Clinical Medicine Insights. Case Reports最新文献

{"title":"Spontaneous Splenic Laceration in Plasmodium falciparum Malaria: A Case Report.","authors":"Absira Begosew Abate, Maedot Berhanu Abera, Bisrat Berhanu Abera, Yana Takele Gemeda","doi":"10.1177/11795476261470653","DOIUrl":"10.1177/11795476261470653","url":null,"abstract":"<p><strong>Introduction: </strong>Splenic complications of <i>Plasmodium falciparum</i> malaria are rare but potentially life-threatening. While splenic rupture is more commonly reported, high-grade splenic injury with associated vascular compromise and infarction is less well-described and may present diagnostic and management challenges.</p><p><strong>Case presentation: </strong>A 32-year-old male presented with a three-day history of high-grade fever, chills, and progressive abdominal symptoms, including acute left upper quadrant pain radiating to the back. On examination, he was febrile with signs of peritonism, including involuntary guarding and rigidity. Laboratory investigations confirmed <i>P. falciparum</i> infection with severe anemia (Hgb 5.1 g/dL). A diagnostic abdominal tap yielded hemorrhagic fluid. Contrast-enhanced computed tomography (CT) demonstrated a high-grade splenic injury (AAST Grade IV) characterized by multifocal splenic infarctions, perisplenic hematoma, and involvement of the splenic hilum. Notably, no active contrast extravasation was identified. Despite this, the patient developed clinical deterioration with worsening hypotension, necessitating emergency splenectomy. Intraoperative findings confirmed a major splenic laceration with 2000 mL of hemolyzed blood in the peritoneum. The patient received intraoperative and postoperative transfusions. The postoperative course was uneventful, and the patient was discharged following appropriate vaccinations and antimalarial therapy.</p><p><strong>Conclusion: </strong>High-grade splenic injury with infarction should be considered in malaria patients presenting with acute abdominal symptoms. Early recognition and prompt surgical intervention are critical, particularly in patients with clinical deterioration despite non-diagnostic imaging findings for active bleeding.</p>","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261470653"},"PeriodicalIF":0.6,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13379647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Right-Sided Mixed Intrinsic and Extrinsic Ureteral Endometriosis Leading to a Nonfunctioning Kidney: A Case Report.","authors":"Sabine El Breidi, Joey El Khoury, Anthony Mina, Rami Halabi, Joseph Abi Chedid, Valerie Aftimos, Serge Assaf, Raghid El Khoury","doi":"10.1177/11795476261470636","DOIUrl":"10.1177/11795476261470636","url":null,"abstract":"<p><p>Ureteral endometriosis is a rare form of urinary tract endometriosis that may cause silent ureteral obstruction and irreversible renal damage. Mixed intrinsic and extrinsic ureteral involvement is uncommon, and right-sided disease is less frequently reported. We report the case of a 39-year-old woman with known endometriosis who presented with recurrent severe right flank pain. Imaging revealed right uretero-hydronephrosis associated with a right adnexal endometrioma and distal ureteral involvement. Diagnostic ureteroscopy could not be safely performed because of marked narrowing of the right ureteral meatus, and a double-J stent was initially placed. Renal scintigraphy subsequently demonstrated a nonfunctioning right kidney with preserved contralateral function. Definitive surgery was performed after recurrent symptoms and imaging progression documented persistent distal ureteral disease. The patient underwent laparoscopic right nephroureterectomy with open partial cystectomy and right salpingo-oophorectomy. Histopathological examination confirmed multifocal mixed intrinsic and extrinsic ureteral endometriosis associated with end-stage chronic nephritis and a right ovarian endometrioma. This case highlights the diagnostic difficulty of ureteral endometriosis, particularly when right-sided and mixed intrinsic-extrinsic disease is present, and emphasizes the importance of early functional assessment and multidisciplinary management to prevent irreversible renal loss.</p>","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261470636"},"PeriodicalIF":0.6,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13379677/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful Management of Refractory Cannabinoid Hyperemesis Syndrome With Topical Capsaicin: A Case Report With Proposed Mechanism of Action and Literature Review.","authors":"Muhammad Ilyas, Anushka Fernando, Abubakir Choriyev, Mohammad Adi, Ahmed Ashraf","doi":"10.1177/11795476261470568","DOIUrl":"10.1177/11795476261470568","url":null,"abstract":"<p><strong>Introduction: </strong>Cannabinoid hyperemesis syndrome (CHS) is a debilitating disorder of chronic, heavy cannabis users characterized by cyclic severe nausea, vomiting, and abdominal pain that is classically relieved by hot baths. Standard antiemetics often fail, and dysregulation of endocannabinoid signaling with involvement of heat-sensitive TRPV1 channels has been proposed. Topical capsaicin - a TRPV1 agonist - has been reported in small series and case reports to reproduce the hot-water effect and rapidly relieve symptoms.