years, the advent of combination immune checkpoint inhibitor atezolizumab and anti-angiogenic agent bevacizumab has transformed treatment of unresectable hepatocellular carcinoma. As patient outcomes improve, healthcare professionals will more frequently encounter patients with concomitant hepatocellular cancer and end stage kidney disease on haemodialysis. We present the first case in the literature of a 58-year-old male with multifocal hepatocellular carcinoma undertaking regular haemodialysis who was successfully treated with atezolizumab and bevacizumab with a partial response and stable disease for two years, who suffered grade 1 fatigue, grade 2 hypertension and eventually grade 3 wound infection leading to cessation of bevacizumab. After disease progression on atezolizumab monotherapy, all chemotherapy was stopped. We embed this case in a review of the current literature of atezolizumab and bevacizumab use in patients undertaking haemodialysis and conclude that both targeted therapies may be safely used in these patients. We recommend joint close management of these patients between oncology and nephrology teams, with initial cardiovascular risk stratification before commencing atezolizumab and bevacizumab therapy. During therapy, there should be regular monitoring of blood pressure, or proteinuria if the patient is oliguric under guidance of the dialysis team if preservation of residual renal function is required.
Case Report: Concomitant presence of two STIs in a male patient
Authors: Kaveri Rusia, Bhushan Madke, Yash Kashikar
Journal: F1000Res (2024)
Keywords: hpv, sti, syphilis, genital warts, treponema
MeSH terms: Condylomata Acuminata / complications, Syphilis / complications, Case Reports, Adult, Humans, Male, Sexually Transmitted Diseases / complications, Sexually Transmitted Diseases / diagnosis, Young Adult

Background:
The spirochaete Treponema pallidum subsp. pallidum, which causes the infectious disease syphilis, can be spread through sexual contact or perinatal transmission. In recent years, cases of syphilis have increased, especially among individuals engaging in behaviour that makes them more vulnerable (condomless sex and multiple sexual partners). Condylomata acuminata (external genital warts) is one of the most common viral sexually transmitted infections (STIs). Individuals who are behaviourally vulnerable are also highly prone to two or more STIs. Our case exemplifies the occurrence of two STIs in a young man who was behaviourally vulnerable to acquiring STIs.
Case:
We report a case of a 21-year-old year old heterosexual man presenting with concomitant primary syphilis and genital warts. He presented with a painless genital ulcer and warty growths on his glans penis. Examination showed a painless indurated ulcer and multiple genital warts. Serology was positive for quantitative Venereal disease research laboratory test (1:16 titre). The patient was diagnosed with two concomitant STIs. He was treated as per the latest Centers for Disease Control and Prevention (CDC) guidelines for primary syphilis and podophyllin resin for genital warts. After four weeks, the genital ulcer showed complete healing and there was a significant reduction of genital warts.
Conclusions:
Individuals with multiple sexual partners engaging in sexual activity without the use of prevention tools are at a greater chance of acquiring two or more STIs. To reduce concomitant transmission, preventive measures against genital ulcer diseases like syphilis, herpes, and chancroid, such as early identification and treatment, and condom distribution, must be strengthened as part of national STI prevention. Patients with two or more STIs should be followed regularly to assess the progress of infection and should be offered timely medical treatment.
Case report: Sagliker syndrome in the patient with recurrent tertiary hyperparathyroidism due to intrathyroidal parathyroid carcinoma
Authors: Rustam Salimkhanov, Ekaterina Bondarenko, Anna Eremkina, Ekaterina Bibik, Ekaterina Kim, Kamila Begova, Ilya Kim, Sergey Kuznetsov, Natalia Mokrysheva
Journal: Front Endocrinol (Lausanne) (2024)
Keywords: sagliker syndrome, case report, chronic renal failure, parathyroid carcinoma, tertiary hyperparathyroidism
MeSH terms: Carcinoma, Hyperparathyroidism / complications, Hyperparathyroidism / surgery, Parathyroid Neoplasms, Case Reports, Research Support, Non-U.S. Gov't, Humans, Parathyroid Glands, Parathyroidectomy

