European journal of case reports in internal medicine最新文献

{"title":"Twenty Years of Undiagnosed Eosinophilia: Diabetic Attribution Bias Delaying Diagnosis of Anca-Positive EGPA Until End-Stage Organ Damage.","authors":"Minha Aslam, Amira Bitar, Stephanie Ammari, Nawras Ibrahim","doi":"10.12890/2026_007267","DOIUrl":"https://doi.org/10.12890/2026_007267","url":null,"abstract":"<p><strong>Introduction: </strong>Eosinophilic granulomatosis with polyangiitis (EGPA) has the longest diagnostic delay among anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides, with a reported median of 455 days. Cardiac disease, the leading cause of EGPA-related mortality, is largely preventable with early immunosuppression.</p><p><strong>Case description: </strong>A 53-year-old Hispanic woman with type 2 diabetes, hypertension, and no documented asthma had 20 years of persistent peripheral eosinophilia (absolute eosinophil count 1-2.7 ×10<sup>3</sup>/μl) and active glomerulonephritic sediment. Eosinophilia was first documented at age 33 when no medical comorbidities existed, predating the diabetes diagnosis by years. Renal function declined from creatinine 0.6 mg/dl (2013) to end-stage renal disease requiring peritoneal dialysis (2024). Ejection fraction fell from 70% (2024) to 20-24% (2026), with left heart catheterization excluding ischemic aetiology. Peripheral neuropathy was attributed to diabetes without electrodiagnostic evaluation. Bone marrow biopsy excluded clonal eosinophilic disorders. ANCA testing, never previously ordered, revealed myeloperoxidase (MPO)-ANCA positivity (>8.0 units, reference 0-0.9) with ANCA IIF titre 1:160 in April 2026. The 2022 American College of Rheumatology / European Alliance of Associations for Rheumatology classification criteria score was ≥6 points without asthma or nasal polyps. Seven missed diagnostic opportunities were identified across multiple specialties and facilities over two decades.</p><p><strong>Conclusion: </strong>This case illustrates how \"diabetic attribution bias,\" care fragmentation, and socioeconomic barriers delayed EGPA diagnosis for 20 years despite persistent eosinophilia and progressive multi-organ damage. Systematic ANCA testing in patients with unexplained eosinophilia and organ involvement could prevent irreversible end-organ damage.</p><p><strong>Learning points: </strong>Persistent unexplained eosinophilia (absolute eosinophil count >1 ×10<sup>3</sup>/μl) with active glomerulonephritic sediment warrants (ANCA) testing regardless of asthma status, as myeloperoxidase (MPO)-ANCA-positive eosinophilic granulomatosis with polyangiitis (EGPA) may present without prominent asthma and with predominant vasculitic manifestations including glomerulonephritis and peripheral neuropathy.\"Diabetic attribution bias\": the reflexive attribution of organ damage to diabetes in patients with coexisting diabetes. can delay vasculitis diagnosis for years when renal decline and peripheral neuropathy are present alongside atypical features such as improving glycaemic control and active glomerulonephritic sediment.Corticosteroid exposure suppresses eosinophilia in peripheral blood within hours and in body fluids within days, masking the hallmark laboratory finding of EGPA; eosinophil counts and serosal fluid analyses should always be interpreted in the context of recent steroid use.</p","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 8","pages":"007267"},"PeriodicalIF":0.0,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13479843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789926","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":"Paediatric Collagenous Gastritis with Transient Response to Steroid Therapy.","authors":"Rónán O'Connor, Richard Standish, Hirannya Karunadasa, Robbie Chan, Alexander Hodge","doi":"10.12890/2026_006709","DOIUrl":"https://doi.org/10.12890/2026_006709","url":null,"abstract":"<p><strong>Introduction: </strong>Collagenous gastritis is a rare condition characterised by subepithelial collagen deposition and an inflammatory infiltrate. Despite being first described in 1989, the pathogenesis remains poorly understood. Clinical manifestation and histological features have been extensively described in the literature; however, treatment strategies are largely based on expert opinion and show variable efficacy.</p><p><strong>Case description: </strong>We describe a case of paediatric collagenous gastritis presenting with dyspepsia, nausea and iron deficiency anaemia initially attributed to menorrhagia. Endoscopy demonstrated nodular gastritis and histology confirmed the diagnosis. The patient had initial symptomatic improvement with budesonide; however, this was not sustained.