OpenMed/multicare-articles huggingface dataset:
Lazy lips: hyperkalemia and acute tetraparesis-a case report from an urban emergency department
Authors: Christian T Braun, David S Srivastava, Bianca Maria Engelhardt, Gregor Lindner, Aristomenis K Exadaktylos
Journal: Case Rep Emerg Med (2014)

A 58-year-old male patient was admitted to our emergency department at a large university hospital due to acute onset of general weakness. It was reported that the patient was bradycardic at 30/min and felt an increasing weakness of the limbs. At admission to the emergency department, the patient was not feeling any discomfort and denied dyspnoea or pain. The primary examination of the nervous system showed the cerebral nerves II-XII intact, muscle strength of the lower extremities was 4/5, and a minimal sensory loss of the left hemisphere was found. In addition, the patient complained about lazy lips. During ongoing examinations, the patient developed again symptomatic bradycardia, accompanied by complete tetraplegia. The following blood test showed severe hyperkalemia probably induced by use of aldosterone antagonists as the cause of the patient's neurologic symptoms. Hyperkalemia is a rare but treatable cause of acute paralysis that requires immediate treatment. Late diagnosis can delay appropriate treatment leading to cardiac arrhythmias and arrest.
Multimodality Imaging of a Silent Killer
Authors: Ola Abdelkarim, Yehia Saleh, Summit Pandat, Mouaz Al-Mallah
Journal: Methodist Debakey Cardiovasc J (2022)
Keywords: cardiac computed tomography, cardiac fluorodeoxyglucose-positron emission tomography, cardiac magnetic resonance imaging, cardiomyopathy, myocardial infarction
MeSH terms: Multimodal Imaging / methods, Positron-Emission Tomography, Case Reports, Humans, Radiopharmaceuticals, Radiopharmaceuticals

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Sinus Node Dysfunction and Acute Transverse Myelitis As Initial Presentation of Systemic Lupus Erythematosus in a 55-Year-Old Female: A Case Report
Authors: Rio May E Llanes
Journal: Cureus (2023)
Keywords: acute transverse myelitis, case report, methylprednisolone, sinus node dysfunction, systemic lupus erythematosus
MeSH terms: Case Reports

Systemic lupus erythematosus (SLE) is an autoimmune disease involving various organ systems. However, some of these lupus manifestations are underreported but life-threatening, so these unusual presentations need to be documented. This study aims to report a case of sinus node dysfunction (SND) and acute transverse myelitis (ATM) as the initial presentation of SLE. A 55-year-old Filipina newly diagnosed with SLE initially presented with progressive left upper extremity weakness and numbness within two days. On admission, the patient was noted to have 3/5 left upper extremity weakness and progressive C4-C6 dermatome paresthesia. A computed tomography scan of the brain was negative for infarction or hemorrhage. However, on magnetic resonance imaging of the spine, an ill-defined focus of enhancement was noted from C1 to C4 and extensive edema extending from C1 to mid-C6 vertebra. ATM was considered; hence high dose of intravenous methylprednisolone was given for five days with a notable improvement in motor and sensory deficits. Patients within the same admission also developed an onset of atrial fibrillation in rapid ventricular response in the background of baseline sinus bradycardia with associated episodes of fatigue. SND, attributed to SLE, persisted despite steroids. Pacemaker insertion was done as definitive management. The patient was discharged with the improvement of motor strength to 4+/5 and with prednisone and hydroxychloroquine as discharge medications. In conclusion, recognition and documentation of SLE's rare but life-threatening presentations, such as SLE-ATM and SND, are essential to facilitate timely therapeutic management.
Delayed union of a surgically treated fragility fracture of the pelvis: A case report
Authors: Yohei Yanagisawa, Yukei Matsumoto, Tetsuya Hoshino, Yoshiaki Inoue, Masashi Yamazaki
Journal: Int J Surg Case Rep (2020)
Keywords: case report, delayed union, fragility fractures of the pelvic ring, non-union, osteosynthesis
MeSH terms: Case Reports

