European journal of case reports in internal medicine最新文献

{"title":"Unmasking Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD): CNS Demyelination Triggered by TNF-α Inhibition in a Patient with Ankylosing Spondylitis.","authors":"Sujatha Baddam, Siddharth Patel, Navkirat Kahlon, Mrudula Thiriveedi","doi":"10.12890/2025_005467","DOIUrl":"10.12890/2025_005467","url":null,"abstract":"<p><strong>Background: </strong>Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a rare but emerging central nervous system demyelinating disorder that can mimic other neurological conditions. The use of TNF-α inhibitors in patients with autoimmune diseases has been linked to central nervous system demyelinating events, but the relationship remains poorly understood.</p><p><strong>Case description: </strong>We present a 64-year-old male with a history of ankylosing spondylitis previously treated with a TNF-α inhibitor who developed progressive dizziness, ataxia, visual disturbances and cognitive changes. Despite extensive workup, including imaging and cerebrospinal fluid analysis, initial evaluations were inconclusive. MRI was non-diagnostic, and cerebrospinal fluid lacked oligoclonal bands. Ultimately, a serum MOG antibody titre of 1:1,000 confirmed the diagnosis of MOGAD. The patient improved with intravenous corticosteroids and was discharged on a tapering dose of oral prednisone. This case highlights an MRI-negative presentation of MOGAD with strong serologic findings.</p><p><strong>Conclusion: </strong>This case emphasises the diagnostic challenge of MOGAD in patients with autoimmune backgrounds and neurologic symptoms without clear imaging findings. Clinicians should consider MOGAD in the differential diagnosis when evaluating such patients, particularly those with prior TNF-α inhibitor exposure. Early recognition and treatment with immunotherapy can lead to significant clinical improvement.</p><p><strong>Learning points: </strong>Clinicians should maintain a high index of suspicion for MOGAD in patients with atypical neurological symptoms, even when MRI findings are negative.TNF-α inhibitors may act as potential immunologic triggers for central nervous system demyelination, especially in patients with autoimmune conditions.Strong MOG antibody positivity can guide diagnosis in diagnostically ambiguous presentations and warrants the timely initiation of immunotherapy.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 6","pages":"005467"},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274510","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":"Endometriosis Can Cause Gastric Obstruction.","authors":"Sawera Tahir, Muhammad Ilyas, Jaber Gasem","doi":"10.12890/2025_005239","DOIUrl":"10.12890/2025_005239","url":null,"abstract":"<p><strong>Introduction: </strong>Gastric outlet obstruction is commonly associated with malignancies and benign conditions such as peptic ulcer disease and Crohn's disease. This report presents an uncommon instance of gastric endometriosis leading to gastric outlet obstruction, a condition that should be considered in the differential diagnosis.</p><p><strong>Case description: </strong>A 37-year-old female presented with persistent postprandial vomiting occurring approximately 30 minutes after meals, along with significant weight loss of 25.4 kg over 2.5 months. Her medical history included a subtotal colectomy with ileo-distal sigmoid anastomosis for slow transit constipation and a total abdominal hysterectomy with bilateral salpingo-oophorectomy for endometriosis. Clinical examination revealed abdominal tenderness and a vague epigastric mass. An abdominal CT scan identified a 5 cm mass arising from the pylorus and duodenal wall, with associated pathological lymph node enhancement. Despite multiple endoscopic biopsies, histological results were non-diagnostic due to the submucosal nature of the lesion; technical limitations prevented the capture of endoscopy images. Due to the severity of symptoms and a strong clinical suspicion of a gastrointestinal stromal tumour (GIST), the patient underwent a Whipple's resection. Histopathological analysis of the resected specimen unexpectedly confirmed gastric endometriosis.</p><p><strong>Conclusion: </strong>This case highlights the need to consider endometriosis in the differential diagnosis of gastric outlet obstruction, particularly in women with a history of endometriosis or prior gynaecological surgeries. The discrepancy between imaging findings and negative biopsy results underscores the limitations of standard endoscopic biopsy in diagnosing submucosal lesions. Endoscopic ultrasound-guided biopsy or laparoscopic biopsy should be considered when standard biopsies are non-diagnostic. Early recognition of this rare condition can prevent delays in treatment and improve patient outcomes.