European journal of case reports in internal medicine最新文献

{"title":"Cat Bite Leading to Thoracic Aortic Endograft Infection and Fatal Haemoptysis.","authors":"Alejandro Lujan, Diogo Romao, Gregory Mathoux","doi":"10.12890/2026_007484","DOIUrl":"10.12890/2026_007484","url":null,"abstract":"<p><p>Thoracic aortic graft infection is a rare but life-threatening complication of aortic repair, associated with high mortality due to sepsis, aortic rupture and fistulisation. Typical causative bacteria include <i>Staphylococcus spp.</i>, <i>Enterobacteriaceae</i> and <i>Pseudomonas spp.</i> However, atypical microorganisms may be implicated. A 53-year-old patient with a history of thoracic aortic endovascular repair following dissection presented with fever, cough and dyspnoea, initially attributed to non-specific viral illness that led to discharge. Blood cultures later grew <i>Capnocytophaga canimorsus</i>. Subsequent history revealed a recent cat bite, and a fluorine-18 -fluorodeoxyglucose positron emission tomography scan suggested thoracic aortic graft infection. Despite antibiotic therapy and endovascular intervention following a single episode of haemoptysis, fatal haemoptysis occurred. This case highlights the potential for a minor cat bite to cause bacteraemia and catastrophic vascular graft infection. Thorough evaluation, including animal exposure history, and a high index of clinical suspicion are essential in patients with aortic grafts presenting with an infection of unclear origin.</p><p><strong>Learning points: </strong>Aortic graft infections carry a high risk of a fatal outcome, making early identification and multidisciplinary management critical.Early fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography scan should be considered when aortic graft infection is suspected despite inconclusive initial imaging.<i>Capnocytophaga canimorsus</i> bacteraemia following a cat bite can cause life-threatening infections, even in immunocompetent patients.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 10","pages":"007484"},"PeriodicalIF":0.0,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192226","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":"Should the Traditional Algorithm for Syphilis Screening be Abandoned? Neurosyphilis Presenting as Limbic Encephalitis: A Prozone False-Negative RPR Missed by an RPR-Only Initial Screen.","authors":"Hidenori Sanayama, Yuka Hayashi, Takahiko Fukuchi","doi":"10.12890/2026_007473","DOIUrl":"10.12890/2026_007473","url":null,"abstract":"<p><strong>Introduction: </strong>Neurosyphilis is a treatable mimic of viral and autoimmune limbic encephalitis. The prozone phenomenon-antibody excess preventing the antigen-antibody lattice-can render an undiluted non-treponemal test such as the rapid plasma reagin (RPR) test falsely negative, with reactivity restored on dilution.</p><p><strong>Case description: </strong>A 37-year-old man presented with seizures and rapidly progressive limbic encephalitis; Brain magnetic resonance imaging (MRI) with fluid-attenuated inversion recovery sequences showed hyperintensities in the amygdalae, periventricular regions, left insula and left putamen. On admission, the possibility of a sexually transmitted infection was considered, but only an RPR was requested, and it was negative. When the encephalitis failed to respond to empirical antiviral, antibacterial and corticosteroid therapy, a <i>Treponema pallidum</i> haemagglutination assay was added; it was positive, and serially diluted serum yielded a reactive RPR (endpoint titre 1:32), revealing a prozone false negative. Cerebrospinal fluid studies confirmed neurosyphilis, and the patient recovered fully after penicillin.</p><p><strong>Discussion: </strong>With an RPR-only screen, the non-treponemal/treponemal discordance that typically signals a prozone never arose, so the false negative was accepted at face value; the delay reflected the prozone compounded by the initial testing strategy. Because empirical ceftriaxone active against <i>T. pallidum</i> had been started on admission, effective treatment was not delayed.</p><p><strong>Conclusion: </strong>When syphilis is suspected, a negative undiluted RPR does not exclude it; pairing a treponemal test with the RPR-or adopting a treponemal-first screening strategy-guards against prozone-related false negatives.