European journal of case reports in internal medicine最新文献

{"title":"Chronic Lymphocytic Lymphoma Complicated by Mycobacterium Avium and Scedosporium Apiospermum.","authors":"Dhiran Sivasubramanian, Bala Vignesh Kalyanasundaram, Nithish Nanda Palanisamy, Sivakumar Nagaraju","doi":"10.12890/2025_005621","DOIUrl":"10.12890/2025_005621","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic lymphocytic leukaemia (CLL), the most common adult leukaemia in Western countries, poses unique management challenges, particularly when complicated by opportunistic infections. This report presents a rare case of CLL with concurrent <i>Mycobacterium avium</i> and <i>Scedosporium apiospermum</i> infections-pathogens increasingly recognized for causing severe disease in immunocompromised individuals. Their coexistence highlights the need for heightened awareness of diverse infectious complications in CLL patients.</p><p><strong>Case description: </strong>We present a case of a 78-year-old male with CLL receiving chemotherapy, who developed burning pain in the tongue and oral mucosa, accompanied by a non-productive cough. He was initially diagnosed with pneumonia, but further investigation revealed co-infection involving <i>M. avium</i> and <i>S. apiospermum</i>.</p><p><strong>Discussion: </strong>The coexistence of <i>M. avium</i> and <i>S. apiospermum</i> underscores the complexity of infectious complications in CLL. The patient's chemotherapy was halted due to active pneumonitis observed on imaging in order to improve his leukocyte count. Antifungal therapy was not initiated due to a lack of evidence of invasive fungal infection. Antimycobacterial therapy for <i>M. avium</i> complex was initiated.</p><p><strong>Conclusion: </strong>This case highlights the necessity of a multidisciplinary approach and continued research to optimize management strategies and improve outcomes in CLL patients with dual infections.</p><p><strong>Learning points: </strong>A high index of suspicion is needed for rare infections, such as <i>Mycobacterium avium</i> and <i>Scedosporium apiospermum</i>, when typical symptoms are absent or mild in immunocompromised patients with chronic lymphocytic leukaemia.An individualized, evidence-based approach is needed in choosing the treatment for opportunistic organisms while withholding cancer therapy.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 8","pages":"005621"},"PeriodicalIF":0.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12331267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144816125","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":"Anti-N-Methyl-D-Aspartate Receptor Encephalitis Presenting as Isolated First-Episode Psychosis in A 16-Year-Old Girl, Complicated by Neuroleptic Malignant Syndrome.","authors":"Ghizlane Khaloui, Amal Mabkhout, Linda Rachidi, Ghizlane Benjelloun","doi":"10.12890/2025_005679","DOIUrl":"10.12890/2025_005679","url":null,"abstract":"<p><p>Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a rare but increasingly recognized autoimmune disorder that predominantly affects adolescents and young adults. It often presents with prominent psychiatric symptoms at onset, leading to frequent misdiagnosis as a primary psychiatric disorder. We report the case of a 16-year-old girl who presented with acute psychiatric symptoms, including mood lability, hallucinations, and aggression, initially diagnosed as first-episode psychosis. Her condition rapidly deteriorated under antipsychotic treatment, progressing to neuroleptic malignant syndrome, followed by the emergence of cerebellar ataxia, which raised strong suspicion of an underlying organic aetiology. Subsequent investigations confirmed the diagnosis of anti-NMDAR encephalitis. The patient was successfully treated with intravenous immunoglobulin, achieving complete recovery. This case underscores the diagnostic challenges posed by isolated psychiatric presentations of anti-NMDAR encephalitis in adolescents. Early recognition and prompt initiation of immunotherapy are crucial for favourable outcomes, particularly in cases presenting with antipsychotic intolerance or atypical clinical progression.</p><p><strong>Learning points: </strong>Anti-N-methyl-D-aspartate receptor encephalitis can initially present as an isolated psychiatric syndrome mimicking primary psychosis, particularly in adolescents, often leading to misdiagnosis.The development of neuroleptic malignant syndrome during a first-episode psychosis, occurring rapidly and at low antipsychotic doses, should raise suspicion of an organic aetiology, notably autoimmune encephalitis.Magnetic resonance imaging, electroencephalogram, and cerebrospinal fluid analysis are essential to distinguish autoimmune encephalitis from primary psychiatric disorders.