European journal of case reports in internal medicine最新文献

{"title":"Anomalous Origin of the Right Coronary Artery from the Left Main Coronary Artery in A Patient with Non-Specific Chest Pain.","authors":"Ayman F Soliman, Yaqob S Taleb, Fatmah H Alsalman, Osama M Rizk, Bader A Al Benhasan, Muneera O Al Taweel","doi":"10.12890/2025_005701","DOIUrl":"10.12890/2025_005701","url":null,"abstract":"<p><p>Anomalous origin of the coronary arteries is a rare congenital condition that can present as non-specific chest pain or shortness of breath or remain asymptomatic. Early identification is critical as certain variants are linked with a high risk of sudden cardiac death. Here, we report the case of a 53-year-old female with hypertension, hypothyroidism, obesity (class II) and a history of intermittent chest pain radiating to the left arm for two years. A cardiology workup including ECG, cardiac enzymes, echocardiography and CT coronary angiography revealed an anomalous origin of the right coronary artery (RCA) arising from the left main coronary artery (LMCA) with no haemodynamically significant narrowing. This case highlights the significance of advanced imaging techniques in evaluating atypical chest pain, which can reveal critical congenital anomalies of the coronary arteries. Although this anomaly was not associated with ischaemia in our patient, its recognition is vital for appropriate management and risk stratification.</p><p><strong>Learning points: </strong>Advanced imaging techniques are important in evaluating atypical chest pain, which can reveal critical congenital anomalies of the coronary arteries.CT coronary angiography remains an essential tool for diagnosis and risk assessment.Although the right coronary artery was not associated with ischaemia in this case, continued monitoring and cardiovascular risk factor management are essential for long-term prognosis.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 9","pages":"005701"},"PeriodicalIF":0.0,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12416797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029329","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":"Diagnostic and Therapeutic Paradoxes in PCR-Positive, Histopathology-Negative CNS Aspergillosis in A Patient with HIV and Hodgkin Lymphoma.","authors":"Nikolas Kenaya, Joshua Hermiz, Joshua Hailo, Zahra Chehab, Emelia Johnson, Christian Toquica Gahona, Saba Asif","doi":"10.12890/2025_005604","DOIUrl":"10.12890/2025_005604","url":null,"abstract":"<p><strong>Background: </strong>Invasive central nervous system (CNS) aspergillosis is rare among human immunodeficiency virus (HIV)-positive patients due to preserved neutrophil function, despite significant CD4+ T-cell depletion. Diagnosis typically requires histopathologic confirmation, but polymerase chain reaction (PCR) testing has introduced new challenges due to its high sensitivity but limited specificity.</p><p><strong>Case presentation: </strong>We describe a newly diagnosed 43-year-old HIV-positive male with concurrent Hodgkin lymphoma who presented with progressive neurological decline and a ring-enhancing brain lesion. While histopathological analysis of the brain biopsy demonstrated features of HIV-associated leukoencephalopathy, PCR testing paradoxically identified <i>Aspergillus fumigatus</i>; however, histopathological examination failed to demonstrate definitive fungal elements. Despite negative cerebrospinal fluid galactomannan and β-D-glucan assays, empiric voriconazole therapy was initiated in accordance with current treatment guidelines. Over the ensuing month, the patient returned with worsening neurologic status, radiographic lesion progression, and ultimately developed Torsades de Pointes, and multiorgan failure, resulting in death.</p><p><strong>Discussion: </strong>This case underscores the diagnostic and therapeutic complexities of PCR-positive, histopathology-negative CNS aspergillosis in HIV. Overreliance on molecular results without confirmatory pathology may lead to unnecessary antifungal therapy and severe drug toxicity. Additionally, overlapping immunosuppressive conditions-such as HIV and lymphoma-complicate clinical interpretation and management.</p><p><strong>Conclusion: </strong>In HIV-positive patients with CNS lesions, PCR detection of <i>Aspergillus</i> should not independently justify antifungal therapy. Histological confirmation and multidisciplinary evaluation are essential to avoid misdiagnosis and adverse outcomes. This case highlights the urgent need for more precise treatment guidelines on when to initiate and discontinue antifungal treatment in complex immunocompromised populations.