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Results in Journal Archives of Clinical and Medical Case Reports: 362

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Khalid Sawalha, Shoaib Khan, Krishna Vedala
Archives of Clinical and Medical Case Reports, Volume 5, pp 216-220; doi:10.26502/acmcr.96550349

53-year-old patient with multiple recurrent admissions for chest pain and low-grade fever presented after recent discharge for the same complaint. In his previous admission, cardiac work-up was done with no significant findings and he was discharged on oral antibiotics. However, upon this admission he developed cardiac arrest due to ventricular fibrillation and was intubated. Upon further assessment and intervention, he was found to have Pacemaker-lead-wire infective endocarditis. We share this interesting case as Infective endocarditis could present as a vague symptom that needs further intervention.
El Khaldi M, Al Hussaini M, Abu Shattal M, Abu Jazar H, Swaidan M
Archives of Clinical and Medical Case Reports, Volume 5, pp 226-233; doi:10.26502/acmcr.96550351

Hepatic steatosis is a frequent finding in computed tomography (CT) and magnetic resonance imaging (MRI). Chemotherapy is a predisposing factor for both fatty liver infiltration and hemosiderosis. Unusual appearance and behavior of multiple focal nodular fatty infiltration is rare to encounter and when associated with history of malignancy and/or infection presents a dilemma that a confident diagnosis might not be rendered by MRI thus a diagnostic biopsy would be needed to resolve the uncertainty in diagnosis. We present a patient with second relapse of acute myelogenous leukemia (AML) who developed fungal pulmonary infection while receiving salvage chemotherapy. Progressive target-shaped focal liver lesions which demonstrated characteristic fatty signal intensity on MRI were seen along with features of hemosiderosis of the liver parenchyma. Target and non-target liver tru-cut biopsies had to be performed to reach the final diagnosis of focal fatty infiltration and to rule out the differential diagnosis of liver abscesses and leukemia infiltration.
Philip T. Sobash, Krishna Vedala, Gilbert-Roy Kamoga
Archives of Clinical and Medical Case Reports, Volume 5, pp 204-209; doi:10.26502/acmcr.96550347

The incidence of ARB-induced angioedema is an insufficiently reported incidence in medical literature, due to its infrequent incidence and confusion with other confounding factors. Any time patients are on medications that involve the RAAS pathway, suspicion needs to be raised concerning their involvement in angioedema. Cessation of the offending agent is the only definitive way to prevent attacks. Although not well described in the literature, there are reports of recurrence of angioedema after cessation of individuals previously taking ARBs. This raises the question of whether in this transition period after removal can we prophylactically stop an attack?. We present the case of a 62-year-old female who was hospitalized for recurrent angioedema three times before it was decided to stop Olmesartan. During the third hospitalization, she was given tranexamic acid to aid in symptom management along with steroids and antihistamines. After discontinuation, she presented twice to the ER with similar symptoms. We discuss the need for surveillance of angioedema attacks after iatrogenic kinin-mediated angioedema along with the literature on tranexamic acid utilization during this latency period to help prophylactically reduce intermittent attacks.
Arjan Gower Janice Oh, Arjan GowerArjan Gower
Archives of Clinical and Medical Case Reports, Volume 05, pp 240-247; doi:10.26502/acmcr.96550353

Strongyloidiasis is a parasitic infection of various clinical manifestations by the helminth Strongyloides stercoralis, with immunocompromised patients at higher risk for more severe cases. It is uncommonly seen in the United States, with a majority of patients without symptoms. In immigrant patients of immunocompromised state that initially present with nonspecific clinical manifestations, the inclusion of parasitic infections on the differential is crucial to initiate appropriate treatment as early as possible. We report a case of hyperinfection of Strongyloidiasis, which unusually presented with a gastrointestinal ulcerated mass and pulmonary nodules.
Bing Li, Xuan Wang, Mengmeng Pan, Xiu Luo, Bing Xiu, Xiuqin Wang, Aibin Liang
Archives of Clinical and Medical Case Reports, Volume 05, pp 271-279; doi:10.26502/acmcr.96550357

Cold agglutinin syndrome (CAS) is an uncommon disease of the blood system, and systemic lupus erythematosus (SLE)-induced cold agglutinin syndrome is also rare. Herein, we report a case of CAS with SLE induced by megaloblastic anemia. The onset of the disease for this patient was severe anemia, but the severity did not match the lack of raw material of the hematopoietic system. Moreover, peripheral blood assay revealed cold agglutinin. The patient was diagnosed with SLE, which was induced by infection and led to CAS. Anti-infection, blood transfusion, and fluid infusion, was administered with warmer S-line to ensure the infusion temperature was maintained at 30°C. Other treatments included an infusion of specially heated red blood cells with appropriate heating and correction of anemia with glucocorticoids, intravenous gamma globulin, cyclosporine, and hydroxychloroquine. Finally, the SLE recovered to the stationary phase. Although megaloblastic anemia is a common disease in the blood system, missed diagnosis is not rare if it is accompanied by other diseases that increase the severity of anemia. Thus, the primary cause of anemia should be explored and use targeted treatment employed.
Elvana Rista, Endri Hajra, Vilma Cadri, Anila Duni, Juna Musa, Fjolla Hyseni, Ali Guy, Ronny Khadra, Alma Idrizi
Archives of Clinical and Medical Case Reports, Volume 05, pp 234-239; doi:10.26502/acmcr.96550352

Membranous Nephropathy (MN) also known as membranous glomerulonephritis is a slowly progressive kidney disease characterized of subepithelial immune complex deposits and subsequent thickening of glomerular basement membrane. MN is a common cause of proteinuria that may progress to ERDS. The decision to treat MN with immunosuppressive medications is complicated by the well-known natural history of disease and it depends on patient presentation and disease progression. Herein, we present a case of a 48-year-old male patient with weight gain, lower extremity edema, arterial hypertension, and nephrotic range proteinuria (13.5 gr). The patient was diagnosed with MN 14 years ago with relapses and remission of disease over the years. First immunotherapy was stared with cyclosporine and methylprednisolone, but the patient occurred to have cyclosporine-induced toxicity. Second immunotherapy was stared with methylprednisolone and cyclophosphamide that resulted in complete remission for 4 years. The disease relapsed again, and the patient was recommended the Rituximab treatment. Two doses of rituximab 1g were administered. In terms of total remission there was no indication for the third dose of rituximab.
Stefania Federica De Mercanti, Thomas Fraccalini, Luigi Lavorgna, Marinella Clerico
Archives of Clinical and Medical Case Reports, Volume 05, pp 287-290; doi:10.26502/acmcr.96550359

