OpenMed/multicare-articles huggingface dataset:
Bortezomib-induced hyponatremia: tolvaptan therapy permits continuation of lenalidomide, bortezomib and dexamethasone therapy in relapsed myeloma
Authors: N O'Connor-Byrne, S Glavey, R Tudor, P Murphy, C J Thompson, J Quinn
Journal: Exp Hematol Oncol (2019)
Keywords: bortezomib, hyponatremia, multiple myeloma, tolvaptan
MeSH terms: Case Reports

The development of hyponatremia due to syndrome of inappropriate antidiuretic hormone secretion (SIADH) is well recognised in multiple myeloma (MM). SIADH, due to either MM or Bortezomib can be hazardous as severe hyponatremia may develop if large volumes of hypotonic intravenous fluid are used as an adjunct to chemotherapy. We report a case of Bortezomib-induced SIADH, in whom the use of tolvaptan, a vasopressin receptor-2 antagonist, permitted the continuation of triple combination anti-MM therapy with lenalidomide, Bortezomib and dexamethasone (RVD) in a female with aggressive disease, without the development of hyponatremia. Our patient had a rapid relapse, in which the use of Bortezomib as part of an RVD regimen was life-saving. The use of tolvaptan allowed continuation of therapy that is usually halted in other similarly reported cases. This case highlights the possible use of vaptans, which allows an aquaresis to occur by blocking the antidiuretic effects of vasopressin, as a treatment for Bortezomib-induced hyponatremia.
White Esophagus: The Result of Polypharmacy
Authors: Brendan Andres, Pradeep R Kathi, Kai Tey
Journal: Cureus (2023)
Keywords: budesonide, candida esophagitis, immunocompetent adult, infectious esophagitis, polypharmacy
MeSH terms: Case Reports

Candida esophagitis can occur in immunocompetent patients through impairment of host defense mechanisms including salivation, esophageal motility, acidic pH, and innate immunity. Commonly prescribed medications inhibit these mechanisms, and polypharmacy has been shown to have an additive effect on promoting Candida infection. We present the case of an immunocompetent patient who was chronically prescribed multiple medications associated with Candida esophagitis but experienced infection only after the addition of oral delayed-release budesonide, which has not previously been associated with Candida esophagitis.
Co-Occurrence of Exogenous and Endogenous Cushing's Syndromes-Dilemma in Diagnosis
Authors: Chin Voon Tong, Subashini Rajoo
Journal: Case Rep Endocrinol (2019)
MeSH terms: Case Reports

Approach to patients who manifest with features of Cushing's syndrome often begin with exclusion of exposure to excessive exogenous source of glucocorticoids (GC). Most guidelines advocate no further assessment if excessive exogenous GC use is present. We present a case of a 66-year-old lady who was noted to have typical features of Cushing's syndrome. As she gave a very clear history of ingesting exogenous GC for a year, no further work up was undertaken. Despite cessation of GC for a year, she continued to have thin skin and easy bruising. Upon admission for hypertensive emergency, her clinician took note of her changes and investigated her for endogenous Cushing's syndrome. Her cortisol post overnight dexamethasone suppression test was 707 nmol/l. Post low dose dexamethasone suppression test yielded a cortisol of 1133.2 nmol/l. 24 hours urine cortisol was 432.2 nmol/l. Plasma ACTH was 1.1 pmol/l, indicating an ACTH independent Cushing's syndrome. We proceeded with Computed tomography scan (CT scan) of adrenals which revealed a right adrenal adenoma measuring 4.4 × 3.4 × 4.0 cm. Right retroperiteneoscopic adrenalectomy was done. Histopathology examination was consistent with adrenal cortical adenoma with foci of myelolipoma. Post adrenalectomy she developed hypocortisolism secondary to contralateral adrenal suppression which lasted up to the present date. Her cutaneous and musculoskeletal manifestations improved substantially. Co-occurrence of endogenous and exogenous Cushing's syndromes is uncommon but should be considered in patients whose Cushingnoid features do not resolve after cessation of exogenous GC.
Case report: Cytokine therapy and an intracoronary autologous bone marrow-derived cell infusion with Impella support in a patient with dilated cardiomyopathy and a severely reduced ejection fraction
Authors: Russell Charles Hall, Rohini Ramaseshan, Alice Reid, Daniel A Jones, Anthony Mathur
Journal: Front Cardiovasc Med (2022)
Keywords: case report, cell therapy, dilated cardiomyopathy, heart failure, interventional cardiology, regenerative medicine
MeSH terms: Case Reports