</p><p><strong>Learning points: </strong>When a sexually transmitted infection is being considered, obtain a careful, respectful sexual history and request non-treponemal and treponemal tests together; a rapid plasma reagin -only screen cannot reveal the non-treponemal/treponemal discordance that signals a prozone false negative. A treponemal-first (reverse-sequence) algorithm avoids this particular pitfall.A negative undiluted RPR does not exclude syphilis: the prozone phenomenon occurs even at low-to-moderate titres and in human immunodeficiency virus-negative patients, so serial dilution should be requested when clinical suspicion is high.Neurosyphilis is a treatable mimic of limbic encephalitis; outcome depends on prompt effective therapy, and including a treponemal-active agent (e.g. ceftriaxone) in empirical meningoencephalitis coverage may limit harm from diagnostic delay.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 10","pages":"007473"},"PeriodicalIF":0.0,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192366","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":"Progressive Dysphagia Revealing Glioma: Diagnostic Overshadowing by Suspected Myasthenia Gravis.","authors":"Smeelah Rathore, Cliffin Adu-Gyamfi, Hasna Janali, Maya Baroudi","doi":"10.12890/2026_007466","DOIUrl":"10.12890/2026_007466","url":null,"abstract":"<p><p>Progressive dysphagia in older adults presents a diagnostic challenge with a broad differential including neuromuscular, structural and malignant causes. Dysphagia associated with aspiration may lead to significant respiratory compromise requiring intensive care management. We report the case of a 78-year-old patient with rheumatoid arthritis treated with methotrexate who presented with progressive dysphagia to solids and liquids, weight loss, and cough. She subsequently developed aspiration pneumonia complicated by repeated type 2 respiratory failure and required mechanical ventilation. Initial investigations focused on aspiration pneumonitis and possible neuromuscular disease, particularly myasthenia gravis, given the presence of bulbar symptoms and an insensate epiglottis on nasendoscopy. However, subsequent magnetic resonance imaging of the brain demonstrated a glioma explaining the progressive bulbar dysfunction. This case demonstrates diagnostic overshadowing, as recurrent type 2 respiratory failure was repeatedly managed as aspiration pneumonia, delaying the diagnosis of glioma. Early neuroimaging should be considered in patients with progressive dysphagia when initial investigations fail to explain symptoms.</p><p><strong>Learning points: </strong>Progressive dysphagia in an older adult warrants a broad differential - neuromuscular, structural and intracranial causes - not just aspiration-related respiratory disease.A bulbar syndrome (insensate epiglottis, dysphagia) can be produced by an intracranial lesion as well as by myasthenia gravis; negative acetylcholine receptor antibodies do not fully exclude either possibility and should not halt the diagnostic search.Recurrent type 2 respiratory failure that responds poorly to treatment for presumed aspiration pneumonia should prompt reconsideration of the working diagnosis, rather than repeated management of the same presumed cause - a pattern of diagnostic overshadowing and anchoring bias.Early neuroimaging should be considered when dysphagia and respiratory failure evolve atypically or fail to resolve despite appropriate treatment, as magnetic resonance imaging was ultimately pivotal in revealing the underlying glioma in this case.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 10","pages":"007466"},"PeriodicalIF":0.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192326","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":"False-Positive HIV Screening in New-Onset Systemic Lupus Erythematosus Presenting with Polyserositis and Lupus Nephritis.","authors":"Mahima Upadhyay, Susheel Joshi, Bibhush Shrestha, Muhammad Saleem, Omoniyi Henry Akinpeloye, Hoyam Elhaj Omer","doi":"10.12890/2026_006720","DOIUrl":"10.12890/2026_006720","url":null,"abstract":"<p><p>False-reactive human immunodeficiency virus (HIV) screening can occur in systemic lupus erythematosus (SLE) and may delay recognition of the underlying autoimmune disease. A 23-year-old woman presented with weight loss, polyserositis and nephrotic-range proteinuria. Her HIV antigen/antibody screen was reactive, but supplemental testing did not confirm HIV infection. Lupus serologies, hypocomplementemia and kidney biopsy established SLE with mixed proliferative and membranous lupus nephritis. Recurrent pleural and progressive pericardial effusions required immunosuppression, pericardial drainage, a surgical window and pleural decortication. The reactive HIV screen initially favoured an infectious diagnosis; however, proteinuria, haematuria and low complement levels suggested immune-complex disease. This illustrates the risk of diagnostic anchoring on a preliminary screening result. A reactive HIV screen is not diagnostic. Prompt supplemental testing and parallel evaluation for autoimmune disease can prevent delayed diagnosis of SLE.