</p><p><strong>Case presentation: </strong>A 28-year-old man with daily high-potency cannabis use (∼2 g/day for 7 years) presented to the emergency department with 48 hours of intractable non-bilious vomiting (∼20 episodes/day), severe periumbilical cramping (8/10), and a history of similar episodic flares relieved by prolonged hot showers. Initial ED therapy (IV fluids, ondansetron, metoclopramide, pantoprazole) produced minimal benefit; labs showed hypokalemic, hypochloremic metabolic alkalosis and pre-renal azotemia, with otherwise unremarkable imaging and enzymes. After informed consent, ∼2 g of 0.1% topical capsaicin cream was applied across the abdomen. The patient experienced an acute burning sensation for ∼15-30 minutes; retching ceased within 10 minutes, pain fell to 2/10 by 30 minutes and resolved by 90 minutes, and he tolerated oral intake. Vital signs normalized and electrolytes/renal function returned to baseline at 48-hour follow-up. He was discharged with counseling on cannabis cessation and a capsaicin tube for prodromal use.</p><p><strong>Conclusion: </strong>Topical capsaicin produced rapid, durable symptom resolution in this case of refractory CHS with only transient local discomfort. The effect is plausibly mediated by TRPV1 activation followed by peripheral desensitization, recapitulating the therapeutic hot-water response. Given consistent positive signals from case reports, series, and small pilot data, topical capsaicin is a low-risk, accessible adjunct for refractory CHS, but larger controlled studies are needed to define optimal dosing, duration, and long-term outcomes.</p>","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261470568"},"PeriodicalIF":0.6,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13376499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148577303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recurrent Syncope and Sudden Cardiac Death due to Anomalous Origin of the Right Coronary Artery From the Pulmonary Artery (ARCAPA): A Case Report.","authors":"Osman Farah Dahir, Said Abdirahman Ahmed, Abdullahi Mohamed Hassan Fujeyra, Aden Ali Ahmed, Abdishakur Mohamed Abdirahman, Ahmed Shafie Aden, Feyza Aksu, Ahmed Elmi Abdi, Mohamud Mire Waberi, Ishak Ahmed Abdi","doi":"10.1177/11795476261470567","DOIUrl":"10.1177/11795476261470567","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Congenital coronary artery anomalies are uncommon but clinically significant conditions associated with myocardial ischemia, malignant ventricular arrhythmias, and sudden cardiac death, particularly in young individuals. Among these anomalies, anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is exceptionally rare, with a reported prevalence of approximately 0.002%. Although ARCAPA may remain clinically silent for many years due to collateral circulation from the left coronary system, it carries a persistent risk of myocardial ischemia caused by a coronary steal phenomenon and may result in sudden cardiac death.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Case presentation: &lt;/strong&gt;We report the case of a 19-year-old Somali male with no prior medical history who presented with a several-month history of recurrent syncope occurring both at rest and during exertion, without preceding chest pain, palpitations, dyspnea, seizure-like activity, or prodromal symptoms. He presented following a prolonged syncopal episode and was found to be hemodynamically unstable, with a blood pressure of 86/54 mmHg and sinus tachycardia. Initial laboratory investigations, including complete blood count, renal function, serum electrolytes, coagulation profile, and cardiac biomarkers, were within normal limits. Electrocardiography demonstrated diffuse ST-segment depression in the inferolateral leads with reciprocal ST-segment elevation in lead aVR, raising concern for global subendocardial ischemia. Transthoracic echocardiography revealed preserved left ventricular systolic function, with an ejection fraction of 65%, a mildly dilated main pulmonary artery, and mild pulmonary regurgitation. Due to the unavailability of coronary computed tomography angiography, urgent invasive coronary angiography was performed approximately 4 hours after presentation. Angiography revealed anomalous origin of the right coronary artery from the pulmonary artery with retrograde flow into the pulmonary trunk, consistent with a significant coronary steal phenomenon. No obstructive coronary artery disease was identified. Approximately 30 minutes after angiography, the patient developed sudden hemodynamic collapse and progressed to cardiac arrest. Despite prolonged advanced cardiopulmonary resuscitation, return of spontaneous circulation was not achieved. The presumed cause of death was malignant ventricular arrhythmia secondary to myocardial ischemia related to ARCAPA; however, the exact mechanism could not be definitively established.