European journal of case reports in internal medicine最新文献

{"title":"Prolonged Femoral Compression Post Percutaneous Coronary Intervention Leading to Deep Vein Thrombosis.","authors":"Amer Abu-Shanab, Jillianne Unas, Hamzeh Nasr, Zain Albdour, Ahmad Abdulraheem, Doantrang Du","doi":"10.12890/2025_005131","DOIUrl":"10.12890/2025_005131","url":null,"abstract":"<p><p>Deep vein thrombosis is an uncommon yet significant complication of percutaneous coronary interventions. Prolonged manual compression at the access site, a common practice for achieving hemostasis, can inadvertently exacerbate thrombosis risks, including venous stasis and endothelial injury. We present the case of an 84-year-old female with coronary artery disease who underwent staged percutaneous coronary intervention with stent placement in the left circumflex and left anterior descending arteries. After the procedure, manual pressure was applied to the femoral access site for over 30 minutes, after which the patient developed hypotension and leg pain. Point-of-care ultrasound revealed a large deep vein thrombosis in the right femoral vein, extending into the profunda and saphenous veins. The patient was treated with a heparin drip and monitored without surgical intervention. Her condition improved, and follow-up imaging confirmed resolution of the deep vein thrombosis. This case underscores the risks associated with extended manual compression and highlights the importance of adhering to guidelines for post percutaneous coronary intervention care. The use of vascular closure devices may reduce the likelihood of such complications. Additionally, early recognition and management of deep vein thrombosis is critical in preventing further thromboembolic events and improving patient outcomes.</p><p><strong>Learning points: </strong><b>Recognizing the risks of prolonged compression</b> This case highlights that manual compression exceeding recommended durations can lead to complications like deep vein thrombosis, reinforcing the importance of adhering to established guidelines.<b>Considering vascular closure devices</b> The use of vascular closure devices as an alternative to manual compression can significantly reduce the risk of thrombosis and other access site complications, enhancing post-procedure safety.<b>Recognizing risks in routine procedures</b> Even common procedures like percutaneous coronary intervention can sometimes lead to serious complications, such as deep vein thrombosis. This case highlights the need to stay vigilant and manage these risks effectively when they occur.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 2","pages":"005131"},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143381768","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 Cardiac Tamponade as a Complication of Prolonged Left Bundle Branch Area Pacing.","authors":"Nurshafira Kamarulzaman, Wan Nur Amirah Wan Abdullah, Mohd Khairi Othman, W Yus Haniff W Isa, Zurkurnai Yusof, Ahmad Aizuddin Mohamad Jamali, Zulkeflee Muhammad","doi":"10.12890/2025_005144","DOIUrl":"10.12890/2025_005144","url":null,"abstract":"<p><p>Post-cardiac injury syndrome (PCIS) is one of the complications of cardiac interventional procedures. This condition has been postulated to be due to an immune reaction, especially with pacemaker lead implantation. Patients with PCIS can have uncomplicated pericardial effusion until they develop cardiac tamponade. The management of PCIS, which can be conservative management or require pericardiocentesis or surgery depends on the patient's clinical symptoms. As the left bundle branch area pacing (LBBAP) implantation technique and technology are still new, it is associated with longer procedural time than conventional pacemaker implantation. Herein, we report a case of PCIS in a patient who had a prolonged LBBAP procedure due to difficult anatomy and presented with recurrent cardiac tamponade.</p><p><strong>Learning points: </strong>Prolonged fluoroscopy in cardiac procedures can potentially lead to post-cardiac injury syndrome.Active pacemaker lead fixation is one of the risk factors for post-cardiac injury syndrome due to immune reaction.Left bundle branch area pacing in adults with congenital heart disease is challenging because of anatomical differences.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 2","pages":"005144"},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143381776","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":"Unmasking of Normocalcemic Primary Hyperparathyroidism After Sodium-Glucose Cotransporter-2 Inhibitor Initiation.","authors":"Christodoulos Dolapsakis, Emmanouil Karofylakis, Stamatios Chalvatzis","doi":"10.12890/2025_005169","DOIUrl":"10.12890/2025_005169","url":null,"abstract":"<p><p>Sodium-glucose cotransporter-2 (SGLT2) inhibitors have complex interactions with bone metabolism, including an increase in parathyroid hormone (PTH) levels. Here we report a case of a SGLT2 inhibitor-induced hypercalcemia due to primary hyperparathyroidism. In the subset of patients with normocalcemic primary hyperparathyroidism, SGLT2 inhibitor initiation can unmask the disorder causing overt hypercalcaemic hyperparathyroidism. Although normocalcemic primary hyperparathyroidism is a rare entity, we propose obtaining a baseline PTH level before starting a SGLT2 inhibitor in patients with calcium levels in the upper limit of normal and normal total 25-hydroxyvitamin D levels, especially if they are under vitamin D supplementation. PTH should be rechecked in order to exclude overt primary hyperparathyroidism.