</p><p><strong>Learning points: </strong>Endometriosis can cause gastric obstruction and should be considered in the differential diagnosis, especially in women with a history of endometriosis.Endoscopic biopsy may miss the diagnosis due to the submucosal nature of gastric endometriosis.Endoscopic ultrasound-guided fine-needle aspiration or laparoscopic biopsy should be considered before proceeding with major surgery.A trial of medical therapy, such as hormonal suppression, may be an option in some cases before considering surgical intervention.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 6","pages":"005239"},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151560/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274469","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":"From Presentation to Prognosis: A Challenging Case of Multifocal Cerebral Micro Abscesses Due to <i>Citrobacter Freundii</i>.","authors":"Varsha Nandwana, Liam M Cleary, Thomas V Kodankandath","doi":"10.12890/2025_005290","DOIUrl":"10.12890/2025_005290","url":null,"abstract":"<p><strong>Introduction: </strong><i>Citrobacter freundii</i> is a rare cause of central nervous system (CNS) infections, primarily affecting neonates. In adults, cases are uncommon and often associated with high mortality rates.</p><p><strong>Case description: </strong>We describe the case of an adult male with multiple comorbidities who presented with constipation, nausea and vomiting, which rapidly progressed to altered mental status and seizures. Neuroimaging revealed gas densities within intracranial veins and evolving encephalitic changes. Cerebrospinal fluid (CSF) findings were non-specific, but blood and wound cultures identified <i>C. freundii</i>. Targeted antibiotic therapy with cefepime and ampicillin-sulbactam was initiated, but the patient's condition deteriorated leading to withdrawal of care, and death. Autopsy confirmed multiple cerebral micro abscesses, consistent with septic embolization.</p><p><strong>Conclusion: </strong>This case highlights <i>C. freundii</i> as a rare but fatal cause of septic encephalopathy. Diagnostic challenges arose from the atypical neurological presentation and non-specific CSF findings. The transition to cefepime was guided by concerns over <i>C. freundii</i>'s AmpC β-lactamase production. Despite appropriate antimicrobial therapy, the patient's poor outcome underscored the challenges of managing CNS infections in relatively immunocompromised hosts. Early recognition of <i>C. freundii</i> CNS infections is crucial, particularly in high-risk patients. A high index of suspicion, serial imaging and tailored antimicrobial therapy are essential for optimising outcomes. Further research is needed to enhance diagnostic methods and treatment strategies.</p><p><strong>Learning points: </strong>Septic embolization due to <i>C. freundii</i> can present with atypical neurological symptoms.Antibiotic selection should consider <i>C. freundii</i>'s resistance mechanisms.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 6","pages":"005290"},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274471","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":"Nephrogenic Diabetes Insipidus Associated with Temozolomide Therapy in a Patient with Grade IV Astrocytoma.","authors":"Zayd Fargouche, Martin Manderlier, Anne-Pascale Meert, Louis Wolff, Maxime Ilzkovitz","doi":"10.12890/2025_005463","DOIUrl":"10.12890/2025_005463","url":null,"abstract":"<p><p>Temozolomide (TMZ), an alkylating agent used in glioblastoma multiforme and anaplastic astrocytoma treatment, is generally associated with side effects like myelosuppression and nausea. This case report describes a rare occurrence of nephrogenic diabetes insipidus (NDI) in a 45-year-old male with grade IV astrocytoma undergoing TMZ therapy. Following TMZ discontinuation due to haematological toxicity, the patient developed significant polyuria and hypernatremia. Central diabetes insipidus was initially suspected, but limited improvement with desmopressin and normal endocrine investigations suggested renal involvement. The diagnosis of partial NDI was made and linked to TMZ-induced acute tubulointerstitial nephropathy (ATN). Despite symptom onset coinciding with TMZ administration, recovery was delayed after discontinuation, implicating possible lasting tubular damage. Although the precise pathogenesis remains uncertain, it may involve TMZ-induced renal tubule inflammation, affecting aquaporin-2 expression and water retention. In this case, management of NDI included adequate intravenous hydration, oral fluid restriction, and progressive resolution of polyuria without the need for diuretic or non-steroidal anti-inflammatory drug. This case emphasizes the need for vigilance regarding renal complications, particularly NDI, in patients receiving TMZ, warranting careful monitoring of electrolytes, renal function and diuresis to ensure prompt identification and management of this rare but serious side effect.