</p><p><strong>Learning points: </strong>A reactive HIV screening assay is preliminary, not diagnostic; in patients with autoimmune features, prompt supplemental testing is essential because systemic lupus erythematosus can cause false reactivity.A reactive HIV screen may create diagnostic anchoring when weight loss, serosal effusions and renal abnormalities coexist; discordant clinical and laboratory findings should trigger reassessment rather than premature attribution to HIV.In a young patient with unexplained polyserositis, proteinuria and glomerular haematuria, early lupus serology, complement testing and careful family history can expedite the diagnosis of severe lupus nephritis.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 10","pages":"006720"},"PeriodicalIF":0.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192265","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":"Hirayama Disease in A Patient with Loeys-Dietz Syndrome: The First Reported Association.","authors":"Lorenzo Silva-Hernández, Borja Cabal-Paz, Pablo Tutor de Ureta, Beatriz Brea-Álvarez, Beatriz de la Puente-Garrido","doi":"10.12890/2026_007397","DOIUrl":"10.12890/2026_007397","url":null,"abstract":"<p><strong>Introduction: </strong>Hirayama disease (HD) is a rare, self-limiting cervical flexion myelopathy causing progressive, painless distal upper-limb weakness, typically in young Asian males. Loeys-Dietz syndrome (LDS) is a heritable connective tissue disorder due to TGF-β pathway variants, associated with dural ectasia. Their co-occurrence has not previously been reported.</p><p><strong>Case description: </strong>We describe a 23-year-old woman with genetically confirmed LDS type 2 who developed progressive, painless distal upper-limb weakness, initially unilateral and later bilateral. Examination and electrophysiology showed a C7-T1 polyradicular pattern. Dynamic flexion cervical magnetic resonance imaging (MRI) demonstrated anterior displacement of the posterior dural sac at C5-C7, fully reversible on extension, confirming HD.</p><p><strong>Conclusion: </strong>This presentation was atypical for HD (female sex, third-decade onset, bilateral course), yet electrophysiological and dynamic-MRI findings were unequivocal. HD should be considered in patients with heritable connective tissue disease presenting with progressive distal upper-limb weakness, irrespective of sex or age, and dynamic flexion MRI is essential for diagnosis.</p><p><strong>Learning points: </strong>Hirayama disease should be considered in progressive, painless distal upper-limb weakness even outside its classic demographic (young Asian males), including in women and in patients with an underlying connective tissue disorder.Dynamic (flexion) cervical magnetic resonance imaging is required to demonstrate the anterior dural sac displacement that confirms the diagnosis and avoids unnecessary immunomodulatory treatment.Heritable connective tissue disorders such as Loeys-Dietz syndrome may modify cervical dural biomechanics, and internists should be aware of neuromuscular complications beyond the classical cardiovascular, skeletal and dural manifestations.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 10","pages":"007397"},"PeriodicalIF":0.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192246","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":"Behçet's Disease in Non-Endemic Areas: A Delayed Diagnosis in A Young Male With Recurrent Bipolar Aphthosis.","authors":"Mauricio Daniel Cisneros Chávez, Diego Antonio Mendoza Revilla, Victor Gabriel Jimenez Madrigal","doi":"10.12890/2026_006857","DOIUrl":"10.12890/2026_006857","url":null,"abstract":"<p><strong>Introduction: </strong>Behçet's disease (BD) is a rare chronic multisystem inflammatory disorder characterized by vasculitis of vessels of any caliber. It is classically associated with populations along the ancient Silk Road (from the Mediterranean basin to the Far East), but increasing numbers of cases are now reported in non-endemic regions, where delayed diagnosis is common due to low clinical suspicion and the absence of specific diagnostic biomarkers.