European journal of case reports in internal medicine最新文献

{"title":"Acute Pericarditis in an Adult with Cystic Fibrosis: A Case Report and Literature Review.","authors":"Amer Abu-Shanab, Muhammad Tayyeb, Muhammad Saad Anwar, David Angelo Aquino, Pierre Amog, Abdalhakim Shubietah, Doantrang Du","doi":"10.12890/2025_005373","DOIUrl":"10.12890/2025_005373","url":null,"abstract":"<p><strong>Introduction: </strong>Cystic fibrosis, an autosomal recessive disorder (1 in 3,000-6,000 births), causes thick mucus and recurrent lung infections. Improved survival has revealed rare complications such as constrictive pericarditis and cardiac tamponade.</p><p><strong>Case description: </strong>A 24-year-old female with cystic fibrosis, diagnosed at nine months, presented with two weeks of dyspnoea. Examination revealed bilateral rhonchi, facial oedema and non-pitting thigh oedema. Laboratory results showed a white blood cell count of 11.3 ×10⁹/l, erythrocyte sedimentation rate of 99 mm/hr and C-reactive protein level of 45.3 mg/dl. Initially admitted for cystic fibrosis exacerbation, she was found to have pericardial effusion. Despite facial and lower extremity swelling, she denied cardiac symptoms. During hospitalisation, she developed haemodynamic instability requiring pericardiocentesis, with echocardiography confirming constrictive pericarditis. Chest computed tomography angiography showed pericardial calcifications; autoimmune workup was negative. She was discharged on colchicine with close follow-up.</p><p><strong>Conclusion: </strong>Clinicians should have a high index of suspicion for underlying cardiac complications in patients presenting with exacerbations of cystic fibrosis.</p><p><strong>Learning points: </strong>Pericardial disease - including constrictive pericarditis and tamponade - though rare, can complicate cystic fibrosis in adults and may mimic pulmonary exacerbations. Early cardiac imaging is crucial for timely diagnosis.This case highlights the need for a high index of suspicion in cystic fibrosis patients with unexplained dyspnoea, oedema or haemodynamic instability, especially in the setting of pericardial calcifications.Medical management with colchicine and diuretics can be effective in selected cystic fibrosis patients with constrictive physiology, potentially avoiding the need for invasive pericardiectomy.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 6","pages":"005373"},"PeriodicalIF":0.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274504","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":"High-Folate-Low-Vitamin B12 Interaction Syndrome.","authors":"Claudia Cicchini, Antonio De Magistris, Alberto Del Sasso, Donatella Livoli, Francesco Rocco Pugliese","doi":"10.12890/2025_005398","DOIUrl":"10.12890/2025_005398","url":null,"abstract":"<p><strong>Introduction: </strong>Vitamin B12 deficiency is characterised by haematological and neurological complications, from mild symptoms (e.g. fatigue and paraesthesia), to severe symptoms (e.g. pancytopenia and combined degeneration of the spinal cord). If treatment is delayed, irreversible neurological damage may occur. Thus, early recognition and prompt corrective therapy are essential. The vitamin B12 deficiency can be due to a variety of anomalies: the paradoxical interaction between folic acid and vitamin B12 has recently been well described.</p><p><strong>Case description: </strong>We report the case of a patient who presented to the emergency department with balance disorders and a blood count indicating macrocytosis. Vitamin B12 deficiency and a high folate value were detected, supporting the hypothesis of the high-folate-low-vitamin B12 interaction as a cause of vitamin B12 depletion.</p><p><strong>Discussion: </strong>An excessive oral intake of folic acid leads to a reduction in the active fraction of vitamin B12 and this decrease exacerbates the deficiency itself. The neurological signs and symptoms of vitamin B12 deficiency are due to demyelination of the posterior and lateral columns of the spinal cord. This patient had been taking folic acid for 30 years and the serum folate value was high. We hypothesise that the high-folate-low-vitamin B12 interaction represents the cause of vitamin B12 depletion in this patient.</p><p><strong>Conclusion: </strong>All the patients with neurological signs and symptoms should be tested for possible vitamin B12 deficiency: early diagnosis and treatment could stop the progression of the disease and allow the regression of the neurological deficit. It is important not to rely on blood count values to diagnose a vitamin B12 deficiency as the neurological and haematological outlook may be inversely proportional. This study is the first to report a case of combined sclerosis and high-folate-low-vitamin B12 interaction from Italy and is therefore of interest to public health decision makers and clinical practice.