European journal of case reports in internal medicine最新文献

{"title":"Small Intestinal Obstruction Secondary to Migrated Intragastric Balloon Retrieved Endoscopically from the Jejunum.","authors":"Khaled Bamakhrama, Suhana Riyaz, Mizna Musthafa","doi":"10.12890/2024_004743","DOIUrl":"https://doi.org/10.12890/2024_004743","url":null,"abstract":"<p><strong>Introduction: </strong>The intragastric balloon is a medical device inserted into the stomach endoscopically and filled with either air or more commonly, saline. Widely utilised since the 1980s, numerous studies have affirmed its safety and effectiveness as a temporary treatment for weight loss. Despite this, there have been reports of rare but severe complications associated with its usage.</p><p><strong>Case description: </strong>We report the case of a 33-year-old female presented with two-day history of epigastric pain, nausea and vomiting. This occurred after having a gastric balloon placed endoscopically two months earlier. A contrast-enhanced abdominal CT scan revealed a partially deflated and migrated intragastric balloon in the proximal jejunum, causing intestinal obstruction without any signs of bowel perforation. The diagnosis was established as intestinal obstruction due to the migrated intragastric balloon. An emergency endoscopic procedure was undertaken, successfully removing the balloon thus highlighting a unique attempt to endoscopically retrieve a migrated intragastric balloon from the jejunum.</p><p><strong>Conclusion: </strong>The efficacy of an intragastric balloon in reducing weight in a short time is gaining more popularity. The more common it becomes the more we must be vigilant about its complications. We advise regular follow-up of patients and emphasise patient education of possible signs and symptoms of intragastric balloon migration, which will avoid serious complications.</p><p><strong>Learning points: </strong>Endoscopic removal from the jejunum: Learn the procedure for endoscopic removal of a migrated gastric balloon from the jejunum, recognising it is possible without signs of perforation or leakage. Additionally, understand the importance of performing this procedure with surgical backup in a theatre to address any potential complications, such as perforation, during or after the procedure.The role of CT scans: Understand the crucial role of CT scans in diagnosing migrated gastric balloons or perforations related to gastric balloon procedures.Recognising and responding to balloon deflation: Identify signs of a deflated gastric balloon, such as methylene blue in the urine, and understand associated symptoms such as reduction in stomach fullness.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11379120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153463","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":"Mogad may not only Mimic Immune or Infectious Encephalitis, but can also be Triggered by Viral Infections.","authors":"Josef Finsterer","doi":"10.12890/2024_004764","DOIUrl":"https://doi.org/10.12890/2024_004764","url":null,"abstract":"","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11379111/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153426","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 Successful Laparoscopic Appendectomy for an Adult Male Patient with Osteogenesis Imperfecta.","authors":"Mohamed I Farid, Azza Baz, Mohamed Emad El-Dein Hemdan, Taghreed Abdelhamid, Diyaa Ebrahim, Fadl Fayed, Emad Abdel-Haleem","doi":"10.12890/2024_004738","DOIUrl":"https://doi.org/10.12890/2024_004738","url":null,"abstract":"<p><strong>Background: </strong>Osteogenesis imperfecta (OI) is a genetic connective tissue disease defined by the loss of bone mass and density, which makes the bones more brittle and more likely to fracture over time. Bone deformity and articular instability are the subsequent symptoms.</p><p><strong>Case report: </strong>This 25-year-old man had malformed lower limbs and trouble walking due to OI and dwarfism. He arrived complaining of fever, nausea, vomiting and diffuse peri-umbilical pain. During ultrasonography a blinded, oedematous lobe formation containing an appendicolith was discovered. Acute suppurative appendicitis was diagnosed, necessitating a laparoscopic appendectomy. Because the patient had previously undergone general anaesthesia, anaesthesia was thought to be attainable. Pneumoperitoneum and a 10 mm optical port inserted into the umbilicus were used in the surgical procedure. A diagnostic laparoscopy revealed faecolith obstruction and an acute suppurative appendicitis. After an hour, a laparoscopic appendectomy was performed effectively with little blood loss. Without experiencing any difficulties because of the surgery position, the patient was discharged.