European journal of case reports in internal medicine最新文献

{"title":"The Optimal Treatment of Invasive Ductal and Lobular Carcinoma Occurring at the same time needs to be Established.","authors":"Supriya Peshin, Rafi Iftekher, Rabia Iqbal, Shagun Singh, Moka Nagaishwarya","doi":"10.12890/2025_005074","DOIUrl":"10.12890/2025_005074","url":null,"abstract":"<p><p>Bilateral breast cancer with distinct histological subtypes poses a significant clinical challenge, requiring an individualised approach to management. This case discusses a 61-year-old postmenopausal woman with concurrent invasive ductal carcinoma (IDC) in the right breast and invasive lobular carcinoma (ILC) in the left breast. IDC, the most common breast cancer subtype, is known for its aggressive behaviour, nodal involvement and metastatic potential, while ILC, representing a smaller percentage of breast cancers, often exhibits an indolent course with diffuse growth patterns. Both tumours in this patient were hormone receptor-positive (ER/PR-positive) and HER2-negative, warranting targeted endocrine therapies. The complexity of this case was further heightened by a significant family history of breast and colon cancers, and comorbid conditions including borderline diabetes, hypertension and coronary artery disease (CAD), which required careful therapeutic consideration to balance efficacy and tolerability. Pathological evaluation confirmed stage II, grade 2 IDC in the right breast with one positive sentinel lymph node and stage I, grade 1 ILC in the left breast with no nodal involvement. Given her extensive family history, the patient opted for bilateral mastectomy with sentinel lymph node biopsy. Multidisciplinary tumour board discussions emphasised the integration of genetic testing, including BRCA1/2 evaluation, and Oncotype DX genomic profiling to assess recurrence risk and guide adjuvant chemotherapy decisions. Recommendations included adjuvant radiation therapy for the right breast, endocrine therapy for both tumours and the incorporation of CDK 4/6 inhibitors based on recent evidence from the NATALEE trial, which demonstrated improved outcomes in high-risk, hormone receptor-positive, HER2-negative breast cancers. The case highlights the need for further research into the optimal treatment strategies for synchronous breast cancers, a potential knowledge gap in current oncology practice. A literature review revealed limited reports addressing similar cases, underscoring the lack of consensus guidelines. Our approach integrates the best available evidence with multidisciplinary expertise to inform a personalised treatment plan. The learning points emphasise the need for establishing evidence-based strategies for managing synchronous bilateral breast cancers.</p><p><strong>Learning points: </strong>The optimal treatment of synchronous bilateral breast cancers with differing histological subtypes remains uncertain.This case illustrates the importance of leveraging existing evidence, multidisciplinary collaboration and patient-centred decision-making when addressing knowledge gaps.There is a call for further research to establish guidelines for managing simultaneous, histologically distinct breast cancers.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 2","pages":"005074"},"PeriodicalIF":0.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143381788","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>Pseudomonas Mendocina</i> Bacteraemia Secondary to Cellulitis - A Report and Brief Series of Cases.","authors":"Jorge Reis, Francisca Carmo, Inês Soares, Catarina Salvado, Mariana Fidalgo","doi":"10.12890/2025_005094","DOIUrl":"10.12890/2025_005094","url":null,"abstract":"<p><strong>Background: </strong><i>Pseudomonas mendocina</i> is a rare cause of disease in humans with few cases described, but known to cause severe infections, mainly endocarditis and bacteraemia.</p><p><strong>Case description: </strong>An 86-year-old Caucasian male, with several vascular risk factors (type 2 diabetes, hypertension, dyslipidaemia, coronary heart disease and heart failure), who presented long-standing lower limb phlyctens for which he was being treated, developed lower limb cellulitis. When observed in the Emergency Department, he was septic and was admitted for treatment and surveillance. Blood cultures were positive for <i>P. mendocina</i>. He was treated with antibiotics and recovered, and was discharged home.</p><p><strong>Conclusion: </strong>Damage to the skin barrier as in cellulitis provides a point of entry for <i>P. mendocina</i>, a microorganism that lives in soil and water. The source of contamination is rarely identified, but immunocompromised people present a higher risk of infection and severe disease. The antibiotic susceptibility profile is different from the more common <i>Pseudomonas aeruginosa</i>, with fewer known resistances. Albeit rare, this is thought to be an underreported infection that clinicians should be aware of.