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Fever in a transplant recipient: think beyond infection
Key Clinical Message Immune reconstitution inflammatory syndrome (IRIS) is an exaggerated inflammatory cascade initiated in response to immune recovery during the resolution of an infection. Reduction in calcineurin inhibitor levels in organ transplant recipients due to enhanced metabolism from interaction with rifampin can predispose these individuals to develop IRIS during the treatment of tuberculosis and mimic sepsis. Immune reconstitution inflammatory syndrome (IRIS) is an exaggerated inflammatory cascade initiated in response to immune recovery during the resolution of an infection. Reduction in calcineurin inhibito...
Source: Clinical Case Reports - February 21, 2018 Category: General Medicine Authors: Mayanka Kamboj, Volodymyr Chornyy, Abhilash Koratala, Alfonso H. Santos Tags: Case Report Source Type: research

Bladder squamous cell cancer accompanied by Trousseau's syndrome: a case report
We present a case of bladder squamous cell carcinoma associated with multiple cerebral infarctions. This patient was diagnosed as having Trousseau's syndrome and received radiotherapy for bladder cancer treatment, along with anticoagulation therapy. The association between thrombosis and cancer has been recognized since Trousseau's report in 1865. We present a case of bladder squamous cell carcinoma associated with multiple cerebral infarctions. This patient was diagnosed as having Trousseau's syndrome and received radiotherapy for bladder cancer treatment, along with anticoagulation therapy. (Source: Clinical Case Reports)
Source: Clinical Case Reports - February 21, 2018 Category: General Medicine Authors: Satoshi Kayukawa, Kenji Ina, Ryuichi Furuta, Tomoko Nishio, Tadayuki Miyashita, Shun Umeda, Takae Kataoka Tags: Case Report Source Type: research

Parapelvic cysts mimicking hydronephrosis
Key Clinical Message Point‐of‐care renal ultrasonography performed by physicians at bedside assists in rapid evaluation of hydronephrosis, nephrolithiasis and other structural abnormalities, and guides management. As such, it is important to differentiate between various renal pathologies that can mimic one another and herein, we present a case where parapelvic cysts mimicked hydronephrosis. Point‐of‐care renal ultrasonography performed by physicians at bedside assists in rapid evaluation of hydronephrosis, nephrolithiasis and other structural abnormalities, and guides management. As such, it is important to diffe...
Source: Clinical Case Reports - February 21, 2018 Category: General Medicine Authors: Abhilash Koratala, Kawther F. Alquadan Tags: Clinical Image Source Type: research

Successful treatment of refractory TAFRO syndrome with elevated vascular endothelial growth factor using thyroxine supplements
Key Clinical Message Although the clinical significance of hypothyroidism in TAFRO syndrome is unknown, vascular endothelial growth factor (VEGF) levels decreased with improvements in the condition of our refractory TAFRO cases after thyroxine supplement therapy. Our results indicate that elevated VEGF levels are a potential factor in the pathogenesis and anasarca of TAFRO syndrome with hypothyroidism. Although the clinical significance of hypothyroidism in TAFRO syndrome is unknown, vascular endothelial growth factor (VEGF) levels decreased with improvements in the condition of our refractory TAFRO cases after thyroxine ...
Source: Clinical Case Reports - February 21, 2018 Category: General Medicine Authors: Satoko Oka, Kazuo Ono, Masaharu Nohgawa Tags: Case Report Source Type: research

A superelderly case of TAFRO syndrome treated effectively using corticosteroid hormones
Key Clinical Message Peripheral lymphocyte subsets may be less time‐consuming and are a prognostic tool for managing thrombocytopenia, anasarca, myelofibrosis, renal dysfunction, and organomegaly (TAFRO) syndrome. Here, we report a superelderly case of plasma cell type TAFRO syndrome treated effectively using corticosteroid hormones. Peripheral lymphocyte subsets may be less time‐consuming and are a prognostic tool for managing thrombocytopenia, anasarca, myelofibrosis, renal dysfunction, and organomegaly (TAFRO) syndrome. Here, we report a superelderly case of plasma cell type TAFRO syndrome treated effectively using...
Source: Clinical Case Reports - February 21, 2018 Category: General Medicine Authors: Yoshitaka Shimada, Mizuho Adachi, Noritada Kobayashi, Takemichi Okada, Hitoshi Yamazaki, Yasushi Nagaba, Hiroaki Yokomori Tags: Case Report Source Type: research

Neonatal adrenal findings: significance and diagnostic approach. Description of two cases
Key Clinical Message Abnormal adrenal findings such as hemorrhage or calcifications in the neonate can stem from a variety of etiologies. Clinical presentation can vary significantly based on the degree of hemorrhage or the associated condition. Thorough work‐up is important to rule out critical underlying conditions as well as adrenal insufficiency. Abnormal adrenal findings such as hemorrhage or calcifications in the neonate can stem from a variety of etiologies. Clinical presentation can vary significantly based on the degree of hemorrhage or the associated condition. Thorough work‐up is important to rule out criti...
Source: Clinical Case Reports - February 21, 2018 Category: General Medicine Authors: Dimitrios Angelis, Manjula Mudduluru, Sonia Joseph, Christopher Ching, Amanda Hughes, Robert Bennett Tags: Case Report Source Type: research