</p><p><strong>Learning points: </strong>Sodium-glucose cotransporter-2 (SGLT2) inhibitors are a class of medications that cause secondary hyperparathyroidism.In patients with normocalcemic primary hyperparathyroidism, SGLT2 inhibitor' initiation can cause overt hyperparathyroidism and hypercalcemia.We propose obtaining a baseline parathyroid hormone level before starting a SGLT2 inhibitor in patients with calcium levels in the upper limit of normal especially if they are under vitamin D supplementation.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 2","pages":"005169"},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143381851","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":"Chiari Malformation as a Differential Diagnosis of Recurrent Syncope.","authors":"Filipa Figueiredo, Teresa Valido, Martim Bastos, Carolina Chumbo, Jéssica Oliveira, Joana Batista Paulo, Marta Rocha","doi":"10.12890/2025_005136","DOIUrl":"10.12890/2025_005136","url":null,"abstract":"<p><p>Arnold-Chiari malformations are rare anomalies involving inferior displacement of the cerebellar tonsils and hindbrain through the foramen magnum. We present the case of a 19-year-old woman with a relatively rare presentation of recurrent syncope. The patient underwent surgical treatment with resolution of the symptoms. Few cases of surgical treatment have been described. This case underscores the importance of considering Chiari malformations in the differential diagnose of a common symptom - recurrent syncope - and the relevance of considering these patients for surgical treatment.</p><p><strong>Learning points: </strong>Chiari malformation type I (CM-I) should be included in the differential diagnosis in recurrent syncope, especially if accompanied by headache, vertigo, or transient sensory or motor symptoms in the arms or legs.In patients with CM-I with syncope, the good clinical results of surgical decompression should be kept in mind.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 2","pages":"005136"},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143381315","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":"A Complicated Case of An Intracranial Epidermoid Cyst.","authors":"Abdelkader Dib, Johny Salem, Marwan Haddad, Omar Awar, Mirna Fares","doi":"10.12890/2025_005121","DOIUrl":"10.12890/2025_005121","url":null,"abstract":"<p><p>Intracranial vasospasm and ischaemic cerebrovascular accident (CVA) following surgical removal of intracranial tumours are rare. To our knowledge, vasospasm has been reported in only two cases following surgery, with one occurring two weeks post-surgery and the other after four days. However, ischaemic CVA following surgery has not been previously reported. We present a case in which vasospasm resulted in cerebral infarction immediately postoperatively. MRI and serial magnetic resonance angiography (MRA) revealed no flow in the internal carotid artery and middle cerebral artery, with ultrasound showing multiple thrombi in the internal carotid artery and stenotic features in the left middle cerebral artery.</p><p><strong>Learning points: </strong>Intracranial vasospasm and ischaemic cerebrovascular accident (CVA) following surgical removal of intracranial tumours are rare.We report a case of ischaemic CVA and vasospasm following resection of an intracranial epidermoid cyst. Although the tumour was completely resected, vasospasm and ischaemic injury led to significant neurological deficits.Perioperative corticosteroids may be beneficial in reducing the incidence of vasospasm and ischaemic events, though their efficacy can vary.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 2","pages":"005121"},"PeriodicalIF":0.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143381953","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":"Percutaneous Management of Paravalvular Leak-Related Hemolytic Anemia After Transcatheter Aortic Valve Replacement.","authors":"Abiodun Idowu, Christian Witzke","doi":"10.12890/2025_005138","DOIUrl":"10.12890/2025_005138","url":null,"abstract":"<p><p>We present a case of a patient with severe intravascular hemolytic anemia from a paravalvular leak after transcatheter aortic valve replacement and describe a technique of percutaneous repair of the leak with a vascular plug that resolved the patient's transfusion-dependent hemolysis.</p><p><strong>Learning points: </strong>Paravalvular leak after transcatheter aortic valve replacement could lead to intractable hemolytic anemia.Percutaneous paravalvular leak repair with vascular plug implantation is a feasible treatment for aortic prosthesis leak-related hemolysis.