European journal of case reports in internal medicine最新文献

{"title":"Unmasking Vexas Syndrome: A Rare Case with Crescentic Glomerulonephritis.","authors":"Tattvam Shah","doi":"10.12890/2026_006560","DOIUrl":"https://doi.org/10.12890/2026_006560","url":null,"abstract":"<p><strong>Introduction: </strong>VEXAS (vacuoles, E1-enzyme, X-linked, autoinflammation, and somatic) syndrome is a newly recognized autoinflammatory hematologic condition due to mutations in the <i>UBA1</i> gene. This case demonstrates its clinical variability, such as neutrophilic dermatosis, pulmonary disease, and a rare presentation with acute kidney injury and glomerulonephritis.</p><p><strong>Case description: </strong>A 77-year-old man with a history of benign prostatic hyperplasia, osteoarthritis, and patent foramen ovale presented with fatigue, night sweats, weight loss, and recurrent rashes, diagnosed as neutrophilic dermatosis. Laboratory results were pancytopenia and nephrotic-range proteinuria, and imaging revealed mediastinal lymphadenopathy and pulmonary ground-glass opacities. Bone marrow biopsy showed hypercellularity with vacuolization of myeloid and erythroid precursors. Renal biopsy revealed proliferative necrotizing and crescentic glomerulonephritis. Genetic analysis confirmed the UBA1 p.Met41Val mutation, diagnosing VEXAS syndrome. Treatment with corticosteroids, tocilizumab, and mycophenolate mofetil initially improved the symptoms, but steroid dependence continued. Severe pancytopenia necessitated changing to azacitidine after a year, and the patient was assessed for stem cell transplantation. His course was additionally complicated by neutrophilic pulmonary alveolitis.</p><p><strong>Conclusion: </strong>VEXAS syndrome presents with recurring fever, arthritis, pulmonary and cutaneous involvement, and cytopenias. Diagnosis needs to be entertained in the context of cryptic cytopenias and antineutrophil cytoplasmic antibodies (ANCA)-negative vasculitis. Renal involvement is atypical, especially in ANCA negative cases. Treatment continues to remain difficult, with the initial first-line therapy as high-dose glucocorticoids, with the alternative options being Janus kinase inhibitors, interleukin-6 inhibitors, and stem cell transplant. The case highlights the value of identifying both characteristic and atypical presentations of VEXAS syndrome. Prompt genetic testing is essential in diagnosis, and management entails a multidisciplinary strategy.</p><p><strong>Learning points: </strong>VEXAS (vacuoles, E1-enzyme, X-linked, autoinflammation, and somatic) syndrome should be considered in patients with unexplained cytopenias, systemic inflammation, or atypical vasculitis.VEXAS syndrome is caused by a mutation of the UBA1 p.Met41Val gene.VEXAS syndrome usually presents itself as glomerulonephritis in antineutrophil cytoplasmic antibodies (ANCA) positive patients. However, it can be rarely present in ANCA negative patients too.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 4","pages":"006560"},"PeriodicalIF":0.0,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13078764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688432","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":"Early Detection of Nebivolol-Induced Hepatotoxicity.","authors":"Anna M Torunova, Victoria V Kireeva, Ilia S Kurganskii","doi":"10.12890/2026_006549","DOIUrl":"https://doi.org/10.12890/2026_006549","url":null,"abstract":"<p><strong>Introduction: </strong>Nebivolol, a third-generation selective β1-adrenergic receptor antagonist possessing vasodilatory properties, is characterised by a favourable safety profile. However, isolated cases of drug-induced liver injury (DILI) associated with its use have been documented in the literature.</p><p><strong>Case description: </strong>We present a case of hepatotoxicity in a 58-year-old female patient with a history of arterial hypertension, obesity and impaired glucose tolerance. Eight weeks after initiating nebivolol therapy (2.5 mg daily), a significant elevation in liver enzymes was observed: alanine aminotransferase (134.5 U/l), aspartate aminotransferase (118.1 U/l) and alkaline phosphatase (182.1 U/l), compared to previously normal baseline values. After excluding other potential causes (viral hepatitis, alcohol consumption, biliary obstruction), nebivolol was discontinued. Subsequent clinical and laboratory improvement was noted: transaminase levels decreased significantly within two weeks, and biochemical parameters had almost completely normalised after two months. The Naranjo Adverse Drug Reaction Probability Scale score was 7, indicating a probable causal relationship. Subsequent replacement of nebivolol with metoprolol did not result in recurrent hepatic dysfunction.