Renal cyst infection: a diagnostic dilemma
Key Clinical Message Cyst infection is a common complication of autosomal dominant polycystic kidney disease. It presents with vague clinical features and imaging findings which make the diagnosis challenging. Imaging findings can be misinterpreted as renal cell carcinoma, and biopsy of the lesion is often required for definitive diagnosis. Cyst infection is a common complication of autosomal dominant polycystic kidney disease. It presents with vague clinical features and imaging findings which make the diagnosis challenging. Imaging findings can be misinterpreted as renal cell carcinoma, and biopsy of the lesion is often...
Source: Clinical Case Reports - February 21, 2018 Category: General Medicine Authors: Mayanka Kamboj, Xu Zeng, Abhilash Koratala Tags: Clinical Image Source Type: research

Frontline brentuximab vedotin in breast implant ‐associated anaplastic large‐cell lymphoma
We report a woman who developed BIA‐ALCL 9 years after saline implant placement. The lymphoma manifested as a mass lesion associated with axillary lymphadenopathy. She was successfully treated with brentuximab vedotin with minimal toxicity. Brentuximab vedotin may be a promising frontline therapeutic modality for patients with BIA‐ALCL. Breast implant‐associated anaplastic large cell lymphoma (BIA‐ALCL) is a rare peripheral T‐cell lymphoma. BIA‐ALCL presenting with a capsular mass show shorter survival despite implant removal followed by CHOP‐like chemotherapy. We present a patient with BIA‐ALCL succe...
Source: Clinical Case Reports - February 16, 2018 Category: General Medicine Authors: Juan Pablo Alderuccio, Amrita Desai, Monica M. Yepes, Jennifer R. Chapman, Francisco Vega, Izidore S. Lossos Tags: Case Report Source Type: research

A case report of chromosome 17q22 ‐qter trisomy with distinct clinical presentation and review of the literature
Key Clinical Message Terminal 17q trisomy is very rare but a recognizable genetic syndrome. The majority of cases reported are inherited from a balanced translocation carrier. This syndrome involves many organs and the severity ranges from mild to severe depending on the size of the 17q gain. Terminal 17q trisomy is very rare but a recognizable genetic syndrome. The majority of cases reported are inherited from a balanced translocation carrier. This syndrome involves many organs and the severity ranges from mild to severe depending on the size of the 17q gain. (Source: Clinical Case Reports)
Source: Clinical Case Reports - February 14, 2018 Category: General Medicine Authors: Jariya Upadia, Joseph B. Philips, Nathaniel H. Robin, Edward J. Lose, Fady M. Mikhail Tags: Case Report Source Type: research

Low ‐pitch peripheral systolic murmur associated with pulmonary embolism in the acute phase: a report of two cases
Key Clinical Message Acute pulmonary embolism with significant right ventricular strain could be associated with a low‐pitch peripheral systolic murmur radiating to the axillae. Acute pulmonary embolism with significant right ventricular strain could be associated with a low‐pitch peripheral systolic murmur radiating to the axillae. (Source: Clinical Case Reports)
Source: Clinical Case Reports - February 14, 2018 Category: General Medicine Authors: Ahmadou Musa Jingi, Sylvie Ndongo Amougou, Bonaventure Jemea, Christian Ngongang Ouankou, Armelle Foutko, Narcisse Assene Ateba, Clovis Nkoke Tags: Case Report Source Type: research

Intrasinusoidal pattern of bone marrow infiltration by hepatosplenic T ‐cell lymphoma
Key Clinical Message Hepatosplenic T‐cell lymphoma is a rare, aggressive form of extranodal lymphoma, which frequently involves the bone marrow. An intrasinusoidal pattern of infiltration is characteristic of the disease and is often best appreciated on immunohistochemical staining. Bone marrow biopsy can be a useful diagnostic tool. Hepatosplenic T‐cell lymphoma is a rare, aggressive form of extranodal lymphoma, which frequently involves the bone marrow. An intrasinusoidal pattern of infiltration is characteristic of the disease and is often best appreciated on immunohistochemical staining. Bone marrow biopsy can be ...
Source: Clinical Case Reports - February 13, 2018 Category: General Medicine Authors: Liesl Ann Butler, Surender Juneja Tags: Clinical Image Source Type: research

Milk fistula following puerperal breast abscess
We present the first reported video of milk fistula. Milk fistula is a rare complication secondary to abscess or breast intervention in lactating women. It is a clinical diagnosis and the treatment is usually conservative, which included cessation of breastfeeding, with a good prognosis. We present the first reported video of milk fistula. Milk fistula is a rare complication secondary to abscess or breast intervention in lactating women. It is a clinical diagnosis and the treatment is usually conservative, which included cessation of breastfeeding, with a good prognosis. (Source: Clinical Case Reports)
Source: Clinical Case Reports - February 13, 2018 Category: General Medicine Authors: Geok Hoon Lim, Ruey Pyng Ng Tags: Clinical Video Source Type: research

