European journal of case reports in internal medicine最新文献

{"title":"Anasarca Secondary to Cytomegalovirus Viremia in a Post-Liver Transplant Patient.","authors":"Noor Albusta","doi":"10.12890/2026_006253","DOIUrl":"https://doi.org/10.12890/2026_006253","url":null,"abstract":"<p><strong>Introduction: </strong>Cytomegalovirus (CMV) infection is a common complication following solid organ transplantation and is associated with significant morbidity. While CMV classically presents with systemic symptoms, bone marrow suppression or gastrointestinal disease, atypical manifestations may occur. Anasarca and refractory ascites in liver transplant recipients are more commonly attributed to graft dysfunction, vascular complications, cardiac disease or renal pathology, and CMV is not often considered as a primary aetiology.</p><p><strong>Case description: </strong>A 63-year-old woman with a history of alcohol-related cirrhosis underwent deceased donor liver transplantation and later presented with progressive abdominal distension and bilateral lower extremity oedema. Evaluation demonstrated tense ascites and anasarca without evidence of graft dysfunction, acute rejection, portal vascular complications, cardiac disease or nephrotic syndrome. Liver function tests were normal, transthoracic echocardiography revealed preserved systolic function, and urinalysis was negative for proteinuria. Further workup identified CMV viremia, and the patient was treated with valganciclovir per infectious disease recommendations, along with supportive measures including diuresis and large-volume paracentesis. Serial monitoring demonstrated improvement in CMV viral load with corresponding gradual resolution of fluid retention.</p><p><strong>Conclusion: </strong>This case highlights CMV viremia as an important and potentially reversible cause of anasarca in post-liver transplant patients, likely mediated by CMV-induced endothelial dysfunction. Recognition of CMV-related fluid retention is essential to avoid unnecessary invasive procedures and to guide timely antiviral therapy in immunosuppressed individuals.</p><p><strong>Learning points: </strong>Cytomegalovirus (CMV) infection should be considered in the differential diagnosis of unexplained anasarca and refractory ascites in liver transplant recipients, even in the absence of graft dysfunction or classic CMV symptoms.A systematic evaluation to exclude cardiac, renal, vascular and graft-related causes of fluid overload is essential before attributing post-transplant anasarca to non-infectious aetiologies.Early recognition and treatment of CMV viremia can lead to clinical improvement and optimise outcomes in immunosuppressed patients.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 3","pages":"006253"},"PeriodicalIF":0.0,"publicationDate":"2026-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971048/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147431479","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":"When Two Benign Ovarian Pathologies Collide: An Incidental Bilateral Collision Tumour of Mature Cystic Teratoma and Endometrioma.","authors":"Katherine Atallah, Antonio Al Hazzouri, Kaity Saliba, Philippe Attieh, Lamia Azizi, Karam Karam, Emile Dabaj","doi":"10.12890/2026_006209","DOIUrl":"https://doi.org/10.12890/2026_006209","url":null,"abstract":"<p><p>Ovarian collision tumours are rare entities defined by the coexistence of two histologically distinct neoplasms, most commonly reported within the same ovary, while bilateral involvement is extremely uncommon and often under-recognised. Endometriomas are common benign ovarian lesions in women of reproductive age and may be asymptomatic or incidentally detected, whereas mature cystic teratomas are the most frequent ovarian germ cell tumours and are often discovered unintentionally during imaging or surgery. We report the case of a 27-year-old woman in whom adnexal lesions were incidentally identified, with no significant gynaecologic symptoms at presentation. Pelvic magnetic resonance imaging (MRI) showed bilateral ovarian masses, and surgical exploration revealed distinct ovarian lesions involving both ovaries. Histopathological examination confirmed a mature cystic teratoma in one ovary and an endometrioma in the contralateral ovary. This unusual and incidental bilateral presentation highlights the limitations of preoperative imaging in detecting synchronous ovarian pathologies and underscores the importance of thorough intraoperative assessment and definitive histopathological evaluation. Increased awareness of this rare entity is essential to optimise surgical management, fertility preservation and follow-up.</p><p><strong>Learning points: </strong>Ovarian collision tumours are rare pathological entities, and presentations involving histologically distinct tumours in different ovaries are extremely uncommon.This case adds to the limited literature by illustrating an atypical and largely incidental presentation with non-specific symptoms.Such variability in clinical and radiologic presentation underscores the diagnostic complexity of these tumours and the potential for under-recognition.Although advanced imaging, particularly MRI, may provide important diagnostic clues, definitive diagnosis relies on a comprehensive histopathological assessment.Awareness of this unusual presentation is crucial, as early recognition of bilateral but distinct ovarian tumours can influence surgical planning, fertility-preserving strategies and follow-up, ultimately improving individualised patient care.