INTRODUCTIONS AND CONCLUSIONS IN MOST CITES ABSTRACTS OF ARTICLES IN MEDICAL CASE

RERPORTS JOURNAL

INTRODUCTIONS

Metformin-induced lactic acidosis with acute kidney injury is rare but well known. Here we report a
case of a Japanese patient taking metformin who experienced severe acute renal failure
accompanied with significantly elevated metformin plasma concentrations and signs of lactic
acidosis.

Intrahepatic vascular shunts “IHVS” are abnormal communications between intra-hepatic vasculature
involving the arterial, portal, or hepatic venous system. Arterio-portal fistula “APF” is an intrahepatic
communication between the hepatic arterial system and the portal venous system without any
communication with the systemic venous circulation. APF is considered a rare cause of portal
hypertension and gastrointestinal bleeding in infancy.

Intussusception is a rare condition in adults, accounting for 5% of intestinal intussusception and

being responsible for approximately 1% of all adult bowel obstructions. Neoplastic origin is the most
common etiology of intestinal intussusception in adults, unlike pediatric intussusception, which is
usually idiopathic. Intussusception due to the appendiceal mucocele is exceptional, and only a few
cases have been reported in the medical literature.

Salmonella meningitis is a rare but serious complication of Salmonella infection, primarily affecting
infants, children, and immunocompromised individuals.

Patients who experience angina and acute myocardial infarction often receive diagnostic coronary
angiography and percutaneous coronary intervention.

Rathke’s cleft cysts are thought to have a benign clinical outcome apart from associated
hypopituitarism and visual defects. Synchronous central nervous system lesions, including pituitary
adenoma and intracerebral aneurysms, are rarely reported. Diagnosis of Rathke’s cleft cyst after
presenting with a subarachnoid hemorrhage due to a ruptured arterial aneurysm is reported only
once before.

Immune checkpoint inhibitors might cause immune-related adverse events that are still largely
unknown.

Small airways disease (SAD), a novel finding described in post-acute COVID-19 patients, should be
suspected when respiratory symptoms continue, air trapping persists on expiratory CT scans, and
imaging findings fail to improve despite objectively better conventional pulmonary function test (PFT)
parameters. The forced oscillation technique (FOT) and Multiple breathing washout (MBW) are both
very sensitive methods for detecting anomalies in the peripheral airways.

Obstructive jaundice has various causes, and one of the rarest is pancreaticoduodenal artery
aneurysm (PDAA), which is often associated with celiac axis stenosis caused by median arcuate
ligament syndrome (MALS).

Isolated Patellar Aplasia Hypoplasia is a very rare autosomal dominant disorder. Its treatment
depends on the clinical manifestations that can vary widely. The lack of active extension, which can
be responsible for frequent falls due to a knee instability, is the most frequent and disabling
manifestation. We report an original technique that is a modification of the Galeazzi technique for
recurrent dislocation of the patella to gain active extension in case of PTLAH.

Myasthenia gravis is an autoimmune condition affecting the neuromuscular junction and causing
muscle weakness along with fatigue (myasthenia). When the clinical manifestations of myasthenia
gravis are isolated to the eye muscles, only causing weak eye movements, it is referred to as ocular
myasthenia gravis, which can mimic a 1 and ½ syndrome.

Vaccine-induced thrombotic thrombocytopenia is associated with the coronavirus disease 2019

vaccines. It has been reported by vector-based vaccines. To the best of our knowledge, there is no
report about vaccine-induced thrombotic thrombocytopenia in whole-virus vaccines. We are
presenting the first case of vaccine-induced thrombotic thrombocytopenia with this type of vaccine.

Acute presentations of acquired exotropia or divergent alignment of either or both eyes are
commonly observed following intracranial vascular events, trauma, orbital, and endoscopic sinus
surgeries.

Clostridium botulinum is an anaerobic, Gram-positive, rod-shaped bacterium that forms spores and
the neurotoxin botulinum. It is best known for its toxin-induced flaccid paralytic disease, which is
deadly without correct treatment. In this report, we show a completely different clinical course with
fatal outcome.