Simultaneous finding of chronic lymphocytic leukemia and residual hairy cell leukemia using a lymphocyte ‐binding anti‐CD antibody microarray
Key Clinical Message The morphologic diagnosis of hairy cell leukemia coexisting with another lymphoproliferative disorder is hindered by the small size of hairy cell population. It can be simplified by presorting peripheral blood mononuclear cell using an anti‐CD antibody microarray on transparent support (including anti‐CD11c, CD25, CD103, and CD123) before their morphology analysis. The morphologic diagnosis of hairy cell leukemia coexisting with another lymphoproliferative disorder is hindered by the small size of hairy cell population. It can be simplified by presorting peripheral blood mononuclear cell using an ...
Source: Clinical Case Reports - February 13, 2018 Category: General Medicine Authors: Alina N. Khvastunova, Liubov S. Al ‐Radi, Olga S. Fedyanina, Sofya A. Kuznetsova Tags: Clinical Image Source Type: research

Hyperammonemic encephalopathy in a patient receiving fluorouracil/oxaliplatin chemotherapy
Key Clinical Message Hyperammonemia is a rare adverse effect of 5‐fluorouracil (5‐FU) therapy, but can be very serious, even fatal. Physicians must be aware that hyperammonemic encephalopathy sometimes develops as an adverse event after 5‐FU therapy. Hyperammonemia is a rare adverse effect of 5‐fluorouracil (5‐FU) therapy, but can be very serious, even fatal. Physicians must be aware that hyperammonemic encephalopathy sometimes develops as an adverse event after 5‐FU therapy. (Source: Clinical Case Reports)
Source: Clinical Case Reports - February 13, 2018 Category: General Medicine Authors: Hiromi Ihoriya, Hirotsugu Yamamoto, Taihei Yamada, Kohei Tsukahara, Kanae Inoue, Tetsuya Yumoto, Hiromichi Naito, Atsunori Nakao Tags: Case Report Source Type: research

Not everything is as it seems: neurosarcoidosis presenting as leptomeningitis
Key Clinical Message Involvement of the central nervous system in sarcoidosis is rare; neurosarcoidosis, although unusual, can present as leptomeningitis. The diagnosis is usually difficult because of the vague and broad symptomatology; therefore, a prompt diagnosis should be made, and adequate treatment should be administered to reduce morbidity and mortality. Involvement of the central nervous system in sarcoidosis is rare; neurosarcoidosis, although unusual, can present as leptomeningitis. The diagnosis is usually difficult because of the vague and broad symptomatology; therefore, a prompt diagnosis should be made, and...
Source: Clinical Case Reports - February 13, 2018 Category: General Medicine Authors: Javier Andr és Galnares‐Olalde, Roberto Berebichez‐Fridman, Gilberto Gómez‐Garza, Moisés Mercado, Francisco Moreno‐Sánchez, Marco Antonio Alegría‐Loyola Tags: Case Report Source Type: research

A case of immunoglobulin G4 ‐related aortic diseases
Key Clinical Message A 65‐year‐old man had histories of retroperitoneal fibrosis, membranous nephropathy, and acute coronary syndrome. Chest computed tomography showed an enlarged ascending aorta and type B aortic dissection, and he underwent ascending aorta and arch replacement. A pathological examination of the resected aorta showed immunoglobulin G4‐positive plasma cell infiltration. A 65‐year‐old man had histories of retroperitoneal fibrosis, membranous nephropathy, and acute coronary syndrome. Chest computed tomography showed an enlarged ascending aorta and type B aortic dissection, and he underwent ascendi...
Source: Clinical Case Reports - February 13, 2018 Category: General Medicine Authors: Akira Sugaya, Yoshio Misawa, Shin ‐ichi Ohki, Ippei Takazawa, Satoshi Uesugi Tags: Case Report Source Type: research

A case of late orthostatic headache secondary to lumbar hidden dural fistula 20 months after epidural anesthesia
We report the case of a young woman, who presented with a late orthostatic headache 20 months after epidural anesthesia. She developed a lumbar dural fistula of CSF confirmed in myelography CT scanning and treated successfully with epidural blood patch. The clinical recognition of CSF fistula is a clinical challenge. We report the case of a young woman, who presented with a late orthostatic headache 20 months after epidural anesthesia. She developed a lumbar dural fistula of CSF confirmed in myelography CT scanning and treated successfully with epidural blood patch. (Source: Clinical Case Reports)
Source: Clinical Case Reports - February 13, 2018 Category: General Medicine Authors: F. J. Ros Forteza, M. A. Dias da Costa, R. P. Pais Tags: Case Report Source Type: research

