European journal of case reports in internal medicine最新文献

{"title":"When is A Kidney Biopsy Indicated During the Treatment of Brain Cancer?","authors":"Catarina Oliveira-Silva, Johanna Viana, Claudia Coelho, Roberto Silva, Luís Falcão, Joana Rocha, Bárbara Ribeiro","doi":"10.12890/2025_005565","DOIUrl":"10.12890/2025_005565","url":null,"abstract":"<p><strong>Introduction: </strong>Bevacizumab is a monoclonal antibody that targets vascular endothelial growth factor (VEGF) and is widely used in oncology for its anti-angiogenic properties. However, VEGF inhibition may result in significant nephrotoxicity, including thrombotic microangiopathy (TMA). While systemic TMA is well-described, isolated renal-limited TMA remains under recognised.</p><p><strong>Case description: </strong>We present a 46-year-old woman with WHO grade IV IDH-wildtype EGFR-amplified gliosarcoma. She received second-line treatment with bevacizumab and, after 12 months of therapy, developed progressive hypertension and nephrotic-range proteinuria up to 6.2 g/day, with normal renal function and without anaemia or thrombocytopenia. A kidney biopsy revealed glomerular microangiopathy, and a diagnosis of bevacizumab-associated renal-limited TMA was established. Given the stability of the intracranial disease, the drug was discontinued with complete resolution of proteinuria after seven months.</p><p><strong>Conclusion: </strong>Anti-VEGF therapy causes renal TMA and may present with nephrotic-range proteinuria associated with a pattern of glomerular microangiopathy. Recognising anti-VEGF-associated nephrotoxicity is essential in the differential diagnosis of proteinuria in cancer patients, and kidney biopsy is fundamental for guiding clinical decisions. Drug cessation led to the complete resolution of proteinuria.</p><p><strong>Learning points: </strong>Bevacizumab can cause renal-limited thrombotic microangiopathy and may present with nephrotic-range proteinuria, without renal dysfunction.Kidney biopsy is essential to distinguish drug-induced thrombotic microangiopathy from malignancy-associated nephropathies in cancer patients.Early recognition and drug discontinuation can lead to complete proteinuria resolution.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 9","pages":"005565"},"PeriodicalIF":0.0,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12416784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029396","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":"Endoscopic Ultrasound-Guided Drainage of Extraluminal Colorectal Mucocele Using A Lumen-Apposing Metal Stent: A Novel Approach.","authors":"Ryan Njeim, Elie Moussa, Toni Habib, Omar Abureesh, Saif Yasin, Daniel Kalta, Youssef El Douaihy","doi":"10.12890/2025_005703","DOIUrl":"10.12890/2025_005703","url":null,"abstract":"<p><p>Colorectal mucoceles are rare mucinous cysts arising in the gastrointestinal tract and presenting diagnostic and therapeutic challenges. We report the first successful treatment of an extraluminal colorectal mucocele using a lumen-apposing metal stent (LAMS). A 65-year-old male with a known medical history of diverticulitis treated with a partial colectomy presented with constipation and low back pain. Computed tomography scan (CT) revealed a 5.4 cm cystic structure adjacent to the rectal anastomosis. Endoscopic ultrasound (EUS) found a subepithelial lesion with an \"onion peel\" appearance, and aspiration cytology confirmed a colo-colonic mucocele. Management consisted of EUS-guided placement of an 8 × 8 mm LAMS, allowing for drainage, irrigation, and suctioning of the cavity. Complete resolution was achieved without recurrence over a 2-year follow-up period. This case demonstrates the potential of advanced endoscopic techniques, particularly LAMS, in managing extraluminal colorectal mucoceles. While further research is needed to compare the efficacy of LAMS with other treatment modalities, this procedure offers a minimally invasive alternative to surgery for certain patients.</p><p><strong>Learning points: </strong>Novel approach to treat a rare case of colorectal mucocele using a lumen-apposing metal stent.