We report a case of prenatal coronavirus disease 2019, which evolved 6 days after birth into severe
pneumonia with signs of multiple organ failure, in a mother with asymptomatic coronavirus disease
2019.

Hypercalcemia of malignancy, as a paraneoplastic syndrome, is the most common metabolic disorder

that accounts for 30% of malignancies and usually has a poor prognosis. Neuroendocrine tumors are
uncommon and arise from neuroendocrine cells throughout the body. Actually, paraneoplastic
hypercalcemia in neuroendocrine tumors is unusual and mostly associated with parathyroid
hormone-related protein (PTHrP) secretion.

Granulomatosis with polyangiitis (GPA) is a rare small vessel vasculitis predominantly affecting upper
and lower respiratory tract and kidneys. Unilateral diaphragmatic palsy could be a rare manifestation
of GPA. Here we report a case of GPA in a 45-year-old male with unilateral diaphragmatic palsy with
pleuropericarditis.

Acute myeloid leukemia is a rare event in post-liver-transplantation recipients. In the present report,
we described a case of extramedullary acute myeloid leukemia, M4/M5 subtype, following
orthotopic liver transplant.

Bariatric surgery candidates commonly suffer from conditions that constitute the metabolic
syndrome. But they also have a higher risk for autoimmune and malignant diseases. Obesity-
associated comorbidities aside from the metabolic syndrome are often given insufficient attention in
the clinical routine, including preoperative work-ups for bariatric surgery.

Immune checkpoint inhibitors have revolutionized therapy of advanced and metastatic cancers.
However, a significant proportion of patients do not respond to immune checkpoint inhibitors or
develop resistance. Therefore, novel therapies or combinations of therapies that may act
synergistically are needed. It has been suggested that induction of trained immunity may increase
the response to immune checkpoint inhibitor therapy, through reprogramming myeloid cells toward
an antitumor phenotype. On the other hand, activation of the immune system also carries the risk of
potentially sustaining tumorgenicity and increasing immune- related toxicity.

CONCLUSIONS

This is the first reported case of acute kidney injury possibly caused by high levels of metformin with
lactic acidosis in a patient treated with the recommended metformin dose. Thus, the development of
metformin-induced acute kidney injury should be considered for patients with several acute kidney
injury risk factors who are taking metformin.

Any child with recurrent gastrointestinal bleeding, failure to thrive, vomiting, diarrhea, steatorrhea,
splenomegaly, or ascites should be investigated for intrahepatic arterio-portal fistula “IAPF”. Our
novel technique of direct trans hepatic ultrasound guided coiling is an alternative method if trans
arterial embolization “TAE” failed.

The symptoms of bowel intussusception with the appendiceal mucocele as the lead point in adults
are similar to any other bowel intussusception. Differential diagnosis is often carried out thanks to
the injected abdominal computed tomography scan.
Management of Salmonella meningitis is often challenging primarily because of the fact that the
empiric therapy for meningitis may not always provide coverage to the multi-drug resistant
Salmonella species found in South Asia. Prompt administration of appropriate antibiotics based on
sensitivity testing is crucial for successful management. This case emphasizes the importance of early
recognition and effective management of this uncommon yet severe complication of Salmonella
infection.

The occurrence of neuro-ophthalmic complications that may arise from percutaneous coronary
intervention is extremely rare. To our knowledge, this is the second reported case of unilateral rectus
palsy associated with percutaneous coronary intervention.

Rare co-occurrence of a Rathke’s cleft cyst and an anterior communicating artery aneurysm would
have been missed if subtle manifestations atypical for subarachnoid hemorrhage were not further
pursued. This could have led to progressive visual deterioration and hypopituitarism.

The study presents the first reported case of type 1 diabetes in a patient with head and neck
squamous cell carcinoma treated with pembrolizumab monotherapy, in Japan. Efficient
interdepartmental collaboration will promote the management of severe immune-related adverse
events and improve the quality of life of patients.