</p><p><strong>Learning points: </strong>Vitamin B12 and folate should be measured in all patients with neurological symptoms.In case of vitamin B12 deficiency, folate levels should always be measured as well.Vitamin blood levels should be checked periodically while taking vitamin supplements.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 6","pages":"005398"},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274472","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":"ANCA-Positive Pulmonary Granulomatosis in A HER2-Positive Breast Cancer Patient on ANTI-HER2 Therapy: Case Report and Literature Review.","authors":"Florian Collard Vanthournhout, Myriam Remmelink, Laura Polastro, Maxime Ilzkovitz","doi":"10.12890/2025_005349","DOIUrl":"10.12890/2025_005349","url":null,"abstract":"<p><strong>Introduction: </strong>This case highlights the diagnostic complexity of pulmonary granulomatosis in oncology patients, especially when treated with targeted therapy.</p><p><strong>Case report: </strong>We report the case of a 46-year-old female with metastatic HER2-mutated breast cancer who had received multiple lines of HER2-targeted therapies. The patient presented with suspected lung and mediastinal lymph node progression, despite a good response at other affected sites. A lymph node biopsy revealed non-necrotizing pulmonary granulomas, with negative microbiological testing. Further evaluations showed highly elevated anti-PR3 autoantibodies, while angiotensin-converting enzyme (ACE) and calcium levels remained within the normal range. Pulmonary function tests confirmed a restrictive syndrome. Nasal fibroscopy identified chronic sinusitis with massive nasal polyposis, without renal or cutaneous involvement. High-dose corticosteroid therapy was initiated, leading to a favourable response. Based on the clinical presentation, radiological findings, and pathological features, we concluded that the granulomatosis was related to HER2-targeted therapy.</p><p><strong>Conclusion: </strong>This case highlights that both an underlying malignancy and specific drugs-such as HER2-targeted therapy-can occasionally contribute to granuloma formation.</p><p><strong>Learning points: </strong>Differentiating pulmonary granulomatosis is challenging in oncology patients.HER2-targeted therapies can induce non-necrotizing lung granulomatosis.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 6","pages":"005349"},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274507","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":"Swollen Legs and False Nephrotic Syndrome: A Case of Primary Lymphatic Dysplasia with Intermittent Chyluria.","authors":"Giorgia Sasia, Teresa Morgillo, Christian Bracco, Corrado Magnino, Giulia Racca, Remo Melchio, Luigi Maria Fenoglio","doi":"10.12890/2025_005348","DOIUrl":"10.12890/2025_005348","url":null,"abstract":"<p><p>Chyluria, defined as the presence of chyle in urine, is a rare condition caused by an abnormal communication between the lymphatic system and the urinary tract. It can present with massive proteinuria and characteristic milky urine, mimicking nephrotic syndrome. We report the case of a 23-year-old woman with a history of seronegative ocular myasthenia gravis who developed progressive bilateral lower extremity oedema and intermittent nephrotic-range proteinuria despite normal serum albumin and lipid profiles. A renal biopsy, performed to investigate proteinuria, was complicated by a subcapsular hematoma. Shortly thereafter, the patient developed dysuria, urinary retention, and milky urine, leading to the diagnosis of chyluria. Imaging revealed thrombosis of the left iliac vein, associated with hereditary thrombophilia (heterozygosity for factor V Leiden and homozygous <i>G20210A</i> prothrombin mutation), prompting anticoagulation therapy. Lymphoscintigraphy suggested a lympho-vesical fistula and bilateral inguinal lymph node dysplasia. Conservative management, including urinary catheterization, fluid optimization, and dietary modifications with a low-fat, medium-chain triglyceride-enriched regimen, resulted in resolution of chyluria. At 6-month follow-up, there was no recurrence of symptoms, proteinuria improved, and anticoagulation was continued. This case highlights the importance of a multidisciplinary approach in managing rare presentations of chyluria, nephrotic proteinuria, and venous thrombosis.