</p><p><strong>Learning points: </strong>Temozolomide can in rare cases cause diabetes insipidus and, even more exceptionally, nephrogenic diabetes insipidus.The resolution of nephrogenic diabetes insipidus following the discontinuation of a high-intensity regimen is promising, and patients should not be denied temozolomide due to this complication.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 6","pages":"005463"},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151568/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274474","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":"Severe Hypoxaemia and Haemodynamic Instability Following Salt Tablet Broncho-Aspiration: In-Hospital Mimicking of Saltwater Drowning.","authors":"Ermes Lupieri, Enrico Patrese, Alessandro Felice Chiesa, Fabio Corti, Marco Previsdomini","doi":"10.12890/2025_005404","DOIUrl":"10.12890/2025_005404","url":null,"abstract":"<p><p>A 70-year-old woman, hospitalised for asymptomatic hyponatraemia secondary to syndrome of inappropriate antidiuretic hormone secretion (SIADH), required emergency intubation due to severe acute respiratory failure and haemodynamic instability following broncho-aspiration of a salt tablet. We hypothesise that a pathophysiological mechanism resembling saltwater drowning may have contributed to the clinical presentation.</p><p><strong>Learning points: </strong>Salt tablet broncho-aspiration could be associated with severe hypoxaemia and haemodynamic instability.The pathophysiology of salt tablet broncho-aspiration may mimic drowning in saltwater.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 6","pages":"005404"},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274493","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 Pregnancy Outcome in Patient with Pompe Disease Despite Discontinuation of Enzyme Replacement Therapy.","authors":"Dunja Leskovar Lemešić, Dražen Perica, Gordan Zlopaša, Biserka Knezić Frković, Nediljko Šućur, Željko Reiner, Ivan Pećin","doi":"10.12890/2025_005456","DOIUrl":"10.12890/2025_005456","url":null,"abstract":"<p><strong>Background: </strong>Pompe disease (PD), is an autosomal recessive metabolic disorder caused by mutations in the acid alpha-glucosidase (GAA) gene, resulting in a deficiency of the same enzyme and glycogen buildup in tissues. Late onset PD (LOPD) is characterized by muscle illness, accompanied by diaphragmatic involvement and leading to respiratory insufficiency. Fortunately, the disease progresses slowly, and treatment with enzyme replacement therapy can further delay its development. Pregnancy in women with LOPD requires special caution because musculoskeletal changes and greater physical demands may worsen muscular weakness and endanger both the mother and unborn child. Although several cases of pregnant women with LOPD that continued enzyme replacement therapy (ERT) during pregnancy have been reported, there is still a lack of data regarding teratogenicity and safety of the foetus.</p><p><strong>Case report: </strong>We present a case of a 31-year-old pregnant women with a mild form of LOPD who discontinued ERT during whole pregnancy. During the whole pregnancy there were no clinical signs of progression of muscle or pulmonary weakness. With careful monitoring of the patient and foetus, and planned delivery, a healthy baby girl was born. ERT was reintroduced 6 months after delivery with premedication (corticosteroids and antihistamines) for the first application, with no allergic reaction noted.</p><p><strong>Conclusion: </strong>In this patient with well-controlled LOPD, ERT was safely discontinued during pregnancy without disease worsening. The risks of ERT in pregnancy outweighed the potential complications of well-controlled disease. The final decision should be made with an individual approach for each patient by a multidisciplinary team.</p><p><strong>Learning points: </strong>Pompe disease in pregnancy represents a treatment challenge due to the increased risk of worsening respiratory and muscle function and requires a multidisciplinary approach.Although several case reports reported safe usage of enzyme replacement therapy (ERT) during pregnancy, more studies are needed to address the safety for the foetus and overall teratogenicity.In well controlled Pompe disease, ERT can be discontinued during pregnancy with careful foetal and maternal monitoring.