</p><p><strong>Conclusion: </strong>This case substantiates the potential for idiosyncratic mixed-type hepatotoxicity associated with nebivolol administration. Although rare, this report underscores the importance of clinical vigilance and the consideration of DILI in cases of unexplained liver enzyme elevations in patients receiving this agent. Monitoring of liver function during the initial months of therapy is advisable, particularly in patients with underlying comorbidities.</p><p><strong>Learning points: </strong>Nebivolol, despite its favourable safety profile can, rarely, cause significant mixed-type (hepatocellular-cholestatic) liver injury.Early recognition of drug-induced liver injury and prompt discontinuation of the offending agent are crucial for complete recovery.Monitoring of liver enzymes during the initial weeks of nebivolol therapy should be considered, especially in patients with metabolic risk factors.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 4","pages":"006549"},"PeriodicalIF":0.0,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13078758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688988","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":"Pneumoperitoneum Following Perineal Air Insufflation can be Managed Conservatively.","authors":"Mohammad Alabdallat, Ammar Almadani, Murad Alahmad, Ahmad Kloub, Ayman El-Menyar, Sandro Rizoli, Hassan Al-Thani","doi":"10.12890/2026_006464","DOIUrl":"https://doi.org/10.12890/2026_006464","url":null,"abstract":"<p><strong>Introduction: </strong>Pneumoperitoneum is commonly associated with a perforated hollow viscus and often prompts emergency surgical intervention. However, not all cases necessitate operative management. A rare but important cause of pneumoperitoneum is air insufflation through the perianal route, which can lead to extensive subcutaneous emphysema and intra-abdominal free air without evidence of visceral perforation.</p><p><strong>Case description: </strong>We present a case of pneumoperitoneum following perianal air insufflation managed conservatively after a thorough clinical and radiological assessment revealed no indication for surgery.</p><p><strong>Conclusion: </strong>This case underscores the importance of distinguishing non-surgical from surgical pneumoperitoneum. Early recognition and appropriate conservative treatment can prevent unnecessary operative interventions and their associated risks.</p><p><strong>Learning points: </strong>High-pressure air insufflation through the rectum is a rare but potentially severe form of trauma.This can lead to pneumoperitoneum that requires exploratory laparotomy in some cases.However, such traumatic pneumoperitoneum can be treated conservatively after excluding the presence of perforation.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 4","pages":"006464"},"PeriodicalIF":0.0,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13078752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147687538","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":"Pulmonary Embolism or Pulmonary Artery Intimal Sarcoma? Diagnostic Pitfalls in a Rare Vascular Malignancy.","authors":"Raffaele Natale, Sara Mangiacapra, Natalina Iuliano, Mariagrazia Nunziata, Valeria Iorio, Maria Amitrano, Lidia Santarpia","doi":"10.12890/2026_006384","DOIUrl":"https://doi.org/10.12890/2026_006384","url":null,"abstract":"<p><p>Pulmonary artery obstruction is commonly attributed to pulmonary embolism; however, rare malignant conditions may present with similar clinical and radiological findings. Failure to recognize these alternative diagnoses may result in inappropriate treatment and delayed management. We report the case of a 48-year-old man presenting with acute dyspnoea and cough. Computed tomography angiography revealed a filling defect in the right main pulmonary artery, and pulmonary embolism was diagnosed. Despite appropriate anticoagulant therapy, the patient's clinical condition progressively deteriorated. The absence of deep vein thrombosis and the lack of right heart strain prompted diagnostic reconsideration. Endobronchial ultrasound-guided fine-needle aspiration revealed malignant spindle cell proliferation, and immunohistochemistry confirmed pulmonary artery intimal sarcoma. This case highlights the importance of reconsidering the diagnosis when clinical improvement does not occur despite adequate anticoagulation. Pulmonary artery obstruction should not automatically be attributed to thromboembolism, and malignancy must be considered in the differential diagnosis.