European journal of case reports in internal medicine最新文献

{"title":"Concurrent Idiopathic Multicentric Castleman Disease with TAFRO and Sjögren's Syndrome in a Young Patient: A Challenging Diagnostic Overlap.","authors":"Maria Carolina Carvalho, Matilde Coimbra, João Fernandes Serodio, José Delgado Alves","doi":"10.12890/2026_006166","DOIUrl":"10.12890/2026_006166","url":null,"abstract":"<p><strong>Background: </strong>Idiopathic multicentric Castleman disease (iMCD) with TAFRO syndrome (characterized by thrombocytopenia, anasarca, fever, reticulin fibrosis/renal failure, organomegaly) is a recently described disorder. The diagnostic criteria for iMCD-TAFRO exclude patients with concomitant autoimmune diseases such as primary Sjögren's syndrome. However, recent case reports suggest that although rare, these conditions may coexist.</p><p><strong>Case report: </strong>We report the case of a 37-year-old woman who presented with escalating systemic inflammation, cytopenias, anasarca, renal dysfunction and organomegaly, with lymph node biopsy suggestive of Castleman disease. Simultaneously, dense lacrimal gland hyperplasia with histopathology demonstrating lymphoepithelial sialadenitis and strongly positive anti-Ro52 antibodies led to a diagnosis of Sjögren's syndrome. Given the rapid clinical deterioration and marked hyperinflammation, corticosteroid therapy and tocilizumab were implemented, leading to sustained remission.</p><p><strong>Conclusion: </strong>This case illustrates the diagnostic complexity posed by overlapping features of Idiopathic multicentric Castleman disease with TAFRO syndrome and Sjögren's syndrome and reinforces the need to reconsider existing diagnostic criteria to ensure timely diagnosis and effective treatment. Epidemiologically, this is also a rare case of iMCD with TAFRO syndrome in a patient of African descent, contrasting with previous reports predominantly involving Asian individuals.</p><p><strong>Learning points: </strong>Idiopathic multicentric Castleman disease (iMCD) with TAFRO syndrome (thrombocytopenia, anasarca, fever, reticulin fibrosis/renal failure, organomegaly) (iMCD-TAFRO) is a rare, life-threatening disorder marked by severe systemic inflammation and multiorgan failure, and early recognition and timely initiation of immunomodulatory therapy are critical for positive outcomes.Although current diagnostic criteria for iMCD-TAFRO exclude patients with concomitant autoimmune diseases such as Sjögren's syndrome, an increasing number of case reports suggest that these conditions may coexist, challenging existing definitions and suggesting a potential physiopathological overlap.This case highlights the diagnostic challenge posed by the coexistence of these conditions and underscores the need for an individualized assessment integrating clinical, laboratory, and immunological findings.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 2","pages":"006166"},"PeriodicalIF":0.0,"publicationDate":"2026-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12885578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146156557","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 Rare Case of Empyema Necessitans Due to Streptococcus Anginosus with Necrotizing Fasciitis and Retroperitoneal Abscesses.","authors":"Fatemeh Akbarpoor, Rand Al Bawwab, Meera Alshehhi, Zainulabideen Ahmed, Ahmed Amrou, Ishma Aijazi","doi":"10.12890/2026_006065","DOIUrl":"10.12890/2026_006065","url":null,"abstract":"<p><strong>Background: </strong>Necrotizing fasciitis (NF) is a rapidly progressive soft-tissue infection associated with high mortality even when recognized early. Empyema necessitans (EN) is an uncommon complication of pleural empyema in which purulent material extends beyond the thoracic cavity into surrounding soft tissues. Although classically linked to <i>Mycobacterium tuberculosis</i> and <i>Actinomyces</i>, EN due to <i>Streptococcus anginosus</i> is distinctly rare. In exceptional cases, extra thoracic spread of empyema can track along fascial planes and evolve into NF.</p><p><strong>Case report: </strong>A 36-year-old previously healthy woman, recently treated for bilateral empyema, re-presented in severe respiratory distress and septic shock. She was found to have a foul-smelling open thigh wound, widespread soft-tissue involvement, and laboratory evidence of severe infection. Computed tomography (CT) imaging demonstrated bilateral multiloculated empyema with chest-wall extension consistent with EN, NF of the right thigh, multiple large retroperitoneal abscesses, and emphysematous cystitis (EC). She required intubation, vasopressor support, broad-spectrum antibiotics, and multiple surgical debridements. Pleural cultures grew <i>S. anginosus</i>. Retroperitoneal abscesses were managed conservatively, and multidisciplinary care led to steady clinical improvement. After approximately 5 weeks, her empyema had resolved, and her thigh wounds healed adequately, allowing discharge on oral antibiotics.