</p><p><strong>Learning points: </strong>Polymerase chain reaction positivity for <i>Aspergillus</i> in the absence of histopathologic confirmation presents a major diagnostic dilemma, particularly in human immunodeficiency virus (HIV)-positive patients, where overreliance on molecular diagnostics may lead to misdiagnosis, unnecessary antifungal exposure, and significant toxicity.Empiric antifungal treatment should be re-evaluated when central nervous system lesions progress or fail to improve, as prolonged use of agents like voriconazole can result in serious toxicity, including arrhythmias like Torsades de Pointes; clearer guidelines are needed to define when empiric treatment is appropriate in complex cases.HIV-positive patients with coexisting malignancy require a multidisciplinary, evidence-based approach, as overla","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 9","pages":"005604"},"PeriodicalIF":0.0,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12416789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029377","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 Novel Mutation of the NOTCH3 Gene in A Young Patient Presenting with an Acute Stroke: Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL).","authors":"Inas Ragab, Meave Higgins, Antonio F Caballero-Bermejo, Karl Boyle, Kai Covin, Leena Abdelmoti","doi":"10.12890/2025_005297","DOIUrl":"10.12890/2025_005297","url":null,"abstract":"<p><p>This report provides a detailed analysis of a singular case involving cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) in a male patient who suffered a stroke. Our investigation delves into the clinical manifestations, genetic foundations, diagnostic complexities, and prognosis associated with CADASIL. As a notable contributor to stroke occurrence in young patients, CADASIL's impact on morbidity and mortality is influenced by stroke-related complications and cognitive decline. Notably, our report highlights a novel genetic variant (C.3025T>C; p.Cys1009Arg) in the <i>NOTCH3</i> gene linked to CADASIL, shedding light on its underlying pathogenesis. Furthermore, our patient exhibited unexpected white matter changes, challenging conventional age-related norms. These findings underscore the essential role of genetic testing and emphasize the potential diversity in CADASIL's clinical presentation. Further exploration is imperative to enhance our understanding of CADASIL and refine diagnostic strategies, thereby facilitating improved patient prognosis and management.</p><p><strong>Learning points: </strong>Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a significant cause of stroke in young patients, with stroke-related complications and cognitive impairment contributing to morbidity and mortality.Increasing awareness of CADASIL's clinical presentation and the availability of genetic testing has led to a rise in reported cases.CADASIL is caused by mutations in the <i>NOTCH3</i> gene, primarily involving missense substitutions and leading to cysteine residue alterations.There have been many pathogenic variants reported around the world and some families might exhibit private pathogenic variants.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 9","pages":"005297"},"PeriodicalIF":0.0,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12416776/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029321","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 Silent Invader: Asymptomatic Rhodococcus Infection Unmasked in A Patient with Ectopic ACTH-Dependent Cushing's Syndrome.","authors":"Shahzeb Saeed, George Fawzy, Ayesha Shah, Molly John","doi":"10.12890/2025_005711","DOIUrl":"10.12890/2025_005711","url":null,"abstract":"<p><strong>Introduction: </strong><i>Rhodococcus</i> species, particularly <i>Rhodococcus equi</i>, are rare opportunistic pathogens that typically affect immunocompromised individuals. These infections usually present with respiratory or systemic symptoms and are often linked to environmental exposure. Asymptomatic <i>Rhodococcus</i> infections are exceedingly rare and pose unique diagnostic and therapeutic challenges.</p><p><strong>Case description: </strong>We report the case of a 29-year-old male who presented with new-onset diabetes mellitus, resistant hypertension and significant weight gain. Physical examination revealed features consistent with Cushing's syndrome. Biochemical evaluation confirmed ACTH-dependent hypercortisolism with an elevated plasma ACTH level, and a lack of suppression on high-dose dexamethasone testing; imaging identified a suspicious pulmonary nodule. Bronchoscopic biopsy revealed no malignancy, however cultures grew <i>Rhodococcus</i> species. The patient denied any respiratory symptoms or environmental exposure. Initial antibiotic therapy with ciprofloxacin and rifampin was started. Follow-up imaging showed rapid enlargement of the pulmonary mass, prompting surgical resection. Histopathology revealed malakoplakia, and repeat cultures again yielded <i>Rhodococcus spp.