</p><p><strong>Conclusion: </strong>We present a case of an OI dwarf patient with acute suppurative appendicitis. It highlights the possibility of performing laparoscopic surgery in general and a laparoscopic appendectomy in particular on OI patients.</p><p><strong>Learning points: </strong>In rare instances involving OI, laparoscopic surgery in general and laparoscopic appendectomy in particular are practical and efficient options.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11379103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153419","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":"Mycophenolate Mofetil for the Treatment of Warm Autoimmune Haemolytic Anaemia Post-Rituximab Therapy: A Case Series.","authors":"Oscar F Borja-Montes, Alejandro Toro-Pedroza, Darrell D Horton, Leslie A Andritsos, Ala Ebaid","doi":"10.12890/2024_004780","DOIUrl":"https://doi.org/10.12890/2024_004780","url":null,"abstract":"<p><strong>Background: </strong>Warm autoimmune haemolytic anaemia (wAIHA) is an acquired haemolytic disorder most commonly treated with a combination of corticosteroids, rituximab and/or splenectomy. Third-line therapies for refractory cases include immunosuppressive agents. Mycophenolate mofetil is frequently used in these scenarios, although its use is supported by small studies and anecdotal evidence rather than large-scale data.</p><p><strong>Case description: </strong>We describe three cases of refractory warm autoimmune haemolytic anaemia successfully treated with mycophenolate mofetil. Case 1: A persistent case of autoimmune haemolytic anaemia in a 56-year-old was ultimately managed with mycophenolate mofetil, leading to successful steroid tapering and stable haemoglobin levels without relapse. Case 2: A woman with a complex oncological history, including lymphoma and breast cancer, achieved remission with mycophenolate therapy, maintaining stability post-steroid treatment. Case 3: Mycophenolate proved effective for a 63-year-old with cirrhosis after recurrent autoimmune anaemia and deep vein thrombosis, enabling cessation of steroids and maintaining remission.</p><p><strong>Conclusion: </strong>Management of this condition can be challenging and balancing the available treatments is crucial to reduce potential complications from long-term therapies that appear to be ineffective. Our case series demonstrates anecdotal experience on successful use of mycophenolate mofetil for complex refractory cases of wAIHA.</p><p><strong>Learning points: </strong>Warm autoimmune haemolytic anaemia can be a challenging condition to manage. Refractory cases that are steroid-dependent can benefit from trialling steroid-sparing agents such as mycophenolate.Anti-CD20 agents such as rituximab can be very effective in refractory cases, however there is a small percentage of patients that might not be responsive to this monoclonal antibody.Autoimmune haemolytic anaemias can be frequently complicated by thrombotic events, and part of the backbone treatment is establishing good thromboprophylaxis.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11379116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153427","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":"An Intimate Relationship Lies Between the Appendix and the Colon: A Case Report of Colitis Cystica Profunda Post-Laparoscopic Appendectomy.","authors":"Houssein Chebbo, Amer Yazbak, Sarah Saleh, Karam Karam, Lamia Azizi, Elias Fiani","doi":"10.12890/2024_004783","DOIUrl":"https://doi.org/10.12890/2024_004783","url":null,"abstract":"<p><p>Cystica profunda is a rare benign finding of mucous-filled cysts in the submucosa of the gastrointestinal tract, more commonly found in the rectum and colon. Risk factors include rectal prolapse, inflammatory bowel diseases, pelvic radiation and being post-appendectomy. We present a case of a female patient presenting with rectorrhagia, found to have sigmoidal colitis cystica profunda (CCP) six months post-appendectomy. This case is one of the few in medical literature to highlight the direct association between laparoscopic appendectomy and CCP, previously discussed in the literature as a complication post-appendectomy in the American Journal of Gastroenterology.</p><p><strong>Learning points: </strong>Physicians should have a high index of suspicion to rule out colitis cystica profunda (CCP) when approaching a patient with rectorrhagia following laparoscopic appendectomy.It is pivotal to make a prompt diagnosis for CCP in the context of rectorrhagia and initiate timely management.It is important to differentiate CCP from other aetiologies of lower gastrointestinal tract bleed as it is coined 'the great imitator'.