The evidence available suggests that cannabinoid-based products improve spasticity, chronic pain, and bladder dysfunction, which are common symptoms in more than 50% of multiple sclerosis (MS) patients. In this paper we present three cases of patients with progressive or relapsing forms of MS, with different severity, duration, and with various degrees of hypertonia and or bladder dysfuction, treated with nabiximols (Sativex®). Nabiximols was administered as an oral spray to reduce MS-associated hypertonia. The results show the efficacy of the therapy in MS patients with moderate to severe spasticity and resistant or intolerant to common myorelaxants drugs. In conclusion, nabiximols proves to be an effective treatment, easy to administer, even in patients with motor disabilities affecting the hands, and without important side effects.
Valeria Cuccarini, Giovanni Tringali, Elena Anghileri
Archives of Clinical and Medical Case Reports, Volume 05, pp 303-313; doi:10.26502/acmcr.96550362

Introduction: Leptomeningeal dissemination of hemangioblastomas (HB) of the central nervous system (CNS) is very rare. Few studies have reported leptomeningeal involvement in sporadic HB or in HB associated with von Hippel-Lindau (VHL) syndrome. Due to the rarity, no standard of care exists yet. Materials and Methods: A case report is described including clinical, radiological and therapeutic details. From the disease onset, the follow-up continued till death. Results: An adult man developed leptomeningeal dissemination of non-VHL HB starting from original cerebellar site. The initial lesion was removed by surgery; however 10 years later multiple supra- and subtentorial tumoral nodules showed up. Combined treatments with surgery and radiotherapy and radiosurgery were used. After short-term stability, HB progressed to spinal cord and dissemination pattern took advance. Contextually he developed neurological deterioration and polycythemia. Thus, we decided to propose to the patient the use of bevacizumab (BEV), a humanized monoclonal antibody targeting vascular endothelial growth factor (VEGF): the patient experienced 1-year stable disease, with early clinical improvement. After 5 years from the diagnosis of dissemination the patient died due to disease progression. Discussion: Leptomeningeal dissemination of HB is extremely rare within the setting of non-VHL. Based on hypervascularized biology of HB, BEV could hypothetically represent a therapeutic option. We describe an adult sporadic HB with CNS dissemination, showing a temporary stabilization of disease during BEV, improving the secondary polycythemia and exhibiting no adverse effects. Such treatment should be considered in this setting of such patient.
Bastiaan C Ter Meulen, Mark G Van Der Meer, Rob Hemmes, Jan Dirk Blom
Archives of Clinical and Medical Case Reports, Volume 5, pp 110-117; doi:10.26502/acmcr.96550335

Déjà vécu is an extremely rare type of identifying paramnesia characterised by the ongoing sensation of having experienced things before. Having the delusional conviction that this sensation is true, patients frequently exhibit recollective confabulation. We here describe an 84-year-old woman with idiopathic, partial déjà vécu, where her symptoms were limited to people and events. An extensive psychiatric and somatic work-up ruled out cerebrovascular disease, epilepsy, dementia, psychosis, or intoxication as a potential underlying cause. Proposed to be a functional disturbance of the limbic system with the involvement of a network that comprises at least the hippocampus and entorhinal cortex, the pathophysiology of déjà vécu is in need of further elucidation. Our patient and her family were offered psychoeducation, which led to acceptance and improved coping. During the two-year follow-up, the déjà vécu sensations continued unaltered, but all involved were less bothered by them, with the patient’s functioning improving both personally and socially.
Sandeep Moudgil, Sapna Jangral, Lokesh Singh, Anupam Jhobta
Archives of Clinical and Medical Case Reports, Volume 5, pp 70-74; doi:10.26502/acmcr.96550328

Persistent trigeminal artery (PTA), commonest among fetal carotid-vertebrobasilar anastomosis encountered in adult life, is an incidental finding but has often been associated with trigemino-cavernous fistula besides cranial nerve palsies, trigeminal neuralgia, hemifacial spasms, intracranial vascular pathologies like aneurysms, arteriovenous malformations posterior circulation, as TIAs or stroke. We present here an acute posterior circulation stroke and a chronic anterior circulation stroke associated with (PTA), in this case report.
Sandeep Moudgil, Lokesh Singh, Manju Behal
Archives of Clinical and Medical Case Reports, Volume 5, pp 106-109; doi:10.26502/acmcr.96550334

Shreya Sehgal, Lokesh Singh, Uma Debi, Muniraju Maralakunte
Archives of Clinical and Medical Case Reports, Volume 5, pp 91-95; doi:10.26502/acmcr.96550331

Mayumi Nomoto
Archives of Clinical and Medical Case Reports, Volume 5, pp 162-170; doi:10.26502/acmcr.96550343

Although the pathogenesis of acne has been elucidated, many patients do not notice improvement with standard treatments alone. Acne is a multifactorial disease, and although there are different aggravating factors such as diet, external stimuli, and stress that varies among individuals, the correct approach to tackling these factors has likely not been considered. Hence, we recommend using Kampo, a traditional Japanese medicine. Kampo examines a patient physically and mentally through unique concepts such as qi, blood, and fluid, and treats using Kampo medicines. With Kampo, both the illness and other aspects such as the general health and well being of the patient are examined and treated. We believe that if Kampo is employed in identifying and treating the aggravating factors of acne of each patient, both the overall therapeutic effect and patients’ motivation for treatment will be improved. This paper classifies the aggravating factors of acne into five categories, decreased barrier function of the skin, excessive secretion of sebum, exacerbation before menstruation, gastrointestinal symptoms, and stress, and introduces effective Kampo medicines in each case.
Chanceline Formisano, Alain Kenfak Foguena, Valery S Effoe, James Tataw Ashu
Archives of Clinical and Medical Case Reports, Volume 5, pp 156-161; doi:10.26502/acmcr.96550342

Background: Viral myocarditis is a leading cause of mortality and cardiovascular morbidity. Its clinical manifestation is heterogeneous varying from asymptomatic courses to presentations with ventricular arrhythmias, heart failure and cardiogenic shock. Right ventricular endomyocardial biopsy is the gold standard in confirming the diagnosis; however, this may not be readily available in some clinical settings. For identification of the viral causative agent, the expanded use of polymerase chain reaction (PCR) techniques may facilitate precise viral genomic diagnosis and improve outcomes. Case presentation: We report a case of a 56 -year-old female patient who presented to the hospital with chest pain mimicking an acute coronary syndrome and stable monomorphic ventricular tachycardia. She had a medical history notable for permanent pacemaker placement due to high-degree atrioventricular block, Brugada-like syndrome and venous thromboembolic disease. Her high-sensitivity troponin was elevated, evidence of myocardial injury, and an echocardiogram showed an ejection fraction of 55% with no wall motion abnormalities. She was managed with IV Amiodarone with subsequent cardioversion. Coronary angiography performed after cardioversion ruled out ischemia as the cause of her ventricular tachycardia. Examination of the nasopharyngal swap by PCR showed a Human Parainfluenza Virus type 3 (HPIV-3), the most likely culprit for her myocardial injury. The presumptive diagnosis of myocarditis complicated with ventricular tachycardia was made after ruling out other common etiologies. Conclusion: This case illustrates a mild presentation of myocarditis and the diagnostic challenge that may ensue due to the lack of specificity of their clinical presentation and the limitation to perform biopsies or cardiac magnetic resonance imaging.
Dragana Marković, Petar Djurić, Aleksandar Janković, Ljiljana Bogdanović, Snežana Pešić, Nada Dimković, Radomir Naumović
Archives of Clinical and Medical Case Reports, Volume 05, pp 280-286; doi:10.26502/acmcr.96550358