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;This case highlights the potential for rapid fatal deterioration in ARCAPA despite preserved ventricular systolic function. Recurrent syncope and ischemic electrocardiographic abnormalities should be recognized as high-risk features. The electrocardiographic pattern observed may reflect diffuse myocardial ischemia due to coronary steal rather than atherosclerotic coronary artery disease.&lt;/p&gt;&lt;p","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261470567"},"PeriodicalIF":0.6,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13373379/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148469318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hepatic Alveolar Echinococcosis Mimicking Perihilar Cholangiocarcinoma: A Case Report.","authors":"Karam Karam, Kim Charro, Aurélien Morini, Caroline Gatey, Chetana Lim, Emilien Brousset, Christophe Locher","doi":"10.1177/11795476261470690","DOIUrl":"10.1177/11795476261470690","url":null,"abstract":"<p><strong>Background: </strong>Hepatic alveolar echinococcosis (HAE), although rare, is a potentially life-threatening parasitic disease when left untreated. Following infection, the disease typically progresses through a prolonged asymptomatic latent phase, resulting in delayed clinical presentation in most patients. The radiological appearance of HAE may closely resemble that of primary hepatic malignancies, thereby creating significant diagnostic challenges.</p><p><strong>Case presentation: </strong>We report the case of a 49-year-old previously healthy man who presented with cholestatic liver enzyme abnormalities and imaging findings suggestive of biliary obstruction. Cross-sectional imaging revealed a calcified hilar hepatic mass with biliary dilatation and multiple heterogeneous liver lesions, strongly suggestive of perihilar cholangiocarcinoma. Endoscopic retrograde cholangiopancreatography (ERCP) with brush cytology was initially negative for malignancy. Subsequent magnetic resonance imaging (MRI) demonstrated an infiltrative multiloculated solid-cystic hepatic lesion involving the right hepatic lobe and hilar structures. Definitive diagnosis was ultimately established through liver biopsy and positive serology for alveolar echinococcosis. The patient was treated with albendazole followed by extended right hepatectomy, with favorable postoperative recovery.</p><p><strong>Conclusion: </strong>HAE may closely mimic perihilar cholangiocarcinoma, exhibiting similar clinical and radiological characteristics. Maintaining a high index of suspicion and obtaining adequate tissue biopsies are essential for establishing an accurate diagnosis and ensuring timely, appropriate management.</p>","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261470690"},"PeriodicalIF":0.6,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13373432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148469298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clozapine-Associated Generalized Seizure at Therapeutic Dose Without Prior Epilepsy: A Case Report.","authors":"Kebron W Aweke, Yonathan Belay Kebede, Elias Getahun Bayu, Fraol Dereje Bekele, Zaki Abate Zimme, Ermias Fikru Mamo, Mikiyas G Teferi","doi":"10.1177/11795476261467702","DOIUrl":"10.1177/11795476261467702","url":null,"abstract":"<p><strong>Introduction: </strong>Clozapine is the most effective antipsychotic for treatment-resistant schizophrenia but is associated with a dose-dependent reduction in seizure threshold. While seizures are typically linked to high doses or rapid titration, events at therapeutic doses remain clinically significant and poorly characterized, particularly in resource-limited settings.</p><p><strong>Case presentation: </strong>We report a 35-year-old Ethiopian man with treatment-resistant schizophrenia stabilized on clozapine 300 mg/day for 8 months who presented with a first generalized tonic-clonic seizure. There was no prior seizure history. Laboratory evaluation and neuroimaging were unremarkable. Electroencephalography (EEG) demonstrated generalized spike-wave discharges with photoparoxysmal response, suggesting underlying epileptiform susceptibility. Clozapine serum levels were unavailable. After exclusion of alternative causes, the event was considered likely clozapine-associated. Clozapine dose was reduced to 200 mg/day and sodium valproate initiated. The patient remained seizure-free at 6-month follow-up with preserved psychiatric stability.