</p><p><strong>Learning points: </strong>Chyluria should be considered in patients presenting with milky urine and proteinuria, especially after excluding glomerular pathology.Non-parasitic causes, such as trauma or iatrogenic procedures like renal biopsy, are increasingly recognized in non-endemic regions.Conservative management, particularly dietary modifications with medium-chain triglycerides can lead to significant clinical improvement without invasive interventions.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 6","pages":"005348"},"PeriodicalIF":0.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Autoimmune Polyglandular Syndrome Type 3b: A Key to Diagnosing Autoimmune Gastritis and Asymptomatic Primary Biliary Cholangitis.","authors":"Sayaka Mabuchi, Hiroya Mabuchi, Takashi Watari","doi":"10.12890/2025_005376","DOIUrl":"10.12890/2025_005376","url":null,"abstract":"<p><strong>Background: </strong>Autoimmune polyglandular syndrome type 3 (APS-3) encompasses autoimmune thyroid disease and other autoimmune disorders. APS-3 is further categorized into four subtypes, with APS-3B involving gastrointestinal autoimmune diseases. In this case, we diagnosed autoimmune gastritis, a condition challenging to identify based on endoscopic findings alone, and asymptomatic primary biliary cholangitis (PBC) through the recognition of APS-3B.</p><p><strong>Case report: </strong>An 84-year-old female patient presented with forgetfulness and a history of Hashimoto's disease. Although endoscopy revealed pan-atrophic gastritis, autoimmune gastritis was suspected rather than <i>Helicobacter pylori</i> infection due to consideration of the APS-3 framework. Specific observations, including adherent mucus and remnants of oxyntic mucosa, guided tests for anti-endogenous antibodies, confirming autoimmune gastritis. Recognizing APS-3B prompted further evaluation for PBC, including measurement of anti-mitochondrial M2 antibody, which led to the diagnosis of asymptomatic PBC.</p><p><strong>Conclusion: </strong>Recognition of APS-3 offers a valuable framework for the differential diagnosis of autoimmune diseases.</p><p><strong>Learning points: </strong>Autoimmune thyroid disease in a patient should raise suspicion for autoimmune polyglandular syndrome type 3 (APS-3) and other potential autoimmune conditions.If APS-3 is diagnosed, further classification is recommended, along with a thorough search for additional autoimmune diseases.APS-3 serves as a framework for the differential diagnosis of autoimmune diseases.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 6","pages":"005376"},"PeriodicalIF":0.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac Tamponade due to Minoxidil use: A Case Report and Review of the Literature.","authors":"Prami Nakarmi, Joshua Hermiz, Roopeessh Vempati, Sanya Chandna, Umesh Bhagat, Stacy Loree, Christian Toquica Gahona","doi":"10.12890/2025_005379","DOIUrl":"10.12890/2025_005379","url":null,"abstract":"<p><p>Minoxidil is a direct-acting vasodilator that reduces systemic vascular resistance by opening adenosine triphosphate (ATP)-sensitive potassium channels, leading to arteriolar smooth muscle vasodilation. While commonly prescribed for resistant hypertension and androgenic alopecia, minoxidil is associated with fluid retention, and in rare cases, pericardial effusion that can progress to cardiac tamponade. In this report, we present a case of an 81-year-old male with a history of chronic kidney disease (CKD) who developed cardiac tamponade while on chronic minoxidil therapy for hypertension. He presented with progressive dyspnoea, lower extremity oedema, and fever. Imaging revealed an enlarged cardiac silhouette, and a confirmatory echocardiogram demonstrated a pericardial effusion with right ventricular collapse. The patient underwent urgent pericardiocentesis, yielding 545 ml of pericardial fluid. Infectious, malignant, and autoimmune aetiologies were ruled out, and minoxidil was identified as the likely cause. Following discontinuation of minoxidil, the patient's symptoms completely resolved, with no recurrence at 1-month follow-up. In addition, we reviewed 26 previously reported cases of minoxidil-induced pericardial effusion and/or cardiac tamponade, 17 of which are summarized in this report. This case demonstrates the rare but potentially fatal complication of therapy and emphasizes the importance of early detection and clinical vigilance, particularly in vulnerable populations such as patients with CKD.</p><p><strong>Learning points: </strong>This case highlights minoxidil-induced cardiac tamponade - a rare but fatal adverse effect requiring urgent intervention, especially underrecognized in clinical practice.Patients with chronic kidney disease are at increased risk for minoxidil-induced pericardial effusion due to altered fluid regulation and renin-angiotensin-aldosterone system activation.Clinicians should maintain a high index of suspicion and consider routine cardiac monitoring in minoxidil users, even for non-hypertensive indications such as hair loss.