European journal of case reports in internal medicine最新文献

{"title":"Jejunal Duplication in a 10-Year-Old Boy Presenting with Generalized Oedema and Abdominal Distension.","authors":"Thitima Ngoenmak, Chaiyaporn Virochsangaroon, Krittaporn Phruksarudee, Napat Vimtrimate, Pattawarin Wata","doi":"10.12890/2025_005423","DOIUrl":"https://doi.org/10.12890/2025_005423","url":null,"abstract":"<p><strong>Background: </strong>Gastrointestinal tract duplications are rare congenital anomalies, with the jejunum being the second most common site after the ileum. These duplications can vary in size, location, and presence of ectopic mucosa, significantly impacting clinical presentation and often requiring surgical intervention.</p><p><strong>Case presentation: </strong>A 10-year-old Thai boy with haemoglobin (Hb) E trait and iron deficiency anaemia presented with significant oedema and abdominal distention. Laboratory investigations revealed isolated hypoalbuminemia. Imaging studies, including computed tomography (CT) scan, demonstrated a large, loculated, rim-enhancing air-fluid collection adjacent to the jejunum, along with mild dilatation and wall thickening of the affected jejunal loop. The patient underwent exploratory laparotomy, which included jejunal resection and jejunojejunal end-to-end anastomosis.</p><p><strong>Conclusion: </strong>Jejunal duplications are uncommon in children and can present diagnostic challenges, potentially leading to serious complications. This case underscores the importance of considering jejunal duplication in paediatric patients with unexplained abdominal distention and protein-losing enteropathy. Early recognition and timely surgical management are crucial to prevent severe complications and improve patient outcomes.</p><p><strong>Learning points: </strong>Jejunal duplications are rare congenital malformations, which can cause a range of symptoms, including bilious vomiting, abdominal pain, and obstruction.Our patient presented with iron deficiency anaemia, generalized oedema, including swelling of both legs, scrotum, and abdominal distension.The diagnosis was made by computed tomography scan.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 5","pages":"005423"},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987097","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":"Massive Duodenal Angiolipoma: A Rare Case with Severe Haemorrhage.","authors":"Hoang Duc Dong, Thai Van Nguyen, Thanh Binh Mai","doi":"10.12890/2025_005303","DOIUrl":"https://doi.org/10.12890/2025_005303","url":null,"abstract":"<p><strong>Introduction: </strong>Duodenal angiolipoma is an exceptionally rare and often misdiagnosed clinical entity, characterized by a benign proliferation of adipose and vascular tissues. When large, these lesions pose a significant diagnostic challenge, frequently mimicking malignancy during endoscopic evaluation, especially in cases of severe gastrointestinal haemorrhage. Rapid recognition and decisive management are critical, requiring hemodynamic stabilization, advanced diagnostic tools, and expert intervention to prevent life-threatening complications.</p><p><strong>Case description: </strong>We present the case of a 71-year-old female who arrived at the emergency department with acute upper gastrointestinal haemorrhage and hemodynamic instability. Immediate resuscitation, including haemostatic pharmacotherapy and blood transfusion, was initiated. Subsequent endoscopic evaluation, enhanced by endoscopic ultrasound, revealed a 2 × 3 cm duodenal lesion with a high-risk vascular structure. To prevent further haemorrhage, the tumour was swiftly ligated with an endoloop and excised via polypectomy. Histopathological analysis confirmed duodenal angiolipoma, characterized by mature adipose tissue interwoven with proliferative vascular elements. Following intervention, the patient recovered rapidly, with no recurrence of haemorrhage, and was discharged in stable condition.</p><p><strong>Conclusion: </strong>Massive duodenal angiolipomas causing severe haemorrhage to require appropriate medical haemostasis and resuscitation. Timely recognition and diagnosis via endoscopic ultrasound are vital. Endoscopic resection is a safe and effective treatment that prevents recurring bleeding in this case.