Introduction:
There are no universally accepted treatment strategies for fragility fractures of the pelvis (FFPs). The incidence of delayed union or non-union of Type IIIa FFP is still unknown.
Presentation of case:
We describe a case of delayed union of a Type IIIa FFP. A 96-year-old female patient who lives independently accidentally fell when exiting a car. The diagnosis of Type IIIa FFP with displaced left ilium and left pubic rami fracture. Surgical repair was performed using an anterior intrapelvic approach with constructs made using two reconstruction contoured plates to bridge the medial edge and middle part of the fracture. This case was revealed delayed union. The periodic CT examinations were performed to determine the progress of bone union. The patient returned to most social activities including living independently and the Modified Majeed score was 94 at 12 months post-operation.
Discussion:
For the case of TypeⅢa FFP, soft tissue is spread over a wide area. When the fracture site of ilium was exposed, the cortical bone was found to be thin with poor blood flow. There is a possibility that the blood flow was hindered by subperiosteal elevation of the iliacus muscle from the internal iliac fossa in this case.
Conclusion:
Non-union of the iliac wings is relatively rare following high-energy pelvic ring fractures. The incidence of delayed union or non-union of Type IIIa FFP remains unknown; therefore, careful follow-up of patients who undergo treatment is necessary to reduce the risk of delayed union.
Acquired hemophilia A and von Willebrand syndrome in a patient with late-onset systemic lupus erythematosus
Authors: Christina Dicke, Katharina Holstein, Sonja Schneppenheim, Rita Dittmer, Reinhard Schneppenheim, Carsten Bokemeyer, Christof Iking-Konert, Ulrich Budde, Florian Langer
Journal: Exp Hematol Oncol (2014)
Keywords: acquired hemophilia a, acquired von willebrand syndrome, systemic lupus erythematosus, ultralarge von willebrand factor plasma multimers
MeSH terms: Case Reports

Acquired hemophilia A (AHA) and acquired von Willebrand Syndrome (AVWS) are both rare bleeding disorders that can be associated with lymphoproliferative or autoimmune diseases. AHA is uniformly caused by inhibitory autoantibodies against coagulation factor VIII (FVIII), while the pathophysiology of AVWS comprises several distinct mechanisms, including reduced synthesis, accelerated clearance, or increased proteolysis. In this regard, autoantibodies to von Willebrand factor (VWF) have been described in patients with systemic lupus erythematosus (SLE) or monoclonal gammopathy. Here, we report the case of a 71-year-old patient with a recent onset of spontaneous mucocutaneous and soft-tissue bleeding due to severely decreased FVIII and VWF. While there was no evidence for monoclonal gammopathy, specific IgG antibodies against both FVIII and VWF were detected. Furthermore, VWF multimer analysis revealed the presence of ultralarge plasma multimers and absence of the typical multimeric triplet structure, a finding consistent with decreased proteolytic processing of massively released, but rapidly cleared VWF. Both FVIII and VWF readily responded to immunosuppressive therapy with prednisolone. Interestingly, clinical and laboratory findings established the diagnosis of "late-onset SLE" in our patient. Thus, about 45 years after the first description of AVWS in a 12-year-old boy with SLE, we present another unusual case of concomitant autoimmune-mediated AHA and AVWS in an elderly SLE patient, which, to the best of our knowledge, has not been reported so far.
Simultaneous Pheochromocytoma, Paraganglioma, and Papillary Thyroid Carcinoma without Known Mutation
Authors: Lorena Rasquin, Janna Prater, Jane Mayrin, Corrado Minimo
Journal: Case Rep Endocrinol (2018)
MeSH terms: Case Reports

Background:
Pheochromocytoma/paraganglioma is a rare tumor from neuroendocrine cells. 1/3rd of cases have germline mutations. Papillary thyroid carcinoma (PTC) is a common neoplasm from follicular cells of the thyroid. We report a case of pheochromocytoma/paraganglioma and PTC with negative testing for common mutations.
Case:
32-year-old male with incidental liver mass during laparoscopy for acute appendicitis. His symptoms included abdominal pain and profuse axillary hyperhidrosis. MRI showed an 11x12x14 cm cystic and solid mass in right adrenal gland, and 3.4x2.9x3.8 cm mass in porta hepatis. Urine metanephrines was elevated. After preoperative alpha-blockade, patient underwent total right adrenalectomy. Pathology report confirmed diagnosis of pheochromocytoma. According to the Grading system for Adrenal Pheochromocytoma and Paraganglioma (GAPP), tumor's score was 9, indicating poorly differentiated tumor. Ki67 index 5% and S100 were negative. Postoperatively, plasma free metanephrines normalized but plasma free normetanephrines remained elevated. Based on this biochemical profile, presence of paraganglioma was suspected. CT showed 4.2x3.5 cm round soft tissue mass in porta hepatis which increased in size from previous MRI. Simultaneously, PET scan identified a 1.5 cm thyroid mass. Calcitonin level was normal. Fine-needle aspiration was consistent with PTC. Resection of the mass and total thyroidectomy were performed with confirmation of paraganglioma S100 positive and PTC. Normetanephrines decreased to 283 (<148 pg/mL); free metanephrines remained normal. Gene mutation of EGLN1, FH, KIF1B, MEN1, NF1, RET, SDHAF2, SDHC, SDHD, TMEM127, VHL, and SDHA was negative.
Conclusion:
Whether paraganglioma/pheochromocytoma/PTC combination is coincidental or resulted from an underlying unknown mutation cannot be excluded.
Non-O1, non-O139 Vibrio cholerae bacteraemia: case report and literature review
Authors: S Deshayes, C Daurel, V Cattoir, J-J Parienti, M-L Quilici, A de La Blanchardière
Journal: Springerplus (2015)
Keywords: abscess, bacteraemia, non-o1 vibrio cholerae