</p><p><strong>Learning points: </strong>Infection by <i>Pseudomonas mendocina</i> is rare but potentially life-threatening.Its true prevalence is unknown due to underreporting.Immunocompromised patients seem more at risk for infection by this pathogen.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 2","pages":"005094"},"PeriodicalIF":0.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143381952","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":"Lyme Neuroborreliosis as Initial Expression of Lyme Disease in an Elderly Patient.","authors":"Emídio Mata, Bárbara Lage Garcia, André Pereira, Joana Rego, Flávia Santos, Carlos Fernandes, Jorge Cotter","doi":"10.12890/2025_005034","DOIUrl":"10.12890/2025_005034","url":null,"abstract":"<p><strong>Background: </strong>Lyme disease (LD) is a multisystemic infection caused by <i>Borrelia burgdorferi</i> and transmitted by <i>Ixodes</i> ticks, affecting the skin, nervous system, heart and joints. Neuroborreliosis (LNB), a nervous system manifestation of LD, occurs in 10-15% of cases and may present with neurological symptoms at varying stages.</p><p><strong>Case description: </strong>We present the case of an 84-year-old man, admitted to the emergency department following a seizure, with fever and oropharyngeal erythema. After the administration of penicillin for presumed tonsillitis, a generalised skin rash developed and spontaneously resolved after 4 hours. Within 24 hours, two well-defined round erythematous lesions were observed on the neck and shoulder. Due to new onset of confusion and lethargy a lumbar puncture was performed, revealing polymorphonuclear pleocytosis, elevated protein levels and normal glucose. An empirical ceftriaxone course was started for suspected neuroborreliosis. Neuroborreliosis was diagnosed based on the clinical presentation of fever and neurological changes, with supporting cutaneous manifestations and compatible <i>Borrelia burgdorferi</i> serology. The initial rash was interpreted as a Jarisch-Herxheimer reaction, and the two skin lesions were classified as erythema migrans. After completing treatment, the patient made a full recovery.</p><p><strong>Conclusion: </strong>This case underscores the diagnostic complexity of LNB as an initial manifestation of LD, particularly in elderly patients. Early neurological symptoms, often preceding classic cutaneous signs, may lead to diagnostic delays. This highlights the importance of maintaining clinical suspicion for LD, given the limitations of serological and cerebrospinal fluid (CSF) testing. Prompt recognition and intervention are essential to prevent progression and ensure favourable outcomes.</p><p><strong>Learning points: </strong>Lyme disease can present with neurological symptoms such as neuroborreliosis (LNB) before typical cutaneous signs, complicating diagnosis, especially in older adults. Early detection relies on clinical suspicion and cerebrospinal fluid (CSF) analysis, even when serology and PCR may be negative.Serum IgM antibodies can aid diagnosis, but their absence does not rule out LNB. CSF analysis often shows non-specific findings, and PCR testing has low sensitivity. The Jarisch-Herxheimer reaction, seen after treatment, can mimic an allergic response and should be recognised.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 2","pages":"005034"},"PeriodicalIF":0.0,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143381676","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":"Co-Infection with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV-2) and Human Coronavirus HKU1 (HCoV-HKU1).","authors":"Laszlo Madaras, Radean Anvari, Claudia Schuchardt-Peet, Abhinav Hoskote, Rahul Kashyap","doi":"10.12890/2025_005068","DOIUrl":"10.12890/2025_005068","url":null,"abstract":"<p><strong>Introduction: </strong>Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and human coronavirus HKU1 (HCoV-HKU1) are two forms of human coronaviruses known to cause respiratory tract symptoms. A co-infection with both viruses is rare, particularly in the United States.</p><p><strong>Case description: </strong>An 85-year-old male presented to the Emergency Department with recurrent falls, diarrhoea and cough, and whose viral panel was positive for both SARS-COV-2 and HCoV-HKU1. The patient developed bacterial pneumonia and was treated with antibacterial agents and glucocorticoids. His past medical history of atrial fibrillation required careful monitoring and subsequent discontinuation of remdesivir, a medication known to cause adverse cardiovascular effects in COVID-19 patients. The length of stay was also prolonged due to delirium and deconditioning. Ultimately, the patient required an urgent ablation followed by the placement of a permanent pacemaker, and anticoagulation therapy was initiated before discharge. The patient had a favourable outcome given the rarity of this case.