</p><p><strong>Learning points: </strong>Pulmonary artery obstruction should not automatically be attributed to thromboembolism, as rare malignancies may present with similar findings.Lack of clinical improvement despite appropriate anticoagulant therapy should prompt immediate diagnostic reconsideration.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 4","pages":"006384"},"PeriodicalIF":0.0,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13078743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147687582","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":"Acquired Thrombotic Thrombocytopenic Purpura with a Poor Response to Treatment can be an Initial Manifestation of Occult Signet Ring Cell Carcinoma and other Malignancies.","authors":"Mohammad Ahmad, Mahmoud Alhamadeh Alswij, Mais Musleh, Hala Hamdan, Qossay Alhusein","doi":"10.12890/2026_006332","DOIUrl":"https://doi.org/10.12890/2026_006332","url":null,"abstract":"<p><strong>Introduction: </strong>Acquired thrombotic thrombocytopenic purpura (aTTP) is a severe microangiopathic hemolytic anemia (MAHA) characterized by profound ADAMTS13 deficiency. MAHA can also manifest as a paraneoplastic syndrome, particularly in advanced malignancies, with cancer-associated MAHA (CA-MAHA) linked to signet ring cell carcinoma being exceptionally rare.</p><p><strong>Case description: </strong>We present the case of a 42-year-old Arab male who initially presented with classic features of aTTP, including severe MAHA, profound thrombocytopenia, and renal and neurological dysfunction, confirmed by an ADAMTS13 activity level of 6%. Despite standard TTP therapy including plasma exchange, his atypical response and rapid deterioration prompted further investigation, leading to the diagnosis of aggressive, metastatic signet ring cell carcinoma. Tragically, he passed away less than a week after first presentation.</p><p><strong>Conclusion: </strong>This case underscores the critical importance of maintaining a high index of suspicion for occult malignancies in patients with atypical thrombotic microangiopathy presentations, especially those with an incomplete response to conventional TTP therapies. It emphasizes the need for comprehensive diagnostic workup and a multidisciplinary approach to manage these complex and often fatal conditions, as early identification of underlying cancer is crucial for guiding appropriate, often tumour-directed, therapy and improving patient outcomes.</p><p><strong>Learning points: </strong>An atypical response to standard thrombotic thrombocytopenic purpura therapy warrants immediate investigation for alternate diagnoses.Underlying malignancy should be actively considered in patients presenting with thrombotic microangiopathy, particularly in cases with atypical features, poor response to standard therapy, or rapid clinical deterioration.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 4","pages":"006332"},"PeriodicalIF":0.0,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13078742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688969","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>Vibrio Albensis</i> Bacteraemia in a Decompensated Cirrhotic Patient with an Atypical Transmission Source.","authors":"Thi Thu Huong Dinh, Quoc Phuong Nguyen, Thi Thuy Bui, Kim Nam Nguyen","doi":"10.12890/2026_006357","DOIUrl":"https://doi.org/10.12890/2026_006357","url":null,"abstract":"<p><strong>Introduction: </strong><i>Vibrio albensis</i> is a rare Gram-negative halophilic bacterium belonging to the <i>Vibrio cholerae</i> non-O1/non-O139 (NOVC) group, which rarely causes infections in humans. To date, only approximately 5 cases of <i>V. albensis</i> infection in humans have been reported in the global medical literature. This bacterium is typically found in marine and brackish water environments (estuaries), with primary transmission routes including exposure to seawater through open wounds or the consumption of raw seafood.