Non-O1, non-O139 Vibrio cholerae (NOVC) are increasingly frequently observed ubiquitous microorganisms occasionally responsible for intestinal and extra-intestinal infections. Most cases involve self-limiting gastroenteritis or ear and wound infections in immunocompetent patients. Bacteraemia, which have been described in patients with predisposing factors, are rare and poorly known, both on the clinical and therapeutic aspects. We describe a case of NOVC bacteraemia and a systematic literature review in PubMed conducted up to November 2014 using a combination of the following search terms: "Vibrio cholerae non-O1" and "bacter(a)emia". The case was a 70 year-old healthy male subject returning from Senegal and suffering from NOVC bacteraemia associated with liver abscesses. Disease evolution was favourable after 2 months' therapy (ceftriaxone then ciprofloxacin). Three hundred and fifty cases of NOVC bacteraemia have been identified in the literature. The majority of patients were male (77 %), with a median age of 56 years and presenting with predisposing conditions (96 %), such as cirrhosis (55 %) or malignant disease (20 %). Diarrhoea was inconstant (42 %). Mortality was 33 %. The source of infection, identified in only 25 % of cases, was seafood consumption (54 %) or contaminated water (30 %). Practitioners should be aware of these infections, in order to warn patients with predisposing conditions, on the risk of ingesting raw or undercooked seafood or bathing in potentially infected waters.
Successful non-operative management of multiple intra-abdominal solid organ injury after blunt abdominal trauma: a case report
Authors: Rajat Mahawar, Raju Shinde, Sangita Jogdand
Journal: Pan Afr Med J (2022)
Keywords: blunt trauma, case report, hemodynamic stability, multi-organ injuries, non-operative management
MeSH terms: Abdominal Cavity, Abdominal Injuries / surgery, Multiple Trauma, Wounds, Nonpenetrating / surgery, Wounds, Nonpenetrating / therapy, Case Reports, Adult, Hematuria, Humans, Kidney, Male, Retrospective Studies, Spleen / injuries, Young Adult

Injuries to the solid abdominal viscera are common after blunt trauma. The success of non-operative management of these injuries has led to recent extensions of this approach to managing higher-grade, more complicated injuries that are typically treated operatively. We reported a 19-year-old male who presented with abdominal pain and gross hematuria during the late hours due to a motor vehicle accident. Abdominal computed tomography scan revealed moderate hemoperitoneum, extensively devascularized spleen with laceration extending into the hilum, multiple tears in the left kidney extended to the hilum, and large perinephric hematoma suggestive of Grade V injuries (shattered spleen and left kidney). We managed the patient non-operatively until he improved and became ready for discharge from the hospital in stable good health status. In conclusion, this case brings to light a unique instance where severe grade multiple solid organ injury was successfully managed with a conservative approach.
Erythrodermic Psoriasis Causing Uric Acid Crystal Nephropathy
Authors: John Ellis, Jeffrey Lew, Sumir Brahmbhatt, Sarah Gordon, Troy Denunzio
Journal: Case Rep Med (2019)
MeSH terms: Case Reports