</i> Antibiotics were adjusted to azithromycin and rifampin, and the patient was started on ketoconazole to manage hypercortisolism.</p><p><strong>Conclusion: </strong>This case highlights the importance of considering opportunistic infections such as <i>Rhodococcus spp.</i> in immunocompromised patients, even in the absence of symptoms. It underscores the diagnostic value of investigating incidental findings in such populations and illustrates the need for prompt, multidisciplinary management to prevent disease progression.</p><p><strong>Learning points: </strong>This case highlights the diagnostic complexity of incidental pulmonary nodules in immunocompromised patients, reinforcing the need for thorough microbiological investigation even in the absence of infection symptoms.It illustrates a rare, asymptomatic presentation of <i>Rhodococcus</i> infection in the context of ectopic ACTH-dependent Cushing's syndrome, a scenario not widely reported in the literature.Practical is given guidance on managing opportunistic infections and evaluating ectopic ACTH sources, aiding internists in navigating similar diagnostic and therapeutic challenges in complex endocrine-infectious overlaps.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 9","pages":"005711"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12416799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029355","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 Less Could be More: Successful Treatment of Granulomatous Lymphocytic Interstitial Lung Disease with Azathioprine.","authors":"Ana Laura López, Diego Santiago Fernández Romero","doi":"10.12890/2025_005632","DOIUrl":"10.12890/2025_005632","url":null,"abstract":"<p><strong>Introduction: </strong>Interstitial lung disease is a major complication in patients with common variable immunodeficiency. There are some publications that try to shed light on the pathophysiology of this non-infectious complication, most of them highlight the role of follicular T cells and CD21^low B cells. Moreover, there are no guidelines based on randomized controlled studies on the treatment of patients with interstitial lung disease and the published case series or small uncontrolled studies describe a wide range of response rates to treatment. In this scenario, the decisions are based on expert opinion rather than on robust scientific evidence. This could lead to potential biases associated with expert opinion based on a small number of patients.</p><p><strong>Case description: </strong>We present the case of an adult patient with common variable immunodeficiency and interstitial lung disease. He did not receive rituximab due to an adverse reaction and underwent treatment with azathioprine, achieving prolonged remission after treatment discontinuation.</p><p><strong>Discussion: </strong>If T-cell involvement could be the main underlying cause of this complication, treatment targeting T-cells may possibly be an effective therapeutic option. Our case, complemented with a physiopathology review, suggests a beneficial effect of azathioprine that warrants further research.</p><p><strong>Conclusion: </strong>It is important to keep in mind that patients with common variable immunodeficiency are a heterogeneous group, so no single treatment will be the best for all of them. It is necessary to review the rationale for the increasing use of anti-CD20 drugs in non-infectious complications in patients with common variable immunodeficiency. Such use is based on expert recommendations and not on randomized, controlled studies with quantitative endpoints.</p><p><strong>Learning points: </strong>There are no guidelines based on randomized controlled studies on the treatment of patients with common variable immunodeficiency and interstitial lung disease.The use of rituximab in the treatment of various non-infectious manifestations in patients with common variable immunodeficiency, including interstitial lung disease, could be the result of potential biases associated with expert opinion based on a small number of patients.T-cell involvement could be the main underlying cause of this complication so treatment targeting T-cells may possibly be an effective therapeutic option.