</p><p><strong>Case description: </strong>We report a 49-year-old male with decompensated cirrhosis secondary to alcohol abuse and hepatitis C virus infection who presented with acute liver failure. On day 5 of hospitalization, the patient developed fever (39.5°C) and rigors. Two sets of blood cultures were positive for <i>V. albensis</i>. Notably, the patient denied any recent exposure to seawater, brackish water, or raw seafood consumption. The isolate demonstrated full susceptibility to all tested antimicrobial agents. The patient was successfully treated with ertapenem combined with levofloxacin for 7 days and discharged in stable condition after 11 days of hospitalization.</p><p><strong>Conclusion: </strong>This is a rare case with distinctive features: (1) <i>V. albensis</i> bacteraemia without typical environmental exposure, (2) to the best of our knowledge the first reported case of hospital-acquired <i>V. albensis</i> infection, and (3) the case supports the hypothesis of opportunistic pathogenic bacteria originating from the gastrointestinal tract in a cirrhotic patient. This case emphasizes the importance of microbiological diagnosis and careful monitoring of infectious complications in immunocompromised patients.</p><p><strong>Learning points: </strong><i>Vibrio albensis</i> is an extremely rare pathogenic organism in humans, with only 5 previously reported cases worldwide.Liver cirrhosis is a significant risk factor for invasive <i>Vibrio albensis</i> infection due to compromised immune function.Hospital-acquired infection with an unknown source suggests alternative transmission routes that warrant further investigation.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 4","pages":"006357"},"PeriodicalIF":0.0,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13078762/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147689023","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":"Unprovoked Pulmonary Embolism with Bilateral Deep Vein Thrombosis Revealing Occult Nephrotic Syndrome Due to Seronegative Membranous Nephropathy.","authors":"Seyma Eser, Andreas Serra, Martina Kleber, Felix Brombacher","doi":"10.12890/2026_006359","DOIUrl":"https://doi.org/10.12890/2026_006359","url":null,"abstract":"<p><strong>Introduction: </strong>Nephrotic syndrome is a well-recognised risk factor for venous thromboembolism (VTE) but may present without oedema, hyperlipidaemia or impaired kidney function, delaying diagnosis.</p><p><strong>Case description: </strong>A 73-year-old man presented with fatigue, exertional dyspnoea and weight loss over a period of three months. Computed tomography pulmonary angiography showed bilateral central pulmonary emboli. Cardiac biomarkers were elevated with preserved renal function. Therapeutic anticoagulation was initiated. To assess thrombus extent and guide management, lower limb compression ultrasonography was performed and revealed bilateral popliteal deep vein thrombosis. Urinalysis demonstrated nephrotic-range proteinuria (8 g/day) with hypoalbuminaemia and microscopic haematuria. Evaluation for other secondary causes of thrombembolism was unremarkable. Anti-phospholipase A2 receptor and thrombospondin type-1 domain-containing 7A antibodies were negative. Corticosteroid treatment was commenced. A transjugular kidney biopsy confirmed membranous nephropathy, and rituximab was administered for long-term immunosuppressive management.</p><p><strong>Discussion: </strong>This case illustrates that nephrotic syndrome can be clinically occult and should be considered in unprovoked or extensive VTE, particularly when bilateral deep vein thrombosis is present.</p><p><strong>Conclusion: </strong>Urine dipstick testing, and serum albumin should be considered early in the work-up of unexplained VTE, even in the absence of oedema or reduced estimated glomerular filtration rate.</p><p><strong>Learning points: </strong>Occult nephrotic syndrome can present with extensive or unprovoked venous thromboembolism despite normal estimated glomerular filtration rate and absent oedema - include urine dipstick testing and serum albumin early in the work-up.Lower limb compression ultrasonography can help define thrombus extent and guide management in pulmonary embolism. Bilateral deep vein thrombosis is uncommon and should prompt an expanded search for secondary causes.Negative anti-phospholipase A2 receptor and thrombospondin type-1 domain-containing 7A serology does not exclude membranous nephropathy. Kidney biopsy should be pursued when nephrotic-range proteinuria and hypoalbuminaemia are present.