Background:
Erythrodermic psoriasis is a rare and severe variant of psoriasis. It is characterized by widespread skin erythema, scaling, pustules, or exfoliation of more than 75% of the body's surface area. This condition has life-threatening complications to include hemodynamic, metabolic, immunologic, and thermoregulatory disturbances. One metabolic complication, hyperuricemia, occurs from rapid keratinocyte differentiation and infiltration of inflammatory cells into psoriatic lesions. Although renal injury caused by shunting of blood to the skin has been reported, there are no reports of erythrodermic psoriasis causing crystal-induced nephropathy. We present a case of erythrodermic psoriasis and hyperuricemia complicated by uric acid crystal nephropathy.
Case presentation:
A 57-year-old male with long-standing psoriatic arthritis presented with diffuse scaling of his skin. He was being treated with adalimumab, leflunomide, and topical clobetasol, but had recently stopped taking his medications. Physical exam revealed yellow scaling covering his entire body with underlying erythema and tenderness without mucosal involvement. Labs were notable for a creatinine of 3.3 mg/dL, with no prior history of renal disease, and uric acid of 12.7 mg/dL. He was admitted to the intensive care unit given >80% of body surface area involvement and acute renal failure. Despite aggressive fluid resuscitation, renal function did not improve, and creatinine peaked at 4.61 mg/dL. Urine microscopy showed diffuse polymorphic uric acid crystals, consistent with uric acid crystal-induced nephropathy. He was started on rasburicase, urinary alkalinization, and fluids. His renal function improved dramatically; urine output, uric acid, and electrolytes normalized. He was discharged on topical clobetasol and leflunomide and started on secukinumab with little to no skin involvement.
Conclusion:
This case presents the rare complication of crystal-induced nephropathy in a patient with erythrodermic psoriasis. Uric acid crystal nephropathy is well described in diseases with rapid cell turnover such as tumor lysis syndrome. It is thought that rapid keratinocyte differentiation and inflammatory infiltration of psoriatic lesions produced life-threatening electrolyte abnormalities similar to tumor lysis syndrome. Early recognition of this rare complication is critical, and aggressive fluid resuscitation, urine alkalinization, and uric acid lowering agents should be administered immediately.
Trisomy 1q32 and monosomy 11q25 associated with congenital heart defect: cytogenomic delineation and patient fourteen years follow-up
Authors: Vera Ayres Meloni, Sylvia Satomi Takeno, Ana Luiza Pilla, Claudia Berlim de Mello, Maria Isabel Melaragno, Leslie Domenici Kulikowski
Journal: Mol Cytogenet (2014)
Keywords: array, clinical follow-up, congenital heart defects, fish, intellectual disability, partial deletion 11q, partial duplication 1q
MeSH terms: Case Reports

Background:
Partial duplication 1q is a rare cytogenetic anomaly frequently associated to deletion of another chromosome, making it difficult to define the precise contribution of the different specific chromosomal segments to the clinical phenotype.
Case presentation:
We report a clinical and cytogenomic study of a patient with multiple congenital anomalies, heart defect, neuromotordevelopment delay, intellectual disability, who presents partial trisomy 1q32 and partial monosomy 11q25 inherited from a paternal balanced translocation identified by chromosome microarray and fluorescence in situ hybridization.
Conclusion:
Compared to patients from the literature, the patient's phenotype is more compatible to the 1q32 duplication's clinical phenotype, although some clinical features may also be associated to the deleted segment on chromosome 11. This is the smallest 11q terminal deletion ever reported and the first association between 1q32.3 duplication and 11q25 deletion in the literature.
A Case Report of Complete Resolution of Auricular Mucormycosis in an 18-Month-Old Diabetic Child
Authors: Mariam Aljehani, Hatem Alahmadi, Mansour Alshamani
Journal: Case Rep Otolaryngol (2021)
MeSH terms: Case Reports

Background:
One of the most rare but deadly types of infectious fungal infection is Mucormycosis. All the cases reported with this type of infection are immunocompromised individuals. The challenge of early detection and intervention makes it one of the high mortality rates among other infectious diseases. Case Report. We report an 18-month-old girl with undiagnosed diabetes presented with a very aggressive form of necrotic infection of the ear auricle with facial nerve palsy. Using a series of magnetic resonance imaging, antibiotics, and high clinical suspicion, a diagnosis was established, and the patient was sent to the operation theatre for surgical debridement. Monthly follow-ups showed improvement of the facial palsy, and a plan for artificial auricle is set to occur in the following months before the age of five. Discussion. Mucormycosis is considered a very fatal and aggressive infection that has a very high mortality rate in immunocompromised patients. Early detection of such cases with an array of magnetic resonance imaging (MRI) and computed tomography (CT) is crucial in early treatment. Early aggressive surgical debridement and empirical coverage of bacterial, viral, and fungal infections can also alleviate the chances of preventing any secondary infection to develop in such cases.
Conclusion:
A combination of antifungal, antibiotic, and antiviral with timely surgical intervention improved the patient with complete resolution of the facial nerve palsy and no further recurrence of the infection.
Case Report: Response to crizotinib treatment in a patient with advanced non-small cell lung cancer with LDLR-ROS1 fusion
Authors: Yun Shu, Zhouyu Wang, Hongjuan Shang, Wei Le, Yan Lei, Longzhang Huang, Liming Tao, Jun Chen, Jing Li
Journal: Front Oncol (2023)
Keywords: ldlr-ros1 fusion, advanced non-small cell lung cancer, c-ros oncogene 1, crizotinib, next-generation sequencing
MeSH terms: Case Reports

