European journal of case reports in internal medicine最新文献

{"title":"Case Reports in the Past, Present and Future.","authors":"John G Kellett","doi":"10.12890/2024_004965","DOIUrl":"https://doi.org/10.12890/2024_004965","url":null,"abstract":"","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"11 11","pages":"004965"},"PeriodicalIF":0.0,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11542957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616920","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":"Crohn's Disease Confined to the Esophagus, with No Involvement of the Small or Large Bowel.","authors":"Karam Karam, Helena Fahmi, Simon Bechara, Jamil Mrad, Anwar Andrew Nader, Elias Fiani","doi":"10.12890/2024_004926","DOIUrl":"https://doi.org/10.12890/2024_004926","url":null,"abstract":"<p><p>Crohn's disease (CD) is a transmural inflammatory process that can affect any segment of the gastrointestinal tract. CD has a predilection for the colon and the small bowel, specifically the terminal ileum. Esophageal involvement of CD is exceedingly rare and there is a paucity of data regarding the disease phenotypes, course, complications and treatment. We report a case of an 18-year-old male patient presenting for intermittent dysphagia and epigastric pain. Upper endoscopy revealed esophageal ulcers in the middle esophagus surrounded by normal esophageal mucosa. Biopsies were taken from the ulcerated lesions. Histology revealed granulomatous esophagitis. The stomach and duodenum were unremarkable. An ileo-colonoscopy was performed and showed unremarkable mucosa with normal biopsies. The patient was started on proton pump inhibitors and prednisolone as induction therapy with significant symptomatic improvement within 15 days of therapy. The patient was then started on azathioprine 150 mg once daily as maintenance therapy with complete resolution of symptoms. Esophageal CD is an overlooked entity. This article underscores the need to rule out CD when physicians are confronted by esophageal ulcers on upper endoscopy.</p><p><strong>Learning points: </strong>Dysphagia as the initial presentation of esophageal Crohn's disease is exceedingly rare.Esophageal Crohn's disease be included in the differential diagnosis of esophageal ulcers in the absence of Crohn's disease of the colon or small bowel.Treatment of esophageal Crohn's disease should be tailored to each patient taking into account the patient's symptoms, disease activity, disease course, phenotype and disease complications.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"11 11","pages":"004926"},"PeriodicalIF":0.0,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11542952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616938","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":"Paradoxical Hypoxemia Following Positive Pressure Ventilation: Exploring the Pathophysiology.","authors":"Xin Ya See, Zehra Naseem, Susan Synderburn, William Wallace, Neal Chaisson, Daniel A Culver","doi":"10.12890/2024_004976","DOIUrl":"https://doi.org/10.12890/2024_004976","url":null,"abstract":"<p><p>Positive pressure ventilation (PPV), both non-invasive and invasive, enhances ventilation but can sometimes lead to unexpected hypoxemia. This case report describes an instance of paradoxical hypoxemia after initiating bilevel positive airway pressure (BiPAP) in a 58-year-old female with a medical history of systemic lupus erythematosus, interstitial lung disease, and pulmonary embolism. BiPAP was started, leading to improved hypercarbia but worsened hypoxemia. Further investigation revealed a right-to-left interatrial shunt via a small patent foramen ovale (PFO). Adjusting BiPAP settings improved arterial blood gas parameters. This case illustrates how positive pressure ventilation with underlying PFO can cause paradoxical hypoxemia. The case emphasizes the importance of understanding the pathophysiology and tailoring BiPAP settings based on individual haemodynamics.</p><p><strong>Learning points: </strong>Positive pressure ventilation can trigger paradoxical hypoxemia through a right-to-left shunt in patients with patent foramen ovale.Unexplained hypoxemia after initiating positive pressure ventilation warrants investigating intracardiac shunts with a saline contrast echocardiogram.Adjusting bilevel positive airway pressure settings based on individual haemodynamics is essential for improving oxygenation.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"11 11","pages":"004976"},"PeriodicalIF":0.