</p><p><strong>Learning points: </strong>Duodenal angiolipomas are rare benign tumours that can mimic malignancies and cause life-threatening gastrointestinal bleeding.Endoscopic ultrasound and computed tomography scan are essential for differentiating these tumours from malignant lesions and guiding treatment.Endoscopic resection is a safe, minimally invasive option for duodenal angiolipoma to prevent recurrent bleeding, especially in resource-limited settings.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 5","pages":"005303"},"PeriodicalIF":0.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061200/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990553","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":"Atypical Bulbar Myasthenia Gravis in an Elderly Male Unmasked by Levofloxacin: A Diagnostic Challenge.","authors":"Mrudula Thiriveedi, Anil Chimakurthy, Siddharth Patel, Sujatha Baddam, Rafik ElBeblawy, Punuru J Reddy","doi":"10.12890/2025_005386","DOIUrl":"https://doi.org/10.12890/2025_005386","url":null,"abstract":"<p><strong>Background: </strong>Myasthenia gravis (MG) is an autoimmune neuromuscular disorder that typically presents with ocular symptoms. Isolated bulbar symptoms, such as dysphagia and dysarthria, are rare, and most commonly seen in men with late-onset MG. We report one such rare case of MG in an 82-year-old male presenting with progressive bulbar weakness, seemingly triggered by levofloxacin use.</p><p><strong>Case report: </strong>An 82-year-old male with multiple comorbidities presented with progressive weakness, dysphagia, and drooling following levofloxacin therapy. Examination revealed neck drop, weak lower facial muscles, and dysarthria. Initial neuroimaging and labs were inconclusive. Neurology initiated pyridostigmine with rapid improvement. Elevated acetylcholine receptor antibodies confirmed MG. He was started on efgartigimod alfa in the outpatient setting with improvement in MG composite scores.</p><p><strong>Conclusions: </strong>Atypical bulbar MG can mimic other neurologic disorders and is prone to delayed diagnosis, especially in the elderly. Clinicians should maintain a high index of suspicion, particularly when symptoms worsen after medication exposures like fluoroquinolones. Early diagnosis and appropriate treatment can significantly improve outcomes and quality of life.</p><p><strong>Learning points: </strong>Levofloxacin can exacerbate or unmask myasthenia gravis.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 5","pages":"005386"},"PeriodicalIF":0.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When Two Chambers Collide: A Rare Case of an Acquired Gerbode Defect in Infective Endocarditis.","authors":"Elizabeth R Rimsky, Aysan Sattarzadeh, Kaiyu Jia, Shahkar Khan, Danyal Khan, Martin Amor, Jonathan Spagnola","doi":"10.12890/2025_005357","DOIUrl":"https://doi.org/10.12890/2025_005357","url":null,"abstract":"<p><strong>Introduction: </strong>The Gerbode defect is a rare cardiac anomaly characterised by abnormal communication between the left ventricle and right atrium. Although primarily congenital, it can also be acquired, typically as a complication of myocardial infarction or infective endocarditis. This report examines a unique case of multivalvular infective endocarditis caused by group B Streptococcal bacteraemia, which led to the development of an acquired Gerbode defect.</p><p><strong>Case description: </strong>A 64-year-old male patient presented with symptoms of fever and dyspnoea and was diagnosed with group B Streptococcal bacteraemia. Transoesophageal echocardiography (TOE) and cardiac magnetic resonance were used to assess the extent of valvular involvement and detect any underlying structural abnormalities. Comprehensive clinical, microbiological and imaging evaluations were performed to confirm the diagnosis.</p><p><strong>Discussion: </strong>A transthoracic echocardiography revealed multivalvular vegetations and a newly detected left ventricle-to-right atrium shunt, consistent with a Gerbode defect. Cardiovascular magnetic resonance imaging confirmed the acquired defect. Surgery was considered but deemed too high a risk due to the likelihood of postoperative dialysis and a greater than 50% morality risk. After discussing these risks, the patient and family opted for conservative management, and palliative care was initiated.</p><p><strong>Conclusion: </strong>This case highlights the rare development of an acquired Gerbode defect in the context of multivalvular infective endocarditis due to group B Streptococcus. Early diagnosis using advanced imaging techniques is critical for proper management. Surgical intervention remains a key therapeutic option, and a multidisciplinary approach is essential for optimising patient outcomes in such complex cases.