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 9","pages":"005703"},"PeriodicalIF":0.0,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12416772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029312","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":"Spontaneous Aortic Sealing with Tranexamic Acid in Type A Dissection: A Novel Life-Saving Finding.","authors":"Antonio Al Hazzouri, Philippe Attieh, Karam Karam, Elias Fiani","doi":"10.12890/2025_005650","DOIUrl":"10.12890/2025_005650","url":null,"abstract":"<p><p>Aortic dissection is a life-threatening cardiovascular emergency, particularly Stanford type A, which typically necessitates urgent surgical intervention. Despite advances in surgical techniques and perioperative care, preoperative bleeding and coagulopathy remain significant challenges. Tranexamic acid, an antifibrinolytic agent, is widely used to minimize perioperative bleeding in cardiovascular surgeries; however, its role in the non-surgical, preoperative stabilization of aortic dissection has not been well established. We present the case of a 56-year-old woman with a history of hypertension and dyslipidaemia who presented with sudden-onset, severe interscapular chest pain. Computed tomography angiography revealed an ascending aortic dissection. Initial management included intravenous labetalol for blood pressure and heart rate control, along with the administration of 1 gram of tranexamic acid. She was subsequently transferred for emergent surgical repair. Intraoperatively, however, no active aortic bleeding was identified. Instead, a clot was found sealing the dissected segment of the ascending aorta, effectively halting further propagation and haemorrhage. This unexpected finding led to the cancellation of surgical repair. We hypothesize that tranexamic acid contributed significantly to the formation of this stabilizing clot through its antifibrinolytic effects. The patient's clinical outcome was favourable, with no complications observed. This case highlights a novel potential application of tranexamic acid in the emergency management of aortic dissection. To our knowledge, this is the first reported case in which tranexamic acid contributed to spontaneous thrombus formation within a dissected aortic segment, preventing catastrophic haemorrhage and obviating the need for surgery.</p><p><strong>Learning points: </strong>This case highlights a potentially important role for tranexamic acid (TXA) in the management of aortic dissection. To our knowledge, this is the first reported case of its kind.While its established use in reducing postoperative bleeding and transfusion requirements is well documented, our case demonstrates a preoperative benefit, with TXA contributing to the formation of a stabilizing thrombus within the dissected aortic segment.This life-saving clot prevented further dissection and haemorrhage, ultimately deferring the need for surgical repair and reducing the risk of perioperative complications.We aim to underscore the need for further investigation into the potential role of tranexamic acid in the acute management of aortic dissection.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 9","pages":"005650"},"PeriodicalIF":0.0,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12416795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029302","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":"Restless Eyes at Night: A Novel Variant of Restless Legs Syndrome.","authors":"Yasutaka Yanagita, Takanori Uehara, Koichiro Kishimoto, Shiori Kase, Yu Li, Rurika Sato, Daiki Yokokawa","doi":"10.12890/2025_005698","DOIUrl":"10.12890/2025_005698","url":null,"abstract":"<p><strong>Introduction: </strong>Restless legs syndrome (RLS) is a common sensorimotor disorder that primarily affects the lower extremities. This condition is characterized by unpleasant sensations and an irresistible urge to move the affected body regions, typically during periods of rest or at night. While RLS most commonly involves the legs, atypical variants affecting other body parts, including the arms, abdomen, face, and even the head, have increasingly been reported. This has led to the emergence of a broader diagnostic concept termed \"restless X syndrome\". However, no prior cases involving the ocular region have been documented.</p><p><strong>Case description: </strong>Herein, we report a novel case of a 57-year-old woman who experienced chronic, nocturnal ocular pain for over 10 years, which repeatedly woke her from sleep. The pain, described as heavy and crushing, was not associated with any known ocular or neurologic pathology, and could be consistently alleviated by eye movements or eyelid stimulation. Multiple treatments for presumed dry eye syndrome and atypical facial pain were unsuccessful. After extensive evaluation, the condition was identified as a novel variant of RLS affecting the eyes. The patient showed no response to a dopamine agonist (pramipexole), but experienced marked and sustained relief with gabapentin enacarbil.</p><p><strong>Conclusion: </strong>This case highlights the potential for RLS to present in non-traditional locations, including the eyes. Clinicians should maintain a high index of suspicion for RLS variants in patients with nocturnal sensory discomfort that can be relieved by movement, even in the absence of limb symptoms.