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11542950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617135","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 Cutaneous Manifestation of Systemic Sclerosis.","authors":"Joelle Sleiman, Taimur Aslam, Anastasia Slobodnick, Alina G Bridges","doi":"10.12890/2024_004632","DOIUrl":"https://doi.org/10.12890/2024_004632","url":null,"abstract":"<p><p>A 43-year-old male with a history of intravenous drug use and alcohol consumption presented to the emergency department with three-month history of failure to thrive. The patient exhibited a constellation of constitutional symptoms including cough, weight loss, fatigue, decreased appetite, nausea and vomiting. The skin examination revealed multiple subcutaneous hyperpigmented, indurated plaques and nodules on the trunk and arms. Laboratory evaluation revealed abnormal autoimmune tests, anaemia, elevated inflammatory markers and radiological evidence of interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH). An excisional biopsy from a skin lesion demonstrated dermal sclerosis consistent with scleroderma. The patient was diagnosed with diffuse systemic scleroderma with cutaneous findings consistent with nodular or keloidal scleroderma variant. This case highlights a rare cutaneous variant of systemic scleroderma called nodular or keloidal scleroderma.</p><p><strong>Learning points: </strong>Nodular scleroderma can be a diagnostic challenge due to its rarity and wide clinical presentation, which can mimic other medical conditions such as keloid or hypertrophic scar, storiform collagenoma, sclerotic dermatofibroma or sclerosing perineuroma.Clinicians should have a high degree of suspicion for nodular scleroderma when a patient presents with firm nodular or keloidal skin lesions, to diagnose and treat it appropriately.It is important to recognise nodular scleroderma early because timely and accurate diagnosis is crucial for appropriate management to prevent severe debilitation and scleroderma-related complications, and to improve patient outcomes.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"11 11","pages":"004632"},"PeriodicalIF":0.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11542949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616916","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":"Neuroschistosomiasis in Young Filipino Patient Presenting with Seizure.","authors":"Hussein Nemr Al Hussein, Dana Alomari, Sadi Al Nakhalah, Gamal Alfitori","doi":"10.12890/2024_004854","DOIUrl":"https://doi.org/10.12890/2024_004854","url":null,"abstract":"<p><p>Neuroschistosomiasis, a rare manifestation of schistosomiasis affecting the central nervous system (CNS), can result in severe neurological complications if not promptly diagnosed and treated. The condition arises due to the development of granulomas around eggs that become lodged within the CNS. Here we present a case report involving a young Filipino individual who had recurrent, uncontrolled seizures, ultimately attributed to neuroschistosomiasis. On magnetic resonance imaging revealed that the patient had brain lesions consistent with neuroschistosomiasis. Concurrently, serologic tests revealed high titres of anti-schistosoma antibodies. Effective treatment encompassed the administration of corticosteroids and praziquantel, leading to a favourable clinical outcome. This case underscores the necessity of considering neuroschistosomiasis in seizure patients, particularly in regions where the condition is prevalent, and highlights the diagnostic and therapeutic complexities posed by the absence of a biopsy.</p><p><strong>Learning points: </strong>Diagnostic challenge and insightThis case highlights the importance of considering a broad differential diagnosis in patients with atypical neurological presentations, particularly in those from regions where parasitic infections are endemic. The internist plays a crucial role in integrating clinical, serological, and imaging data to arrive at a correct diagnosis, in this case, neuroschistosomiasis.Tailored treatment strategyThe case illustrates the value of personalized patient care. Initiating empirical treatment based on a combination of clinical suspicion, high-risk patient demographics, and imaging findings, without invasive procedures, demonstrates the internist's role in managing complex cases where patient preferences must be balanced with medical necessity.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"11 11","pages":"004854"},"PeriodicalIF":0.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11542959/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617129","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":"Toxoplasmosis Infection in an HIV-Negative Patient Presenting with Clinical and MRI Findings Similar to those of Multiple Sclerosis.","authors":"Bayan Nurgaliyeva, Kulman Nyssanbayeva, Manish Choudhary","doi":"10.12890/2024_004938","DOIUrl":"https://doi.org/10.12890/2024_004938","url":null,"abstract":"<p><p>Toxoplasmosis is a parasitic infection that can present in various clinical forms, ranging from asymptomatic to severe neurological manifestations. The primary sources of infection include undercooked meat, unwashed produce and contact with cat faeces. Toxoplasmosis can lead to encephalitis, particularly in immunocompromised patients, and is often misdiagnosed as other neurological conditions such as multiple sclerosis (MS). We report the case of a 44-year-old male from Almaty, Kazakhstan, who presented with neurological symptoms including headaches, dizziness, diplopia, leg weakness and elevated blood pressure. The patient had a history of consuming undercooked meat, but no prior neurological conditions. Initial magnetic resonance imaging (MRI) revealed demyelinating lesions, leading to a diagnosis of MS. However, high levels of IgG antibodies against <i>Toxoplasma gondii</i> were detected, prompting further testing. A polymerase chain reaction test for toxoplasmosis was negative, but the patient was treated empirically with trimethoprim and sulfamethoxazole for six months. A follow-up MRI showed a significant reduction in brain lesions, and the patient's symptoms improved.