Membranoproliferative glomerulonephritis (MPGN) is characterized by mesangial cell proliferation and structural changes in glomerular capillary walls and double-contoured glomerular basement membrane (GBM). Usually, it is connected with cryoglobulinemia which is defined by the presence of a circulating, a cold-precipitating immunoglobulin. The chemical and immunological features of the cryoglobulins are used to define three types of cryoglobulinemia. In this report we describe the third case of MPGN type II with essential cryoglobulinemia without HCV infection, which is usually defined in the literature as MPGN type II. Here, we present 61-years old woman previously diagnosed with MPGN in 2012 at another institution. At that time, she was not examined in terms of cryoglobulinemia. Initially she was treated with pulses of methylprednisolone, then oral corticosteroids until cessation when complete remission was achieved. Meanwhile, she had two relapses of the disease. In October 2020 we re-evaluated her and found out positive cryoglobulins in repeating testing. Serological studies for anti-neutrophil cytoplasmic antibodies (ANCA), myeloperoxidase and proteinase 3, anti-double stranded DNA antibodies, anti-hepatitis C antibodies, anti-HIV antibodies and anti-hepatitis B surface antibodies were all negative. Serum M protein or monoclonal IgM were not detected. Percutaneous renal biopsy was compatible with the diagnosis of MPGN. Based on clinical, laboratory and histological evaluation, it was concluded that the patient had a MPGN with essential cryoglobulinemia. Therapy with mycophenolate mofetil had a beneficial effect on the course of disease and the patient achieved partial remission and stabile renal function for the last 3 months of follow-up. Since the therapy for MPGN with essential cryoglobulinemia is not standardized, further research in the field is needed.
Gabriel Melo Alexandre Silva, Herbert Iago Feitosa Fonseca, Pablo André Brito de Souza, Ana Cássia Silva Oliveira, Luciana Lopes Albuquerque da Nobrega
Archives of Clinical and Medical Case Reports, Volume 05, pp 368-372; doi:10.26502/acmcr.96550368

Introduction: Wheezing in infants is an extremely common complaint, being markedly frequent in emergency services. Nonetheless, such a complaint is part of a wide spectrum of pathologies thus, demanding deeper investigation over the differential diagnosis must be addressed in an appropriate manner, in order to implement the necessary therapy as early as possible, and excessive intervention avoided, as much as possible Therefore, this case-report seeks to serve as a reminder of the importance of keeping a high suspicion on aspiration pneumonia even in previously healthy patients. The Case: HPDJ, male, date of birth (Dec, 30th of 2019), then 10 months and 10 days old, enters the medical emergency service of the pediatric hospital on November, 10th of 2020, with a report of flu-like symptoms that persisted for 10 days. The possibilities of bronchiolitis, pneumonia and SARS-COV 2 are questioned given the pandemic context, therefore being approached with salbutamol and prednisolone, chest x-ray and complementary exams. The patient is hospitalized, under regimen of ceftriaxone, salbutamol and general symptomatic medication. The patient is discharged 6 days after the first hospitalization with recovered general condition and without adventitious sounds or pathological findings on auscultation, being referred to the pulmonology outpatient clinic of the pediatric hospital. During outpatient follow-up, the patient complains of a feverish respiratory condition, and then the possibility of aspiration by a foreign body was questioned. On Dec, 09th, foreign body is removed, with subsequent improvement of symptoms in 48 hours. Conclusion: The maintenance of high clinical suspicion and attention to anamnesis are extremely important factors for the early diagnosis of less common causes of common complaints, such as aspiration of a foreign body in the face of a wheezing complaint, thus avoiding prolonged and not fully effective treatments, which can put the child at risk for more severe complications and worse prognosis.
Archives of Clinical and Medical Case Reports, Volume 05, pp 342-354; doi:10.26502/acmcr.96550365

Recently, we proposed the third entity of microscopic colitis (MC), termed colitis nucleomigrans (CN). The present review describes clinicopathological features of CN. CN shares clinical and endoscopic features of MC with collagenous colitis and lymphocytic colitis. We analyzed endoscopic biopsy specimens of nonspecific colitis clinically manifesting chronic watery diarrhea or inflammatory bowel disease (IBD)-like symptoms, but with minor endoscopic abnormality. The histopathological criteria of CN are as follows: a) chained nuclear migration to the middle part of the surface-lining columnar epithelia, b) apoptotic nuclear debris scattered below the nuclei, and c) mild to moderate chronic inflammation in the lamina propria. Thirty-three patients (M: F=20:13, median 63 years; range 17-88) fulfilled the above criteria. Seven cases accompanied MC-like clinical/endoscopic features. Mucosal reddening with or without erosions/aphthae was endoscopically observed in the remaining 26 cases with IBD-like clinical features: occult/gross hematochezia (n=19), abdominal pain (n=2) and mucin secretion (n=2). Apoptotic debris immunoreactive for cleaved caspase-3 appeared more frequently in IBD-like CN than in MC-like CN. CD8-positive intraepithelial lymphocytes were comparable in both types. Proton pump inhibitors (PPIs) were administered in five (71%) CN cases with MC-like features, and the diarrhea improved after cessation of PPIs in three. In IBD-like CN cases, eight (31%) received PPIs. Altered apoptotic processes in the colorectal surface-lining epithelia, predominantly with a debris pattern of apoptosis, may be involved in the pathogenesis. Mechanisms of nuclear migration to the unusual position and the impairment of nuclear anchoring to the basal situation in the surface-lining epithelia remain to be established.
Mitsuhiro Tachibana, Seiya Kitano, Ayako Mikura, Masakazu Fujimoto, Kuniaki Ohara, Miki Izumi, Yutaka Tsutsumi
Archives of Clinical and Medical Case Reports, Volume 05, pp 355-360; doi:10.26502/acmcr.96550366