</p><p><strong>Conclusion: </strong>This case highlights the importance of considering collagenous gastritis as a cause of iron deficiency anaemia, particularly in young female patients. It also demonstrates the management challenges in achieving sustained clinical response, reflecting the limited evidence base guiding management.</p><p><strong>Learning points: </strong>Collagenous gastritis is a rare but important cause of iron deficiency anaemia, particularly in young patients with persistent gastrointestinal symptoms.Alternative causes of iron deficiency beyond menstruation should be considered in young female patients, with early consideration for endoscopy.Symptomatic improvement with corticosteroids may be transient and sustained clinical or histological remission remains difficult to achieve.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 8","pages":"006709"},"PeriodicalIF":0.0,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13479908/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789764","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":"Refractory Pruritus in End-Stage Prostatic Adenocarcinoma: An Unusual Presentation of A Hypereosinophilic Syndrome.","authors":"Luca Lorusso, Manuel Vittorio Bovello, Mattia Cavagna, Micaela Mare, Clarissa Caimi, Tanja Fusi-Schmidhauser","doi":"10.12890/2026_007237","DOIUrl":"https://doi.org/10.12890/2026_007237","url":null,"abstract":"<p><strong>Introduction: </strong>Hypereosinophilic syndrome (HES) associated with advanced adenocarcinoma of the prostate is an exceptionally rare paraneoplastic condition. Available evidence suggests that eosinophilia may correlate with tumour progression and poor prognosis. Cutaneous manifestations, including severe pruritus and angioedaema, may significantly impair quality of life and represent particularly challenging symptoms in a palliative care setting. Pruritus management requires individualised multidisciplinary approaches including corticosteroids, antihistamines, gabapentinoids, antidepressants, opioid modulation and supportive care measures. In refractory cases, severe pruritus associated with HES may become a source of profound suffering and in end-of-life care may require palliative sedation to relieve otherwise intolerable distress.</p><p><strong>Case description: </strong>We report the case of a patient with prostatic acinar adenocarcinoma who developed paraneoplastic HES, presenting with severe refractory pruritus and recurrent angioedaema. Despite multiple symptomatic treatments, the patient experienced progressive symptom burden with significant impairment in quality of life, ultimately requiring terminal palliative sedation during end-of-life care.</p><p><strong>Conclusion: </strong>This case highlights the diagnostic challenges of HES, the importance of malignancy progression and the severe impact of uncontrolled eosinophil-mediated symptoms in advanced cancer.</p><p><strong>Learning points: </strong>Paraneoplastic hypereosinophilic syndrome should be considered in patients with advanced prostate adenocarcinoma and persistent unexplained eosinophilia after exclusion of allergic, infectious, autoimmune, endocrine and haematologic causes.In paraneoplastic hypereosinophilic syndrome, the severity of pruritus may not correlate with peripheral eosinophil counts, and symptom burden can persist despite corticosteroid therapy and normalisation of eosinophilia.To our knowledge, this is one of the first reported cases of paraneoplastic hypereosinophilic syndrome secondary to metastatic prostate adenocarcinoma in which refractory pruritus became the indication for palliative sedation.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 8","pages":"007237"},"PeriodicalIF":0.0,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13479876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789808","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":"Severe Secondary Haemophagocytic Lymphohistiocytosis Syndrome Due to Crimean-Congo Haemorrhagic Fever Virus: Thinking out of the Box.","authors":"Poulia Asimakopoulou, Sara Georgiadou, Nikolaos Gatselis, George N Dalekos","doi":"10.12890/2026_007254","DOIUrl":"https://doi.org/10.12890/2026_007254","url":null,"abstract":"<p><strong>Introduction: </strong>Crimean-Congo haemorrhagic fever is an acute, often severe haemorrhagic disease caused by the homonymous virus. On the other hand, severe life-threatening secondary haemophagocytic lymphohistiocytosis is a rare entity usually associated with underlying haematological malignancies, infectious or autoimmune diseases. Herein, we report a fatal case of severe secondary haemophagocytic lymphohistiocytosis due to the abovementioned virus but also a second case of Crimean-Congo haemorrhagic fever with virus-induced threatening haemophagocytic lymphohistiocytosis in an internist who was responsible for the patient's management.