</p><p><strong>Learning points: </strong>This case aids in the differential diagnosis between multiple sclerosis and cerebral toxoplasmosis. It highlights the necessity of conducting ELISA tests for parasitic infections when multiple sclerosis is suspected.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"11 11","pages":"004938"},"PeriodicalIF":0.0,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11542945/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617140","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":"Iatrogenic Haemothorax: A Life-Threatening Complication Following A 12Fg Seldinger Intercostal Drain Insertion for Pneumothorax.","authors":"Sylvia Amini, Salim Meghjee, Muhammad Rahim Khan","doi":"10.12890/2024_004865","DOIUrl":"https://doi.org/10.12890/2024_004865","url":null,"abstract":"<p><p>A man in his 30s with no previous medical history presented to the emergency department with acute dyspnoea. His chest X-ray (CXR) showed a massive left-sided pneumothorax, and a 12Fg post-intercostal drain (ICD) was inserted. Twenty-four hours later there was evidence of blood in the drain, and he had a significant haemoglobin drop of 44 g/l in only one day. His vital signs were stable. A CXR and an urgent computed tomography (CT) scan showed a large haemothorax therefore he was transferred to the tertiary thoracic centre, where he was taken to theatre and had a thoracoscopy and evacuation of a blood clot. Follow-up two weeks later showed complete resolution of the haemopneumothorax. This case report highlights the rare complication of a massive iatrogenic haemothorax. This was despite all the safety precautions including normal coagulation and platelet count, the patient not being on any anti-coagulant drugs and an ICD approach via the triangle of safety for insertion of the small-bore tube. In the case of iatrogenic haemothorax, urgent resuscitation and surgical treatment are needed as this is a life-threatening situation.</p><p><strong>Learning points: </strong>Iatrogenic haemothorax post-intercostal drain (ICD) insertion has not been reported in recent literature since the new British Thoracic Society (BTS) guidelines advised ultrasound-assisted procedure for pleural effusions, and a 'triangle of safety' for pneumothorax patients. Nevertheless, it should be included in the differential diagnoses as it still could happen.If it is a massive haemothorax, cardiothoracic surgeons must be notified immediately.Point-of-care ultrasound can be used to diagnose pleural fluid while awaiting a chest X-ray. However, point-of-care ultrasound will not be able to differentiate between blood and normal pleural fluid, whereby a formal chest CT can.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"11 11","pages":"004865"},"PeriodicalIF":0.0,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11542937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617116","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":"Valacyclovir Induced Neurotoxicity, with Therapeutic Drug Monitoring, in a Hospital-Based Setting in the Netherlands.","authors":"Job F H Eijsink, Joost N Udo, Daan J Touw, Bart J Dekkers","doi":"10.12890/2024_004479","DOIUrl":"https://doi.org/10.12890/2024_004479","url":null,"abstract":"<p><strong>Background: </strong>Valacyclovir-induced neurotoxicity is a rare side effect. The aim of this study was to perform a retrospective analysis of patients with valacyclovir-induced neurotoxicity and establish valacyclovir plasma concentrations in a tertiary hospital between January 2018 and November 2022.</p><p><strong>Case descriptions: </strong>In total 208 patients were identified with measured acyclovir concentrations, and the electronic health records of these patients were analysed. Based on the in- and exclusion criteria, 4 patents were identified in whom high plasma concentrations were linked to neurotoxicity. The first patient experienced balance and coordination problems, visual hallucinations, speaking difficulties and headaches. The second patient experienced a progressive decline of consciousness, resulting in coma. The third patient also experienced reduced consciousness and was found unconscious on the floor during the night. The fourth patient experienced vertigo after administration of acyclovir.