European journal of case reports in internal medicine最新文献

{"title":"Swollen Legs and False Nephrotic Syndrome: A Case of Primary Lymphatic Dysplasia with Intermittent Chyluria.","authors":"Giorgia Sasia, Teresa Morgillo, Christian Bracco, Corrado Magnino, Giulia Racca, Remo Melchio, Luigi Maria Fenoglio","doi":"10.12890/2025_005348","DOIUrl":"10.12890/2025_005348","url":null,"abstract":"<p><p>Chyluria, defined as the presence of chyle in urine, is a rare condition caused by an abnormal communication between the lymphatic system and the urinary tract. It can present with massive proteinuria and characteristic milky urine, mimicking nephrotic syndrome. We report the case of a 23-year-old woman with a history of seronegative ocular myasthenia gravis who developed progressive bilateral lower extremity oedema and intermittent nephrotic-range proteinuria despite normal serum albumin and lipid profiles. A renal biopsy, performed to investigate proteinuria, was complicated by a subcapsular hematoma. Shortly thereafter, the patient developed dysuria, urinary retention, and milky urine, leading to the diagnosis of chyluria. Imaging revealed thrombosis of the left iliac vein, associated with hereditary thrombophilia (heterozygosity for factor V Leiden and homozygous <i>G20210A</i> prothrombin mutation), prompting anticoagulation therapy. Lymphoscintigraphy suggested a lympho-vesical fistula and bilateral inguinal lymph node dysplasia. Conservative management, including urinary catheterization, fluid optimization, and dietary modifications with a low-fat, medium-chain triglyceride-enriched regimen, resulted in resolution of chyluria. At 6-month follow-up, there was no recurrence of symptoms, proteinuria improved, and anticoagulation was continued. This case highlights the importance of a multidisciplinary approach in managing rare presentations of chyluria, nephrotic proteinuria, and venous thrombosis.</p><p><strong>Learning points: </strong>Chyluria should be considered in patients presenting with milky urine and proteinuria, especially after excluding glomerular pathology.Non-parasitic causes, such as trauma or iatrogenic procedures like renal biopsy, are increasingly recognized in non-endemic regions.Conservative management, particularly dietary modifications with medium-chain triglycerides can lead to significant clinical improvement without invasive interventions.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 6","pages":"005348"},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274498","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":"Autoimmune Polyglandular Syndrome Type 3b: A Key to Diagnosing Autoimmune Gastritis and Asymptomatic Primary Biliary Cholangitis.","authors":"Sayaka Mabuchi, Hiroya Mabuchi, Takashi Watari","doi":"10.12890/2025_005376","DOIUrl":"10.12890/2025_005376","url":null,"abstract":"<p><strong>Background: </strong>Autoimmune polyglandular syndrome type 3 (APS-3) encompasses autoimmune thyroid disease and other autoimmune disorders. APS-3 is further categorized into four subtypes, with APS-3B involving gastrointestinal autoimmune diseases. In this case, we diagnosed autoimmune gastritis, a condition challenging to identify based on endoscopic findings alone, and asymptomatic primary biliary cholangitis (PBC) through the recognition of APS-3B.</p><p><strong>Case report: </strong>An 84-year-old female patient presented with forgetfulness and a history of Hashimoto's disease. Although endoscopy revealed pan-atrophic gastritis, autoimmune gastritis was suspected rather than <i>Helicobacter pylori</i> infection due to consideration of the APS-3 framework. Specific observations, including adherent mucus and remnants of oxyntic mucosa, guided tests for anti-endogenous antibodies, confirming autoimmune gastritis. Recognizing APS-3B prompted further evaluation for PBC, including measurement of anti-mitochondrial M2 antibody, which led to the diagnosis of asymptomatic PBC.</p><p><strong>Conclusion: </strong>Recognition of APS-3 offers a valuable framework for the differential diagnosis of autoimmune diseases.</p><p><strong>Learning points: </strong>Autoimmune thyroid disease in a patient should raise suspicion for autoimmune polyglandular syndrome type 3 (APS-3) and other potential autoimmune conditions.If APS-3 is diagnosed, further classification is recommended, along with a thorough search for additional autoimmune diseases.APS-3 serves as a framework for the differential diagnosis of autoimmune diseases.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 6","pages":"005376"},"PeriodicalIF":0.