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 9","pages":"005632"},"PeriodicalIF":0.0,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12416771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029394","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 Clever Stroke Mimic: Thrombotic Thrombocytopenic Purpura Without Schistocytes - A Case Report and Literature Review.","authors":"Ko Takamatsu, Chalothorn Wannaphut, Kevin Benavente, Yoshito Nishimura, Christina Chong","doi":"10.12890/2025_005628","DOIUrl":"10.12890/2025_005628","url":null,"abstract":"<p><strong>Background: </strong>Thrombotic thrombocytopenic purpura (TTP) is a life-threatening hematologic emergency caused by ADAMTS13 deficiency, leading to microvascular thrombosis, haemolytic anaemia, thrombocytopenia, and end-organ damage. Neurological symptoms occur in up to 90% of cases and are frequently misdiagnosed as stroke. Prompt recognition and treatment reduce the mortality rate from over 90% to 10-20%.</p><p><strong>Case presentation: </strong>A 70-year-old woman with no significant medical history presented with acute aphasia and right-sided facial and upper extremity numbness. Five days prior, she had experienced fatigue, headache, and bruising. On admission, she had stable vitals with mild aphasia and purpuric ecchymoses noted on examination. Laboratory findings revealed haemolytic anaemia (haemoglobin 7.8 g/dl, lactate dehydrogenase 875 U/l, total bilirubin 2.4 mg/dl), thrombocytopenia (35 ×10⁹/l), and unremarkable coagulation studies (partial thromboplastin time 30 sec, prothrombin time-international normalized ratio 1, fibrinogen 370 mg/dl, D-dimer 2.15 ng/ml). Peripheral smear showed no schistocytes but noted 2+spherocytes. Stroke was ruled out with brain magnetic resonance imaging/magnetic resonance angiography. Given the bicytopenia with possible haemolysis along with new neurological symptoms, TTP was considered in the differential diagnosis. A PLASMIC score of 5 suggested a high probability of TTP. Plasma exchange and corticosteroids were initiated within 5 hours of presentation. ADAMTS13 activity <1% confirmed the diagnosis 4 days after presentation. After five plasma exchange sessions, the patient's platelet count normalized and neurologic deficits resolved by discharge.</p><p><strong>Conclusion: </strong>This case underscores the importance of considering TTP in stroke mimics, even in the absence of schistocytes, if clinical suspicion is high. Early recognition and initiation of treatment significantly improve patient outcomes.</p><p><strong>Learning points: </strong>Start plasmapheresis and high-dose steroids immediately for suspected thrombotic thrombocytopenic purpura (TTP), even if schistocytes are absent when clinical suspicions are high.Recognizing TTP's neurological symptoms mimicking stroke is crucial to avoid misdiagnosis and ensure timely treatment.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 9","pages":"005628"},"PeriodicalIF":0.0,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12416773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029304","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 Pneumococcal Periaortitis: Periaortitis is not Always Autoimmune.","authors":"Georges El Hasbani, John Wilson, Kenneth Warrington","doi":"10.12890/2025_005633","DOIUrl":"10.12890/2025_005633","url":null,"abstract":"<p><strong>Introduction: </strong>Periaortitis is a rare inflammatory condition with both infectious and non-infectious aetiologies, often presenting a diagnostic challenge. A comprehensive evaluation-including history, physical examination, imaging, and a broad infectious work-up-is essential, as negative blood cultures do not rule out infection, and premature use of glucocorticoids may be harmful in cases of infectious periaortitis.</p><p><strong>Case description: </strong>We report the case of a 70-year-old man presenting with flank pain and periaortitis, in whom positron emission tomography/computed tomography (PET/CT) scan revealed moderate-to-severe ¹⁸F-fluorodeoxyglucose (FDG) uptake. Despite negative cultures, a Karius test and urine antigen confirmed <i>Streptococcus pneumoniae</i> as the causative agent. The patient underwent successful open surgical repair of a mycotic pararenal abdominal aortic aneurysm, followed by targeted antibiotic therapy.</p><p><strong>Discussion: </strong>Pneumococcal periaortitis is a rare condition with few reported cases, though <i>S. pneumoniae</i> has been implicated in various vascular infections including mycotic aneurysms, and diagnostic challenges persist, especially when blood cultures are negative. The Karius Spectrum^™, despite its cost and limited guidance for use, and FDG-PET/CT imaging have emerged as helpful tools in identifying infectious aetiologies, with high maximum standardized uptake value values favouring infection over autoimmune causes, as seen in this case.</p><p><strong>Conclusion: </strong>Infectious periaortitis should be suspected when there is a high uptake of FDG on PET/CT prompting an infectious disease work-up which may include a Karius test.