Introduction:
This is the first reported case of a patient with dilated cardiomyopathy (DCM) and severely impaired left ventricular function to receive a combined treatment of granulocyte colony-stimulating factor therapy and an intracoronary delivery of autologous bone marrow-derived mononuclear cells with percutaneous circulatory assistance (the Impella CP device; Abiomed, Danvers, MA).
Main symptoms and outcome:
Three months post-treatment, the gentleman in his early 70s demonstrated an improvement in left ventricular ejection fraction (13-17%) and a reduction in New York Heart Association class from III to class I. There was also an improvement in his 6-minute walk test (147-357 meters), N-terminal pro-brain natriuretic peptide level (14,099-7,129 ng/l) and quality of life scores. There were no safety concerns during the treatment or follow-up.
Conclusion:
This case report suggests combined cell and cytokine therapy with adjunctive circulatory support could be a safe and promising treatment for patients with DCM and severely reduced ejection fraction.
A case report of complete remission of acute myeloid leukemia combined with DNMT3A, FLT3-TKD, and IDH2 gene mutations and active pulmonary tuberculosis treated with homeharringtonine + venetoclax + azacytidine
Authors: Lin Ji, Wei Yang, Xiao-Feng Xu, Ya-Qing Xu
Journal: Front Med (Lausanne) (2023)
Keywords: dnmt3a mutation, flt3-tkd mutation, idh2 mutation, active pulmonary tuberculosis, acute myeloid leukemia, complete remission, homeharringtonine
MeSH terms: Case Reports

In March 2022, a 58-year-old man was admitted to the local hospital for nausea and vomiting. His blood routine indicated that he had leukocytosis and anemia. The patient was diagnosed with acute myeloid leukemia (AML)-M5b accompanied by DNMT3A, FLT3-TKD, and IDH2 mutations, chest CT revealed pulmonary tuberculosis (TB). Acid-fast bacillus (AFB) was detected in sputum. The patient then received anti-TB treatment with isoniazid + rifampicin + pyrazinamide + ethambutol. On April 8, he was transferred to our hospital's Hematology Department after three consecutive negative sputum smears. He was administered the VA (Venetoclax + Azacytidine) regimen of anti-leukemia treatment and also received levofloxacin + isohydrazide + pyrazinamide + ethambutol anti-TB treatment. After one course of VA therapy, there was no remission in the bone marrow. Therefore, the patient received the HVA (Homeharringtonine + Venetoclax + Azacytidine) regimen of anti-leukemia treatment. On May 25, the bone marrow smear revealed that the original mononuclear cells were 1%. Moreover, bone marrow flow cytometry revealed the absence of any abnormal cells. mNGS showed DNMT3A (mutation rate 44.7%), but no mutations were detected in FLT3-TKD and IDH2. The patient then received the HVA regimen three consecutive times, resulting in complete remission. Repeated chest CT examinations revealed progressive regression of pulmonary TB foci, no AFB was detected in the sputum. This AML patient with DNMT3A, FLT3-TKD, and IDH2 mutations and active TB is difficult to treat. It is very necessary for him to administer prompt anti-leukemia treatment under the premise of active anti-TB treatment. The HVA regimen is effective for this patient.
Glucagonoma-induced acute heart failure
Authors: Kun Zhang, Lukas J Lehner, Damaris Praeger, Gert Baumann, Fabian Knebel, Marcus Quinkler, Torsten K Roepke
Journal: Endocrinol Diabetes Metab Case Rep (2014)

Neuroendocrine tumours (NETs) represent a broad spectrum of tumours, of which the serotonin-producing carcinoid is the most common and has been shown to cause right ventricular heart failure. However, an association between heart failure and NETs other than carcinoid has not been established so far. In this case report, we describe a 51-year-old patient with a glucagon-producing NET of the pancreas who developed acute heart failure and even cardiogenic shock despite therapy. Heart failure eventually regressed after initialising i.v. treatment with the somatostatin analogue octreotide. Chromogranin A as a tumour marker was shown to be significantly elevated, and it decreased with clinical improvement of the patient. The effects of long-time stimulation of glucagon on the myocardium have not been studied yet; however, sarcoplasmic reticulum calcium leak can be discussed as a possible mechanism for glucagon-induced heart failure.
Learning points:
Glucagonoma can be a cause for heart failure.i.v. infusion of octreotide can be successfully used to treat glucagonoma-induced acute heart failure.We suggest that cardiac function should be monitored in all NET patients.
Sertoli-Leydig Cell Tumour and DICER1 Mutation: A Case Report and Review of the Literature
Authors: B Wormald, S Elorbany, H Hanson, J W Williams, S Heenan, D P J Barton
Journal: Case Rep Obstet Gynecol (2018)
MeSH terms: Case Reports