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 8","pages":"005679"},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12331270/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144816123","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":"Isolated Mitral Valve Hydatid CYST Mimicking Myxoma: A Rare Case of Mitral Valve Echinococcosis.","authors":"Nana Gonjilashvili, Ekaterine Gagnidze, Arwa Fareah Ansar, Ana Gonjilashvili","doi":"10.12890/2025_005667","DOIUrl":"10.12890/2025_005667","url":null,"abstract":"<p><strong>Background: </strong>Cardiac involvement by <i>Echinococcus granulosus</i> is extremely rare, accounting for less than 2% of all hydatid disease cases. When it occurs, it commonly affects the left ventricle, while valvular involvement is exceedingly unusual.</p><p><strong>Case presentation: </strong>We present the case of a 74-year-old woman from rural Georgia who developed progressive exertional dyspnoea and fatigue. Physical examination revealed multiple murmurs, and transthoracic echocardiography identified a mobile, hyperechoic mass attached to the posterior mitral valve leaflet. Transoesophageal echocardiography raised suspicion for a myxoma or vegetation, and surgical excision was pursued due to embolic risk. Intraoperatively, a teardrop-shaped cystic mass containing multiple daughter cysts was found on the P2 segment of the mitral valve. Histopathology confirmed a hydatid cyst, consistent with cardiac echinococcosis. The patient underwent successful segmental excision of the cyst with mitral valve repair and tricuspid annuloplasty. Her postoperative course was complicated by atrial fibrillation and new-onset type 2 diabetes mellitus. She was treated with albendazole and discharged in stable condition.</p><p><strong>Conclusion: </strong>This report highlights a rare instance of isolated mitral valve echinococcosis, initially misdiagnosed as a myxoma. It underscores the importance of considering parasitic aetiologies in the differential diagnosis of intracardiac masses, particularly in patients with rural backgrounds.</p><p><strong>Learning points: </strong>Mitral valve involvement in cardiac echinococcosis is exceedingly rare and may clinically and radiographically mimic myxomas or vegetations.Hydatid disease should be considered in the differential diagnosis of intracardiac masses, especially in patients with epidemiologic exposure to livestock or dogs.Early recognition and surgical intervention, coupled with antiparasitic therapy, are essential for optimal outcomes in rare valvular hydatid disease.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 8","pages":"005667"},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12331268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144816132","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":"Thyroid Storm in the Shadows of Multiple Endocrine Neoplasia (Men) 2A: A Case of Overlapping Endocrine Emergencies.","authors":"Ridda Khattak, Enrique Cortez, Madihah Alam, Rohab Sohail, Zaraq Khan, Maria Azhar","doi":"10.12890/2025_005559","DOIUrl":"10.12890/2025_005559","url":null,"abstract":"<p><p>Thyroid storm is observed in patients with untreated Graves' disease, typically triggered by stressors such as acute illness or recent surgery. This case presents a female with acute metabolic encephalopathy initially attributed to drug overdose and septic shock, later diagnosed with thyroid storm. Despite clinical stabilisation, the patient developed resistant hypertension and elevated metanephrine levels, raising suspicion for phaeochromocytoma and potential multiple endocrine neoplasia (MEN) 2A. This case highlights the importance of considering syndromic and autoimmune associations in complex endocrine presentations.</p><p><strong>Learning points: </strong>Thyroid storm should be considered when there is a rising temperature and increasing agitation despite appropriate treatment.If hypertension persists after the fever of thyroid storm was managed with propylthiouracil and iodine an additional diagnosis, such as phaeochromocytoma, should be considered.We found no published reports on MEDLINE linking Graves' disease or thyroid storm with MEN 2A to help guide our management.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 8","pages":"005559"},"PeriodicalIF":0.0,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12331264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144816069","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":"Delayed Presentation of Blind Loop Syndrome as Iron Deficiency Anaemia Following Ileo-Colonic Anastomosis: A Rare Postoperative Complication.","authors":"Lana El Chal, Philippe Attieh, Cynthia Ghraizi, Ibtihaj Saad, Karam Karam, Elias Fiani","doi":"10.12890/2025_005570","DOIUrl":"10.12890/2025_005570","url":null,"abstract":"<p><p>Blind loop syndrome is a malabsorptive condition resulting from intestinal stasis, which promotes bacterial overgrowth and leads to various gastrointestinal and systemic manifestations. It often occurs secondary to anatomical or motility abnormalities, particularly after gastrointestinal surgeries. We present the case of a 75-year-old male with a history of colon cancer status post right hemicolectomy with ileo-colonic anastomosis, who