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 6","pages":"005379"},"PeriodicalIF":0.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Full Recovery Over One Year of the Overlap Syndrome Scleromyositis to Maintenance Therapy with Mycophenolate Mofetil and Rituximab, which Relapsed within 8 Months of Discontinuation.","authors":"Inês Amarante, Catarina Faustino, Bruna Mota, Mariana Cascais, Jorge Almeida, Marta Valentim","doi":"10.12890/2025_005154","DOIUrl":"https://doi.org/10.12890/2025_005154","url":null,"abstract":"<p><p>Scleromyositis (SM) is an emerging, distinct entity within the spectrum of diffuse systemic sclerosis (SSc) and autoimmune inflammatory myopathies. It can carry a poorer prognosis due to multisystem involvement and extramuscular complications, with no consensus on treatment strategies currently available. We report on a 20-year-old woman with a history of recurrent infections over the past year, who presented with persistent myalgias for four months. On examination, she exhibited muscle weakness in the scapular and pelvic girdles, along with sclerodactyly. Laboratory results showed elevated creatine kinase (13,000 U/l), aldolase (15.6 U/l), lactate dehydrogenase (1,481 U/l) and myoglobin (4,400 ng/ml). Autoimmune screening was positive for antinuclear antibodies, anti-PM-scleroderma (anti-PM-Scl) 75 and 100, and anti-CENP-B antibodies. An MRI of the pelvic girdle indicated acute/subacute myositis, and electromyography revealed both distal and proximal myopathy. Muscle biopsy showed extensive necrosis with minimal inflammatory infiltration. Nailfold capillaroscopy demonstrated an early scleroderma pattern, while CT and spirometry revealed mild interstitial restrictive lung disease. Initial treatment involved intravenous immunoglobulin (IVIG), mycophenolate mofetil (MMF) and prednisolone. This was followed by maintenance therapy with MMF and rituximab (RTX) every six months for the first year. Over six months, the patient showed progressive improvement in muscle strength and normalisation of muscle enzyme levels. In conclusion, SM presents with variable phenotypes, ranging from mild to extensive systemic involvement. This case underscores the importance of individualised patient stratification and highlights the need for structured induction and maintenance therapy due to the disease's extensive activity.</p><p><strong>Learning points: </strong>Scleromyositis (SM) is a rare and poorly understood condition that combines features of systemic sclerosis and immune-mediated myositis, often linked to anti-PM-scleroderma antibodies.Despite efforts to classify SM, it demonstrates unique clinical patterns that distinguish it from other myositis subtypes.The management of SM remains challenging, as there are no established guidelines or standardised treatment protocols.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 5","pages":"005154"},"PeriodicalIF":0.0,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143983909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring ANCA Pathogenicity in Ulcerative Colitis: A Case Report Highlighting the Risk of Progression to ANCA-Associated Vasculitis.","authors":"Abir Hamid, Frederic Vandergheynst, Maxime Ilzkovitz","doi":"10.12890/2025_005061","DOIUrl":"https://doi.org/10.12890/2025_005061","url":null,"abstract":"<p><strong>Background: </strong>The relationship between anti-neutrophil cytoplasmic antibodies (ANCA) and inflammatory bowel disease has attracted significant attention due to shared immunopathological mechanisms and clinical associations.</p><p><strong>Case description: </strong>This case report describes a 20-year-old African woman with a history of ulcerative colitis who developed diffuse alveolar haemorrhage in the setting of elevated proteinase 3 (PR3)-ANCA. She was treated for ANCA-associated vasculitis with corticosteroids, plasma exchange, and rituximab, leading to a complete resolution.</p><p><strong>Conclusion: </strong>The case highlights the association between ulcerative colitis and ANCA-associated vasculitis, particularly with PR3-ANCA, and the importance of recognizing this overlap. Although ANCA are frequently present in inflammatory bowel disease, especially ulcerative colitis, their pathogenic role remains unclear. The incidence of ANCA-associated vasculitis is higher in inflammatory bowel disease patients, with ulcerative colitis often preceding ANCA-associated vasculitis. Despite the common presence of ANCA in inflammatory bowel disease, not all patients progress to ANCA-associated vasculitis. This case underscores the need for careful monitoring in ulcerative colitis patients with elevated PR3-ANCA and the role of ANCA in guiding diagnosis and treatment.