</p><p><strong>Conclusion: </strong>Based on this study, neurotoxicity appears to be an underreported adverse effect of valacyclovir therapy in a hospital setting. This side effect may have a high impact on individuals as well as on the duration of hospitalization. In order to exclude valacyclovir as the cause, clinicians should consider requesting an acyclovir plasma concentration as standard hospital-based intervention whenever a patient experiences neurotoxic symptoms. Moreover, pharmacists and clinicians should be made better aware of the interaction between valacyclovir and cyclosporine and/or mycophenolic acid, in particular in elderly patients with impaired kidney function.</p><p><strong>Learning points: </strong>Valaciclovir-induced neurotoxicity diagnosis is underreported.Accessible and frequent therapeutic drug monitoring (TDM) of valacyclovir is recommended.Interactions between valaciclovir and ciclosporin and/or mycophenolic acid, in particular in elderly patients with impaired kidney function, need a follow-up during hospitalization.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"11 11","pages":"004479"},"PeriodicalIF":0.0,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11542946/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617041","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":"Non-Surgical Management of Methicillin-Sensitive <i>Staphylococcus Aureus</i> Bacteremia-Related Mediastinitis.","authors":"Carlo Vignati, Alessandra Pietragalla, Gianfranco Dedivitiis, Maria Elisabetta Mancini, Piergiuseppe Agostoni","doi":"10.12890/2024_004899","DOIUrl":"https://doi.org/10.12890/2024_004899","url":null,"abstract":"<p><strong>Background: </strong>Acute mediastinitis is rarely caused by haematogenous spread of a remote infection. In this respect, since the only medical therapy is usually unsuccessful, treating acute mediastinitis with no source of infection detected is very challenging and management not standardized. In this case report, we describe non-surgical management experience of acute mediastinitis caused by methicillin-sensitive <i>Staphylococcus aureus</i>.</p><p><strong>Case presentation: </strong>In a 79-year-old man judged not eligible for cardiac surgery, we attempted the infection source control through vacuum-assisted closure therapy, together with antimicrobial therapy. We observed gradual clinical, laboratory and radiologic improvements: reduced swelling and normalization of the white blood cell count and C-reactive protein level were associated with reduction in size of a periaortic abscess.</p><p><strong>Conclusion: </strong>We managed a clinical condition with high mortality risk with chronic antimicrobial therapy alone, a strategy that is rarely considered. With this medical strategy we achieved an optimal response to a clinical picture that does not allow any other approach.</p><p><strong>Learning points: </strong>Mediastinitis is a rare but severe infection with a high mortality rate.Chronic antimicrobial therapy can be an effective strategy in high surgical risk patients.The present case demonstrates good tolerability of lifelong antibiotic therapy.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"11 11","pages":"004899"},"PeriodicalIF":0.0,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11542951/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617133","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":"Malignant Peripheral Nerve Sheath Tumour Presenting as Sciatica in a Patient with Neurofibromatosis Type 1: Is Magnetic Resonance Imaging an Effective Screening Tool?","authors":"Adisalem M Teferi, Sangam Sangam, Azana Newman, Osman Alvarado, Irvianny Madera, Julian Paniagua","doi":"10.12890/2024_004818","DOIUrl":"https://doi.org/10.12890/2024_004818","url":null,"abstract":"<p><p>Peripheral malignant nerve sheath tumours (MPNST) are rare and aggressive soft tissue sarcomas often associated with neurofibromatosis type I (NF-1). We describe a case of 26-year-old female with NF-1, initially misdiagnosed as sciatica, who was later found to have a malignant spindle cell peripheral nerve sheath tumour of the right sciatic nerve. Magnetic resonance imaging (MRI) proved to be a valuable tool for diagnosis. This case illustrates the importance of considering the transformation of neurofibromas into MPNST as a potential cause of worsening neuropathic pain in patients with NF-1. Given the overlap in clinical presentation with benign conditions, we analyse the utility of MRI for early screening for. Early detection is crucial to improve the chances of cure and prolonged disease-free survival.</p><p><strong>Learning points: </strong>Malignant peripheral nerve sheath tumours can occur in patients with neurofibromatosis and present as sciatica.Magnetic resonance imaging screening should be considered early on in this patient population.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"11 11","pages":"004818"},"PeriodicalIF":0.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11542955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617125","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}