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 3","pages":"006209"},"PeriodicalIF":0.0,"publicationDate":"2026-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147431600","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 Uncommon Case of Tularaemia in Portugal after an Arthropod Bite.","authors":"João Horta Antunes, Sara Frazão de Brito, Hugo Jorge Alves, André Santos, Bárbara Picado","doi":"10.12890/2026_006057","DOIUrl":"https://doi.org/10.12890/2026_006057","url":null,"abstract":"<p><p>Tularaemia is a rare zoonosis caused by <i>Francisella tularensis</i>, with only a few reported cases in Western Europe and only 4 notified in Portugal between 2014 and 2021. We describe an imported case diagnosed in Portugal in 2023. A 40-year-old female developed a painful left inguinal lymphadenopathy after an arthropod bite in England. Despite initial treatment with doxycycline, symptoms persisted with systemic manifestations and progressive lymphadenopathy. Serology tests confirmed <i>F. tularensis</i> infection. The patient required prolonged follow up and antibiotic adjustment, showing gradual clinical improvement. This case highlights the diagnostic challenges of tularaemia and the importance of thorough physical examination and epidemiological history.</p><p><strong>Learning points: </strong>Diagnosing and differentiating zoonosis presents a challenge, since it is important to remember even the rarer and imported ones, such as tularaemia.Once the diagnosis is made, the clinical condition and treatment of the patient may not evolve as expected, being important for the clinician to adjust to new findings.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 3","pages":"006057"},"PeriodicalIF":0.0,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147431436","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":"When Allergy Strikes the Heart: Kounis Syndrome and Cardiac Arrest.","authors":"Marta Chiara Sircana, Roberto Manetti, Gavino Casu, Alfredo Caturano","doi":"10.12890/2026_006244","DOIUrl":"https://doi.org/10.12890/2026_006244","url":null,"abstract":"<p><strong>Introduction: </strong>Kounis syndrome is an acute coronary syndrome precipitated by allergic or hypersensitivity reactions and mediated by the release of inflammatory substances that affect the coronary circulation. In spite of increasing awareness of this syndrome, it remains underdiagnosed, particularly in young patients without conventional cardiovascular risk factors.</p><p><strong>Case description: </strong>We report the case of a patient with recurrent Kounis syndrome presenting with two distinct acute coronary syndromes within one month, initially classified as myocardial infarction with nonobstructive coronary arteries and subsequently recognised after angiographic documentation of transient coronary vasospasm. A 28-year-old man with a history of non-steroidal anti-inflammatory drug (NSAID) hypersensitivity presented with acute chest pain shortly after NSAID intake. Electrocardiography showed ischemic changes, and cardiac biomarkers showed a modest elevation. Coronary angiography revealed severe, reversible multivessel coronary artery spasm in the absence of structural coronary disease, consistent with type I Kounis syndrome. During the procedure, the patient developed ventricular fibrillation, successfully treated with electrical defibrillation and intracoronary nitrates. Left ventricular function fully recovered, and the patient was discharged with strict avoidance of NSAIDs. Subsequent allergological evaluation confirmed NSAID hypersensitivity.</p><p><strong>Conclusion: </strong>This case highlights that type I Kounis syndrome may present as a severe acute coronary syndrome complicated by malignant ventricular arrhythmias. A careful allergological and pharmacological history is essential for accurate diagnosis, guide management, and prevent recurrent potentially fatal events.</p><p><strong>Learning points: </strong>Kounis syndrome should be considered in young patients presenting with acute coronary syndromes and non-obstructive coronary arteries, especially when symptoms occur after exposure to drugs or allergens.Type I Kounis syndrome, despite the absence of structural coronary artery disease, may be complicated by life-threatening ventricular arrhythmias, underscoring that it is not always a benign condition.A detailed allergological and pharmacological history is crucial in patients with suspected myocardial infarction with nonobstructive coronary arteries to avoid misdiagnosis, prevent repeated exposure to triggering agents such as non-steroidal anti-inflammatory drugs, and guide appropriate multidisciplinary management.