</p><p><strong>Case description: </strong>A 72-year-old stockbreeder progressed to fatal secondary haemophagocytic lymphohistiocytosis due to Crimean-Congo haemorrhagic fever virus (fever, hepatosplenomegaly, severe cytopenias, low fibrinogen, hypertriglyceridemia and extremely high ferritin levels), despite aggressive supportive measures and specific treatment with corticosteroids and intravenous γ-immunoglobulin. The second case was a 54-year-old internist who acquired the Crimean-Congo haemorrhagic fever virus through mucocutaneous exposure to the patient's blood, recovering fully with prompt double treatment against active viral replication and early stage haemophagocytic lymphohistiocytosis.</p><p><strong>Discussion: </strong>Crimean-Congo haemorrhagic fever virus is a rare cause of secondary haemophagocytic lymphohistiocytosis with an unfavourable outcome if the patient has a rapidly progressing course as in our first case. Clinicians should maintain a high level of clinical suspicion in the appropriate clinical setting since prompt initiation of treatment for secondary haemophagocytic lymphohistiocytosis as in the second case, can be lifesaving.</p><p><strong>Conclusion: </strong>These cases emphasize that Crimean-Congo haemorrhagic fever virus can be a cause of severe life-threatening haemophagocytic lymphohistiocytosis even in non-endemic areas, while stringent infection control to prevent secondary healthcare-associated transmission is of the utmost importance.</p><p><strong>Learning points: </strong>Crimean-Congo haemorrhagic fever virus can be a rare cause of severe life-threatening haemophagocytic lymphohistiocytosis syndrome even in non-endemic areasClinical suspicion for haemophagocytic lymphohistiocytosis due to Crimean-Congo haemorrhagic fever virus should be high in the appropriate clinical setting as prompt initiation of therapy can be lifesavingIt is important to apply secondary prevention of healthcare-associated transmission of Crimean-Congo haemorrhagic fever.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 8","pages":"007254"},"PeriodicalIF":0.0,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13479874/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789882","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":"Octreotide as A Bridge to Anti-TNF Therapy in Severe Fistulizing Crohn's Disease Complicated by A Clinically High-Output Enterocutaneous Fistula: A Case Report and Literature Review.","authors":"Essadi Btissam, Benderrou Mouhssine, Ouiam Elmqaddem, Hajar Koulali, Abdelkrim Zazour, Zahi Ismaili, Ghizlane Kharrasse","doi":"10.12890/2026_007112","DOIUrl":"https://doi.org/10.12890/2026_007112","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Fistulizing Crohn's disease is a severe phenotype of inflammatory bowel disease and may be complicated by enterocutaneous fistulas, which are associated with substantial morbidity due to sepsis, fluid and electrolyte disturbances, skin damage, and severe malnutrition. Anti-tumour necrosis factor agents, particularly infliximab, represent a cornerstone of medical therapy for fistulizing Crohn's disease. However, their initiation may need to be temporarily deferred in patients with septic risk, uncontrolled fistula output, or profound nutritional impairment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Case report: &lt;/strong&gt;We report the case of a 54-year-old man with severe stenosing and fistulizing ileocolonic Crohn's disease, classified as A3L3B3P0 according to the Montreal classification, complicated by a long-standing -clinically high-output- enterocutaneous fistula. On admission, he had severe malnutrition, with a body mass index of 13.8 kg/m&lt;sup&gt;2&lt;/sup&gt;, hypoalbuminemia at 24 g/L, hyponatremia, elevated C-reactive protein, and multiple complex fistulous tracts on abdominopelvic computed tomography, without a drainable deep collection.Because immediate infliximab therapy was considered unsafe, a multidisciplinary -bridging strategy- was initiated, combining nutritional optimization, local wound care, correction of deficiencies, and subcutaneous octreotide at a dose of 100 μg every 8 hours for one month. This approach was associated with a marked reduction in fistula output, from six to seven pouch changes per day to one daily change, progressive improvement of skin lesions, weight gain without edema, increased serum albumin, and decreased systemic inflammation. These improvements allowed subsequent initiation of infliximab therapy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This case suggests that octreotide may be useful as -adjunctive antisecretory