Attention deficit/hyperactivity disorder as an associated feature in OCTN2 deficiency with novel deletion (p.T440 ‐Y449)
Key Clinical Message This boy presented with ADHD at 3 years and at 8 years was hyperactive with no documented hypoglycemia and had myopathy, cardiomyopathy, and very low serum carnitine. L‐carnitine improved his exercise intolerance, cardiomyopathy, and behavior. Analysis of SLC22A5 revealed a premature stop codon (p.R282*) and a novel in‐frame deletion (p.T440‐Y449). This boy presented with ADHD at 3 years and at 8 years was hyperactive with no documented hypoglycemia and had myopathy, cardiomyopathy, and very low serum carnitine. L‐carnitine improved his exercise intolerance, cardiomyopathy, and behavior. Analy...
Source: Clinical Case Reports - February 9, 2018 Category: General Medicine Authors: Anne ‐Marie Lamhonwah, Ivo Barić, Jessica Lamhonwah, Marina Grubić, Ingrid Tein Tags: Case Report Source Type: research

Multiple cerebral infarction revealing Takayasu's disease: a case report in a 32 ‐year‐old man from Cameroon, sub‐Saharan Africa
Key Clinical MessageThis case suggests that young patients with few vascular risk factors, and who present with acute stroke syndrome involving more than one vascular territory should be screened for an inflammatory or infectious cause. This case suggests that young patients with few vascular risk factors, and who present with acute stroke syndrome involving more than one vascular territory should be screened for an inflammatory or infectious cause. (Source: Clinical Case Reports)
Source: Clinical Case Reports - February 7, 2018 Category: General Medicine Authors: F élicité Kamdem, Caroline Kenmegne, Ba Hamadou, Yacouba Mapoure, Fernando K. Lekpa, Sidicki Mouliom, Ahmadou Musa Jingi, Henry Luma, Marie Solange Doualla Tags: Case Report Source Type: research

Arachnoid diverticulum diagnosis following treatment of cryptococcal meningitis in a dog
Key Clinical Message Successful long‐term treatment of cryptococcal meningitis in dogs is clinically challenging. In humans, there are only rare case reports of complications post‐treatment including arachnoid diverticula. Combination antifungal therapy is standard of practice in human medicine and should be considered in veterinary patients. Successful long‐term treatment of cryptococcal meningitis in dogs is clinically challenging. In humans, there are only rare case reports of complications post‐treatment including arachnoid diverticula. Combination antifungal therapy is standard of practice in human medicine a...
Source: Clinical Case Reports - February 7, 2018 Category: General Medicine Authors: Evelyn Galban, Jennifer Perkins Tags: Case Report Source Type: research

Combined mitral valve repair and heart transplantation
Key Clinical Message In times of donor organ shortage, organs with extended allocation criteria, for example, valve pathologies, have to be taken into consideration for transplantation. The donor pool can be extended to hearts with mitral valve insufficiency. Mitral valve repair can rapidly be performed in the donor heart on the back table with excellent results. In times of donor organ shortage, organs with extended allocation criteria, for example, valve pathologies, have to be taken into consideration for transplantation. The donor pool can be extended to hearts with mitral valve insufficiency. Mitral valve repair can ...
Source: Clinical Case Reports - February 7, 2018 Category: General Medicine Authors: Anke Sprengel, Wojtek Skwara, Tibor Ziegelh öffer, Ayse Cetinkaya, Markus Schönburg, Manfred Richter Tags: Case Report Source Type: research

Solitary metastasis of ampullary carcinoma to the spleen: a case report
Key Clinical Message Here, we report a first case of ampullary cancer with solitary metastasis of the spleen, which was successfully treated with pancreatoduodenectomy and splenectomy and was discharged 7 days after the operation with outpatient chemotherapy. In such cases, physicians should consider splenectomy as an effective treatment option. Here, we report a first case of ampullary cancer with solitary metastasis of the spleen, which was successfully treated with pancreatoduodenectomy and splenectomy and was discharged 7 days after the operation with outpatient chemotherapy. In such cases, physicians should consider ...
Source: Clinical Case Reports - February 7, 2018 Category: General Medicine Authors: Tri M. Phan Tags: Case Report Source Type: research

Issue Information
(Source: Clinical Case Reports)
Source: Clinical Case Reports - February 6, 2018 Category: General Medicine Tags: Issue Information Source Type: research

Pseudo liposarcomatous plasma cells in a patient with liposarcoma and lymphoplasmacytic lymphoma
Key Clinical Message First, patients may always develop a second severe illness, even a second cancer. Second, things are not always as they are expected to be. So, careful diagnosis is mandatory. Third, morphology is very important, but sometimes misleading. Always be aware of morphological variants! First, patients may always develop a second severe illness, even a second cancer. Second, things are not always as they are expected to be. So, careful diagnosis is mandatory. Third, morphology is very important, but sometimes misleading. Always be aware of morphological variants! (Source: Clinical Case Reports)
Source: Clinical Case Reports - February 6, 2018 Category: General Medicine Authors: Adrian Schmidt, Antoinette Monn, Elisabeth Schmidt ‐Weiss, Mathias Schmid, Beatrix Boesch Tags: Case Report Source Type: research