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274467","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":"Cardiac Tamponade due to Minoxidil use: A Case Report and Review of the Literature.","authors":"Prami Nakarmi, Joshua Hermiz, Roopeessh Vempati, Sanya Chandna, Umesh Bhagat, Stacy Loree, Christian Toquica Gahona","doi":"10.12890/2025_005379","DOIUrl":"10.12890/2025_005379","url":null,"abstract":"<p><p>Minoxidil is a direct-acting vasodilator that reduces systemic vascular resistance by opening adenosine triphosphate (ATP)-sensitive potassium channels, leading to arteriolar smooth muscle vasodilation. While commonly prescribed for resistant hypertension and androgenic alopecia, minoxidil is associated with fluid retention, and in rare cases, pericardial effusion that can progress to cardiac tamponade. In this report, we present a case of an 81-year-old male with a history of chronic kidney disease (CKD) who developed cardiac tamponade while on chronic minoxidil therapy for hypertension. He presented with progressive dyspnoea, lower extremity oedema, and fever. Imaging revealed an enlarged cardiac silhouette, and a confirmatory echocardiogram demonstrated a pericardial effusion with right ventricular collapse. The patient underwent urgent pericardiocentesis, yielding 545 ml of pericardial fluid. Infectious, malignant, and autoimmune aetiologies were ruled out, and minoxidil was identified as the likely cause. Following discontinuation of minoxidil, the patient's symptoms completely resolved, with no recurrence at 1-month follow-up. In addition, we reviewed 26 previously reported cases of minoxidil-induced pericardial effusion and/or cardiac tamponade, 17 of which are summarized in this report. This case demonstrates the rare but potentially fatal complication of therapy and emphasizes the importance of early detection and clinical vigilance, particularly in vulnerable populations such as patients with CKD.</p><p><strong>Learning points: </strong>This case highlights minoxidil-induced cardiac tamponade - a rare but fatal adverse effect requiring urgent intervention, especially underrecognized in clinical practice.Patients with chronic kidney disease are at increased risk for minoxidil-induced pericardial effusion due to altered fluid regulation and renin-angiotensin-aldosterone system activation.Clinicians should maintain a high index of suspicion and consider routine cardiac monitoring in minoxidil users, even for non-hypertensive indications such as hair loss.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 6","pages":"005379"},"PeriodicalIF":0.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274468","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":"Full Recovery Over One Year of the Overlap Syndrome Scleromyositis to Maintenance Therapy with Mycophenolate Mofetil and Rituximab, which Relapsed within 8 Months of Discontinuation.","authors":"Inês Amarante, Catarina Faustino, Bruna Mota, Mariana Cascais, Jorge Almeida, Marta Valentim","doi":"10.12890/2025_005154","DOIUrl":"https://doi.org/10.12890/2025_005154","url":null,"abstract":"<p><p>Scleromyositis (SM) is an emerging, distinct entity within the spectrum of diffuse systemic sclerosis (SSc) and autoimmune inflammatory myopathies. It can carry a poorer prognosis due to multisystem involvement and extramuscular complications, with no consensus on treatment strategies currently available. We report on a 20-year-old woman with a history of recurrent infections over the past year, who presented with persistent myalgias for four months. On examination, she exhibited muscle weakness in the scapular and pelvic girdles, along with sclerodactyly. Laboratory results showed elevated creatine kinase (13,000 U/l), aldolase (15.6 U/l), lactate dehydrogenase (1,481 U/l) and myoglobin (4,400 ng/ml). Autoimmune screening was positive for antinuclear antibodies, anti-PM-scleroderma (anti-PM-Scl) 75 and 100, and anti-CENP-B antibodies. An MRI of the pelvic girdle indicated acute/subacute myositis, and electromyography revealed both distal and proximal myopathy. Muscle biopsy showed extensive necrosis with minimal inflammatory infiltration. Nailfold capillaroscopy demonstrated an early scleroderma pattern, while CT and spirometry revealed mild interstitial restrictive lung disease. Initial treatment involved intravenous immunoglobulin (IVIG), mycophenolate mofetil (MMF) and prednisolone. This was followed by maintenance therapy with MMF and rituximab (RTX) every six months for the first year. Over six months, the patient showed progressive improvement in muscle strength and normalisation of muscle enzyme levels. In conclusion, SM presents with variable phenotypes, ranging from mild to extensive systemic involvement. This case underscores the importance of individualised patient stratification and highlights the need for structured induction and maintenance therapy due to the disease's extensive activity.