Acral syringotropic melanoma with eccrine duct hyperplasia (ASMEDH) is rare. We describe ASMEDH arising in the right sole of a Japanese woman aged 80’s. On a 15 x 10 mm-sized, irregular-shaped pigmented macule, the dermoscopy indicated pararrel ridges. The lesion was removed surgically. No nodal swelling was noted. Microscopically, the pigmented melanoma cells were distributed not only in the basal epidermis but also in the cutaneous sweat gland duct. The melanoma cells were positive for HMB45, melan A, S-100 protein, bcl-2, vimentin, CD5 and SOX10, but negative for CKs and adipophilin. Ki-67 labeling was around 10%. In the dermis, basal cells immunoreactive for cytokeratin (CK) 34βE12, CK5/6 and p40 surrounded the intraductally spreading melanoma cells and ductal lumina were frequently located in the center. Invasive growth was absent. The surgical margins were negative. The patient did not receive adjuvant chemotherapy, and she is doing well eight months after surgery. Our final diagnosis was ASMEDH, melanoma in situ, the third case in the world.
Sara Vive, Roland Zugner, Roy Tranberg, Lina Bunketorp-Kall
Archives of Clinical and Medical Case Reports, Volume 05, pp 325-341; doi:10.26502/acmcr.96550364

Objectives: In this single-subject experimental design study, we investigated the effect of late-phase stroke rehabilitation on gait pattern. Methods: A subgroup from a previous clinical study, four men in the chronic phase after stroke, received 3 weeks of enriched and task-specific therapy (ETT) consisting of task-specific exercise, socialization, sensory and cognitive stimulation in a Mediterranean climate. Spatiotemporal gait variables, kinematics and symmetry were measured before and after the intervention in an advanced gait laboratory. Statistical significance was determined with the two-standard deviation band method. Results: Subject 1 had kinematic improvements (increased knee flexion during swing and dorsiflexion during stance) and spatiotemporal gains (increased speed, double-limb support, stride length and cadence) after ETT. Subject 2 had improved swing time symmetry ratio but no spatiotemporal or kinematic improvements. Subject 3 had gains in speed, stride width and length, and knee flexion during swing. Subject 4 had a change in cadence but no gain in kinematics, nor symmetry. Conclusions: Two of the four participants had significant improvements in gait kinematics, symmetry, and spatiotemporal variables after the intervention. Future research should consider the potential effects of ETT with the aim of validating the conclusions that can be drawn from this study.
Pakize Ozciftci Yilmaz, Barcin Ozturk, Ali Riza Kagnici, Mustafa Deniz, Ali Ihsan Sert, Ongun Sahin, Can Karaman, Ibrahim Kurt
Archives of Clinical and Medical Case Reports, Volume 05, pp 314-324; doi:10.26502/acmcr.96550363

Introduction: Influenza A (H1N1) virus have been a serious problem in 2009, which was considered as a pandemic and caused the death of more than 12000 people. Pneumonia is the most common complication of influenza infection and can be seen as viral pneumonia and/or bacterial coinfection. However, since November 2019, the world has been exposed to a new pneumonia agent named SARS - CoV - 2 from the Coronavirus family. In this case series, we aimed to re-evaluate the cases we followed up in the intensive care unit due to severe pandemic Influenza A infection between November 2019 and March 2020 from the Covid-19 perspective. Cases: There were five cases diagnosed with pandemic influenza A (H1N1) pneumonia in intensive care between November 2019 and March 2020, and the average age was 50. Given the risk factors two patients had immunosuppression and two patients had diabetes. Fever, respiratory distress and cough were the most prominent symptoms, and involvement in both lungs was detected in all patients on radiological imaging. Unfortunately, all patients had died despite antiviral therapy, antibiotic treatment against secondary bacterial infection, hemodynamic and respiratory support treatments. Discussion: Considering the literature, covid-19 and influenza co-infections have been detected in 34 cases since November 2019. In general terms, covid-19 and influenza tables are similar, with slight differences. In this case we look back to our findings, similar cases are considered as covid-19 under current conditions.
Badillo Mc, Abdul Haium Aa, Chandran S, Saffari Se, Rajadurai Vs
Archives of Clinical and Medical Case Reports, Volume 5, pp 182-192; doi:10.26502/acmcr.96550345

Introduction: Patent ductus arteriosus (PDA) is common in preterm neonates. Indomethacin and ibuprofen are commonly used for medical closure of patent ductus arteriosus. This study aims to evaluate the safety and efficacy of ibuprofen for treatment of PDA in very low birth weight (VLBW) infants. Methods: A retrospective audit of VLBW infants who received ibuprofen for treatment of PDA in a single centre between March 2010 and December 2014 was conducted. Infants with hemodynamically significant PDA were treated with intravenous or oral ibuprofen after echocardiographic evaluation. Response to treatment was documented with follow up echocardiography. The baseline patient characteristics, the ductal closure rate, adverse effects and need for PDA ligation were analysed. Results: Total of 138 VLBW infants received ibuprofen. 108 infants with birth weight ranging from 430-1500g received intravenous ibuprofen (group 1) and 30 infants with birth weight ranging from 661-1483g received oral ibuprofen (group 2). The closure rate of PDA was 50.9% (55/108) in-group 1 and 43.3% (13/30) in-group 2. Necrotizing enterocolitis or spontaneous intestinal perforation was observed in 11.1% (12/108) of group 1 and 10% (3/30) of group 2 infants. PDA ligation rate was 20.4% (22/108) in-group 1 and 6.7% (2/30) in-group 2. Conclusion: The closure rate of PDA following intravenous ibuprofen was 50.9% in VLBW infants. Serious gastrointestinal adverse effects occurred in 10-11% of infants treated with ibuprofen. Relatively lower closure rates and serious gastrointestinal adverse effects should be considered when treatment decisions are made for closure of PDA with ibuprofen.
Itai Zilberman
Archives of Clinical and Medical Case Reports, Volume 5, pp 193-203; doi:10.26502/acmcr.96550346

FAM20A is a Protein Coding gene. It acts as an allosteric activator of the Golgi serine/threonine protein kinase FAM20C and is involved in biomineralization of teeth. A novel homozygous deletion mutation in exon 11 of FAM20A has been described in five members from a large consanguineous Bedouin family, all five with hypoplastic-hypocalcified AI and unerupted and crown resorbed permanent molars, a very rare phenotype. Deciduous mandibular canines and first molar, and maxillary first and second molars of an affected girl were compared to normal pair-matched teeth. Slices of the teeth were examined using SEM, and the ion content of enamel and dentine was determined using Energy Dispersive X-ray Spectrometer (EDS). The deciduous teeth showed missing enamel and the dentin was hypercalcified with very few open tubuli. Calcium and phosphorous percentages were reduced by 45 % in the enamel, and extensive apposition of secondary dentin and calcification of the pulps was observed. The permanent dentition showed impacted molars, premolars and canines with hypoplastic enamel and reduced dimensions of the erupted teeth. The mutation of FAM20A caused a peculiar type of AI with very thin amorphic enamel, infraoccluded deciduous teeth and impacted permanent canines, premolars and molars.
Yuejiao Lang, Xiaojuan Li, Shaoyu Chen, Pei Xiang, Anjia Han
Archives of Clinical and Medical Case Reports, Volume 5, pp 129-136; doi:10.26502/acmcr.96550337