</p><p><strong>Conclusion: </strong>Clozapine may precipitate seizures at therapeutic doses in patients with latent epileptiform susceptibility. When therapeutic drug monitoring is unavailable, careful clinical assessment, EEG evaluation, and exclusion of alternative causes are essential. Dose reduction with anticonvulsant therapy may permit safe continuation of clozapine.</p>","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261467702"},"PeriodicalIF":0.6,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13346814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148419202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidental Multisystem Anomalies in an Adolescent Female: A Case Report of a Diagnostic Dilemma.","authors":"Deekshitha Alla, Pranathi Chanti, Moksh Sanjay Khetan, Srinidhi Appala, Rohit Rao Dugyala, Sagnik Roy, Keerthana Chittepu, Pritha Mohanta, Ram Prasanjith Reddy Bollampalli, Ruth Getaneh Bayeh","doi":"10.1177/11795476261467685","DOIUrl":"10.1177/11795476261467685","url":null,"abstract":"<p><strong>Background: </strong>Congenital anomalies of the urogenital system frequently coexist with renal abnormalities due to their shared origin from the intermediate mesoderm. Skeletal anomalies may also be associated, reflecting overlapping embryological development of mesodermal derivatives. Such multisystem involvement can pose a diagnostic challenge, particularly when identified incidentally.</p><p><strong>Case presentation: </strong>We report a 15-year-old female who presented with abdominal swelling and pain, later diagnosed as an umbilical hernia. During radiological evaluation, incidental findings of right renal agenesis, scoliosis, and a bicornuate uterus were identified. The patient underwent successful surgical management of the umbilical hernia. This case highlights the importance of recognizing coexisting anomalies and adopting an integrated approach in evaluation and management.</p><p><strong>Conclusion: </strong>This case highlights the need for a systematic, bidirectional evaluation when a congenital anomaly is identified, particularly involving the renal, genital, and skeletal systems. A syndromic perspective is essential to avoid missed diagnoses, facilitate appropriate follow-up, and anticipate long-term implications in such patients.</p>","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261467685"},"PeriodicalIF":0.6,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13346742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148419200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gastric Adenocarcinoma Missed at the Incisura Angularis During Initial Endoscopy: A Case Report.","authors":"Philippe Attieh, Bassem Derbas, Wael El Mustapha, Karam Karam, Elias Fiani","doi":"10.1177/11795476261466408","DOIUrl":"10.1177/11795476261466408","url":null,"abstract":"<p><strong>Background: </strong>Gastric adenocarcinoma remains a major cause of cancer-related morbidity and mortality worldwide. Early detection is crucial for improving prognosis; however, early lesions may be overlooked during esophagogastroduodenoscopy (EGD), particularly in anatomically challenging areas such as the incisura angularis. This region is considered a high-risk site for gastric neoplasia and may act as a blind spot during routine endoscopic evaluation.</p><p><strong>Case summary: </strong>A 38-year-old female with a history of chronic gastroesophageal reflux disease presented with worsening reflux symptoms, postprandial epigastric pain, and recurrent vomiting. Nine months prior, the patient had undergone an EGD for similar symptoms, which showed no significant abnormalities. Despite treatment with proton pump inhibitors, her symptoms progressively worsened and were accompanied by early satiety and an 8-kg unintentional weight loss. A repeat EGD was performed and revealed suspicious ulcerative lesions at the level of the incisura angularis. Multiple biopsies were obtained, and histopathological examination confirmed gastric adenocarcinoma. The patient was subsequently referred for multidisciplinary management and oncological evaluation.</p><p><strong>Conclusion: </strong>This case highlights the potential for gastric adenocarcinoma to be missed during initial endoscopic examination, particularly at the incisura angularis. Careful mucosal inspection and appropriate retroflexion during EGD are essential for improving lesion detection in this high-risk anatomical region.