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 2","pages":"005138"},"PeriodicalIF":0.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801517/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143381742","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":"Bile Cast Nephropathy (Cholemic Nephropathy) Associated with Hepatitis A-Induced Acute Liver Failure and Haemolysis in a Patient with Glucose-6-Phosphate Dehydrogenase Deficiency.","authors":"Ali Hamdan, Johny Salem, Karam Karam, Maria Ziadeh, Pierre Hani","doi":"10.12890/2025_005064","DOIUrl":"10.12890/2025_005064","url":null,"abstract":"<p><strong>Introduction: </strong>The hepatitis A virus (HAV) is a common cause of acute hepatitis, while glucose-6-phosphate dehydrogenase (G6PD) deficiency is a widespread enzyme disorder that predisposes individuals to haemolysis and hyperbilirubinemia. We report a case of a G6PD-deficient patient with hepatitis A-induced acute renal failure (ARF), highlighting the role of plasmapheresis and haemodialysis in management.</p><p><strong>Case description: </strong>A 40-year-old male with G6PD deficiency and hypertension was transferred for further care after presenting with fever, diarrhoea and jaundice. Laboratory results showed severe haemolysis and elevated bilirubin (70 μmol/l); hepatitis A serology was positive. The patient developed acute liver failure and ARF, with creatinine reaching 7.3 mg/dl. Plasmapheresis and haemodialysis were initiated, leading to stabilisation of renal function and a significant decrease in bilirubin by six weeks post-discharge.</p><p><strong>Discussion: </strong>G6PD deficiency increases the risk of haemolysis, especially during infections such as hepatitis A. This can lead to severe hyperbilirubinemia and complications including bile cast nephropathy. In this case, plasmapheresis effectively reduced bilirubin and inflammatory mediators, while haemodialysis addressed renal dysfunction. Together, these therapies were crucial in stabilising renal function.</p><p><strong>Conclusion: </strong>Bile cast nephropathy is an important cause of kidney injury in severe hyperbilirubinemia. This case highlights the effectiveness of plasmapheresis and haemodialysis in managing the condition and supporting renal recovery, especially in the absence of established treatment guidelines.</p><p><strong>Learning points: </strong>Bile cast nephropathy is a significant yet underrecognised cause of acute kidney injury, often associated with severe hyperbilirubinemia in the setting of acute liver failure.In this case, glucose-6-phosphate dehydrogenase (G6PD) deficiency combined with hepatitis A-induced haemolysis led to elevated bilirubin levels, contributing to kidney injury.This case highlights the importance of extracorporeal therapies in managing bile cast nephropathy and promoting renal function recovery, particularly in the absence of standard treatment guidelines.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 2","pages":"005064"},"PeriodicalIF":0.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801507/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143381295","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":"Primary Lymphoma Arising in Paget's Disease in A Patient with Primary Hyperparathyroidism.","authors":"Mercedes De La Fuente, Marina Arroyo, Ana S Collado, Elena C Gallardo, Santiago Montes, José M Olmos","doi":"10.12890/2025_004778","DOIUrl":"10.12890/2025_004778","url":null,"abstract":"<p><strong>Background: </strong>Paget's disease of bone (PDB) is characterized by a disturbance of the balance between bone formation and bone resorption at one or more bone sites. Its neoplastic transformation to osteosarcoma of the bone has been widely cited in the literature; however, association with non-Hodgkin's lymphoma (NHL) is very uncommon. In addition, whereas the pathophysiological relationship between PDB and secondary hyperparathyroidism is well established, there is much debate about the association between PDB and primary hyperparathyroidism (PHPT).</p><p><strong>Case report: </strong>We present a case of NHL arising in pagetoid bone in a 56-year-old man, who was subsequently diagnosed with primary hyperparathyroidism (PHPT).</p><p><strong>Discussion: </strong>The malignant potential of pagetoid bone is well known, with sarcomatous degeneration being the most common neoplasm. Therefore, when pain recurred in our patient, 3 years after treatment of PDB, the presumptive diagnosis was a sarcomatous degeneration of the pagetoid bone. However, bone biopsy revealed a primary lymphoma, an extremely rare association that has been described only in a few cases. In addition, PHPT is rarely associated with PDB, although a link between PHPT and an increased risk of malignancy has been suggested.</p><p><strong>Conclusion: </strong>To the best of our knowledge, this is the first case of these three different bone diseases in the same patient. Further studies are needed to understand the possible molecular basis of the association among these diseases.