</p><p><strong>Learning points: </strong>Periaortitis may have an autoimmune aetiology; however, an infectious cause should always be considered, particularly when there is high ¹⁸F-fluorodeoxyglucose uptake on positron emission tomography/computed tomography imaging.<i>Streptococcus pneumoniae</i> is a rare cause of periaortitis and has been more commonly reported in association with mycotic aneurysms.Microbial cell-free deoxyribonucleic acid testing, such as the Karius test, may be a useful tool for identifying specific bacteria, especially when blood cultures are negative.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 8","pages":"005633"},"PeriodicalIF":0.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12331271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144816120","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":"Distal Renal Tubular Acidosis Secondary to Hyperbilirubinemia.","authors":"Fawzi Srour, Aline Pourcelet, Ishak Beklevic, Guillaume Benoit, Serge Treille de Grandsaigne, Nathan Neveux","doi":"10.12890/2025_005661","DOIUrl":"10.12890/2025_005661","url":null,"abstract":"<p><strong>Introduction: </strong>Bile cast nephropathy (BCN) is a rare and often overlooked cause of acute kidney injury (AKI), usually seen in the context of severe hyperbilirubinemia. It results from the deposition of bile pigments and bile casts in renal tubules, specifically distal and collector tubules, leading to obstruction and direct tubular toxicity.</p><p><strong>Case description: </strong>We describe the case of 49-year-old male who presented with severe jaundice and oliguric AKI. With the gradual resolution of liver dysfunction, the patient's kidney function also improved. However, during the recovery phase, the patient developed persistent hypokalaemia and normal anion gap metabolic acidosis. Further work-up was consistent with distal renal tubular acidosis (dRTA).</p><p><strong>Discussion: </strong>While BCN is being increasingly recognized in patients with cholestatic liver diseases, complications arising during the recovery phase - particularly acid-base disturbances like dRTA - are rarely reported. In this case, the onset of dRTA during renal recovery may reflect delayed or selective tubular healing after bile-induced injury. This case highlights the importance of continued monitoring for renal tubular defects even after apparent improvement in glomerular function.</p><p><strong>Conclusion: </strong>This case emphasizes the need to consider dRTA as a potential complication in patients recovering from BCN. Close follow-up of electrolyte and acid-base parameters is advised during renal recovery, especially in the presence of persistent hypokalaemia.</p><p><strong>Learning points: </strong>Bile cast nephropathy (BCN) is an under-recognized cause of acute kidney injury (AKI) in patients with severe hyperbilirubinemia and should be considered in the differential diagnosis of AKI in jaundiced patients.Distal renal tubular acidosis (dRTA) can emerge during the recovery phase of BCN-related AKI, possibly due to tubular dysfunction from bile-induced injury, highlighting the need for close metabolic monitoring after renal recovery.The co-occurrence of BCN and dRTA emphasizes the importance of serial electrolyte assessments and acid-base evaluation in jaundiced patients with AKI, even after apparent improvement in renal function.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 8","pages":"005661"},"PeriodicalIF":0.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12331275/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144816128","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 Novel, Non-Invasive AI-Based Telemonitoring System for Heart Failure: Detection of Undiagnosed Hyperthyroidism in an Asymptomatic Patient.","authors":"Allan Böhm, Julia Lucka, Amitai Segev, Marta Kollarova, Stefan Toth, Nikola Jajcay, Branislav Bezak","doi":"10.12890/2025_005420","DOIUrl":"10.12890/2025_005420","url":null,"abstract":"<p><strong>Background: </strong>Untreated thyroid disorders may precipitate heart failure (HF) decompensation. Assessment of cardiac filling pressures may aid in the early detection and prevention of clinical decompensation. Therapy guided by monitoring of cardiac filling pressures has been shown to improve quality of life and survival and reduce hospitalizations of individuals with HF. We have developed a non-invasive method to assess left ventricular filling pressures (LVFP) by analysing the photoplethysmography signal with Seeling HeartCore technology (Seerlinq, Bratislava, Slovakia).