European journal of case reports in internal medicine最新文献

{"title":"Myopericarditis Secondary to Silent Autoimmune Thyroiditis: A Case of Severe Thyrotoxicosis.","authors":"Pavel Antonio Montes Hernández, Dylani Rosa Ávila Salcedo, Jorge Alejandro Ayala San Pedro","doi":"10.12890/2025_005526","DOIUrl":"10.12890/2025_005526","url":null,"abstract":"<p><strong>Introduction: </strong>Myopericarditis is an uncommon but potentially severe complication of thyroid dysfunction. Although cardiovascular manifestations of hyperthyroidism are well documented, its association with myocardial and pericardial inflammation is rare and diagnostically challenging.</p><p><strong>Case presentation: </strong>A 36-year-old previously healthy male presented with precordial chest pain and a 1-month history of diarrhoea, heat intolerance, palpitations, and unintentional weight loss. Laboratory evaluation revealed elevated cardiac biomarkers, and electrocardiogram showed diffuse ST-segment elevation suggestive of acute pericarditis. Coronary angiography demonstrated no obstructive coronary lesions. Thyroid function tests revealed suppressed TSH and markedly elevated free T4, with positive anti-thyroglobulin antibodies. Thyroid scintigraphy confirmed decreased uptake consistent with thyroiditis. A diagnosis of myopericarditis secondary to silent autoimmune thyroiditis was established. The patient was treated with nonsteroidal anti-inflammatory drugs, colchicine, beta-blockers, and methimazole, achieving complete clinical and biochemical recovery.</p><p><strong>Conclusion: </strong>This case emphasizes the importance of considering thyroid dysfunction in patients presenting with myopericarditis. Early recognition and targeted management can reverse myocardial injury and optimize patient outcomes.</p><p><strong>Learning points: </strong>Myopericarditis may be the initial and sole manifestation of silent autoimmune thyroiditis. Thyroid function testing should be routinely considered in young patients with chest pain and elevated troponins but normal coronary arteries.Early identification of thyroid dysfunction allows complete reversal of cardiac involvement with appropriate endocrine and anti-inflammatory treatment, preventing unnecessary invasive procedures.This case highlights a practical diagnostic pitfall that internists may encounter and underscores the importance of integrating endocrine evaluation in unexplained cardiac presentations.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 7","pages":"005526"},"PeriodicalIF":0.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12236635/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599812","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 Case of Polyserositis with Pericarditis Caused by <i>Mycobacterium SPP</i>.","authors":"Filipa Figueiredo, Teresa Valido, Jéssica Oliveira, Carolina Chumbo, Joana Batista Paulo, Garcieth Gomes, Marta Rocha","doi":"10.12890/2025_005548","DOIUrl":"10.12890/2025_005548","url":null,"abstract":"<p><p>The incidence of diseases and deaths caused by non-tuberculous mycobacteria (NTM) has been increasing globally. However, the broad and nonspecific clinical manifestations of NTM infections make diagnosis challenging, compounded by the difficulty in isolating NTM organisms. While NTM are rarely associated with heart disease, including pericarditis, and pleural effusion, such presentations are exceptional. We report the case of an 85-year-old female who presented with polyserositis, characterized by pleural and pericardial effusion, and was diagnosed with an unusual manifestation of NTM infection causing pericarditis. Initially, the patient was misdiagnosed with tuberculosis, which delayed the correct diagnosis and appropriate treatment. Upon accurate diagnosis, her condition improved with adjustments to the treatment regimen. This case highlights the importance of considering NTM infection in the differential diagnosis, particularly when faced with atypical presentations. Early recognition and timely microbiological testing are crucial for accurate diagnosis, enabling targeted treatment and improving patient outcomes.</p><p><strong>Learning points: </strong>Non-tuberculous mycobacteria infection can have non-specific presentations such as weight loss and night sweats, which are similar to lymphomas and tuberculosis.Unusual presentations of non-tuberculous mycobacteria infection, such as pleural effusions and pericarditis, can occur.Diagnosis is needed to ensure the correct treatment and may require polymerase chain reaction testing.