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 3","pages":"006244"},"PeriodicalIF":0.0,"publicationDate":"2026-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971037/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147431593","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":"Possible Fruquintinib Associated Ischemic Colitis in a Patient with Metastatic Ampullary Adenocarcinoma.","authors":"Frank Epitropoulos, Omar Brijawi, Dustin Lee, Katherine Guardado, Sumit Sharma","doi":"10.12890/2026_00006219","DOIUrl":"https://doi.org/10.12890/2026_00006219","url":null,"abstract":"<p><strong>Introduction: </strong>Ischemic colitis is a severe gastrointestinal condition resulting from compromised colonic perfusion and may occur as a rare adverse effect of anti-angiogenic therapies.</p><p><strong>Case description: </strong>We report a case of severe acute ischemic colitis temporally associated with recent fruquintinib exposure, presenting with large-volume haematochezia in a patient with metastatic ampullary adenocarcinoma.</p><p><strong>Discussion: </strong>Fruquintinib is a highly selective vascular endothelial growth factor receptor tyrosine kinase inhibitor approved for refractory gastrointestinal malignancies and is generally well tolerated. Although gastrointestinal toxicities are well described, ischemic colitis has not been well characterized in association with fruquintinib.</p><p><strong>Learning points: </strong>Vascular endothelial growth factor receptor tyrosine kinase inhibitors, including fruquintinib, may predispose to ischemic colitis through microvascular dysfunction, even in the absence of large-vessel occlusion or traditional ischemic risk factors.Ischemic colitis should be considered in patients receiving or recently exposed to anti-angiogenic therapies who present with acute haematochezia and segmental colitis, despite delayed symptom onset after drug discontinuation.Early recognition, exclusion of alternative aetiologies, and prompt withdrawal of the suspected agent with supportive management can lead to favourable outcomes and may prevent progression to perforation or surgical intervention.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 3","pages":"00006219"},"PeriodicalIF":0.0,"publicationDate":"2026-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147431634","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":"Adult-Onset Still's Disease Presenting with Progressive Motor Neuropathy.","authors":"Ana Rita Freire, Nádia Santos, Patrícia Fernandes, Diana Moura, Adriana Santos Silva","doi":"10.12890/2026_006231","DOIUrl":"https://doi.org/10.12890/2026_006231","url":null,"abstract":"<p><strong>Introduction: </strong>Adult-onset Still's disease (AOSD) is a rare systemic autoinflammatory disorder characterized by dysregulation of the innate immune system and excessive cytokine production. Its presentation is often non-specific and heterogeneous, making diagnosis challenging and one of exclusion.</p><p><strong>Case description: </strong>We report the case of an 18-year-old woman admitted with quotidian fever, frequent episodes of tonsillitis, intermittent skin rash and progressive distal lower limb weakness. Neurological assessment demonstrated progressive motor neuropathy. Laboratory findings revealed neutrophilic leucocytosis, significantly elevated inflammatory markers and hyperferritinaemia. Extensive investigation excluded infectious, malignant and autoimmune causes, and the patient met the Yamaguchi classification criteria for AOSD. Treatment with systemic corticosteroids, colchicine and the interleukin-1 receptor antagonist resulted in rapid and sustained clinical improvement.</p><p><strong>Conclusion: </strong>This case highlights the diagnostic complexity of AOSD and emphasizes the importance of considering this diagnosis in patients with persistent fever, hyperferritinaemia and rare neurological manifestations.</p><p><strong>Learning points: </strong>Adult-onset Still's disease should be considered in patients with fever of unknow origin and hyperferritinaemia.Neurological involvement, including polyneuropathy, may occur as an atypical manifestation.Early cytokine-targeted therapy is associated with rapid clinical improvement and better outcomes.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 3","pages":"006231"},"PeriodicalIF":0.0,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971045/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147431674","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":"Aggressive Systemic Mastocytosis Presenting as Diffuse Osteoblastic Bone Disease: A Diagnostic Pitfall Mimicking Metastatic Cancer.","authors":"Ana Melício, Hélder Diogo Gonçalves, Mariana Dias, Sara Vasconcelos-Teixeira, João Madeira Lopes","doi":"10.12890/2026_006143","DOIUrl":"https://doi.org/10.12890/2026_006143","url":null,"abstract":"<p><strong>Background: </strong>Systemic mastocytosis is a rare clonal disorder characterised by the proliferation and accumulation of mast cells in one or more extracutaneous organs. Its clinical presentation is highly heterogeneous and aggressive variants may mimic metastatic malignancy, leading to significant diagnostic delay.