</p><p><strong>Case description: </strong>A 99-year-old female visited the clinic for a routine cardiac check-up. Laboratory investigations showed elevated NTproBNP and moderately elevated high sensitive troponin T. HeartCore algorithm indicated elevated LVFP. As part of the evaluation of worsening of sub-clinical HF, extended laboratory tests revealed low thyroid-stimulating hormone with high free thyroxine levels indicating increased thyroid function. The endocrinologist diagnosed hyperthyroidism with multinodular goitre and prescribed thiamazole. To prevent progression to clinical HF decompensation, the dose of furosemide was increased. At 4 months, during scheduled cardiac follow-up, the patient was clinically doing well, without any signs or symptoms of HF.</p><p><strong>Discussion: </strong>Remote monitoring devices that track pressures in the pulmonary artery require invasive implantation and are associated to potential complications. The high cost of these devices presents a significant barrier to widespread use. SEERLINQ is a novel system for remote haemodynamic monitoring based on non-invasive assessment of LVFP, presenting a promising alternative to current invasive methods.</p><p><strong>Conclusion: </strong>This case underscores the potential benefits of this technology in the early recognition of pre-clinical deterioration and its implementation for remote home monitoring in patients with HF.</p><p><strong>Learning points: </strong>Untreated thyroid disorders in patients with heart failure (HF) can exacerbate signs and symptoms of HF.Left ventricular filling pressure (LVFP) rises 3-4 weeks before HF symptoms. Echocardiographic assessment of LVFP can be challenging in patients with atrial fibrillation or paced rhythms.Photoplethysmography-based analysis could be utilized to assess LVFP, enabling remote monitoring of HF patients and potentially preventing HF decompensation and hospitalization.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 8","pages":"005420"},"PeriodicalIF":0.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12331272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144816121","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":"Acute Pancreatitis Associated with Tacrolimus in A Lung Transplant Recipient: A Case Report and Review of Literature.","authors":"Ana Šmaguc, Maja Mačković, Nikolina Marić, Nikola Udiljak","doi":"10.12890/2025_005619","DOIUrl":"10.12890/2025_005619","url":null,"abstract":"<p><strong>Background: </strong>Tacrolimus is a commonly used immunosuppressant with well-defined side effects, including hypertriglyceridemia and hyperglycaemia. However, acute pancreatitis is still not widely recognized as an adverse event related to tacrolimus.</p><p><strong>Case presentation: </strong>A 60-year-old male was admitted to the intensive care unit with symptoms and signs of acute pancreatitis. He underwent lung transplantation 4 years ago and since then received tacrolimus, mycophenolate mofetil (MMF) and prednisone. His initial laboratory tests revealed elevated serum amylase and lipase, high inflammatory parameters, markedly elevated triglycerides and hyperglycemia with diabetic ketoacidosis. He was treated with continuous insulin infusion, electrolyte correction, crystalloid titration and antimicrobial therapy. During the fasting period, immunosuppression was maintained with parenteral methylprednisolone and tacrolimus. Gradually, oral tacrolimus, MMF and full enteral nutrition were introduced. A control computed tomography scan showed pancreatic body necrosis with a large pseudocyst. The patient was discharged on a strict diet, fenofibrate and short- and long-acting insulin. Immunosuppressive therapy with tacrolimus, MMF and prednisone was continued. He was hospitalized several times within a year due to complications of severe necrotizing pancreatitis.</p><p><strong>Conclusion: </strong>Acute pancreatitis associated with the use of tacrolimus is rare. Factors contributing to its occurrence are longer exposure period, toxic levels of the drug and concurrent metabolic derangements, predominantly hypertriglyceridemia. In this case report we present a patient after lung transplantation on tacrolimus therapy who developed severe acute necrotizing pancreatitis along with hypertriglyceridemia and diabetes mellitus. We also conducted a literature search and found 13 other cases of acute pancreatitis presumably related to tacrolimus therapy.</p><p><strong>Learning points: </strong>Tacrolimus related complications including metabolic changes are commonly observed.Development of acute pancreatitis is one of the rare complications of tacrolimus therapy, seldomly reported in transplant recipients.The definitive therapeutic approach is still to be determined.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 9","pages":"005619"},"PeriodicalIF":0.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12416798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029334","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}