was incidentally found to have severe iron deficiency anaemia during a routine check-up. One year prior, follow-up endoscopies were normal. However, recent investigations revealed a hyperplastic polyp in the gastric cardia and, more importantly, a blind loop with ulcerations distal to the ileum on colonoscopy. Biopsies confirmed ulcerated ileal/colonic mucosa with granulation tissue. The patient underwent surgical resection of the blind loop with the creation of an ileo-transverse anastomosis. Postoperatively, he recovered well and was discharged on a regular diet. This case illustrates the importance of considering blind loop syndrome in patients with a history of bowel surgery who present with non-specific symptoms such as anaemia. It also highlights the potential for delayed onset and the diagnostic value of endoscopy when routine workups are inconclusive. Surgical correction remains the definitive treatment in anatomically driven cases, offering significant symptomatic relief and prevention of further complications.</p><p><strong>Learning points: </strong>Blind loop syndrome should be suspected in patients with prior bowel surgeries.It can present as anaemia.It may present years after surgery.It may be more common than statistics suggest, as it is often underdiagnosed or misdiagnosed.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 8","pages":"005570"},"PeriodicalIF":0.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12331273/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144816127","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":"CD4+ Lymphocytopenia and Pneumocystis Jirovecii Pneumonia in A Metastatic Breast Cancer Patient Treated with Palbociclib and Corticosteroids.","authors":"Shahar Dekel, Emmanuelle Alaluf, Tal Sella, Avshalom Leibowitz, Ana Belkin","doi":"10.12890/2025_005519","DOIUrl":"10.12890/2025_005519","url":null,"abstract":"<p><strong>Background: </strong>Palbociclib, a cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitor used to treat metastatic breast cancer, is known to cause myelotoxicity and primarily neutropenia, but its potential to induce severe lymphopenia and opportunistic infections is less understood.</p><p><strong>Case description: </strong>A 61-year-old woman with metastatic breast cancer treated with palbociclib and corticosteroids was admitted with fever and general weakness. Chest radiography and computed tomography showed bilateral consolidation. She was diagnosed with severe cellular immunodeficiency, very low CD4+ T cell count and several opportunistic infections including Pneumocystis jirovecii pneumonia (PCP).</p><p><strong>Conclusion: </strong>This case underscores the need for monitoring lymphocyte counts in patients on CDK4/6 inhibitors, particularly those on concomitant corticosteroid therapy. and considering the risk for opportunistic infections in relevant patients.</p><p><strong>Learning points: </strong>Palbociclib, a CDK4/6 inhibitor, may be associated with severe immunosuppression and low CD4+ T cell count.There may a greater risk for patients with additional risk factors such as concomitant corticosteroid therapy.Significant opportunistic infections such as Pneumocystis jirovecii pneumonia should be considered in clinically relevant patients.Safety measures should be taken such as blood count monitoring and even consideration of an antibiotic prophylaxis in relevant patients.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 8","pages":"005519"},"PeriodicalIF":0.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12331285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144816124","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 Confluence: Hepatic Artery Aneurysm and Infective Endocarditis in a Patient with a Mitral Valve Prosthesis.","authors":"Fnu Arty, Shreya Devarashetty, Anoohya Vangala, Sai R Gaddameedi, Doantrang Du","doi":"10.12890/2025_005606","DOIUrl":"10.12890/2025_005606","url":null,"abstract":"<p><strong>Introduction: </strong>Hepatic artery aneurysm (HAA) is a rare condition, comprising only 0.1% of all arterial aneurysms, yet it is the most common visceral pseudoaneurysm with a 20% prevalence among such cases. Mycotic HAA in the context of infective endocarditis is uncommon and results from microbial invasion and arterial wall damage.</p><p><strong>Case description: </strong>A 73-year-old woman with coronary artery disease, atrial fibrillation, repaired mitral valve prolapse and on warfarin presented with sudden left lower quadrant abdominal pain. She was hypotensive (BP 60/45 mmHg) and exhibited periumbilical tenderness. Laboratory findings included white blood cell count 18,000 cells/μl, haemoglobin 7.7 g/dl, platelets 1,023,000/μl, aspartate transferase 509 U/l, alanine transaminase 313 U/l and positive SARS-CoV-2. Non-contrast CT of the abdomen/pelvis revealed haemoperitoneum, rectus sheath haematoma and a hypodense hepatic lesion. Contrast-enhanced CT confirmed a left hepatic lobe pseudoaneurysm, supported by Doppler ultrasound. Coil embolisation of the pseudoaneurysm stabilised the patient's haemodynamics. Blood cultures grew <i>Staphylococcus epidermidis</i>, prompting treatment with meropenem and vancomycin due to her prosthetic mitral valve. Transthoracic echocardiogram showed valve vegetation, though a transoesophageal echocardiogram later revealed no vegetations. Follow-up imaging showed a stable thrombosed pseudoaneurysm. The patient remained stable and was transferred for mitral valve replacement. Blood cultures remained negative, but antibiotics were continued for six weeks. Warfarin was resumed without further bleeding.