</p><p><strong>Conclusion: </strong>This case illustrates an exceptionally rare progression of <i>S. anginosus</i> empyema to EN with concurrent NF and widespread retroperitoneal involvement. Early recognition of atypical dissemination, aggressive surgical management, and coordinated multidisciplinary care are essential for survival in such complex presentations.</p><p><strong>Learning points: </strong><i>Streptococcus anginosus</i>, although a commensal organism, has strong abscess-forming potential and can cause disseminated, life-threatening infections even in immunocompetent adults.This case highlights the importance of optimal treatment of lung empyema. Partially treated lung empyema can lead to empyema necessitans, with pus tracking along fascial planes and causing multiple superficial and retroperitoneal abscesses.Early recognition, repeated surgical source control, and multidisciplinary collaboration are critical to survival in multifocal invasive infections.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 3","pages":"006065"},"PeriodicalIF":0.0,"publicationDate":"2026-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147431692","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":"Prolonged Follow-Up of a Case of Takayasu's Arteritis Presenting with Spastic Paraplegia Secondary to Thoracic Compressive Myelopathy.","authors":"Matthew Spiteri, Victoria Farrugia, Michela Frendo","doi":"10.12890/2026_006089","DOIUrl":"10.12890/2026_006089","url":null,"abstract":"<p><p>This is the case of a 63-year-old woman who presented with a few weeks' history of progressive bilateral lower limb weakness and spastic paraparesis. Urgent imaging revealed spinal cord compression caused by dural thickening between the T2 and T9 levels, as well as an incidental finding of ongoing aortitis. The impression of a large-vessel vasculitis with concurrent thoracic pachymeningitis was given. The patient underwent an urgent thoracic laminectomy and tissue samples were sent for culture and histology. Tissue cultures later identified Enterobacter and Pseudomonas species, introducing further diagnostic complexity. Histology showed findings consistent with a non-specific chronic inflammatory process. An autoimmune and vasculitic screen revealed nothing of note and IgG4 levels were within normal range. A diagnosis of Takayasu's arteritis with thoracic compressive myelopathy was made. Long-term follow-up was essential to the patient's management following her diagnosis of Takayasu's arteritis. Ongoing surveillance was required to assess physical recovery after prolonged immunosuppression and rehabilitation, as well as to recognise and detect delayed complications. These were related both to the vasculitis and to her prolonged corticosteroid therapy, despite an initial favourable response to the multidisciplinary treatment.</p><p><strong>Learning points: </strong>Spastic paraplegia is an uncommon and potentially misleading presentation of Takayasu's arteritis. The resulting dural thickening may initially mimic primary spinal pathology.The presence of concurrent large-vessel inflammation is a crucial diagnostic clue; positron emission tomography/computed tomography scans and magnetic resonance imaging are invaluable in confirming vasculitis and monitoring treatment response.Long-term follow-up is essential, as it reveals new and significant complications related both to Takayasu's arteritis and to its management.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 2","pages":"006089"},"PeriodicalIF":0.0,"publicationDate":"2026-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12885591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146156415","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":"B-Cell Lymphoma Following an Indolent Course Over 30 Years with Immunophenotypic Changes at Each Recurrence.","authors":"Shintaro Yamanaka, Shinji Hasebe, Tomomi Fujii, Toshikazu Gondo, Riko Kitazawa, Sohei Kitazawa, Yoshihiro Yakushijin","doi":"10.12890/2026_006191","DOIUrl":"10.12890/2026_006191","url":null,"abstract":"<p><strong>Introduction: </strong>Diffuse large B-cell lymphoma (DLBCL) comprises biologically distinct subtypes, but whether cell-of-origin-related features remain stable over long disease courses is unclear.</p><p><strong>Case description: </strong>A woman was initially diagnosed with CD20-positive B-cell lymphoma in 1988 and treated with cyclophosphamide, vincristine and prednisolone (COP) chemotherapy. She experienced a first relapse in 1998 and received cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP) chemotherapy. The second relapse occurred in 2008 and was managed with rituximab. At the third relapse in 2011, rituximab plus bendamustine (RB) was administered. During the fourth relapse in 2015, R-pirarubicin (THP)-COP chemotherapy was given. At the fifth relapse in 2017, at 80 years of age, RB therapy was administered again. A sixth relapse occurred in 2019, and the patient died within the same year. Histopathological evaluation throughout the disease course consistently demonstrated DLBCL. Notably, the immunophenotype showed sequential changes from a germinal centre B-cell-like pattern to an activated B-cell-like pattern and ultimately to a CD30-positive anaplastic B-cell variant.