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 4","pages":"006359"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13078757/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688439","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":"Urinary Ascites Secondary to Recurrent Spontaneous Bladder Rupture Mimicking Renal Failure: A Diagnostic Odyssey in a Post-Radiation Patient.","authors":"Bettina Schreiber, Nicola Hosek, Sebastian Burgener","doi":"10.12890/2026_006293","DOIUrl":"https://doi.org/10.12890/2026_006293","url":null,"abstract":"<p><strong>Introduction: </strong>Urinary ascites secondary to spontaneous rupture of the urinary bladder (SRUB) is a rare clinical entity presenting with non-specific symptoms, which poses a significant diagnostic challenge. A specific presentation involves pseudo-renal failure because of peritoneal reabsorption of urinary solutes.</p><p><strong>Case description: </strong>We present the case of a female in her sixties with recurrent severe abdominal pain and ascites, concomitated with apparent acute kidney injury. Her medical history was significant for Wertheim-Meigs hysterectomy and pelvic radiation for cervical cancer. She underwent multiple hospitalisations with extensive investigations and even exploratory surgeries, driven by misleading CT findings of diffuse bowel wall thickening and gross ascites. The definitive diagnosis was made by extensive review of the patients' medical records and research of similar cases in the literature, as also by paracentesis, revealing an ascites-to-serum creatinine ratio of 3.76. A computed tomography cystogram confirmed an intraperitoneal bladder rupture with contrast extravasation. The patient was successfully managed conservatively with intermittent self-catheterisation.</p><p><strong>Conclusion: </strong>In patients with urogenital comorbidities developing large-volume ascites without preceding trauma, urinary ascites should be considered an important differential diagnosis, typically defined by an ascites-to-serum creatinine ratio of >1. This case explores the diagnostic pitfalls of urinary ascites secondary to SRUB in a patient with late radiation cystitis focusing on the phenomenon of reverse auto peritoneal dialysis and a normal cystatin C level as key diagnostic clues.</p><p><strong>Learning points: </strong>Urinary ascites by spontaneous bladder rupture is a rare but critical late complication of pelvic radiation therapy, often misdiagnosed by its non-specific symptoms.Urinary ascites drives the diffusion of urinary solutes back into the systemic circulation, mimicking acute kidney injury by reverse auto peritoneal dialysis.The following constellation of laboratory parameters can be found in uroperitoneum: high serum creatinine but normal serum cystatin C, high serum-ascites albumin gradient and a high ascites-to-serum creatinine ratio.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 4","pages":"006293"},"PeriodicalIF":0.0,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13078754/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688433","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":"Symptomatic Chronic Strongyloides Stercoralis Infection after Roux-en-Y Gastric Bypass in an Immunocompetent Patient.","authors":"Jara Stevens, Maurits P A van Meer, Sean H P P Roerink, Jet H Gisolf, Marc L Ooft, Jan M Vrolijk, Robert J Hassing","doi":"10.12890/2026_006028","DOIUrl":"https://doi.org/10.12890/2026_006028","url":null,"abstract":"<p><strong>Introduction: </strong><i>Strongyloides stercoralis</i> is a parasitic nematode with a unique auto infective life cycle, enabling persistent infection. While infection can remain asymptomatic for decades, factors such as malnutrition may facilitate the transition to symptomatic strongyloides infection. Roux-en-Y gastric bypass (RYGB) induce malnutrition due to reduced intake and impaired nutrient absorption.</p><p><strong>Case description: </strong>A 31-year-old male presented with nausea, diarrhoea, and general malaise following RYGB six months earlier. Jejunal biopsy and faecal polymerase chain reaction (PCR) confirmed chronic <i>S. stercoralis</i> infection, likely acquired during travel to Bali in 2016. Treatment with ivermectin led to rapid clinical improvement, normalization of eosinophil counts, and negative faecal PCR within four weeks.