Mycoplasma pneumoniae ‐induced mucositis without rash in an 11‐year‐old boy
Key Clinical Message Mycoplasma pneumoniae is a frequent cause of childhood pneumonia, and extrapulmonary manifestations may be noted at the time of infection. While M. pneumoniae has long been associated with Stevens–Johnson syndrome, a separate diagnostic entity, Mycoplasma pneumoniae‐induced rash and mucositis (MIRM), has recently been proposed to better characterize the rash and severe mucositis that some patients exhibit. A subset of patients with MIRM will have mucositis without skin rash. Physicians should recognize this clinical entity and be familiar with treatment options for MIRM. Mycoplasma pneumoniae ...
Source: Clinical Case Reports - February 6, 2018 Category: General Medicine Authors: Morgan Bowling, Tyler Schmutzler, Sarah Glick Tags: Clinical Image Source Type: research

Prenatal sonography of placental abscess and prolonged antibiotic treatment for Serratia marcescens bacteremia
Key Clinical Message Termination of pregnancy is indicated for Serratia marcescens bacteremia, a major cause of mortality. Our present case was highly challenging because the patient wished to continue with her pregnancy, and the ultrasonography showed features of a placental abscess. Although the outcomes were good after prolonged antibiotic treatment, this was an exceptional case. Termination of pregnancy is indicated for Serratia marcescens bacteremia, a major cause of mortality. Our present case was highly challenging because the patient wished to continue with her pregnancy, and the ultrasonography showed features of...
Source: Clinical Case Reports - February 6, 2018 Category: General Medicine Authors: Annisa Shui Lam Mak, Tommy Hing Cheung Tang, Kwok Wai Lam, Angie Lok Ming Kwok, Wah Cheuk, Tak Chiu Wu, Kwok Yin Leung Tags: Case Report Source Type: research

Portal vein thrombosis after cesarean section in a patient on prolonged bed rest due to threatened preterm labor
Key Clinical Message Portal vein thrombosis is a rare but life‐threatening complication during pregnancy and postpartum period. Color Doppler ultrasound is useful for prompt diagnosis. Although the risk of complications should be considered, successful pregnancy with comorbid portal vein thrombosis is possible with appropriate anticoagulation therapy and close monitoring. Portal vein thrombosis is a rare but life‐threatening complication during pregnancy and postpartum period. Color Doppler ultrasound is useful for prompt diagnosis. Although the risk of complications should be considered, successful pregnancy with com...
Source: Clinical Case Reports - February 6, 2018 Category: General Medicine Authors: Arata Hibi, Kazumasa Mogi Tags: Case Report Source Type: research

Coccidioides immitis soft tissue infection mimicking pseudofolliculitis barbae
Key Clinical Message Endemic fungal infections can present atypically and should be considered in the differential diagnosis of any soft tissue infection not responding appropriately to antibiotic therapy. Diagnosis can be confirmed with a biopsy. Most fungal soft tissue infections require extended duration of treatment. Endemic fungal infections can present atypically and should be considered in the differential diagnosis of any soft tissue infection not responding appropriately to antibiotic therapy. Diagnosis can be confirmed with a biopsy. Most fungal soft tissue infections require extended duration of treatment. (Sou...
Source: Clinical Case Reports - February 1, 2018 Category: General Medicine Authors: Wendy Gerstein, Valeria Ilieva Tags: Clinical Image Source Type: research

PostOperative ST ‐segment elevation: not a blocked coronary artery, then what?
Key Clinical Message ST‐segment elevation is well known for its diagnostic value for transmural myocardial infarction due to acute thrombotic occlusion of a coronary artery, and often requires emergency reperfusion therapy. However, ST segment is by no means pathognomonic for acute coronary events. Here, we report a case of ST‐segment elevation after hepatectomy secondary to an unusual etiology. ST‐segment elevation is well known for its diagnostic value for transmural myocardial infarction due to acute thrombotic occlusion of a coronary artery, and often requires emergency reperfusion therapy. However, ST segment i...
Source: Clinical Case Reports - February 1, 2018 Category: General Medicine Authors: Wai ‐Ching Sin, Joy Melody Kwong, Tiffany Cho‐Lam Wong, Charlotte Kwong, Carmen Chan, Chung‐Wah Siu Tags: Case Report Source Type: research

Bilateral bullous keratopathy secondary to melting keratitis in a Suri alpaca (Vicugna pacos)
Key Clinical Message An young alpaca was evaluated for bilateral progressive melting corneal ulcers and developped secondary bullous keratopathy during hospitalization. The tragic progression of melting ulcers in both eyes observed in our case leads us to recommend a rapid intensive medical therapy in young and debilitated alpacas presenting a corneal ulcer. The tragic progression of melting ulcers in both eyes observed in our case leads us to recommend a rapid intensive medical therapy in young and debilitated alpacas presenting a corneal ulcer. (Source: Clinical Case Reports)
Source: Clinical Case Reports - February 1, 2018 Category: General Medicine Authors: Alexandre Guyonnet, Aur élie Bourguet, Elise Donzel, Guillemette Bataille, Quentin Pascal, Eve Laloy, Henri‐Jean Boulouis, Yves Milleman, Sabine Chahory Tags: Case Report Source Type: research