</p><p><strong>Discussion: </strong>This unusually long clinical course highlights stepwise immunophenotypic evolution during repeated relapses, suggesting that surrogate subtype profiles may change over time.</p><p><strong>Conclusion: </strong>Repeat biopsies with comprehensive pathological (and, when available, molecular) re-evaluation are important to accurately characterize relapsed DLBCL and inform treatment selection.</p><p><strong>Learning points: </strong>Diffuse large B-cell lymphoma (DLBCL) can undergo stepwise immunophenotypic and molecular evolution over decades, progressing from a germinal Center B-cell-like (GCB)-like phenotype to an activated B-cell -like/non-GCB pattern (MUM1+, CD30+) and ultimately to an aggressive anaplastic variant.The cell-of-origin profile and its associated molecular features are not necessarily static; thus, therapeutic strategies for relapsed DLBCL should be tailored to the current disease state rather than relying on the signature at initial diagnosis.Longitudinal re-evaluation through repeat biopsies is imperative to capture the evolving landscape of the malignancy, ensuring that treatment selection is guided by the most recent pathological and molecular findings.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 2","pages":"006191"},"PeriodicalIF":0.0,"publicationDate":"2026-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12885577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146156583","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":"Sequential Systemic Thrombolysis for Clot-In-Transit after Thrombolytic Failure in Massive Pulmonary Embolism.","authors":"Evans MacCready, Sanaa Afriyie-Ansah, Ama Owusuaa Kwakye, Romeo Boaheng","doi":"10.12890/2026_006153","DOIUrl":"https://doi.org/10.12890/2026_006153","url":null,"abstract":"<p><strong>Introduction: </strong>A clot-in-transit (CIT) is a mobile thrombus within the right heart associated with acute pulmonary embolism (PE) and high mortality. Although systemic thrombolysis remains the standard treatment for massive or high-risk PE, management of thrombolytic failure and associated CIT remains challenging, particularly when surgical embolectomy and catheter-directed thrombectomy are unavailable. Sequential systemic thrombolysis represents a practical therapeutic option in these high-risk scenarios.</p><p><strong>Case description: </strong>A 54-year-old woman with hypertension presented with progressive dyspnoea and pleuritic chest pain. Computed tomography pulmonary angiography confirmed massive bilateral PE, and she was treated with intravenous tenecteplase. Despite initial hemodynamic improvement, hypoxemia persisted, and echocardiography revealed a large CIT within the right atrium. In the absence of surgical or catheter-directed options, she received repeat systemic thrombolysis with alteplase, achieving complete thrombus resolution and rapid clinical recovery without bleeding complications. Further evaluation revealed large uterine fibroids compressing the iliac veins as the likely source of extensive deep vein thrombosis.</p><p><strong>Discussion: </strong>This case demonstrates the potential role of sequential systemic thrombolysis in managing thrombolytic failure and CIT when advanced interventions are unavailable. Switching to alteplase after unsuccessful thrombolysis with tenecteplase may enhance thrombus dissolution due to pharmacological differences in fibrin affinity and duration of fibrinolytic activity. Early reassessment following thrombolysis is critical to detect persistent thrombus and guide timely intervention.</p><p><strong>Conclusion: </strong>Sequential systemic thrombolysis can serve as a safe, effective, and practical rescue strategy for clot-in-transit complicating massive PE, particularly in low-resource settings where surgical or catheter-based interventions are not available.</p><p><strong>Learning points: </strong>Sequential systemic thrombolysis can be a safe and effective rescue option following thrombolytic failure in massive pulmonary embolism.Early echocardiographic reassessment is essential to detect treatment failure and guide further therapy.Large uterine fibroids can cause iliac vein compression and predispose to extensive deep vein thrombosis.