Sertoli-Leydig cell tumours of the ovary (SLCT) are rare tumours predominantly caused by mutations in the DICER1 gene. We present a patient with a unilateral SLCT who had an underlying germline DICER1 gene mutation. We discuss the underlying pathology, risks, and screening opportunities available to those with a mutation in this gene as SLCT is only one of a multitude of other tumours encompassing DICER1 syndrome. The condition is inherited in an autosomal dominant fashion. As such, genetic counselling is a key component of the management of women with SLCT.
Epstein-Barr Virus (EBV)-Associated Haemophagocytic Syndrome
Authors: Lorenza Torti, Luigi M Larocca, Giuseppina Massini, Annarosa Cuccaro, Elena Maiolo, Rosaria Santangelo, Maria Bianchi, Mariano Alberto Pennisi, Stefan Hohaus, Luciana Teofili
Journal: Mediterr J Hematol Infect Dis (2012)
MeSH terms: Case Reports

We describe the case of a 17- year old female who developed fatal haemophagocytic syndrome (HPS) one month following acute infection caused by Epstein-Barr virus (EBV). Despite initiation of treatment and reduction of EBV load, laboratory signs of HPS as severe cytopenia, hypofibrinogenemia, hyperferritinemia and hypertriglyceridemia persisted, and the patient died of multiorgan failure. HPS is a rare, but life-threatening complication of EBV infection.
Misplacement of a Port Catheter: A Differentiated View
Authors: Christoph Evers, Angelos Gazis, Wendy Thuss-Patiance, Albrecht Kretzschmar
Journal: Case Rep Radiol (2017)
MeSH terms: Case Reports

Clinical radiological controls after the insertion of central venous catheters (CVC) are of high importance. Misplacement of the CVC, outside of large vessels, as described in our first case, occurs in more than 7% of cases and may be associated with life-threatening events. A persistent left-sided superior vena cava (PLSSVC) occurs in 0.3-0.5% of the standard population. In one of the cases a CT scan of the chest showed the catheter in a PLSSVC. Neoadjuvant radiochemotherapy was indicated in a patient with an adenocarcinoma of the oesophagus. Under hospitalised monitoring, full-dose chemotherapy was given. Consequences for the patients arise when the findings are known for future interventions. If a PLSSVC is expected and a CVC is to be inserted, the venous return to the heart should be evaluated first, to preclude a possible backflow to the left atrium. With this constellation, a right-to-left shunt can be expected in in 10% of cases. Affected patients face a high risk of developing cardioembolic events.
Professional accountability in a sternal bone marrow aspiration: a forensic case report
Authors: Sami Bardaa, Narjes Karray, Zouhir Hammami, Samir Maatoug
Journal: Pan Afr Med J (2020)
Keywords: sternal bone marrow aspiration, aortic injury, liability, malpractice, pericardial tamponade
MeSH terms: Aorta / injuries, Biopsy, Needle / adverse effects, Cardiac Tamponade / etiology, Case Reports, Aged, Bone Marrow Examination, Fatal Outcome, Humans, Liability, Legal, Male, Malpractice, Multiple Myeloma / diagnosis, Sternum

An aortic injury with concomitant pericardial tamponade caused by sternal bone marrow aspiration is rare. We report a case of fatal sternal bone marrow aspiration performed to a 73 year old man for the purpose of confirming the diagnosis of multiple myeloma. This puncture was followed by an injury in the aorta causing a pericardial tamponade and the death of the patient immediately after the aspiration. This paper stresses the precautions to be taken, by the operator, in certain particular situations that make the sternal bone marrow aspiration difficult and risky, and discusses the different types of operator´s liability that can be involved and their foundations.
Mechanical failure of a femoral lengthening nail: a case report
Authors: WeiWei Wu, Kevin M Kuhn
Journal: Patient Saf Surg (2018)
Keywords: distraction osteogenesis, femoral lengthening nail, nonunion
MeSH terms: Case Reports