</p><p><strong>Learning points: </strong>Scleromyositis (SM) is a rare and poorly understood condition that combines features of systemic sclerosis and immune-mediated myositis, often linked to anti-PM-scleroderma antibodies.Despite efforts to classify SM, it demonstrates unique clinical patterns that distinguish it from other myositis subtypes.The management of SM remains challenging, as there are no established guidelines or standardised treatment protocols.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 5","pages":"005154"},"PeriodicalIF":0.0,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143983909","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":"Exploring ANCA Pathogenicity in Ulcerative Colitis: A Case Report Highlighting the Risk of Progression to ANCA-Associated Vasculitis.","authors":"Abir Hamid, Frederic Vandergheynst, Maxime Ilzkovitz","doi":"10.12890/2025_005061","DOIUrl":"https://doi.org/10.12890/2025_005061","url":null,"abstract":"<p><strong>Background: </strong>The relationship between anti-neutrophil cytoplasmic antibodies (ANCA) and inflammatory bowel disease has attracted significant attention due to shared immunopathological mechanisms and clinical associations.</p><p><strong>Case description: </strong>This case report describes a 20-year-old African woman with a history of ulcerative colitis who developed diffuse alveolar haemorrhage in the setting of elevated proteinase 3 (PR3)-ANCA. She was treated for ANCA-associated vasculitis with corticosteroids, plasma exchange, and rituximab, leading to a complete resolution.</p><p><strong>Conclusion: </strong>The case highlights the association between ulcerative colitis and ANCA-associated vasculitis, particularly with PR3-ANCA, and the importance of recognizing this overlap. Although ANCA are frequently present in inflammatory bowel disease, especially ulcerative colitis, their pathogenic role remains unclear. The incidence of ANCA-associated vasculitis is higher in inflammatory bowel disease patients, with ulcerative colitis often preceding ANCA-associated vasculitis. Despite the common presence of ANCA in inflammatory bowel disease, not all patients progress to ANCA-associated vasculitis. This case underscores the need for careful monitoring in ulcerative colitis patients with elevated PR3-ANCA and the role of ANCA in guiding diagnosis and treatment.</p><p><strong>Learning points: </strong>High proteinase 3 (PR3)-anti-neutrophil cytoplasmic antibodies (ANCA) titre impacts the severity and management of ulcerative colitis patients.ANCA-associated vasculitis is more frequent in ulcerative colitis patients and occurs several years after ANCA positivity.Close monitoring of ulcerative colitis patients with PR3-ANCA is essential for early detection of progression to ANCA-associated vasculitis.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 5","pages":"005061"},"PeriodicalIF":0.0,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978883","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":"Autoantibodies Directed Against Insulin Receptor During the Course of Castleman Disease: A New Case Reaffirming Autoimmune Hypoglycemia as a Relapse Warning Signal.","authors":"Xavier Jannot, Martine Auclair, Martin Martinot, Amin Maazouzi, David Boutboul, Corinne Vigouroux, Yannick Dieudonné","doi":"10.12890/2025_005355","DOIUrl":"https://doi.org/10.12890/2025_005355","url":null,"abstract":"<p><p>This case study presents the case of a 54-year-old human immunodeficiency virus (HIV)-positive male who developed type B insulin resistance syndrome (TBIRS) in conjunction with a relapse of human herpesvirus 8 (HHV8)-positive multicentric Castleman disease (MCD). This case is only the sixth reported instance of TBIRS associated with HHV8-associated MCD. The diagnosis was confirmed by the presence of anti-insulin receptor autoantibodies, and the patient was treated effectively with rituximab, with no relapse in follow-up. The cases described are discussed, along with the differences between them and our own case. Additionally, the potential for an autoimmune complication of MCD, even when HIV is well controlled, is addressed, as well as the available therapeutic approaches.</p><p><strong>Learning points: </strong>Unexplained hypoglycemia can reveal autoimmunity against insulin receptors associated with lymphoproliferative disorders, including multicentric Castleman disease.Autoimmune hypoglycemia can occur independently of inflammatory signs or uncontrolled human immunodeficiency virus infection in patients with multicentric Castleman disease.