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 3","pages":"006153"},"PeriodicalIF":0.0,"publicationDate":"2026-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12971032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147431562","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":"Spinal Ischemia after Prolonged Resuscitation and Coronary Angiography Under Impella Protection.","authors":"Anna Rom, Aikaterini Anastasiou, Ioanna Giatagantzidou, Özgür Yaldizli, Jasper Boeddinghaus, Marios-Nikos Psychogios, Daniel Tobias Tuchscherer","doi":"10.12890/2026_006023","DOIUrl":"10.12890/2026_006023","url":null,"abstract":"<p><p>Spinal ischemia is a rare condition and accounts for only 1-2% of all neurovascular diseases. In this case, spinal ischemia occurred in a 46-year-old patient after prolonged resuscitation after out-of-hospital cardiac arrest and following invasive coronary angiography and percutaneous coronary intervention under mechanical circulatory support with an Impella (Abiomed, Danvers, MA, USA). Magnetic resonance imaging showed an infarct demarcation from the 5^th thoracic vertebra to the conus medullaris. The supply areas of the anterior spinal artery (paraplegia, no response to pain stimulus) as well as the posterior spinal arteries (reduced sensation of touch) were affected. Magnetic resonance imaging of the brain showed both signs of hypoxic brain damage and embolic events. In terms of pathogenesis, the low-flow-phase of resuscitation with associated arterial thromboembolism as well as a thromboembolic event by the Impella need to be considered. To date, limited data on the prevalence and incidence of spinal ischemia after resuscitation and/or use of an Impella are available in the literature.</p><p><strong>Learning points: </strong>Impella (ventricular assist device) can be associated with thromboembolic events.The low flow phase of resuscitation can be associated with arterial thromboembolism.Spinal ischemia can occur after resuscitation.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 2","pages":"006023"},"PeriodicalIF":0.0,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12885581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146156388","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":"From Breast Mass to Paralysis: Lymphocytic Mastitis as the Sentinel Manifestation of Sjögren's Syndrome.","authors":"Khawla K Alghanim, Rana K Almuqati, Hanan T Albaqshi, Nayef S Alahmadi","doi":"10.12890/2026_006125","DOIUrl":"10.12890/2026_006125","url":null,"abstract":"<p><p>Sjögren's syndrome is a systemic autoimmune disease classically characterized by sicca symptoms; however, extra glandular manifestations may precede glandular involvement and, in rare cases, present as life threatening emergencies. We report a middle-aged patient who presented with acute flaccid paralysis due to severe hypokalaemia secondary to distal renal tubular acidosis, requiring intensive care admission. Notably, the patient had undergone breast excision two years earlier for a painful breast mass, with histopathology highly suggestive of lymphocytic mastitis, which was misdiagnosed and treated as a breast abscess. Subsequent immunological evaluation confirmed primary Sjögren's syndrome. Prompt electrolyte correction and immunosuppressive therapy resulted in complete neurological recovery.</p><p><strong>Learning points: </strong>Sjögren's syndrome may initially present with rare extra glandular manifestations, preceding classical sicca symptoms and leading to significant diagnostic delay.Lymphocytic mastitis can represent an early autoimmune manifestation of Sjögren's syndrome and may closely mimic infectious or malignant breast disease.Distal renal tubular acidosis is the most frequent renal manifestation of Sjögren's syndrome and may result in life-threatening hypokalemia and acute flaccid paralysis.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 2","pages":"006125"},"PeriodicalIF":0.0,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12885588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146156563","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":"Life-Threatening Thrombotic Events Revealing Systemic Lupus Erythematosus in a Patient with Chronic Myelomonocytic Leukaemia.","authors":"Abdelhamid Khadidja, Valery Salle, Magalie Joris, Jean Schmidt, Jean-Pierre Marolleau","doi":"10.12890/2026_005954","DOIUrl":"10.12890/2026_005954","url":null,"abstract":"<p><p>Associations between systemic autoimmune and inflammatory diseases and myelodysplastic syndromes have been reported for at least 25 years, suggesting a potential pathogenic link. We present the case of a 62-year-old woman with chronic myelomonocytic leukaemia, initially diagnosed in August 2022 based on persistent monocytosis, thrombocytopenia, polyclonal hypergammaglobulinemia, <i>NRAS</i> and <i>SCMA1</i> mutations, and cytogenetic abnormalities (46 chromosomes with a long arm deletion of chromosome 16). In August 2024, she was hospitalized for worsening general condition and dyspnoea, revealing hyperleukocytosis (206 g/l), progressive monocytosis, medullary infiltration, and bilateral pericardial/pleural effusions. A positron emission tomography scan demonstrated bone marrow hypermetabolism and splenomegaly. Treatment with azacitidine and venetoclax was initiated, but weeks later, she developed ST elevation myocardial infarction, ischemic stroke, and deep vein thrombosis, requiring intensive care. Immunological testing showed high-titre antinuclear antibodies (1/1280), anti-Ro52, anti-Sm/RNP, and anti-U1 RNP and complement consumption, leading to a diagnosis of systemic lupus erythematosus (/American College of Rheumatology/ European League Against Rheumatism 2019 criteria). Hydroxychloroquine was started, followed by hydroxycarbamide, azacitidine, and ruxolitinib due to persistent hyperleukocytosis (peaking at 100 g/l), resulting in clinical and biological improvement. The patient underwent allogeneic stem cell transplantation in mid-March 2025. This case highlights the complex interplay between hematologic malignancies and autoimmune diseases, emphasizing the need for multidisciplinary management.