Background:
This case report describes the mechanical failure of a femoral lengthening nail in order to allow early recognition and prevent its occurrence.
Case presentation:
A femoral lengthening nail was used to achieve goal distraction length over eight weeks and sustained a mechanical failure during progressive weightbearing. Re-distraction was attempted with subsequent non-weight-bearing status. Although the patient was not able to attain the original goal length, radiographs demonstrated stable shortening of the patient's right lower extremity along with early signs of incomplete regenerate bone. She eventually received exchange nailing with bone graft.
Conclusion:
Post-operative protocol and weight-bearing status should be further researched and standardized after re-evaluating the mechanical stiffness of the intramedullary nail construct.
Absence of PSA Flare With Apalutamide Administered 1 Hour in Advance With GnRH Agonists: Case Report
Authors: Zhiquan Hu, Zhenghao Liu, Zhiyuan Chen, Xing Zeng, Zhihua Wang, Chunguang Yang
Journal: Front Oncol (2022)
Keywords: adt, gnrh agonist, apalutamide, flare, hormone-sensitive prostate cancer
MeSH terms: Case Reports

Objective:
To examine the effects of apalutamide on endocrine function and flare prevention in metastatic hormone-sensitive prostate cancer (mHSPC) patients administered GnRH agonists.
Methods:
The first newly diagnosed mHSPC patient took apalutamide for 2 weeks followed by combination with GnRH agonist, as recommended by clinical guidelines. Serum luteinizing hormone (LH), testosterone, and PSA were detected during the oral administration of apalutamide before and after ADT. Eight newly diagnosed mHSPC patients innovatively took apalutamide 1 hour before GnRH agonist administration; LH, testosterone and PSA were detected before and after ADT.
Results:
In the first patient, LH and testosterone levels were increased during apalutamide monotherapy, and serum PSA levels decreased rapidly, demonstrating apalutamide effectively blocked AR signaling. In patients on the 1-hour regimen, combined treatment with apalutamide and GnRH agonists led to peak level of testosterone on day 3 and castration level on day 28, while PSA decreased continuously. No one experienced dysuria or bone pain worsen after ADT.
Conclusion:
Taking apalutamide 1 hour in advance may effectively prevent the flare-up effect in prostate cancer patients treated with GnRH agonists. Compared with the 2-week regimen, the 1-hour regimen could simplify the treatment process and bring testosterone to castration levels in advance.
Chronic koro-like symptoms - two case reports
Authors: Nilamadhab Kar
Journal: BMC Psychiatry (2005)
MeSH terms: Koro / diagnosis, Case Reports, Research Support, Non-U.S. Gov't, Adult, Chronic Disease, Humans, India / epidemiology, Koro / epidemiology, Koro / psychology, Longitudinal Studies, Male, Prognosis, Treatment Outcome

Background:
Koro is a culture bound syndrome, which has been reported usually from Asian countries. It has been described as an acute, brief lasting illness, which often occurs in epidemics. There is no description in literature of a chronic form of this syndrome.
Case presentation:
Two sporadic cases with koro-like symptoms from East India are presented where the illness had a chronic course with durations spanning more than ten years. In contrast to acute, good prognosis, psycho-education responsive form that is usually seen in epidemics; the chronic form, appeared to be associated with greater morbidity and poorer response to interventions.
Conclusion:
There is a possibility of a chronic form of koro syndrome.
Case Report: Multicentric Reticulohistiocytosis Associated With Posterior Mediastinal Adenosquamous Carcinoma, Antinuclear Antibody Positivity and Lupus Anticoagulant Positivity
Authors: Ziyi Tang, Xiangpeng Wang, Zijing Xia, Zhongming Wang, Yi Zhao, Yi Liu
Journal: Front Immunol (2022)
Keywords: case report, mediastinal malignancy, multicentric reticulohistiocytosis, paraneoplastic syndrome, rare disease
MeSH terms: Antibodies, Antinuclear / immunology, Carcinoma, Adenosquamous / immunology, Carcinoma, Adenosquamous / pathology, Carcinoma, Adenosquamous / therapy, Histiocytosis, Non-Langerhans-Cell / immunology, Histiocytosis, Non-Langerhans-Cell / pathology, Histiocytosis, Non-Langerhans-Cell / therapy, Lupus Coagulation Inhibitor / immunology, Mediastinal Neoplasms / immunology, Mediastinal Neoplasms / pathology, Mediastinal Neoplasms / therapy, Case Reports, Research Support, Non-U.S. Gov't, Adult, Humans, Male, Antibodies, Antinuclear, Lupus Coagulation Inhibitor