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 6","pages":"005456"},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151579/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274495","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":"An Unexpected Cause of Severe Metabolic Acidosis.","authors":"Suzanne K Veneman, Stephanie E Veneman, Hardjit Kharagjitsing, Thiemo F Veneman","doi":"10.12890/2025_005276","DOIUrl":"10.12890/2025_005276","url":null,"abstract":"<p><strong>Introduction: </strong>Metabolic acidosis is a potentially serious electrolyte disorder with a variety of potential causes. It can cause serious harm to multiple organ systems with irreversible damage and if untreated it can even cause mortality.</p><p><strong>Case description: </strong>A 66-year-old man presented at the emergency room of our hospital because of abdominal pain, nausea, and vomiting for 3 days, with no diarrhoea. Physical examination showed a sick, restless, shaking, middle-aged man with a maximal eye-motor-verbal score. He had a history of polycythaemia vera but had been lost to follow-up. He was clinically dehydrated with extremely dry mucous membranes and complaining of thirst. Laboratory investigations showed severe metabolic acidosis with a pH of 7.08 and electrolyte disturbances with hyperkalaemia and hyponatremia. The treatment with a high dose of hydroxyurea had been re-started 14 days before presentation at the emergency room.</p><p><strong>Conclusion: </strong>We believe that the recent initiation of the treatment with a (too) high dose of hydroxyurea with consequently gastrointestinal complications could have been the underlying cause. In addition to the indirect effect of dehydration resulting from the gastrointestinal side effects of hydroxyurea, another known but rarely reported adverse effect is (tubular) renal dysfunction, which may have contributed to the progression of metabolic acidosis. The exact mechanisms by which hydroxyurea induces metabolic acidosis remain unknown. It is important to recognize hydroxyurea as the culprit of the development of severe metabolic acidosis. If unrecognized, metabolic acidosis can worsen and cause irreversible damage.</p><p><strong>Learning points: </strong>Metabolic acidosis is a potentially severe, even lethal metabolic derangement.Hydroxyurea can be the causative agent through indirect side effects on the gastrointestinal system causing dehydration.In rare instances hydroxyurea can cause direct (tubular) renal failure thus adding to the development of metabolic acidosis.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 6","pages":"005276"},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274506","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 Slow Pathway Modification with Radiofrequency Ablation in a Patient with AVNRT and Congenital IVC Continuity with Azygos Vein.","authors":"Elizabeth R Rimsky, Kaiyu Jia, Aysan Sattarzadeh, Michel El Khoury, Antonios Zakharia, Phillipe Akhrass","doi":"10.12890/2025_005401","DOIUrl":"10.12890/2025_005401","url":null,"abstract":"<p><strong>Background: </strong>Congenital anomalies of the inferior vena cava (IVC), such as interrupted or azygos continuation, complicate catheter-based procedures like atrioventricular nodal reentrant tachycardia (AVNRT) ablation. Understanding IVC variations is crucial for successful outcomes in interventional cardiology.</p><p><strong>Case presentation: </strong>A 57-year-old male with long-standing paroxysmal atrial fibrillation (AF) underwent successful catheter ablation for AVNRT. Intra-procedurally, a congenital IVC anomaly was identified, requiring modified vascular access.</p><p><strong>Conclusion: </strong>Recognizing IVC anomalies and adapting access strategies are key to overcoming procedural challenges and ensuring successful ablation outcomes. Comprehensive imaging and planning are vital for managing patients with IVC variations.</p><p><strong>Learning points: </strong>Congenital inferior vena cava (IVC) anomalies, including azygos continuation, can complicate catheter-based interventions such as ablation of atrioventricular nodal reentrant tachycardia.Congenital anomalies of IVC are rare but critical considerations for atrioventricular nodal reentry tachycardia (AVNRT) ablation procedures.Understanding these variations is essential for ensuring successful catheter-based interventions and minimizing the risk of complications.