</p><p><strong>Conclusion: </strong>Mycotic HAAs - though rare - can be life-threatening, especially in anticoagulated patients with prosthetic valves. They often present only upon rupture. Prompt diagnosis, vascular intervention and empirical antibiotic therapy are essential for successful outcomes.</p><p><strong>Learning points: </strong>Hepatic artery aneurysm is a rare vascular entity that typically presents with non-specific symptoms, making early diagnosis challenging.One notable aetiology is septic embolisation resulting from infective endocarditis.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 8","pages":"005606"},"PeriodicalIF":0.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12331263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144816122","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":"Haemophagocytic Lymphohistiocytosis: An Uncommon Presentation in Systemic Lupus Erythematosus and Acute Leukaemia.","authors":"Nada Msabri Gharbi, Alex Smithson, He Zhang Lin, Mario Mandis, Diana Carolina Quiroga Parada, Oriana Guevara Vasquez, Gloria De la Red Bellvis","doi":"10.12890/2025_005555","DOIUrl":"10.12890/2025_005555","url":null,"abstract":"<p><strong>Introduction: </strong>Haemophagocytic lymphohistiocytosis (HLH) is a rare and potentially life-threatening hyperinflammatory syndrome, characterised by uncontrolled activation of cytotoxic T lymphocytes, natural killer cells and macrophages, leading to a cytokine storm and subsequent multiorgan damage. While HLH predominantly affects paediatric populations, it is increasingly recognised in adult patients, often occurring in association with malignancies, infections or autoimmune diseases.</p><p><strong>Case description: </strong>We present two distinct adult cases of HLH. Case 1 involves a 21-year-old woman with newly diagnosed systemic lupus erythematosus (SLE), who developed macrophage activation syndrome (MAS)-associated HLH. She presented with prolonged fever, polyarthralgia, malar rash, hepatosplenomegaly, bicytopenia, hypofibrinogenaemia, hypertriglyceridaemia and elevated serum ferritin levels. Case 2 describes a 44-year-old woman with acute monoblastic leukaemia (AML-M5) and malignancy-associated HLH, who presented with fever, malaise, hepatosplenomegaly, hypofibrinogenaemia, hypertriglyceridaemia and hyperferritinaemia. An initial haematological response was achieved; however, disease progression ultimately led to fatal multiorgan failure secondary to neutropenic pancolitis caused by <i>Clostridioides difficile</i> infection.</p><p><strong>Discussion: </strong>Both cases illustrate key clinical and pathophysiological differences in the evolution, management and outcomes of HLH, depending on the underlying cause. While both fulfilled the HLH-2024 diagnostic criteria, they exhibited markedly different responses to therapy and outcomes.</p><p><strong>Conclusion: </strong>These cases highlight the need to suspect HLH in patients with prolonged fever, cytopaenia, organomegaly and high ferritin. Early treatment improves prognosis, especially in autoimmune HLH, where steroids are effective, while malignancy-related HLH often has poorer outcomes.</p><p><strong>Learning points: </strong>Haemophagocytic lymphohistiocytosis (HLH) should be suspected in patients with persistent fever, cytopaenia, organomegaly and markedly elevated ferritin, particularly in the context of autoimmune diseases or haematologic malignancies.Early therapeutic intervention significantly improves prognosis in autoimmune-associated HLH, where corticosteroid therapy is often effective, while malignancy-driven HLH typically carries poorer outcomes despite aggressive treatment.A multidisciplinary approach is essential for HLH management, with treatment strategies tailored to the underlying cause rather than following a uniform protocol.