Herein, we first reported a case of undifferentiated sarcoma with epithelioid features harboring TFE3 amplification. A 66-year-old woman with a history of chronic lymphocytic leukemia and chemotherapy presented with a 4 cm palpable nodule in the left lower leg. Microscopically, the large epithelioid tumor cells with remarkable pleomorphism and the small round tumor cells intermingled with each other in a diffuse sheet or a hemangiopericytoma-like vascular growth pattern. Atypical mitotic figures and lymph node metastasis were found while tumor necrosis was absent. Immunohistochemically, the tumor was positive for vimentin, TFE3, and CD34. TFE3 gene amplification was identified by fluorescence in situ hybridization. The patient was alive and well without recurrence or metastasis for 12 months after tumor resection. The tumor should differentiate from PEComa, alveolar soft part sarcoma, epithelioid sarcoma, epithelioid angiosarcoma, and epithelioid rhabdomyosarcoma.
Marion Jaffrelot, Noémie Gadaud, Jean-Pierre Delord, Carlos Gomez-Roca, Sarah Bétrian
Archives of Clinical and Medical Case Reports, Volume 5, pp 96-100; doi:10.26502/acmcr.96550332

Hemophagocytic lymphohistiocytosis (HLH) is a rare and severe condition of immune dysregulation characterized by severe organ damage induced by a hyperinflammatory response and uncontrolled T-cell and macrophage activation. Secondary HLH, also known as macrophage activation syndrome, commonly presents in adulthood and characterized by acquired immune dysfunction in response to infections, malignancies, or autoinflammatory/autoimmune disorders. Secondary HLH induced by regorafenib has not been yet described. Here we report a case of HLH induced by regorafenib, confirmed by clinical, laboratory and histopathological findings, with typical results on bone marrow aspiration.
Yeun-Hwa Gu, Takenori Yamashita, Tota Inoue, Ki-Mun Kang
Archives of Clinical and Medical Case Reports, Volume 5, pp 118-128; doi:10.26502/acmcr.96550336

Natural products are able to inhibit radiation effects and exert an antitumor effect with fewer adverse reactions; however, their antitumor effects are less than those of widely-used synthetic drugs. Flavonoid is a natural material that has attracting attention, and we extracted this material with alcohol and investigated the effect of continuous flavonoid administration on radioactivity-induced reduction of hemocytes, in addition to the antioxidant and antitum or effects of flavonoid. Following a 1-week adjustment period, flavonoid was administered intraperitoneally to male ICR mice at a dose of 100 mg/kg every other day for 2 weeks. Following administration, 2 Gy whole-body irradiation was performed and the counts of leukocytes, lymphocytes, and granulocytes and monocytes in the peripheral blood were determined 1, 3, 7, 15 and 30 days after irradiation. These cells were considered since they are closely associated with immunity to radioactivity. In a second experiment, flavonoid was similarly administered to the mice for 2 weeks after a 1-week adjustment period, and 2 Gy whole-body irradiation was performed. The antioxidant effects in hemocytes were then investigated using 2,2'-azobis (2-amidinopropane) dihydrochloride (AAPH), a radical generator. In a third experiment, 1×106 Sarcoma-180 cells were inoculated into the right thigh of mice, which were divided into four groups: control, flavonoid-treated, 6 Gy irradiated and Flavonoid-treated + 6 Gy irradiated groups, and changes in tumor size were measured for 20 days. Statistical analysis was conducted using ANOVA for multiple groups. In the three experiments, administration of Flavonoid inhibited the reduction of hemocytes caused by whole-body irradiation, showed antioxidant effects against radioactivity, and inhibited tumor growth, respectively. In conclusion, our data suggest that the antioxidant effect of Flavonoid inhibits hemocyte reduction caused by whole-body irradiation and enhances immunological inhibition of tumor growth.
Daniel Sohinki, Phi Wiegn, Owen A. Obel
Archives of Clinical and Medical Case Reports, Volume 5, pp 143-147; doi:10.26502/acmcr.96550339

Anoop Nagpal, Uma Debi, Pankaj Gupta, Lokesh Singh, Ms Sandhu, Kailash Kurdia
Archives of Clinical and Medical Case Reports, Volume 5, pp 148-150; doi:10.26502/acmcr.96550340

Oesophageal perforation due to foreign body ingestion mainly seen in children and is rare in adult population. In adults, involuntary ingestion of foreign body usually occurs due to some predisposing factors. Ingestion of dental implant causing esophageal perforation is rare. Our patient is a 50 year old male with history of dental implant ingestion. On attempt of endoscopically removing the implant, impaction of implant occurred leading to perforation of cervical oesophagus. The clinical picture further complicated with formation of pneumomediastiunum, mediastinal collection and subcutaneous emphysema.
Mariangela Rutigliani, Davide. Lijoi, Andrea DeCensi, Laura Paleari
Archives of Clinical and Medical Case Reports, Volume 05, pp 291-295; doi:10.26502/acmcr.96550360

Ovarian hemangiomas are very rare benign tumors of the female genital tract. Most cases are small lesions that are discovered by chance. Although they are often an incidental finding at surgery, these lesions may sporadically be associated with systemic manifestations. Here, we describe a 63 year-old woman with a right ovary benign hemangioma who presented with a clinically suspicious left ovarian torsion.
Áurea Lima, Diana Dias, Alcinda Reis, Joana Malheiro, Joana Rodrigues
Archives of Clinical and Medical Case Reports, Volume 5, pp 221-225; doi:10.26502/acmcr.96550350

Khalid Sawalha, Bryan Huang, Shoaib Khan, Naveed Younis
Archives of Clinical and Medical Case Reports, Volume 05, pp 256-260; doi:10.26502/acmcr.96550355

A 43-year-old female patient with past medical history of superficial DVTs, nicotine dependency, and morbid obesity presented with shortness of breath and syncope. She was found to be tachycardic with elevated D-Dimer. Emergent chest-CT was performed which revealed large bilateral pulmonary emboli. As her vitals were within normal limits at that time, there were no indications for tissue plasminogen activator. Later, patient started having fleeting episodes of bradycardia and hypotension with drop in systolic pressure over 40mmHg on slight movements. Being in a rural hospital with limited resources, the decision was made to transfer the patient. Following the transfer, the patient was pronounced deceased due to complications related to her condition. We report this case to emphasize the importance of early recognition and management with thrombolytic therapy or mechanical thrombectomy if contraindications exist in patients with recurrent syncope in a rural setting.
Alena Varantsova
Archives of Clinical and Medical Case Reports, Volume 05, pp 361-367; doi:10.26502/acmcr.96550367