C-ros oncogene 1 (ROS1) fusion is a pathogenic driver gene in non-small cell lung cancer (NSCLC). Currently, clinical guidelines from the National Comprehensive Cancer Network (NCCN) have recommended molecular pathologic tests for patients with NSCLC, including the detection of the ROS1 gene. Crizotinib is a small molecule tyrosine kinase inhibitor of anaplastic lymphoma kinase (ALK), ROS1, and mesenchymal-epithelial transition (MET). In recent years, the efficacy of crizotinib in NSCLC patients with ROS1 fusion has been reported. Here, a 77-year-old woman was diagnosed with stage IVA lung adenocarcinoma harboring a novel low-density lipoprotein receptor (LDLR)-ROS1 fusion variant. This novel LDLR-ROS1 fusion was identified by targeted DNA next-generation sequencing (NGS) panel and then verified by RNA fusion panel based on amplicon sequencing. This patient benefited from subsequent crizotinib therapy and achieved progression-free survival of 15 months without significant toxic symptoms. Our case report recommended a promising targeted therapeutic option for patients with metastatic NSCLC with LDLR-ROS1 fusion and highlighted the importance of genetic testing for accurate treatment.
A novel use for suture button suspension: reconstruction of the dorsal ulnar ligament to treat thumb metacarpal dislocation
Authors: Ajul Shah, Garry Martin 3rd, James Grant Thomson
Journal: Case Reports Plast Surg Hand Surg (2015)
Keywords: cmc joint, hand, dorsal ulnar ligament, mini tight rope, plastic surgery, suture button, thumb cmc
MeSH terms: Case Reports

There are numerous treatment algorithms that have been developed to treat thumb carpometacarpal (CMC) arthritis. A newer treatment option for these patients is CMC stabilization using suture button suspensionplasty. The authors of this case report have extensive experience with the suture-button suspensionplasty using the Mini TightRope CMC technique (Arthrex). We present a novel usage of the suture-button suspensionplasty to reconstruct the dorsal ulnar ligament (in contrast to the usual reconstruction of the volar beak ligament) to treat a patient with persistent thumb metacarpal dislocation at the CMC joint. Two separate patients are presented. One patient demonstrates volar beak ligament instability, and the other demonstrates dorsal ulnar ligament instability. Both patients' demographics and operative indications are described. The operative technique for the novel usage of the suture-button suspensionplasty is described. Operative results of the dorsal ulnar ligament reconstruction are reviewed. After suture-button suspension of the thumb metacarpal to the trapezium, the dorsal ulnar ligament has been reconstructed. The patient demonstrated stability of the thumb CMC joint without dorsal or radial dislocation. The authors of this case report present a novel usage of the suture-button suspensionplasty to treat a patient with proximal thumb metacarpal dislocation at the trapezial-metacarpal interface. This method, in contrast to the referenced method of volar beak ligament reconstruction, allows reconstruction of the dorsal ulnar ligament. This allows stabilization of the joint by preventing dorsal and radial dislocation of the metacarpal.
Celiac disease causing severe osteomalacia: an association still present in Morocco!
Authors: Latifa Tahiri, Hamida Azzouzi, Ghita Squalli, Fatimazahra Abourazzak, Taoufik Harzy
Journal: Pan Afr Med J (2014)
Keywords: morocco, osteomalacia, bone loss, celiac disease, vitamin d
MeSH terms: Celiac Disease / complications, Diet, Gluten-Free, Osteomalacia / etiology, Case Reports, Adult, Calcium / administration & dosage, Celiac Disease / therapy, Female, Humans, Iron / administration & dosage, Morocco, Osteomalacia / physiopathology, Osteomalacia / therapy, Severity of Illness Index, Vitamin D / administration & dosage, Vitamin D, Iron, Calcium

Celiac disease (CD), a malabsorption syndrome caused by hypersensitivity to gliadin fraction of gluten. CD can manifest with classic symptoms; however, significant myopathy and multiple fractures are rarely the predominant presentation of untreated celiac disease. Osteomalacia complicating celiac disease had become more and more rare. We describe here a case of osteomalacia secondary to a longstanding untreated celiac disease. This patient complained about progressive bone and muscular pain, weakness, fractures and skeletal deformities. Radiological and laboratory findings were all in favor of severe osteomalacia. Improvement of patient's weakness and laboratory abnormalities was obvious after treatment with gluten free diet, vitamin D, calcium and iron. This case affirms that chronic untreated celiac disease, can lead to an important bone loss and irreversible complications like skeletal deformities.