Giant cell myocarditis causing refractory ventricular tachycardia in a pediatric patient
Key Clinical Message Giant cell myocarditis should be considered in all pediatric patients with refractory ventricular arrhythmia. Endomyocardial biopsy should be obtained to confirm the diagnosis of giant cell myocarditis. Giant cell myocarditis should be considered in all pediatric patients with refractory ventricular arrhythmia. Endomyocardial biopsy should be obtained to confirm the diagnosis of giant cell myocarditis. (Source: Clinical Case Reports)
Source: Clinical Case Reports - February 1, 2018 Category: General Medicine Authors: Apurva Panchal, Obehioye Okojie, Brittany Slagle, Ossama Tawfik Tags: Case Report Source Type: research

Angioimmunoblastic T ‐cell lymphoma: a rare subtype of peripheral T‐cell lymphoma
Key Clinical Message Angioimmunoblastic T‐cell lymphoma (AITL) is a rare form of NHL and usually presents in the late stage due to the atypical laboratory findings. Immunohistochemistry of the lymph node in AITL is characterized by positive CD2, CD3, CD4, CD10, CXCL‐13, PD1 often BCL‐6 and CD20 positive. Meshworks of follicular dendritic cells are seen outside follicles with CD21 and CD23 stains. EBV can be often positive as well. Autologous transplantation should be offered in the first remission as poor outcome is reported with anthracycline‐containing regimens. Angioimmunoblastic T‐cell lymphoma (AITL) is a r...
Source: Clinical Case Reports - February 1, 2018 Category: General Medicine Authors: Manoj Ponadka Rai, Prabhjot Singh Bedi, Edwin B Marinas, Nazia Naz S. Khan Tags: Clinical Image Source Type: research

Prenatally diagnosed distal 16p11.2 microdeletion with a novel association with congenital diaphragmatic hernia: a case report
Key Clinical Message A prenatal case presenting with congenital diaphragmatic hernia (CDH) and distal 16p11.2 microdeletion suggests two possible causative hypotheses: (1) a functional effect of chromatin loopings between the distal and the proximal 16p11.2 microdeletion traits, associated with CHD; (2) a possible role of ATP2A1, a deleted gene involved in diaphragm development. A prenatal case presenting with congenital diaphragmatic hernia (CDH) and distal 16p11.2 microdeletion suggests two possible causative hypotheses: (1) a functional effect of chromatin loopings between the distal and the proximal 16p11.2 microdelet...
Source: Clinical Case Reports - February 1, 2018 Category: General Medicine Authors: Rita Genesio, Giuseppe Maria Maruotti, Gabriele Saccone, Angela Mormile, Anna Conti, Rita Cicatiello, Viviana Sarnataro, Angelo Sirico, Antonella Izzo, Pasquale Martinelli, Lucio Nitsch Tags: Case Report Source Type: research

Patent Blue dye allergy and the deep inferior epigastric perforator free flap: a unique interaction
We report a unique case of successful free flap transfer in this setting. Despite inotropic support and abnormal blue hue, allergic response does not preclude safe flap transfer and monitoring. Patent Blue dye for sentinel lymph node biopsy is associated with systemic allergic response and generalized blue hue. We report a unique case of successful free flap transfer in this setting. Despite inotropic support and abnormal blue hue, allergic response does not preclude safe flap transfer and monitoring. (Source: Clinical Case Reports)
Source: Clinical Case Reports - February 1, 2018 Category: General Medicine Authors: Shanesh Kumar, Raminder Dhillon, Snehal Shah, Dean C. White, Warren Matthew Rozen Tags: Case Report Source Type: research

Is shock impedance value alone to be considered a good predictor for shock efficacy in subcutaneous implantable cardioverter defibrillator?
Key Clinical Message Subcutaneous implantable cardioverter defibrillator (S‐ICD) is easy to implant, with poor risks of the patient. However, fat is a poor current conductor and increases defibrillation threshold. As shock impedance alone should not be considered a good efficacy predictor of an S‐ICD system, an X‐ray latero‐lateral view for lead position should be achieved. Subcutaneous implantable cardioverter defibrillator (S‐ICD) is easy to implant, with poor risks of the patient. However, fat is a poor current conductor and increases defibrillation threshold. As shock impedance alone should not be considered...
Source: Clinical Case Reports - February 1, 2018 Category: General Medicine Authors: Enrico Di Girolamo, Nanda Furia, Massimiliano Faustino, Marianna Appignani, Giampiero Arcari, Alessandro Angelini, Loris Spadoni Tags: Case Report Source Type: research

A reminder of the place of morphology and the H ‐score in the diagnosis of hemophagocytic lymphohistiocytosis (HLH)
Key Clinical Message This case report reminds the reader of the place of hemophagocytosis and the H‐Score in the diagnosis of secondary hemophagocytic lymphohistiocytosis. This case report reminds the reader of the place of hemophagocytosis and the H‐Score in the diagnosis of secondary hemophagocytic lymphohistiocytosis. (Source: Clinical Case Reports)
Source: Clinical Case Reports - February 1, 2018 Category: General Medicine Authors: Favresse Julien, Lardinois Benjamin, Chatelain Bernard, Mullier Fran çois, Jacqmin Hugues Tags: Case Report Source Type: research