Nada Lahmidani, Sara Bahja, Ibrahimi Sidi Adil, Mohammed El Abkari
Archives of Clinical and Medical Case Reports, Volume 5, pp 100-105; doi:10.26502/acmcr.96550333

Buschke - Löwenstein tumor is an uncommon disease associated with human papillomavirus infection. It occurs most often in pubescent male subjects with sexual activity. It is located at the level of the external genitalia. The diagnosis is based on the histological study and the treatment is essentially surgical with complete and wide excision in order to avoid recurrence. The prevention of this tumor is based on the treatment of condylomata acuminata as a sexually transmitted disease.
Rohit Aloor, Shravana Aryal, Debajit Roy, Beth Allen, Louis Saade, Christopher James Haas
Archives of Clinical and Medical Case Reports, Volume 05, pp 373-387; doi:10.26502/acmcr.96550369

Coronavirus disease 2019 (COVID-19) originally emerged as respiratory disease from a novel coronavirus, SARS-CoV-2. While initial cases revealed a spectrum of respiratory-associated clinical presentations ranging from mild shortness of breath with associated cough to severe respiratory distress, extrapulmonary symptoms, with or without concomitant respiratory disease, have been increasingly reported. Cardiovascular complications are noted in a subset of patients with presentations ranging from non-ST elevation myocardial infarction to fulminant myopericarditis. While cardiac myocytes express the SARS-CoV-2 receptor, Angiotensin converting enzyme 2 (ACE2), the mechanism of cardiac effects remains unknown, further underscoring the complex nature of COVID-19. Here we report two cases of COVID-19 in which cardiac manifestations – pericarditis with associated pericardial effusion and tamponade physiology and fulminant myocarditis – were the predominant manifestation of COVID-19. We hypothesize that many of COVID-19 pulmonary and extra-pulmonary manifestations manifest not only from direct SARS-CoV-2 toxicity in select tissues, but also its interaction with a complex interplay of host factors including genetic and epigenetic modifications of crucial genes – Angiotensin Converting Enzyme 2, Angiotensin Converting Enzyme 1, and Transmembrane protease serine-2 – and their respective affiliation with multiple signaling cascades with resultant dysregulated proinflammatory effects.
Jasmine Gray, Shahrzad Bazargan-Hejazi, Gul Ebrahim, Daniel Cho
Archives of Clinical and Medical Case Reports, Volume 05, pp 388-392; doi:10.26502/acmcr.96550370

Autism Spectrum disorder (ASD) is a neurodevelopmental disorder characterized by impairments in social communication and social interaction, repetitive and stereotyped behaviors, and /or sensory aberrations. On the other hand, obsessive-compulsive disorder (OCD) is characterized by the presence of obsessions and/or compulsions. In consideration of these distinct pathologies, research suggests that anxiety disorders and OCD are highly prevalent in individuals with ASD. This case report will discuss an adolescent patient with ASD and OCD who experiences an exacerbation, most notably, in his symptoms of OCD. We outline the hospital course of a 13 year-old male who ultimately requires nasogastric (NG) tube feeding resulting from an acute worsening in symptoms and refusal of oral intake during the COVID-19 pandemic. The patient demonstrated significant improvement in symptoms following the administration of high-dose selective serotonin reuptake inhibitor (SSRI) and low-dose antipsychotic therapy.
Ben Amar W, Siala H, Zribi M, Karray N, Hammami Z, Khemekhem Z, Maatoug S
Archives of Clinical and Medical Case Reports, Volume 05, pp 248-255; doi:10.26502/acmcr.96550354

Background: Self-strangulation with a vehicle-assisted ligature is reported to be very uncommon suicidal method. Related cases are rarely published, and many of them report massive injuries to neck organs, and even complete decapitation. Case presentation: We report an unusual case of self-strangulation where a body was found dead inside a car with a rope around his neck and tied to an electric pole behind the car. The rope didn’t break while the car moved away, and no decapitation was associated. The manner of death was determined as suicide based on a complete criminal investigation supported by a detailed crime scene investigation and autopsy. Conclusion: This case is reported for its originality due to the unusual method of suicide employed by the victim, and because it was not related to decapitation.
Manabu Yamamoto, Kazuhito Sakata, Hiroko Yano, Tomonobu Gion, Yohei Tominaga, Hiroyuki Kobayashi, Masazumi Tuneyoshi
Archives of Clinical and Medical Case Reports, Volume 05, pp 296-302; doi:10.26502/acmcr.96550361

Colorectal cancer with intestinal malrotation is very rare, while intestinal malrotation is one of congenital anomaly that is rare in adults. We thus report a case of sigmoid colon cancer with intestinal malrotation treated by laparoscopic surgery. A 39-year-old woman was admitted to our hospital with constipation. A colonoscopy revealed the sigmoid colon tumor. Three-dimensional abdominal enhanced computed tomography showed that small and large intestines occupied the right- and left-side of the abdominal cavity, respectively. Her diagnosis was the sigmoid colon cancer with nonrotation type of intestinal malrotation, and she underwent laparoscopic sigmoidectomy. There have been 43 cases reports of colorectal cancer with intestinal malrotation who underwent laparoscopic surgery in Japan medical literatures. Colorectal cancer was in the right-side in 69.8% of these cases, although that in the left-side is generally more common. Three-dimensional abdominal enhanced computed tomography angiography can reveal vascular anatomic anomalies to allow laparoscopic surgery to be performed safety.
Catharine Marigo Costa, Paula Cristina Eiras Poço, Jean Marcos de Souza
Archives of Clinical and Medical Case Reports, Volume 05, pp 261-270; doi:10.26502/acmcr.96550356

Background: Hypocomplementemic urticarial vasculitis syndrome (HUVS) is a rare multisystemic autoimmune disease. The cardiac involvement in HUVS, mainly in the heart valves, can be differentiated from late-onset rheumatic fever sequelae with specific criteria, although similarities are observed among these pathologies. Case Report: We describe the case of a patient with Jaccoud’s arthropathy associated with urticarial skin lesions, elevated inflammatory markers and consumed complement fractions. Skin biopsy revealed leukocytoclastic vasculitis, fully controlled with rituximab and mycophenolate. In the follow-up, echocardiographic abnormalities consistent with rheumatic heart disease (RHD) were detected. Review: HUVS is an immune complex-mediated small vessel vasculitis involving prominently the skin vessels, synovial membrane and glomeruli. Case reports showing mitro-aortic valve involvement in patients with HUVS raised the possibility of association with post-rheumatic valve disease, corroborating the hypothesis of a common pathophysiological pathway linking HUVS and RHD. The initial treatment of HUVS include corticosteroids, hydroxychloroquine, colchicine and dapsone, however more potent immunosuppressants, such as mycophenolate or immunobiological therapy are often necessary for complete remission of symptoms and weaning from corticosteroid therapy. Conclusions: Although rare, it is important to consider the association of RHD in patients with HUVS, due to significative changes in the treatment and preventive measures.
Archives of Clinical and Medical Case Reports, Volume 5, pp 210-215; doi:10.26502/acmcr.96550348