</p><p><strong>Learning points: </strong>An acquired Gerbode defect (left ventricular to right atrial shunt) is a rare but critical complication of infective endocarditis.Infective endocarditis caused by group B <i>Streptococcus</i> in adults, though uncommon, carries a high risk of complications and mortality, especially in prosthetic valve patients.Early transoesophageal echocardiography is essential for identifying structural complications of infective endocarditis.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 5","pages":"005357"},"PeriodicalIF":0.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143991558","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":"Rhabdomyolysis Associated with the Use of Tirzepatide.","authors":"Kunal Sonavane, Pallavi Shirsat, Gautam Agrawal, Bhawna Agarwal","doi":"10.12890/2025_005392","DOIUrl":"https://doi.org/10.12890/2025_005392","url":null,"abstract":"<p><strong>Introduction: </strong>Tirzepatide is one of the commonly used combined glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) agonists for weight loss in recent years. There are significant advantages of these medications for weight reduction, improved glycaemic control and cardiorenal benefits. However, these medications come with serious adverse events and need closer monitoring once they are initiated.</p><p><strong>Case description: </strong>We present a case of a 35-year-old female with no comorbidities taking tirzepatide for weight loss. She developed severe rhabdomyolysis that required hospitalisation; muscle biopsy revealed necrotising myopathy. Her rhabdomyolysis resolved after stopping tirzepatide and conservative management with intravenous fluids. Since no other contributing factor could be identified, we believe tirzepatide may have increased her risk of rhabdomyolysis.</p><p><strong>Conclusion: </strong>In patients presenting with rhabdomyolysis, consideration should be given to GLP-1 agonists as a potential contributing factor for the development of rhabdomyolysis.</p><p><strong>Learning points: </strong>Clinicians need to be aware of unusual side effects of glucagon-like peptide-1 (GLP-1) agonists like rare occurrence of rhabdomyolysis potentially associated with the use of tirzepatide.Risks versus benefits of these medications should be discussed in detail with patients before prescribing.Close patient follow-up and monitoring for adverse events is necessary, especially after prescribing relatively newer medications such as GLP-1 agonists with evolving knowledge of adverse event profile.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 5","pages":"005392"},"PeriodicalIF":0.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061213/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143975684","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 Intravascular Large B-Cell Lymphoma Complicated by Hypercalcaemia.","authors":"Masahiro Yabe, Takashi Abe, Saori Yamaga, Seiga Ozaki, Katsuhiro Tomiyama, Hideki Hashidate","doi":"10.12890/2025_005406","DOIUrl":"https://doi.org/10.12890/2025_005406","url":null,"abstract":"<p><strong>Introduction: </strong>Hypercalcaemia in intravascular large B-cell lymphoma (IVLBCL) is extremely rare, occurring more often in other non-Hodgkin's lymphomas (NHL).</p><p><strong>Case description: </strong>A 68-year-old man was admitted with a fever of unknown origin, mild disturbance of consciousness and respiratory failure. Laboratory findings showed hypercalcaemia with elevated parathyroid hormone-related protein (PTHrP) and decreased intact parathyroid hormone and 1,25-dihydroxyvitamin D. The patient was diagnosed with IVLBCL via random skin biopsy. Chemotherapy resulted in complete remission and normalised PTHrP levels.</p><p><strong>Conclusion: </strong>More than half of all cases of hypercalcaemia in NHL are not associated with PTHrP or 1,25-dihydroxyvitamin D, and the cause of the hypercalcaemia is unknown. However, PTHrP levels are elevated in most cases of IVLBCL with hypercalcaemia, which may present as humoral hypercalcaemia of malignancy.