</p><p><strong>Case description: </strong>We report the case of a 28-year-old man from Mexico with an 18-month history of recurrent painful oral ulcers, later associated with genital ulcers, arthralgias, and cutaneous lesions. The patient had been previously evaluated by multiple physicians and received several empirical treatments without improvement. Physical examination revealed multiple oral and genital ulcers, erythematous macular lesions on the palms and soles, and acneiform lesions on the back. Laboratory and immunological studies were unremarkable, and ophthalmological evaluation was normal. After exclusion of infectious and autoimmune diseases, Behçet's disease was suspected. The patient met the International Criteria for Behçet's Disease (ICBD, 2014) with a total of 5 points. Treatment with azathioprine and prednisone led to progressive clinical improvement.</p><p><strong>Conclusion: </strong>This case highlights the diagnostic challenges of Behçet's disease in non-endemic regions. Awareness of its heterogeneous clinical spectrum and the use of validated clinical criteria are essential to avoid diagnostic delay and prevent irreversible organ damage.</p><p><strong>Learning points: </strong>Behçet's disease should be suspected in patients with recurrent bipolar aphthosis, even in non-endemic regions.The absence of specific biomarkers and histological findings contributes significantly to delayed diagnosis.The International Criteria for Behçet's Disease (ICBD, 2014) provide a sensitive and practical clinical tool for recognizing incomplete but clinically relevant forms of the disease.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 10","pages":"006857"},"PeriodicalIF":0.0,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666620/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192284","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":"Intravascular Large B-Cell Lymphoma Presenting with Rhabdomyolysis and Inflammatory Myositis: A Diagnostic Challenge.","authors":"Queen Okereke, John Wood, Alana Gedrose","doi":"10.12890/2026_007411","DOIUrl":"10.12890/2026_007411","url":null,"abstract":"<p><strong>Introduction: </strong>Intravascular large B-cell lymphoma (IVLBCL) is a rare and aggressive extranodal lymphoma characterised by the proliferation of lymphoma cells within small blood vessels. Distinctively, IVBCL typically lacks the lymphadenopathy, discrete tumour masses, or circulating lymphoma cells characteristic of other lymphomas. This results in substantial diagnostic delays and historically high rates of postmortem diagnosis. Common clinical features of IVLBCL include fever of unknown origin, cytopenias, elevated lactate dehydrogenase, and neurological dysfunction. This case highlights the diagnostic challenges of IVLBCL and an unusual presentation with rhabdomyolysis and inflammatory myositis.</p><p><strong>Case description: </strong>An 80-year-old man presented with recurrent falls, progressive lower limb weakness, fever, and a left foot drop. Investigations revealed bicytopenia, acute kidney injury, and markedly elevated creatine kinase (peaking at 11,200 U/l). Despite extensive negative investigations including positron emission tomography scans and bone marrow biopsy, his condition deteriorated with progressive neurological impairment and evidence of myositis on magnetic resonance imaging (MRI). The diagnosis was established by random deep skin biopsies obtained from clinically normal-appearing skin.</p><p><strong>Conclusion: </strong>IVLBCL should be considered in patients with unexplained fever, cytopenias, and neurological decline. Rhabdomyolysis and myositis-like MRI findings are rare but important manifestations. Random incisional skin biopsy is a key diagnostic tool, offering a high diagnostic yield even in the absence of cutaneous lesions. Early recognition of this clinical constellation and timely random skin biopsy can facilitate diagnosis and enable potentially life-prolonging therapy.