We describe a young female patient with schistosomiasis, HIV and posterior reversible encephalopathy syndrome (PRES) from a South African township. There are overlapping pathophysiological molecular mechanisms between schistosomiasis and PRES and yet no previous descriptions linking the two conditions. This presentation highlights the need for further investigation of this possible link. It also serves to emphasize the need for an updated geographical distribution map of schistosomiasis in South Africa. The interplay between HIV and schistosomiasis continues to be an important study subject in endemic areas.
Monika Sadlonova, Birgit Gerecke, Aschraf El-Essawi, Lars-Olav Harnisch, Onnen Moerer, Konrad Meissner, Claudius Jacobshagen, Hassina Baraki, Ingo Kutschka
Archives of Clinical and Medical Case Reports, Volume 5, pp 171-181; doi:10.26502/acmcr.96550344

Background: Cardiogenic shock (CS) is the clinical representation of circulatory failure with a state of critical end-organ hypoperfusion due to primary cardiac dysfunction. A severe cardiogenic shock can present with clinical complications such as arrhythmias, ischemia and organ failure and even today is associated with a high mortality of 40-50%. Extracorporeal life support (ECLS) by veno-arterial extracorporeal membrane oxygenation (VA-ECMO), Impella® and other mechanical circulatory support systems can reduce the acute circulatory failure and therefore constitute an important treatment option in the management of severe CS as a bridge to long-term strategies. Case summary: We present the case of a 38-year-old woman with an acute heart failure due to a coronary artery disease who underwent emergency coronary artery bypass grafting and intraoperative implantation of a veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Over the next 4 months, a multidisciplinary team-approach bridged the patient using first a left ventricular (LV) support system (Impella), then additionally a right ventricular (RV) Impella and finally a temporary paracorporeal continuous flow left ventricular support (Rotaflow). Following a promising neurological recovery, a long-term left ventricular assist device (LVAD) was implanted in a bride to transplant (BTT) concept. Discussion: The addition of LV Impella and RV support by Impella (BiPELLA) on top of VA-ECMO may support survival of patients with refractory cardiogenic shock. In complex biventricular heart failure, an expert center must be able to provide an early multi-modular intervention with elaborated mechanical circulatory support due to a multidisciplinary expertise.
Archives of Clinical and Medical Case Reports, Volume 5, pp 84-90; doi:10.26502/acmcr.96550330

For much of mankind, the COVID-19 pandemic created an extraordinary condition, with a severe impact on almost all domains of life. Physical activity (PA) was no exception, and disturbing findings showing the deleterious effect of lockdown measures on PA were recorded in relevant studies conducted in several different countries. It appears that society has overlooked or underestimated the advantages of PA in developing a defense against the virus and the incremental trend of non-communicable diseases (NCDs), and the prevalence of physical inactivity has presented many major challenges to public health authorities. In this article, in the presence of COVID-19, we briefly remember and highlight the beneficial impact of a physically active life and daily exercise training on public health, even more so for the most vulnerable groups. In this respect, we should not underestimate the role of PA and non-exhaustive exercise as a countermeasure and an indirect therapeutic agent against the virus, as well as against NCDs and mental health issues arising from the COVID-19 crisis.
Raghav Seth, Uma Debi, Pankaj Gupta, Lokesh Singh, Vishal Sharma, Harjeet Singh, Kaushal Kishor Prasad
Archives of Clinical and Medical Case Reports, Volume 5, pp 137-142; doi:10.26502/acmcr.96550338

In countries like India where TB is endemic, it is extremely difficult to differentiate between Intestinal-TB and Crohn’s-disease as both have overlapping clinical, radiological, endoscopic and histological features [1-4]. Incorrect diagnosis causes increased morbidity and mortality. Hence, there is a need for an imaging test that can accurately diagnose both and can be easily integrated into existing clinical practice. We describe a new technique of CT perfusion for differentiation between the two diseases. We present 2 cases (biopsy proven) of intestinal-TB and Crohn’s-disease. The clinical, laboratory investigations, imaging and endoscopic findings will be discussed along with analysis of the perfusion parameters. The final diagnosis will be considered according to the biopsy findings. We conclude that CT perfusion is a highly sensitive and specific non invasive imaging modality for differentiation between intestinal-TB and crohn’s-disease.
Leydimar Anmad Shihadeh, Maria Jose Romero-Castro, Andrea Moreno-Arciniegas, Ana Pastor, Beatriz Fuertes, Blanca Zorita, Daniel Prieto, Belén Díaz, Jose María Castellano, Leticia Fernández-Friera
Archives of Clinical and Medical Case Reports, Volume 5, pp 75-83; doi:10.26502/acmcr.96550329

Although cardiac magnetic resonance (CMR) may proof useful in the diagnosis of myocardial injury triggered by COVID-19, limited experience has yet been published. We report several cases presenting its utility at various COVID-19 disease stages in diagnosing different cardiac manifestations. The current COVID-19 crisis will undoubtedly transform CMR imaging Units.
Archives of Clinical and Medical Case Reports, Volume 5, pp 151-155; doi:10.26502/acmcr.96550341

A fifty-one-year-old woman presented with pain related to metastatic breast cancer. The palliative care team was consulted for acute pain management intervention. At home, she was taking methadone for pain control. However, shooting pains down her legs had progressed to an unmanageable level, to the point where she was confided to bed. She was admitted to the hospital and was started on a hydromorphone PCA without complete pain control. Intravenous lidocaine was trialed and significantly improved the patient’s pain and decreased the need for other opioid medications. After these results, she was started on a lidocaine drip without side effects noted.
Derqaoui Sabrine, Antonio Blata Vladimir, Jahid Ahmed
Archives of Clinical and Medical Case Reports, Volume 4, pp 124-129; doi:10.26502/acmcr.96550177