</p><p><strong>Learning points: </strong>High proteinase 3 (PR3)-anti-neutrophil cytoplasmic antibodies (ANCA) titre impacts the severity and management of ulcerative colitis patients.ANCA-associated vasculitis is more frequent in ulcerative colitis patients and occurs several years after ANCA positivity.Close monitoring of ulcerative colitis patients with PR3-ANCA is essential for early detection of progression to ANCA-associated vasculitis.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 5","pages":"005061"},"PeriodicalIF":0.0,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Autoantibodies Directed Against Insulin Receptor During the Course of Castleman Disease: A New Case Reaffirming Autoimmune Hypoglycemia as a Relapse Warning Signal.","authors":"Xavier Jannot, Martine Auclair, Martin Martinot, Amin Maazouzi, David Boutboul, Corinne Vigouroux, Yannick Dieudonné","doi":"10.12890/2025_005355","DOIUrl":"https://doi.org/10.12890/2025_005355","url":null,"abstract":"<p><p>This case study presents the case of a 54-year-old human immunodeficiency virus (HIV)-positive male who developed type B insulin resistance syndrome (TBIRS) in conjunction with a relapse of human herpesvirus 8 (HHV8)-positive multicentric Castleman disease (MCD). This case is only the sixth reported instance of TBIRS associated with HHV8-associated MCD. The diagnosis was confirmed by the presence of anti-insulin receptor autoantibodies, and the patient was treated effectively with rituximab, with no relapse in follow-up. The cases described are discussed, along with the differences between them and our own case. Additionally, the potential for an autoimmune complication of MCD, even when HIV is well controlled, is addressed, as well as the available therapeutic approaches.</p><p><strong>Learning points: </strong>Unexplained hypoglycemia can reveal autoimmunity against insulin receptors associated with lymphoproliferative disorders, including multicentric Castleman disease.Autoimmune hypoglycemia can occur independently of inflammatory signs or uncontrolled human immunodeficiency virus infection in patients with multicentric Castleman disease.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 5","pages":"005355"},"PeriodicalIF":0.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061218/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Juvenile Dermatomyositis and Hepatitis B Viral Infection.","authors":"Ali A Younis, Ahmed A Ahmed Al-Harbi","doi":"10.12890/2025_005372","DOIUrl":"https://doi.org/10.12890/2025_005372","url":null,"abstract":"<p><p>Juvenile dermatomyositis (JDM) is an uncommon autoimmune illness with unexplained origin. It affects the skin, skeletal muscles, and blood vessels. This case report emphasizes an unusual case of an 8-year-old girl from Ninevah in Iraq, who presented with limb weakness and rash. She had a family history of hepatocellular carcinoma. The patient had hall mark features of JDM: heliotrope rash, Gottron's papules, and progressive proximal muscle weakness as well as elevated muscle enzymes. A positive hepatitis B surface antigen with high viral load proved concomitant infection. Treatment started with entecavir and intravenous immunoglobulins, followed by methotrexate and corticosteroids leading to steady clinical improvement. Effective antiviral treatment in combination with immunosuppressants is crucial for treating autoimmune diseases without infection reactivation. The correlation between hepatitis B infection and JDM is still obscure. This case suggests that that hepatitis B may lead to autoimmune diseases when there is a genetic susceptibility. This example adds to the scarce literature on JDM connection with viral hepatitis, highlighting the importance of being alert and using specialized treatment approaches in such cases.</p><p><strong>Learning points: </strong><b>Rare case insight</b> highlights the difficulties in diagnosing autoimmune and viral disorders by presenting a rare case of concurrent juvenile dermatomyositis and chronic hepatitis B infection.<b>Lessons in clinical management</b> emphasizes the significance of controlling the risk of viral reactivation and screening for hepatitis B prior to immunosuppressive treatment.<b>Multidisciplinary and educational value</b> highlights the importance of a multidisciplinary approach and provides internists with useful knowledge on how to provide individualized care in complicated rheumatic situations.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 5","pages":"005372"},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}