</p>","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261466408"},"PeriodicalIF":0.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13323661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148374670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atypical Palmoplantar Scabies in an Adolescent: A Case Report.","authors":"Zahraa Jafat Al-Shibani, Maram Mahmood Hasan, Usama Abdul-Jaleel Althuwayni, Mohammad Adi","doi":"10.1177/11795476261463716","DOIUrl":"10.1177/11795476261463716","url":null,"abstract":"<p><strong>Background: </strong>Scabies is a common ectoparasitic infestation with characteristic age-related clinical patterns. Palmoplantar involvement is typically associated with infantile scabies and is rarely observed in adolescents, leading to diagnostic delay and mismanagement.</p><p><strong>Case presentation: </strong>A 13-year-old male presented with a two-week history of intensely pruritic papular eruptions involving the trunk and acral areas, including the palms and soles. Pruritus was worse at night. Previous treatment with topical corticosteroids showed no improvement. Dermatological examination revealed diffuse erythematous papules on the trunk and symmetrical papulovesicular lesions with crusting on the palmoplantar surfaces. Based on clinical features and treatment failure, a diagnosis of scabies was made. The patient was treated with 6% sulfur ointment for three consecutive days, resulting in complete resolution of pruritus and clinical improvement within one week.</p><p><strong>Conclusion: </strong>Palmoplantar lesions in adolescents, though atypical, should not exclude scabies. Early recognition, appropriate treatment, and household management are essential. Further studies are needed to characterize age-atypical presentations and optimize diagnostic strategies.</p>","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261463716"},"PeriodicalIF":0.6,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13319581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148367196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reversible Secondary Carnitine Deficiency Associated With Chronic <i>Achromobacter xylosoxidans</i> Bacteremia Presenting as Acute Metabolic Myopathy: A Case Report.","authors":"Amogh Verma, Dilip Kumar Kakru, Kotina Shridevi, Ranjana Roy, Dinesh Puri, Sushma Verma, Jeffrin Reneus Paul, Sorabh Lakhanpal, Sanjay Kumar, Prakasini Satapathy","doi":"10.1177/11795476261465063","DOIUrl":"10.1177/11795476261465063","url":null,"abstract":"<p><strong>Introduction: </strong>Infectious diseases exert systemic effects beyond localized inflammation, yet selective disruption of host metabolic pathways remains incompletely characterized. Carnitine-dependent fatty-acid transport is essential for mitochondrial energy production, and acquired deficiencies are rarely attributed to infection. Chronic bacteremia has not been clearly linked to functional impairment of this pathway.</p><p><strong>Case presentation: </strong>A 34-year-old man with no prior metabolic or neuromuscular disease presented with subacute proximal muscle weakness, fasting intolerance, and episodic confusion following several weeks of constitutional symptoms. Evaluation demonstrated hypoketotic hypoglycemia (plasma glucose 46-54 mg/dL with β-hydroxybutyrate <0.3 mmol/L), elevated creatine kinase (peak 2,140 U/L), and reduced plasma free carnitine (12 μmol/L; reference 25-50 μmol/L), indicating impaired mitochondrial fatty-acid transport. Serial blood cultures isolated <i>Achromobacter xylosoxidans</i>, confirming persistent bacteremia. Alternative endocrine, metabolic, and immunologic causes were excluded.</p><p><strong>Discussion: </strong>Resolution of metabolic abnormalities following targeted antimicrobial therapy supports an acquired and reversible disruption of fatty-acid transport. Potential mechanisms include inflammation-mediated renal carnitine loss and host-pathogen metabolic competition during prolonged bacteremia.</p><p><strong>Conclusion: </strong>Chronic <i>Achromobacter xylosoxidans</i> bacteremia may be associated with reversible secondary carnitine deficiency and selective impairment of fatty-acid transport. Plasma free carnitine normalized after antimicrobial therapy and short-term L-carnitine supplementation, with no recurrence during six months of follow-up. Metabolic evaluation should be considered in patients with unexplained hypoketotic hypoglycemia and persistent bloodstream infection.</p>","PeriodicalId":10357,"journal":{"name":"Clinical Medicine Insights. Case Reports","volume":"19 ","pages":"11795476261465063"},"PeriodicalIF":0.6,"publicationDate":"2026-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13310334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148344064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}