</p><p><strong>Conclusion: </strong>Chronic <i>S. stercoralis</i> infection may become symptomatic following RYGB, likely due to postoperative physiological changes, such as malnutrition. Malabsorption, particularly zinc deficiency, may impair mucosal immunity and facilitate parasite persistence. Additionally, reduced colonic motility and gastric acid secretion post-RYGB may compromise host defence mechanisms, increasing the risk of transformation to symptomatic infection. These findings suggest that preoperative screening for <i>S. stercoralis</i> might be considered in bariatric candidates with prior exposure to endemic regions. Further research is warranted to clarify the pathophysiological mechanisms linking bariatric surgery to reactivation of chronic strongyloidiasis.</p><p><strong>Learning points: </strong>This case suggests that malnutrition, reduced gastric acid, and altered gut motility after Roux-en-Y gastric bypass (RYGB), might impair parasite clearance and immunity, turning an asymptomatic chronic infection into a clinical threat.The findings of this case suggest that preoperative screening in bariatric surgery candidates with relevant travel history related to <i>S. stercoralis</i> could be useful as RYGB may elevate risk for parasitic flare-ups.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 4","pages":"006028"},"PeriodicalIF":0.0,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13078756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688339","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":"Bleeding Disorder, A Newly Recognized Adverse Event Following Sacubitril/Valsartan Therapy.","authors":"Yaser W Al-Omari, Samer A Mustafa, Ali H Saleh, Wesam S Abdel-Razaq","doi":"10.12890/2026_006178","DOIUrl":"https://doi.org/10.12890/2026_006178","url":null,"abstract":"<p><strong>Introduction: </strong>Sacubitril/valsartan (Entresto) is the only currently approved angiotensin receptor-neprilysin inhibitor (ARNI) drug. It demonstrates important therapeutic outcomes in heart failure patients by reducing hospitalizations and deaths. ARNI is generally safe but concerns about adverse drug reactions (ADRs) exist. This report documents a potential bleeding disorder, evidenced by elevated prothrombin time (PT) and international normalized ratio (INR), as a newly identified ADR.</p><p><strong>Case description: </strong>Despite not receiving anticoagulant medication, three male heart failure patients had elevated PT/INR values within 14 days to four months of initiating Entresto 50 mg twice daily. Temporary discontinuation (dechallenging) of Entresto resulted in a decline in PT/INR, while it increased upon re-challenge in at least one patient. Laboratory findings showed varying degrees of anaemia, occasional renal and hepatic abnormalities, with normal platelet counts. Naranjo scores (6-8) support a probable causal relationship between Entresto and the bleeding tendency, warranting careful coagulation monitoring during treatment.</p><p><strong>Conclusion: </strong>This case series explicitly identified a probable causal relationship between Entresto (ARNI) and a potential bleeding risk as evaluated by the Naranjo ADR probability scale. By highlighting this previously unidentified ADR, this report attempts to raise awareness among healthcare practitioners regarding the need for vigilant monitoring of coagulation parameters in high-risk patients, even without concomitant anticoagulant treatment.</p><p><strong>Learning points: </strong>To our knowledge, this case series is the first report in the medical literature to specifically recognize a probable causal relationship between angiotensin receptor-neprilysin inhibitor treatment and a potential bleeding risk as evaluated by the Naranjo adverse drug reaction probability scale.Healthcare practitioners are urged to vigilantly monitor coagulation parameters in high-risk patients, even in the absence of concomitant anticoagulant treatment.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 4","pages":"006178"},"PeriodicalIF":0.0,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13078763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688938","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}