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 7","pages":"005548"},"PeriodicalIF":0.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12236685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599775","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 Rare Case of Esophageal Intramural Pseudodiverticulosis.","authors":"Manhal Aldaher, Mohamed Elbayoumy, Abdulrahman Alangari, Ibrahim Alruzug","doi":"10.12890/2025_005609","DOIUrl":"10.12890/2025_005609","url":null,"abstract":"<p><p>We report the case of a 45-year-old male who presented with 10-month progressive dysphagia to solids and liquids and was subsequently diagnosed with oesophageal intramural pseudodiverticulosis (EIPD). EIPD is an uncommon benign condition characterized by multiple small outpouchings within the oesophageal wall, measuring about 1-4 mm in length and 1-2 mm in width. This case emphasizes the importance of thorough diagnostic evaluation to exclude associated conditions and potential complications. The patient's symptoms, diagnostic workup, and treatment approaches are discussed, emphasizing the importance of recognizing this rare condition in the differential diagnosis of dysphagia and highlighting the importance of patient follow-up for optimal patient outcomes and to avoid complications. The clinical presentation can vary, but dysphagia is the most common symptom. Treatment of oesophageal intramural pseudodiverticulosis has historically been limited to addressing the underlying condition and symptom management with acid suppression, anti-fungal therapy, and endoscopic dilation in areas of stricture.</p><p><strong>Learning points: </strong>Oesophageal intramural pseudodiverticulosis should be considered in any patient with chronic dysphagia, even in younger, healthy individuals without traditional risk factors.Definitive diagnosis requires a comprehensive multimodal workup-endoscopy, barium oesophagography, manometry, pH monitoring, and biopsies-to exclude other aetiologies.Symptomatic relief and disease stability are typically achieved through conservative management with proton pump inhibitors and tailored dietary modifications.Scheduled follow-up with periodic clinic reviews and repeat endoscopy is essential to monitor for stricture formation, rare perforations, or potential malignant transformation.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 7","pages":"005609"},"PeriodicalIF":0.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12236678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599804","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":"<i>Lactobacillus Rhamnosus</i>, a Bacterium Commonly Found in the Gut and Used in Probiotic Supplements, as a Cause of Endocarditis in a Patient with a Surgical Aortic Valve Replacement and Recent Dental Cleaning.","authors":"Kade Wagers, Raumin Neuville, Casey Strobelt, Richard Rose","doi":"10.12890/2025_005545","DOIUrl":"10.12890/2025_005545","url":null,"abstract":"<p><p><i>Lactobacillus rhamnosus</i> endocarditis is a rare but significant complication in patients with mechanical heart valves. We present a case of a 73-year-old male with a mechanical aortic valve who developed endocarditis following a routine dental cleaning, despite receiving standard of care prophylactic antibiotics. Blood cultures confirmed <i>L. rhamnosus</i>, and imaging highlighted persistent inflammation around the mechanical valve. Management focused on evolving antibiotic therapy with close routine monitoring. This case underscores the diagnostic challenges and therapeutic complexities of <i>Lactobacillus</i>-related endocarditis and highlights the need for heightened vigilance in at-risk populations following invasive procedures. Further research is warranted to optimize management strategies for this uncommon pathogen.</p><p><strong>Learning points: </strong>This case highlights the importance of considering <i>Lactobacillus</i> species as potential pathogens in patients with mechanical valves, particularly those with specific risk factors that may promote translocation of this bacterium.Early recognition with appropriate workup including blood cultures and imaging, with timely initiation of antibiotic therapy is key to ensuring positive outcomes for patients with <i>Lactobacillus</i> endocarditis.There remains the need for vigilant follow-up and monitoring in <i>Lactobacillus</i> endocarditis to assess for efficacy and complications through the disease course even in the setting of standard of care treatment, including prophylactic antibiotics.