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 5","pages":"005355"},"PeriodicalIF":0.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061218/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984865","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":"Juvenile Dermatomyositis and Hepatitis B Viral Infection.","authors":"Ali A Younis, Ahmed A Ahmed Al-Harbi","doi":"10.12890/2025_005372","DOIUrl":"https://doi.org/10.12890/2025_005372","url":null,"abstract":"<p><p>Juvenile dermatomyositis (JDM) is an uncommon autoimmune illness with unexplained origin. It affects the skin, skeletal muscles, and blood vessels. This case report emphasizes an unusual case of an 8-year-old girl from Ninevah in Iraq, who presented with limb weakness and rash. She had a family history of hepatocellular carcinoma. The patient had hall mark features of JDM: heliotrope rash, Gottron's papules, and progressive proximal muscle weakness as well as elevated muscle enzymes. A positive hepatitis B surface antigen with high viral load proved concomitant infection. Treatment started with entecavir and intravenous immunoglobulins, followed by methotrexate and corticosteroids leading to steady clinical improvement. Effective antiviral treatment in combination with immunosuppressants is crucial for treating autoimmune diseases without infection reactivation. The correlation between hepatitis B infection and JDM is still obscure. This case suggests that that hepatitis B may lead to autoimmune diseases when there is a genetic susceptibility. This example adds to the scarce literature on JDM connection with viral hepatitis, highlighting the importance of being alert and using specialized treatment approaches in such cases.</p><p><strong>Learning points: </strong><b>Rare case insight</b> highlights the difficulties in diagnosing autoimmune and viral disorders by presenting a rare case of concurrent juvenile dermatomyositis and chronic hepatitis B infection.<b>Lessons in clinical management</b> emphasizes the significance of controlling the risk of viral reactivation and screening for hepatitis B prior to immunosuppressive treatment.<b>Multidisciplinary and educational value</b> highlights the importance of a multidisciplinary approach and provides internists with useful knowledge on how to provide individualized care in complicated rheumatic situations.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 5","pages":"005372"},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959970","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":"Jejunal Duplication in a 10-Year-Old Boy Presenting with Generalized Oedema and Abdominal Distension.","authors":"Thitima Ngoenmak, Chaiyaporn Virochsangaroon, Krittaporn Phruksarudee, Napat Vimtrimate, Pattawarin Wata","doi":"10.12890/2025_005423","DOIUrl":"https://doi.org/10.12890/2025_005423","url":null,"abstract":"<p><strong>Background: </strong>Gastrointestinal tract duplications are rare congenital anomalies, with the jejunum being the second most common site after the ileum. These duplications can vary in size, location, and presence of ectopic mucosa, significantly impacting clinical presentation and often requiring surgical intervention.</p><p><strong>Case presentation: </strong>A 10-year-old Thai boy with haemoglobin (Hb) E trait and iron deficiency anaemia presented with significant oedema and abdominal distention. Laboratory investigations revealed isolated hypoalbuminemia. Imaging studies, including computed tomography (CT) scan, demonstrated a large, loculated, rim-enhancing air-fluid collection adjacent to the jejunum, along with mild dilatation and wall thickening of the affected jejunal loop. The patient underwent exploratory laparotomy, which included jejunal resection and jejunojejunal end-to-end anastomosis.</p><p><strong>Conclusion: </strong>Jejunal duplications are uncommon in children and can present diagnostic challenges, potentially leading to serious complications. This case underscores the importance of considering jejunal duplication in paediatric patients with unexplained abdominal distention and protein-losing enteropathy. Early recognition and timely surgical management are crucial to prevent severe complications and improve patient outcomes.</p><p><strong>Learning points: </strong>Jejunal duplications are rare congenital malformations, which can cause a range of symptoms, including bilious vomiting, abdominal pain, and obstruction.Our patient presented with iron deficiency anaemia, generalized oedema, including swelling of both legs, scrotum, and abdominal distension.The diagnosis was made by computed tomography scan.