Multicentric reticulohistiocytosis (MRH) is a rare systemic disease of non-Langerhans cell histiocytosis. A number of studies in the literature have documented that it can coexist with malignancy or autoimmune disease, making it difficult to determine the most appropriate therapy. Here, we present a case study of MRH associated with posterior mediastinal adenosquamous carcinoma along with antinuclear antibody positivity and lupus anticoagulant positivity. The patient experienced 6 months of clinical benefit after surgical resection and chemoradiotherapy of the mediastinal malignancy. This case adds to the available literature on multicentric reticulohistiocytosis associated with different types of malignancy and provides supplementary clinical data on the coexistence of this syndrome with malignancy and immune system abnormalities. To the best of our knowledge, this is the first case study describing MRH accompanied by posterior mediastinal adenosquamous carcinoma and lupus anticoagulant positivity. The unknown aetiology and polymorphic clinical presentation of MRH warrants further investigation.
Case Report: Novel Disseminated Paecilomyces formosus Infection in a Dog
Authors: Stephanie Anderson, Daniel Felipe Barrantes Murillo, Mandy Womble, Nicole Gibbs, Karyn Harrell, Tatiane Terumi Negrão Watanabe
Journal: Front Vet Sci (2022)
Keywords: paecilomyces formosus, dog, domestic animal, hyalohyphomycosis, systemic mycosis
MeSH terms: Case Reports

A 2.5-year-old, 25.5 kg, spayed female Australian Shepherd dog had a 2-month history of shifting leg lameness in all limbs, tetraparesis, progressive lethargy, and severe pain. On the physical examination, fever (40.61°C), tachycardia, tachypnea, mild diffuse pelvic limb muscular atrophy, left prescapular and right popliteal lymphadenomegaly were observed. Due to the poor prognosis and difficult pain management, humane euthanasia was elected. Macroscopic and histological findings revealed multifocal to coalescing granulomas with central areas of lytic necrosis within the right femur, left humerus, left scapula, left biceps brachii, right semimembranosus muscle, liver, spleen, and lymph nodes. The necrotic areas contained myriad intralesional, intracellular, and extracellular negatively stained, non-pigmented, septate acute angle branching hyphae with parallel walls measuring 3-6 μm in width with polar bulbous projections measuring 7-13 μm in width. Fresh samples of the liver were submitted for fungal culture. Panfungal PCR targeting the major conserved genes-ITS, TUB, CAL-confirmed Paecilomyces formosus. Paecilomyces spp. are members of anamorphic fungi classified under the phylum Ascomycota. Paecilomycosis is an uncommon fungal infection caused by Paecilomyces spp with a disease reported in humans and animals ranging from superficial to systemic clinical forms affecting both immunocompromised and immunocompetent individuals. In dogs, disseminated paecilomycosis has been reported, but the species of fungi are not always determined. To our knowledge, this is the first case of disseminated paecilomycosis caused by P. formosus infection in a dog.
Gelatin sponge as a rare and forgotten cause of early-onset neurological deficit post osteotomy of thoracolumbar kyphosis-A case report and review of literature
Authors: Didik Librianto, Fachrisal, Ifran Saleh
Journal: Int J Surg Case Rep (2020)
Keywords: absorbable gelatin sponge, case report, postoperative neurological deficit, spinal cord compression
MeSH terms: Case Reports

Introduction:
Neurological deficits complicating the correction of spinal deformity usually occur acutely during surgery or immediately after surgery. Absorbable gelatin sponges have been used to control bleeding and prevent undesired event during and after spinal surgery since more than 50 years ago. However, its potency of osmotic expansion within an enclosed space containing neural tissue can cause compression of the spinal cord. We presented a rare, early-onset postoperative neurological deficit caused by the use of absorbable gelatin sponge.
Method:
A 27 years old female patient with kyphosis of thoracolumbal vertebrae at the level of Th 10 - L2 presented with neurologic deficit gradually started 24 h after the posterior vertebrae column resection (PVCR), laminectomies, and Smith Peterson (SPO) osteotomy procedure of severe fixed kyphosis correction of deformity in thoracolumbar area.
Result:
Immediate surgical exploration within 24 h was performed with the duration of surgery of 1 h. Hematoma and retained sponge were found within the site of laminectomy, compressing the spinal cord. After removal of gelatin sponge and its associated hematoma, the neurological function returned to normal at 48 h postoperatively.
Conclusion:
The use of absorbable gelatin sponge for controlling bleeding and preventing adhesions in spinal surgery has the potency of spinal cord compression due to expansion within the enclosed space, therefore a large piece of absorbable gelatin sponge should be removed once hemostatic control is achieved and small piece, soaked sponge should be used if the sponge is to be left in place, in order to avoid this complication.