Sagliker syndrome (SS) is an extremely rare disorder that manifests in patients with advanced chronic kidney disease (CKD) undergoing programmed hemodialysis as a renal replacement therapy. Treatment of secondary hyperparathyroidism (SHPT) in these patients is still challenging. The main clinical manifestations of SS include craniofacial and fingertip deformities, dental anomalies, gingival hyperplasia, short stature, hearing loss, neurological and psychiatric impairment. The etiology and pathogenesis of SS in patients with SHPT require further clarification. However, mutations in the GNAS1, FGF23, and FGFR3 genes were described in some patients, suggesting a possible role of genetic predisposition to the syndrome. The preferred therapeutic approach for SS is surgery, but the volume of the operation is debated. The main surgical strategies include total, subtotal parathyroidectomy, or total parathyroidectomy with autotransplantation of the parathyroid gland (PG). Unfortunately, parathyroidectomy does not contribute to the regression of significant skeletal deformities. We present a unique clinical case of a patient with classical features of SS, recurrent tertiary hyperparathyroidism (THPT) after total parathyroidectomy due to intrathyroidal parathyroid carcinoma (PC).
Hepatic arterial infusion chemotherapy and trastuzumab in gastric cancer with liver metastases: a case report
Authors: Hui-Qin Li, Qin Wang, Liu-Yan Zhang, Jia-Yin Li, Ying-Jie Wang, Li Wei, Li-Ge Yao
Journal: Front Oncol (2023)
Keywords: gastric cancer, hepatic arterial infusion chemotherapy, human epidermal growth factor receptor 2, liver metastases, trastuzumab
MeSH terms: Case Reports

Background:
Gastric cancer is a common cancer worldwide and is responsible for over one million new cases in 2020 and an estimated 769,000 deaths, ranking fifth for incidence and fourth for mortality globally. Incidence rates are highest in Eastern Asia and Eastern Europe. Gastric cancer is highly heterogeneous and progresses rapidly. The prognosis of gastric cancer with liver metastases is poor, and clinical treatment remains challenging. Human epidermal growth factor receptor 2 (HER2) positivity is correlated to a bad prognosis for gastric cancer. Trastuzumab combined with systemic chemotherapy is the preferred treatment for HER2-positive advanced gastric cancer. However, intravenous chemotherapy has severe systemic toxicity, which reduces the local drug concentration and tumor uptake rate, and the effect is unsatisfactory.
Case summary:
We reported a 66-year-old patient with HER2-positive advanced gastric cancer with jaundice due to multiple liver metastases, after 6 cycles of trastuzumab combined with hepatic arterial infusion chemotherapy (HAIC), the tumor retracted significantly, the jaundice subsided, and the patient recovered well. The patient achieved disease control with an intensive regimen followed by less toxic maintenance therapy. Trastuzumab combined with capecitabine maintenance therapy followed up for more than 16 months.
Conclusion:
HAIC plus trastuzumab may be a tolerable treatment option for patients with severe liver metastases from HER2-positive gastric cancer to achieve local control and prolong survival.
ACUM, an easily underdiagnosed cause of dysmenorrhea-A case report
Authors: Qicai Hu, Chunlei Guo, Qing Chen, Wei Zhang, Huifang Wang, Weixia Wei
Journal: Front Med (Lausanne) (2024)
Keywords: accessory cavitated uterine malformation, dysmenorrhea, laparoscopy, surgery, ultrasound
MeSH terms: Case Reports

This report described three cases with long-term severe dysmenorrhea, and these cases were referred to our department for medical help. The diagnosis of accessory cavitated uterine malformation (ACUM) was considered based on symptoms and ultrasound/MRI findings. Moreover, a combined approach involving hysteroscopic surgery and laparoscopic surgery was undertaken, and no complications occurred during surgery and in the post-operative period. It is important to consider ACUM in patients with severe dysmenorrhea that does not respond to medical management. Surgery is the most effective treatment for this anomaly.
A Case of Bullous Sweet's Syndrome Associated With Esophageal Adenocarcinoma
Authors: Adriana G Bagos-Estevez, Sarah Moore, Leslie Turner, Brooke Baldwin
Journal: Cureus (2024)
Keywords: bullous, esophageal adenocarcinoma, malignancy, neutrophilic dermatosis, sweet’s syndrome
MeSH terms: Case Reports