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 8","pages":"005555"},"PeriodicalIF":0.0,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12331282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144816130","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":"Pyloric Botulinum Toxin for Diabetic Gastroparesis: A Case of Sustained Glycaemic Improvement.","authors":"Luke Bugeja, Lianne Camilleri, John Schembri","doi":"10.12890/2025_005495","DOIUrl":"10.12890/2025_005495","url":null,"abstract":"<p><strong>Introduction: </strong>Diabetic gastroparesis is a gastrointestinal motility disorder defined as a delay in gastric emptying time without any mechanical obstruction. This affects about 40% of patients with type 1 diabetes and up to 30% of patients with type 2 diabetes, especially those with long-standing disease, and arises from dysfunction of the autonomic and enteric nervous systems. Unfortunately, it can cause great difficulty in controlling post-meal glucose excursions because food absorption can become unpredictable in this group of patients. Gastroparesis is therefore linked with fluctuations in glycaemic control due to variable nutrient absorption. This may worsen the extent of gastroparesis, making glucose control even more difficult. Treatment with botulinum toxin injections has been described in clinical trials with doubtful efficacy to abating symptoms associated with gastroparesis.</p><p><strong>Case presentation: </strong>We report a case of how pyloric botulinum toxin injections significantly improved a patient's type 1 diabetic control and gastrointestinal symptoms associated with gastroparesis and is still maintaining improved glucose levels six months after her procedure. Although current data and case studies highlight a potential role for pyloric botulinum toxin injections, no association was found between pyloric botulinum toxin injections and blood glucose control in type 1 diabetics.</p><p><strong>Conclusion: </strong>This article examines a potential promising association between botulinum toxin injection in the pylorus and enhanced diabetic control in type 1 diabetics.</p><p><strong>Learning points: </strong><i>Long-lasting effect:</i> Despite being a temporary intervention, pyloric botulinum toxin injection provided sustained clinical benefit in this case.<i>Glycaemic impact:</i> The treatment significantly improved glucose control and symptoms of autonomic neuropathy in a type 1 diabetic patient.<i>Future potential:</i> Current data lack evidence for glycaemic benefit in type 1 diabetics, highlighting the need for targeted clinical trials.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 8","pages":"005495"},"PeriodicalIF":0.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12331266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144816065","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":"Continuous Irrigation for Refractory Multidrug-Resistant Brain Abscess in two Patients.","authors":"Nguyen Quang Thanh, Nguyen Trung Cap, Vu Dinh Phu, Mac Duy Hung, Nguyen Quoc Phuong, Dong Phu Khiem, Pham Ngoc Thach","doi":"10.12890/2025_005566","DOIUrl":"10.12890/2025_005566","url":null,"abstract":"<p><strong>Introduction: </strong>Brain abscesses remain a significant clinical challenge, particularly in cases involving multidrug-resistant (MDR) organisms or failure of standard surgical and medical therapy. Newer adjunctive techniques, such as continuous irrigation therapy, have been explored to enhance infection control and patient outcomes in these complex scenarios.</p><p><strong>Case description: </strong>We present two cases of brain abscess treated at a tertiary care centre using continuous abscess cavity irrigation after conventional interventions proved insufficient. The first patient, a 15-year-old male, experienced recurrent MDR brain abscesses despite multiple surgical procedures and broad-spectrum antibiotics. Initiation of continuous irrigation, combined with targeted antimicrobial therapy, resulted in rapid clinical stabilisation and marked radiological improvement, with minimal long-term sequelae. The second patient, a 65-year-old female, developed multiple brain abscesses after traumatic brain injury and decompressive surgery. Although continuous irrigation effectively controlled the intracranial infection and imaging confirmed resolution, her neurological recovery was limited due to profound pre-existing brain damage.</p><p><strong>Conclusion: </strong>Continuous irrigation therapy appears to be a valuable adjunct in the management of refractory or MDR brain abscesses, facilitating rapid infection control when conventional treatments are inadequate. However, ultimate neurological outcomes are largely dependent on the extent of underlying brain injury. These cases highlight the importance of considering continuous irrigation in selected patients and underscore the need for further research and multidisciplinary collaboration to optimise management protocols and improve patient outcomes.</p><p><strong>Learning points: </strong>Continuous irrigation with alternating saline and antibiotic solutions is an effective adjunct in the management of refractory or multidrug-resistant brain abscesses.Unfortunately, successful infection control does not always guarantee neurological recovery.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 8","pages":"005566"},"PeriodicalIF":0.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12331261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144816126","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}