bridge therapy- in selected patients with Crohn's disease-associated clinically high-output enterocutaneous fistulas when biologic therapy must be delayed. Its role should not be interpreted as definitive fistula therapy, but rather as part of a broader strategy aimed at reducing fistula output, improving nutritional and inflammatory status, and creating safer conditions for disease-modifying treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Learning points: &lt;/strong&gt;This case highlights the potential role of octreotide as adjunctive antisecretory bridge therapy in Crohn's disease-associated clinically high-output enterocutaneous fistulas when immediate biologic therapy is considered unsafe because of severe malnutrition, major inflammatory burden, or septic risk.This observation emphasizes the importance of multidisciplinary stabilization before biologic therapy, including nutritional optimization, correction of metabolic and electrolyte abnormalities, local wound care, and inflammatory control in fragile patients with complicated fistulizing Crohn's disease.This case demonstrates that a conservative strategy integrating oct","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 8","pages":"007112"},"PeriodicalIF":0.0,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13479899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789822","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":"Novel Transoesophageal Application of EBUS-Guided Cryobiopsy for Diagnosis of A Gastric Subepithelial Lesion.","authors":"Rahaf A Jereisat, Nawras Ibrahim, Ya Xu, Maher Dahdel","doi":"10.12890/2026_007239","DOIUrl":"https://doi.org/10.12890/2026_007239","url":null,"abstract":"<p><strong>Background: </strong>Gastrointestinal subepithelial lesions (SELs) arising from the muscularis propria pose diagnostic challenges, particularly paucicellular tumours such as leiomyomas, which frequently yield insufficient tissue on endoscopic ultrasound -guided fine-needle biopsy (EUS-FNB). Endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy (EBUS-TBMC) achieves superior diagnostic yield over conventional needle aspiration by obtaining intact tissue cores that preserve histologic architecture. Transoesophageal cryobiopsy has been reported for mediastinal lymph node sampling but has not been applied to gastrointestinal wall lesions.</p><p><strong>Case report: </strong>A 50-year-old man presented with a progressively enlarging gastroesophageal junction mass originating from the muscularis propria (70 × 52 mm). Two EUS-FNB sessions (eight total passes with 19-, 22-, and 25-gauge needles) yielded only scant paucicellular smooth muscle fragments insufficient for definitive diagnosis. Positron emission tomography/computed tomography scan demonstrated fluorodeoxyglucose avidity (SUV_max 6.6), raising concern for malignancy. After the patient declined surgical excision and mucosal incision-assisted biopsy referral, transoesophageal cryobiopsy was performed using an EBUS bronchoscope with a 1.1 mm CO₂ cryoprobe advanced through the oesophageal wall under ultrasound and fluoroscopic guidance. Cryobiopsy yielded tissue fragments up to 0.4 cm with preserved architecture. Immunohistochemistry confirmed leiomyoma (SMM+, desmin+, DOG1-, c-kit-, S100-, CD34-), excluding gastrointestinal stromal tumour. The patient developed a post-procedural sterile inflammatory response (C-reactive protein 188.2 mg/l) requiring 3-day hospitalization; imaging excluded perforation. He remains asymptomatic at 3-month follow-up.</p><p><strong>Conclusion: </strong>Transoesophageal EBUS-guided cryobiopsy can provide diagnostic tissue from gastric subepithelial lesions refractory to standard EUS-FNB. However, the significant inflammatory response underscores the need for systematic safety evaluation, beginning with animal model studies, before broader clinical application.</p><p><strong>Learning points: </strong>Transoesophageal endobronchial ultrasound-guided cryobiopsy can yield architecturally preserved tissue sufficient for comprehensive immunohistochemical characterization of paucicellular gastric subepithelial lesions when standard endoscopic ultrasound-guided fine-needle biopsy fails.The significant post-procedural inflammatory response observed in this case highlights that the safety profile of transmural cryobiopsy at the gastrointestinal wall remains uncharacterized and requires systematic evaluation before broader application.Multidisciplinary collaboration between interventional pulmonology and gastroenterology is essential when adapting bronchoscopic techniques to gastrointestinal indications.