</p><p><strong>Discussion: </strong>COVID-19 patients co-infected with other human coronaviruses should be monitored for disease progression and superimposed bacterial infections. Providers should be cautious with the use of remdesivir in cases of co-infection and in severely ill COVID-19 patients who have a history of atrial fibrillation.</p><p><strong>Learning points: </strong>This is a rare clinical case of a patient co-infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and human coronavirus HKU1 (HCoV-HKU1), two forms of coronaviruses; the report presents an epidemiological anomaly and a treatment framework.The importance of close monitoring of bacterial infections in coronavirus co-infections is reinforced.The cautious use of remdesivir in patients with a history of atrial fibrillation in severe or unique COVID-19 disease is recommended.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 2","pages":"005068"},"PeriodicalIF":0.0,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801512/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143381674","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":"Adalimumab-Induced Optic Neuropathy in A Patient with Behçet's Syndrome.","authors":"Sofia Miranda, Daniel Calado, Joana Rua, Fernando Salvador","doi":"10.12890/2025_005112","DOIUrl":"10.12890/2025_005112","url":null,"abstract":"<p><p>A 37-year-old woman with a diagnosis of Behçet's syndrome, treated with colchicine and prednisolone, maintained low disease activity for a period of 10 years, after which, she developed a new episode of anterior uveitis. A cycle of high dose systemic corticosteroids was required but the patient presented with a new flare during dose tapering. A decision to initiate a corticosteroid-sparing agent was then made, with an initially satisfactory response. However, 3 months later the ocular symptoms recurred, and a new bout of oral ulceration appeared concurrently. As a result, adalimumab was then started, but the patient presented with a sudden and severe decrease of visual acuity in her right eye 4 months later. The initial bloodwork showed no elevated inflammatory markers. A lumbar puncture showed a normal cerebrospinal fluid composition. Although these findings made it less probable that the patient's symptoms were caused by infectious or autoimmune disease, extensive investigations directed at these possible causes were performed, with negative results. Several imaging tests were also performed, which showed no alterations. However, a sensory evoked potentials test revealed a functional compromise at the pre-chiasmatic level. An iatrogenic optic neuropathy induced by adalimumab seemed the most probable cause and a decision to suspend the treatment was made. A new cycle of high dose systemic corticosteroids consisting of three pulses of methylprednisolone followed by pred-nisolone with a quick tapering over 4 weeks was also started, with gradual improvement of visual acuity.</p><p><strong>Learning points: </strong>Albeit used for the management of ocular manifestations of systemic diseases like Behçet's syndrome, anti-tumour necrosis factor (TNF)-alpha inhibitors can paradoxically be associated with ocular adverse effects.Optic neuritis is one of the possible ocular adverse effects although rarer than anterior uveitis.Iatrogenic optic neuritis due to anti-TNFα inhibitors remains a diagnosis of exclusion but should be kept in mind.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 2","pages":"005112"},"PeriodicalIF":0.0,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801509/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143381954","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":"Posterior Reversible Encephalopathy Syndrome Related to Severe Hypomagnesaemia.","authors":"Martín Naya Rosato, María Luisa Núñez Calvo, Lucía Barrera López","doi":"10.12890/2025_005098","DOIUrl":"10.12890/2025_005098","url":null,"abstract":"<p><strong>Introduction: </strong>Posterior reversible encephalopathy syndrome (PRES) might be associated with a wide spectrum of symptoms, including irreversible neurological damage. Management is primarily symptomatic and focuses on addressing the underlying causes.</p><p><strong>Case description: </strong>A 65-year-old female with a medical history of smoking, arterial hypertension and dyslipidaemia, was admitted due to dysarthria associated with ataxia, visual disturbances and diarrhoea. The neurological physical examination revealed a mild decreased strength in both legs (4/5), mild dysdiadochokinaesia and mild heel-knee dysmetria. Remarkable laboratory findings showed potassium 2.6 mmol/l and magnesium 0.24 mg/dl. Brain computed tomography (CT) showed no suggestive ischaemic areas. During hospitalisation, potassium and magnesium levels were initially corrected through intravenous supplementation. A brain magnetic resonance imaging (MRI) scan revealed symmetrical cortical alterations in the posterior regions of both cerebellar hemispheres, consistent with a diagnosis of PRES. After the exclusion of other potentially related diseases, the final diagnosis was PRES in the setting of severe hypomagnesaemia.