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 7","pages":"005545"},"PeriodicalIF":0.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12236636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599773","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":"Tuberculous Meningitis and Hemophagocytic Lymphohistiocytosis in a Patient on Adalimumab: Diagnostic Challenges in the Setting of Suspected Non-Tuberculous Mycobacteria Co-Infection.","authors":"Dimitrios Dimitriadis, Irene Terzi, Ioulia Dragoumani, Konstantinos Liapis, Dimitrios Papazoglou","doi":"10.12890/2025_005590","DOIUrl":"10.12890/2025_005590","url":null,"abstract":"<p><strong>Background: </strong>Tumour necrosis factor-alpha (TNF-alpha) inhibitors increase susceptibility to granulomatous infections, including both <i>Mycobacterium tuberculosis</i> (MTB) and nontuberculous mycobacteria. We describe a complex case of sequential disseminated <i>Mycobacterium avium complex</i> (MAC) and central nervous system MTB infection in a patient treated with adalimumab, complicated by hemophagocytic lymphohistiocytosis (HLH).</p><p><strong>Case report: </strong>A 65-year-old man on long-term adalimumab for psoriasis presented with prolonged fever, hepatosplenomegaly, cytopenia and elevated inflammatory markers. Bone marrow aspiration revealed hemophagocytosis and liver and bone marrow biopsy revealed granulomatous inflammation. Polymerase chain reaction (PCR) testing of bronchoalveolar lavage (BAL) fluid identified MAC, supporting a diagnosis of disseminated MAC-associated HLH. The patient responded to triple MAC therapy (azithromycin, ethambutol, rifampicin), intravenous immunoglobulin and low-dose corticosteroids, with rapid clinical improvement. Three months later, he was readmitted with fever and altered mental status. Brain magnetic resonance imaging showed meningeal thickening. Lumbar puncture revealed cerebrospinal fluid pleocytosis, hypoglycorrhachia and elevated protein. PCR detected MTB complex deoxyribonucleic acid and a rifampicin resistance gene, prompting the initiation of a four-drug antituberculosis regimen (isoniazid, pyrazinamide, levofloxacin, ethambutol) and high-dose dexamethasone. The patient improved and was discharged after a month of hospitalization, remaining clinically stable at 1-year follow-up.</p><p><strong>Conclusion: </strong>This case highlights the risk of sequential or overlapping MAC and MTB infections in patients receiving TNF-alpha inhibitors, the potential for HLH as a serious complication, and the diagnostic value and limitations of BAL PCR testing. Vigilant screening and multidisciplinary management are essential in such high-risk populations.</p><p><strong>Learning points: </strong>The increased risk of opportunistic infections associated with long-term tumour necrosis factor-alpha inhibitor use necessitates ongoing infection screening.Hemophagocytic lymphohistiocytosis triggered by mycobacterial infections requires prompt recognition and targeted treatment.Polymerase chain reaction results should be interpreted with caution in complex clinical scenarios, as deoxyribonucleic acid detection may indicate colonization rather than active infection.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 7","pages":"005590"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12236640/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599816","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 Rare Cause of Heart Failure in a Young Female: Rupture of a Sinus of Valsalva Aneurysm into the Right Atrium.","authors":"Leila Bigdelu, Ossama Maadarani, Ali Azari, Zouheir Bitar","doi":"10.12890/2025_005582","DOIUrl":"10.12890/2025_005582","url":null,"abstract":"<p><p>The aortic sinuses of Valsalva are small pouches typically located above the aortic valve and play a crucial role in allowing the aortic valve leaflets to move freely and in supporting the valve itself. Enlargement and dilatation of one or more of these sinuses may result in aneurysm formation that can be complicated with either compression-like effects or spontaneous rupture. A sinus of Valsalva aneurysm (SVA) is a rare cardiac anomaly. We present a case of acute heart failure in a young female caused by spontaneous rupture of an SVA that was diagnosed by echocardiography and required surgical treatment.