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 8","pages":"007239"},"PeriodicalIF":0.0,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13479873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789753","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":"Unintended Distal Embolisation of A Drug-Coated Balloon During Percutaneous Coronary Intervention: When Is Leaving the Device in Situ Feasible?","authors":"Luai Alhazmi","doi":"10.12890/2026_007251","DOIUrl":"https://doi.org/10.12890/2026_007251","url":null,"abstract":"<p><strong>Background: </strong>Balloon angioplasty can lead to multiple complications, such as myocardial perforation and dissection of coronary arteries. Device dislodgment during percutaneous coronary intervention (PCI) is a rare but potentially life-threatening complication.</p><p><strong>Case description: </strong>We report on a 67-year-old woman presenting with acute coronary syndrome due to in-stent restenosis of the left circumflex artery, treated with a drug-coated balloon (DCB) following lesion preparation. During DCB retrieval resistance was encountered, and angiography revealed separation of the balloon from its shaft with distal embolisation. Despite this, thrombolysis in myocardial infarction (TIMI) flow grade 3 was preserved. After multidisciplinary discussion, conservative management was chosen due to the distal location of the embolised device and risks associated with retrieval. Final angiography showed no procedural complication, and at 12-month follow-up, the patient remained asymptomatic without ischaemic or device-related events.</p><p><strong>Conclusion: </strong>This example shows that in certain patients with intact coronary flow and no procedural complications, conservative therapy of distal DCB embolisation might be a safe and feasible strategy.</p><p><strong>Learning points: </strong>This case highlights that, in selected patients, leaving an embolised device in situ may be a safe and feasible strategy when distal flow is preserved and procedure risks outweigh benefits of retrieval.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 8","pages":"007251"},"PeriodicalIF":0.0,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13479845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789899","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":"Invariant Natural Killer T Cell-Based Immunotherapy Using α-Galactosylceramide-Pulsed CD14⁺ Monocytes for Advanced Gallbladder Cancer.","authors":"Keigo Hanada, Katsuyuki Kobayashi","doi":"10.12890/2026_007198","DOIUrl":"https://doi.org/10.12890/2026_007198","url":null,"abstract":"<p><strong>Introduction: </strong>Gallbladder cancer is a rare and aggressive malignancy. Patients with unresectable or metastatic disease generally have poor outcomes despite standard chemotherapy. Novel immunotherapeutic strategies that enhance antitumor immunity are of considerable clinical interest. Invariant natural killer T (iNKT) cells rapidly produce cytokines and activate immune effector cells, representing a potential target for immunotherapy.</p><p><strong>Case description: </strong>We report a case of advanced gallbladder cancer treated with gemcitabine chemotherapy in combination with autologous iNKT cell-targeted therapy. Peripheral blood CD14⁺ monocytes were isolated, pulsed in vitro with α-galactosylceramide (α-GalCer), and administered intravenously to activate iNKT cells in vivo. Post-treatment contrast-enhanced computed tomography scan demonstrated shrinkage of multiple liver metastases and reduction in intra-abdominal lymphadenopathy. Liver function markers improved, and interferon-γ-producing cells increased, indicating systemic immune activation. The therapy was well tolerated, with only mild transient fever observed.</p><p><strong>Discussion: </strong>Although the specific contribution of immunotherapy cannot be definitively separated from concomitant chemotherapy, the temporal association between α-GalCer-pulsed CD14⁺ monocytes (GC-MO) administration, immune activation, and clinical improvement suggests a potential synergistic effect. Activation of iNKT cells may enhance antitumor immunity, contributing to tumour regression and improved hepatic function. This case highlights the feasibility and safety of combining iNKT-targeted therapy with standard chemotherapy in advanced gallbladder cancer.</p><p><strong>Conclusion: </strong>iNKT cell-targeted immunotherapy using GC-MO may serve as a promising adjunctive strategy for advanced gallbladder cancer. Further studies are warranted to validate its efficacy and define its role in combination with conventional chemotherapy.</p><p><strong>Learning points: </strong>Invariant natural killer T (iNKT) cells play an important role in antitumor immunity by rapidly producing cytokines and activating multiple immune effector cells, including NK cells and cytotoxic T lymphocytes.