</p><p><strong>Learning points: </strong>Intravascular large B-cell lymphoma (IVLBCL) should be suspected in older patients presenting with unexplained fever, cytopenias, elevated lactate dehydrogenase, and progressive neurological dysfunction, particularly when conventional imaging and bone marrow biopsies are unrevealing.IVLBCL may masquerade as an inflammatory myositis, representing an under-recognised manifestation of the disease.Random deep skin biopsy even from clinically normal-appearing skin is a valuable diagnostic tool in suspected IVLBCL, with reported diagnostic yields of above 75%; and should be performed early in the diagnostic workup.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 10","pages":"007411"},"PeriodicalIF":0.0,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192357","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":"Emphysematous Gastritis Precipitated by Malignant Gastric Outlet Obstruction from Advanced Pancreatic Ductal Adenocarcinoma.","authors":"Yong Yang Lim","doi":"10.12890/2026_007418","DOIUrl":"10.12890/2026_007418","url":null,"abstract":"<p><strong>Introduction: </strong>Emphysematous gastritis is a rare, frequently fatal infection of the gastric wall caused by gas-forming organisms. Gastric outlet obstruction is well recognised as a cause of benign gastric emphysema but is seldom reported as a precipitant of emphysematous gastritis. This report adds a rare presentation of emphysematous gastritis with malignant gastric outlet obstruction as a risk factor.</p><p><strong>Case description: </strong>An 86-year-old man with locally advanced pancreatic ductal adenocarcinoma presented after a fall preceded by generalised weakness, abdominal bloating, diarrhoea, nausea and fever. He was hypotensive and tachycardic, with acute kidney injury and severe high anion gap metabolic acidosis. Computed tomography scan demonstrated a markedly distended stomach with intramural gas and distal obstruction from progressive pancreatic malignancy; blood cultures were negative. He was managed non-operatively with aggressive resuscitation, broad-spectrum intravenous antibiotics and gastric decompression, with subsequent clinical, biochemical and radiological improvement.</p><p><strong>Conclusion: </strong>Malignant gastric outlet obstruction, compounded by chemotherapy-related immunosuppression, can precipitate emphysematous gastritis. In selected patients without perforation or ischaemia, even those who are frail and immunocompromised, conservative management can achieve resolution.</p><p><strong>Learning points: </strong>Malignant gastric outlet obstruction from advanced pancreatic cancer can precipitate emphysematous gastritis, a rare and often fatal infection, particularly when compounded by chemotherapy-related immunosuppression.This case adds to the growing evidence that carefully selected patients without perforation or ischaemia can be managed conservatively with antibiotics and gastric decompression rather than surgery.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 10","pages":"007418"},"PeriodicalIF":0.0,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666637/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192262","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":"Acute Hemiparesis as the Initial Manifestation Of Chiari I-Associated Syringomyelia: A Stroke Mimic.","authors":"Suhasini Rallabandi, Robin McFarlane, Ruoyan Zhu, Ipsita Chauhan, Mansi Sharma, Amrut Savadkar, Vimala S Vajjala","doi":"10.12890/2026_007386","DOIUrl":"10.12890/2026_007386","url":null,"abstract":"<p><strong>Introduction: </strong>Syringomyelia is a rare neurological disorder characterised by the formation of a fluid-filled cystic cavity (syrinx) within the spinal cord, most commonly resulting from disruption of cerebrospinal fluid flow. It typically presents as slowly progressive dissociated sensory loss in a cape-like distribution involving bilateral shoulders, upper back, neck and arms, and is often accompanied by muscle weakness.</p><p><strong>Case description: </strong>A 44-year-old female presented with sudden-onset posterior headache followed by right-sided blurred vision, right-sided hemiparesis along with numbness and paraesthesia. The initial evaluation ruled out a stroke. Magnetic resonance imaging (MRI) of the brain and spinal cord revealed an Arnold Chiari-I malformation with an extensive multiseptate syrinx from the cervical spinal cord to the conus medullaris. Multiple teleneurology consultations with multiple repeat imaging failed to elucidate the cause of the patient's progressive symptoms. Persistent and progressive neurological deterioration prompted a transfer for an in-person neurology evaluation where the definitive diagnosis was made, resulting in urgent transfer to a tertiary level centre for emergent posterior fossa decompression.