</p><p><strong>Learning points: </strong>There is a two-way relationship between hematologic malignancies and autoimmune diseases, where each can potentially initiate or exacerbate the other.Effective management requires close collaboration between haematologists, immunologists/rheumatologists, and intensive care specialists.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 2","pages":"005954"},"PeriodicalIF":0.0,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12885582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146156661","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":"Dermatomyositis Mimicking Statin-Induced Myopathy in A 62-Year-Old Woman.","authors":"Itzamar Pastrana-Echevarria, Merab Rivera-Serrano, Karina Cancel-Artau, Stephen Bury-Fiol","doi":"10.12890/2026_006098","DOIUrl":"10.12890/2026_006098","url":null,"abstract":"<p><p>Dermatomyositis (DM) is an autoimmune inflammatory myopathy that may rarely be drug induced. Statin-induced dermatomyositis (DIDM) is uncommon, with only few atorvastatin-related cases described in the literature. We present a case of a 62-year-old Hispanic woman who developed progressive proximal muscle weakness, myalgias, and joint discomfort shortly after initiating atorvastatin therapy. Despite discontinuation of the statin, her symptoms persisted and were accompanied by new cutaneous lesions. Laboratory evaluation revealed marked elevation of muscle enzymes, and subsequent skin biopsy revealed lymphocytic perivascular and perifollicular infiltrated with dermal mucin. Autoimmune serologies were negative, and malignancy screening was unremarkable. Treatment with systemic corticosteroids and mycophenolate mofetil resulted in gradual improvement. This report underscores the diagnostic challenges in differentiating statin-induced rhabdomyolysis from inflammatory myopathy, highlights the potential for rapid onset of dermatomyositis after statin exposure, and expands the limited literature on DIDM in Hispanic patients. By sharing this case, we aim to raise awareness among clinicians of this rare but clinically significant association, emphasizing the need for early recognition, histopathology, and malignancy screening to optimize outcomes.</p><p><strong>Learning points: </strong>Statin-induced dermatomyositis is a rare immune-mediated complication that may mimic rhabdomyolysis early in its presentation.Lack of clinical or biochemical improvement after statin withdrawal and intravenous hydration should raise suspicion for inflammatory myopathy.Cutaneous findings, seronegative myositis profile, and skin biopsy features are key to distinguishing dermatomyositis from necrotizing autoimmune myopathy.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 2","pages":"006098"},"PeriodicalIF":0.0,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12885587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146156595","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":"Coil Embolization of an Appendiceal Artery Bleed Leading to Appendicitis and Surgical Resection.","authors":"Omar Brijawi, Katherine Guardado, Khizar Ghuman, Frank Epitropoulos","doi":"10.12890/2026_006144","DOIUrl":"10.12890/2026_006144","url":null,"abstract":"<p><strong>Background: </strong>Appendiceal bleeding is an infrequent cause of lower gastrointestinal bleeding (LGIB), accounting for only 0.014% of cases.</p><p><strong>Case report: </strong>We present the case of a 48-year-old male on heparin who developed an acute LGIB from the appendicular artery requiring coil embolization and subsequently developed appendicitis.</p><p><strong>Conclusion: </strong>This case highlights appendicitis as a potential complication of appendiceal artery embolization. Careful patient selection and consideration of alternative approaches, including upfront surgery or endoscopic therapy, are essential in managing appendiceal artery bleeds.</p><p><strong>Learning points: </strong>Expands the internist's differential and management strategy for obscure lower gastrointestinal bleeding.Identifies appendicitis as a real, not theoretical, complication of appendiceal artery embolization.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"13 2","pages":"006144"},"PeriodicalIF":0.0,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12885593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146156603","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}