Introduction: Peutz-Jeghers syndrome (PJS) is a rare autosomal inherited polyposis syndrome, characterized by multiple hamartomatous polyps in the gastrointestinal tract, associated with mucocutaneous pigmentation. Polyps mainly occur in the small intestine. Patients with PJS have an increased risk of many cancers. Histologically, the presence of a smooth muscle arborization within the lamina propria is the hallmark of those polyps. Intussusceptions is a rare complications of gastrointestinal polyps. In the present study, we report the case of this rare entity with particular histological features in a young woman who developed a jejunal obstruction caused by an intussusception. Case Presentation: A 32-year-old woman presented to the emergency department with jejunal obstruction caused by an intussusception. She had a pigmented macules around the mouth and on the tongue. An urgent exploratory laparotomy was performed, revealing a distended invaginated ischemic part of proximal jejunum.Careful exploration of the abdominal cavity and intestine revealed multiple polyps inside the small intestine. On gross, one pedunculated polyp was found. Histollogically, it had a central core of smooth muscle showing a tree like branching with a pseudo-invasion like pattern due to the extension of glands in the subserousa. Conclusion: PJS is a rare syndrome, which often remains undiagnosed for many years. Early diagnosis, treatment, and regular follow-up are important for an excellent prognosis in individuals presenting with this rare syndrome.
Lygerou D, Bolaki M, Stylianou K, Margaritopoulos G, Dermitzaki Ek, Vasarmidi E, Drosataki E, Maragkou Sa, Paraskevopoulos A, Perisinaki G, et al.
Archives of Clinical and Medical Case Reports, Volume 3, pp 550-559; doi:10.26502/acmcr.96550133

Sarcoidosis is a disease characterized by granulomatous inflammation potentially affecting multiple organ systems. Although it can affect any organ, lungs, lymph nodes, skin and eyes are most commonly involved. Renal sarcoidosis, although rare, remains a challenging clinical issue requiring mandatory treatment, given the risk of developing renal failure. Taking into consideration the rarity of the disease, data regarding its diagnosis and treatment are scarce. This case series describes seven cases of sarcoidosis with predominantly renal manifestations, and moreover provides a review of the current literature on renal sarcoidosis.
Olesya Pavlova, Wolfram Weinrebe
Archives of Clinical and Medical Case Reports, Volume 4, pp 312-328; doi:10.26502/acmcr.96550202

Multiple myeloma is an incurable haematological malignancy with complex pathogenesis, affecting mostly the elderly and characterized by the presence of monoclonal plasma cells within the bone marrow secreting an abnormal immunoglobulin, which results in gammapathy with organ or tissue injury. The chemotherapy used for the treatment of multiple myeloma causes various adverse effects, including serious psychiatric and cognitive problems, which pose a significant challenge to the clinician, present an impact on the quality of patient’s life and augment hospital stays and health care costs. We reported a clinical case of 73-year-old women with new diagnosed multiple myeloma developing severe, rapidly progressing and persisting hyperactive delirium with psychotic symptoms and mania-episodes during Velcade-Revlimid-Dexamethasone-based treatment. We discuss possible causes, clinical presentation, treatment and deficits maintained after recovery. Our report demonstrates the rare possibility of an association between chemotherapy and the development of combined psychiatric disorders.
Wanqi Zheng, Yuchuan Wang, Zhengjuan Liu, Xinbo Yu, Zhao Sun
Archives of Clinical and Medical Case Reports, Volume 4; doi:10.26502/acmcr.96550206

Marwa Chbihi, Cécile Dumaine, Georges Deschênes, Anne Couderc, Renato C Monteiro, Julien Hogan, Alexandra Cambier
Archives of Clinical and Medical Case Reports, Volume 4, pp 218-225; doi:10.26502/acmcr.96550189

IgA nephropathy (IgAN) is one of the most common primary glomerulonephritis in children and adolescents. Pharyngitis infections are known to be a trigger of IgA attacks. It has been suggested that IgAN is an immune complex disease with circulating immune complexes galactose-deficient IgA1 (Gd-IgA1), IgG and IgA anti-Gd-IgA1 antibodies, and soluble CD89. Amyloidosis is the most common renal complication of Familial Mediterranean Fever (FMF), the most common form of auto-inflammatory syndromes characterized by flares of fever and polyserositis. Besides amyloidosis, other renal lesions have been exceptionally reported in patients with FMF and other hereditary periodic fevers. We report a child who presented with haematuria during febrile attacks in the context of FMF, and in whom kidney biopsy revealed deposits of predominant mesangial IgA with no evidence of amyloidosis and presence of immune complexes in the serum (Gd-IgA and sCD89-IgA).
Eva McGhee, Sameeran Das, Adin Handler, Julian Handler, Joel Palefsky
Archives of Clinical and Medical Case Reports, Volume 4, pp 206-217; doi:10.26502/acmcr.96550188

Human papillomavirus16 (HPV) E6/E7 oncoproteins are associated with increased chromosomal instability through Robertsonian aberrations. Robertsonian translocations are common constitutional abnormalities in humans but are considered rare occurrences in cancer cells. Research is sparse surrounding Robertsonian translocations in viral infected cells; therefore, we examined whether HPV-E6/E7 transfection could facilitate the formation of Robertsonian aberrations. We used spectral karyotyping (SKY) and array-comparative genomic hybridization (array-CGH) to score Robertsonian aberrations in 16-MT cells, which were derived from human keratinocytes that were transfected with HPV16 E6/E7 oncoproteins. We analyzed 30 metaphases to determine the types of Robertsonian translocations present in the 16-MT cells. The results showed non-homologous Robertsonian translocations in 100% of metaphases scored and homologous acrocentric rearrangements-isochromosome types in 75% of metaphases scored. We studied two types Robertsonian translocations: der(13;14), the non-homologous type, and i(13), the homologous isochromosomes type. The results showed that HPV E6/E7 oncoproteins induce genomic instability, causing Robertsonian translocations on chromosomes 13 and 14. This analysis provides a reliable method for future research in the mechanisms of Robertsonian translocations as a result of centromeric fusion in HPV-transformed cells.
Jinpeng Li, Congcong Shi, Jutian Shi, Jinlong Song, Nan Wang
Archives of Clinical and Medical Case Reports, Volume 4, pp 336-343; doi:10.26502/acmcr.96550204

DEBs?Drug-eluting microspheres) is a new embolic agent in recent years, which can achieve the dual effects of embolization and local drug release, and achieve more satisfactory tumor response rate and survival time than C-TACE?conventional transcatheter arterial chemoembolization. VL (vascular lake) was a special complication of embolization of HCC with DEBs. Although it had been reported that the occurrence of VL could predict a satisfactory tumor response rate in the literature, but there was a risk of local tumor residue or tumor rupture, which should be paid more attention to. We report a case of hepatocellular carcinoma with tumor rupture after D-TACE treatment and complete response after (TAE) treatment. A 48-year-old man came to our hospital with liver tumor and clinically diagnosed as hepatocellular carcinoma (HCC). Vascular lake appeared during D-TACE treatment. The patient developed abdominal pain the second day after embolization, and was diagnosed as hepatocellular carcinoma rupture by abdominal puncture. Then selective TAE was performed. After TAE, the elevated tumor marker liver level (3008 ng/mL) decreased to the normal level. According to the mRECIST [4], the curative effect was evaluated as partial remission contrast baseline disease. During the follow-up to January 2020, the patient still had no recurrence of the disease, the quality of life was good, and the side effects of targeted drugs were mild.
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