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11379119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153421","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":"Syphilis Should not be Overlooked in any Individual, Irrespective of their Condition.","authors":"Oriane Cellier, Juliette Jourdan, Lotfi Dahmane, Véronique Perronne, Aurélien Dinh, Karim Jaffal","doi":"10.12890/2024_004578","DOIUrl":"https://doi.org/10.12890/2024_004578","url":null,"abstract":"<p><strong>Introduction: </strong>Syphilis remains a significant challenge in public health, largely because of its diverse clinical manifestations, often resulting in underdiagnosis especially among patients with neurogenic disability.</p><p><strong>Case description: </strong>We present a case of neurosyphilis in a 63-year-old patient with a spinal cord injury. Despite syphilis being a well-established sexually transmitted infection, the exacerbation of neurological and dermatological symptoms during physical examination prompted an investigation into alternative causes beyond the patient's pre-existing paraparesis, ultimately resulting in the diagnosis of neurosyphilis.</p><p><strong>Conclusion: </strong>This case highlights the importance of considering syphilis as a potential diagnosis in individuals regardless of their medical history.</p><p><strong>Learning points: </strong>The incidence of syphilis cases is on the rise, presenting an ongoing challenge.Faced with atypical neurological symptomatology, it is necessary to know how to investigate and discuss tertiary syphilis.In the event of neurological worsening in a neuro-injured patient, it is necessary to know how to discuss a curable diagnosis.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11379106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153465","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":"An Unusual Case of HHV-8 Negative, Idiopathic, Multicentric Castleman Disease Following Chronic Lymphocytic Leukaemia.","authors":"Pierre-Yves Sansen, Hélène Vellemans, Julien Depaus, Caroline Fervaille, Benoit Krug, Anne Sonet, Elodie Collinge","doi":"10.12890/2024_004688","DOIUrl":"https://doi.org/10.12890/2024_004688","url":null,"abstract":"<p><strong>Background: </strong>Castleman disease is a rare condition characterised by polytypic lymphocytes proliferation and lymphadenopathy generally with a benign course. Whereas high grade lymphoma (Richter syndrome) is a classical complication seen in chronic lymphocytic leukaemia with a poor outcome, benign conditions mimicking this entity are infrequent.</p><p><strong>Case description: </strong>We describe the case of an 81-year-old Caucasian male who developed a human herpesvirus-8 (HHV-8)-negative, idiopathic multicentric Castleman disease (iMCD) following a treated Binet C chronic lymphocytic leukaemia (CLL). The clinical and radiological pattern raised initially the suspicion of a classical Richter transformation. Blood analysis showed auto-immune haemolytic anaemia and thrombocytopenia. He had normal immunoglobulin levels. The anatomopathological analysis of a cervical adenomegaly showed hypervascularisation and a polytypic plasmocytic proliferation compatible with a plasmocytic iMCD type. Interestingly, bone marrow examination showed reticuline fibrosis but, in the absence of anasarca or generalised oedema, we were not allowed to conclude to the diagnosis of a TAFRO syndrome. We excluded all other mimicking conditions, comprising haematological malignancies, infections, and auto-immune diseases He was first treated with corticosteroids with poor results but dramatically responded to tocilizumab (anti-Il6).</p><p><strong>Conclusion: </strong>To our knowledge, this the first case described of a Castleman disease following CLL and surprisingly mimicking Richter syndrome. Clinicians should be aware of this rare misleading condition.</p><p><strong>Learning points: </strong>Castleman disease can mimic a Richter transformation in a CLL patient.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11379110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142157165","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 Presentation of a Large Left Atrial Myxoma with Gastrointestinal Symptoms.","authors":"Samuel Kim, Jiyeon Kim, Ahmed Shukri, Romelia Barba, Muhammad Qudrat-Ullah, Zhaunn Sly, Ty Whisenant","doi":"10.12890/2024_004773","DOIUrl":"10.12890/2024_004773","url":null,"abstract":"<p><p>Atrial myxoma is a rare primary tumour of the heart that typically arises from the left atrium. Patients typically present with obstructive symptoms such as dyspnoea, but constitutional and embolic symptoms can be seen as well. Gastrointestinal symptoms in the absence of embolisation are rarely reported in the literature. Our case presents a 55-year-old female who was found to have a large left atrial myxoma after presenting with gastrointestinal symptoms, which resolved upon resection of the tumour. This case illustrates that atrial myxomas can have an atypical presentation with gastrointestinal symptoms, which could be related to inflammation of gastric mucosa from interleukin-6 produced by the tumour cells. Careful history-taking followed by early detection and prompt treatment is important as atrial myxomas can lead to potentially devastating complications.