Indomethacin induced ductus arteriosus closure in midgestation fetus
This article reports a rare but potentially serious complication of ductus arteriosus closure resulting from second‐trimester indomethacin exposure. Serial echocardiograms are indicated to monitor for development of right heart dysfunction and to ensure delivery prior to the onset of right heart failure and hydrops fetalis. This article reports a rare but potentially serious complication of ductus arteriosus closure resulting from second‐trimester indomethacin exposure. Serial echocardiograms are indicated to monitor for development of right heart dysfunction and to ensure delivery prior to the onset of right heart fa...
Source: Clinical Case Reports - January 31, 2018 Category: General Medicine Authors: Jeanette I. Beaute, Kevin G. Friedman Tags: Case Report Source Type: research

Direct Factor X sequestration by systemic amyloid light ‐chain amyloidosis
We present a lymphoplasmacytic lymphoma patient with Factor X (FX) deficiency. Despite the absence of FX inhibitor, the administration of fresh frozen plasma and anti‐inhibitor coagulant complex did not increase the FX level. The autopsy showed that massive amyloid depositions to multiple organs and FX existed in union with amyloidosis. We present a lymphoplasmacytic lymphoma patient with Factor X (FX) deficiency. Despite the absence of FX inhibitor, the administration of fresh frozen plasma and anti‐inhibitor coagulant complex did not increase the FX level. The autopsy showed that massive amyloid depositions to multi...
Source: Clinical Case Reports - January 31, 2018 Category: General Medicine Authors: Haruko Tashiro, Ryosuke Shirasaki, Masato Watanabe, Kazuo Kawasugi, Yoshihisa Takahashi, Naoki Shirafuji Tags: Case Report Source Type: research

Severe pancytopenia and splenomegaly associated with felty's syndrome, both fully responsive solely to corticosteroids
Key Clinical Message In severe cases of pancytopenia with subsequent infections due to long‐term untreated Felty's syndrome, the initiation of immunosuppressive treatment with sole prednisone (1 mg/kg iv) should be considered, despite that, the low neutrocytes count would make one physician hesitant. A full resolution of whole blood count within 3 weeks and a 30% reduction in spleens sized was noted. In severe cases of pancytopenia with subsequent infections due to long‐term untreated Felty's syndrome, the initiation of immunosuppressive treatment with sole prednisone (1 mg/kg iv) should be considered, ...
Source: Clinical Case Reports - January 31, 2018 Category: General Medicine Authors: George D. Liatsos, Ioanna Tsironi, Dimitrios Vassilopoulos, Spyridon Dourakis Tags: Case Report Source Type: research

Spoon nails: still seen in today's world
Key Clinical Message Koilonychia is a nail abnormality characterized by thin, brittle, and spoon‐shaped nails. It is frequently observed in chronic iron deficiency secondary to malnutrition, chronic blood loss, or malabsorption. It may also be idiopathic or related to occupation and rare systemic disorders. Presence of koilonychia should prompt investigations for iron deficiency. Koilonychia is a nail abnormality characterized by thin, brittle, and spoon‐shaped nails. It is frequently observed in chronic iron deficiency secondary to malnutrition, chronic blood loss, or malabsorption. It may also be idiopathic or relat...
Source: Clinical Case Reports - January 31, 2018 Category: General Medicine Authors: Bushra Moiz Tags: Clinical Image Source Type: research

Fracture of a femoral hemodialysis catheter during placement in a man with metastatic cancer
Key Clinical Message Central venous catheterization can be challenging in patients that had undergone repeated catheter placements. Ultrasound scan may overlook venous stenosis which is better visualized using venography. The use of venography should be considered to assess for venous stenosis or vascular anomalies in individuals with multiple catheterizations or in close proximity to cancer. Central venous catheterization can be challenging in patients that had undergone repeated catheter placements. Ultrasound scan may overlook venous stenosis which is better visualized using venography. The use of venography should be ...
Source: Clinical Case Reports - January 26, 2018 Category: General Medicine Authors: Xiang ‐Yang Li, Hai‐Yan He, Pearl Pai Tags: Clinical Image Source Type: research

Iatrogenic seeding of osteosarcoma in a tracheotomy tract – a case report
Key Clinical Message Here, we describe the first reported case of osteosarcoma occurring postsurgically in a tracheotomy tract, highlighting the possibility of osteosarcoma seeding during head and neck surgery. Preventative measures such as performing the tracheostomy after the tumor resection while walling off the tracheostomy site from the operative field should be considered. Here, we describe the first reported case of osteosarcoma occurring postsurgically in a tracheotomy tract, highlighting the possibility of osteosarcoma seeding during head and neck surgery. Preventative measures such as performing the tracheostomy...
Source: Clinical Case Reports - January 26, 2018 Category: General Medicine Authors: Irit Duek, Richard Lopchinsky, Sharon Akrish, Ziv Gil Tags: Case Report Source Type: research