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 5","pages":"005423"},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987097","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":"Massive Duodenal Angiolipoma: A Rare Case with Severe Haemorrhage.","authors":"Hoang Duc Dong, Thai Van Nguyen, Thanh Binh Mai","doi":"10.12890/2025_005303","DOIUrl":"https://doi.org/10.12890/2025_005303","url":null,"abstract":"<p><strong>Introduction: </strong>Duodenal angiolipoma is an exceptionally rare and often misdiagnosed clinical entity, characterized by a benign proliferation of adipose and vascular tissues. When large, these lesions pose a significant diagnostic challenge, frequently mimicking malignancy during endoscopic evaluation, especially in cases of severe gastrointestinal haemorrhage. Rapid recognition and decisive management are critical, requiring hemodynamic stabilization, advanced diagnostic tools, and expert intervention to prevent life-threatening complications.</p><p><strong>Case description: </strong>We present the case of a 71-year-old female who arrived at the emergency department with acute upper gastrointestinal haemorrhage and hemodynamic instability. Immediate resuscitation, including haemostatic pharmacotherapy and blood transfusion, was initiated. Subsequent endoscopic evaluation, enhanced by endoscopic ultrasound, revealed a 2 × 3 cm duodenal lesion with a high-risk vascular structure. To prevent further haemorrhage, the tumour was swiftly ligated with an endoloop and excised via polypectomy. Histopathological analysis confirmed duodenal angiolipoma, characterized by mature adipose tissue interwoven with proliferative vascular elements. Following intervention, the patient recovered rapidly, with no recurrence of haemorrhage, and was discharged in stable condition.</p><p><strong>Conclusion: </strong>Massive duodenal angiolipomas causing severe haemorrhage to require appropriate medical haemostasis and resuscitation. Timely recognition and diagnosis via endoscopic ultrasound are vital. Endoscopic resection is a safe and effective treatment that prevents recurring bleeding in this case.</p><p><strong>Learning points: </strong>Duodenal angiolipomas are rare benign tumours that can mimic malignancies and cause life-threatening gastrointestinal bleeding.Endoscopic ultrasound and computed tomography scan are essential for differentiating these tumours from malignant lesions and guiding treatment.Endoscopic resection is a safe, minimally invasive option for duodenal angiolipoma to prevent recurrent bleeding, especially in resource-limited settings.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 5","pages":"005303"},"PeriodicalIF":0.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061200/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990553","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":"Atypical Bulbar Myasthenia Gravis in an Elderly Male Unmasked by Levofloxacin: A Diagnostic Challenge.","authors":"Mrudula Thiriveedi, Anil Chimakurthy, Siddharth Patel, Sujatha Baddam, Rafik ElBeblawy, Punuru J Reddy","doi":"10.12890/2025_005386","DOIUrl":"https://doi.org/10.12890/2025_005386","url":null,"abstract":"<p><strong>Background: </strong>Myasthenia gravis (MG) is an autoimmune neuromuscular disorder that typically presents with ocular symptoms. Isolated bulbar symptoms, such as dysphagia and dysarthria, are rare, and most commonly seen in men with late-onset MG. We report one such rare case of MG in an 82-year-old male presenting with progressive bulbar weakness, seemingly triggered by levofloxacin use.</p><p><strong>Case report: </strong>An 82-year-old male with multiple comorbidities presented with progressive weakness, dysphagia, and drooling following levofloxacin therapy. Examination revealed neck drop, weak lower facial muscles, and dysarthria. Initial neuroimaging and labs were inconclusive. Neurology initiated pyridostigmine with rapid improvement. Elevated acetylcholine receptor antibodies confirmed MG. He was started on efgartigimod alfa in the outpatient setting with improvement in MG composite scores.</p><p><strong>Conclusions: </strong>Atypical bulbar MG can mimic other neurologic disorders and is prone to delayed diagnosis, especially in the elderly. Clinicians should maintain a high index of suspicion, particularly when symptoms worsen after medication exposures like fluoroquinolones. Early diagnosis and appropriate treatment can significantly improve outcomes and quality of life.</p><p><strong>Learning points: </strong>Levofloxacin can exacerbate or unmask myasthenia gravis.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 5","pages":"005386"},"PeriodicalIF":0.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987182","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}