</p><p><strong>Learning points: </strong>Sarcomatous degeneration is the most common primary bone neoplasm associated with Paget's disease of bone (PDB). However, primary lymphoma in pagetoid bone is unusual.The association between PDB and primary hyperparathyroidism is very rare.The uniqueness of this case lies in coexistence of three bone diseases in the same patient.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 2","pages":"004778"},"PeriodicalIF":0.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143381751","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":"Paraparesis and Paraesthesia Following A Black Ant Sting.","authors":"Norah Alobaid, Majed Alanazi, Sultan Aleshaiwi, Abdulrahman Alhassan","doi":"10.12890/2025_005125","DOIUrl":"10.12890/2025_005125","url":null,"abstract":"<p><p>Hymenoptera stings can lead to a different range of local and systemic reactions. However, rare and unexpected reactions can develop and may be life threatening. In this paper, we present a 29-year-old female who developed anaphylactic shock followed by paraparesis and paraesthesia after a black ant sting. Her symptoms completely resolved after treatment with plasma exchange. Several studies have linked these neurological complications to delayed immunological reactions that are triggered by insect antigen.</p><p><strong>Learning points: </strong>Environmental antigen exposure can present with immediate and delayed reactions.Weakness and paraesthesia are an unusual presentation reported after an ant sting that might be triggered due to an immunological response to an antigen, or antigen that directly causes neurotoxicity.Plasmapheresis might be an option for management of unexplained acute paraparesis and paraesthesia.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 2","pages":"005125"},"PeriodicalIF":0.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143381816","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":"Tracheal Perforation and Subcutaneous Emphysema Secondary to Pseudomembranous Invasive Aspergillus Tracheobronchitis Successfully Managed with Endotracheal Tube Manipulation.","authors":"Kazushige Shiraishi, Takkin Lo","doi":"10.12890/2025_005118","DOIUrl":"10.12890/2025_005118","url":null,"abstract":"<p><strong>Introduction: </strong>Aspergillus is a ubiquitous fungus causing various pulmonary diseases depending on the host's immune status. Aspergillus tracheobronchitis, a rare form of invasive aspergillosis, primarily affects severely immunocompromised or critically ill patients. We present the first known case of Aspergillus tracheobronchitis complicated by tracheal perforation and subcutaneous emphysema successfully treated with conservative endotracheal tube manipulation.</p><p><strong>Case description: </strong>A 64-year-old male with type 2 diabetes mellitus presented with generalized weakness and abdominal discomfort, later diagnosed with a perforated cecum requiring right colectomy. His postoperative course in the intensive care unit was complicated by septic shock, acute kidney injury, and failed extubation due to airway compromise. Seven days after the failed extubation, he developed subcutaneous emphysema in the neck. Chest computed tomography scan showed neck, left chest wall, and mediastinal emphysema. Bronchoscopy identified a focal black necrotic lesion on the left proximal tracheal wall and multiple small mucosal ulcerations throughout the proximal to distal trachea. The endotracheal tube was advanced beyond proximal tracheal necrotic lesion. Subcutaneous emphysema reduced overnight, suggesting that the lesion was the source of the air leak. Bronchial washings confirmed Aspergillus fumigatus, establishing a diagnosis of invasive Aspergillus tracheobronchitis. Treatment with voriconazole prevented further expansion of emphysema, which gradually resolved.</p><p><strong>Conclusion: </strong>Subcutaneous emphysema in ventilated patients with tracheobronchitis is a rare and challenging complication. This case demonstrates successful management through endotracheal tube manipulation to tamponade the lesion, highlighting subcutaneous emphysema as a potential manifestation of Aspergillus tracheobronchitis and offering a minimally invasive treatment approach.</p><p><strong>Learning points: </strong>Subcutaneous emphysema may present as a manifestation of Aspergillus/fungal tracheobronchitis.Aspergillus tracheobronchitis should be considered in patients with predisposing factors such as lung transplantation, acquired immunodeficiency syndrome (AIDS), diabetes mellitus, chronic obstructive pulmonary disease, and malignancies.Tracheal perforation caused by Aspergillus tracheobronchitis can be managed through endotracheal tube manipulation.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 2","pages":"005118"},"PeriodicalIF":0.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143381792","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}