</p><p><strong>Learning points: </strong>Restless legs syndrome (RLS) variants can affect body parts beyond the lower limbs, including the eyes.Symptoms are typically nocturnal and relieved by voluntary movement or sensory stimulation.Gabapentin enacarbil may be effective in treating these atypical RLS presentations.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 9","pages":"005698"},"PeriodicalIF":0.0,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12416793/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029324","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":"Brugada ECG Pattern in A Caucasian Patient with Severe Hypothyroidism.","authors":"Erminia De Cristofaro, Maria Giulia Canè, Davide Cunzi, Giorgia Prampolini, Silvia Daniela Umbertina Fedeli, Aurelio Negro","doi":"10.12890/2025_005544","DOIUrl":"10.12890/2025_005544","url":null,"abstract":"<p><p>Brugada syndrome (BrS) is a disorder leading to potentially life-threatening ventricular arrhythmias in patients with an apparently normal heart. It mostly affects men of Asian descent, and the prevalence varies between ethnicities. Typical ECG abnormalities with no symptoms are referred to as the Brugada pattern, and hypothyroidism is a potential trigger of this. We report on a Caucasian man with severe hypothyroidism and Brugada ECG pattern, which normalised after starting replacement therapy. The association has been previously described in only a few patients.</p><p><strong>Learning points: </strong>Brugada syndrome (BrS) is a potentially life-threatening disease that can be easily recognized on the electrocardiogram (ECG). Typical ECG abnormalities associated with no clinical symptoms is referred to as the Brugada pattern.Many studies have underscored the association between hypothyroidism and Brugada ECG pattern, that can be reversed by a prompt initiation of replacement therapy.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 9","pages":"005544"},"PeriodicalIF":0.0,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12416803/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029337","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":"Catheter-Based Thrombectomy for Clot-In-Transit and Massive Pulmonary Embolism In A Young Patient with Rheumatoid Arthritis: Inflammation as A Hidden Catalyst for Catastrophic Thromboembolism.","authors":"Han Shin Lee, Christ Ordookhanian, Ryan Amidon, Benjamin Tabibian","doi":"10.12890/2025_005695","DOIUrl":"10.12890/2025_005695","url":null,"abstract":"<p><strong>Introduction: </strong>Pulmonary embolism (PE) is a life-threatening condition with well-defined management strategies; however, the presence of a clot-in-transit (CIT)-a mobile thrombus within the right heart-introduces a uniquely high-risk scenario associated with a significantly elevated mortality rate. While several therapeutic approaches are available-including anticoagulation, systemic thrombolysis, surgical embolectomy, and catheter-directed therapies-there is no established consensus on a superior treatment modality. Catheter-based mechanical thrombectomy has emerged as a promising, minimally invasive alternative that mitigates the bleeding risks of systemic thrombolysis and the invasiveness of surgery.</p><p><strong>Case description: </strong>A 37-year-old male with untreated rheumatoid arthritis presented to the emergency department with dyspnea and chest pain, ultimately found to have massive bilateral PE with CIT. This was successfully treated with percutaneous thrombectomy using the INARI FlowTriever device (Inari Medical, USA).</p><p><strong>Discussion: </strong>This case is accompanied by uncommon post-thrombectomy imaging that vividly demonstrates the thrombus burden in the majority of bilateral pulmonary vessels, providing valuable visual insight into the disease process and intervention efficacy. Rheumatoid arthritis is an independent risk factor for PE, deep vein thrombosis, and venous thromboembolism, highlighting the importance of treatment.</p><p><strong>Conclusion: </strong>This report contributes to the limited literature on atypical CIT presentations, highlights the need for standardized treatment algorithms, and demonstrates the success of catheter-directed mechanical thrombectomy in these scenarios.</p><p><strong>Learning points: </strong>Rheumatoid arthritis is a risk factor for pulmonary embolism, deep vein thrombosis, and venous thromboembolism.Catheter-directed mechanical thrombectomy for massive pulmonary embolism with clot-in-transit is a promising, minimally invasive alternative to systemic thrombolysis.