The necessity of integrating these tests when detecting SAD is emphasized in our paper. This article
lays the foundation for future research into the best ways to manage and monitor SAD in post-acute
COVID-19 patients.

In unexpected obstructive jaundice due to a mass with vascular origin in the head of the pancreas,
PDAA should be considered, and celiac trunk should be evaluated because the main reason for PDAA
is celiac trunk stenosis or occlusion by atherosclerosis or MALS. The treatment method chosen
(including transarterial embolization, open surgery, or combined method) depends on the patient's
clinical status and radiological findings, but transarterial embolization would be safer and should be
used as a first-line method.

Reconstruction of isolated hypoplasia of the patella by a modified Galeazzi procedure is a safe and
reliable technique for skeletally immature patients offering satisfying long-term outcomes.

Our patient who presented with “blurred vision” was discovered to have binocular diplopia due to
significant dysconjugate eye movements. After diligently ruling out central etiologies, we concluded
that her presentation was due to a peripheral etiology. Her serologies and her presentation helped
confirm a diagnosis of ocular myasthenia gravis. Also, as in most cases, our patient also progressed to
develop generalized myasthenia gravis while on pyridostigmine. Efgartigimod infusions instituted
after our patient recovered from a myasthenic crisis have helped her restore a normal life.

This case highlights the possibility of vaccine-induced thrombotic thrombocytopenia occurrence by

whole-virus coronavirus disease 2019 vaccines. Compared with vector-based vaccines, this
phenomenon is rare for whole-virus vaccines. More studies on this type of vaccine regarding
thrombotic thrombocytopenia should be considered.

The reported case is about an uncommon clinical finding of exotropia seen in a common toxicological
emergency: acute amitriptyline overdose. The importance of having a wide knowledge of various
clinical presentations of drug toxicities is highlighted here, as any delay in diagnosis or initiation of
life-saving measures could have resulted in fatal consequences.

This is a rare case of fatal septic shock due to Clostridium botulinum-induced septic arthritis without
any sign of the classic clinical syndrome of botulism.

This case report demonstrates the incompatibility between maternal asymptomatic coronavirus
disease 2019 and severe neonatal lung involvement. We emphasize the need for vigilance to avoid
missing the most severe forms of neonatal coronavirus disease 2019.

Pancreatic neuroendocrine tumor could lead to malignant hypercalcemia; secretion of PTHrP is the
most common cause, and signs and symptoms are usually milder than paraneoplastic syndrome due
to hematologic and solid tumor. Generally, survival is better; however, its treatment is challenging,
and primary debulking surgery is often required. A team approach to management is important at all
points.

GPA should be suspected in all patients with diaphragmatic palsy and pleuropericarditis with
appropriate clinical and laboratory picture.

Acute myeloid leukemia is a rare phenomenon after liver transplantation, and it can follow a rapidly
fatal clinical course.

Preoperative endoscopy and imaging techniques can be valuable since surprising pre- and
intraoperative findings can force the bariatric surgeon to change the initially planned operative
strategy. But the diagnostic accuracy of abdominal ultrasound may be limited in bariatric surgery
patients. With the expansion of bariatric surgery, the complexity of bariatric surgery patients is also
likely to increase. However, with the appropriate awareness and strategies, bariatric surgery can be
safely executed and even contribute to the treatment of severe comorbidities that exceed the
metabolic spectrum.
In this study, we show the feasibility to combine checkpoint inhibitor therapy with inducers of
trained immunity in a patient with an aggressive neuroendocrine tumor. Autoimmune side effects
are common under programmed cell death protein 1 inhibitor therapy, which was considered the
most likely cause of colitis, although an additive effect of Bacillus Calmette–Guérin vaccination or
radiotherapy cannot be excluded. The patient displayed only mild progression during the
combination therapy, but larger studies are warranted to fully explore the potential benefit of
trained immunity inducers as an adjuvant to immune checkpoint inhibitor therapy.