</p><p><strong>Case description: </strong>We report the case of an 83-year-old woman presenting with fatigue, weight loss, low-grade evening fever and night sweats over two months. Laboratory evaluation showed pancytopenia, mild inflammatory response, and normal hepatic and renal function. Imaging studies revealed diffuse osteoblastic lesions throughout the axial skeleton, initially interpreted as bone metastases from an unknown primary tumour. Further imaging demonstrated hepatosplenomegaly and prominent periportal lymph nodes. Bone biopsy of an iliac lesion revealed replacement of marrow by sheets of epithelioid mast cells (CD117+, tryptase, CD68+). Serum tryptase was elevated (56.3 ng/ml), fulfilling World Health Organization (WHO) diagnostic criteria for systemic mastocytosis. The patient was diagnosed with aggressive systemic mastocytosis and started cladribine therapy with antimicrobial prophylaxis, with progressive improvement of constitutional symptoms and she remains under follow-up in the haematology department.</p><p><strong>Discussion: </strong>Aggressive systemic mastocytosis presenting with diffuse osteoblastic bone lesions is extremely uncommon and may closely mimic metastatic carcinoma, particularly of breast or prostate origin. Diagnosis requires a high index of suspicion and confirmation through histopathology, immunophenotyping and serum tryptase measurement. KIT mutations, especially D816V, are frequent but were absent in this case.</p><p><strong>Conclusion: </strong>This case highlights the importance of considering systemic mastocytosis in the differential diagnosis of osteoblastic bone disease, particularly in elderly patients with constitutional symptoms and unexplained cytopenias. Early recognition allows timely initiation of appropriate therapy and avoids unnecessary oncology investigations.</p><p><strong>Learning points: </strong>Aggressive mastocytosis can rarely present with diffuse osteoblastic bone lesions mimicking metastatic disease.Elevated serum tryptase and histopathological confirmation are essential for diagnosis, even when KIT mutations are absent.Early recognition prevents unnecessary oncologic investigations and allows timely initiation of cytoreductive therapy.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 3","pages":"006143"},"PeriodicalIF":0.0,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147431715","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":"Looking Beyond Severe Hypertriglyceridemia when Diagnosing Adult-Onset Citrullinemia Type II.","authors":"Thanh-Huong Truong, Ngoc-Thanh Kim, Doan-Loi Do, Minh-Phuong Vu, Mai-Ngoc Thi Nguyen, Hong-An Le, Thanh-Tung Le","doi":"10.12890/2026_006200","DOIUrl":"https://doi.org/10.12890/2026_006200","url":null,"abstract":"<p><strong>Background: </strong>Adult-onset citrullinemia type II (CTLN2) is a rare autosomal recessive urea cycle disorder caused by mutations in the solute carrier family 25 member 13 (<i>SLC25A13</i>) gene, which encodes citrin-a mitochondrial transporter involved in the malate-aspartate shuttle. In adults, CTLN2 may present atypically as isolated hypertriglyceridemia, often misattributed to secondary dyslipidaemia.</p><p><strong>Case description: </strong>A 30-year-old Vietnamese male with longstanding severe hypertriglyceridemia, first identified at age 13, was referred after an episode of acute pancreatitis at age 28. At presentation, plasma triglyceride levels reached 34.61 mmol/l. Secondary causes were excluded. Genetic testing via next-generation sequencing revealed compound heterozygous <i>SLC25A13</i> mutations: c.2T>C and c.1638_1660dup, resulting in p.Met1Thr and p.Ala554GlyfsTer17, confirming the diagnosis of CTLN2. Initiation of a low-carbohydrate, high-protein, low-fat diet combined with fenofibrate (145 mg/day) led to a rapid reduction in triglyceride levels, normalizing within two weeks and remaining stable over three months. The treatment was well tolerated, with no reported adverse effects.</p><p><strong>Conclusion: </strong>CTLN2 should be considered in young adults with persistent, unexplained, and severe hypertriglyceridemia. Dietary modification constitutes the cornerstone of management, with fibrates playing a supportive role.</p><p><strong>Learning points: </strong>Persistent, unexplained, and severe hypertriglyceridemia in young adults should prompt consideration of inherited metabolic disorders, including adult-onset citrullinemia type II (CTLN2).Genetic testing to detect compound heterozygous or homozygous <i>SLC25A13</i> variants is essential for definitive diagnosis of CTLN2.In CTLN2, dietary management with a low-carbohydrate, high-protein, low-fat represents the cornerstone, with fibrates serving as adjunctive lipid-lowering therapy.