</p><p><strong>Learning points: </strong>Sinus of Valsalva aneurysm is a rare cardiac anomaly that can be either congenital or acquired and usually remains silent until rupture, which is considered a life-threatening condition with a high mortality rate.Echocardiography is a diagnostic tool that plays a crucial role in arousing suspicion for and confirming the anatomical connection between the ruptured sinus and the cardiac chamber. Timely diagnosis is critical, and management depends on the aneurysm's size, location, and whether rupture has occurred.Asymptomatic cases may be monitored, while symptomatic or ruptured aneurysms generally require surgical repair or transcatheter intervention to prevent catastrophic outcomes.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 7","pages":"005582"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12236634/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599805","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":"Trimethylaminuria In A 58-Year-Old Male with Liver Cirrhosis and Hepatitis C.","authors":"Martina Knapp","doi":"10.12890/2025_005520","DOIUrl":"10.12890/2025_005520","url":null,"abstract":"<p><p>Trimethylaminuria (TMAU), also known as fish odor syndrome, is a rare metabolic disorder resulting from a deficiency in the enzyme flavin-containing monooxygenase 3, which is responsible for the detoxification of trimethylamine produced during the metabolism of certain foods. This case report describes a 58-year-old male who presented with a sudden onset of fish-like body odor, diagnosed with secondary TMAU likely triggered by liver cirrhosis and dietary supplements. The report outlines the clinical presentation, diagnostic approach, and management strategies for this rare condition.</p><p><strong>Learning points: </strong>Doctors must be aware of the side effects of dietary supplements and actively ask about their use.Trimethylaminuria is a rare metabolic disorder, but doctors should be aware of it.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 7","pages":"005520"},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12236676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599815","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":"Vexas Syndrome in a Moroccan Patient: The Story of a Two-Year Diagnostic Lag.","authors":"Abire Allaoui, Lilia Zizi, Halima Hadri, Doha Kabil, Ahmed Aziz Bousfiha, Abdelhamid Naitlho, Mohamed Adnaoui","doi":"10.12890/2025_005419","DOIUrl":"10.12890/2025_005419","url":null,"abstract":"<p><strong>Background: </strong>VEXAS syndrome, also known as vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic syndrome, is a newly identified genetic condition characterised by a combination of autoinflammatory symptoms and myeloid dysplasia. The initial description was documented in 2020 and since then, there has been an increasing number of cases and series reported globally.</p><p><strong>Case description: </strong>We present a case of VEXAS syndrome in an 88-year-old male patient. The patient has a p.Met41Val mutation in the UBA1 gene with notable skin, joint and lung involvement. As far as we know, this is the first documentation of VEXAS syndrome in Morocco and Africa. This condition may exhibit characteristics of recurrent fever, neutrophilic dermatitis, arthritis and chondritis, along with cytopaenias and myelodysplastic syndrome. The p.Met41Val mutation is known to be associated with severe clinical presentation and poor prognosis, with less chondritis involvement and more undifferentiated inflammatory syndrome, as seen in the described case.</p><p><strong>Conclusions: </strong>VEXAS syndrome represents a prototype for a new classification of diseases, although it is still insufficiently identified in many underdeveloped countries, especially in Africa. It should be considered in elderly males with unexplained fever associated with systemic manifestations and worsening haematologic abnormalities.</p><p><strong>Learning points: </strong>This is the first documentation of VEXAS syndrome in Morocco and Africa, underscoring the technical challenges in the diagnosis of VEXAS disease in this part of the world.Fever and myelodysplastic syndrome in adults should suggest the diagnosis of VEXAS syndrome.A p.Met41Val mutation in the UBA1 gene is related to an increased mortality.