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 9","pages":"005695"},"PeriodicalIF":0.0,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12416788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029386","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":"Potential Pharmacokinetic Interaction Between Enteral Nutrition and Valproic Acid.","authors":"Natalí Giselle Lara-Gonzalez, Iván Alejandro Díaz-Rengifo, Ana Isabel Terleira-Fernández, María Rosario Salas-Butrón","doi":"10.12890/2025_005657","DOIUrl":"10.12890/2025_005657","url":null,"abstract":"<p><strong>Background: </strong>Certain scientific publications suggest that medications with high protein binding, such as phenytoin, have lower-than-expected serum levels in patients receiving enteral nutrition (EN) preparations or nutritional supplements. Valproic acid (VPA) is highly protein bound but currently no interactions with EN that would reduce serum levels have been documented.</p><p><strong>Case description: </strong>A 69-year-old patient receiving enteral VPA oral solution via a nasojejunal tube experienced a clinically significant decrease in serum concentration when EN was initiated. Other sources of interactions were ruled out, and VPA serum concentration increased when doses were separated from EN by one hour.</p><p><strong>Discussion: </strong>Interactions between highly protein bound compounds and EN have been previously described for other medications. However, there is a lack of data regarding the interaction between EN and VPA; only one published case has involved a protein supplement administered via percutaneous endoscopic gastrostomy. In our case, adjusting the timing of medication administration relative to enteral feeding resulted in increased serum VPA levels, which correlated with an improvement in clinical outcomes, suggesting the potential interaction.</p><p><strong>Conclusion: </strong>These findings suggest a potential interaction between EN and the absorption of VPA, which may lead to reduced drug absorption and significant clinical implications.</p><p><strong>Learning points: </strong>Enteral nutrition may reduce the absorption of valproic acid. This could potentially result in subtherapeutic serum levels and worsen clinical outcomes.Clinicians should closely monitor serum levels and consider separating the administration of valproic acid and enteral nutrition by at least one hour.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 9","pages":"005657"},"PeriodicalIF":0.0,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12416780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029389","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":"Piperacillin/Tazobactam Induced Immune-Mediated Anaemia and Thrombocytopenia.","authors":"Agnes-Sophie Fritz, Marten Trendelenburg, Markus Mutke","doi":"10.12890/2025_005460","DOIUrl":"10.12890/2025_005460","url":null,"abstract":"<p><p>Piperacillin/tazobactam (PTZ) is known to cause cytopenia but case reports on PTZ causing combined haemolytic anaemia and thrombocytopenia are scarce. We report on a 56-year-old male who developed severe, immune-mediated thrombocytopenia and anaemia during two treatment episodes with PTZ. After the first exposure, his blood count rapidly returned to normal after discontinuation of PTZ. One year later, in the context of an unintentional re-challenge with PTZ, the level of red blood cells and platelets dropped again causing acute haemolytic anaemia and immune thrombocytopenia. Recovery was delayed after discontinuation of PTZ. PTZ should be considered as a potential cause of immune-mediated bicytopenia.</p><p><strong>Learning points: </strong>Piperacillin/tazobactam can induce immune-mediated haemolytic anaemia and thrombocytopenia.Patients with underlying alteration of the immune system might be at higher risk for bicytopenia.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 9","pages":"005460"},"PeriodicalIF":0.0,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12416790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029350","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":"Misleading Detection of Herpes Simplex Virus Type 1 In A Patient with Paraneoplastic Encephalitis.","authors":"Mirko Lischer, Marten Trendelenburg, Özgür Yaldizli, Nikolaos S Avramiotis, Grischa Marti, Anna Vital","doi":"10.12890/2025_005705","DOIUrl":"10.12890/2025_005705","url":null,"abstract":"<p><p>Encephalitis is a potentially life-threatening condition with infectious or autoimmune aetiologies. Autoimmune encephalitis includes paraneoplastic variants associated with specific onconeural antibodies such as anti-Hu, frequently linked to malignancies. Herpes simplex virus type 1 (HSV-1) is the leading infectious cause in adults. Differentiating between these aetiologies can be challenging. We report the case of an 88-year-old woman admitted with confusion following a fall. Initial evaluation showed clinical signs consistent with encephalitis. During hospitalisation, a seizure was witnessed. Cerebrospinal fluid (CSF) analysis revealed mild pleocytosis, but no infectious agent was detected, and brain imaging revealed no significant