Febrile neutropenia with bacterial paronychia
Key Clinical Message The symptoms of infection can be minimal or absent in patients with febrile neutropenia at first. The focal site of infection, which may be the main cause of a fever or be a complication of neutropenia, can develop as neutrophils increase during the clinical course of febrile neutropenia. The symptoms of infection can be minimal or absent in patients with febrile neutropenia at first. The focal site of infection, which may be the main cause of a fever or be a complication of neutropenia, can develop as neutrophils increase during the clinical course of febrile neutropenia. (Source: Clinical Case Reports)
Source: Clinical Case Reports - January 26, 2018 Category: General Medicine Authors: Yuki Hosono, Takeshi Uenami, Yukihiro Yano, Masahide Mori Tags: Clinical Image Source Type: research

Fatal cardiac arrhythmia caused by tumor lysis in a patient with diffuse large B ‐cell lymphoma upon start of R‐CHOP
Key Clinical Message Tumor lysis syndrome is rare in diffuse large cell lymphoma, but it is important to recognize the risk in patients with massive tumor burden and reduced kidney function. Very intense vigilance can be necessary despite adequate prophylactic measures and certain drugs may exacerbate electrolyte derangements. Tumor lysis syndrome is rare in diffuse large cell lymphoma, but it is important to recognize the risk in patients with massive tumor burden and reduced kidney function. Very intense vigilance can be necessary despite adequate prophylactic measures and certain drugs may exacerbate electrolyte derang...
Source: Clinical Case Reports - January 26, 2018 Category: General Medicine Authors: Nina S ørensen, Paw Jensen, Erik Clasen‐Linde, Jacob Moesgaard Larsen, Tarec El‐Galaly Tags: Case Report Source Type: research

The histopathology and phenotypic variability in H syndrome
Key Clinical Message Skin biopsy may be helpful in the diagnosis of H syndrome. A triad of dermal fibrosis, lymphocytic aggregates, and numerous CD68+, CD163+, S100‐positive, and CD1a‐negative dermal histiocytes is characteristic. Skin biopsy may be helpful in the diagnosis of H syndrome. A triad of dermal fibrosis, lymphocytic aggregates, and numerous CD68+, CD163+, S100‐positive, and CD1a‐negative dermal histiocytes is characteristic. (Source: Clinical Case Reports)
Source: Clinical Case Reports - January 25, 2018 Category: General Medicine Authors: David Dias ‐Polak, Margarita Indelman, Reuven Bergman, Emily Avitan‐Hersh Tags: Case Report Source Type: research

Diffusion ‐weighted imaging characteristics of methotrexate‐induced acute encephalopathy
We report that the diffusion‐weighted (DW) imaging is useful for early detection of acute leukoencephalopathy. Methotrexate (MTX)‐induced encephalopathy is a grave complication in patients with malignancies. The early diagnosis of acute encephalopathy was difficult by conventional computed tomography (CT), and T1‐ or T2‐weighted magnet resonance (MR) imaging. We report that the diffusion‐weighted (DW) imaging is useful for early detection of acute leukoencephalopathy. (Source: Clinical Case Reports)
Source: Clinical Case Reports - January 22, 2018 Category: General Medicine Authors: Mayumi Yoshimi, Shoko Abe Tags: Case Report Source Type: research

Congenital central hypoventilation syndrome mimicking mitochondrial disease
Key Clinical Message Later‐onset congenital central hypoventilation syndrome (LO‐CCHS) does not present only breathing problems but can be present as episodic multiple organs involvement. Our unique case demonstrated LO‐CCHS should be considered in the differential diagnosis of mitochondrial diseases and having nontypical polysomnography result. Later‐onset congenital central hypoventilation syndrome (LO‐CCHS) does not present only breathing problems but can be present as episodic multiple organs involvement. Our unique case demonstrated LO‐CCHS should be considered in the differential diagnosis of mitochondri...
Source: Clinical Case Reports - January 19, 2018 Category: General Medicine Authors: Kitiwan Rojnueangnit, Maria Descartes Tags: Case Report Source Type: research

Clinical Case Reports is celebrating!
(Source: Clinical Case Reports)
Source: Clinical Case Reports - January 17, 2018 Category: General Medicine Authors: Charles Young Tags: Editorial Source Type: research

Issue Information
(Source: Clinical Case Reports)
Source: Clinical Case Reports - January 17, 2018 Category: General Medicine Tags: Issue Information Source Type: research

Clinical presentation and imaging of a rare case of Tarsal Tuberculosis
Key Clinical Message A 43‐year‐old woman arrived to emergency unit of our hospital, referring intense deteriorated pain and swelling of midfoot. Rapid clinical evolvement of osteoarticular tuberculosis represents a potential clinical scenario. Clinicians should always include foot tuberculosis in differential diagnosis, in cases of severe clinical and radiological manifestations. A 43‐year‐old woman arrived to emergency unit of our hospital, referring intense deteriorated pain and swelling of midfoot. Rapid clinical evolvement of osteoarticular tuberculosis represents a potential clinical scenario. Clinicians shou...
Source: Clinical Case Reports - January 17, 2018 Category: General Medicine Authors: Stylianos Kapetanakis, Danai Chourmouzi, Elissavet Papadopoulou, Dimitrios Oikonomou, Nikolaos Gkantsinikoudis Tags: Clinical Image Source Type: research