</p><p><strong>Discussion: </strong>PRES pathophysiology is unknown, while its incidence is probably underestimated. It is suggested that rapid increases in blood pressure are thought to overwhelm the self-regulatory capability of cerebral blood flow, especially in the posterior brain regions where the regulatory flow capacity may be weaker. This might result in increased cerebral perfusion leading to oedema due to capillary leakage. PRES has been associated with poorly controlled arterial hypertension, autoimmune diseases, eclampsia and chemotherapy, among others.</p><p><strong>Conclusion: </strong>Hypomagnesaemia represents an uncommon but potentially reversible cause of PRES and should be taken into account for differential diagnosis.</p><p><strong>Learning points: </strong>Chronic drug therapies should always be included in the medical approach.The most common aetiology of posterior reversible encephalopathy syndrome is arterial hypertension with poor control and the use of cytotoxic drugs. However, other less common causes, such as severe hypomagnesaemia, should be taken into account.The diagnosis of posterior reversible encephalopathy syndrome is based on neuroimaging findings in the correct clinical setting. Therapy is mainly symptomatic and focuses on the underlying causes.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 2","pages":"005098"},"PeriodicalIF":0.0,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143381746","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/Inflammatory Syndrome Induced by Adjuvants (ASIA) after Silicone Breast Implants.","authors":"Jaouad Yousfi, Soukaina Oumlil, Lamiaa Essaadouni","doi":"10.12890/2025_005048","DOIUrl":"10.12890/2025_005048","url":null,"abstract":"<p><p>Autoimmune/inflammatory syndrome is a complex condition characterized by various autoimmune and inflammatory symptoms following the exposure to an adjuvant such as silicone. Autoimmune/inflammatory syndrome induced by adjuvants (ASIA) is challenging to diagnose because it can mimic other autoimmune diseases and requires specific criteria for identification. We report a case of a 35-year-old woman who developed inflammatory joint pain, fatigue and myalgia after receiving silicone breast implants. Symptoms improved significantly after administration of steroids. Based on the fulfilment of the ASIA diagnostic criteria, the diagnosis was made. This case emphasizes the importance of understanding this condition in patients with unexplained systemic symptoms after exposure to adjuvants.</p><p><strong>Learning points: </strong>Autoimmune/inflammatory syndrome induced by adjuvants (ASIA) should be considered in patients with unexplained systemic symptoms following exposure to adjuvants.Steroids can offer significant symptom relief; however, implant removal may be necessary if symptoms persist or recur.Awareness of ASIA can help in early diagnosis, and in improving patient outcomes.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 2","pages":"005048"},"PeriodicalIF":0.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801511/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143381955","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":"Oral and Intestinal Manifestations of Giant Cell Arteritis.","authors":"Mathieu Pernet, Laura Moi, Fulvia Serra, Nicolas Garin","doi":"10.12890/2025_005081","DOIUrl":"10.12890/2025_005081","url":null,"abstract":"<p><strong>Background: </strong>Giant cell arteritis (GCA) is the most common primary vasculitis in individuals over 50 years of age. GCA typically affects large- and medium-sized arteries and is classically associated with cranial manifestations of ischaemia, such as headaches (notably in the temporal region), jaw claudication and visual symptoms that can lead to blindness. Extracranial symptoms are less frequently reported and are related to involvement of the thoracic and abdominal aorta and its main branches. Classic diagnostic tools (such as temporal artery ultrasonography and temporal artery biopsy) can be negative in extracranial GCA.</p><p><strong>Case description: </strong>We report a difficult diagnosis of GCA in a 75-year-old woman who developed painful tongue ulcers that responded to prednisone treatment. However, a comprehensive diagnostic work-up did not lead to a certain diagnosis of GCA and corticosteroids were stopped after one month. A few months later, the patient suffered from mechanical ileus secondary to ischaemic stenosis of the small bowel. Pathological examination of the small bowel resection, and a second FDG-PET/CT, led to the diagnosis of extracranial GCA.