abnormalities. After initial improvement under antiepileptic therapy, the patient experienced worsening cognitive dysfunction. Repeat CSF testing 4 weeks after initial symptom onset showed even milder pleocytosis but was positive for HSV-1 and magnetic resonance imaging showed bilateral hippocampal hyperintensities. Analysis of the first CSF sample retrospectively revealed high-titer anti-Hu antibodies. Positron emission tomography-computed tomography scan identified a hypermetabolic lung lesion and para-aortic lymph node, with biopsy confirming the diagnosis of small cell lung cancer. Immunosuppressive and oncologic treatment led to transient improvement, followed by progressive neurological deterioration. Supportive care was ultimately prioritized. This case underscores the diagnostic challenges of encephalitis, especially when autoimmune and infectious features overlap, and diagnostic findings are misleading. Detection of HSV-1 should not delay the investigation of alternative causes of encephalitis in the absence of typical HSV-related features. Early recognition of paraneoplastic encephalitis is critical, as neurologic symptoms may precede the diagnosis of underlying malignancy.</p><p><strong>Learning points: </strong>Onconeural antibodies, such as anti-Hu antibodies, are an under-recognized cause of encephalitis and should be specifically tested for when an autoimmune encephalitis is clinically suspected.Detection of anti-Hu antibodies mandates a comprehensive malignancy workup.A positive herpes simplex virus type 1 polymerase chain reaction in cerebrospinal fluid does not definitively confirm active infection and must always be interpreted in conjunction with the patient's clinical presentation.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 9","pages":"005705"},"PeriodicalIF":0.0,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12416775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029347","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":"Cold Agglutinin Disease in the Setting of Pancreatic Adenocarcinoma.","authors":"Hong Phan, Vanita Motiani, Ayema Haque, Sarrah Ali Asghar, Harshank Patel, Zafir Zohab Hussain Khan, Susan Bannon","doi":"10.12890/2025_005587","DOIUrl":"10.12890/2025_005587","url":null,"abstract":"<p><p>Autoimmune haemolytic anaemia (AIHA) is caused by antibody-mediated destruction of red blood cells. There are two broad categories of AIHA: warm and cold, both categorized by the thermal reactivity of the autoantibodies. Cold agglutinin disease (CAD) occurs at temperatures below normal body temperature and primarily involves IgM antibodies. CAD typically occurs secondary to other processes: lymphoproliferative disorders or infection, although it can be rarely idiopathic. We present a case of a 65-year-old male with no past medical history who initially presented with haematuria and proteinuria, along with thrombocytopenia and leukopenia. He reported an unintentional weight loss of more than 9 kg, constipation, and pale-greasy coloured stools. Computed tomography (CT) scan of the abdomen and pelvis revealed findings suspicious for primary pancreatic neoplasm with nodal metastases and early carcinomatosis, severe right hydronephrosis, and distended gallbladder. Direct antiglobulin test (DAT) screening was negative, but an antibody screen was positive. The patient had a positive cold agglutin screen and elevated CA 19-9, carcinoembryonic antigen (CEA), and cyclic citrullinated peptide (CCP) levels, tumour markers used typically for diagnosis of pancreatic cancer. The patient presented with symptoms and laboratory findings suggestive of a complex interplay between haemolytic anaemia and a suspected solid organ malignancy, specifically pancreatic cancer. His elevated tumour markers and positive antibody screen and cold agglutinin screen suggested the possibility of paraneoplastic syndrome secondary to his pancreatic cancer. However, his infectious and autoimmune panel findings further complicated the picture and underscored the multifactorial nature of his condition.</p><p><strong>Learning points: </strong>This case highlights a rare association between autoimmune haemolytic anaemia (AIHA) and pancreatic adenocarcinoma.While AIHA is a known paraneoplastic syndrome of hematologic malignancies, this case report suggests that it may also be a paraneoplastic syndrome for solid tumours.This case report highlights the difficulty of treating AIHA in the setting of comorbidities, suggesting that standard treatment guidelines may not be effective.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 9","pages":"005587"},"PeriodicalIF":0.0,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12416801/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029383","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}