α-Galactosylceramide-pulsed CD14⁺ monocytes can activate iNKT cells and induce systemic immune responses.Combination therapy with chemotherapy and iNKT cell-targeted immunotherapy may contribute to tumour regression and immune activation in patients with advanced gallbladder cancer.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 8","pages":"007198"},"PeriodicalIF":0.0,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13479901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789813","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":"Giant Bladder Calculus Presenting as A Rare Cause of Renal Impairment in A Young Adult with Substance Use Disorder.","authors":"Eftychia Charatsi, Alexandros Kyriakides, Stefanos Chrysanthakopoulos, Vasiliki Zisopoulou, Sofia Kalantzi, Lamprini Kosma","doi":"10.12890/2026_007277","DOIUrl":"https://doi.org/10.12890/2026_007277","url":null,"abstract":"<p><strong>Background: </strong>Giant vesical calculi, defined as stones larger than 40 mm and weighing over 100 grams, are uncommon in young patients. In developed countries, only a limited number of case reports have been published, and no previous cases have been reported in patients with substance use disorder.</p><p><strong>Case report: </strong>The rare case of a young male presenting with a giant bladder calculus causing obstructive nephropathy and renal impairment is reported. The patient had a history of substance use disorder, mainly opioids, and suffered from chronic urinary retention. Clinical and biochemical recovery was achieved after open cystolithotomy and antibiotic treatment for concomitant urinary infection.</p><p><strong>Conclusion: </strong>Vesical lithiasis can occur in young individuals with chronic substance abuse due to urinary stasis. Opioids have been implicated in the development of chronic urinary retention. In severe cases, the progressive formation of giant stones can be complicated by chronic renal impairment, obstructive hydronephrosis and urinary tract infections. Surgical management with open cystolithotomy remains the gold standard treatment when not contraindicated.</p><p><strong>Learning points: </strong>Despite their rarity, giant vesical calculi should be an important diagnostic consideration in young individuals presenting with renal impairmentHidden predisposing factors such as chronic substance abuse may result in chronic urinary retention and stone formation.Delayed diagnosis and treatment of giant stones can result in chronic kidney injury with bilateral hydronephrosis, necessitating invasive therapeutic interventions.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 8","pages":"007277"},"PeriodicalIF":0.0,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13479906/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789747","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":"Semaglutide-Induced Ischemic Colitis in A Middle-Aged Female Without Vascular Risk Factors.","authors":"Marwan Joma, Abdulrahman M Karam, Wasef Sayeh, Bisher Sawaf, Anan Bseiso, Ajay Katwala, Yaseen Alastal","doi":"10.12890/2026_006649","DOIUrl":"10.12890/2026_006649","url":null,"abstract":"<p><p>Ischemic colitis (IC) typically occurs in patients with vascular risk factors. We report a case of a 53-year-old woman without comorbidities who developed IC after initiating semaglutide. She presented with acute abdominal pain and haematochezia. Imaging, colonoscopy, and biopsy confirmed IC, while infectious workup was negative. Symptoms resolved following discontinuation of semaglutide and supportive care. This case highlights a potential association between glucagon-like peptide-1 receptor agonists and IC and underscores the importance of recognizing rare adverse effects in patients without traditional risk factors.</p><p><strong>Learning points: </strong>Glucagon-like peptide-1 receptor agonists (GLP-1RAs) may be associated with ischemic colitis even in patients without traditional vascular risk factors, highlighting the need for heightened clinical suspicion in atypical presentations.New-onset abdominal pain and haematochezia in patients receiving GLP-1RAs should prompt early evaluation for ischemic colitis, including imaging and endoscopic assessment to exclude alternative diagnoses.Prompt discontinuation of the suspected offending agent and supportive management can lead to complete clinical recovery, emphasizing the importance of early recognition and intervention.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 7","pages":"006649"},"PeriodicalIF":0.0,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374836/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148469555","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}