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 7","pages":"005419"},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12236677/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599819","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":"¹⁸FDG PET/CT is Sensitive but not Specific for Malignancy: Two Cases of Disseminated Tuberculosis Mimicking Metastatic Cancer on Imaging and Clinical Presentation.","authors":"Maxime Collin, Bruno Krug, Marie-Cécile Nollevaux, Fanny Collette, Quentin Gilliaux, Laurence Faugeras, Lionel D'Hondt","doi":"10.12890/2025_005475","DOIUrl":"10.12890/2025_005475","url":null,"abstract":"<p><strong>Introduction: </strong>¹⁸Fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸FDG PET/CT) scan is widely used in the evaluation of suspected tumoral processes. In addition to its oncological applications, it is also employed in the diagnosis and follow-up of various conditions, including multiorgan tuberculosis.</p><p><strong>Case description: </strong>We report a case series of two young patients with exclusive extrapulmonary disseminated tuberculosis that mimicked a neoplastic process both clinically and on ¹⁸FDG PET/CT imaging. Initially, both patients were admitted to the oncology unit with a presumed diagnosis of cancer. However, following an exhaustive work-up, a definitive diagnosis of tuberculosis was established via histopathological and microbiological analysis.</p><p><strong>Conclusion: </strong>These cases underscore the importance of considering disseminated tuberculosis as a differential diagnosis during oncologic evaluations, especially in patients from endemic regions, and highlight the potential psychological impact of prematurely labelling a condition as cancer.</p><p><strong>Learning points: </strong>Extrapulmonary tuberculosis can mimic metastatic malignancies.Imaging does not replace pathology, which remains the gold standard for accurately diagnosing multiorgan involvement.Prematurely announcing a diagnosis of cancer before final confirmation can have significant psychological consequences.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 7","pages":"005475"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12236639/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599774","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":"Unexpected Falsely High Vancomycin Concentrations in a Patient with Endocarditis During Routine Therapeutic Drug Monitoring.","authors":"Laura Galán-Caballero, María Rosario Salas-Butrón, Daniel Lozano-Martín, Iván Alejandro Díaz-Rengifo, Isabel Ortega-Madueño, Lucia Diaz-Garcia, Ana Isabel Terleira-Fernández","doi":"10.12890/2025_005464","DOIUrl":"10.12890/2025_005464","url":null,"abstract":"<p><strong>Introduction: </strong>Vancomycin is a glycopeptide antibiotic indicated for the treatment of infections caused by methicillin-resistant <i>Staphylococcus aureus</i>. Appropriate vancomycin therapeutic drug monitoring is an essential exercise to improve the achievement of the target therapeutic levels.</p><p><strong>Case description: </strong>An 87-year-old female was admitted with diagnosis of endocarditis. She was started on antibiotic therapy with intravenous vancomycin. The first vancomycin level registered in our hospital was 36.4 μg/ml. Because this value exceeded the critical threshold (15-20 μg/ml) the prescription was interrupted. New vancomycin concentration tests were indicated for the next days with 65.8 μg/ml, 73 μg/ml, 55.1 μg/ml, 77.9 μg/ml and 100 μg/ml results. Two samples were reanalysed in Hospital Universitario La Paz and were undetectable. Our Clinical Analysis Department found an analytical interference; however, the responsible molecule could not be identified, so the clinical team changed antibiotic treatment to daptomycin, and the infectious condition of the patient improved.</p><p><strong>Conclusions: </strong>It is recommended that clinicians have a high index of suspicion to investigate cases where drug concentrations do not correlate with clinical expectations. Healthcare professionals need to understand that occasional interference still occurs due to the binding of proteins.</p><p><strong>Learning points: </strong>Unknown compounds or mechanisms may interfere with vancomycin assays.Assay interference should be suspected in patients with persistently high vancomycin levels who continue to deteriorate clinically.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 7","pages":"005464"},"PeriodicalIF":0.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12236687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599817","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}