Sweet's syndrome (SS), or acute febrile neutrophilic dermatosis, characteristically presents with fever, dermal neutrophilic infiltrates, and neutrophilia. It typically manifests as tender erythematous plaques; however, various variants are documented, including bullous. Malignancy-associated Sweet's syndrome (MASS) can present as a paraneoplastic syndrome in those with established cancers or with undiagnosed malignancies. We present a 72-year-old male with a three-day history of a progressive bullous, erythematous papular rash starting on his right forearm and spreading to his extremities, trunk, palms, and soles. It was mildly pruritic but nontender. He had no recent febrile illnesses. On examination, the rash was violaceous with tense bullae overlying edematous targetoid papules coalescing into plaques. Histopathologic analysis of punch biopsies from his abdomen and thigh demonstrated dense inflammatory infiltrates of neutrophils, eosinophils, histiocytes, and lymphocytes, suggestive of neutrophilic dermatosis, or Sweet's syndrome. He was treated with prednisone 1 mg/kg with improvement in his cutaneous symptoms, and a malignancy workup was initiated. Blood work showed elevated free kappa, lambda light chains, lactate dehydrogenase (LDH), and C-reactive protein (CRP) levels. A positron emission tomography (PET) scan revealed lesions in the esophagus and kidney. He was referred to Heme/Onc, GI, and Urology. He was diagnosed with esophageal adenocarcinoma stage IIb and a renal mass. He has since completed neoadjuvant chemotherapy and radiation, is s/p robotic Ivor-Lewis esophagectomy with no evidence of residual carcinoma on pathology, and is undergoing surveillance with imaging every three months for his renal mass. This case highlights the importance of rapid identification of MASS and the impact dermatologists can make in getting these patients the potentially lifesaving care they need.
Asteroid Hyalosis: A Mimicker of Vitreous Hemorrhage on Point of Care Ultrasound: A Case Report
Authors: Eniola C Gros, Lauren R Mccafferty
Journal: POCUS J (2023)
Keywords: diagnosis opthamology, ocular ultrasound
MeSH terms: Case Reports

Ocular point of care ultrasound (POCUS) can help make timely recognition of multiple emergent ocular conditions and differentiate these from more benign conditions. While asteroid hyalosis (AH) is benign, it can easily mimic the more potentially serious vitreous hemorrhage on ocular POCUS, as both consist of numerous echogenic opacities within the vitreous with a classic "washing machine" appearance with eye movement. However, asteroid hyalosis particles tend to be more discrete, hyperechoic, scintillating, and seen throughout the vitreous. Knowledge of this mimic and ability to recognize the subtle sonographic differences can help differentiate these disease processes, which can influence management and potentially disposition.
Improvement in Serum Magnesium Levels With Sodium-Glucose Cotransporter 2 Inhibitors
Authors: Arunava Saha, Abdulkadir Omer, Nitin Trivedi
Journal: JCEM Case Rep (2022)
Keywords: sglt2 inhibitor, hypomagnesemia, low magnesium, magnesiuria, refractory hypomagnesemia
MeSH terms: Case Reports

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are associated with a modest but significant increase in serum magnesium levels. This report describes improvement in serum magnesium and associated symptoms after initiating SGLT2i therapy in a patient with refractory hypomagnesemia. A 58-year-old woman presented with persistent hypomagnesemia refractory to oral magnesium supplements. She had history of type 2 diabetes mellitus, hypothyroidism, fibromyalgia, and degenerative disk disease. The cause of hypomagnesemia was attributed to excessive renal losses. Laboratory investigations revealed serum magnesium of 1.2 mg/dL with fractional excretion of magnesium of 8.9%. She was started on empagliflozin 10 mg daily. Within 4 weeks of therapy, her serum magnesium level corrected with symptomatic improvement, which was sustained a few weeks later. Subsequently, her oral magnesium supplements dose was reduced. SGLT2i has been shown to improve magnesium levels in patients with urinary magnesium wasting. Several mechanisms have been postulated, but the exact physiology remains unknown. SGLT2i have been efficacious for glycemic control, renal protection, decreasing the risk of atherosclerotic cardiovascular disease events, and cardiac mortality in patients with diabetes. In addition, renal and cardiac benefits are also demonstrated in patients without diabetes. This observation demonstrates that SGLT2i can improve the management of patients with otherwise intractable hypomagnesemia.
Regional anesthesia for pain control in children with solid tumors-a review of case reports
Authors: Aliya Baizhanova, Azhar Zhailauova, Vitaliy Sazonov
Journal: Front Pediatr (2024)
Keywords: oncology, pain, palliative care, pediatric, regional anesthesia