</p><p><strong>Learning points: </strong>Intravascular large B-cell lymphoma, a rare, clinically aggressive type of B-cell non-Hodgkin's lymphoma, is prone to central nervous system disturbances, including altered consciousness.Hypercalcaemia, which causes impaired consciousness, is extremely rare in intravascular large B-cell lymphoma, occurring more often in other non-Hodgkin's lymphomas.Parathyroid hormone-related protein is elevated in most cases of intravascular large B-cell lymphoma with hypercalcaemia, which may present as humoral hypercalcaemia of malignancy.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 5","pages":"005406"},"PeriodicalIF":0.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971827","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 Non-Rheumatic Myocarditis Following Group G Streptococcal Pharyngitis: A Rare Mimic of Acute Myocardial Ischemia in a Young Adult.","authors":"Elizabeth R Rimsky, Kaiyu Jia, Aysan Sattarzadeh, Jeffrey Loeffler, Yisroel Grabie, Jonathan Spagnola","doi":"10.12890/2025_005354","DOIUrl":"https://doi.org/10.12890/2025_005354","url":null,"abstract":"<p><strong>Background: </strong>Acute myocarditis is a rare but serious inflammatory condition of the myocardium, often triggered by infections or rheumatic heart disease. While group A <i>Streptococcus</i> is commonly associated with bacterial myocarditis, group G <i>Streptococcus</i> is rarely implicated. This case highlights a rare instance of non-rheumatic acute myocarditis also known as Streptococcal pharyngitis acute myocarditis caused by group G <i>Streptococcus</i> in a 19-year-old male without rheumatic fever.</p><p><strong>Case report: </strong>A previously healthy 19-year-old male presented with chest pain, fever, and sore throat, prompting hospitalization. The diagnosis of acute myocarditis was based on elevated cardiac biomarkers, electrocardiographic abnormalities, and cardiac magnetic resonance imaging, with group G <i>Streptococcus</i> infection confirmed by throat polymerase chain reaction. The patient responded well to antibiotics and anti-inflammatory therapy.</p><p><strong>Conclusions: </strong>This case highlights group G <i>Streptococcus</i>-induced pharyngitis acute myocarditis, stressing the need for prompt diagnosis and treatment in young adults presenting with recent streptococcal pharyngitis.</p><p><strong>Learning points: </strong>This case highlights a rare instance of non-rheumatic acute myocarditis also known as Streptococcal pharyngitis acute myocarditis, caused by group G streptococcus in a 19-year-old male without rheumatic fever.Streptococcal pharyngitis acute myocarditis may present with clinical features closely resembling an acute coronary syndrome; hence advance cardiac imaging is essential to confirm myocarditis and rule out true ischemic heart disease.Cardiac magnetic resonance imaging was used to diagnose Streptococcal pharyngitis acute myocarditis which showed subepicardial hyper-enhancement 4 weeks after discharge and resolution of symptoms.Prompt diagnosis was achieved, and the patient was treated with antibiotics and anti-inflammatory therapy in a timely fashion with good response.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 5","pages":"005354"},"PeriodicalIF":0.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984829","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":"Lemierre's Syndrome: An Unlikely Diagnosis in a Patient Presenting with Diarrhoea and Vomiting, or Maybe not?","authors":"Giorgos Papaleontiou, Adam Young","doi":"10.12890/2025_005063","DOIUrl":"https://doi.org/10.12890/2025_005063","url":null,"abstract":"<p><p>Lemierre's syndrome is an infectious thrombophlebitis of the internal jugular vein (IJV) where the commonest causative agent is a <i>Fusobacterium</i> from a tonsillar or peritonsillar abscess. This is a case presentation of a patient whose primary complaint was diarrhoea. The blood cultures of this patient grew a <i>Fusobacterium necrophorum</i> which prompted imaging. The imaging demonstrated a right peritonsillar abscess and IJV thrombosis with septic emboli in the lungs. Key points highlighted are: 1) blood cultures remain a key investigation in making a diagnosis in the septic patient; 2) abdominal symptoms can be part of Lemierre's syndrome; 3) abdominal symptoms (abdominal pain, vomiting and diarrhoea) have been characterised as the third, fourth and fifth most common feature after fever and dyspnoea. This case is presented because it shows how Lemierre's syndrome can present with abdominal features, and this may be incongruent with clinicians' understanding and teaching.