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 3","pages":"006200"},"PeriodicalIF":0.0,"publicationDate":"2026-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147431518","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":"Persistent Hyperprocalcitoninemia as the Initial Diagnostic Clue to Sporadic Medullary Thyroid Carcinoma.","authors":"Aysun Şeker","doi":"10.12890/2026_006176","DOIUrl":"https://doi.org/10.12890/2026_006176","url":null,"abstract":"<p><p>Medullary thyroid carcinoma (MTC) is a rare neuroendocrine tumour arising from parafollicular C cells, and serum calcitonin remains its most reliable biochemical marker. Procalcitonin (PCT), widely used in the evaluation of bacterial infections, is usually undetectable under non-infectious conditions. Persistent elevation of PCT in the absence of clinical or microbiological evidence of infection is uncommon and may represent an early clue to underlying endocrine malignancy. We report the case of a 48-year-old woman who presented with markedly elevated PCT levels (>20 ng/ml) detected during routine laboratory testing despite being asymptomatic and having normal inflammatory markers. Extensive infectious work-up was negative, and antibiotic therapy did not reduce PCT levels. Further endocrine evaluation revealed a calcitonin level >2000 ng/l, elevated carcinoembryonic antigen, and a suspicious thyroid nodule on ultrasonography. Fine-needle aspiration with calcitonin washout confirmed the diagnosis of MTC. The patient underwent total thyroidectomy with central neck dissection, and histopathology demonstrated a 4.5 cm sporadic MTC without nodal metastasis. Postoperative PCT and calcitonin levels declined markedly, supporting their parallel behaviour in relation to disease activity. This case highlights the clinical importance of considering MTC in patients with unexplained hyperprocalcitoninemia and supports the potential role of PCT as an adjunct biomarker in diagnostic evaluation and postoperative monitoring once infection has been excluded.</p><p><strong>Learning points: </strong>Persistent elevation of procalcitonin in the absence of infection should raise suspicion for medullary thyroid carcinoma and other neuroendocrine malignancies.Procalcitonin may serve as a useful adjunct biomarker alongside calcitonin in the diagnostic evaluation and postoperative follow-up of medullary thyroid carcinoma.Awareness of non-infectious causes of hyperprocalcitoninemia can prevent unnecessary antimicrobial therapy and reduce diagnostic delay in internal medicine practice.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 3","pages":"006176"},"PeriodicalIF":0.0,"publicationDate":"2026-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147431457","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":"Dexmedetomidine-Associated Polyuria Mimicking Diabetes Insipidus.","authors":"Sankalp Acharya, Sai Shahane, Sanket Patel, Dhruvil Patel, Vyoma Patel, Shailesh Aggarwal, Hardikkumar Bhanderi","doi":"10.12890/2026_006195","DOIUrl":"https://doi.org/10.12890/2026_006195","url":null,"abstract":"<p><p>Dexmedetomidine is a highly selective α2-adrenergic agonist widely used for sedation in the intensive care unit (ICU) and is generally considered well tolerated, with hypotension and bradycardia being the most commonly reported adverse effects. Rarely, dexmedetomidine has been associated with polyuria resembling a diabetes insipidus-like syndrome, particularly during prolonged infusions. We report the case of a 53-year-old male admitted to the ICU for severe alcohol withdrawal who developed profound polyuria during a 5-day dexmedetomidine infusion. Urine output progressively increased to 6.75 litres per day, prompting an extensive evaluation that excluded osmotic diuresis, infection, intracranial pathology, and nephrogenic diabetes insipidus. Laboratory studies demonstrated preserved renal function and normal serum electrolytes. The temporal association between dexmedetomidine initiation and polyuria onset, along with resolution following drug discontinuation, supported the diagnosis of dexmedetomidine-associated polyuria, with a Naranjo adverse drug reaction probability score of 8 indicating a probable association. This case highlights an underrecognized adverse effect of dexmedetomidine. It underscores the importance of monitoring urine output and electrolytes during prolonged infusions to facilitate early recognition, prevent unnecessary diagnostic testing, and avoid complications related to volume depletion and electrolyte imbalance.</p><p><strong>Learning points: </strong>Dexmedetomidine can, in rare cases, cause profound polyuria mimicking central diabetes insipidus, particularly during prolonged infusions beyond the Food and Drug Administration -approved 24-hour duration.Early recognition of dexmedetomidine-associated polyuria can prevent unnecessary diagnostic evaluations, reduce the risk of volume depletion and electrolyte disturbances, and prompt timely discontinuation of the offending agent.Internists managing critically ill patients should closely monitor urine output and serum electrolytes during extended dexmedetomidine use, especially in patients with hepatic impairment or refractory delirium.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 3","pages":"006195"},"PeriodicalIF":0.0,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147431449","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}