Introduction:
Around seventy percent of all childhood cancer patients suffer from severe pain. This pain can arise from various sources, including tumors themselves, pain caused by metastasizing tumor cells or as the outcome of therapy meant to deal with tumors. If managed inadequately, such pain can lead to many hazardous sequelae. However, there are extreme cases when pain does not respond to standard treatment. For such cases, regional anesthesia or nerve blocks are utilized as the utmost pain control measure. Blocks are used to treat pain in patients who no longer respond to conventional opioid-based treatment or whose worsened condition makes it impossible to receive any other therapy. The data regarding the use of regional anesthesia for such cases in the children population is limited.
Methods:
For this review we searched for case reports in Scopus and PubMed from inception to 2023. The descriptive search items included terms related to childhood cancer and the description of each block. The inclusion criteria for review include children (0-18 years old) receiving oncology-related surgical procedures or palliative care. The data collection was limited to solid tumor-related cases only. We analyzed a total of 38 studies that included case reports and one retrospective study.
Results and discussion:
It was concluded that nerve blocks, although rarely performed, are a safe and efficient way of pain control in children with solid tumors. The major settings for block performance are postoperative pain control and palliative care. We observed that block indication and its outcomes depend on unique health circumstances in which they should be performed. Patients with similar diagnoses had differing outcomes while receiving the same block treatment.
Left atrial myxoma presenting with acute pulmonary edema and syncope in a middle-aged black African woman: a case report
Authors: Kasiemobi Eberechukwu Uchime, Oladipo Ayoola Olanipekun, Olamide Nelson Ogidan, Stephen Olawale Oguntola, Okechukwu Obumneme Ezekpo, Olaniyi Abiodun Oluwafemi Olatunde, Akinola Akinmade
Journal: Pan Afr Med J (2023)
Keywords: heart, case report, myxoma, neoplasm
MeSH terms: Heart Neoplasms / complications, Heart Neoplasms / diagnosis, Heart Neoplasms / surgery, Myxoma / complications, Myxoma / diagnosis, Myxoma / surgery, Pulmonary Edema / complications, Pulmonary Edema / etiology, Case Reports, Echocardiography, Female, Heart Atria / diagnostic imaging, Humans, Middle Aged, Syncope / etiology

Cardiac myxoma is a very rare benign cardiac neoplasm. Its annual incidence globally is between 0.5 to 1 case per one million individuals. It has a 0.03% prevalence rate in the general population. It commonly occurs in the left atrium, but can also be located in the other heart chambers. Its clinical presentations are variable, non-specific, and can mimic various cardiovascular and systemic diseases, posing a diagnostic dilemma. Thus, a high index of suspicion with appropriate use of radiologic and laboratory diagnostic tools is essential for its accurate diagnosis and management. The diagnosis and management of a rare case of left atrial myxoma in a middle-aged African woman who presented with heart failure-like symptoms, features of acute pulmonary edema, and syncope is presented in this literature. The diagnosis was suspected following echocardiography. The tumor was surgically excised, and the diagnosis was confirmed histopathologically. The patient´s post-operative condition has been excellent.
Bladder Cancer Invading the Prostate and Penis and Multiple Bone Metastases Showing Significant Improvement after a Short-Term Pembrolizumab Therapy following Radiation and Gemcitabine and Cisplatin Therapy Leading to a Pathologically Complete Remission
Authors: Kyohei Ishida, Akira Ogose, Gen Kawaguchi, Go Hasegawa, Yohei Ikeda, Noboru Hara, Tsutomu Nishiyama
Journal: Case Rep Urol (2024)
MeSH terms: Case Reports

A 65-year-old man was diagnosed with bladder cancer invading the prostate and penis and multiple bone metastases. He underwent palliative radiation (30 Gy/10 fr) through vertebral bones (Th3 and Th12-L5) and pelvic bones for pain control. The patient received pembrolizumab therapy after three courses of gemcitabine and cisplatin therapy. CT four weeks after starting pembrolizumab therapy showed that both the primary and metastatic lesions had notably reduced in size, and no new lesion was detected. He subsequently fell, resulting in a femoral neck pathological fracture, and underwent hemiarthroplasty. Pathological examination of the pathological fracture site revealed no residual tumor tissue.