</p><p><strong>Learning points: </strong>Lemierre's syndrome is an infectious thrombophlebitis of the internal jugular vein most commonly due to <i>Fusobacterium necrophorum</i> originating from a tonsillar or peritonsillar abscess, which may cause septic emboli in the lungs.Gastrointestinal symptoms, including diarrhoea, are commoner than appreciated or classically taught in this syndrome.Blood cultures are a key investigation in the septic patient and in those that grow a Gram-negative rod, <i>Fusobacterium</i> should be considered, and suspicions of Lemierre's syndrome should be raised.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 5","pages":"005063"},"PeriodicalIF":0.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987368","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":"Baclofen-Induced Pancreatitis.","authors":"Nicolas Nassif, Nadia Katrib, Karam Karam, Elias Fiani","doi":"10.12890/2025_005393","DOIUrl":"https://doi.org/10.12890/2025_005393","url":null,"abstract":"<p><p>Acute pancreatitis is an inflammatory condition of the pancreas that can result from various aetiologies, one of them being drug-induced pancreatitis, a relatively rare cause. Drug-induced pancreatitis should be considered in patients presenting with epigastric pain, elevated pancreatic enzymes, and imaging findings consistent with acute pancreatitis, in the absence of any common precipitants such as alcohol, gallstones, trauma. We report a case of acute pancreatitis following the initiation of baclofen therapy, with no other identifiable risk factors. A probable drug adverse reaction was established through the Naranjo Adverse Drug Reaction Probability Scale. This case highlights the need for physicians to consider baclofen as a potential cause of acute pancreatitis.</p><p><strong>Learning points: </strong>Given the patient's presentation following baclofen initiation and absence of other identifiable causes, this case suggests a probable association between baclofen and acute pancreatitis.Physicians should recognize the potential of baclofen to cause this inflammation when prescribing it and consider it as a differential diagnosis in cases of unexplained acute pancreatitis.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 5","pages":"005393"},"PeriodicalIF":0.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997262","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":"Potential Role of Upadacitinib in Cytomegalovirus Colitis Recurrence.","authors":"Kaito Tsujinaka, Marina Kanno, Atsushi Ogawa, Kei Kawada, Mitsuhiro Goda, Hisanori Uehara, Keisuke Ishizawa","doi":"10.12890/2025_005309","DOIUrl":"https://doi.org/10.12890/2025_005309","url":null,"abstract":"<p><strong>Background: </strong>Cytomegalovirus (CMV) colitis is a common complication in patients with ulcerative colitis (UC), which is often associated with immunosuppressive therapies including steroids, azathioprine, and biologics such as infliximab. Although CMV infections related to upadacitinib, a Janus kinase (JAK) inhibitor, have been reported, they typically occur after prolonged use. Consequently, early onset CMV colitis following the initiation of JAK inhibitors has not been extensively recognised.</p><p><strong>Case report: </strong>We present the case of a 68-year-old Japanese woman with refractory UC who developed CMV colitis that initially improved but worsened shortly after starting upadacitinib. The patient improved following upadacitinib discontinuation and CMV-specific treatment. This case suggests that early onset CMV colitis after upadacitinib initiation is clinically significant and highlights the importance of monitoring lymphocyte counts and CMV antigen levels during JAK inhibitor therapy.</p><p><strong>Conclusion: </strong>These findings provide valuable insights into the early risk of CMV reactivation and may guide future management strategies for patients with UC undergoing JAK inhibitor treatment.</p><p><strong>Learning points: </strong>This case provides insights into managing cytomegalovirus (CMV)-related adverse effects in patients receiving Janus kinase (JAK) inhibitors.The risk of CMV disease, including CMV colitis, should be considered owing to lymphocyte reduction during upadacitinib treatment.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 5","pages":"005309"},"PeriodicalIF":0.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061224/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978967","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}