</p><p><strong>Learning points: </strong>Atrial myxomas are primary tumours of the heart that can present with a wide spectrum of symptoms.Early consideration and recognition of atypical presentations of atrial myxomas can be crucial in preventing serious consequences such as cardiac arrest.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11313115/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141916406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Atypical Scleroderma Renal Crisis.","authors":"Ayushi Lalwani, Shefali Amin, Zohaib Yousaf, Muhammad Umer Riaz Gondal, Sami Al Ampnti, Andrew Pajak, Christopher Reggio","doi":"10.12890/2024_004706","DOIUrl":"10.12890/2024_004706","url":null,"abstract":"<p><p>We present the case of a 63-year-old female diagnosed with atypical SSc in the setting of acute SRC. She was undergoing work-up for progressive dyspnoea in the outpatient setting when she was found to have newly diagnosed restrictive lung pathology and worsening renal function, thus prompting acute hospital admission. Given multisystem involvement of the pulmonary and renal systems, the differential diagnosis included autoimmune and connective tissue disorders. Although serologies were non-specific, renal biopsy confirmed scleroderma renal disease, and she was started on treatment with captopril. This case highlights the importance of clinical judgment and timely diagnosis, even when laboratory data might indicate otherwise.</p><p><strong>Learning points: </strong>Scleroderma renal crisis (SRC) remains an important cause of morbidity and mortality in systemic sclerosis (SSc), and clinicians should have a high index of suspicion to diagnose it.The absence of specific serologic markers makes SSc diagnosis challenging and necessitates reliance on clinical findings and additional diagnostic tools such as imaging studies and tissue sampling.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11313114/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141918605","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":"Durvalumab-Induced Triple-M Syndrome.","authors":"Femi Williams Adeoye, Nida Jaffar, Sanggeeta Surandran, Gulshad Begum, Mohammad Rafiqul Islam","doi":"10.12890/2024_004729","DOIUrl":"10.12890/2024_004729","url":null,"abstract":"<p><strong>Background: </strong>While the use of immunotherapy has revolutionised the treatment of various cancers, it is often associated with a myriad of immune-related adverse effects.</p><p><strong>Case presentation: </strong>In this article, we report a rare case of durvalumab-induced triple-M syndrome in a 69-year-old woman with stage III lung adenocarcinoma. She was admitted with profound generalised muscle weakness, myalgia, and exertional breathlessness, about a week into her second cycle of durvalumab, an immune checkpoint inhibitor. She had clinicopathological features of myositis, myasthenia and myocarditis with acute onset symptomatic tri-fascicular block on electrocardiogram, requiring urgent cardiology intervention. Durvalumab was discontinued and she was treated with a combination of high-dose steroids and intravenous immunoglobulin after which she had clinical and biochemical improvement, albeit with residual muscle weakness.</p><p><strong>Conclusion: </strong>Myocarditis-myositis-myasthenia complex is a rare side effect of immunotherapy which has been reported in other immune checkpoint inhibitors, but less so with durvalumab. We report this clinical case to raise awareness of this rare and potentially life-threatening adverse effect of this agent.</p><p><strong>Learning points: </strong>Triple-M syndrome is a rare immune-related adverse effect, which has been noted in other immune checkpoint inhibitors, but less so with durvalumab specifically.Immunotherapy-induced myositis, myocarditis and myasthenia can occur in isolation or, rarely, in association as a syndrome.This case demonstrates the potentially life-threatening nature of this entity, the need for early recognition, and multi-specialist teamwork to ensure good outcome.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11313117/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141916408","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}