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 6","pages":"005401"},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274497","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":"Veno-Venous ECMO Support in the Management of a Jehovah's Witness with Severe COVID-19: A Case Report and Literature Review.","authors":"Mohamed Qandil, Rabee Tawel, Ans Alamami, Hani Jaouni, Ibrahim Fawzy Hassan, Ayman El-Menyar, Ahmed Labib Shehatta","doi":"10.12890/2025_005493","DOIUrl":"10.12890/2025_005493","url":null,"abstract":"<p><strong>Background: </strong>Severe coronavirus disease 2019 (COVID-19) infection can lead to severe acute respiratory syndrome for which extracorporeal membrane oxygenation (ECMO) could be used in selected cases. Most Jehovah's witnesses (JWs) do not accept transfusion of blood and/or blood products. The use of ECMO for the management of JWs during the pandemic was challenging.</p><p><strong>Case report: </strong>We present a case of a JW with severe COVID-19 infection and multiple organ failure necessitating ECMO support for 20 days. We discuss the management challenges in patients who do not accept blood transfusions. A significant drop in the patient's haemoglobin and platelet count was observed throughout ECMO duration. An anti-coagulation-free ECMO circuit was maintained, and we did not observe any major circuit or patient complications.</p><p><strong>Conclusion: </strong>Management strategies to minimize blood loss, avoid bleeding, augment haemoglobin production, maintain ECMO circuit integrity without systemic anticoagulation, and reduce blood loss during ECMO decannulation are helpful in the management of JW followers on ECMO. We recommend treatment in such a situation at experienced centres with the involvement of a haematologist within an interprofessional team.</p><p><strong>Learning points: </strong>Management of patients who are Jehovah's witnesses, who do not accept blood transfusion is challenging.Conservative transfusion strategies are feasible on selected patients supported by extracorporeal membrane oxygenation.Transfusion thresholds should be dynamic and reviewed daily.Mitigation of blood loss, rationalization of blood tests, and anticoagulation help reduce the need for transfusion.Transfusion targets and guidelines need revision, and it is best to adopt patient-specific targets tailored to each patient's needs.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 6","pages":"005493"},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274511","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":"Massive Haemoptysis and Cardiopulmonary Arrest Secondary to Acute Pulmonary Histoplasmosis in a Traveller from China Successfully Managed with Cryoextraction.","authors":"Shunsuke Kondo, Yusuke Hirao, Kaihei Masuda, Kazushige Shiraishi, Natsumi Hamahata-Tanabe","doi":"10.12890/2025_005425","DOIUrl":"10.12890/2025_005425","url":null,"abstract":"<p><p><i>Histoplasma capsulatum</i> is a dimorphic fungus that grows as a mould in the environment and as a yeast in human tissues causing histoplasmosis. Histoplasmosis varies in clinical presentations and severities of the illness and is endemic in certain areas of North, Central, and South America, Africa, and Asia. A 47-year-old previously healthy male presented with a sudden onset of massive haemoptysis requiring emergent intubation in the emergency department. Bronchoscopy revealed blood clots within the endotracheal tube extending into both main bronchi with active bleeding from both airways. Subsequently, the patient experienced a cardiac arrest with asystole, requiring three rounds of cardiopulmonary resuscitation before achieving return of spontaneous circulation. A computed tomography scan of the chest demonstrated diffuse ground-glass opacities. Collateral information obtained from the patient's family indicated travel to Southeast China two months prior to hospitalization. Histoplasma antigen testing returned positive, and antifungal therapy was initiated. Along with serial suctioning and forceps use via fibreoptic bronchoscopy, cryoextraction of blood clots from the bronchi was performed, leading to successful extubation and hospital discharge. This case highlights the need to consider histoplasmosis in patients who have travelled to endemic areas and present with severe respiratory symptoms.</p><p><strong>Learning points: </strong>Acute pulmonary histoplasmosis can present with life-threatening complications such as massive haemoptysis, even in immunocompetent individuals.A thorough travel and occupational history are critical for diagnosing histoplasmosis, especially in non-endemic regions.Combined management with antifungal therapy and bronchoscopic cryoextraction can be effective in severe pulmonary histoplasmosis with airway obstruction.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 6","pages":"005425"},"PeriodicalIF":0.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151571/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274473","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}