</p><p><strong>Conclusions: </strong>We present a case of CGA which sequentially affected cranial and extracranial arteries and illustrate pitfalls in the diagnosis of this polymorph condition.</p><p><strong>Learning points: </strong>Giant cells arteritis (GCA) should be considered in older adults with symptoms and signs suggestive of tongue ischaemia, including tongue pain, inflammation, swelling and ulceration.GCA may present with extracranial manifestations due to involvement of the aorta and its main branches, including mesenteric ischaemia.Classic diagnostic tools for cranial GCA (temporal artery ultrasound and biopsy) may be negative in extracranial GCA, and FDG-PET CT should be obtained when this form of the disease is suspected.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 2","pages":"005081"},"PeriodicalIF":0.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143381813","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":"Would you Rather Treat? A Rare Case of <i>Mycobacterium Scrofulaceum</i>.","authors":"Junaid Zafar Sheikh, Nonhlanhla Lunjani, Hira Gul, Louay Kila, Brian Casserly","doi":"10.12890/2025_004963","DOIUrl":"10.12890/2025_004963","url":null,"abstract":"<p><p><i>Mycobacterium scrofulaceum</i> is a rare cause of non-tuberculous mycobacterial infection in adults, primarily affecting the immunocompromised. Pulmonary involvement has been seen in individuals with pre-existing lung pathology. We report a case of a 63-year-old female who presented with abdominal pain, cough and sputum samples yielding <i>M. scrofulaceum</i>, with a normal clinical examination. Initial investigations were unremarkable, prompting abdomen and pelvis computed tomography (CT), revealing minimal pericardial and ascitic fluid. Thoracic CT exhibited calcified tree-in-bud nodules and a trivial left pleural effusion. Given subdued symptoms and limited disease, discerning colonisation versus clinically relevant infection was uncertain. Due to lack of empirical data for guidance, treatment approaches at this juncture remain unclear. The patient was monitored closely for a period of one year with a plan to treat should there be evidence of active disease.</p><p><strong>Learning points: </strong>This case demonstrated an atypical presentation of rare non-tuberculous Mycobacterium.Whether the case involves <i>Mycobacterium scrofulaceum</i> infection or colonisation needs to be distinguished.There is limited utility of clinical diagnostic algorithms for non-tuberculous mycobacteria in <i>Mycobacterium scrofulaceum</i>.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 2","pages":"004963"},"PeriodicalIF":0.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143381854","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":"Pus in the Pericardium: A Pericardial-Oesophageal Fistula with Cardiac Tamponade after Ablation for Atrial Fibrillation.","authors":"Taha Mansoor, Nahal Massoudi, Anandbir Bath, Matthew Kelly, Santhosh Koshy, Armand Tanase","doi":"10.12890/2025_005102","DOIUrl":"10.12890/2025_005102","url":null,"abstract":"<p><strong>Background: </strong>Pericardial/atrial oesophageal fistula (PEF/AEF) is the most feared complication of cardiac atrial fibrillation (AF) ablation. Without urgent surgical treatment, most cases of this infrequent complication rapidly prove fatal.</p><p><strong>Case report: </strong>We present an uncommon case of a 60-year-old male who had undergone an AF ablation 2 weeks prior and presented with chest pain. Following diagnosis and treatment of ST-elevation myocardial infarction (STEMI), a small pericardial effusion was noticed on computed tomography (CT) scan. Despite an initially reassuring hospital course, rapid decompensation and expansion of his purulent pericardial effusion led to his death within 24 hours of presentation. A post-mortem review of his CT imaging revealed an inconspicuous PEF.</p><p><strong>Conclusions: </strong>It is essential to maintain a high suspicion of PEF/AEF in patients presenting after AF ablation with suggestive symptoms, such as fever, chest pain/odynophagia, and neurological deficits. CT chest is the most common diagnostic modality and surgical correction is the treatment of choice.</p><p><strong>Learning points: </strong>Pericardial/atrial oesophageal fistula is a devastating complication of atrial fibrillation ablation and early detection is the keystone of effective management.Urgent surgical repair is the most effective treatment to prevent mortality.Preventative measures include power titration, limiting energy delivery times, and avoiding overlapping ablation lines during the ablation procedure.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 2","pages":"005102"},"PeriodicalIF":0.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801515/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143381771","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}