</p><p><strong>Conclusion: </strong>This case highlights an unusual presentation of syringomyelia with acute, rapidly progressive unilateral neurological deficits without an identifiable precipitating event, closely mimicking acute ischaemic stroke. It emphasises the need to maintain a broad differential diagnosis when the presentation is atypical, or investigations do not explain the neurological deficits. This case also underscores the importance of comprehensive bedside neurological examination, as reliance on teleneurology may delay diagnosis. Early recognition and timely neurosurgical intervention can result in substantial neurological recovery.</p><p><strong>Learning points: </strong>Syringomyelia should be considered in the differential diagnosis of patients presenting with atypical unilateral neurological deficits when imaging studies are non-conclusive for stroke.Careful neurological examination remains crucial in distinguishing spinal cord disorders from cerebral causes of weakness.Syringomyelia presenting with acute, rapidly progressive neurological deficits and spinal cord compression requires urgent neurosurgical evaluation and intervention.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 10","pages":"007386"},"PeriodicalIF":0.0,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666566/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192279","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":"Isolated Ulnar Artery Occlusion with Concurrent Internal Jugular Vein Thrombosis in Severe Iron-Deficiency Anaemia.","authors":"Zahraa H Alhaboobi, Mohammad Kais A Jawish, Abdullah Layth Alshawi, Abdulrahman Jihad Homsi, Mohammad Fahmawi, Albatole Imad Spereeg, Touseef A Kazmi","doi":"10.12890/2026_007395","DOIUrl":"10.12890/2026_007395","url":null,"abstract":"<p><strong>Introduction: </strong>Severe iron deficiency anaemia (IDA) is increasingly recognized as a cause of a reversible hypercoagulable state, although simultaneous arterial and venous thrombosis are rare. Several mechanisms have been proposed, including reactive thrombocytosis, endothelial dysfunction, and changes in erythrocyte rheology, which may be secondary to reduced tissue oxygenation.</p><p><strong>Case description: </strong>We report the case of a 41-year-old woman with chronic menorrhagia due to fibroids who developed digital cyanosis and neurologic deficits due to severe microcytic anaemia (Hb 6.7 g/dl), associated with severe iron deficiency and mild thrombocytosis (442 ×10⁹/l). She was discharged after blood transfusion with therapy for Raynaud phenomenon (amlodipine) but returned to the emergency room due to an acute right ulnar artery occlusion complicated by internal jugular vein thrombosis that was managed with embolectomy and anticoagulation. Her digital function fully recovered, and she remained free of thrombophilia.</p><p><strong>Conclusion: </strong>Our case highlights the potential for severe IDA to cause both arterial and venous thrombosis, even in the setting of only modest platelet elevations. Chronic tobacco use may have contributed to her presentation, and clinicians should remain aware of the possibility of thrombosis in patients presenting with severe IDA who do not have other known pro-thrombotic conditions.</p><p><strong>Learning points: </strong>Severe iron deficiency anaemia can cause both arterial and venous thrombosis even in the setting of only mildly elevated platelet count, so platelet count alone should not be used as a determinant for thrombotic risk.Painless discoloration of the digits with diminished or non-existent pulse on examination in a young patient with no vascular risk factors requires vascular imaging prior to arriving at a diagnosis of Raynaud phenomenon, as the presentation can mimic acute arterial occlusion and require urgent intervention.A negative workup for thrombophilia and autoimmune disease cannot be used to rule out the possibility of a prothrombotic state, as severe iron deficiency anaemia can act as a prothrombotic trigger.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 10","pages":"007395"},"PeriodicalIF":0.0,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192369","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}